Bilateral MRI/MRA/MRV displays abnormalities of the osseous structures and soft tissues of the cervicothoracic spine that disrupt fascial planes of the brachial plexus and compress the lymphatics, veins and arteries that supply the nerves. Congenital osseous abnormalities include cervical ribs, synchondrosis, Klippel‐Feil and Sprengel's deformity, among many others. Acquired abnormalities, including inflammatory, traumatic, neoplastic and infectious, also cause symptoms of thoracic outlet syndrome. Monitored multiplanar MRI/MRA/MRV displays sites of compression of the brachial plexus. Images were acquired on a 1.5 Tesla GE Signa unit, 44 cm field of view and saline water bags to enhance signal to noise ratio. This presentation displays an adult Sprengel's deformity and the sequelae of childhood polio resulting in costoclavicular compression of the bicuspid valves within the draining veins within the neck, supraclavicular fossae, and of the subclavian and axillary arteries with binding nerve roots. In both Sprengel's and polio the patients had significant atrophy of the shoulder muscles with costoclavicular compression. The patient with Sprengel's deformity had acute sloping ribs with tension on the sternocleidomastoid and scalene muscles. The omovertebral bar was not fused to the scapula. The patient with polio also ruptured his carotid artery lifting a heavy object and required stent placement.
INTRODUCTION. A month‐old female infant was brought to the emergency room because she would not take in fluids. Her mother indicated the infant had a birth history of a traumatic brain injury stemming from a difficult instrumental delivery. A nurse assigned to care for the infant observed what appeared to be blood on the right ear. She immediately alerted the pediatrician on duty of a possible case of child abuse. The pediatrician concurred and ordered an anterior‐posterior chest radiograph and anterior posterior and lateral skull radiographs. RESULTS. The chest radiograph was interpreted by the hospital radiologist as being positive for fractures of the ribs and the skull radiographs as being positive for bilateral parietal bone fractures without soft tissue swelling. Three‐dimensional computerized axial tomography was then performed and interpreted as positive for bilateral parietal bone fractures. Although the infant was not in acute distress, she was hospitalized with the suspected diagnosis of child abuse. An outside radiologist was consulted finding no evidence of fractures and/or swelling over the sites dictated by the hospital radiologist. The outside radiologist found an anomalous parietal bone suture misinterpreted as the parietal bone fracture. CONCLUSIONS. The purpose of this presentation is not to review the division of the parietal bone but to inform physicians and health professionals that anomalous parietal bone sutures are rare and often misdiagnosed as fractures.
INTRODUCTION. Costoclavicular compression of the brachiocephalic veins decreases vertebral vein drainage of the vertebral venous plexus / Batson's plexus of the vertebral column. This causes painful head and neck, upper extremity and sacral complaints. Bilateral MRI/MRA/MRV displays sites of venous, lymphatic, and arteries with binding nerve roots. METHODS and MATERIALS. Monitored multiplanar images with 2D Time of Flight MRA/MRV without contrast are acquired on a 1.5 Tesla GE Signa LX unit, 44 cm field of view, 512 x 256 matrix and saline water bags to enhance signal to noise ratio and Fast Spin Echo (FSE) to display lymphedema. RESULTS. Two patients were selected: one post trauma from utility wire exploration with anomalous course of the right axillary artery inferior to the vein and the other from repetitive stress injury with an enlarged thymus gland. CONCLUSIONS. MRI/MRA/MRV is the only monitored imaging modality that displays altered fascial plane anatomy of the brachial plexus. Health professionals need to know landmark anatomy to make an accurate diagnosis.
In migraine patients with thoracic outlet syndrome (TOS) bilateral multiplanar magnetic resonance imaging (MRI), angiography (MRA) and venography (MRV) of the brachial plexus display sequential images of the neck, thorax and shoulder girdle and demonstrate costoclavicular compression abnormalities of the great vessels and neurovascular bundles without the use of contrast material. Migraine patients with TOS present with upper extremity pain and paresthesias; migrainous headache with or without visual changes; tinnitus; facial, back and leg pain; muscle spasms and dystonia, and syncope. Some patients present with chronic, debilitating gastrointestinal complaints beyond the nausea and vomiting of the migraine attack and in addition to the usual TOS symptoms. Bilateral multiplanar imaging was conducted on a 1.5 Tesla GE Signa LX (Clin. Anat. 1995; 8:–16), with the field of view modified to include the dural sinuses. Unexpectedly, these patients were found to have congenital anomalies of the aortic arch and the great vessels. Patients with TOS and congenital vascular abnormalities of the aortic arch and great vessels present with difficulty swallowing, pain on eating, gastroesophageal reflux and hoarseness. This presentation displays patients with right aortic arch, aberrant left subclavian artery and left superior vena cava, who presented with severe gastrointestinal symptoms along with the TOS and migraine complaints.
As the longevity of AIDS patients successfully treated with anti retroviral therapy increases, a rise in the prevalence of older AIDS patients that also have AD is expected. This study was undertaken to assess the incidence of AD lesions in a cohort of well-characterized prospectively studied HIV/AIDS patients. Brain specimens for this study are part of the National Neurological AIDS Bank (NNAB) collection, a Los Angeles site of the NIH funded National Neuro-AIDS Tissue Consortium, which collects and distributes brain and other tissues for studies of neurological diseases in HIV/AIDS. Microscopic sections from a total of 31 cases AIDS cases 50 years or older at death were analyzed. Of those cases, 23 were 50 to 59 years old, 5 were 60 to 69 years old and 3 cases were 70 to 76 years old at death. Seven additional non-AIDS, HIV negative cases age 51 to 78 years served as controls. Sections of frontal and temporal cortex, hippocampus and basal ganglia were stained with Bielschowski techniques and immunostained for beta amyloid, neurofibrillary tangles and alpha synuclein. Amyloid deposits were found in 6 out of 31 AIDS cases, age 54, 58, 61, 66, 66 and 70 years. In one of these cases, age 66 years, amyloid deposits were severe presenting as florid AD. Amyloid deposits were found in 3 out of 7 non-AIDS control cases. Although the incidence of amyloid deposits in AIDS cases was lower then expected, this preliminary study is too small to draw a significant conclusion and larger studies are needed to explore the picture of co-incident AD and AIDS. Supported by NIH NS 38841.
A white man with a progressive spastic paraparesis that began 15 months after sustaining severe trauma in a motor vehicle accident was positive for antibodies to human T-lymphotropic virus type I (HTLV-I) by enzyme-linked immunosorbent assay. Serum antibody to HTLV-I was confirmed by Western blot and radioimmunoprecipitation assay. We detected specific proviral DNA in peripheral blood lymphocytes by the polymerase chain reaction. Because the incidence of HTLV-I is generally restricted to Southern Japan and Caribbean black populations, the most likely source of HTLV-I infection in this patient was multiple intraoperative blood transfusions. The relatively short interval between transfusion and development of HTLV-I-associated myelopathy is consistent with the more rapid evolution of this clinical syndrome compared with adult T-cell leukemia.
Magnetic resonance imaging (MRI), angiography (MRA) and venography (MRV) display venous and neurovascular compression in patients with thoracic outlet syndrome (TOS) and migraine (Clin.Anat.1995; 8:–16). Kyphosis of the cervicothoracic spine enhances costoclavicular compression (JNMA. 2003; 95:–306). Causes of kyphosis (and examples) include congenital and developmental anomalies (achondroplasia, dysraphism, Scheuremann's), connective tissue disorders (Ehler's-Danlos), infection (Pott's), neoplasm, trauma, immobilization, and aging with muscle and tissue laxity. Kyphosis increases the slope of the first ribs; backwardly displaces the manubrium sterni and narrows the thoracic inlet, with resultant compression of the brachiocephalic, internal jugular and subclavian veins and the subclavian artery and binding nerve roots in the scalene triangle. Abduction and external rotation of the upper extremities increases TOS symptoms of pain, numbness and tingling, temperature and color changes in the hands and headache. Multiplanar imaging of suspected TOS patients with kyphosis was conducted on the 1.5 Tesla (GE Signa LX), 4.0 mm thickness, 512 × 256 matrix and saline water bags to enhance signal to noise ratio. Blood flow was displayed as changes in proton density without contrast. This presentation displays TOS patients with kyphosis causing venous and neurovascular compression.
