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

✓ 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.

1979 ◽  
Vol 50 (1) ◽  
pp. 64-69 ◽  
Author(s):  
Fong Y. Tsai ◽  
James E. Huprich ◽  
Hervey D. Segall ◽  
James S. Teal

✓ The authors review 29 cases of surgically-proven isodense subdural hematomas examined by non-contrast and contrast-enhanced computerized tomography scans. Three types of isodense collections were noted: homogeneous isodense collections, mixed-density collections, and gravitational layering within subdural collections. Contrast enhancement within the cerebral cortex, cortical vessels, and subdural membranes led to the correct diagnosis in each case. Contrast-enhanced scans are essential for the evaluation of isodense subdural hematomas.


1989 ◽  
Vol 71 (5) ◽  
pp. 639-641 ◽  
Author(s):  
M. Stephen Mahaley ◽  
Edward J. Dropcho ◽  
Linda Bertsch ◽  
Tammy Tirey ◽  
G. Yancey Gillespie

✓ Recombinant beta-interferon in escalating dosages was administered intravenously three times weekly to seven patients with recurrent gliomas. No evidence of response was seen in any patient, either on neurological examination or by computerized tomography (CT). However, stabilization of tumor volume, assessed from contrast-enhanced CT scans, occurred for 8 to 26 weeks in three patients. Immediate progression of disease despite treatment occurred in four patients.


BJS Open ◽  
2021 ◽  
Vol 5 (1) ◽  
Author(s):  
M J Wilkinson ◽  
H Snow ◽  
K Downey ◽  
K Thomas ◽  
A Riddell ◽  
...  

Abstract Background Diagnosis of lymph node (LN) metastasis in melanoma with non-invasive methods is challenging. The aim of this study was to evaluate the diagnostic accuracy of six LN characteristics on CT in detecting melanoma-positive ilioinguinal LN metastases, and to determine whether inguinal LN characteristics can predict pelvic LN involvement. Methods This was a single-centre retrospective study of patients with melanoma LN metastases at a tertiary cancer centre between 2008 and 2016. Patients who had preoperative contrast-enhanced CT assessment and ilioinguinal LN dissection were included. CT scans containing significant artefacts obscuring the pelvis were excluded. CT scans were reanalysed for six LN characteristics (extracapsular spread (ECS), minimum axis (MA), absence of fatty hilum (FH), asymmetrical cortical nodule (CAN), abnormal contrast enhancement (ACE) and rounded morphology (RM)) and compared with postoperative histopathological findings. Results A total of 90 patients were included. Median age was 58 (range 23–85) years. Eighty-eight patients (98 per cent) had pathology-positive inguinal disease and, of these, 45 (51 per cent) had concurrent pelvic disease. The most common CT characteristics found in pathology-positive inguinal LNs were MA greater than 10 mm (97 per cent), ACE (80 per cent), ECS (38 per cent) and absence of RM (38 per cent). In multivariable analysis, inguinal LN characteristics on CT indicative of pelvic disease were RM (odds ratio (OR) 3.3, 95 per cent c.i. 1.2 to 8.7) and ECS (OR 4.2, 1.6 to 11.3). Cloquet’s node is known to be a poor predictor of pelvic spread. Pelvic LN disease was present in 50 per cent patients, but only 7 per cent had a pathology-positive Cloquet’s node. Conclusion Additional CT radiological characteristics, especially ECS and RM, may improve diagnostic accuracy and aid clinical decisions regarding the need for inguinal or ilioinguinal dissection.


1995 ◽  
Vol 82 (6) ◽  
pp. 995-1001 ◽  
Author(s):  
Takehide Onuma ◽  
Yasuko Shimosegawa ◽  
Motonobu Kameyama ◽  
Hiroaki Arai ◽  
Kiyoshi Ishii

✓ The authors have treated five cases of severe head trauma in children in which abnormally high density along gyri, “gyral high density,” was seen on plain computerized tomography (CT) scans in the subacute stage of the injury. The prognosis in all cases was poor, with either severe disability or a vegetative state as the outcome due to significant brain atrophy following gyral high density. This pathology was classified into three clinical stages: 1) acute stage, cerebral ischemia in which there is diffuse low density of the cerebrum on CT scans (most marked on the 3rd and 4th days); 2) subacute stage, hemorrhagic infarction showing gyral high density on plain CT scans (between 1 and 4 weeks); and 3) chronic stage, brain atrophy (beginning 4 weeks after the trauma). In their consecutive series of head-injured patients (516 children, 1459 adults), the authors did not find gyral high density on CT scan in adults. This is probably due to the fact that adults who suffer the severe head trauma associated with diffuse brain swelling or diffuse brain edema cannot survive, thus making this gyral high density unique to children.


1995 ◽  
Vol 82 (5) ◽  
pp. 726-738 ◽  
Author(s):  
Shoji Asari ◽  
Tomohide Maeshiro ◽  
Susumu Tomita ◽  
Masamitsu Kawauchi ◽  
Nobuyoshi Yabuno ◽  
...  

✓ Meningiomas arising from the falcotentorial junction are extremely rare. The authors describe the clinical features, neuroimaging studies, and results of surgical treatment of meningiomas of the falcotentorial junction and clarify the characteristics of this lesion based on a review of the literature and seven patients treated at their institution. The most common symptoms resulted from intracranial hypertension. Upward-gaze palsy appeared in only one patient. Computerized tomography (CT) showed no specific findings, but there was no evidence of edema around the tumor. Magnetic resonance (MR) imaging revealed a round, smooth-bordered mass with a peritumoral rim, without edema, and showing marked contrast enhancement. The multiplanar capability of MR imaging delineated the relationship between the tumor and adjacent structures better than did CT. Detailed knowledge of the vascular structures, especially evidence of occlusion of the galenic venous system and the development of collateral venous channels, is critical for successful surgery; stereoscopic cerebral angiography is necessary to achieve this aim. The seven patients described developed five types of collateral venous channels: through the basal vein of Rosenthal to the petrosal vein, through the veins on the medial surface of the parietal and occipital lobes to the superior sagittal sinus, through superficial anastomotic veins, through veins of the posterior fossa to the transverse or straight sinus, and through the falcian veins to the superior sagittal sinus. The first three types mainly developed after occlusion of the galenic system. The tumors were removed through the occipital transtentorial approach with a large window at the posterior part of the falx. A favorable prognosis for patients undergoing surgical treatment of falcotentorial junction meningiomas can be expected if detailed neuroimaging studies and microsurgical techniques are used.


1984 ◽  
Vol 60 (2) ◽  
pp. 424-427 ◽  
Author(s):  
Takeshi Hasegawa ◽  
Haruhide Ito ◽  
Katsuo Shoin ◽  
Yuzaburo Kogure ◽  
Toshihiko Kubota ◽  
...  

✓ 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.


1987 ◽  
Vol 67 (6) ◽  
pp. 919-922 ◽  
Author(s):  
Shobu Shibata ◽  
Kazuo Mori

✓ Intracerebral cavernous hemangiomas are relatively easy to remove surgically, but extracerebral cavernous hemangiomas attached to the cavernous sinus are extremely difficult to treat. The authors report three cases of extracerebral cavernous hemangioma in the middle fossa that were treated with radiotherapy. The follow-up studies with serial computerized tomography (CT) scans during and after irradiation are described. In Case 1 radiotherapy after partial removal of the tumor decreased the tumor size on the contrast-enhanced CT scans, reduced its Hounsfield units on the nonenhanced CT scans, and facilitated later total tumor removal. In Case 2 the tumor responded to irradiation with approximately 3000 rads, showing significant reduction in size and Hounsfield units of the tumor. Subtotal removal was then possible. In Case 3 the tumor responded to irradiation, and the patient's vertigo improved after delivery of approximately 3000 rads. The CT scan showed significant reduction in the size and Hounsfield units of the tumor. No surgical intervention was deemed necessary. It is concluded that, in cases of extracerebral cavernous hemangioma with massive hemorrhage, irradiation with up to 3000 rads may be the treatment of choice. Radiation therapy offers an increased probability of total removal of the tumor and the possibility of eliminating surgery.


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