Journal of neuroimaging : official journal of the American Society of Neuroimaging
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To evaluate the utility of computed tomographic angiography (CTA) as the primary diagnostic investigation in patients with spontaneous subarachnoid hemorrhage (SAH), and to correlate the results with intraoperative findings in those with ruptured aneurysms. ⋯ CTA can provide prompt and accurate diagnostic and anatomic information in the setting of SAH with an excellent detection rate in acute ruptured aneurysms. These findings suggest an increased role for CTA in the evaluation of cerebral aneurysms.
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Diffuse axonal injury (DAI) is a common aftermath of brain trauma. The diagnosis of DAI is often difficult using conventional magnetic resonance imaging (MRI). ⋯ White matter damage identified by DTI was correlated with the patient's language impairment as assessed by functional MRI (fMRI) and a neuropsychological exam. The findings demonstrate the utility of DTI for identifying white matter changes secondary to traumatic brain injury (TBI).
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Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction in older individuals. Controversy remains in terms of the optimal timing and indications for surgical intervention. In this context, it would be of benefit to define clinical and magnetic resonance imaging (MRI) predictors of outcome after intervention for CSM. ⋯ Patients with high intramedullary signal change on T2WI who do not have clonus or spasticity may experience a good surgical outcome and may have reversal of the MRI abnormality. A less favorable surgical outcome is predicted by the presence of low intramedullary signal on T1WI, clonus, or spasticity. These data suggest that there may be a window of opportunity to obtain optimal surgical outcomes in patients with CSM.
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We describe a case of stent-assisted coil embolization of a wide neck right posterior inferior cerebellar artery (PICA) aneurysm via a transbrachial artery approach. ⋯ Current advances in technology produce neuroendovascular devices that are smaller with increased flexibility, allowing nonfemoral vascular access to the cerebral circulation via alternate arterial routes. This patient case demonstrates transbrachial access is a viable approach for endovascular aneurysm coil embolization, with or without stent assistance, in cases with an unstable guide catheter due to tortuous vessels or abnormal anatomy when femoral access is complicated or contraindicated.
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Subdural empyema represents a loculated infection between the dura and the arachnoid. It has been described either intracranially or in the spinal canal, the latter localization being quite rare. While treatment guidelines for a single (either brain or spinal) localization of a subdural empyema are more or less established, its management when a massive involvement of CNS is evident represents a challenge. ⋯ Spinal subdural empyema and brain subdural empyema are not always, as in our case, two different entities. Prompt diagnosis and treatment constitute the major variables affecting outcome.