AJNR. American journal of neuroradiology
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AJNR Am J Neuroradiol · Nov 2004
ReviewRetroclival ecchordosis physaliphora: MR imaging and review of the literature.
Ecchordosis physaliphora (EP), found in about 2% of autopsies, is a clinically inconspicuous notochordal remnant appearing at the dorsal wall of the clivus. To our knowledge, a systematic review of its MR features does not exist. The aim of this study was to describe the MR imaging findings of incidentally found retroclival EP with special respect to its differentiation from intradural chordomas. ⋯ Because of the benign character of EP and the difficulties in its histopathologic differentiation from chordomas, precise knowledge of the radiologic characteristics of EP is important. On the basis of these five cases and a review of literature, contrast enhancement and the presence of clinical symptoms seem to be highly reliable parameters in the differential diagnosis of intradural chordoma and EP.
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AJNR Am J Neuroradiol · Nov 2004
Treatment of internal carotid artery aneurysms with a covered stent: experience in 24 patients with mid-term follow-up results.
We present our preliminary experience, including mid-term angiographic and clinical follow-up results, with an alternative technique for the endovascular treatment of intracranial aneurysms in a series of patients. This new method, previously described in anecdotal case reports, consists of endovascular deployment of an artificial vessel graft (stent graft or covered stent) in the parent vessel to exclude the intracranial aneurysm sac from circulation. ⋯ Initial anatomic, clinical and mid-term follow-up results in this small series of patients are encouraging. This technique has been proved to have potential in the reconstructive treatment of intracranial aneurysms. Further research and development are needed to optimize the stent graft technology for the cerebrovascular system.
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AJNR Am J Neuroradiol · Nov 2004
Predictors of outcome after endovascular treatment of cerebral vasospasm.
Angioplasty and intra-arterial papaverine are promising treatments for severe symptomatic vasospasm after subarachnoid hemorrhage (SAH), but there is little information on the clinical factors that predict treatment outcome. We sought to determine variables for predicting functional outcome in this setting. ⋯ Advanced age and poor clinical status at the time of SAH onset are predictive of poor clinical outcome despite endovascular treatment with angioplasty or intra-arterial papaverine in patients with symptomatic vasospasm.
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AJNR Am J Neuroradiol · Nov 2004
Acute methotrexate neurotoxicity: findings on diffusion-weighted imaging and correlation with clinical outcome.
Acute lymphocytic leukemia (ALL) is a common malignancy of childhood treated with methotrexate (MTX), which is associated with acute neurotoxicity. We evaluated diffusion-weighted (DW) and conventional MR images in children with ALL and acute MTX-induced neurotoxicity, with clinical correlation. ⋯ Diffusion abnormalities in acute MTX neurotoxicity indicated cerebral dysfunction but not necessarily overt structural injury to the cerebrum. Subsequent demyelination or gliosis could not be predicted on the basis of diffusion abnormalities. A single strokelike episode with diffusion abnormalities should not necessarily prompt modification of potentially curative chemotherapeutic regimens.
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Lumbar epidural injections are typically performed blindly or with fluoroscopic guidance. CT fluoroscopy (CTF) can be used to guide needle placement precisely and rapidly, allowing visualization of the optimal needle path and identifying potential problems such as severe stenosis and synovial cysts before needle insertion. ⋯ By using this technique, just more than 2000 epidural steroid injections have been performed with no major complications. CTF is a useful guidance tool when performing lumbar epidural injections.