An acute traumatic epidural hematoma extending from the odontoid process to the dorsum sella is described. The mechanism for the formation of an extradural hematoma in this unusual location seems to be related to age and a severe hyperflexion injury.
Although CT effectively demonstrates normal and herniated intervertebral disks, the value of CT in low back pain has not been adequately evaluated. We compared CT prospectively with myelography in 107 patients referred to Ulleval Hospital Department of Radiology for myelography. Fifty-two patients subsequently had spinal explorations, one patient twice during the study and two patients at two levels. Forty-six CT and 44 myelographic diagnoses agreed perfectly with the operative diagnosis at that level. In 30 disk herniations, there were 29 true-positive CT diagnosis and 28 true-positive myelographic diagnoses. False-negative diagnoses of herniated nucleus pulposus were made twice on myelography and once on CT. In 24 other spinal operations, there were eight false-positive CT and nine false-positive myelographic diagnoses of herniated nucleus pulposus. CT demonstrates lumbar disk disease as effectively as myelography.
Two cases of pontine vascular malformation with a characteristic venous angiographic appearance are reported. Both patients had a slowly progressive clinical course, normal spinal fluid, and evidence of a pontine mass. In the late venous phase, large abnormal vessels were seen to coverage towards the midline from each cerebellar hemisphere. The abnormal vessels were microscopically identified as teleangiectases in one of the cases. Both cases had pontine hematomas, originating from a cavernous angioma in one of them; in the other the exact origin of the bleeding could not be determined. It is concluded that in cases with a progressive pontine syndrome the characteristic appearance of the venous phase of angiography may indicate a bleeding pontine vascular malformation.
The interpretation of cervical metrizamide myelography requires specific anatomic considerations, particularly when the lateral C1-2 puncture technique is employed. Fresh unfixed cervical spine specimens were injected with a mixture of metrizamide and methylene blue. Radiologic examinations of these specimens were compared with a retrospective analysis of 100 consecutive unselected cervical myelograms obtained by lateral C1-2 puncture during the years 1979-1980. Epidural, subdural, subpial, dentate ligament, and spinal cord injections may be encountered when the lateral C1-2 puncture for myelography is employed; possible artifacts from such injection are discussed.
Six hundred lumbar radiculographies were performed with metrizamide in 581 patients. Excellent radiographs were obtained in almost all cases. The adverse effects were minor and no serious complications occurred. The authors consider metrizamide superior to other water-soluble contrast media in present use from both toxicological and radiological points of view.
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