Neuroradiology
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MRI of the brain and spinal cord was performed in 21 patients with amyotrophic lateral sclerosis (ALS), 8 normal volunteers and 16 neurological disease controls. High signal was seen in the intracranial corticospinal tract in 16 of the 21 patients on T2-weighted and in 10 on proton density (PD)-weighted images. In one patient, the high signal on T2-weighted images became less marked with progression of the disease. ⋯ Low signal intensity in the motor cortex on T2 weighted images was seen in three normal volunteers and four disease controls. However, high signal intensity was seen in the intracranial corticospinal tract on T1 weighted images in five patients with ALS who showed pronounced upper motor neurone signs including spastic paraparesis, but not in controls. Thus, abnormalities on MRI in the brain and spinal cord should be considered in the diagnosis of ALS, and high signal intensity of the intracranial corticospinal tract on T1-weighted images may reflect the severe pathological changes of the upper motor neurones in ALS.
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Of 440 patients with spontaneous subarachnoid haemorrhage in whom an aneurysm was suspected, 60 had a negative angiogram. A second angiogram performed 1-4 weeks later revealed an aneurysm in 5 of 40 cases. ⋯ There were three aneurysms of the anterior communicating artery and two of the carotid siphon. The reasons for the false-negative angiograms and the usefulness of repeated angiography are discussed.
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The cerebellum has anatomical connections to the cerebral cortex, through which it can affect language function. To study these connections, we investigated patients with chronic Broca's aphasia using MRI and single-photon emission computed tomography (SPECT). We selected 15 such patients (9 male, 6 female, aged 17-64 years, mean age 56 years) from 30 chronically aphasic patients. ⋯ Patients in group 1 showed classical Broca's aphasia, while patients in group 2 showed mainly word-finding difficulty. Patients with CCD hat infarcts involving the lower part of the frontal gyrus but patients without CCD did not, which suggests that this region may have functional and anatomical connections with the cerebellum. Our findings support the notion that the cerebellum contributes to language.
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In patients with hepatic cirrhosis, the globus pallidus and putamen show high intensity on T1-weighted MRI. While the causes of this high signal have been thought to include paramagnetic substances, especially manganese, no evidence for this has been presented. Autopsy in four cases of hepatic cirrhosis permitted measurement of metal concentrations in brain and histopathological examination. ⋯ These findings were similar to those in chronic manganese poisoning. On T1-weighted images, copper deposition shows no abnormal intensity. It is therefore inferred that deposition of highly concentrations of manganese may caused high signal on T1-weighted images and nerve cell death in the globus pallidus.