Cranial CT scan in transient global amnesia

The occurrence of cerebral infarction in patients with transient global amnesia (n = 43) was evaluated by CT scan and compared to that of patients with transient ischemic attacks (TIA) (n = 58) and with no neurological disease (n = 52). Significant differences were demonstrated between TGA and TIA patients in relation to the control group, but no differences were found between patients with TGA and TIA. Our study suggests a vascular mechanism for TGA and that TGA could be considered a low risk TIA in most cases.     

外伤性脑梗死的CT诊断

目的总结外伤性脑梗死的CT特征,探讨其发生机制,揭示其对疾病预后的判定价值。方法回顾性分析40例外伤性脑梗死患者头颅CT表现及相关临床资料。结果轻微外伤引起的脑梗死多发于儿童,好发部位为基底节内囊区,预后较好;重症外伤引起的脑梗死好发于成人,发病部位多见于颅内血肿同侧,且大脑后动脉支配区域最为多见,预后较差。结论CT扫描对外伤性脑梗死的诊断及预后判定有重要价值。     

Cerebral toxocariasis: a possible cause of epileptic seizure in children

Introduction Toxocariasis is a worldwide human helminthiasis, which is mostly asymptomatic and caused by toxocara canis, a roundworm in dogs. These can cause visceral larva migrans syndrome in humans who ingest contaminated soil. CNS manifestation with a focal mass lesion is very rare, seizures often being the first symptom.Case report We describe an 11-year-old girl presenting with a generalized epileptic seizure and eosinophilia in blood. Under antibiotic therapy under the assumption of toxoplasmosis the lesion did not decrease and surgical resection was considered. We used computer-assisted surgery (CAS) for careful tissue resection. Postoperatively the diagnosis of toxocariasis was confirmed and albendozole medication was administered for 7 days. The patient developed well without neurological deficits or seizures.Conclusion We conclude that although neurological involvement is rare in toxocariasis, a cerebral infection in a child with epileptic seizures and eosinophilia should be considered.     

Diagnostic CT scan findings in an adult case of acute disseminated leuco-encephalitis

Summary A complex neurological syndrome, which rapidly appeared in a 54-year-old woman, created strong diagnostic difficulties. In fact, while the carotid-angiography was negative and CSF not significant, the scintigraphy suggested a multifocal metastatic or infarctual pathology. The CT scan easily allowed us to resolve the diagnostic problem, showing in the oval centres numerous enhanced areas which were consistent with a disseminated leuco-encephalitis. This case confirmed the opinion of the authors that CT scan may usefully contribute to the diagnosis of the demyelinating disorders of CNS.Neuroradiological Service     

EEG findings in minor head trauma as a clue for indication to CT scan

In order to investigate the role of EEG in minor head traumata in the pediatric age, EEG and CT scan findings were compared in a series of 103 consecutive cases of children hospitalized within 24 h after head trauma. The EEGs were classified as normal in 50 patients, borderline in 10 patients, and abnormal in 43 patients. CT scan showed contusion in 6 patients and extracerebral hematoma in 4. All cases of abnormal CT scans were reported for patients with frankly abnormal EEG findings. In contrast, no pathological findings were found in CT scans for patients with normal EEG. The data suggest that EEG findings can play a major role in the diagnostic workup of patients with minor head traumata. Specifically, in the case of asymptomatic patients with normal EEG findings, it is likely that the CT scan will also be normal.Presented at the 11th Meeting of the European Society for Paediatric Neurosurgery, Naples 1988     

CT scan and threshold vibrometry in the diagnosis of spinocerebellar degenerations

45 patients with spinocerebellar degeneration (SCD) underwent through quantitative investigation of the ventricular and cisternal systems by CT scanning and threshold vibrometry in the limbs to find out whether these parameters could be used for distinguishing mainly spinal from cerebellar forms or from olivopontoce-rebellar atrophy. The increase in the vibration sense threshold and the mild atrophy in the posterior cranial fossa proved typical of spinal forms and the reverse for cerebellar forms. In olivopontocerebellar atrophy enlargement of the cisterns and dilatation of the ventricles always exceeded 85% of normal values.

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Sommario 45 pazienti affetti da degenerazione spinocerebellare (SCD) sono stati sottoposti ad uno studio approfondito di esplorazione quantitativa del sistema ventricolare e cisternale alla TAC e della soglia di percezione vibratoria agli arti per valutare la possibilità di distinguere con questi parametri le forme prevalentemente spinali da quelle cerebellari o delle atrofie olivopontocerebellari. L'aumento della soglia vibratoria e la modesta atrofia in fossa posteriore è risultata tipica delle forme spinali, mentre l'inverso si verifica per le forme cerebellari. Nelle atrofie olivopontocerebellari l'allargamento delle cisterne e la dilatazione dei ventricoli supera quasi sempre l'85% rispetto ai casi normali.

     

Co-registration of isotope bone scan with CT scan and MRI in the investigation of spinal pathology

Image fusion software enables technetium^99m-methylene diphosphonate (Tc^99m-MDP) bone scan images to be co-registered with CT scan or MRI, allowing greater anatomical discrimination. We examined the role of bone scan images co-registered with CT scan or MRI in the investigation of patients presenting with axial spinal pain and/or limb pain. One hundred and thirty-nine consecutive patients were examined, and thereafter investigated with CT scan, MRI, and/or dynamic plain films. At this point diagnosis (pathology type and anatomical site) and treatment intention were declared. The co-registered Tc^99m-MDP bone scan images were then studied, after which diagnosis (pathology type and anatomical site) and treatment intention were re-declared. This data were then analysed to determine whether the addition of co-registered bone scan images resulted in any change in diagnosis or treatment intention. The most significant change in diagnosis was pathology type (10%). Anatomical site changed markedly without overlap of the pre and post-isotope fields in 5%, and with overlap in 10%. Treatment intention had a major change in 3.6% and minor change in 8.6%. In the two groups where there was (i) no obvious pathology after full pre-isotope investigation, or (ii) a spinal fusion under suspicion, addition of the bone scan information led to a major change in the pathology and/or anatomical localisation in 18% and 19%, respectively. The addition of co-registered Tc^99m-MDP bone scan images offers significant diagnostic assistance, particularly in the difficult diagnostic groups where a failed spinal fusion may be the suspected pain generator, or when no pain generator can otherwise be found.     

Computed tomography (CT) scan findings in children with seizures only

One hundred and fifteen children with seizures only were studied with Computed Tomography (CT) scan at King Khalid University Hospital (KKUH), Riyadh, Saudi Arabia. Eighty percent of the children had normal CT scan; 8.7% showed cerebral atrophy and in only 11.3% was there a specific abnormality; such as infarction, porencephalic cysts, and arachnoid cysts. These specific type of abnormalities belong to partial and combined types of seizures and were treated medically. Fifty-seven cases of generalized type of seizures showed only 6 cases of abnormal CT scan and that is only brain atrophy. Based on these findings, we believe that CT scan should not be a part of the routine investigations of children with seizures only, especially those of generalized type.     

帕金森病患者认知功能与脑电活动及脑影像学改变的相关性研究

目的研究帕金森病（Parkinsondisease,PD）患者认知功能、脑电活动及脑影像学的相关性。方法对70例PD患者及40例正常人进行中文版简易智能状态检查（MMSE）量表、BEAM频谱分析及脑影像学检查,对经MMSE初步测查后可疑认知功能障碍者进一步行成套神经心理学评估（FOM、RVR、DST、BD、BNT、HAMD）。结果PD痴呆组的神经心理学评估分值明显降低,痴呆组慢波（δ、θ频段）相对功率谱较非痴呆组明显增高（P〈0.01）,而快波（β1、β2频段）的相对功率谱显著降低（P〈0.05）;痴呆组额叶、颞叶的皮质萎缩及皮质下萎缩程度明显增加,且合并脑白质疏松症（LA）者明显高于非痴呆组;PD认知功能损害与额叶脑沟宽度、外侧裂宽度、三脑室宽度、脑室指数、前角指数及δ波功率值相关。结论神经心理学测验有利于发现PD患者的认知功能障碍,PD认知功能障碍与额颞叶皮质萎缩、皮质下机构萎缩程度、δ波功率及抑郁障碍密切相关,合并LA者痴呆发生率高。     

Seizure recurrence in adults after a newly diagnosed unprovoked epileptic seizure

PURPOSE: To investigate the risk of seizure recurrence after a newly diagnosed unprovoked epileptic seizure in an adult population-based cohort. MATERIAL AND METHODS: A total of 107 patients aged >or=17 years with a newly diagnosed unprovoked epileptic seizure (index seizure) were prospectively identified for the period 1985-87. Patients were followed until the date of death or to the end of 1996 with a median follow-up of 10.3 years for surviving cases. Overall cumulative recurrence rates and possible influencing variables were calculated. RESULTS: At 750 days after the index seizure the recurrence was 58%, and after that no events occurred. Recurrence risk was significantly higher when index seizure was remote symptomatic or preceded by two or more seizures. No other study variable predicted seizure recurrence. CONCLUSION: Etiology and the occurrence of seizures before the index seizure after a newly diagnosed unprovoked epileptic seizure predict seizure recurrence. Thus, particular consideration should be given to these factors in the decision of whether or not to initiate antiepileptic treatment.     

Computed tomography (CT) in late infantile metachromatic leucodystrophy

Computed tomographic features of 7 cases of the late infantile form of MLD confirmed by sural nerve biopsy are presented. Diffuse symmetrical white matter, low attenuation of the cerebral parenchyma was the common feature. Hypodensity of the temporal lobes and the cerebellar hemispheres are 2 features which have not been reported earlier. Three patients had brainstem atrophy without evidence of cerebral atrophy. Awareness of the various CT features of MLD may help in more definitive radiological diagnosis of the disease and to differentiate it from other dysmyelinating diseases of the central nervous system.     

Computer-assisted CT measurements in late paraphrenics with and without Schneiderian first-rank symptoms: A preliminary report

Computer-assisted measurements were made on the computed tomography (CT) scans of 14 patients meeting ICD-9 diagnostic criteria for late paraphrenia, seven of whom had exhibited one or more first-rank symptoms during their illness. When the CT scans of all 14 late paraphrenics were compared with those of an age-matched healthy control group, there were no significant differences with regard to planimetric measurements of brain and ventricle areas. Comparison of the scans of late paraphrenics with first-rank symptoms and those without them demonstrated that late paraphrenics without first-rank symptoms had a greater degree of cerebral atrophy, which was significantly so for the left frontal lobe. The findings support the observation that late paraphrenia is a heterogeneous condition which is comprised of a group with first-rank symptoms who probably represent late-onset schizophrenia and a group without first-rank symptoms who have structural brain abnormalities and a presumed organic substrate for their symptoms that is impossible to exclude through clinical evaluation.     

Detection of subarachnoid haemorrhage on early CT: is lumbar puncture still needed after a negative scan?

Computed tomography may be normal in up to 5% of patients who are investigated within one or two days after subarachnoid haemorrhage. This study investigated the need for further diagnostic evaluation after a normal CT scan was found very early (within 12 hours) in patients suspected of subarachnoid haemorrhage. A consecutive series of 175 patients with sudden headache and a normal neurological examination who had first CT within 12 hours after the onset of headache were investigated. The patients with normal CT underwent lumbar puncture, but not earlier than 12 hours after the event. Computed tomography showed subarachnoid blood in 117 patients, and was normal in 58. Spectrophotometric analysis of CSF gave evidence for a subarachnoid haemorrhage in two of these 58 patients (3%; 95% confidence interval (95% CI) 0.4-12%); a ruptured aneurysm was found in both. Thus CT was normal in two of 119 patients with a definite subarachnoid haemorrhage (2%; 95% CI 0.2-6%). It is concluded that in patients with sudden headache but normal CT a deferred lumbar puncture is necessary to rule out subarachnoid haemorrhage, even if CT is performed within 12 hours after the onset of symptoms.     

First seizure in adults: a prospective study from the emergency department

A prospective study of 98 consecutive adults with a first seizure to determine the most important etiological factors and the optimum diagnostics. 27 were thought to have cryptogenic seizures. Main causes of symptomatic seizures were: cerebral infarction, alcohol-withdrawal, CNS infections, tumors, vascular malformations, traumatism and miscellanea. Eight were infected by human immunodeficiency virus (HIV-1) representing 8.2% of all the patients with a first seizure and 20% of the 15-45-year age group. CT disclosed structural lesions in 33 cases. MRI in those with normal CT and no other explanation of seizure revealed additional lesions in 22.2%, but did not change management in any. We conclude that CT is essential in evaluation of adults with first seizure. MRI may be useful in selected cases. The HIV-infected now represent an important group with a first seizure.     

Socioeconomic prognosis after a newly diagnosed unprovoked epileptic seizure in adults: a population-based case-control study

PURPOSE: To investigate the socioeconomic prognosis after a newly diagnosed unprovoked epileptic seizure in adults. METHODS: Sixty-three patients 17 years or older with a newly diagnosed unprovoked epileptic seizure from 1985 through 1987 and 107 sex- and age- matched controls were followed up for 10 years to 1996. Studied variables were income, source of income, sickness periods, incapacity rate, diagnosis-specific incapacity rate, vocational status, and education. RESULTS: Relative growth of income was similar between patients and controls during follow-up. Patients had lower income than did controls 2 years before seizure onset and during the entire follow-up. This was related to higher morbidity among patients, as measured by sickness periods and incapacity rate. Employment rates did not evolve negatively among patients after seizure onset and were close to employment rates of controls during follow-up time. There was no difference between patients and controls regarding education. CONCLUSIONS: After a newly diagnosed unprovoked epileptic seizure in adults, no negative development regarding employment and education occurs. Income development is positive unless refractory seizures evolve. However, income is lower among patients with epilepsy than among controls, and this difference can be related to overall morbidity.     

Prognostic evaluation of brainstem hematomas: the role of CT scan and brainstem auditory evoked potentials

Abstract– 6 cases of brainstem hematoma were studied utilizing CT scan and brainstem auditory evoked potential (BAEP) recordings. CT scan did not contribute to an early discrimination between primary and secondary hematomas. Size of the hematoma and the presence of blood in the CSF did not represent evident signs in differentiating benign from unfavourable brainstem hematomas or hemorrhages. BAEP recordings showed the presence of electrophysiological anomalies at the level of the lesion, demonstrating that bleeding as well as tumor in the brainstem can provoke a focal damage.     

Chronic epileptic foci in monkeys: correlation between seizure frequency and proportion of pacemaker epileptic neurons.

A total of 1,802 neurons from 15 alert, undrugged Macaca mulatta monkeys were studied. Thirteen monkeys had chronic epilepsy induced by subpial alumina injections in precentral cortex. Precentral neurons were judged epileptic by the magnitude and variability of the percentage of interspike intervals less than 5 msec during periods when the monkeys were awake. This method of quantifying epileptic single neuron activity appears highly reliable in distinguishing epileptic neurons from precentral neurons in either normal cortex, cortex contralateral to, or within the focus. For the 13 epileptic monkeys, the relative proportion of strongly epileptic neurons found within foci was logarithmically correlated with the mean number of daily seizures. Because of the similarity between the physiology of the alumina focus in monkeys and epileptic foci in humans, these data imply that the severity of focal human epilepsy is a function of epileptic neuronal mass.     

新型国产16层移动CT在颅脑创伤中的临床应用

目的探讨新型国产16层移动CT在颅脑创伤中的应用价值。 方法收集吉林大学第一医院神经创伤外科自2018年10月16日至11月16日选取的100例志愿者的新型16层移动CT的头部影像资料,包括普通头部体检者50例,神经创伤外科普通病房患者25例和重症监护室患者25例。所有患者在神经创伤外科重症监护病房的铅防护CT室内进行16层移动CT头部扫描,同时在放射线科行普通CT头部检查。对比分析新型16层移动CT头部成像质量和性能,并对重症监护室患者行16层移动CT头部检查耗时与转运去放射线科普通CT头部检查耗时进行比较。 结果50例体检者头部16层移动CT扫描显示脑组织形态、结构和密度清楚,成像质量清晰;50例颅脑创伤患者头部16层移动CT扫描显示脑挫裂伤、颅内血肿、脑梗死、颅骨骨折等病灶显示清晰,满足颅脑创伤疾病的诊断要求。重症监护室患者16层移动CT检查耗时[（7.2±0.4）min]显著少于转运去放射线科普通CT检查耗时[（22.3±1.9）min]。 结论新型国产16排移动CT成像清晰,适合于颅脑创伤患者的临床应用,并且耗时短,尤其适合神经重症监护室的颅脑创伤患者。     

Acutely unstable cervical spine injury with normal CT scan findings: MRI detects ligamentous injury

MRI can detect ligamentous injury not detectable with CT scan. The authors present a trauma patient with normal CT imaging despite dislocation on standing radiograph. MRI detected disruption of the C5–C6 posterior ligamentous complex that requires surgery.     

Mortality risk in an adult cohort with a newly diagnosed unprovoked epileptic seizure: a population-based study

PURPOSE: We sought to investigate mortality risk in an adult cohort with newly diagnosed unprovoked epileptic seizures. METHODS: One hundred seven patients who were at least 17 years old and had newly diagnosed unprovoked epileptic seizures were prospectively identified during a period of 20 months between 1985 and 1987. Patients were followed until the date of death or the end of 1996. The standard mortality ratio (SMR) was analyzed in the whole cohort and in the portion of the cohort with recurrent seizures at inclusion. The influences on the SMR of time since diagnosis, sex, age at diagnosis, seizure cause, seizure type, and cause of death were also investigated. RESULTS: The SMR was significantly increased (SMR, 2.5; 95% confidence interval [CI], 1. 2-3.2). This significantly increased risk was found during the first 2 years after diagnosis (year 1: SMR, 7.3; 95% CI, 4.4-12.1; year 2: SMR, 3.6; 95% CI, 1.6-8.1) and at years 9-11 (SMR, 5.4; 95% CI, 2. 7-11.2). The increased mortality risk was most pronounced when the seizures occurred before the age of 60 years. Mortality risk was elevated among patients with remote symptomatic epilepsy (SMR, 3.3; 95% CI, 2.4-4.5) but not idiopathic epilepsy. CONCLUSIONS: There is increased mortality risk in an adult cohort with newly diagnosed unprovoked epileptic seizures. This increase is found in symptomatic patients, young patients, and during the first 2 years after the diagnosis.