Binswanger's subcortical arteriosclerotic encephalopathy: a special form of dementia associated with systemic arterial hypertension

The encephalopathy is characterized by an important arteriosclerotic involvement of the vessels of the cerebral white matter and a diffuse subcortical demyelination, sparing the cortex. The diagnosis is presently possible, ante mortem, by connecting the clinical picture with the CT scan findings, which are essential. Three cases with Binswanger encephalopathy are reported and the following picture was found: age 50 to 70 years old at the onset; dementia with scanty neurological signs; systemic arterial hypertension; subacute course of the disease; and a CT scan, highly characteristic, that shows bilateral and symmetric subcortical hypodensity. In one of the patients, that eventually died, an angiography disclosed a right internal carotid thrombosis and a diminished flow in the thalamic striate arteries in both sides. The other two patients are apparently stabilized with anti-hypertensive medication. Binswanger encephalopathy is still seldom described in spite of being a very well defined entity. This diagnosis should be considered much more frequently because it is possible to prevent the encephalopathy avoiding systemic hypertension that is probably intimately linked with the genesis of the disease.     

Abdominal aortic aneurysm in association with horseshoe kidney.

The authors report 3 cases of infra-renal abdominal aortic aneurysms resected in the presence of horseshoe kidney. In all these cases the diagnosis of the renal anomaly was done before the aneurysmectomy. In the first case, the diagnosis of horseshoe kidney was done by an aortography. In the second case by a previous operation to remove an urinary calculi. Three years after this surgery the diagnosis of abdominal aortic aneurysm was done when a computed tomography, an intravenous pyelography and an aortography, confirmed the diagnosis of horseshoe kidney. The third case come to our hospital in the fourth day after an exploratory laparotomy done in another hospital, when was observed the aneurysm and the horseshoe kidney. The second case had two anomalous arteries. One of them arose from the aneurysm to the renal isthmus and the other one from the common iliac to the isthmus. The three patients had an uncomplicated postoperative course. Only in the second case we had the necessity to reattache an anomalous artery directly to the graft.     

The use of bovine pericardium as an arterial graft. A 5-year follow-up

From June 1980 to June 1985, 42 patients were subjected to patch graft angioplasties using glutaraldehyde tanned bovine pericardium. Life-table analysis showed a 100% patency in the grafted areas. Histological studies made on specimens recovered at 7 and 19 months showed no major deterioration of the original structure. Fibrous cell infiltration was not extensive enough to be harmful. Elastic fibers were relatively preserved, with some dissociation. No endothelialization, infection, thrombosis, or aneurysm dilatation was detected. Angiographic control up to 37 months showed patency and normal internal surface of the graft. It appears from this study that bovine pericardium is a good alternative as a vascular graft material.     

One-and-a-half syndrome: anatomo-clinical considerations apropos of a case

A 36 years-old man was admitted in September 1987. For 5 years he suffered from 4 recurrent episodes of throbbing headache, tinnitus, nausea, diplopia and divergent strabismus to which a facial palsy was recently added. In all episodes, the symptoms disappeared spontaneously and completely. A neuro-ophthalmological examination at admission disclosed an exotropia of the right eye, gaze paralysis to the left, paralysis of adduction of the left eye and preserved right eye abduction which triggered a rhythmic horizontal nystagmus. The upward and downward gazes and the convergence were well preserved. Moreover, there was a left peripheral facial palsy, and Babinski sign at the right side. Auditory evoked potentials were slowed at the mesencephalopontine transition. CT scan showed a low-density area with no contrast enhancement at the left pontine tegmentum and a left anterolateral atrophy of the pons. CSF examination showed increase in protein content and increase in the IgG content. Additional investigation included a dopplerometry of the cervical arteries, a panangiography and a bidimensional echocardiography which were normal. Diagnosis of one-and-a-half syndrome was made, possibly secondary to multiple sclerosis, and immunossuppressive therapy was initiated.     

Medial arterial calcification and diabetic neuropathy

Summary The aim of this study was to detect linear arterial calcification (M?nckeberg’s sclerosis) localized in feet, ankles, legs, knees and hands in an attempt to correlate the extent of calcification with the presence and severity of autonomic neuropathy as well as with microangiopathy (proliferative retinopathy, proteinuria >200 mg/die) and peripheral neuropathy. Typical linear calcification were observed in 37 out of 41 (90.2%) patients with autonomic neuropathy and in none of those without autonomic neuropathy (p<0.001). These 37 patients were divided into two subgroups by cluster analysis: Subgroup A, including 18 subjects with calcification length ranging from 8 to 26 cm and moderate autonomic neuropathy, and Subgroup B, including 19 subjects with calcification length between 58 and 126 cm and severe autonomic neuropathy (p<0.0001 by Spearman’s test). No difference in the length of arterial calcification was detected between patients with proteinuria >200 mg/24h and/or proliferative retinopathy and patients without these complications. A possible relationship between arterial calcification and peripheral neuropathy is difficult to evaluate; in fact, the majority of subjects having autonomic neuropathy had peripheral neuropathy, too. Vice versa, around 10% of patients without peripheral neuropathy but with autonomic neuropathy did not have M?nckeberg’s sclerosis. Autonomic neuropathy is the principal factor responsible for calcification of the arterial media, and in addition the severity of the neuropathy, rather than the patient’s age or the known disease duration seems to determine the extent of calcification.     

Electromyographic behaviour of the gastrocnemius muscle during knee extension and flexion performed on the leg press.

The gastrocnemius was analysed in 10 male volunteers during knee flexion and extension with the foot in normal, plantar flexion and dorsal flexion positions. Hewlett-Packard surface electrodes, an electromyographic signal amplifier, a computer equipped with an A/D conversion plaque (Model CAD 10/26), a software specially designed to record and analyse the signals, a horizontal leg press, and electrogoniometers were used. The gastrocnemius muscle showed strong potentials at the end of knee extension and beginning of knee flexion. The muscle presented a similar activity both in the upper and lower platforms. As to bilateral action, the right gastrocnemius presented stronger potentials on the upper platforms, whereas the potentials were bilaterally similar on the lower platforms. As for foot position, the gastrocnemius presented strong potentials when the foot was in plantar flexion. The remaining positions had no effect on the work of the muscle.     

New black blood pulse sequence for studies of the heart

The black blood concept is based on the signal void principle of the sequences in Spin Echo, SE or FSE, which are very useful for studying the mediastinum and heart. In this setting, new sequences are continuously introduced to eliminate the artifacts caused by breathing and heart movements. One such sequence is the Double-IR preparation Black Blood FSE. We report our experience in 97 patients, using this new pulse sequence to evaluate cardiac pathology, and establish comparisons with the conventional Spin Echo sequences. The study comprises mediastinal disease and aorta and heart explorations. We consider this new Double-IR preparation FSE sequence to be an excellent choice for evaluating chest, mediastinal and cardiac images. The sequence offers improved spatial resolution of both the vessels and other chest structures with respect to conventional Spin Echo imaging. With the exception of patients presenting severe heart problems, or in the presence of intense bradycardia, the required 16 cycles in apnea are well tolerated. The purpose of the present study is to present our initial results with this new pulse sequence as applied to cardiac pathology, in comparison with conventional Spin Echo imaging.     

Sonographic findings in a case of tetrasomy 9p associated with increased nuchal translucency and Dandy‐Walker malformation

We report a case of a 23‐year‐old pregnant woman, who underwent amniocentesis after ultrasound (US) examination in the first trimester which revealed a nuchal translucency thickness of 2.9 mm. Cytogenetic analysis revealed complete tetrasomy of the short arm of chromosome 9. Further US evaluation in the second trimester revealed Dandy‐Walker malformation, ventriculomegaly, bilateral clubfoot, lip and palate clefts, arthrogryposis and hyperechoic kidneys with bilateral pelvic dilatation. At 30 weeks of gestation, a placental abruption was noted and a Cesarean section was performed. The infant died shortly after birth. A review of previous cases of tetrasomy 9p shows that the remarkable sonographic findings are ventriculomegaly, intrauterine growth restriction, genitourinary anomaly, Dandy‐Walker malformation, cleft lip/palate and limb malformation, but the association of tetrasomy 9p and increased nuchal translucency had not been reported. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound, 2009.