are found. Left untreated, the natural course of the disease leads to paraplegia and death [1 -9]. Paraplegia results from compression of the spinal cord or cauda equina by the epidural mass or from thrombophlebitis of the spinal epidural veins resulting in venous infarction of the spinal cord. Death is a result of septicemia. The prognosis for survival and prevention of serious neurologic deficit relates to the rapidity with which appropriate decompression and antibiotic therapy are instituted. The neurologic deficit is less likely to be reversible the more severe and the longer it has been present. Thus, many authors have recognized that prompt and early diagnosis is critical to the management of this potentially curable disease [1-13]. We recently encountered four patients with spinal epidural infections (three pyogenic, one tuberculous) in whom MR imaging of the spine led to expeditious treatment and better clinical outcome.
Materials and Methods
Four patients with spinal epidural infections (three Staphylococcus aureus, one Mycobacterium tuberculosis)were examined with MR imaging. MR was performed on a GE Signa system with a 1.5-T superconducting CT scans of the spine were obtained on a Siemens DR3 Somatom or Picker 1200 SX unit. Radiographs of the spine were available in all cases.
Previous studies have demonstrated a high correlation between hydrocephalus and the resistive index (RI), as determined by transcranial Doppler ultrasonography. Measurements of RI, calculated by dividing the difference between the peak systolic velocity and the end-diastolic velocity by the peak systolic velocity, were attempted in 55 pediatric patients during evaluations for ventriculoperitoneal shunt malfunctions; values were obtained in 52. Indications of shunt malfunction included both clinical and radiographic evidence of increased intracranial pressure. Eleven patients, determined to have functional shunts both by clinical criteria and subsequent outcome, had RIs of 47 +/- 5 (average +/- 1 standard deviation). Shunt malfunctions were confirmed in 41 patients. Prior to shunt revisions, these 41 patients had RIs of 71 +/- 10%; following revision, the RIs fell to 53 +/- 12%. Nine patients had had pre-malfunction RIs of 48 +/- 11% obtained during routine follow-ups; when they subsequently had shunt malfunctions, their RIs had significantly increased. Four of the 41 patients with shunt malfunctions had essentially normal RIs (52 +/- 7%), but had fluid tracking along the shunt; in these, RIs were essentially unaffected by shunt revision. For comparison, 119 pediatric patients with clinically functional ventriculoperitoneal shunts had RIs of 50 +/- 9%. The data, statistically significant with a P value of less than 0.001, showed a correlation between elevated RIs and shunt malfunction; thus, transcranial Doppler ultrasonography is a practical, non-invasive technique useful in the diagnosis of ventriculoperitoneal shunt malfunction.
We present a child with a rapidly growing mass and lytic skull lesion that on pathologic evaluation was diagnosed as cranial fasciitis. This disease entity is not widely known by radiologists, and should be included in the differential diagnosis of lytic skull lesions.
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