PURPOSE: To determine the relation between characteristic findings of hepatic arteriography and nontumorous perfusion defects which on CT arterioportography (CTAP) had been inadequately described. MATERIALS AND METHODS: To identify pseudolesions, the CTAP results of 46 patients with perfusion defects which were not recognized on conventional CT or ultrasonography were reviewed and compared with MRI, iodized-oil CT, surgical findings, and histopathologic reports. Typical and atypical pseudolesions were divided according to location, shape and cause, as revealed in previous reports. The number, shape and the location of pseudolesion seen on CTAP were determined and hepatic arteriography correlatively reviewed to determine vascular change in the corresponding area. RESULTS: Seventy-two additional lesions of 46 patients were detected. Among these, 12 cases were true lesions. Sixty pseudolesions were divided into typical (n = 18) and atypical (n = 42) ; the typical pseudolesions were found in familiar locations adjacent to the porta hepatis, falciform ligament or gall bladder and except for increased vascular staining around the gall bladder in two lesions, specific vascular changes were not seen. The shapes of the atypical pseudolesion were wedged (n = 22), nodular (n = 15) and flat (n = 5). They were located subcapsularly (n= 30) or nonspecifically within liver parenchyma (n = 12). The early appearance of a small portal vein branch with subsequent focal hepatic parenchymal staining, which suggests a small AP shunt, was identified on the hepatic arteriography, and on CTAP matched the areas of 96% atypical pseudolesions (26/34) which were more than 1cm in size. CONCLUSION: A small AP shunt should be regarded as a cause of nontumorous, nonsegmental perfusion defectson CTAP.
Angiography* ; Humans ; Ligaments ; Liver* ; Magnetic Resonance Imaging ; Perfusion* ; Portal Vein ; Portography* ; Ultrasonography ; Urinary Bladder

No abstract available.
Craniocerebral Trauma* ; Head* ; Hematoma*

No abstract available.
Frontal Bone* ; Humans

BACKGROUND: Pontine infarction extending to the basal surface has been reported to possess different characteristics from deep pontine infarction without extending to the basal surface. METHODS AND RESULTS: We studied 54 patients ; 30 patients with pontine infarction extending to the basal surface (group SE) and 24 patients with deep pontine infarction without extension (group DL) based on the site of the infarcts on precontrast sagittal T2WI. We assessed angiographic findings(MRA, 54; DSA, 31), risk factors, clinical features and the effectiveness of the intraluminal signal changes on spin-echo MRI in the diagnosis of occlusion or stenosis of the basilar artery. The incidence of basilar artery stenosis or occlusion in MRA or DSA in group SE(60%) was significantly more frequent than group DL(12.5%), whereas the incidence of vertebral artery stenosis or occlusion was not different between two groups. A noteworthy finding was that five patients (17%) of the group SE had not been extended to the basal surface on axial T2WI. The risk factors were similarly distributed between the two groups. The effectiveness of abnormal signal void of axial MRI was poor in the diagnosis of basilar artery occlusion or stenosis. CONCLUSIONS: Our results suggest that the two types of pontine infarction may be caused by different arterial pathology. Although the presence of abnormal flow void on MRI cannot predict the stenosis or occlusion of basilar artery, sagittal T2WI and angiographic study help to evaluate the patients with pontine infarction.
Basilar Artery* ; Constriction, Pathologic ; Diagnosis ; Humans ; Incidence ; Infarction* ; Magnetic Resonance Imaging ; Pathology ; Risk Factors ; Vertebrobasilar Insufficiency

Rhino-orbito-cerebral mucormycosis is an uncommon fulminant fungal infection that occurs usually in debilitated or immune suppressed patients. Intracranial lesions such as cerebral ischemia mostly develop secondary to vascular injuries like thrombosis of cavernous sinus or internal carotid artery and also from arteritis. However, intracranial hemorrhage complicated by mucormycosis is very rare. We report a patient with a fatal complicaton of intracranial hemorrhage presumably due to arteritis by mucormycosis. A 66-year-old female patient with uncontrolled diabetes mellitus developed complete ophthalmoplegia in her left eye for two days. Rhinoscopic examination revealed black necrotic turbinate. Orbital CT scan and Brain MRI showed soft tissue material at the left orbital apex and mild deformities in the left lateral cavernous sinus. On the basis of radiological evidence and biopsy, a diagnosis of mucormycosis was established, and the patient underwent surgical debridement followed by an Amphotericin B infusion. On the following day, she suddenly developed a right hemiparesis and stupor. An immediate brain CT scan revealed a large intracranial hemorrhage in the left frontal head region. Removal of the hematoma and a biopsy was performed immediately. A pathological examination revealed a fungal invasion of the small arterial wall and an acute inflammatory reaction of the surounding tissues.
Aged ; Amphotericin B ; Arteritis ; Biopsy ; Brain ; Brain Ischemia ; Carotid Artery, Internal ; Cavernous Sinus ; Congenital Abnormalities ; Debridement ; Diabetes Mellitus ; Diagnosis ; Female ; Head ; Hematoma ; Humans ; Intracranial Hemorrhages* ; Magnetic Resonance Imaging ; Mucormycosis* ; Ophthalmoplegia ; Orbit ; Paresis ; Stupor ; Thrombosis ; Tomography, X-Ray Computed ; Turbinates ; Vascular System Injuries

BACKGROUND: Periventricular white matter changes(PVWC) in chronic cerebrovascular disease are regarded to be caused by chronic low perfusion and as forms of small arterial disease of cerebral circulation. In some reports, these are suggested to be concerned with the fluctuation of blood pressure. The purpose of this study was to elucidate the diurnal pattern of BP in chronic cerebrovascular disease and the relationship between severity of PVWC and decrement of nocturnal dip through the ambulatory 24 hour blood pressure monitoring (ABPM). Subjects and METHODS: ABPM were carried out every 30 minutes in 36 patients with chronic cerebrovascular disease, prospectively. Twenty-five had PVWCS and/or multiple lacunar infarction (MLI) with various grades, 11 had large artery territorial infarction (LATI) without PVWC. The patterns of ABPM in each group were analyzed by disease entity and severity of PVWC. RESULTS: There was no differences in the two groups; PVWC/MLl and LATI, in properties(age, sex, etc.) and possible stroke risk factors (hypertension, diabetes mellitus, hypercholesterolemia, smoking, etc.) (P<.05). The pattern of ABPM of PVWC/MLl group showed the decrement of nocturnal dip of BP unlike LATI group (P<.05). The decrement of nocturnal dip of BP correlated with severity of PVWC (P<.05). CONCLUSION: We conclude that the diurnal pattern of BP in small artery disease is different from that of large arterial disease group and related to the severity of PVWC.
Arteries ; Blood Pressure Monitors* ; Blood Pressure* ; Diabetes Mellitus ; Humans ; Hypercholesterolemia ; Infarction ; Perfusion ; Prospective Studies ; Risk Factors ; Smoke ; Smoking ; Stroke ; Stroke, Lacunar

It is generally agreed that a small hematoma can be treated conservatively, whereas a larger one requires aggressive surgery; the surgical indication for those that are medium-sized remains controversial. To determine the criteria for conservative or surgical management, the authors analyzed 64 cases of spontaneous cerebellar hemorrhage diagnosed by CT scan between January 1990 and May 1996. An assessment was made of the relationship of initial GCS(Glasgow Coma Scale) score and GOS(Glasgow Outcome Scale) to hypertension, the location and size of the hematoma, obstructive hydrocephalus, intraventricular hemorrhage and the CT appearance of the quadrigeminal cistern. The results may be summarized as follows: 1) The incidence of spontaneous cerebellar hemorrhage was 6.37%(64/1005 spontaneous intracerebral hemorrhage). 2) The location of hematoma and hypertension did not correlated with initial GCS and GOS(p>0.05, p>0.05). 3) Obstructive hydrocephalus, intraventricular hemorrhage and obliteration of the quadrigeminal cistern correlated with intial GCS and GOS(p<0.01, p<0.001). 4) In case of spontaneous cerebellar hemorrhage, the mortality rate was 17.2%(11/64). 5) Poor prognostic factors were initial GCS score of less than 10(p<0.05), hematoma volume greater than 15 ml (p<0.01), the occurrance of intraventricular hemorrhage(p<0.05), and obliteration of the quadrigeminal cistern(p<0.001).
Coma ; Glasgow Coma Scale ; Glasgow Outcome Scale ; Hematoma ; Hemorrhage* ; Hydrocephalus ; Hypertension ; Incidence ; Mortality ; Tomography, X-Ray Computed

Among 1350 craniocerebral trauma patients treated between January 1992 and December 1995. The authors analyzed 25 who had suffered combined head and spine trauma and had been subject to follow up. The ratio of males to females was 4 : 1 ; their ages ranged from less than twenty to over sixty. As clinical parameters, we use of the Glasgow Coma Scale(GCS), Revised Trauma Score(RTS) and Glasgow Outcome Scale(GOS) at discharge, and for clinical statistics, used the chi-square test. The results of the study were as follows : 1) Among craniocerebral trauma patients, the incidence of combined head and spine trauma was 2%(25/1350). 2) In cases with combined craniospinal trauma, the incidence of intracranial hemorrhage and cervical spine injury was 76% and 68%, respectively. 3) Among cases with spinal injury, head trauma combined with cervical spine injury showed the worst outcome (p<0.05). 4) Combined high cervical spine injury showed a poorer outcome than did lower cervical spine injury(p<0.05). 5) Initial GCS was significantly related to initial RTS(p<0.05). 6) At discharge, there was a very highly significant correlation between initial GCS and GOS(p<0.01), but not between initial RTS and GOS(p<0.081). 7) Especially in patients who are unconscious because of head trauma, it is important to investigate the possibility of spinal injury other than that of at cervical level.
Coma ; Craniocerebral Trauma ; Female ; Follow-Up Studies ; Head* ; Humans ; Incidence ; Intracranial Hemorrhages ; Male ; Spinal Injuries ; Spine*

Cerebrovascular lesions during pregnancy, although uncommon, account for a significant number of maternal deaths. Maternal mortality related to stroke is usually associated with eclampsia complicated by cerebral edema or intracerebral hemorrhage. At times, hypertensive intracerebral hemorrhage, cerebral arteriovenous malformation, and moyamoya disease may also be related. Nine patients with cerebrovascular disease during pregnancy were reviewed. The mean age of pregnancy related hypertensive intracerebral hemorrhage was 32.1+/-6.6years and the time of attack was intrauterine pregnancy(IUP) 27.2+/-13.8 weeks. The basal ganglia hemorrhage was noted in 55.5%(5 ca-ses), followed by intraventricular hemorrhage(IVH)(4 cases) and subcortical hemorrhage(3 cases). The pregnancy related hypertensive intracerebral hemorrhage was developed more often in multigravida(6 out of 9) than in priemiparous woman. Good outcome was expected in patients with subcortical location(p=0.058), primigravida(p=0.058), and high initial GCS score(p=0.056).
Basal Ganglia Hemorrhage ; Brain Edema ; Cerebral Hemorrhage ; Eclampsia ; Female ; Humans ; Intracranial Arteriovenous Malformations ; Intracranial Hemorrhage, Hypertensive ; Maternal Death ; Maternal Mortality ; Moyamoya Disease ; Pregnancy* ; Stroke

The solitary fibrous tumor, of rare mesodermal origins, primarily affects the pleura and occasionally occursin the peritoneum and at nonserosal sites. Although this is a pathologically well established entity, it isfrequently confused radiologically and pathologically with other tumors of mesenchymal origin. We report one case of a solitary fibrous tumor in the retroperitoneum. The 15X10X7cm mass, lacated in the left perirenal space just above the left kidney, had relatively homogeneous consistency and was well-delineated from surrounding organs inCT and MR images. It showed intense, gradual, centripetal enhancement during dynamic scans, and partially unenhanced areas which matched the high signal intensity portions in T2 weighted MR images, pathologically correlated to myxoid degeneration. Although not specific, when a large, well-delineated mass of strong contrast enhancement with lack of massive necrosis is encountered, solitary fibrous tumor must be included in the differential diagnosis of a refroperitoneal soft tissue mass.
Diagnosis, Differential ; Fibroma ; Kidney ; Mesoderm ; Necrosis ; Peritoneum ; Pleura ; Solitary Fibrous Tumors*