CT and MR imaging have been used to diagnose polymicrogyria and determine the topological involvement of bilateral frontal, perisylvian, parietal or occipital cortices. We present CT and MR appearances of bilateral asymmetrical frontal and parietal perisylvian polymicrogyria in an eighteen year-old-girl.
Recent advances in molecular genetics, together with further understanding of cerebral biochemical metabolism affecting the white matter, when taken together with the information provided by MRI and MRS, provide new insights into the inherited white matter diseases.
Ischaemic stroke accounts for 80% of cerebrovascular disease. It is the third commonest cause of death, the second cause of dementia and the primary cause of disability. The widespread availability of CT scanning, the speed of examination and its low cost make CT the gold standard for early diagnosis of stroke before the mechanisms of cell swelling are triggered heralding irreversible neuronal damage. CT scanning allows morphological assessment of brain parenchyma demonstrating or excluding any bleeding and direct or indirect signs of ischaemia. It also allows perfusion imaging to display the cerebral territory at risk. Our study aimed to devise a dynamic CT perfusion imaging technique for use on an ordinary spiral CT system to be combined with morphological study and head and neck CT angiography to disclose the cause of the stroke correlated to clinical findings. Eighty patients with transient and permanent clinical forms of acute ischaemic stroke were referred to our institution within 0.5 to eight hours after clinical onset of symptoms. All patients underwent standard CT scan followed by CT perfusion imaging, intracranial CT angiography, neck CT angiography and brain CT scan after contrast administration. Each patient received a 40 ml bolus of iodate contrast agent for each examination for a total of 120 ml at a concentration of 300 mg/ml. CT perfusion imaging yielded a graph obtained over a ROI centred on the lentiform nuclei showing the peak time (PT) equal to the mean transit time (MTT) and dependent on cerebral blood flow (CBF). The graphic profiles of perfusion correlated to clinical findings and intra and extracranial CT angiography MIP reconstructions demonstrated the etiopathogenesis of stroke, the vascular territory affected and the prognosis. Combined with morphological study of brain parenchyma, CT angiography and clinical findings, CT perfusion graphs offer an immediate diagnosis of hyperacute ischaemic stroke allowing prompt therapeutic decisions to improve the prognosis.
Debilitating backache due to different types of neoplastic spinal lesions is a common cause of morbidity in different age groups. Percutaneous vertebroplasty (PV) gives substantial pain relief and stabilizes the weak vertebrae. The objective of our study was to assess the therapeutic benefit of PV in alleviating backache and improving functional status in patients with painful neoplastic conditions of vertebrae. A retrospective hospital-based (tertiary teaching hospital) study of 13 patients was undertaken from January 2001 to January 2005. Nineteen vertebroplasties were done in seven male and six female patients. The Wilcoxon Signed Rank test was used to evaluate the statistical significance of differences between the preoperative and postoperative levels of pain, mobility and analgesic usage. Most patients had pain relief within 48–72 hours. No patient had any added deficit related to the procedure. At one to 48 months follow-up the patients had a statistically significant improvement in their clinical condition (p<0.001). PV is effective in relieving debilitating backache and can improve the functional status of patients with painful vertebrae harboring various neoplastic lesions.
Polyvinyl chloride and plasticizer intoxication have a degenerative effect on the cerebral white matter characterized by bilateral, confluent lesions that reflect diffuse demyelination. We report similar clinical and neuroimaging manifestations in two patients with inhalation of these substances. MRI findings described here may be helpful in the diagnosis of future cases of suspected chloroparaffin poisoning.
