A 44-year-old woman was examined for progressive left lower extremity weakness and spasticity. Thoracic spine MR imaging and CT myelography showed a ventral dural defect at T7-T8 with an extradural subarachnoid fluid collection and extradural herniation of the spinal cord. Intraoperative sonography confirmed the appropriate level for dural entry and the finding of spinal cord herniation. After reduction of the herniated spinal cord, the patient experienced gradual improvement in neurologic function.
To classify cerebral hemiatrophy on the basis of childhood febrile seizures and magnetic resonance (MR) imaging findings of mesial temporal sclerosis.Medical records and brain MR images obtained in 23 patients aged 1-64 years with cerebral hemiatrophy were retrospectively reviewed. Age, neurologic deficit, and history of childhood febrile seizures were recorded and correlated with MR findings of mesial temporal sclerosis, focal cortical or white matter signal intensity abnormalities, ipsilateral thalamic or contralateral cerebellar atrophy, and compensatory calvarial changes.Eleven patients had MR mesial temporal sclerosis findings. Of these, nine had a history of childhood febrile seizures. Of the other 12 patients, only one had a history of childhood febrile seizures. All patients without mesial temporal sclerosis had focal parenchymal lesions in the distribution of the middle cerebral artery.Two patterns of central nervous system involvement in cerebral hemiatrophy are suggested: (a) MR mesial temporal sclerosis findings and a history of childhood febrile seizures and (b) no MR mesial temporal sclerosis findings and rarely a history of childhood febrile seizures. This correlates with previous descriptions of cerebral hemiatrophy (a) with multifocal neuronal loss after seizures and (b) with a more focal cerebral hemisphere abnormality usually due to vascular insult.
PURPOSE: To determine optimal acquisition parameters and measurement techniques for CT angiography of the carotid bifurcation. METHODS: Anatomic phantoms were created in which the diameter of the carotid artery stenoses ranged from 15% to 95%. Initially, we compared the accuracy of stenosis determination obtained by using various values of section collimation and table pitch. Subsequently, applying the combination of collimation and pitch that yielded the greatest longitudinal coverage without degradation in accuracy, we compared the accuracy of measurements performed with various display algorithms, including axial, magnified axial, maximum intensity projection (MIP), and shaded surface display (SSD) images. Last, we determined the effect on accuracy of varying both window and level settings. The standard of reference for all measurements was considered to be caliper measurements made of the models at the time of their construction. RESULTS: CT angiography was highly accurate for determining the percentage of stenosis; the average difference between CT angiographic measurements and the standard of reference was less than 1% for all parameter combinations and measurement techniques. Precision varied among the measurement techniques. Magnified axial images provided more precise measurements than either the MIP or SSD images. Although there was a trend toward improved precision with the use of magnified versus unmagnified axial images and MIP versus SSD images, neither of these comparisons reached statistical significance. Systematic error was produced by changing the level setting from that halfway between the luminal density and vessel wall density. Random error was introduced by using window settings greater than zero. CONCLUSION: CT angiography was highly accurate and precise for determining percentage of stenosis. The highest precision was attained by using magnified axial images with the level halfway between luminal density and vessel wall density and with the window set to zero.
The remains of an unidentified female neonate were discovered in a field in central Missouri. Examination revealed bilateral absence of the parietal bones. A search of the literature describing similar defects suggests that the present case represents a unique condition, described here for the first time.
We intended to characterize the CT patterns of hemorrhage associated with ruptured posterior inferior cerebellar artery (PICA) aneurysms.CT scans of 44 cases of angiographically confirmed ruptured saccular PICA aneurysms (4) aneurysms at the junction of the vertebral artery and the PICA and three distal PICA aneurysms) were retrospectively reviewed. All scans had been obtained within 2 days of the subarachnoid hemorrhage (SAH) (day 0 [less than 24 hr], 35 patients; day 1, eight patients; day 2, one patient). Presence or absence of hemorrhage in specific subarachnoid, intraventricular, and intraparenchymal locations was noted, as were the presence and degree of hydrocephalus.Posterior fossa SAH was present in 95% of cases. Isolated posterior fossa SAH was present in 30% of cases, but in no case was isolated supratentorial SAH present. Supratentorial SAH was present in 70% of cases. SAH involving the sylvian fissure or the interhemispheric region was present in 25% and 23% of cases, respectively. SAH along the convexity was present in 2% of cases. Intraventricular hemorrhage (IVH) with or without associated SAH was seen in 95% of cases, whereas isolated IVH was seen in 5% of cases. Hydrocephalus was present in 95% of cases and was moderate to marked in 70%. Both IVH and hydrocephalus were present in 93% of cases.Ruptured PICA aneurysms almost always coexist with hydrocephalus and IVH, as seen in 93% of cases, and almost never coexist with SAH along the convexity. The most common pattern of hemorrhage associated with such aneurysms includes IVH and posterior fossa hemorrhage. Extensive supratentorial SAH, in conjunction with posterior fossa SAH, is a common finding in patients with ruptured PICA aneurysms. SAH isolated to the posterior fossa is present in a sizeable minority of cases.
To optimize parameters with computed tomographic angiography for the detection of cerebral aneurysms.Model aneurysms were placed randomly at various branch points and scanned multiple times with spiral technique. The final analysis included 63 branch points and 22 aneurysms. Each spiral scan used a different parameter combination. Collimation ranged from 1.5 to 4.0 mm and pitch ranged from 1:1 to 1.5:1. Images were constructed with shaded surface display (SSD) and maximum intensity projection (MIP) algorithms and were interpreted by three readers for the presence or absence of aneurysm.The receiver operating characteristic (ROC) curve area for 1.5-mm collimation was greater than those of 3- or 4-mm collimation (P < .01 and P < .001, respectively). There was no statistically significant difference in the ROC curve areas between 3- and 4-mm collimation (P = .37). There was no statistically significant decrease in ROC curve area when increasing pitch from 1:1 to 1.5:1 for any value of collimation (P = .96). For all parameter combinations the ROC curve areas for SSD images was greater than that of MIP images (P < .0001).For cerebral aneurysm detection, narrow collimation is superior to wider collimation. Mild increases in pitch do not substantially degrade diagnostic accuracy. SSD offers improved diagnostic accuracy over MIP display in this model.
Abstract Autoimmune encephalitis is an uncommon complication of immune checkpoint inhibitor therapy. This article reports a case of fatal anti-Hu-associated autoimmune limbic encephalitis presenting within 8 weeks following anti-PD1 therapy in a patient with myxoid chondrosarcoma and pre-existing anti-Hu antibodies. Although tumor reduction occurred in response to PD-1 inhibitor therapy, the patient had a rapidly progressive decline in neurologic function despite initial stabilization with immunosuppression. Considering the increasing use of immune checkpoint inhibitors for the treatment of various malignancies, an increase in the occurrence of neurologic adverse events is likely, requiring prompt intervention and enhanced pharmacovigilance in malignancies associated with onconeuronal antibodies.
