Creutzfeldt-Jakob disease: focal symmetrical cortical involvement demonstrated by MR imaging.

The authors present two biopsy-proved cases of Creutzfeldt-Jakob disease. MR appears to be more sensitive than CT in detecting pathologic changes; signal abnormalities, when found, are predominantly within gray matter and may involve only peripheral cortex.     

Periodic alternating skew deviation

A 78-year-old hypertensive woman suddenly developed blurred vision, followed shortly by dizziness, difficulty walking with a tendency to veer to the left, and vertical diplopia. Examination 3 weeks later revealed a unique neuro-ophthalmologic motility pattern, which may be described as periodic alternating skew deviation. This previously unreported motility disturbance was associated with downbeat nystagmus in our patient, and a focal lesion at the level of the interstitial nucleus of Cajal was demonstrated on computed tomography. The spectrum of physiologically related motility patterns--including periodic alternating nystagmus, cyclic oculomotor paralysis, see-saw nystagmus, periodic alternating gaze deviation, "ping-pong" gaze, and intermittent aperiodic alternating skew deviation--has been considered and is helpful in topical neuro-ophthalmologic diagnosis.     

Cerebrospinal fluid shunt function and hydrocephalus in the pediatric age group: a radiographic/clinical correlation.

Eighty-four pediatric patients were evaluated clinically and radiographically on 112 separate admissions for suspected increased intracranial pressure and possible shunt malfunction. The shunt system was tested clinically in each patient and correlated with the ventricular size as determined by CT. Of the patients with enlarged ventricles, 87% had an improperly functioning shunt and 13% had a normally functioning shunt. Of the patients with normal or small ventricles, 93% had a normally functioning shunt. Thus the "false negative" rate was 4% (small ventricles with a nonfunctioning shunt) and the "false positive" rate was 13% (large ventricles with a functioning shunt).     

Fortschritte im Verständnis der Rückenmarkverletzungen Klinik, Bildgebung, pathologische Korrelationen

Close inspection of MR images in all stages of SCI can reveal alterations which are important for our understanding of the changes which occur in SCI and may be crucial for planning surgical intervention. Importantly also, these observations may assist in the evaluation of novel therapies in SCI, such as cellular transplantation. It is hopeful that MR strategies which are currently in routine use in the brain, such as diffusion weighted imaging, perfusion studies, spectroscopy, and magnetization transfer can be adopted for use in the spine [8]. Because of the small size of the cord, the magnetic susceptibility problems caused by surrounding air and bone, and nearby vascular and CSF flow/pulsations, these techniques are currently very difficult to employ in the cord. They will however evolve over time and give us greater insights into the in-vivo status of the injured cord.     

Proton magnetic resonance spectroscopy of the thalamus in patients with chronic neuropathic pain after spinal cord injury

BACKGROUND AND PURPOSE: Spinal cord injury (SCI) results in a number of consequences; one of the most difficult to manage is chronic neuropathic pain. Thus, defining the potential neural and biochemical changes associated with chronic pain after SCI is important because this may lead to development of new treatment strategies. Prior studies have looked at the thalamus, because it is a major sensory relay station. The purpose of our study was to define alterations in metabolites due to injury-induced functional changes in thalamic nuclei by using single-voxel stimulated echo acquisition mode MR spectroscopy. METHODS: Twenty-six men were recruited: 16 patients with SCI and paraplegia (seven with pain, nine without pain) and 10 healthy control subjects. Pain was evaluated in an interview, which included the collection of information concerning the location, quality, and intensity of pain, carefully identifing the dysesthetic neuropathic pain often seen in SCI. Localized single-voxel (8-cm(3) volume) proton spectra were acquired from the left and right thalami. RESULTS: The concentration of N-acetyl (NA) was negatively correlated with pain intensity (r = -0.678), and the t test showed that NA was significantly different between patients with pain and patients without pain (P =.006). Myo-inositol was positively correlated with pain intensity (r = 0.520); difference between patients with pain and those without pain was almost significant (P =.06). CONCLUSION: The observed differences in metabolites in SCI patients with and pain and in those without pain suggest anatomic, functional, and biochemical changes in the thalamic region.