Speed of development of cerebral swelling following blunt cranial trauma

A 22-year-old male suffered severe injuries to the head, chest and abdominal cavities in a vehicle crash, with death occurring at the scene. At autopsy, the cranial cavity was opened and markedly disrupted with compound and comminuted fracturing of all bones of the skull and facial skeleton. The brain showed extensive lacerations with almost complete parenchymal disruption. However, a preserved fragment of right frontal lobe exhibited marked swelling with gyral flattening. This case could provide further evidence for prompt cerebral swelling after blunt head trauma, and is supportive of animal studies that have demonstrated rapid swelling that is most likely is related to reactive vasodilation rather than to vasogenic oedema.     

CT for the follow-up of cranial trauma.

The author's experience in diagnosing lesions of cerebral trauma with the CT scanner are outlined. The study is divided into acute and chronic lesions. Special attention is drawn to the morphology of subdural and intracerebral haematomas, which is dependent upon their duration.     

Nonrigid registration for subtraction CT angiography applied to the carotids and cranial arteries

RATIONALE AND OBJECTIVES: Computed tomography angiography (CTA) is an established tool for vascular imaging. However, high-intensity nonvascular structures in the contrast image can seriously hamper luminal visualization. This is an issue for three-dimensional visualization, where high-intensity structures might cover the underlying vasculature. But also in two dimensions, calcified plaques adjacent to the contrast-enhanced vessel lumen impede correct determination of the vessel boundary. High-intensity structures can be eliminated using subtraction CTA, where a native image is subtracted from the contrast image. However, patient and organ motion limits the widespread application of this technique. We propose to use nonrigid image registration to solve this problem. MATERIALS AND METHODS: For each patient, a native image and a contrast image are recorded, respectively, before and after contrast administration. The native image is registered to the contrast image using an automatic intensity-based nonrigid three-dimensional registration algorithm. Both images are merged in a fused image, allowing the user to switch between a view of the arteries, the bone or both. The procedure has been applied to 95 patients. RESULTS: In all cases, subtraction CTA using nonrigid registration allows for a significantly better artifacts removal than subtraction CTA without registration. Image quality of all images was judged adequate for clinical use. The average total processing time for each dataset is about 30 minutes. CONCLUSION: Nonrigid registration can allow for a great reduction in subtraction artifacts for subtraction CTA, resulting in a clear view of the vasculature.     

Contribution of meningeal arteries to cerebral arteriovenous malformations

Summary We studied 52 patients with cerebral arteriovenous malformations (AVMs) by selective angiography and found that half received supply from meningeal branches of the external carotid artery. The frequency of meningeal arteral contribution was significantly higher in superficial AVMs, especially in the temporal, parietal and occipital regions. Larger lesions and higher shunt with steal phenomena on angiography were other factors favouring a meningeal arterial contribution. Diffuse AVMs with pial arterial networks around the nidus commonly received meningeal blood supply. In the past, meningeal feeders have been though to be congenital, but this study suggests that they may develop during growth of the AVM.     

异丙酚对急性颅脑外伤手术脑保护作用的临床研究

目的研究急性颅脑外伤患者手术前和手术期间血清神经冗特异性烯醇化酶（NSE）和S100蛋白（S100B）的变化及静脉麻醉剂异丙酚对这一变化的影响,评价异丙酚的脑保护作用。方法10例无颅脑损伤的泌尿系统手术患者为正常对照组。急症颅脑外伤手术患者30例,随机分为异丙酚组（A组,n=15）和异氟醚组（B组,n=15）。两组患者分别于手术前,手术开始2h,手术结束时测定血清NSE和S100B含量。正常对照组只在术前测定血清NSE和S100B含量。对急症颅脑外伤手术患者进行格拉斯哥评分并记录。结果急性脑外伤患者手术前NSE和S100B显著高于正常对照组（P〈0．01）,格拉斯哥评分越低的口才1术前NSE和S100B也越高。手术结束时异丙酚组NSE和S100B显著低于异氟醚组（P〈0．05）,开颅手术2h和手术结束时两组NSE和S100B均较术前升高。结论急性颅脑外伤手术患者血清NSE和S100B含量升高,开颅手术期间持续静脉泵注临床麻醉剂量的异丙酚可降低血清NSE和S100B水平,减轻继发性脑损害,具有脑保护作用,是颅脑手术麻醉的理想药物。     

Diagnostic performance of helical CT angiography in trauma to large arteries of the extremities

PURPOSE: The purpose of this work was to assess the performance of helical CT angiography (CTA) in the diagnosis of injuries to large arteries of the extremities. METHOD: We performed helical CTA on 45 consecutive patients referred for conventional angiography for evaluation of suspected arterial injuries after sustaining trauma to the extremities (13 upper, 32 lower). Two radiologists interpreted the helical CTA studies independently. Diagnostic performance parameters evaluated included sensitivity, specificity, receiver operating characteristic (ROC) curves, and interobserver agreement (kappa statistics). Conventional angiography was used as the standard of reference for determination of final diagnoses. RESULTS: Forty-three of 45 patients (96%) had diagnostic helical CTA examinations. Final diagnoses in these 43 patients were arterial occlusion (n = 7), partial obstruction (n = 3), pseudoaneurysm (n = 5), arteriovenous fistula (n = 1), pseudoaneurysm and arteriovenous fistula (n = 3), and normal findings (n = 24). Sensitivity and specificity were 90% [95% confidence interval (CI), 80-99] and 100% (95% CI, 99-100), respectively, for Reader 1 and 100% (95% CI, 99-100) and 100% (95% CI, 99-100), respectively, for Reader 2. ROC curve analysis revealed high diagnostic performance, with areas under the curve of >0.9 for both readers. Interobserver agreement was 0.9. CONCLUSION: The diagnostic performance of helical CTA for detection of major injuries of large arteries of the extremities is high.     

Occlusion of the cerebral arteries in Recklinghausen's disease

Summary Two children, aged 18 months and 6 years, who had Recklinghausen's disease, had occlusion of cerebral arteries. One child had no motor deficit but the other had right hemiparesis and partial occlusion of the left posterior cerebral artery, a fact not found in the literature.     

The reaction of cerebral arteries to non-ionic contrast media during cerebral angiography

Summary The purpose of this study was to evaluate possible vasoconstrictive or vasocilatator effects of the low osmolar non-ionic contrast medium iohexol (Omnipaque) on the calibre of cerebral arteries. The diameters of respectively 5 and 6 different locations of the vertebral and carotid arteries were recorded from angiograms of 3 successive injections. The material consisted of 18 patients. It could not be shown that Omnipaque induced vasoconstriction or vasodilatation when normal doses and adequate technique was applied. The difference in diameters found were not statistically significant and are probably due to natural pulsations and to the difficulties in performing exact measurements.