Chylous effusion complicating chronic lymphocytic leukemia.

We present a case of chylous effusion (CE) occurring in a patient with chronic lymphocytic leukemia (CLL), an observation which has rarely been reported. Therefore, CLL should be added to the differential diagnosis of nontraumatic chylothorax. CE in CLL can be successfully managed by irradiation of the mediastinum.

MR features of an intracerebellar chloroma.

Granulocytic sarcoma (chloroma) is a rare tumor almost always associated with leukemia. Intraaxial brain lesions are rare, and can mimic infection or primary neoplasm. This intracerebellar chloroma arose after autologous bone marrow transplantation in a 29-year-old woman with leukemia. On T1-weighted MR images, the lesion was isointense with gray matter, and enhanced homogeneously. On T2-weighted and proton density-weighted MR sequences, the center was isointense with gray matter and the periphery was isointense with white matter. The lesion's tendency to remain isointense on sequences with long repetition times is presumably attributable to the presence of myeloperoxidase.

Inadvertent use of ionic contrast material in myelography: case report and management guidelines.

A 38-year-old man with chronic low back pain underwent myelography and was inadvertently injected with ionic contrast medium. Within minutes, he started complaining of muscle spasms in his lower extremities, followed by respiratory distress and myoclonus. Immediate intravenous treatment with fluids, antihistamines, and supplemental oxygen was started. Within 1 hour after the myelogram, he was intubated and paralyzed with a neuromuscular blocking agent. Shortly thereafter, he began receiving triple anticonvulsant therapy and a lumbar drain was inserted to allow for the evacuation of cerebrospinal fluid. Electroencephalographic monitoring, which initially showed that the patient was in status epilepticus, subsequently showed no more episodes of seizure activity. Massive rhabdomyolysis, renal failure, and metabolic derangement were prevented. He was then extubated and regained full consciousness. He was discharged on the 13th day of hospitalization with mild amnesia and some cognitive dysfunction. A review of the literature reveals descriptions of 9 of 15 patients who survived similar episodes. We conclude that prompt identification of the contrast medium error and prompt intervention are crucial to increase significantly the chances of survival. Elective paralysis, anticonvulsant therapy, and cerebrospinal fluid drainage are the recommended modes of treatment.

Pediatric spinal blastomycosis: case report.

A 5-year-old male patient presented with flank pain, limping, weight loss, and cachexia. Magnetic resonance imaging revealed destructive vertebral changes, an epidural mass, psoas abscesses, and lack of involvement of the disc spaces. Blastomyces dermatitidis was isolated from a needle aspiration specimen. Sparing of the disc spaces, an unusual finding, suggested that the spread of infection was by way of paravertebral structures and surrounding potential spaces. Management was simplified by using gadolinium contrast-enhanced magnetic resonance imaging, which indicated that the epidural mass was mainly solid, thereby obviating abscess drainage.

Magnetic resonance imaging detection of a lesion compatible with central pontine myelinolysis in a pregnant patient with recurrent vomiting and confusion.

The authors report a patient who presented with unexplained confusion. She was 15 weeks pregnant and had been having recurrent vomiting for several weeks. This was felt to possibly represent hyperemesis gravidarum, but she had several other possible contributing factors. Her serum sodium was 146 mmol/L, and her potassium was 2.6 mmol/L. She was alert but had disorientation, visual hallucinations, memory impairment, and confabulation despite being a college graduate with no history of illicit drug use or excessive alcohol consumption. Her initial magnetic resonance imaging (MRI) brain scan was interpreted as being normal. However, her follow-up MRI brain scan revealed typical findings of central pontine myelinolysis, which correlated with hyperreflexia and positive Babinski reflexes. This patient illustrates the constellation of signs and symptoms that can be seen with a demyelinating lesion of the pons. In addition, our case illustrates how this MRI scan finding can be quite nonspecific but may help to explain the clinical findings.

Adult diastematomyelia: a complex dysraphic state.

It is rare for patients with diastematomyelia to manifest initial symptoms in adult life. Clinical, radiological, and surgical features of a patient with symptomatic adult diastematomyelia are presented. Pathogenetic mechanisms are considered to include a variety of congenital spinal anomalies, distinct from the spur, as well as mechanical factors.

Spinal epidural compression in head and neck cancer. Report of five cases.

Patients with newly diagnosed head and neck cancer (HNC) during a 13-year period were retrospectively studied for the development of spinal epidural compression (SEC). Of the 759 patients studied, 5 developed epidural compression (1%), 4 of whom were relatively young. SEC occurred simultaneously with HNC in 2 patients and long after the diagnosis of HNC in 3 individuals. There was no observed tendency to involve a particular segment of the spine. Local control of HNC following definitive treatment along with regained ability to walk after palliative radiotherapy in a patient was associated with long-term survival. Recommendations are made for aggressive treatment of SEC to achieve a satisfactory outcome.

Radiotherapy for mediastinal obstruction and intrathoracic lymphadenopathy in chronic lymphocytic leukemia.

Four of 65 patients (6%) with chronic lymphocytic leukemia (CLL) were treated by megavoltage teleradiotherapy for palliation of symptoms arising from mediastinal obstruction or intrathoracic lymphadenopathy. External beam irradiation was found to be effective treatment for these disease complications associated with CLL.

Audiological findings in glomus tumours.

Glomus tumours involving the middle ear and the cerebellopontine angle are reported with emphasis on audiological findings. Magnetic resonance imaging (MRI), angiographic and pathological results are presented. Audiological tests, including impedance audiometry, evoked otoacoustic emissions and auditory brainstem responses, are valuable in evaluation of the effect of glomus tumours on the auditory system as well as their pathological extent.

Neurotologic evaluation of facial nerve paralysis caused by gunshot wounds.

Facial nerve injury is one of the most common neurotologic sequelae of a gunshot wound (GSW) to the head or neck. However, few neurotologic studies have been performed on the nature and time course of such facial nerve impairments. This study was designed to characterize the neurotologic manifestations and time course of facial nerve paralysis caused by GSWs to the head and neck. We conducted a battery of electrodiagnostic tests on 10 patients who had experienced traumatic facial paralysis due to a GSW to the head or neck. The etiologies of facial nerve paralysis--including direct injury, compression, fracture, and concussion of the temporal bone--were demonstrated by audiologic, radiologic, and surgical findings. Hearing loss and other cranial nerve injuries were also seen. Six of the 10 patients experienced a complete paralysis of the facial nerve and a poor recovery of its function. We also present a comprehensive case report on 1 patient as a means of discussing the evaluation of facial nerve function during the course of management.

Nonspecificity of meningeal enhancement in craniospinal magnetic resonance imaging.

Magnetic resonance imaging contrast agents are exquisitely sensitive in detecting meningeal abnormalities, which almost invariably manifest as abnormal enhancement. This property of the contrast agents is not accompanied by an equal degree of specificity, but as shown by the two case reports, contrast agents are still helpful to detect and define the extent of the meningeal abnormality, and to document its resolution, or the lack thereof.

Volumetric Examination of MS Plaques and Correlation with EDSS Ratings.

This study is a retrospective analysis of 17 patients with multiple sclerosis. The total volume of plaques from three different MR image sets of the brain was correlated with the EDSS ratings of the patients. Each of the correlations showed a positive relationship, but none was statistically significant. A more extensive study is required in order to give significance to these relationships.

Gadopentetate dimeglumine in craniospinal magnetic resonance imaging: common uses and some potential pitfalls.

In the first few years since its release for clinical use gadopentetate dimeglumine has become an integral part of craniospinal magnetic resonance imaging (MRI). Its efficacy and high degree of safety, as well as patient tolerance of the contrast medium, have made it indispensable for imaging small acoustic neuromas, metastases, meningeal disease, intramedullary tumours and recurrent disk disease. In addition, its utility for imaging other abnormalities is being increasingly recognized. Because the mechanism of this compound differs from those of other contrast agents, the pitfalls it can create are also different. Better and more affordable contrast media are expected to further increase the practice of gadolinium-enhanced MRI.

Craniospinal magnetic resonance imaging enhanced with Gd-DTPA in von Hippel-Lindau disease.

The case presented illustrates the utility of enhancement with gadolinium diethylenetriaminepenta-acetic acid in magnetic resonance imaging (MRI) of the brain and the spinal cord in a patient with von Hippel-Lindau disease. The patient had numerous lesions in the brain stem and the cervical and the thoracic spinal cord, most of which were not demonstrated or were only poorly demonstrated with noncontrast MRI. Contrast-enhanced MRI should be performed in two sessions with a separate dose of contrast agent for each. Regular follow-up examinations should be conducted in the same manner.

Neuroimaging of arachnoiditis induced by spinal anesthesia.

Despite the simplicity, effectiveness, and safety of spinal anesthesia, arachnoiditis can occur as a complication. The cause of this is often unknown, especially since disposable spinal kits are now normally used. It is postulated that an untoward reaction to the anesthesia or chemical contamination was the cause of arachnoiditis in our patient. We also outline the use of MRI in the diagnosis of arachnoiditis. This mode of investigation is often sufficient to establish the diagnosis. When necessary, it can be augmented by myelography and CT.

Neuroimaging of fractureless transforamen magnum penetrating injury of the cerebellum.

An unusual case of penetrating injury to the cerebellum by a foreign body is described. The authors recommend plain radiographs and computed tomography to rule out fractures of the skull vault and base and the upper cervical spine, as well as to ascertain the presence and location of foreign bodies. Magnetic resonance imaging is ideal for the follow-up assessment of brain damage.

Aneurysms of the posterior cerebral and superior cerebellar arteries in a child.

The authors describe an 11-year-old girl with two aneurysms in the posterior circulation of the brain; one of the lesions was treated surgically, and the second resolved spontaneously. The utility of magnetic resonance imaging and angiography in the detection and follow-up of the lesions is discussed.

Hypersexuality in stroke.

Hyposexuality is a common problem in stroke patients. Some stroke patients, however, may present with hypersexuality. We report three stroke patients who demonstrated hypersexuality and deviant sexual behavior after stroke. Abnormal sexual behavior was noted by members of the stroke rehabilitation team while the patients were in hospital. Details of pre- and poststroke sexual activity were obtained from patients and their spouses. All three patients had temporal lobe lesions on computerized tomography, and all had a history of poststroke seizure activity. The 53-year-old man reported poststroke increase in libido and coital frequency with a tendency towards priapism. The two women (47 and 55 years old) exhibited deviant sexual behavior, mood changes, and hyperphagia. The exact cause of these behavior changes is unknown but they may be related to temporal lobe involvement. Hypersexuality has previously been reported in animals and in patients with temporal lobe seizures.

Central pontine myelinolysis as a manifestation of the paraneoplastic syndrome.

We have described a patient who had lung carcinoma, syndrome of inappropriate antidiuretic hormone, and central pontine myelinolysis (CPM). Although this association is well-known, it appears to be the first report having radiographic documentation of both the intracranial and intrathoracic abnormalities. When searching for the cause of CPM, the possibility of an underlying malignancy should also be considered. This may be more common than the radiology literature would suggest.

Small cell cancer of the cervix presenting as compression of the spinal cord and cauda equina.

Spinal cord or cauda equina compression by metastatic cancer usually occurs months or even years after the diagnosis of the primary tumor. We describe the unusual simultaneous presentation of small cell cancer of the cervix and metastatic tumor compressing the spinal cord and cauda equina.