Neuroradiology 0028-3940

Wilmink, J.; Penning, L.; Burg, W.

doi: 10.1007/BF00342411pmid: 6738850

234 26 26 3 3 J. T. Wilmink L. Penning W. van den Burg Department of Diagnostic Radiology, Section of Neuroradiology University Hospital Groningen The Netherlands Department of Neuropsychology University Hospital Groningen The Netherlands Summary Myelographic flexion-extension studies were performed in four groups of 10 patients each, with (A) normal myelogram; (B) bilateral nerve root compression at L4-L5; (C) unilateral nerve root compression at L4-L5 and (D) nerve root compression at L5-S1. The aim of the investigation was to assess the role of spinal stenosis in contributing to nerve root compression. The results indicate that a form of stenosis of the spinal canal plays an important role in bilateral nerve root compression at L4-L5, and to a lesser extent in unilateral nerve root compression at L4-L5. It does not appear to play a role in L5-S1 nerve root compression (stenosis of the lateral recess left aside). It is advocated that in myelographic L4-L5 nerve root compression additional flexion-extension studies should be performed in order to evaluate the possible role of stenosis of the spinal canal contributing to this compression. Even in nerve root compression by disc extrusion, concomitant spinal stenosis may necessitate additional decompressive laminectomy.

Pasto, M.; Rifkin, M.; Rubenstein, J.; Northrup, B.; Cotler, J.; Goldberg, B.

doi: 10.1007/BF00342412pmid: 6738851

234 26 26 3 3 M. E. Pasto M. D. Rifkin J. B. Rubenstein B. E. Northrup J. M. Cotler B. B. Goldberg Department of Radiology, Division of Ultrasound and Radiologic Imaging Thomas Jefferson University Hospital Philadelphia Pennsylvania USA Department of Neurosurgery Thomas Jefferson University Hospital Philadelphia Pennsylvania USA Department of Orthopaedic Surgery Thomas Jefferson University Hospital Philadelphia Pennsylvania USA Summary Fourteen subjects with spinal cord pathology were studied with 10 MHz linear array or 5 MHz mechanical sector ultrasound scanners. Twelve patients were studied intraoperatively. The examinations were rapid, aiding the surgeon at the time of exploration. Sonography defined cysts, outlined the extent of neoplasia and aided in the localization of bone fragments. Guidance for placement of syringo-subarachnoid shunts reduced the amount of surgical manipulation. Four patients were examined postoperatively through laminectomy defects, three confirming adequate position and function of shunts and in one case demonstrating tumor recurrence.

Ringelstein, E.; Zeumer, H.

doi: 10.1007/BF00342413pmid: 6234477

234 26 26 3 3 E. B. Ringelstein H. Zeumer Department of Neurology Technical University Aachen FRG Neuroradiological Service Technical University Aachen FRG Summary Twelve patients suffering from subclavian steal syndrome of various severity due to either proximal subclavian stenoses (10 cases) or subclavian occlusion (2 cases) were treated with percutaneous transluminal angioplasty (PTA). Olbert's dilatation catheters were used. The occlusions could neither be recanalized by the transfemoral nor transaxillary approach. In one right-sided subclavian stenosis an additional distal subclavian occlusion prevented proper placement of the catheter. All the other patients were treated successfully with no re-occlusion during a follow-up period of 1 to 7 months. In one patient, a transient embolic occlusion of the finger arteries was seen following post-interventional repeat angiography. Before, during and after PTA, continuous ultrasound monitoring of the homolateral vertebral flow patterns revealed an unexpected “delay” phenomenon. Despite sufficient recanalization of the proximal subclavian artery, the flow direction within the vertebral artery did not immediately change to antegrade but rather did so gradually within 20 s up to several minutes. This delay of flow-reversal is thought to serve as a protective mechanism against cerebral embolism during, and shortly after PTA of the subclavian artery. Relying on Doppler ultrasound findings, a staging of the subclavian steal is proposed in order to allow adequate selection of patients for PTA.

Stoeter, P.; Prey, N.; Hoffmann, C.; Büdingen, H.; Bergleiter, R.

doi: 10.1007/BF00342414pmid: 6738852

234 26 26 3 3 P. Stoeter N. Prey C. Hoffmann H. J. Büdingen R. Bergleiter Department of Neuroradiology Elisabethen-Hospital Ravensburg FRG Department of Neurology Elisabethen-Hospital Ravensburg FRG Summary In 55 patients, the blood flow in the carotid and supratrochlear arteries was examined by Doppler sonography during cerebral angiography. In general, a threefold response was observed: an initial phase of turbulence during the injection was followed by a phase of depressed and then of increased arterial flow. The second phase of reduced perfusion which probably is caused by the increased viscosity of the mixture of contrast medium and blood, is more pronounced in the internal carotid artery, whereas the third phase of accelerated flow is more marked in the external carotid artery. In patients with an occlusion of the internal carotid artery, the cerebral blood supply often depends on the collateral pathway via the ophthalmic artery. In these cases, the reduction of the blood flow is specially marked and long-lasting, as we could show. This may contribute to a higher angiographic risk of those cases with an important ophthalmic collateral flow.

Lewis, B.; Kwan, E.; Enzmann, D.

doi: 10.1007/BF00342415pmid: 6377117

234 26 26 3 3 B. D. Lewis E. Kwan D. R. Enzmann Department of Radiology Stanford University School of Medicine Stanford California USA Summary Continuing improvements in intravenous DSA techniques have now shown it to be useful in the angiographic evaluation of STA-MCA bypass function. Both patent and non-patent bypasses were observed in this study. Diagnostically adequate spatial resolution and signal to noise ratio were achieved by electronic magnification and integration techniques. Patient positioning was important and the projection which gave optimal visualization of the STA-MCA bypass, free of vessel overlap, was a 40° oblique, 20° craniocaudal view on the side of interest. Intravenous DSA can complement, and in some cases may supplant, conventional arteriography in the radiologic evaluation of STA-MCA bypass surgery.

Resta, M.; Gentile, M.; Cuonzo, F.; Vinjau, E.; Brindicci, D.; Carella, A.

doi: 10.1007/BF00342416pmid: 6738853

234 26 26 3 3 M. Resta M. A. Gentile F. Di Cuonzo E. Vinjau D. Brindicci A. Carella Service of Neuroradiology University of Bari Bari Italy Institute of Radiology University of Bari Bari Italy Summary We have found numerous case reports, but no systematic study of the megadolichoverte-brobasilar anomaly (MDVBA). The purpose of this paper is to evaluate the relationships between arterial shifts of the vertebro-basilar system and neurological findings in the posterios fossa in our series of 132 cases. We found a high percentage (77.3%) of angiographic-clinical correlations having evaluated the arterial shifts, measured in mm, of the vertebro-basilar system in a frontal and a sagittal plane and concluded that the greater the degree of dislocation, the greater the number of positive cases. Nevertheless it is not possible to predetermine the presence of particular neurosymptomatology related to arterial dislocation degrees.

Valk, J.; Crezée, F.; Olislagers-de Slegte, R.

doi: 10.1007/BF00342417pmid: 6377118

234 26 26 3 3 J. Valk F. Crezée R. G. M. Olislagers-de Slegte Department of Neuroradiology Free University Hospital Amsterdam The Netherlands Summary Iohexol 300 mg I/ml and Hexabrix 320 mg I/ml have been compared in a randomized, double blind, parallel study, to evaluate hemodynamic parameters, diagnostic information and adverse reactions. A total of 55 patients entered the study, one of them was later excluded, bacause both contrast media were given by mistake. In the included material, 21 patients were given iohexol 300 mg I/ml in 55 selective injections and 23 patients Hexabrix 320 mg I/ml in 65 selective injections. The median total dose was 52 (12–88) ml in the iohexol group and 51 (13–118) ml in the Hexabrix group. No changes in heart rate were seen. Angiograms of good or excellent quality were obtained, and no difference between the two media was shown. No serious adverse reaction accured, and no statistical significant difference was found between the two media with respect to subjective patient reactions. The results indicate that the non-ionic, low-osmotic contrast medium iohexol is well tolerated in cerebral angiography with respect to the parameters tested. No statistical significant difference was found in any of these parameters between iohexol and Hexabrix.

Stevens, J.; Kendall, B.; Love, S.

doi: 10.1007/BF00342418pmid: 6738854

234 26 26 3 3 J. M. Stevens B. E. Kendall S. Love Lysholm Radiological Department National Hospital for Nervous Diseases Queen Square London England Department of Neuropathology National Hospital for Nervous Diseases Queen Square London England Summary The features of 17 symptomatic subependymomas on X-ray computed tomography are described. Thirteen were reviewed from isolated case reports and 4 were original material. Over half were entirely intraventricular, 6 extended into brain substance and 2 into subarachnoidal cisterns. Twelve were isodense, 15 showed diffuse but irregular enhancement, and 5 contained nodular calcification. Large low density cysts, intratumoural haemorrhage and brain oedema were found almost exclusively in lesions extending into brain substance. It is concluded that subependymomas resemble ependymomas too closely on CT to be distinguished radiographically from them as a separate group. However subependymomas contain calcification slightly less frequently, and usually appear as mainly intraventricular lesions even when they occur above the tentorium.

Galle, G.; Huk, W.; Arnold, K.

doi: 10.1007/BF00342419pmid: 6738855

234 26 26 3 3 G. Galle W. Huk K. Arnold Neurological Clinic University of Erlangen-Nuremberg FRG Neurosurgical Clinic University of Erlangen-Nuremberg FRG Psychiatric Clinic University of Erlangen-Nuremberg FRG Summary Groups each consisting of ten patients underwent lumbar and cervical myelography with metrizamide and iopamidol, together with a control group of ten patients who underwent lumbar punctures only. These groups were studied with a psychopathometric test procedure in order to demonstrate and quantify mental disturbances. It was shown that in contrast to myelography with iopamidol, mild mental disturbances are common after myelography with metrizamide. The severity of the mental disturbances after myelography with metrizamide was dependent on the quantity of contrast medium which diffused into the intracranial space after myelography, suggesting a dose-related neurotoxic effect of this substance. Such a correlation was not found with iopamidol.

Maly, P.; Olivecrona, H.; Almén, T.; Golman, K.

doi: 10.1007/BF00342420pmid: 6547514

234 26 26 3 3 P. Maly H. Olivecrona T. Almén K. Golman Department of Diagnostic Radiology and Experimental Research Malmö General Hospital Malmö Sweden Research Department Nyegaard Oslo Norway Summary During a 14-day period, 45 of 78 rabbits were treated intravenously with chlorpromazine (5 mg kg -1 day -1 ). Metrizamide or iohexol was injected subarachnoidally and the neurotoxic effects of each substance on rabbit behaviour were evaluated for 3 h in both chlorpromazine-treated and non-treated rabbits. Chlorpromazine increased both the excitative and the depressive effects of metrizamide and the depressive effects of iohexol. No signs of excitation were observed in chlorpromazine-treated and non-treated rabbits after subarachnoid injections of iohexol. In spite of a free flow of clear fluid from the needle both before and after the intended subarachnoid injection, radiography disclosed that 26 of 67 suboccipital injections inadvertently resulted in a subdural deposition of the contrast medium. Contrast medium effects following subdural injection significantly differed from those following subarachnoid injection.