Computed tomography of suprasellar cystic lesions

Difficulties are often encountered in the differential diagnosis of suprasellar cystic lesions in computed tomography (CT). During the past 5 years and 7 months we experienced 22 such cases. In this report we tried to review the characteristic CT findings for the differential diagnosis of these lesions. Population of this study is consisted by 7 pituitary adenomas (4 non-functioning adenomas, 2 prolactinomas and 1 GH-secreting adenoma), 8 craniopharyngiomas, 4 arachnoid cysts and 3 Rathke's cleft cysts. In cases of pituitary adenomas and craniopharyngiomas, we included only those cases which were found to be completely cystic. Each case was scanned before and after contrast material injection and in majority of cases coronal scans were also obtained after contrast injection. The analysis was based on the CT appearance of the shape, the content and the wall of each cyst. The wall of the cyst was evaluated according to its thickness, density, presence of calcification and contrast enhancement. In 14 out of 22 cases the X-ray attenuation values of their content were calculated after setting the ROI in the cyst on the CT display console. Craniopharyngioma often showed calcification in its wall, which was not seen in the wall of pituitary adenoma. The wall of pituitary adenoma revealed contrast enhancement in all cases, but half of craniopharyngioma showed no contrast enhancement in its wall. These two points are useful for the differential diagnosis of these lesions which we encounter most frequently.(ABSTRACT TRUNCATED AT 250 WORDS)     

Epidemiology of spinal cord lesions in Denmark

Denmark has a population of about 5.2 million. The rehabilitation of spinal cord injured (SCI) takes place in two specialised rehabilitation hospitals. The incidence of new traumatic SCI admitted to these hospitals in the period 1975-1984 was 9.2 per million per year. During this period 92 Danes with non-traumatic and 268 with newly sustained traumatic spinal cord lesions were admitted to the rehabilitation hospital in Hornboek, which uptake area corresponded to South and East Denmark and Greenland and the Faroe Islands. Among the traumatic SCI 47% were due to traffic accidents, 23% to falls to a level below, 8% to attempted suicides, 6% to shallow water diving, and 6% to sporting accidents. The number of SCI caused by traffic accidents was found to decrease coincidently with the introduction of general speed limits and compulsory seat belt wearing. The male/female ratio was for the traumatic SCI 3.3, which was significantly lower than in the preceding 10-year period. 40% of all traumatic SCI were sustained at 15-24 years of age, and 51% had tetraplegia. Traffic accidents gave rise to more cervical, and falls to more caudal lesions. 41% of the traumatic SCI had an improvement in their neurological status after their admission to the neurosurgical department until the discharge from the rehabilitation hospital. Those with incomplete lesions showed greater improvement than those with complete lesions regardless of the level. Complete cervical lesions had significant better remissions than complete thoracic/lumbar lesions.     

Athetosis-dystonia in intramedullary lesions of spinal cord

Athetosis and dystonia are well known clinical signs, described in disorders of basal ganglia. As opposed to pseudoathetosis, true athetosis was hitherto not reported in cord lesions. We here report three patients with athetosis and dystonia of hands due to intramedullary lesions of cervical cord: two patients with syringomyelia and one with glioma. Even though pseudoathetosis can be produced by lesions of posterior columns and likely to be confused with the involuntary movements of our patients, they had clinical and EMG findings consistent with true athetosis. A possible explanation for the athetosis and dystonia due to cord lesion is being postulated.     

Diagnostic imaging of spinal cord lesions

Magnetic resonance imaging (MRI) has greatly facilitated morphologic evaluation of spinal cord lesions. Eleven cases representative of inflammatory, demyelinating, neoplastic and vascular diseases, are presented which illustrate and summarize important abnormal features in spinal cord imaging, particularly MR findings. Recently, specialised techniques such as MR angiography, fat-inhibiting methods, dynamic MRI and functional imaging have been developed. These methods have facilitated not only lesion diagnosis but also qualitative assessment, and are being used to analyze pathophysiology. Comprehensive diagnoses based on such modalities may be important in determining indications for surgery or defining the extent of surgery or the intensity of other treatments.     

Intramedullary mass lesions of the spinal cord

Intramedullary tumors form 10% of all the spinal cord tumors. Majority of them are gliomas and rarely benign tumors are encountered. Twenty five cases of intramedullary mass lesions are studied regarding their clinical presentation, radiological features, surgical aspects and outcome following the surgery and radiotherapy. There were six benign lesions where the outcome was excellent. There were 11 patients with astrocytoma and 8 cases with ependymoma. In all, arrest of the disease or improvement could be achieved in 20 cases. Extent of surgical resection and role of radiotherapy, which are still controversial, are discussed.     

Positron emission tomography in imaging spinal cord tumors

The ability of positron emission tomography (PET) to detect spinal cord tumors was studied prospectively in 14 patients presenting over a 5-year period. Abnormal uptake by [18F]-fluorodeoxyglucose (FDG) or 11C-methionine was detected in all except one. These data were assessed in relation to magnetic resonance imaging (MRI) findings with regard to tumor type and extent preoperatively, findings at operation, and subsequent clinical course. The group consisted of six astrocytomas, five ependymomas, one mixed ependymoma and astrocytoma, one schwannoma, and one ganglioglioma, all confirmed histologically. This is the largest study comparing spinal PET to MRI. Accurate preoperative correlation between PET and MRI was found in all eight patients scanned at first presentation. The PET uptake was in keeping with the low-grade histology of the tumors. Postoperatively, PET and MRI findings were in agreement in nine patients. In eight of these the findings were in keeping with the subsequent clinical course. In three patients, however, the PET findings were at variance with the clinical course and MRI findings. In one, persistent FDG uptake after radiotherapy was seen where there was subsequent tumor resolution. In two patients with low-grade astrocytomas, scanned with FDG and 11C-methionine, respectively, tracer was not taken up by residual tumor. In this small group of patients, PET did not provide additional useful information. This could be because all tumors studied were low grade and the limited spatial resolution of PET does not lend itself to imaging small spinal cord tumors. The prospective study of larger numbers of patients with a wider range of tumor types is required, but this might be difficult to achieve given the rarity of spinal cord tumors.     

Domoic acid induced spinal cord lesions in adult mice: evidence for the possible molecular pathways of excitatory amino acids in spinal cord lesions

Domoic acid (DA) is an excitatory amino acids (EAAs) analog which induced excitotoxicity lesion to central nervous system, but whether induced adult animal spinal cord is not known, furthermore, previous studies have shown that EAAs play an important role in spinal cord lesion, however, the molecular pathways in spinal cord lesion are not fully known. Therefore, a motor neuron-like cell culture system and a DA-induced spinal cord lesioned mice model were used to study the effect of DA on spinal cord in adult mice and the possible molecular pathways of EAAs in spinal cord lesions. Exposure of motor neuron-like cells NSC34 to DA dramatically increased reactive oxygen species (ROS) production by the DCF fluorescent oxidation assay, reduced mitochondrial function by MTT assay, cell viability by trypan blue exclusion assay, and was accompanied by an increase of cell apoptosis by histone protein release assay. In DA-induced spinal cord lesioned mice model, we showed that the decrease of proteasome activity, increase of UCP4 expression by immunohistochemistry and neural cell apoptosis by TUNEL staining, and was accompanied by an decrease of motor disturbance grade during the different stages of DA treatment. Taken together, the in vitro and in vivo data presented in the current report demonstrated that DA induces spinal cord lesions in adult mice, and the multiple molecular pathways promoted by EAAs in spinal cord lesions, at least partially was associated with ROS generation increase, mitochondrial dysfunction, proteasome activity decrease and UCP4 expression increase.     

Cutaneous silent periods in intramedullary spinal cord lesions

OBJECTIVE: The neurophysiological assessment of intramedullary spinal cord lesions has been unsatisfactory. Previous studies in patients with syringomyelia suggest that testing of cutaneous silent periods (CSPs) may be useful to assess centromedullary lesions. METHODS: The authors studied nine patients with intramedullary spinal cord lesions of different etiologies. Eight patients with cervical lesions presented with hypalgesia, hypothermesthesia, or pain in at least one upper extremity; five of them had also upper limb weakness or sensory impairment. One patient with a thoracic lesion had normal upper limb function. The authors recorded CSPs in abductor pollicis brevis muscle following digit II and digit V stimulation. Somatosensory evoked potentials (SEPs) were obtained following median and tibial nerve stimulation. Motor evoked potentials (MEPs) were obtained in biceps brachii, abductor digiti minimi and tibialis anterior muscles following transcranial magnetic or electrical stimulation. RESULTS: CSP abnormalities were found in all patients with cervical lesions, but not in the patient with a thoracic lesion. Cortical median nerve SEPs had normal latencies in all patients, while tibial nerve SEPs, upper limb MEPs, and lower limb MEPs were delayed in five patients each. In one patient, abnormal CSP were the only neurophysiological finding. CSP abnormalities were associated with hypalgesia and hypothermesthesia in 95% of the studies. CONCLUSION: Upper extremity CSP testing is a sensitive neurophysiological technique for the assessment of cervical intramedullary lesions. In particular, abnormal CSPs are highly associated with spinothalamic dysfunction.     

Unusual spinal cord lesions in late-onset non-ketotic hyperglycinemia

Non-ketotic hyperglycinemia is a disorder of glycine metabolism with severe neurologic regression in the infantile stage, while late-onset non-ketotic hyperglycinemia is a rare form characterized by variable clinical, biochemical, and imaging features. This report describes a boy of late-onset non-ketotic hyperglycinemia presenting with an unusual long tract-like lesion of the spinal cord aside by magnetic resonance imaging. This is the first reported child of non-ketotic hyperglycinemia with abnormal imaging features of spinal cord.     

Peripheral nerve implants in the spinal cord in experimental animals

This paper challenges the concept of 'spinal cord autotomy' as an essential process which will prevent the penetration of spinal cord fibres into a peripheral nerve implant. It proposes that mechanical distraction between the graft and the cord is the main reason why spinal cord fibres fail to traverse a graft. Clinical, neurophysiological and histological evidence is presented to show that embedding an autogenous peripheral nerve implant into a trough in the dorsal half of the cord is effective in restoring continuity in some of the long fibre tracts. Reference is made to other recent work which supports these observations. Possible methods of enhancing the number of fibres which traverse the graft are discussed and an attempt is made to anticipate the possible results of the clinical application of this technique in spinal cord injury patients.     

Delayed radiation lesions of the human spinal cord

Summary A report is given on patho-anatomical findings in five adult patients with cervical myelopathy following X-irradiation of hypopharyngeal cancer. The findings were largely consistent with those of earlier reports; however, telangiectases were found in all cases. The pathogenesis of the damage is briefly discussed in relation to experimental work on postirradiation lesions of the central nervous system. A vascular lesion is held to be the most important pathogenetic factor.

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Zusammenfassung Es wird über die pathologischen Befunde bei fünf Erwachsenen mit cervicaler Myelopathie nach Röntgenbestrahlung von Hypopharynx-Carcinomen berichtet. Die Befunde zeigten weitgehende Übereinstimmung mit jenen früherer Beobachtungen, doch wurden in allen Fällen Teleangiektasien angetroffen. Die Pathogenese der Röntgenspätschädigung des Rückenmarks wird unter Berücksichtigung experimenteller Befunde diskutiert. Eine Gefäßschädigung — vorwiegend durch Schädigung der Gefäßendothelzellen — wird als wichtigster pathogenetischer Faktor angenommen.

     

脊髓髓内病变的显微外科治疗

目的分析脊髓髓内占位性病变的手术特点,探讨手术时机、手术方式及预后。方法回顾性分析2002年7月-2008年4月经手术和病理证实的25例脊髓髓内占位性病变,随访患者术后神经功能状态。结果病变全切20例,次全切除3例,大部切除2例。术后病理证实室管膜瘤15例,星形细胞瘤2例,海绵状血管瘤2例,脂肪瘤2例,神经鞘瘤1例,血管畸形1例,结核瘤1例,炎性肉芽肿1例。术后神经功能好转20例,无变化3例,加重2例。结论对脊髓髓内病变应早期诊断,应在发生明显神经功能障碍之前实施手术。沿着确切的瘤一髓界面分离、切除病变,是肿瘤一级切除的基本保证,重建蛛网膜下腔能有效防止脊髓粘连;采用椎板成型解剖学复位技术可提高术后脊柱稳定性。