Diagnosis of an “isodense” pituitary microadenoma by dynamic CT scanning

1984 ◽  
Vol 60 (2) ◽  
pp. 424-427 ◽  
Author(s):  
Takeshi Hasegawa ◽  
Haruhide Ito ◽  
Katsuo Shoin ◽  
Yuzaburo Kogure ◽  
Toshihiko Kubota ◽  
...  
Keyword(s):  
Pituitary Gland ◽  
Adrenocorticotropic Hormone ◽  
Ct Scanning ◽  
Ct Scans ◽  
Dynamic Ct ◽  
Content Type ◽  
Pituitary Microadenoma ◽  
Enhanced Ct ◽  
Dynamic Ct Scanning ◽  
Fine Print

✓ A case of Nelson's syndrome with an adrenocorticotropic hormone-secreting pituitary chromophobe microadenoma is presented to demonstrate the potential capability of rapid sequential (dynamic) computerized tomography (CT) scanning for the diagnosis of a pituitary microadenoma that was isodense with the adjacent pituitary gland on conventional enhanced CT scanning. The dynamic CT scans showed transient high density in this microadenoma contrasting with the pituitary gland in the early-enhancement phase, and thereafter the contrast density was indistinguishable from that of the pituitary gland in the delayed-enhancement phase. For the detection of pituitary microadenoma, dynamic CT combined with subsequent delayed CT scanning can provide diagnostic and localizing information.

Incidence of silent hemorrhage and delayed deterioration after stereotactic brain biopsy

1998 ◽  
Vol 89 (1) ◽  
pp. 31-35 ◽  
Author(s):  
Abhaya V. Kulkarni ◽  
Abhijit Guha ◽  
Andres Lozano ◽  
Mark Bernstein
Keyword(s):  
Ct Scan ◽  
Neurological Deficit ◽  
Stereotactic Biopsy ◽  
Brain Biopsy ◽  
Ct Scanning ◽  
Ct Scans ◽  
Stereotactic Brain Biopsy ◽  
Content Type ◽  
Fine Print

Object. Many neurosurgeons routinely obtain computerized tomography (CT) scans to rule out hemorrhage in patients after stereotactic procedures. In the present prospective study, the authors investigated the rate of silent hemorrhage and delayed deterioration after stereotactic biopsy sampling and the role of postbiopsy CT scanning. Methods. A subset of patients (the last 102 of approximately 800 patients) who underwent stereotactic brain biopsies at the Toronto Hospital prospectively underwent routine postoperative CT scanning within hours of the biopsy procedure. Their medical charts and CT scans were then reviewed. A postoperative CT scan was obtained in 102 patients (aged 17–87 years) who underwent stereotactic biopsy between June 1994 and September 1996. Sixty-one patients (59.8%) exhibited hemorrhages, mostly intracerebral (54.9%), on the immediate postoperative scan. Only six of these patients were clinically suspected to have suffered a hemorrhage based on immediate postoperative neurological deficit; in the remaining 55 (53.9%) of 102 patients, the hemorrhage was clinically silent and unsuspected. Among the clinically silent intracerebral hemorrhages, 22 measured less than 5 mm, 20 between 5 and 10 mm, five between 10 and 30 mm, and four between 30 and 40 mm. Of the 55 patients with clinically silent hemorrhages, only three demonstrated a delayed neurological deficit (one case of seizure and two cases of progressive loss of consciousness) and these all occurred within the first 2 postoperative days. Of the neurologically well patients in whom no hemorrhage was demonstrated on initial postoperative CT scan, none experienced delayed deterioration. Conclusions. Clinically silent hemorrhage after stereotactic biopsy is very common. However, the authors did not find that knowledge of its existence ultimately affected individual patient management or outcome. The authors, therefore, suggest that the most important role of postoperative CT scanning is to screen for those neurologically well patients with no hemorrhage. These patients could safely be discharged on the same day they underwent biopsy.

The pseudodelta sign in acute head trauma

1988 ◽  
Vol 69 (6) ◽  
pp. 867-868 ◽  
Author(s):  
Joel W. Yeakley ◽  
John S. Mayer ◽  
Larry L. Patchell ◽  
K. Francis Lee ◽  
Michael E. Miner
Keyword(s):  
Head Trauma ◽  
Superior Sagittal Sinus ◽  
Ct Scans ◽  
Content Type ◽  
Sagittal Sinus ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct ◽  
Triangular Area ◽  
Fine Print

✓ The “delta sign” is a triangular area of high density with a low-density center seen on contrast-enhanced computerized tomography (CT) scans in the location of the superior sagittal sinus. It indicates thrombosis of the sinus. The authors describe the “pseudodelta sign,” which is similar but is seen on non-contrast-enhanced CT scans and which has a high correlation with hemorrhage secondary to acute head trauma.

Acute brain edema in fatal head injury: analysis by dynamic CT scanning

1985 ◽  
Vol 63 (6) ◽  
pp. 830-839 ◽  
Author(s):  
Eiji Yoshino ◽  
Tarumi Yamaki ◽  
Toshihiro Higuchi ◽  
Yoshiharu Horikawa ◽  
Kimiyoshi Hirakawa
Keyword(s):  
Head Injury ◽  
Brain Edema ◽  
Subdural Hematoma ◽  
Ct Scans ◽  
Acute Subdural Hematoma ◽  
Dynamic Ct ◽  
Content Type ◽  
Injured Patients ◽  
Fine Print ◽  
Diffuse Brain

✓ Dynamic computerized tomography (CT) was performed on 42 patients with acute head injury to evaluate the hemodynamics and to elucidate the nature of fatal diffuse brain bulk enlargement. Patients were divided into two groups according to the outcome: Group A included 17 nonfatally injured patients, eight with acute epidural hematomas and nine with acute subdural hematomas; Group B included 25 fatally injured patients, 16 with acute subdural hematomas and nine with bilateral brain bulk enlargement. Remarkable brain bulk enlargement could be seen in all fatally injured patients with acute subdural hematoma. In 29 (69%) of 42 patients, dynamic CT was performed within 2 hours after the impact. In the nonfatally injured patients with brain bulk enlargement, dynamic CT scans suggested a hyperemic state. On the other hand, in 17 (68%) of the 25 fatally injured patients, dynamic CT scans revealed a severely ischemic state. In the fatally injured patients with acute subdural hematoma, CT Hounsfield numbers in the enlarged hemisphere (hematoma side) were significantly lower than those of the opposite side (p < 0.001). Severe diffuse brain damage confirmed by follow-up CT scans and uncontrollable high intracranial pressure were noted in the fatally injured patients. Brain bulk enlargement following head injury originates from acute brain edema and an increase of cerebral blood volume. In cases of fatal head injury, acute brain edema is the more common cause of brain bulk enlargement and occurs more rapidly than is usually thought.

Pituitary enlargement mimicking pituitary tumor

1985 ◽  
Vol 63 (1) ◽  
pp. 39-42 ◽  
Author(s):  
Larissa T. Bilaniuk ◽  
Thomas Moshang ◽  
Jose Cara ◽  
Martin Z. Weingarten ◽  
Leslie N. Sutton ◽  
...  
Keyword(s):  
Pituitary Gland ◽  
Pituitary Tumor ◽  
Primary Hypothyroidism ◽  
Ct Scans ◽  
Content Type ◽  
Presenting Symptoms ◽  
Pituitary Enlargement ◽  
Work Up ◽  
Fine Print ◽  
Gland Enlargement

✓ Primary hypothyroidism can result in reactive enlargement of the pituitary gland which is indistinguishable from primary pituitary lesions on computerized tomography (CT) scans. The presenting symptoms may be due to pituitary gland enlargement, as in two of the three cases reported here. Therefore, the diagnosis of pituitary hypertrophy or hyperplasia secondary to hypothyroidism must be based on the endocrinological work-up. Following treatment of primary hypothyroidism, the diminution in size of the pituitary gland can be demonstrated with CT.

Progressive hemorrhage after head trauma: predictors and consequences of the evolving injury

2002 ◽  
Vol 96 (1) ◽  
pp. 109-116 ◽  
Author(s):  
Matthias Oertel ◽  
Daniel F. Kelly ◽  
David McArthur ◽  
W. John Boscardin ◽  
Thomas C. Glenn ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ct Scan ◽  
Ct Scanning ◽  
Older Age ◽  
Ct Scans ◽  
Female Ratio ◽  
Content Type ◽  
Male Sex ◽  
Time From Injury ◽  
Fine Print

Object. Progressive intracranial hemorrhage after head injury is often observed on serial computerized tomography (CT) scans but its significance is uncertain. In this study, patients in whom two CT scans were obtained within 24 hours of injury were analyzed to determine the incidence, risk factors, and clinical significance of progressive hemorrhagic injury (PHI). Methods. The diagnosis of PHI was determined by comparing the first and second CT scans and was categorized as epidural hematoma (EDH), subdural hematoma (SDH), intraparenchymal contusion or hematoma (IPCH), or subarachnoid hemorrhage (SAH). Potential risk factors, the daily mean intracranial pressure (ICP), and cerebral perfusion pressure were analyzed. In a cohort of 142 patients (mean age 34 ± 14 years; median Glasgow Coma Scale score of 8, range 3–15; male/female ratio 4.3:1), the mean time from injury to first CT scan was 2 ± 1.6 hours and between first and second CT scans was 6.9 ± 3.6 hours. A PHI was found in 42.3% of patients overall and in 48.6% of patients who underwent scanning within 2 hours of injury. Of the 60 patients with PHI, 87% underwent their first CT scan within 2 hours of injury and in only one with PHI was the first CT scan obtained more than 6 hours postinjury. The likelihood of PHI for a given lesion was 51% for IPCH, 22% for EDH, 17% for SAH, and 11% for SDH. Of the 46 patients who underwent craniotomy for hematoma evacuation, 24% did so after the second CT scan because of findings of PHI. Logistic regression was used to identify male sex (p = 0.01), older age (p = 0.01), time from injury to first CT scan (p = 0.02), and initial partial thromboplastin time (PTT) (p = 0.02) as the best predictors of PHI. The percentage of patients with mean daily ICP greater than 20 mm Hg was higher in those with PHI compared with those without PHI. The 6-month postinjury outcome was similar in the two patient groups. Conclusions. Early progressive hemorrhage occurs in almost 50% of head-injured patients who undergo CT scanning within 2 hours of injury, it occurs most frequently in cerebral contusions, and it is associated with ICP elevations. Male sex, older age, time from injury to first CT scan, and PTT appear to be key determinants of PHI. Early repeated CT scanning is indicated in patients with nonsurgically treated hemorrhage revealed on the first CT scan.

Intracranial cavernous angioma: presentation and management

1986 ◽  
Vol 64 (5) ◽  
pp. 720-723 ◽  
Author(s):  
Patricio Tagle ◽  
Isidro Huete ◽  
Jorge Méndez ◽  
Sergio del Villar
Keyword(s):  
Cerebellopontine Angle ◽  
Unusual Case ◽  
Clinical Presentation ◽  
Ct Scanning ◽  
Cavernous Angioma ◽  
Mass Effect ◽  
Ct Scans ◽  
Content Type ◽  
Neurological Signs ◽  
Fine Print

✓ Thirteen cases of cerebral cavernous angiomas are reported, and their radiological and pathological features are reviewed. The clinical presentation was variable: 53.8% of patients had seizures, 30.8% intracerebral hemorrhage, and 15.4% focal neurological signs, including one unusual case that presented as a cerebellopontine angle tumor. The computerized tomography (CT) scans were abnormal in all cases. Angiography was positive only when there was mass effect due to associated hematoma. Surgery was performed in 12 cases with good results. The prognosis of the 13 cases was favorable, with no mortality in this series. These data suggest that the combination of a recent seizure disorder with a hyperdense intracerebral nodule on the CT scanning should alert the neurosurgeon to the possibility of a cavernous angioma.

Brain abscesses in neonates

1988 ◽  
Vol 69 (6) ◽  
pp. 877-882 ◽  
Author(s):  
Dominique Renier ◽  
Cécile Flandin ◽  
Elizabeth Hirsch ◽  
Jean-François Hirsch
Keyword(s):  
Cerebrospinal Fluid ◽  
Intelligence Quotient ◽  
Ct Scanning ◽  
Ct Scans ◽  
Neonatal Meningitis ◽  
Shunt Complication ◽  
Iq Testing ◽  
Content Type ◽  
Brain Abscesses ◽  
Fine Print

✓ Since the introduction of ultrasonography and computerized tomography (CT) scanning, brain abscesses are found more frequently in cases of neonatal meningitis and septicemia, particularly when the offending pathogen is Proteus. Thirty cases of brain abscess in neonates are reported, 27 of which were caused by Proteus species infections. Twenty infants had meningitis and 13 had septicemia. Most of the abscesses were enormous, and multiple abscesses were observed in 17 cases. The frontal region was involved in 22 cases (12 unilaterally and 10 bilaterally). The ventricles were enlarged on the first CT scan in 13 cases. The abscesses were treated by aspiration and antibiotics in 25 cases, and by antibiotics alone in five. A shunt for hydrocephalus was necessary in 14 infants. Four infants died, three from the initial illness and one from a shunt complication. Sixteen children have seizures. Subsequent intelligence quotient (IQ) testing was performed in 22 children: eight (36%) have an IQ at or above 80 and eight have an IQ of less than 60. In the 17 children followed for more than 2 years, the proportion with an IQ at or above 80 fell to 24% (four cases). The absence of initial seizures, sterile cerebrospinal fluid, normal ventricles on CT scans, and early aspiration of the abscess seem to be factors portending a better prognosis in terms of epilepsy and mental sequelae.

Intracranial tuberculoma and the CT scan

1986 ◽  
Vol 64 (4) ◽  
pp. 568-574 ◽  
Author(s):  
Umesh S. Vengsarkar ◽  
Ramkrishna Prasad Pisipaty ◽  
Bharat Parekh ◽  
Venilal G. Panchal ◽  
Manohar N. Shetty
Keyword(s):  
Ct Scanning ◽  
Mass Effect ◽  
Ct Scans ◽  
Complete Disappearance ◽  
Antituberculous Therapy ◽  
Content Type ◽  
Diagnosis And Management ◽  
Intracranial Tuberculoma ◽  
Serial Ct ◽  
Fine Print

✓ Computerized tomography (CT) has greatly influenced the diagnosis and management of intracranial tuberculomas and has helped us to formulate guidelines for the management of these lesions. Solid and ringenhancing lesions seen on CT scans are diagnostic of tuberculoma if supported by other clinical and ancillary criteria. Conservative management of intracranial tuberculoma is usually indicated because serial CT scans have shown complete disappearance of these lesions with antituberculous therapy. Only lesions associated with raised intracranial pressure and CT evidence of a mass effect should be considered for surgery. Nonresponse to antituberculous therapy, as judged by serial CT scanning, should raise doubts regarding the diagnosis of a tuberculomatous lesion, and therefore such lesions should be subjected to surgery and histopathological confirmation. Representative clinical cases illustrating the principles of diagnosis and management of intracranial tuberculoma with the help of CT scanning are briefly described and discussed.

CT-assisted stereotaxic aspiration of colloid cysts of the third ventricle

1985 ◽  
Vol 62 (2) ◽  
pp. 238-242 ◽  
Author(s):  
Juan J. Rivas ◽  
Ramiro D. Lobato
Keyword(s):  
Computerized Tomography ◽  
Third Ventricle ◽  
Ct Scanning ◽  
Ct Scans ◽  
Content Type ◽  
The Third ◽  
Colloid Cysts ◽  
Reproducible Method ◽  
Inner Diameter ◽  
Fine Print

✓ A technique is reported for the stereotaxic evacuation of colloid cysts of the third ventricle using a stereotaxic system adapted for computerized tomography (CT) scanning. This is an accurate, simple, and reproducible method that avoids the risks of direct approaches. Successful intracystic aspiration resulting in the cure of the patient may be difficult when the viscosity of the cyst contents is high. Thus, the authors use a large cannula (1.8 mm in inner diameter) to evacuate cysts that appear hyperdense on CT scans; these seem to contain a thicker colloid material than hypodense or isodense cysts.

A cervical dural arteriovenous fistula in a patient presenting with radiculopathy

1996 ◽  
Vol 84 (1) ◽  
pp. 119-123 ◽  
Author(s):  
Michihiro Kohno ◽  
Hiroshi Takahashi ◽  
Katsuhisa Ide ◽  
Buichi Ishijima ◽  
Katsuhiro Yamada ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Ct Scanning ◽  
Mass Effect ◽  
Preoperative Embolization ◽  
Venous Plexus ◽  
Content Type ◽  
Embolization Therapy ◽  
Dynamic Ct Scanning ◽  
Fine Print

✓ A 51-year-old man presenting with radiculopathy with a rare cervical dural arteriovenous fistula (AVF) is reported. Angiography revealed that the cervical dural AVF was fed mainly by the left C-3 and C-4 radicular arteries and drained into the internal vertebral venous plexus with no communication with intradural structures. The dural AVF was treated surgically after embolization therapy. Although the AVF showed mass effect on computerized tomography (CT) scanning, abnormal vessels, which were suspected to drain the AVF, were observed intraoperatively to compress the left C-4 and C-5 nerve root sleeves. After resection of these abnormal epidural vessels, monoparesis of the left proximal upper extremity was markedly improved. In this patient, dynamic CT scanning was useful in the initial diagnosis, and the preoperative embolization therapy was very effective.

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