A traumatic epidural hematoma of the cervical spine is reported in a 13-year-old girl. The patient recovered spontaneously over several days without surgical intervention. The diagnosis was made on magnetic resonance (MR) imaging, which also demonstrated subsequent resolution of the hematoma. The etiological factors of spinal epidural hematomas are reviewed and the utility of MR imaging in differentiating other causes of acute spinal cord injury is emphasized.
Previous animal models of thromboembolic stroke have focused upon the carotid artery system. An alternative approach utilizing the vertebrobasilar system in rabbits is presented here. Left vertebral artery catheterization was accomplished relatively simply in this model using transfemoral angiographic techniques. Twenty-four-hour-old clot emboli with calculated volumes in the range of 0.007-0.11 cc were delivered by this route and found to lodge at the juncture of the basilar tip and the Circle of Willis in 11 of 13 rabbits. Intra-arterial infusion of streptokinase in one animal resulted in angiographically complete clearing of clot. Certain technical advantages in this particular approach are discussed.
ABSTRACT. The objective of the current study was to assess the utility of 64-row helical computed tomography angiography (CTA) in the evaluation of extremity vascular traumas. The extremities from 17 clinical cases of suspected traumatic vascular damage were evaluated using 64-row helical CTA. To evaluate extremity vascular traumas using CTA, volume rendering, multiple planar reconstruction, and curved planar reconstruction technology were applied to accurately and rapidly indicate the type and extent of blood vessel damage, as well as any relationship with injuries to adjacent bones, joints, soft tissue swelling, or hematomas. The types of extremity vascular traumas evaluated included damaged arteries, artery spasms or block, blood vessels shifted because of pressure, pseudo aneurysms, arteriovenous fistula, and vein occlusion. The results of the study indicated that 64-row helical CTA could be highly efficient and accurate in the evaluation of extremity vascular traumas, and could aid in making clinical assessments.
PurposeTo show the utility of MRI and histology in diagnosing rare cases of trigeminal hypertrophic interstitial neuropathy (HIN).ObservationsA 57-year-old African-American woman presented with a 4-year history of right eye proptosis with tearing, headaches, and worsening right-sided trigeminal neuralgia symptoms and jaw pain. HIV and diabetes tests were negative and thyroid function was normal. MRI identified abnormal thickening of all trigeminal nerve divisions and proptosis secondary to right trigeminal nerve V1 division enlargement. The excised tissue contained S-100 positive Schwann cells in an onion-bulb pattern. Headaches resolved, but proptosis and mild trigeminal neuralgia remained 1 year post-surgery.Conclusions and importanceTrigeminal HIN is very rare, but presents as chronic progressive ocular symptoms with trigeminal neuralgia. Trigeminal nerve hypertrophy is identified by MRI and confirmed histopathologically by detection of Schwann cells in an onion bulb formation.
Fifty-five computed tomography (CT) scans of the pelves and abdomens of 33 patients who had undergone pelvic exenteration were reviewed. There were 27 gynecologic and six colorectal malignancies. The interval between surgery and the first CT scan ranged from 2 weeks to 37 months (median, 8 months). CT findings included abnormal fluid collections (33.3%), abnormalities of the neovagina (30.3%) and presacral soft tissues (36.4%), increased hydronephrosis (54.5%), and lymphocysts (6.1%). Tumors recurred in 17 of 33 patients (51.5%) at a median interval of 9 months after surgery and had several CT manifestations. The most common of these was a soft-tissue mass of variable density and shape, but pelvic fluid collections as well as abnormalities of the neovagina and presacral soft-tissue layer were also associated with tumor recurrence. The surgical indications, methods, and potential post-operative complications of pelvic exenteration were reviewed and the role of CT in the follow-up of these patients was emphasized.
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