AJNR. American journal of neuroradiology
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AJNR Am J Neuroradiol · Nov 1991
Subacute necrotizing myelopathy: MR imaging in four pathologically proved cases.
This report describes the MR and correlative imaging findings of four histologically proved cases of subacute necrotizing myelopathy in which there was no evidence of a spinal dural arteriovenous fistula. Subacute necrotizing myelopathy is characterized clinically by progressive motor and sensory deterioration, and pathologically by necrosis in the spinal cord. Initial MR imaging showed focal enlargement of the spinal cord and nonspecific T1 and T2 lengthening. ⋯ A prolonged course distinguishes subacute necrotizing myelopathy from acute transverse myelitis, but the clinical course and imaging appearance are similar to those of intramedullary tumor. Rimlike rather than solid contrast enhancement may be a distinguishing feature. In the absence of a demonstrable spinal dural arteriovenous fistula, the radiologic differentiation of subacute necrotizing myelopathy from tumor is probably impossible, and biopsy establishes the correct diagnosis.
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AJNR Am J Neuroradiol · Nov 1991
Case ReportsParticulate embolization of the anterior choroidal artery in the treatment of cerebral arteriovenous malformations.
The anterior choroidal artery is commonly recruited to supply arteriovenous malformations in the temporal lobe, basal ganglia, lateral ventricle, and internal capsule. Embolization of this artery is theoretically hazardous owing to its supply to important motor territory, relative lack of collaterals, and small caliber. ⋯ Significant flow reduction was achieved in 14 patients. Two symptomatic and two asymptomatic complications arose, including permanent hemiparesis in one patient.
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AJNR Am J Neuroradiol · Sep 1991
Correct placement of epidural steroid injections: fluoroscopic guidance and contrast administration.
We prospectively evaluated 316 caudal-approach epidural steroid injections given by staff radiologists and residents in our department over a 1-year period. Needle placement was checked with fluoroscopy and corrected if necessary. When the needle tip was within the sacral canal, nonionic contrast material was injected. ⋯ The presence of blood on the needle stylus was not a reliable indicator of venous placement of the needle. Our findings indicate that fluoroscopy is essential for correct placement of epidural steroid injection. Contrast administration is necessary to avoid venous injection of steroids.
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AJNR Am J Neuroradiol · Sep 1991
Nonaneurysmal perimesencephalic subarachnoid hemorrhage: CT and MR patterns that differ from aneurysmal rupture.
We describe a characteristic distribution of cisternal blood in 52 patients with nonaneurysmal subarachnoid hemorrhage proved by a normal angiogram. On CT, the center of the bleeding was located immediately anterior to the brainstem in all patients, which was confirmed in four patients who were studied with MR imaging. Extension to the ambient cisterns or to the basal parts of the sylvian fissures was common, but the lateral sylvian or anterior interhemispheric fissures were never completely filled with blood. ⋯ Only one patient with a basilar artery aneurysm on angiography was incorrectly labeled by both observers as having a nonaneurysmal perimesencephalic pattern of hemorrhage. The high predictive value of the perimesencephalic pattern of hemorrhage for a normal angiogram (0.95 and 0.94, respectively, for the two observers) and the excellent interobserver agreement (kappa 0.87) demonstrate that nonaneurysmal perimesencephalic hemorrhage can be distinguished on CT in the majority of patients. Recognition of this pattern of hemorrhage is important as patients with this subset of subarachnoid hemorrhage have an excellent prognosis.
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AJNR Am J Neuroradiol · Sep 1991
Contrast-enhanced MR imaging of optic nerve lesions in patients with acute optic neuritis.
The purpose of this study was to determine if administration of gadopentetate dimeglumine aids in the MR detection of optic nerve lesions in patients with acute optic neuritis and to establish an efficient MR imaging protocol to effectively demonstrate such lesions. Patients with acutely decreased visual acuity were referred for MR imaging of the brain and orbits. ⋯ Our results indicate that administration of gadopentetate dimeglumine aids in the MR detection of lesions of the optic nerve and optic chiasm. Applicability of our MR imaging protocol was confirmed by the demonstration of these lesions and by the disseminated white matter lesions seen simultaneously elsewhere in the brain.