Triple spontaneous cervical artery dissection

A 39-year-old healthy man had several transient ischaemic attacks suggesting left internal carotid artery (ICA) occlusion. There were no vascular risk factors and no preceding trauma. Colour-coded duplex sonography suggested a pseudo-occlusion of the left ICA, and cerebral angiography demonstrated dissection of the left ICA and both vertebral arteries. Angiography 6 months later was completely normal. This underlines the importance of four vessel angiography in young patients with dissections of cervical arteries. Received: 27 August 1998 Accepted: 13 November 1998     

Role of CT and MRI in the preoperative evaluation of auditory brainstem implantation in patients with congenital inner ear pathology

PURPOSE: The purpose of this study was to evaluate the reliability of computed tomography (CT) and magnetic resonance imaging (MRI) in characterising cochlear nerve anomalies in auditory brainstem implant candidates with congenital hearing loss. MATERIALS AND METHODS: Seventeen patients affected by congenital sensorineural hearing loss were examined by CT and MRI. Inner ear malformations eligible for auditory brainstem implants were classified according to the Casselman classification. All patients subsequently received auditory brainstem implants. RESULTS: Suspected congenital anomalies were confirmed by CT and MRI in all 17 patients. There were 5/17 bilateral cochlear nerve aplasias and 12/17 cochleovestibular anomalies. Of these, 5/12 patients had a common cochleovestibular cavity, 2/12 had bilateral cochlear aplasia and cochlear nerve agenesis, 1/12 had type I incomplete partition, 2/12 had type II incomplete partition and 2/12 had cochlear hypoplasia. CONCLUSIONS: Preoperative CT and MRI assessment of patients with sensorineural hearing loss is reliable. MRI provided additional information, identifying the possible absence of cochlear nerve and excluding other central nervous system (CNS) diseases.     

一键去骨法与减影法在头颅CTA血管重建中的对照研究

目的:比较一键去骨法与减影法在头颅CTA血管重建中图像质量及对血管病变检出的差异,探讨一键去骨法的应用价值。方法:对247例患者分别进行一键去骨法和减影法头颅CTA重建,对两种去骨法CTA所得颈内动脉(七段),大脑前、中、后动脉(分别为四段),椎动脉(四段),前后交通动脉和基底动脉血管图像质量按照5个等级标准进行评分,同时分别记录两组图像诊断病变血管数目分布差异。应用秩和检验比较两组血管图像质量差异,配对卡方检验比较两者诊断病变血管能力差异。结果:247例病例共10868段脑动脉。两种方法总体图像质量评分无统计学差异(P=0.405),一键去骨法血管质量评分均值为4.49±1.098,减影法血管质量评分均值为4.50±1.065,双侧椎动脉V4段图像质量减影法优于一键去骨法(左侧V4:P=0.026,右侧V4:P=0.017)。双侧颈内动脉C2段图像质量一键去骨法优于减影法(左侧C2:P=0.039;右侧C2:P=0.028)。其他分段血管图像质量评分两者无统计学差异。在血管狭窄、闭塞及动脉瘤检出方面两者无统计学差异。在血管钙化及血管病变术后金属夹、支架显示一键去骨法优于减影法(P均为0.000)。结论:一键去骨法对于血管病变显示和图像质量均不劣于减影法,在显示血管钙化和金属夹、支架方面有一定优势,值得应用和推广。     

Severe brainstem compression by an unruptured giant vertebral aneurysm--an autopsy case

We describe an autopsy case of sudden unexpected death due to severe brainstem compression by an unruptured giant vertebral aneurysm. A 71-year-old male was found dead in his bedroom. The forensic autopsy revealed no severe trauma leading to his death. On internal examination, a giant intracranial aneurysm (3.4 x 2.6 x 2.7 cm) was observed on the trunk of the right vertebral artery. The aneurysm compressed the right side of the lower one-third of the pons and adjacent medulla oblongata. On sectioning, almost all of the aneurysm lumen was filled with a firm, clearly laminated organized thrombus. There was no evidence of subarachnoid hemorrhage. Histopathological analyses revealed congestion and hypoxic tissue changes in all organs examined. In microscopic sections of the giant vertebral aneurysm, thick fibrotic walls, intimal hyperplasia and organized thrombi in the lumen were found. Lots of intrathrombotic clefts with fresh erythrocytes were also observed. Moreover, Elastica van Gieson staining revealed fragmentation and disruption of the intimal elastic lamina in the aneurysmal wall. Collectively, we considered that some triggers in his daily life, including head rotation, might have caused the rapid onset of respiratory disturbance due to severe brainstem compression by a giant vertebral aneurysm.     

飞行学员高频听力损失的变化跟踪及评价

目的 探讨一定程度高频听力损失的学员其听力变化情况及分析其对语频听力的影响,预判其变化趋势.方法 对某年入某航校的全部飞行学员2年后转校体检时进行听力学检测,对其中16名入校时即有高频听力损失学员的听力水平进行统计学分析.结果 入校时有高频听力损失的学员在2年后所有频率的听力改变差异均不具有统计学意义（H=0）.结论 一定程度的高频听力损失2年后无明显进展趋势,对语频听力影响不显著.     

Anomalous branching of the inferior thyroid artery from the left vertebral artery

In a 53 years old woman hospitalized for a suddenly developed picture of vascular insufficiency in the verterobrobasillary vascular bed the authors detected an anomalous division of the left vertebral artery from aortic arch. Moreover, at the level of thyroid gland there was the division of inferior thyroid artery from the vertebral artery. We express the opinion that the finding did not participate in the clinical symptomatology.     

Duplication of the vertebro-basilar system.

During the examination of 75 fixed brains and 2086 vertebral angiograms we encountered two cases of fenestration of the vertebral artery and two cases of partial duplication of the basilar artery. In the first case, an 81 year old male, there was fenestration, of the basilar artery at the union of the two vertebral arteries. The fenestration was 9mm long with no associated vascular disease. The other partial duplication of the basilar artery was observed in the upper portion of the artery in a 54 year old male patient investigated angiographically for subarachnoid haemorrhage. The fenestration of the third case was demonstrated in the intracranial part of the right vertebral artery of a 50 year old female patient during digital subtraction angiography for subarachnoid haemorrhage. In the fourth case, the fenestration was found angiographically at the atlanto-axial level in the extracranial portion of the left vertebral artery in a 37 year old female patient with subarachnoid haemorrhage from an arteriovenous malformation in the left cerebral hemisphere. The embryonic, histological and radiological implications of the duplication are discussed.     

颞岩部胆脂瘤对面听神经损害的特征与治疗对策

目的探讨岩部胆脂瘤发病特征、对面听神经损害特点及治疗方法。方法回顾性分析1991年7月—2005年6月间收治的17例岩部胆脂瘤的临床资料。结果 17例中16例重度耳聋及全聋,1例为中度混合性聋,15例伴有面瘫,其中11例为迷路段缺损,1例垂直段缺损,CT检查岩部均有膨胀性改变及骨性破坏,手术采用乳突迷路进路6例次,颅中窝进路8例次,乳突颅中窝联合进路3例,颞骨扩大切除术2例,行面神经全程减压4例,由内听道段与水平段面神经端端吻合5例,舌下神经-面神经吻合1例。全部病例均顺利恢复,无感染和复发。结论岩部胆脂瘤发病率低,早期症状多不明显,中晚期可有面肌抽搐、耳流脓等症状,应详细检查,颞骨CT及MRI是最佳的检查和诊断方法 ,对已确诊岩部胆脂瘤应争取早作手术,避免颅内感染和对面听神经的进一步损害,根据病变的部位及破坏程度选择适当的手术途径。     

Superficial intraventricular surface siderosis brain

Superficial siderosis of the central nervous system is a chronic condition characterized by hemosiderin deposition in the brain and spinal cord. It''s diagnosed by brain MRI. It can be caused by low-grade extravasation of blood into the subarachnoid space of the brain. There are 2 types of superficial siderosis cortical and infratentorial. Although asymptomatic in many cases; Cerebellar-predominant siderosis, a subtype of infratentorial, can affect hearing, gait, and even muscles. In this report, we present a case of a 51-year old female with complaints of hearing loss, unsteadiness in his lower limb, and spastic paresis. During MRI neuroimaging, we noticed findings of hypointensity areas within the brainstem and cerebellum, probably due to hemosiderin deposition. Based on the MRI findings, the patient was diagnosed with superficial siderosis. The patient was started on deferiprone and followed for the consecutive 18 months. Moderate improvement of the hearing loss and ataxia was noted while no change in muscle force. However, the repetitive MRI did not reveal any changes compared to the previous one.     

Left pulmonary artery sling in the adult: Case report and review of the literature

The aberrant left pulmonary artery is a serious anomaly in neonates; in the adult it is most often an incidental finding. One case is reported, incidentally discovered in the diagnostic workup of a patient with a vertebral lytic lesion. This vascular anomaly, mimicking a mediastinal adenopathy on the chest roentgenogram, which also showed a peripheral lung malignancy, was better assessed by an esophagogram (indentation on the posterior tracheal wall as well as on the anterior esophageal wall) along with fluoroscopy which showed the lesion to be pulsating. Its thorough anatomic evaluation was allowed by computed tomography (CT), performed for the staging of the lung tumor. The latter proves the choice modality due to its capability to provide precise information on all the different structures existing in a given cross-section.     

Posttraumatic occlusion of the 2 vertebral arteries

Initial radioclinical examination of a 24 year old patient following a road accident showed a hemomediastinum on computed tomography imaging. Digital subtraction angiography by the arterial route demonstrated integrity of abdominal aorta and occlusion of both vertebral arteries soon after their origin. This bilateral occlusion had failed to provoke any neurologic sign imputable to the vascular lesion. A review venous digital subtraction angiography examination two months later gave similar angiographic appearance. Emphasis is placed on the asymptomatic nature of this acute occlusion of the two vertebral arteries and on the value of digital subtraction angiography for vascular exploration of this type of disease.     

Oculomotor nerve palsy evaluated by diffusion-tensor tractography

Introduction The aim of the study was to test the feasibility of the tractography technique based on diffusion-tensor imaging (DTI) for the assessment of small infarcts involving the brainstem.Methods A patient who presented with an isolated left third cranial nerve palsy underwent magnetic resonance examination. Images were obtained by use of a whole-body, 1.5-T imager. Data were transferred to an off-line workstation for fiber tracking.Results The conventional diffusion-weighted imaging (DWI) performed using a 5 mm slice thickness could only depict an equivocal hyperintensity lesion located at the left paramedian midbrain. An additional thin-slice DTI was performed immediately after the initial DWI using a 3 mm slice thickness and was able to delineate the lesion more clearly. Image postprocessing of thin-slice DTI data revealed that the lesion location involved the course of the third cranial nerve tract, corresponding with the patient’s clinical symptoms.Conclusion The tractography technique can be applied to assess fine neuronal structures of the brainstem, enabling direct clinicoradiological correlation of small infarcts involving this region.     

The megadolichobasilar artery anomaly and expansion of the internal auditory meatus

Summary A case of megadolichobasilar artery anomaly (MDBA) with expansion of the internal auditory meatus is presented. There was no associated hearing loss and it is postulated that IAM expansion without hearing loss may occur with this anomaly.     

Symptomatic unilateral dolicho-ectasia of the intracranial arteries in a child

Dolicho-ectasia of the left posterior cerebral artery and internal carotid artery in a 5-year-old boy is reported. There was compression of the brainstem, the mammillary bodies and the optic tract. The value of MR angiography in the diagnosis of this vascular anomaly is demonstrated. Dolicho-ectasia of more than one cerebral artery in a child is extremely rare. Received: 1 June 1999; Revised: 31 August; Accepted: 1 September 1999     

豚鼠噪声性听觉损伤易感性与血浆六种生化指标间的关系

目的 探讨6种血浆指标与噪声性听觉损伤易感性的关系.方法 123只雄性健康豚鼠(体质量280～320 g)随机分为为对照组(非噪声暴露,10只)和噪声暴露组(113只).检测噪声暴露前后豚鼠脑干诱发电位阈.根据暂时性听阈偏移分布,利用百分位数法确定易感组(10只)和不易感组(10只),检测2组豚鼠血浆钾、钠、氯、钙、磷和镁等6种指标,分析2组间6种指标差异.结果 易感组与不易感组钾、钠、氯、钙和磷含量差异无统计学意义(P＞0.05),而血浆镁含量差异有统计学意义(P＜0.05).结论 低镁可能是豚鼠噪声性听觉损伤易感的一个诱发因素.     

Bilateral common carotid occlusion without neurological deficit

A 40-year-old man presented with pain and numbness in his right arm. On his clinical examination, no neurological deficit was found. Bilateral common carotid artery duplex sonography scan demonstrated no flow in either lumen. No abnormality was recognized on brain CT. On cerebral digital substraction angiogram, total occlusion of the brachiocephalic trunk and left carotid artery were shown. There was a modest stenosis in the left vertebral artery. Collateral circulation feeding the intracranial carotid system mainly originated from the left vertebrobasilar system. Previous cases of bilateral carotid occlusion are reviewed and discussed.     

Diffusion-weighted MRI of the cervical cord in acute spinal cord injury with type II odontoid fracture

The authors present a case of acute spinal cord injury demonstrated by diffusion-weighted MRI (DWI) of the cervical cord. DWI taken 2 hours after injury showed intramedullary hyperintensity with a decrease of the apparent diffusion coefficient (ADC) value at C1-C2 vertebral levels. On T -weighted images obtained 1 month after injury, the lesion was hyperintense, indicating the existence of myelomalacia. DWI of the cervical cord provided satisfactory images and was a useful method for detecting and visualizing of the affected cord in the super-early stage.(2)     

MRI diagnosis of brown tumor based on magnetic susceptibility

A 56-year-old male with chronic renal failure was incidentally found to have lytic bone lesions in the pubic symphysis, left femoral head, left acetabulum, left iliac bone, and L1 vertebra on computed tomography (CT). Subsequent magnetic resonance imaging (MRI) of the abdomen was performed (for evaluation of a renal lesion) which demonstrated marked loss of signal intensity in the L1 bone lesion on increasing TE gradient echo images, consistent with magnetic susceptibility effect due to hemosiderin. Brown tumor was confirmed at biopsy. The susceptibility imaging probes one particular histological characteristic of tissues and allows a restricted differential of lytic tumors that contain significant hemosiderin, including brown tumor.     

Gadolinium ring enhancement and mass effect in acute disseminated encephalomyelitis

A 9-year-old boy presented with a subacute history of optic neuritis followed by brainstem involvement, with fever and a lymphocytic pleocytosis in the cerebrospinal fluid. Gadolinium-enhancing ring lesions were demonstrate in the white matter of the cerebrum, brainstem and cerebellum on day 17 of the illness, all appearing simultaneously as part of a monophasic illness. A parietal lesion exerted mass effect. Needling and biopsy yielded no evidence of a pyogenic lesion, tumour or tuberculosis and showed vasculitis. There was insufficient material for myelin staining. Dexamethasone therapy lead to rapid improvement of the radiological lesions: MRI and CT on day 34 of the illness showed complete clearing of the lesions except for residual abnormality at the biopsy site.