Reversible cerebral atrophy in recently abstinent chronic alcoholics measured by computed tomography scans.

Eight chronic alcoholics received repeated computed tomography scans. Four, who maintained abstinence and functionally improved, showed partially reversible cerebral atrophy. Two nonabstinent patients and two abstinent patients who had completed functional improvement before the first scan showed no change in atrophy.

Cerebral atrophy and functional deficits in alcoholics without clinically apparent liver disease.

Ninety-seven chronic alcoholics, both impaired and unimpaired, without clinically evident liver disease, showed significantly more cerebral atrophy on computed tomography than age-matched neurologic controls. Age was the variable most highly correlated with cerebral atrophy measurements, and it accounted for most of the correlations between atrophy and functional impairment, except in the Wernicke-amnesic group. Analysis of the slopes of atrophy scores versus age showed a more rapid "rate" of development of cerebral atrophy in alcoholics compared with controls. There were no correlations between liver biopsy scores (51 cases), drinking history (47 cases), or dietary intake (39 cases) and cerebral atrophy measurements.

Technetium-99m-HMPAO SPECT, CT and MRI in the evaluation of patients with chronic traumatic brain injury: a correlation with neuropsychological performance.

UNLABELLED: The purposes of this study were: (1) to compare 99mTc-hexamethylpropyleneamineoxime (HMPAO) SPECT with CT and MRI in chronic traumatic brain injury (TBI) patients and (2) to correlate both functional and structural neuroimaging measurements of brain damage with neuropsychological (NP) performance. METHODS: Twenty-nine patients (minor TBI, n = 15 and major TBI, n = 14) and 17 normal controls (NC) underwent HMPAO SPECT, CT, MRI and NP testing. Imaging data were analyzed both visually and quantitatively. RESULTS: Nineteen (66%) patients showed 42 abnormalities on SPECT images, whereas 13 (45%) and 10 (34%) patients showed 29 abnormalities on MRI and 24 abnormalities on CT. SPECT detected relatively more abnormalities than CT or MRI in the minor TBI subgroup. The TBI group showed impairment on 11 tests for memory, attention and executive function. Of these, the anterior-posterior ratio (APR) correlated with six tests, whereas the ventricle-to-brain ratio (VBR), a known structural index of a poor NP outcome, correlated with only two tests. CONCLUSION: In evaluating chronic TBI patients, HMPAO SPECT, as a complement to CT or MRI, may play a useful role by demonstrating brain dysfunction in morphologically intact brain regions and providing objective evidence for some of the impaired NP performance.

Deficits in gray matter volume are present in schizophrenia but not bipolar disorder.

Studies using magnetic resonance (MR) imaging have provided strong evidence that patients with schizophrenia as a group have structural brain abnormalities, including enlarged ventricles and sulci as well as smaller cortical gray matter volumes. This study was undertaken to investigate whether the brain abnormalities found in schizophrenia could be distinguished from those seen in bipolar disorder. The MR scans of 23 patients with schizophrenia were compared to those of 17 healthy community volunteers and 14 patients with bipolar disorder. Images were processed using computer-based image processing techniques to generate quantitative measures of cerebrospinal fluid (CSF), gray matter and white matter volumes. Compared to the community volunteers, the schizophrenia group had larger total CSF volumes while the bipolar group had larger ventricles. Smaller cortical gray matter volumes were found in the schizophrenia group, but not in the bipolar group. The schizophrenia group had regional deficits in gray matter volumes in comparison with both the community volunteers and the bipolar group. These findings suggest that the brain tissue abnormalities found in schizophrenia and bipolar disorder may be distinguishable using MR imaging.

Sexual sadism: brain, blood, and behavior.

The behavior of sadists is bizarre and poorly understood. There are gross endocrine and brain abnormalities in a small number of these men. Approximately two-fifths show subtle temporal lobe brain abnormalities that are logically linked to sexual behavior and require further exploration. It would be interesting to explore the interface of the endocrine system and the brain--that is, to determine if there are interactive processes that may be related to the development of sexual anomalies, perhaps early in life as suggested by Kolarsky et al. Certainly, biological factors cannot determine whether an individual will act on his sexual impulses. Many psychological factors, such as family background and substance abuse, play a significant role in the dangerousness of the individual. However, it appears that biological factors are noteworthy in sexual sadism. Brain pathology, especially, shows some correlation with force used in offences and likelihood of recidivism, and for this reason alone it merits further study.

Tomographic abnormalities simulating pituitary microadenomas.

False-positive and false-negative interpretations of sellar tomography were found in about one-fifth of cases in a recent autopsy study correlating the presence of pituitary microadenomas with abnormal sellar tomograms. An analysis of minor variations in the bony configuration of the sella disclosed variations due to posterior lobe asymmetry, intercavernous venous channels, bony asymmetry, and an empty sella in 27 of the 120 sellas examined. In some instances, the asymmetry resulted from a combination of these causes. A further study of 50 pituitary glands in situ showed posterior lobe asymmetry to be a common anomaly (76%) that can produce an obvious disparity between the two halves of the sella. Thus, the minor radiologic criteria of local thinning of the anterior wall or floor, slant of the floor, or asymmetry of the two halves of the sella must be interpreted with caution as being indicative of the presence of pituitary microadenoma. In the absence of clinical or biochemical dysfunction, the changes more likely result from explainable anatomic causes.

Progressive multifocal leukoencephalopathy: clinical and MR response to treatment.

Progressive multifocal leukoencephalopathy (PML) is a fatal demyelinating disease that occurs in immunocompromised hosts. We describe two patients with biopsy-proved PML who showed improvement clinically and radiologically after medical therapy. These cases reveal that interval improvement can in rare instances be consistent with a diagnosis of PML.

Spinal meningioma en plaque. Report of two cases.

Two cases of spinal meningiomas exhibiting en plaque patterns of growth are presented, one of which is reviewed more fully with emphasis on the radiographic and histological characteristics. The difficulties in diagnosis of this unusual tumor, its surgical management, and its postoperative course are discussed.

Computerized tomography (CT) in otolaryngology.

Computerized tomography (CT) of the brain has been available since 1973 and has changed neurological, neurosurgical and radiological practice beyond recognition. A rapid growth of literature has documented it role in the diagnosis of intracranial hematoma, cerebral atrophy, brain tumor, orbital lesions and postoperative tumor evaluation. This computerized method of image reconstruction is now also being applied to the rest of the body and to other diagnostic modalities such as isotopes and ultrasound. The initial impact of CT scanning in otolaryngology is largely in four areas: 1. Facial deformities either acquired or congenital as hypertelorism, fibrous dysplasia, ossifying fibroma and Crouzon's disease. 2. Tumors involving sinuses primarily or by secondary invasion. 3. Cerebello-pontine angle lesions as meningiomas, acoustic neuromas, and glomus jugulare tumors. The larger acoustic neuroma is well visualized by this technique rendering contrast myelography unnecessary. In CT scanning, subtle differences in position and an increase in density before contrast enhancement should allow a differentiation of angle meningiomas from acoustic neuromas; in addition, CT scanning has a very important role in the postoperative assessment of angle tumors. 4. Infections as cerebral abscess or cerebritis secondary to sinus or mastoid disease. The future holds changes that will allow much finer detail, re-orientation of the horizontal information into any plane, and much more accurate differentiation of tissue density. The principle of CT image reconstruction is being applied to both isotope and ultrasound scanning and should improve their accuracy and yield. If the rapid growth of the new technology over the past two years continues, even greater usefulness can be anticipated.

Clinically-directed CT in occult disease of the skull base involving foramen ovale.

Occult disease of the skull base may present as an isolated neurogenic symptom in the absence of physical signs or radiologic findings. It therefore often remains undiagnosed until advanced. Computed tomography (CT) provides the potential for diagnostic imaging far beyond conventional radiology. Not only do current generation scanners provide exquisite bone detail, they also provide the capability of soft tissue imaging. In the past year, we have matched the diagnostic problem of occult disease of the middle fossa skull base and its foramina with the potential diagnostic imaging solution of CT. Five patients were referred with possible occult middle fossa skull base disease--all had persistent unilateral facial paraesthesia in the distribution of one of the lower two trigeminal nerve divisions (V2 V3) as their only complaint; all had previously been extensively investigated (including axial CT); all remained undiagnosed. Utilizing clinically-directed CT (based on acoustic neuroma diagnostic index of suspicion and imaging experience), 2 of the 5 patients were found to have small mass lesions involving foramen ovale. This presentation will demonstrate our experience based on image-manipulated CT, actively monitored by both radiologist and otolaryngologist.

Sophisticated CT in complex maxillofacial trauma.

Conventional radiology and selective complex-motion tomography suffice for the diagnosis of isolated facial fractures. Complex facial fractures, however, require a more directed diagnostic approach, utilizing the imaging potential of computed tomography (CT). In the acutely injured but stable patient, unenhanced axial CT (preview-monitored under clinical orientation) provides the most effective, safe, reasonably rapid diagnostic examination. Direct coronal CT can also be utilized. The brain is studied by contiguous 10 mm slices; the facial skeleton is studied with contiguous 5 mm slices, which permits coronal and sagittal reformations. In suspected cervical spine injury (where direct coronal CT is contraindicated), the axial CT format above will provide essential diagnostic information and allow image reconstruction. The late complications of brain abscess and CSF leak are well imaged by CT; the latter is best assessed (during activity) by preview-controlled CT after intrathecal injection of metrizamide.

The clinical significance of radionuclide bone and gallium scanning in osteomyelitis of the head and neck.

Osteomyelitis of the head and neck remains a difficult clinical problem both in diagnosis and treatment evaluation. The purpose of this manuscript is to review our clinical experience with 25 cases of osteomyelitis distributed evenly among the temporal bone and skull base, the paranasal sinuses, and the mandible. Radionuclide bone and gallium scan images accurately depicted the biologic activity of the disease process and permitted accurate treatment evaluation and patient monitoring. This work demonstrates the potentials and limitations of radionuclide imaging with bone and gallium scan agents and attempts to define a role for their contemporary use in the management of osteomyelitis of the head and neck.

Computerized transaxial tomography: its role in the post-operative tumor case.

The role of computerized transaxial tomography (CTT) of the brain in 100 post-operative tumor cases is assessed. CTT proves an accurate method of determining tumor recurrence and in evaluating such complications as intracerebral hemorrhage, subdural or extradural hemorrhage, cerebral infarction, hydrocephalus and shunt patency. Its accuracy decreases the need for interventional procedures. Its usefulness may be limited by the presence of metal clips or plates, by radio-opaque contrast media or intracranial air.

Assessment of cognitive impairment: the role of CT.

The value of CT as a routine screening procedure in the investigation of cognitive impairment is being increasingly challenged. To address this issue, we reviewed the records of 175 patients with intellectual deficits admitted to a Behavioural Neurology Unit over a two-year period. In the vast majority of cases, ie. 82%, the CT served essentially to confirm the clinical impression and added no new diagnostic information that impacted the management of the presenting problem. In 15% of cases the CT scan was helpful for diagnosis, especially in the differentiation between Alzheimer's disease and multi-infarct dementia.

Partially reversible cerebral atrophy and functional improvement in recently abstinent alcoholics.

52 recently abstinent chronic alcoholics were given repeated psychological tests and 20 of these had repeated CT scans. The first scan was done within 5 weeks of the last drink. The degree of measurably reversible cerebral atrophy on CT scan correlated negatively with the interval between the last drink and the first CT scan. Significantly more reversibility of cerebral atrophy was noted in those subjects claiming interscan abstinence. There were positive correlations between functional improvement scores on neurological exam and reversible cerebral atrophy measurements. Significant improvement on psychological test performance was restricted to patients tested initially within 3 weeks of the last drink. Both the CT results and the psychological test results suggest that reversible changes occur soon after the cessation of drinking.

Correlation between computed tomography and magnetic resonance imaging in Graves' orbitopathy.

Radiologic examination of patients with severe Graves' disease with possible optic neuropathy has routinely been done with computed tomography (CT). With the more widespread use of magnetic resonance imaging (MRI), its potential use in Graves' disease must be considered. We compared these two imaging techniques for use in severe Graves' orbitopathy. Thirty-nine orbits of 20 consecutive patients with severe Graves' disease (19 with optic neuropathy and 20 without optic neuropathy) were examined clinically. CT and MRI were performed, and the radiologic images were assessed for five measures chosen to illustrate overall muscular changes, tissue plane changes of the orbital apex, optic nerve changes and proptosis. The MR images were significantly more reliable than the CT scans for two measures in particular: degree of fat effacement (a measure of optic nerve compression) and minimal optic nerve index (a measure of optic nerve thickness), both of which involve the orbital apex. We conclude that MRI is a better technique than CT for imaging the apex in Graves' optic neuropathy.