Prognostic significance of early CT changes in ischemic stroke patients]

The aim of the study was to establish the prognostic value of early CT findings in predicting the 30-day mortality after stroke, to assess the prevalence of these findings in acute stroke patients, and to examine the correlation between these findings and the clinical status. 134 patients (mean age 67.5 +/- 12.1) with supratentorial ischaemic stroke and CT performed within 12 hours from onset of the symptoms were included into the study. The neurological deficit and consciousness disturbances were assessed by means of Scandinavian Stroke Scale. The 30-day mortality was registered. CT findings were found in 84 (63.7%) patients, including hypodense lesions in 74 (55.5%), mass effect in 55 (41.0%) and hyperdense middle cerebral artery sign in 5 (3.7%) cases. Patients with mass effect had greater neurological deficit on admission (p < 0.0001), more frequently developed disorders consciousness (p = 0.001) and had greater 30-day mortality (p < 0.0001). Patients with hypodense lesions of at least two types presented with greater neurological deficit observed on the second day of hospitalization (p < 0.05) and had also greater 30-day mortality (p = 0.01). On multivariate analysis mass effect seen in early CT, as well as older age and greater neurological deficit appeared to be independent predictors of 30-day mortality.     

A case of cerebellar infarction presenting as thunderclap headache

Thunderclap headache (TCH) refers to a sudden-onset, severe headache that features in subarachnoid hemorrhage, unruptured intracranial aneurysm, cerebral venous thrombosis, pituitary apoplexy, cervical artery dissection, and hypertensive reversible posterior leukoencephalopathy. TCH is a rare manifestation in cerebral or cerebellar infarctions. Herein, we report on a 60-year-old woman with a thunderclap headache as the first symptom of cerebellar infarction, in the absence of abnormal findings in the brain computed tomography (CT), CT angiography, and lumbar puncture. An urgent brain MRI showed an acute infarction of the right cerebellar hemisphere. The next day, the patient presented with right side ataxia. In emergency cases presenting with thunderclap headache, one should consider an expanded evaluation and/or close observation, with frequent neurological examinations, even though the findings are normal on the initial neurological examination, cerebrospinal fluid analysis, and brain CT.     

EEG and CT abnormalities in xeroderma pigmentosum

Xeroderma pigmentosum associated with neurological abnormalities is a less familiar neurocutaneous disorder. In this report, 35 patients with group A xeroderma pigmentosum were assessed for neurological complications. Of these, 17 showed microcephaly and 24 mental retardation. Of 25 patients over 7 years of age, 22 had sensorineural deafness and 12 showed spinocerebellar signs such as nystagmus, dysarthria, tremor and ataxia, while none below 7 years of age had such neurological complications. Thirty-five EEG studies were performed on 29 patients, and 15 showed intermittent spindles of grouped theta waves with abnormal slow background activity and a poorly developed alpha rhythm, suggesting immature brain development or a regression from normal brain function in many areas including the diencephalon. Twenty-six patients were examined by cranial CT scan, of whom 20 showed abnormal CT findings such as ventricular dilatation, diffuse cortical atrophy, and marked thickening of the calvarial bones. The incidence of abnormal EEG and CT findings increased with advancing age in accordance with the development of neurological complications in the CNS, thus suggesting a chronic progressive degenerative disease.     

Morphological cerebral asymmetries in autistic children

A group of 36 children with infantile autism and various neurological disorders matched closely on age, sex, and handedness underwent computerized tomographic (CT) scanning of the brain. All CT scans were assessed blindly and independently by a neuroradiologist. Two techniques modified from two published CT studies concerning cerebral asymmetries were used for measuring frontal and parieto-occipital asymmetries. The present study found that the CT pattern of cerebral asymmetries in autistic children is the same as observed in the neurological patients. Contradictory results were noted when the distributions of such asymmetries between the present autistic group and normal adults included in two previous studies were compared. One of the striking findings in this study is that the brains of the present autistic patients seem to be more symmetric than those of the normals. This finding, however, is also noted in the present matched controls as well as in the dyslexic children previously studied by other investigators. Further sophisticated studies are needed to explain the difference in the brain morphology between normals and children with a developmental disorder or a neurological disorder.     

Prolonged Focal Cerebral Edema Associated with Partial Status Epilepticus

Following several days of partial status epilepticus, three patients developed striking focal cerebral edema as demonstrated by computed axial tomography (CT) scan. An angiogram done in one patient showed a capillary blush and early cortical draining veins in the corresponding area. All patients developed severe focal neurological deficit which resolved as the edema improved, and this was demonstrated on serial CT scans (at 6 months, 1 month, and 2 months, respectively). In the first patient, an underlying tumor, and in the second and third, vascular occlusions, were suspected because we were not aware that edema due to status epilepticus could produce changes of such intensity and duration. The neurological disability after the partial status was long-lasting but reversed completely in our patients. Maximal radiological changes occurred in the area of maximal epileptic discharge. Minimal atrophic changes persisted in two of the three patients. The clinical, CT scan, and angiographic findings suggest that partial status epilepticus can be associated with abnormal vascular permeability leading to prolonged focal cerebral edema. Similar pathophysiology of lesser intensity may be responsible for shorter postictal neurological deficits. Awareness of this clinical and radiological entity should avoid misdiagnosis of cerebral tumor or infarction.     

Intracranial hydatid cyst: contribution of scanography

We reviewed 14 cases of intracranial hydatid cysts, describing the clinical features and radiographic findings. The clinical presentation was dominated by signs of increased intracranial pressure and neurological manifestations. Diagnosis was established on the basis of CT findings, most valuable as a diagnostic tool.     

Cranial computed tomography in purulent meningitis of childhood

The cranial computed tomography (CT) findings of 48 children with purulent meningitis were examined, prospectively, to determine the importance of cranial CT findings on the prognosis of childhood meningitis, in a developing country. The age of children ranged from 2 months to 13 years. Of 48 patients, 29 (60.5%) survived without sequelae, 13 (27%) survived with sequelae, and six (12.5%) died. Cranial CT was normal in 21 (43%) patients of 48 children with meningitis at admission. Abnormal CT findings were detected in 10, 11, and 6 children in the groups of survived without sequelae, survived with sequelae, and deaths, respectively, at admission (p <.05) We found that CT scan results were correlated with neurological signs (p <.05). At least one or more cranial CTs were was re-taken in children in whom the first CT revealed abnormal findings; we did not find a statistically significant difference for the follow-up CT findings between the groups (p >.05). Hydrocephalus and subdural effusion were the commonest abnormal CT findings. In conclusion, our findings showed that cranial CT may safely be used to detect intracranial complications of meningitis in childhood and the ratio of sequelae and death were more common in children with abnormal cranial CT than those of normal cranial CT findings. Additionally, there was a positive correlation between CT scan results and neurological signs.     

A case of chronic toluene intoxication with atrophy of cerebrum, cerebellum and brainstem on CT and MRI]

A 28-year-old man developed neurological disorders consisting of cerebellar symptoms and dementia over a period of 8 years of inhalation of toluene. He also developed bilateral optic atrophy. CT scan and MRI revealed atrophy of cerebrum, cerebellum and brainstem. The severity of neurological symptoms corresponded with the findings of CT and MRI. Furthermore, MRI (T2) showed reduced signal intensity in bilateral thalamus. This patient was also admitted to another hospital 2.5 years ago. Compared with the previous findings, present examinations showed significant progress of the atrophy of cerebrum and brainstem. It was suggested from the results of ABR that the disturbance of the brainstem was aggravated through this period.     

颅脑外伤后血清、脑脊液髓鞘碱性蛋白的变化及其临床意义

目的①探讨颅脑外伤后血清、脑脊液髓鞘碱性蛋白（MBP）的变化及其意义；②探讨血清、脑脊液MBP水平与伤情、CT、颅内压（ICP）、脑灌注压（CCP）的关系。方法采用免疫组化法测定90例颅脑损伤病人伤后24h内、3d、7d时的血清、脑脊液MBP水平，并结合颅脑损伤程度、CT、ICP、CPP进行分析。结果①颅脑损伤病人血清、脑脊液MBP浓度升高的程度与脑损伤程度密切相关；②血浆、脑脊液MBP水平随ICP增加而升高，随CPP增高而降低；③血清、脑脊液MBP水平随CT图像改变而变化。结论监测血清、脑脊液MBP浓度，联合CT、ICP、CPP等指标，可更准确地判断病情。     

Value of computed tomographic scan in the evaluation of adult patients after their first seizure

The role of the computed tomographic (CT) scan in evaluating adults after their first seizure(s) was determined by reviewing the hospital records of 148 patients studied within 30 days of their ictus. Patients with alcohol or drug intoxication or withdrawal or with known brain tumor, craniotomy, or open skull fracture were excluded. Type of seizure; neurological, CT, and electroencephalographic findings; final diagnosis; and hospital outcome were cross correlated. The cause of seizure was established in 71 patients (48%); a structural lesion was identified by CT in 55 (37%), and 16 (11%) had metabolic seizures. CT findings agreed with the results of neurological examination 82% of the time. Structural lesions (including three tumors) were found by CT in 14 patients (15%) with nonfocal findings and in 12 (22%) of those with generalized electroencephalographic abnormalities. Our findings are similar to those reported in adult epileptics and lead us to conclude that the CT scan is a valuable aid in establishing the cause of seizures and in disclosing early lesions.     

Hemiplegic Cerebral Palsy: Correlation Between Ct Morphology and Clinical Findings

Morphological findings on CT were compared with clinical features of 111 children with hemiplegic cerebral palsy. Periventricular atrophy, interpreted as periventricular leukomalacia, was the most prevalent CT finding, although this type of lesion did not indicate severity of neurological impairment. Maldevelopments were associated with arm-dominated hemiplegia and with a wider range of clinical impairments than previously described. Cortical/subcortical atrophy, less common than presumed, indicated arm-dominated hemiplegia and was associated with more severe impairment than were other CT findings. A normal CT scan indicated leg-dominated hemiplegia and mild impairment. The morphological information obtained by CT was found to be useful for predicting clinical outcome, and was considered an important adjunct to clinical history and findings in these children.     

Anatomo-clinical study of Beh?et's syndrome with involvement of the central nervous system

The authors report a patient with Beh?et disease who developed severe central neurological disturbances. The M.R.I. was largely coincident with the distribution of the lesions verified in the neuropathological examination, while CT only shows an hypodense lesion in basal ganglia with contrast enhancement. The neurological symptoms did not respond to a treatment with prednisone and azathioprine. The main histopathological findings are similar to those described by previous observers. Reactive histiocytic infiltration with severe lymphocytic phagocytosis, probably related to immunosuppressor treatment, was also observed.     

Prognostic value of neonatal CT scans in asphyxiated term babies: low density score compared with neonatal neurological signs

Twenty-five asphyxiated term babies were investigated in order to evaluate the prediction of their neurodevelopmental outcome by means of computerized tomography (CT) as compared to neurological symptoms during the neonatal period. Low density (LD) areas, thought to represent hypoxicischaemic lesions, were assessed quantitatively by means of a LD score based on the extent and degree of LD, the total score ranging from 0-36. Neonatal scans were defined according to the time span elapsed between asphyxia and CT as (1) early CT (day 1-7, n = 15), and (2) intermediate CT (day 9-23: n = 14; day 29: n = 1). The newborns were classified according to the neonatal neurological findings as having mild (n = 8, 32%), moderate (n = 9, 36%), and severe (n = 8, 32%) encephalopathy, following the definition of Sarnat and Sarnat (1976). Among the twenty-two survivors, the follow-up (mean age 19.2 +/- 6.0 mts) revealed fourteen (56%) with normal outcome, two (8%) with transient neurodevelopmental anomalies during the first year, and nine (36%) with permanent abnormalities such as cerebral palsy and/or retardation (mainly global) and/or epilepsy. Early CT scans had no predictive value. Intermediate CT, however, showed distinct variations of LD areas which resulted in an LD score well correlated with the later outcome. In particular, a LD score below 14 characterized every baby who developed normally; a prediction not possible in a reliable way be means of neonatal neurological signs. For all abnormal children, the score correlated with the severity of the later neurodevelopmental disorder, except for one with the latest intermediate CT (day 29).     

Assessment of brainstem damage by the auditory brainstem response in acute severe head injury.

In 64 cases suffering from severe head injury (Glasgow coma scale: less than seven- the auditory brainstem responses (FARs) recorded at the vertex, which are thought to be volumet conducted far-field potentials reflecting the sequential electrical activities of the auditory afferen) system in the brainstem, were recorded in the neurosurgical intensive care room immediately after admission. The alterations in the responses were compared with the types of primary injury, neurological signs., CT findings and outcome following treatment. Based on the results obtained, it is concluded that the FAR is a useful indicator for predicting the effects of treatment on brainstem damage in patients with severe head injury, and that it provides more reliable information about the function of the brainstem than the neurological signs or CT findings. Moreover, it also offers a diagnostic method for primary brainstem injury. Three cases or primary brainstem injury without lesions in the supratentorial region were diagnosed by means of combined CT and FAR recording.     

Dynamics of clinical changes in correlation with computerized tomography in ischemic strokes

Sixty patients with ischaemic stroke were studied observing during the acute period of the disease (10 days) changes in their neurological state in relation to findings in computerized tomography. It was found that in 24 patients with serious state changes prevailed involving nearly the whole lobe in CT. In patients with minor stroke CT demonstrated major lesions with involvement of a whole lobe as well as small deep lesions and cortical foci. In 27 patients the first CT examination demonstrated extensive lesions involving a whole lobe or a hemisphere. In this group clinical manifestations regressed completely in 3 cases within 10 days, in 15 cases an improvement was observed, 3 cases failed to improve and 6 patients died. In 12 cases with small cortical lesions regression of clinical manifestations was observed in 3 patients, 8 patients improved and one failed to improve. These observations showed a certain correlation between the clinical state and CT findings. Prognostic conclusions could be reached, however, only if a correlation existed between the clinical picture and CT. In case of lack of agreement, that is if extensive lesions coexisted with slight clinical changes or small lesions with a serious condition the clinical picture was of greater prognostic significance than CT findings.     

Diagnosis of IIIrd ventricular cyst with "amipaque (metrizamide) CT ventriculography (author's transl)]

The patient is a 17-year-old female. She was suffering from dwarfism, irregular menstruation and obesity. Out of the dwarfism, there were no other neurological abnormalities. The serious clinical examinations were performed, and the cerebral angiography and the CT scan demonstrated the findings of the obstructive hydrocephalus. Namely, enlarged IIIrd ventricle and small IVth ventricle were observed with routine CT scan. Because these findings on CT scan, we thought the hydrocephalus was based on the aqueductal stenosis. The vertebral angiography showed stretched posterior medial choroidal arteries and compressed the basilar tip posteriorly and inferiorly. Moreover, the carotid-angiography demonstrated the following findings, unrolling of the anterior cerebral arteries laterally stretched bilateral lenticulostriate arteries laterally shifted sylvian groups of the middle cerebral arteries, and stretched bilateral internal cerebral veins. Judging from that angiographic findings and CT scan, we thought there would be cystic tumor in the IIIrd ventricle. However, we suspected the IIIrd ventricular tumor, we were not able to differentiated it from the enlarged IIIrd ventricle itself exactly. Because, it's density in CT scan was equaled with that the cerebrospinal fluid. According to above facts, we performed "Amipaque CT ventriculography through the ventricular catheter after V-P shunt. By "the Ampiqque CT ventriculography" we found exactly there was large cystic tumor in the IIIrd ventricle. Their manifestation and some differential diagnosis were discused.     

Hypertensive basal ganglionic hemorrhage with hemianopsia as the sole symptom--report of 2 cases

The majority of patients with sudden onset of homonymous hemianopia are caused by occlusion of the posterior cerebral artery. Apart from a subcortical hemorrhage in the occipital lobe, no previous cases of the hypertensive intracerebral hemorrhage presenting isolated homonymous hemianopia have been reported. Since the introduction of computed tomography (CT), the authors have experienced two cases of hypertensive basal ganglionic hemorrhage (including a thalamic hemorrhage) showing homonymous hemianopia alone as the neurological manifestation. Both patients (age 40 and 45) are right-handed male with known hypertension. The CT scans demonstrated a hematoma laterally and posteriorly along the thalamus on the left side. The cerebral angiography were unremarkable. The authors discussed the mechanism presenting homonymous hemianopia without association of pyramidal signs. These two cases described above are unique, hypertensive basal ganglionic hemorrhage, presenting a localized damage in the optic peduncle with sparing the pyramidal tract. In addition, they are worthwhile to be paid attention, because of showing homonymous hemianopia as a single, neurological manifestation, as well as being able to be diagnosed only by CT.     

CT brain scan and EEG in the diagnosis of adult onset seizures

Incidence of CT abnormalities and their correlation with clinical and EEG features were evaluated in a consecutive series of 202 adult patients with newly diagnosed epileptic seizures. Abnormal CT findings were found in 36% of these patients; the abnormalities consisted of brain tumors (17%), atrophic lesions (11%) and other organic findings (8%) such as arteriovenous malformations. Focal features of seizures, in neurological examination and/or in EEG, correlated significantly with CT abnormalities. The absence of these findings did, however, not exclude the possibility of brain lesions, which in many cases were treatable by surgery.     

Neurological impairment in congenital bilateral ptosis with ophthalmoplegia.

A case is described of congenital bilateral ptosis and ophthalmoplegia due to incomplete bilateral paralysis of the third cranial nerve associated with dysmorphisms, brain malformations and epileptiform EEG abnormalities. We hypothesize that in our case the ophthalmological disturbance is due to mesencephalic impairment. In literature there are few reports of congenital bilateral paralysis of the third cranial nerve and they lack detailed MRI findings. We stress in patients with congenital third cranial nerve palsy the importance of thorough neurological investigations including prolonged wake-sleep EEG monitoring as well as CT scan and MRI to establish the origin of the disorder.