HAEMATOMYELIA FOLLOWING WARFARIN THERAPY

SUMMARY Perispinal haemorrhage is a rare but serious complication of anticoagulation therapy, and should be considered in patients presenting with sudden pain in the back or neck, with or without neurological signs.     

MRI in the heavy eye phenomenon

The heavy eye phenomenon presents as progressive esotropia and hypotropia in high myopia. It appears to be due to compression of the lateral rectus muscle against the lateral orbital wall by the enlarged myopic globe. We present the first published magnetic resonance imaging (MRI) scans of this condition and a summary of the literature.     

Hysterosalpingography in Infertility — An Experience of 3,631 Examinations

EDITORIAL COMMENT: The introduction of chromotubation — laparoscopy with instillation of methylene blue through the cervix — has in many centres replaced hysterosalpingography as the primary procedure for investigation of tubal patency in patients with infertility. Proponents of laparoscopy emphasize the value of inspection of the tubes for evidence of disease and assessment for suitability for repair if the tubes are occluded. Several studies comparing findings at laparoscopy and hysterosalpingography have reported that laparoscopy frequently finds significant tubal pathology when the salpingogram was reported as normal.     

Forensic Radiology

FORENSIC RADIOLOGY: B.G. Brogdon with 13 contributors CRC Press, Boca Raton, 1998; 477pp; RRP US$99.95 cloth; Australian distributor DA Books & Journals; ISBN 0 8493 8105 3.     

A case of hyperdense diploic epidermoid cyst on CT scan mimicking meningioma

Epidermoid cysts typically have images characteristic similar to cerebrospinal fluid (CSF). A case of a hyperdense epidermoid cyst on computed tomography (CT) scan mimicking meningioma is described and the possibility of unusual imaging characteristics of epidermoids is highlighted as a diagnostic problem.     

The influence of diabetes mellitus and hyperglycaemia on stroke incidence and outcome

Diabetes mellitus is a complex metabolic syndrome with significant effects on the systemic and cerebral vasculature. The incidence and severity of ischaemic stroke are increased by the presence of diabetes, and outcome from stroke is poorer. More than one third of patients admitted with acute stroke are hyperglycaemic at presentation. Reasons for the altered prognosis in diabetes associated stroke are multifactorial. A direct influence of hyperglycaemia at the time of ischaemia is likely to be important. The use of novel methods to delineate stroke topography and pathophysiology such as MR spectroscopy, diffusion and perfusion weighted MRI appear helpful in delineating the effects of hyperglycaemia on stroke pathophysiology. Randomised clinical trials to determine optimal management for patients with hyperglycaemia following stroke are ongoing. Such trials will determine if aggressive control of acute hyperglycaemia following stroke has similar benefits to that observed following acute myocardial infarction. Clinicians responsible for stroke patients should be aware of the importance of adequate glycaemic control in both primary and secondary prevention of stroke.     

Percutaneous retrieval of a partially expanded iliac artery stent: Case report

A partially expanded, intraluminal, balloon-expandable Palmaz vascular stent was retrieved percutaneously in a 48-year-old woman after attempted placement across a common iliac artery stenosis. A pinhole in the balloon prevented expansion, and the stent could not be stabilized to allow balloon exchange. The stent was snared by a 5Fr 4 mm balloon catheter replaced coaxially through the stent and then withdrawn into a 14Fr Amplatz sheath which had been percutaneously placed in the external iliac artery. Open surgical removal of the stent was thus avoided.     

Pelvimetry — a Squatter''s View

Patients were X-rayed in supine and squatting positions in order to measure any increase in pelvic outlet diameters. An increase of less than 2% was found. Previous estimates of 20-30% increases in pelvic outlet area were not duplicated.     

Solitary intracranial plasmacytoma

Solitary intracranial plasmacytomas (SIPs) are rare tumours that may be mistaken radiologically for meningiomas. According to the literature, the predominant feature on polytomography and computed tomography (CT) is a bone-eroding, contrast-enhancing soft tissue mass, part of which might have extended extracranially before initial presentation. The lesions can be solitary and are therefore amenable to surgical excision. Although no recurrence is seen for up to 10 years after treatment, some authors believe progression to multiple myeloma is inevitable. Lesions that are extramedullary in origin are thought to have the best prognosis. We describe three cases treated surgically at Westmead Hospital in the past 6 years. All had CT features similar to those reported previously. On magnetic resonance imaging, which in this condition has not been fully documented, the lesions were slightly hyperintense with the brain on T1-weighted sequences, and were inhomogeneous and hyperintense with T2-weighted images. The two patients who received intravenous contrast showed dense and uniform enhancement. Occasional intralesional signal voids suggested increased vascularity, which was confirmed surgically. The presence of intracellular immunoglobulins may account for the hyperintensity on T2 sequence. Although no specific imaging features were identified to distinguish meningiomas from SIP, the latter should be included in the differential diagnosis of solitary bone eroding intracranial tumours.     

Recommendation from Australian Radiation Laboratory

The National Health and Medical Research Council, at its 97th Session (June 1984) modified one of its earlier recommendations relating to the radiological examination of young women. This was made on the recommendation of its Radiation Health Committee and the Council have requested publication of the new recommendation so that all people who prescribe radiological examination should be aware of the Council's recommendation.
With the mean age of menarche in Australian girls now being before their 13th birthday, a substantial proportion of a paediatric population will be affected by these recommendations.