A dynamic study of magnetic resonance (MR) imaging was used to obtain successive heavily T1-weighted coronal images (spin-echo [SE] 100/15 [repetition time msec/echo time msec]) of normal pituitary glands and pituitary adenoma immediately after patients were given an intravenous bolus injection of gadopentetate dimeglumine. The images were obtained every minute for 5-8 minutes at 1.5 T. Usual T1-weighted images (SE 600/15) were also obtained before and after the dynamic study was performed. The study group consisted of 18 patients, 10 with normal pituitary glands, and eight with pituitary adenoma. Normal pituitary glands showed maximum enhancement on the first or second image following the administration of gadopentetate dimeglumine, followed by gradual signal reduction through the later images, whereas pituitary adenomas reached a peak of enhancement later and showed slower signal reduction than normal pituitaries. The difference of enhancement patterns between the normal pituitary gland and the pituitary adenoma produced prominent image contrast on the first or second image after administration of gadopentetate dimeglumine, which improved the visualization of one microadenoma and four normal pituitary glands that had been displaced by large adenomas. Dynamic MR imaging is a useful diagnostic procedure not only for detection of microadenomas, but also for visualization of pituitary glands that have been displaced by large pituitary adenomas.
The authors present an extremely rare case of aspergillosis of the central nervous system (CNS) causing subarachnoid hemorrhage (SAH). A 78-year-old female developed facial pain, progressive deteriora tion in left visual acuity, and left total ophthalmoplegia.Computed tomography demonstrated a heterogeneously enhanced mass extending from the sphenoid sinus to the left cavernous sinus and left orbit, and angiography showed luminal narrowing and irregularity of the left internal carotid ar tery at its siphon. Biopsy of the left orbital and sphenoid sinus mass resulted in the diagnosis of Aspergillus granuloma. Despite combined administration of amphotericin-B and 5-FC, she became comatose from brainstem infarction and finally, suddenly died. Postmortem examination revealed massive SAH due to a ruptured mycotic aneurysm of the basilar artery. Aspergillosis of the CNS is a growing problem with the wider use of immunosuppressants and antibiotics. To the authors' know ledge, however, only 13 cases of CNS aspergillosis causing SAH have been reported. The prognosis is absolutely bad, with all patients dying from rupture of major intracranial arteries such as the internal carotid artery and basilar artery. Early diagnosis and vigorous chemotherapy are important.
We have operated on 12 of 14 cases of arteriovenous malformation (AVM) in the posterior fossa since 1968, with one death. The lesions were in the cerebellum in 10 cases (three anteromedial, one central, three lateral, and three posteromedial), and in the cerebellopontine angle in two; in two cases the lesions were directly related to the brain stem. The AVM's in the anterior part of the cerebellum were operated on through a transtentorial occipital approach.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.