Cerebral Hereditary Haemorrbagic Telangiectasia Demonstrated Angiographically

The findings on cerebral angiography in a patient with hereditary haemorrhagic telangiectasia are described. These consisted of a telangiectatic vascular lesion with pooling of contrast and early venous filling. It is suggested that cerebral angiography should be carried out in a patient with Osier's disease and cerebral signs to exclude such a lesion.     

Long-term survival with thorotrast cervical granuloma

Thorium dioxide, a radioactive contrast material, was commonly used for cerebral angiography prior to recognition of its radiation hazard. Extravasation of the material into the extravascular tissue in the neck results in granuloma formation, thorotrastoma, long-term morbidity, and an increased incidence of benign and malignant tumors. We report our experience with the management of 2 patients who underwent cerebral angiography with thorotrast more than 25 years ago. Aggressive surgical excision of involved tissue is warranted to ameliorate symptoms and diminish the risk of malignancy.     

Vertebral Angiography In Bilateral VIII Cranial Nerve Tumours A Report Of A Case

A case of von Recklinghausen's disease displaying the uncommon clinical feature of extensive central and peripheral involvement is described. Vertebral angiography was chosen as the initial investigation to define the extent of the suspected bilateral acoustic tumours because of the presence of papilledema. The angiographic study outlined bilateral extracanalicular tumours. The relative merits of catheter angiography and posterior fossa myelography (using negative or positive contrast media) in this situation are discussed.     

颅底软骨瘤及软骨肉瘤的影像学诊断7例报告

 目的　分析颅底软骨瘤及软骨肉瘤的影像学表现,提高诊断水平。方法　7例经头颅X线平片配合CT、脑血管造影、MRI检查,经手术病理证实。结果　1.头颅X线片和CT：鞍区团絮状高密度钙化肿块2例,低密度钙化1例,等密度、高密度4例,强化后不均匀增强5例。2.脑血管造影：颈内动脉、大脑中动脉、大脑前动脉受压移位,无肿瘤血管染色2例;3.MRI：MRI T1WI像不均匀低信号及不均匀增强,T2WI像不均匀高信号4例,手术病理诊断：软骨瘤6例,软骨肉瘤1例。结论　头颅X线片和CT对鞍旁颅中窝大量钙化的软骨瘤容易诊断。对不典型者,应配合MRI或DSA脑血管造影检查有助于正确诊断。     

Contrast media and the brain. The basis of computed tomography and magnetic resonance imaging enhancement: A review

The blood, cerebrospinal fluid (CSF), and extracellular fluid of the parenchyma form the fluid compartments of the brain with three interfaces between, namely the blood–brain interface (BBB), the CSF–brain interface, and the blood–CSF interface. When either water‐soluble iodinated contrast media (CM) or water‐soluble paramagnetic CM are injected intravenously, they are rapidly brought into contact with both the BBB and the blood–CSF interface. It is the behaviour of the water‐soluble CM at these two interfaces that determines the normal and abnormal enhancement patterns demonstrated by either CT or MRI. Unlike lipophilic solutes, current iodinated and MRI contrast media all have high affinities for plasma water, low affinities for plasma proteins and, in particular, extremely low partition coefficients. Therefore they do not penetrate the normal BBB. On the other hand, radiopharmaceuticals used in positron emission tomography (PET) and single photon emission computed tomography (SPECT) to demonstrate regional cerebral blood flow are highly lipophilic and readily cross the intact BBB completely during the first pass through the cerebral vasculature. It is the inability of the current iodinated and MRI contrast media to cross the normal intact BBB that is the basis of their use in CT and MRI studies of the brain.     

Contrast Media Deaths

Ninety-two deaths resulting from the use of contrast media are described and analyzed together with 228 deaths reported earlier. Of these new deaths, 11 were associated with angiography, 28 with intravenous cholangiography and 53 with urography or C.T. The majority of deaths were associated with cardiac arrest or pulmonary oedema. The mode of death appears to be unrelated to the formulation of the contrast media. The suddenness of the demise and the organs affected suggest that a neurologic mechanism may be involved.     

Lateral sinus thrombosis presenting as hemiplegia-a rare presentation

Lateral sinus thrombosis (LST) is an important complication of otitis media with mastoiditis. Even in the present antibiotic era it carries high mortality. Hemiplegia has been reported to be a very rare complication in such a setting. A case of lateral sinus thrombosis proved on cerebral angiography presenting as hemiplegia is reported. A brief review of relevant literature is also presented.     

Iohexol,Ioxaglate and Iopamidol in Coronary Angiography A Double-Blind Comparative Study of 300 Patients

A randomized, double-blind study was carried out in 300 consecutive coronary angiography examinations to investigate the clinical safety of three low osmolar contrast media, iohexol 300, ioxaglate 320 and iopamidol 300, and the electrocardiographic changes that occurred with them. The ECG from electrode V5/V6 or AVF and intra-arterial pressure were monitored continuously, and recorded before and after the first contrast injections into the left and right coronary arteries. Of the variables tested, no statistically significant changes occurred in systolic arterial pressure, PR interval or ventricular extrasystole. The QT interval increased in the ioxaglate group (p=0.001). Heart rate decreased in all groups, but slightly less in the ioxaglate group than in the iopamidol group (p=0.02). The ST segment depression (mean 0.67m) was more marked in the ioxagiate group than in the other treatment groups (p=0.0001) during right coronary angiography. The same characteristics, but less marked, were observed during left coronary angiography, the ioxaglate group (mean 0.251mm) differing from the iopamidol group (mean 0.050mm) (p=0.04). No significant difference in severe adverse reactions were detected between these groups (ioxaglate 1, iopamidol 1). Ioxaglate produced mild side effects (nausea, vomitus, urticaria) in 16% of the patients, the other two contrast agents producing side effects in 1%.     

Dense middle cerebral artery computed tomography sign: Confirmation by magnetic resonance (MR) imaging and MR angiography

In acute ischaemic stroke, the dense middle cerebral artery sign on computed tomography indicates occlusion of the middle cerebral artery. A case is described in which the sign was confirmed by magnetic resonance (MR) imaging and MR angiography.     

Perimesencephalic subarachnoid haemorrhage: Negative angiography and favourable prognosis

The computed tomography (CT) scans of 110 consecutive patients who presented, over a 4.5-year period, following spontaneous subarachnoid haemorrhage (SAH), were reviewed. All 110 patients also had one or more 4-vessel digital subtraction cerebral angiograms. The CT scans were reviewed in each case without knowledge of the angiographic result. In nine patients (8%), SAH was confined to the perimesencephalic area, interpeduncular cistern and/or prepontine region at CT. All nine patients had at least two, and some as many as four, negative cerebral angiograms. Eighteen of the 110 patients (16%) ultimately had negative angiography. Hence, the patients with isolated perimesencephalic haemorrhage (PMH) accounted for 50% of the negative angiograms. There was a significant association between isolated PMH and negative angiography (X²= 50.1, P < 0.005). The specificity of PMH for negative angiography was 100% (95% confidence interval (CI) = 97–100%) and the sensitivity of PMH for a negative study was 50% (95% CI = 16–84%). Six of the 110 patients had basilar artery aneurysms demonstrated angiographically as the cause of their SAH but none of these six had isolated PMH at CT. All patients with isolated PMH were alive and well at follow up and none had suffered repeat SAH or vasospasm-related ischaemic cerebral injury. Perimesencephalic haemorrhage should be distinguished from SAH in general, because of the good prognosis associated with it and the doubtful need for repeat cerebral angiography after an intitial negative study.     

MRA应用于颈动脉外科之经验

了解ＮＭＲ在颈动脉外科的应用价值。方法：对本院头颈科１９９７年８月－１９９９年５月收治的涉及颈动脉疾病患者９例中６例,进行了术前ＭＲＡ检测,其中２例实施术后分析检测。结果颈动脉体瘤,颈动脉瘤及某些颈部转移肿瘤累及颈动脉的ＭＲＡ表现与血造影相似;ＭＲＡ可直接显示预动脉分歧部切除术后脑血管侧支循环血管影像。     

Combined diagnostic and therapeutic imaging in the diagnosis of venous sinus thrombosis in postpartum patients

The case of a woman on day four post partum with sensorimotor deficit of the right side and CT evidence of a left temporofrontal hemorrhagic lesion, is presented. Attending physicians requested cerebral angiography. To better evaluate the clinical justification of requested imaging procedure the patient medical history and performed CT examination were carefully revised. According to this analysis and based on a clinicoradiological methodology, the request of a cerebral angiography was considered appropriate. The examination showed several radiological signs but a definitive diagnosis could not be established. Second choice imaging procedures were analyzed and MRI completed with MR-angiography was performed. It allowed to document transverse and sigmoid sinus thrombosis. Therefore, in the diagnosis of venous sinus thrombosis, MRI combined with MR-angiography was shown to be a method of first choice while angiography plays a major role in therapy for intravascular thrombolysis.     

Usefulness of 320-Row Area Detector Computed Tomography for the Diagnosis of Cystic Falx Meningioma

We present a case of cystic falx meningioma. Cystic meningioma is rare and not easy to diagnose preoperatively; it is often misdiagnosed as other tumors, including glial or metastatic tumors with cystic or necrotic changes. This study showed the potential impact of 320-row computed tomography (CT) on image-based diagnostic evaluation of cystic meningioma with special attention to the novel techniques of 4-dimensional CT angiography (4D-CTA) and CT whole-brain perfusion (CTP). 4D-CTA showed the arterial supply feeding the tumor and late enhancement of the tumor nodule, similar to that seen in meningioma by conventional angiography. CTP showed that the tumor had a higher cerebral blood flow and cerebral blood volume and a longer mean transit time than adjacent brain tissue. These findings were consistent with meningioma and reinforced the other imaging findings, resulting in the correct preoperative diagnosis. The new techniques available for 320-row CT can potentially be used to improve differential diagnosis and preoperative assessment of cystic tumors with nodules.Key words: Cystic meningioma, 320-row area detector computed tomography, 4-dimensional computed tomography angiography, Computed tomography perfusion     

Silent embolism in diagnostic cerebral angiography: Detection with diffusion‐weighted imaging

Angiography has known and documented risks of neurological events. We prospectively studied 20 patients who underwent diagnostic cerebral angiographic examinations and diffusion‐weighted MRI (DWI). Eighteen patients had DWI before and after their angiogram, whereas two patients had a DWI only after their angiogram (DWI was normal in both of these patients). No clinical neurological deficits were detected in any of our patients after angiography, but in three of 20 patients there was a new hyperintense signal abnormality found on DWI. Diffusion‐weighted MRI provides an objective means of detecting both clinical and subclinical neurological events. Diffusion‐weighted imaging might therefore provide an easier method of assessing complication rates in cerebral angiography by reducing the number of patients required for meaningful statistical analysis.     

头颈部肿瘤难治性出血的急诊介入栓塞治疗

目的探讨介入栓塞对头颈部肿瘤难治性出血的急诊治疗价值。方法2017年2月至2019年2月中国医学科学院肿瘤医院介入治疗科采用介入栓塞术治疗21例头颈部肿瘤难治性出血患者,回顾性分析其肿瘤治疗史、出血史、血管造影表现、介入栓塞技术成功率、临床成功率和并发症情况。结果21例患者造影阳性率为100%(21/21),其中表现为异常肿瘤染色11例,造影剂外溢5例,假性动脉瘤2例,血管畸形2例,颈外动脉起始部破裂1例。1例颈动脉破裂患者转入综合性医院治疗,余20例患者共行22次介入栓塞治疗,技术成功率为100%(22/22)。4例患者在30 d内发生再出血,临床成功率为80.0%(16/20)。5例(25.0%)患者出现轻度颌面部疼痛,无严重并发症发生。结论急诊介入栓塞治疗头颈部肿瘤难治性出血安全、有效。     

Carotid Occlusion — A Hair's Breadth Away

Amongst the many recognized complications of cerebral angiography are those due to the introduction of emboli into the cerebral circulation. This report documents a previously undescribed iatrogenic embolic material, pubic hair, together with the simple measures necessary to prevent this potential hazard.     

Patient with Leriche's syndrome and concomitant superior mesenteric aneurysm: Evaluation with contrast‐enhanced three‐dimensional magnetic resonance angiography,computed tomography angiography and digital subtraction angiography

Conventional angiography is regarded as the gold standard in vascular imaging but it is invasive, and difficulty may be encountered in the evaluation of aortic occlusion disease. Superior mesenteric artery aneurysm is an uncommon disease, which can result in life‐threatening haemorrhage after rupture. With the rapid development of computed tomography angiography (CTA) and magnetic resonance angiography (MRA), high‐quality images of the vascular system can be obtained in a non‐invasive manner. We report a case of Leriche's syndrome with concomitant superior mesenteric aneurysm using contrast‐enhanced 3‐D CTA and MRA, with digital subtraction angiography correlation.     

Cerebral arterial disturbances in a transient encephalopathy induced by methotrexate

The mechanism of the transient encephalopathy induced by high dose systemic administration of methotrexate (HDMTX) is unknown. Metabolic and vascular hypothesis have been formulated but convincing evidence is lacking. We report the first case of vascular disturbances (thinness of cortical arteries on angiography, reversible fall down of cerebral flow and increase of carotid resistance) in a young Algerian patient treated for an osteogenic osteosarcoma. This observation might lead to the exploration by non invasive and easily repeatable techniques of the cerebral vascular dynamic in patients submitted to HDMTX and thus contributed to the elucidation of the mechanism and to the prevention of these neurological side effect.     

Diagnosis and treatment of cerebral metastasis from lung cancer

A clinical analysis of 38 patients with cerebral metastasis from lung cancer is reported 17 patients had primary cancer symptoms prior to the increased intracranial pressure 34 patients were examined by cerebral angiography or ventriculography and 4 by CT scan. The incidence of cerebral metastasis with lung as the primary focus ranks first (54.7%). Three pathologic processes of intracranial metastasis: (1) cancer cell thrombosis stage (2) growth reaction stage (3) increased intracranial pressure stage. In this series, 16 patients were given conservative treatment and 22 were operated by craniotomy and resection. The results show that the operation could improve the symptoms and signs and prolong the survival time. The surgical treatment of lesions in the brain is emphasized and the indications are discussed.     

Cerebral Vasculopathy and Multiple Infarctions in a Woman with Carcinomatous Meningitis While on Treatment with Intrathecal Methotrexate

We report on a 33-year-old woman with carcinomatous meningitis due to carcinoma of the breast who developed multiple cerebral infarctions within four days after intrathecal chemotherapy with methotrexate. MR angiography revealed a narrowing of basal cerebral arteries, which is consistent with vasculopathy. The vasculopathy was probably due to carcinomatous meningitis itself, an acute toxic effect of methotrexate, or a combination of both.