Ciamexone in endocrine orbitopathy. A randomized double-blind, placebo-controlled study.

Abstract The influence of ciamexone on the activity and course of endocrine orbitopathy was investigated. Fifty-one patients with active orbitopathy classes II-VI were allocated randomly to two groups: over a period of six months, 26 patients received 300 mg/day ciamexone and 25 patients received placebo tablets. In both groups, prednisolone was administered in addition in the first four weeks. Ophthalmological investigations and clinical tests as well as orbit sonography were carried out before as well as one, three and six months after the beginning of therapy. Before and after treatment, computer tomography of the orbit was performed. Symptoms and signs did not show any significant impro…

How angioarchitecture of cerebral arteriovenous malformations should influence the therapeutic considerations.

PURPOSE To evaluate the angioarchitectural criteria of complex cerebral arteriovenous malformations (AVMs), concerning the risk of hemorrhage and therapy planing. METHODS The magnetic resonance (MR) imaging and neuroangiographic findings of 227 AVMs (223 patients) were retrospectively evaluated. Statistical analysis was used to define the relative frequency of these lesions for hemorrhage in correlation with various parameters (i.e. age of the patient, size, location, associated aneurysms). RESULTS Onset of symptoms was between 21 and 40 years of age in 50% of cases. The ratio of centrally to convexially located lesions was 1:2. Convexial AVMs are classified by MR imaging into sulcal and gy…

Neuroimaging of Visual Pathway Pathology

Magnetic resonance imaging in juvenile Canavan disease

We present a 2-year-old boy and a 6-year-old girl with mild Canavan disease (CD). Aspartoacylase activity in skin fibroblasts was deficient. Magnetic resonance imaging (MRI) of the brain did not show the prominent leucodystrophy previously reported in CD, but there was a hyperintense signal from the lentiform nuclei and the heads of the caudate nuclei on the T2-weighted MR images. This suggests a specific vulnerability of the corpus striatum in these patients. In the older patient, the white matter became affected at the age of 6 years. Proton magnetic resonance spectroscopy (1H-MRS) of white matter revealed a normal concentration of N-acetyl-L-aspartate (NAA) and a markedly decreased conce…

Anatomy of the visual system

This brief systemic overview presents the anatomic details of the orbit with respect to imaging modalities CT and MR. The structures of the four orbital compartments, intrakonal and extrakonal space, globe and optic nerve are demonstrated in detail on different CT and MR views (axial, coronal, in soft tissue and bone window, T1-weighted, T2-weighted) with corresponding diagrams. The intracranial visual pathway is explained in detail with emphasis to the striate cortex and extrastriate visual association cortex, presented with diagrams and high-resolution MR.

Neuropathology of Cerebellar Infarction: Its Morphology in Comparison to Selective Postmortem Angiography of Cerebellar Arteries

A typology of infarctions [11, 20] is established for the cerebral hemispheres and has recently also been used, chiefly in neuroradiological diagnosis, for cerebellar infarctions [2–5, 8, 10, 16]. Detailed clinical [12] and microangiographic [7, 9, 13, 15, 17] investigations of the vascularization of the posterior cranial fossa can be referred to in this context. With the aid of selective postmortem angiograms we examined the territories of the superior cerebellar artery (SCA), anterior inferior cerebellar artery (AICA), and posterior inferior cerebellar artery (PICA) on serial sections in the three planes of projection. The sagittal plane offers decisive advantages for assigning cerebellar…

Intracranial pathology of the visual pathway.

Intracranial pathologies involving the visual pathway are manifold. Aligning to anatomy, the most frequent and/or most important extrinsic and intrinsic intracranial lesions are presented. Clinical symptoms and imaging characteristics of lesions of the sellar region are demonstrated in different imaging modalities. The extrinsic lesions mainly consist of pituitary adenomas, meningeomas, craniopharyngeomas and chordomas. In (asymptomatic and symptomatic) aneurysms, different neurological symptoms depend on the location of aneurysms of the circle of Willis. Intrinsic tumors as astrocytoma of any grade, ependymoma and primary CNS-lymphoma require the main pathology in the course of the visual …

The preoperative assessment of stroke risk in lesions involving the internal carotid artery.

Patients with vascular or tumourous lesions involving the internal carotid artery are at risk of damage or occlusion of this vessel during surgical or endovascular procedures. To assess the stroke risk transcranial Doppler aided carotid compression tests were performed in 82 patients. Based on changes of blood flow velocity (BFV), pulsatility index, systolic/diastolic ratio and length of transient hyperaemic response three groups could be differentiated. Patients in group A (31%) showed only a slight reaction of BFV and were at minimal risk in case of carotid occlusion. Patients in group B (52%) underwent a distinct decrease of Doppler readings with partial improvement and were considered t…

Psychic Stress as a Trigger of the Spontaneous Development and Rupture of an Aneurysm?: A Case Report

We present angiographical and neuropathological data of a 51-year-old woman, who primarily suffered from a recurrent glomus tempo-rale tumour on the left side and who finally died after a spontaneous rupture of a distal basilar aneurysm which developed during angiography. As a second important finding the existence of a vasospasm at the time of the rupture is also confirmed.

Reflexions about imaging technique and examination protocol

Computed tomography as imaging technique is established since decades, especially in examinations of the orbit. New technical development of multi-slice helical CT requires new attention, concerning radiation burden. Always asked is the use of contrast material in orbital examination. Indications and contraindications are discussed.