Is the routine CT head scan justified for psychiatric patients? A prospective study.

Thirty-four psychiatric patients, assessed for a physical illness that was missed during diagnosis, underwent a CT scan. After investigation, the diagnosis of 14 patients changed from a functional to an organic illness. In nine patients, the CT scan was reported to be abnormal, and yet only two were diagnosed as having an organic syndrome. In seven patients, the CT scan was normal but the patients had an undisputed organic brain syndrome. These findings indicate that the use of CT scans should be restricted to cases in which the diagnosis is seriously in question. The clinical findings should dictate the use of CT scans either to clarify or to complement them.     

Management of cerebrospinal fluid fistulae: physiopathology, imaging and treatment

Cerebrospinal fluid (CSF) fistulae can produce leakage through a defect in the bony skull and meninges into the contiguous air-filled cavities at the base of the skull. The major risk is central nervous system infection. When abundant clear rhinorrhea or otorrhea is present, the diagnosis is obvious and imaging is used to localize the fistula. Computed tomography (CT) with millimetric slices and magnetic resonance imaging (MRI) are the most effective diagnostic tools. CT cisternography, an invasive procedure, should only be used when the diagnosis remains uncertain following CT scan and MRI. When CSF leakage is sparse or intermittent, the diagnosis can be made by measuring beta-2 transferrine in the escaping fluid. CT scan followed by MRI are also useful for making the diagnosis and locating the fistula when exterior leakage is absent. CT scan alone is effective for assessing isolated otorrhea. If the diagnosis remains uncertain after all these studies have been used, the patient should be closely followed clinically and isotopic study or surgery should be considered.     

Imaging Studies in Partial Epilepsy in Children and Adolescents

Summary: We reviewed the results of imaging studies on 111 children and adolescents with partial epilepsy to determine which imaging procedure had the greatest sensitivity and specificity for partial epilepsy in this age range. All cases were classified as idiopathic, lesional, and cryptogenic epilepsy based on the 1989 International League Against Epilepsy Classification. All patients had magnetic resonance imaging (MRI) and 98 also had computed tomography (CT). Thirty patients with negative CT had MRI lesions that were most likely the cause of the epilepsy, and the initial diagnosis of cryptogenic partial epilepsy was changed to lesional partial epilepsy. We concluded that CT use is unwarrantedly common. MRI should be considered the procedure of first choice. CT has a complementary role, and functional neuroimaging should be encouraged.     

颅脑CT在脑性瘫痪诊治中的应用

目的：为了探讨脑性瘫痪患儿的颅脑CT表现以及CT结果在脑瘫患儿的诊断、治疗及预后中的应用。方法：对1994年~1998年临床诊治的25例脑瘫患儿均作颅脑CT扫描并进行分析。结果：所有25例患儿之CT结果中有22例显示异常。结论：颅脑CT可为脑性瘫痪患儿提供病因及病理基础，并为诊治及预后提供依据，但因受其分辨率所限，CT结果应结合临床进行科学分析。     

Multiple sclerosis presenting as major depression: a diagnosis suggested by MRI scan but not CT scan

A 43-year-old woman had melancholic major depression and mild incoordination. A magnetic resonance imaging (MRI) scan showed extensive lesions of the cerebral white matter that were not detected on a computed tomography (CT) scan. Since multiple sclerosis may initially present as depression, the differential sensitivities of MRI and CT scanning should be considered in deciding which neurodiagnostic studies should be conducted in depressed patients.     

Diagnostic value of delayed enhancement CT scan for syringomyelia

The article reported nine cases with syringomyelia confirmed by delayed enhancement CT scan. It was emphasized that the delayed enhancement CT scan was helpful not only to as certain position, shape, and size of lesions, but also to be fairly significant to the diagnosis of syringomyelia without typical manifestation, especially in differential diagnosis. It was suggested that delayed enhancement CT scan should be taken as a routine examination method for syringomyelia in hospitals having CT scan.     

急诊CT检查85例颅脑外伤阴性病例分析

目的 探讨颅脑外伤病例CT检查阴性的原因。方法 回顾性分析1998-2004年我院收治的颅脑外伤痛例85例, 归纳各种导致急诊CT检查结果阴性的原因。结果 最后共查出颅骨骨折19例,脑挫裂伤45例,蛛网膜下腔出血7例,硬膜下 血肿13例,硬膜外血肿7例。结论造成CT检查阴性的原因可分为四类:一是CT操作员与读片医生经验不足;二是病人烦躁 不配合造成图像失真;三是CT本身的局限性;四是损伤早期征象细微或不典型。对急诊CT检查阴性的可疑颅脑损伤病例,一定 要将CT结果与临床表现及其它检查结果综合分析判断,必要时复查或留院观察以减少漏诊率。     

海洛因中毒性脑病的临床与影像学观察

目的：研究海洛因中毒性脑病的临床特点及影像学（CT和MRI）特征，方法：对13例海洛因中毒性脑病患者的临床和影像学资料进行观察和分析。结果：13例为男性，均以烫吸海洛因为吸毒方式，9例是在毒品戒断过程中发病，主要临床表现为亚急性起病的弥漫性脑扣害，尤为精神症状和小脑性共济失计为突出表现。13例CT表现为脑内多发，广泛且明显对称性的低密度灶，累及双额，顶、颞、枕叶白质区及小脑半球齿状核和脑干，一般无占位征象，6例周期MRI检查显示病灶的部位，范围与CT所见大致相同。结论：本病的诊断依靠明确烫吸海洛因史及具有特征性的临床表现和影像学征象。CT与MRI一样，对本病的诊断具有重要价值。激素对本病治疗效果差。     

自发性低颅压综合征伴双侧硬膜下血肿二例

目的探讨自发性低颅压综合征的临床表现及影像学特征,以及其并发症慢性硬膜下血肿的处理。方法收集河北医科大学第二医院就诊的2例自发性低颅压综合征伴慢性硬膜下血肿的临床资料。分析该病的主要临床表现及影像学特征,及其慢性硬膜下血肿的处理。结果自发性低颅压综合征伴慢性硬膜下血肿,若有血肿进展或意识改变应及时外科治疗。结论自发性低颅压综合征伴慢性硬膜下血肿应密切观察患者病情,随访CT/MRI,了解有无血肿的进展,以便及早给予相应的治疗。     

The value of immediate post-operative routine CT related to uncomplicated ventricle drainage in childhood hydrocephalus

Retrospectively we assessed the value of routine postoperative CT scans in 113 children shunted for hydrocephalus. Of the 165 routine CT scans 13 showed fortuitous findings (= 8%) with a change in treatment accompanied by questionable benefits in only 2 (= 1.3%). Therefore we suggest that post-operative CT should not be performed as a routine examination but only on clinical grounds.     

The contribution of computerized tomography and MRI in the diagnosis of degenerative dementia

CT and MRI are presently the most commonly used imaging techniques providing optimal visualisation of brain images. Normal aging is observed on CT and especially on MRI: these changes should be recognized and differentiated from pathological brain anomalies. The authors briefly describe changes demonstrated by CT and MRI in the most commonly encountered dementia: still emphasis is put on the fact that these anomalies are poorly specific and never pathognomonic. On the contrary, it must be prompted to perform CT and MRI in demented patients in order to rule out diseases curable by surgery such as normal pressure hydrocephaly, subdural hematoma, meningioma and so on especially well demonstrated by CT and MRI.     

Intracranial neoplasms

CT has made possible the diagnosis of intracranial neoplasms with greater precision than other currently available neurodiagnostic studies. Because it is not always possible to determine the precise pathologic features of these neoplasms without angiography and surgical biopsy, over-reliance on CT should be avoided.     

Congenital muscular dystrophy with cerebral involvement--report of a case of "occidental type cerebromuscular dystrophy"?

Cerebral CT scan abnormalities have been seen to be afflicted with some cases of classic occidental type congenital muscular dystrophy (CMD) with normal or borderline intelligence without neurological abnormality. A case is presented with early hypotonia, joint contractures, muscle biopsy features of CMD, normal intelligence and diffuse white matter hyperlucency on CT scan. Every CMD case should be screened with cerebral CT and magnetic resonance (MRI) scans to reach more aspects of this heterogenous disorder.     

Mineralization of the basal ganglia detected by CT in Hallervorden-Spatz syndrome

We studied a patient with autopsy-proven Hallervorden-Spatz syndrome (HSS) and the previously unreported finding of high-density lesions in the basal ganglia on CT. The diagnosis of HSS should be considered in a patient with dystonia and basal ganglia mineralization on CT.     

The impact of delays in computed tomography of the brain on the accuracy of diagnosis and subsequent management in patients with minor stroke

OBJECTIVES: To determine the proportion of haemorrhagic strokes misdiagnosed as infarcts on computed tomography (CT) in patients with mild stroke, and the implications for health care. METHODS: Patients with mild stroke presenting as inpatients or outpatients four or more days after stroke to our stroke service (catchment population 500 000) were recruited prospectively. They underwent detailed clinical examination and brain imaging with CT and magnetic resonance imaging (MRI) on the day of presentation. CT and MR images were examined independently to identify infarct, primary intracerebral haemorrhage, haemorrhagic transformation, or non-vascular lesion. RESULTS: In 228 patients with mild stroke (median time from stroke to scan 20 days), primary intracerebral haemorrhage was identified by CT in two patients (0.9%; 95% confidence interval (CI), 0.1% to 3.1%) and MRI in eight (3.5%; 1.5% to 6.8%). Haemorrhagic transformation was identified by CT in three patients (1.3%; 0.1% to 5.6%) and MRI in 15 (6.6%; 3.7% to 10.6%). The earliest time primary intracerebral haemorrhage was not identified on CT was 11 days. CONCLUSIONS: CT failed to identify 75% of primary intracerebral haemorrhages, equivalent to 24 patients per 1000 (95% CI, 14 to 37) with mild strokes. To detect haemorrhages reliably, CT would need to have been performed within about eight days. Rapid access to neurovascular clinics with same day CT brain imaging is required to avoid inappropriate secondary prevention. Increased public awareness of the need to seek urgent medical attention after stroke should be encouraged. MRI should be considered in late presenting patients.     

Lumbar puncture and the risk of herniation: when should we first perform CT?

Death following lumbar puncture (LP) is feared by physicians. Many opinions are found in literature on the question whether computed cranial tomography (CT) should be performed before LP, to prevent herniation. These opinions are mainly based on retrospective studies and pathophysiological reasoning. In this review the difficulties in the decision whether we should perform CT before LP are discussed. It is explained that the concept of “raised intracranial pressure” is confusing, and that the less ambiguous terms “brain shift” and “raised CSF pressure” should be used instead. Brain shift is a contraindication to LP, whether CSF pressure is raised or not, and whether papilloedema is present or not. Subsequently, recommendations are offered for indications to perform CT before LP, grouped according to the safety and clinical utility of LP. Received: 28 May 2001, Accepted: 24 July 2001     

CT scans in the diagnosis of cerebellar hemangioblastomas. Analysis of 21 cases

Computed tomography (CT) scans in 21 patients with pathological verified cerebellar hemangioblastoma were analysed. There were 14 cases of cystic nodular pattern, 4 cases of nodular pattern and 3 cases with the pattern of cyst only in this series. The characteristic features of hemangioblastomas on the CT scans usually consisted of large circumscribed cystic low density lesions with a small enhanced nodule in each of them. On surgical operations 20 cases in this series were classified to be of cystic-nodular pattern. In order to show the cystic-nodular pattern in a better manner on the CT the thin slice CT scan 5 should be recommended in addition to the use of an appropriately increases amount of intravenous contrast medium when hemangioblastoma of the cerebellum would be suspected.     

Practice parameter: neuroimaging of the neonate: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society

OBJECTIVE: The authors reviewed available evidence on neonatal neuroimaging strategies for evaluating both very low birth weight preterm infants and encephalopathic term neonates. IMAGING FOR THE PRETERM NEONATE: Routine screening cranial ultrasonography (US) should be performed on all infants of <30 weeks' gestation once between 7 and 14 days of age and should be optimally repeated between 36 and 40 weeks' postmenstrual age. This strategy detects lesions such as intraventricular hemorrhage, which influences clinical care, and those such as periventricular leukomalacia and low-pressure ventriculomegaly, which provide information about long-term neurodevelopmental outcome. There is insufficient evidence for routine MRI of all very low birth weight preterm infants with abnormal results of cranial US. IMAGING FOR THE TERM INFANT: Noncontrast CT should be performed to detect hemorrhagic lesions in the encephalopathic term infant with a history of birth trauma, low hematocrit, or coagulopathy. If CT findings are inconclusive, MRI should be performed between days 2 and 8 to assess the location and extent of injury. The pattern of injury identified with conventional MRI may provide diagnostic and prognostic information for term infants with evidence of encephalopathy. In particular, basal ganglia and thalamic lesions detected by conventional MRI are associated with poor neurodevelopmental outcome. Diffusion-weighted imaging may allow earlier detection of these cerebral injuries. RECOMMENDATIONS: US plays an established role in the management of preterm neonates of <30 weeks' gestation. US also provides valuable prognostic information when the infant reaches 40 weeks' postmenstrual age. For encephalopathic term infants, early CT should be used to exclude hemorrhage; MRI should be performed later in the first postnatal week to establish the pattern of injury and predict neurologic outcome.     

Neuroradiological aspects of infantile spasms

With the modern noninvasive brain imaging methods, cerebral lesions of different types and degrees can frequently be determined in infants with West syndrome. In CT examinations preceding the spasms and the ACTH therapy, "idiopathic" forms of infantile spasms were rare. The CT findings consistent with perinatal or postnatal encephalopathy were more frequent than those found with embryonic or fetal lesions alone. The fact that pathognomonic changes cannot be determined, may reflect the low specificity of CT diagnosis in infants with chronic CNS diseases. A slight and mostly transient enlargement of CSF spaces during ACTH therapy is a probable side-effect of the medication. In infants with persistent or progressive enlargement of the CSF spaces, however, this alteration appears to be mainly due to pre-existing brain damage. CT examinations of infants with West syndrome should be performed because prognostic information may be obtained and in a few cases operations to drain CSF may be necessary.     

Results of surgical treatment of multiple brain abscesses--3 case reports

On the basis of three cases of multiple cerebral abscesses, the authors showed that an attempt at conservative treatment could be ineffective and should, therefore, be closely monitored with CT scanning. If surgery is not avoidable one should excise those abscesses with which cause a mass effect as antibiotic therapy may be insufficient.