BACKGROUND AND OBJECTIVES: Otogenic cerebrospinal fluid (CSF)fistula referrs to the abnormal communication between the CSF and the middle ear space due to defects in the inner ear, and is one of the causes of recurrent meningitis. MATERIALS AND METHODS: We report on five children with congenital otogenic CSF fistula, presented by recurrent meningitis and confirmed by surgical exploration. We also propose diagnostic steps for detecting otogenic fistula in the children based on our experiences and paper review. RESULTS: We used the metrizamide CT in the diagnostic procedure for most cases, although not all. The temporal bone CT was an useful initial diagnostic step for clinically suspicious cases. CONCLUSION: No one test or combination of specific tests were found to accurately predict the presence or absence of CSF fistula. It is thought that the only way to diagnose the CSF fistula is by surgical exploration. If the CSF fistula was suspected, aggressive diagnostic evaluation was needed in order to prevent recurrence.
Cerebrospinal Fluid ; Child* ; Diagnosis* ; Ear, Inner ; Ear, Middle ; Fistula* ; Humans ; Meningitis* ; Metrizamide ; Recurrence ; Temporal Bone

Meningeal irritation signs sometimes develop after myelography due to bacterial infection by contamination during the procedure or chemical irritiation by contrast media itself. CSF profiles of chemical meningitis often mimick those of bacterial meningitis, sometimes causing difficulty in differentiation, but in that case clinical course soon reverse in short time without any complication. Postmyelography chemical meningitis by metrizamide (AmipaqueR) has been well described but iohexol (OmnipaqueR) has rarely been reported to cause chemical meningitis. We experienced a patient of chemical meningitis by iohexol and here descibe the case.
Bacterial Infections ; Contrast Media ; Humans ; Iohexol ; Meningitis* ; Meningitis, Bacterial ; Metrizamide ; Myelography*

The normal volume hydrocephalus is a serious, late complication of cerebrospinal fluid shunting procedures. It is characterized by persistent symptoms of headaches, vomiting and/or lethargy in shunted patients and is associated with normal-sized or slightly decreased ventricles. The subependymal gliosis that has been described in experimental and human hydrocephalus was offered as an explanation for the increased elastance in this condition. This 21-yearold male was shunted at 13 years of age for hydrocephalus secondary to pineal gland tumor. He remained asymptomatic for approximately 7 years before admission, when headaches and vomiting developed. A brain CT showed nearly normal-sized ventricles and spinal tapping documented elevated intracranial pressure (300mg CSF). A metrizamide shuntgram suggested obstruction of distal abdominal shunt catheter. After a revision of the distal shunt catheter, the patient became asymptomatic. On follow-up brain CT, no significant decrease in ventricle size was noted.
Brain ; Catheters ; Cerebrospinal Fluid Shunts ; Follow-Up Studies ; Glioma, Subependymal ; Headache ; Humans ; Hydrocephalus* ; Intracranial Hypertension ; Lethargy ; Male ; Metrizamide ; Pinealoma ; Spinal Puncture ; Vomiting

The authors report four cases of thoracic spinal canal stenosis caused by thickening of the laminar arch, facet joint and ligamentum flavum. Main symptoms of this disease are gait disturbance and spastic motor seakness, numbness of both legs and feet. Metrizamide myelogram, CT and MRI are most useful diagnostic tools. Sufficient postetior decompressive laminectomy and medial facetectomy are treatment of choice and resulting in satisfactory improvement in 3 patients with fair course in 1 case.
Constriction, Pathologic* ; Foot ; Gait ; Humans ; Hypesthesia ; Laminectomy ; Leg ; Ligamentum Flavum ; Magnetic Resonance Imaging ; Metrizamide ; Muscle Spasticity ; Spinal Canal* ; Spinal Cord Diseases ; Spinal Stenosis ; Zygapophyseal Joint

The authers report a case of spontaneous lumbar epidural hematoma in a 16-year-old boy who developed lumbago, paraparesis and gait disturbance over a six-day period. Metrizamide myelography and CT demonstrated the extradural mass lesion at the L3-4 level. MRI revealed a hyperintense mass on T1-weighted and T2-weighted sequences and it enabled to make diagnosis of epidural hematoma. The patient had full postsurgical recovery. We concludes MRI is the most helpful diagnosis modality for spinal epidural hematoma.
Adolescent ; Decompression, Surgical ; Diagnosis ; Gait ; Hematoma* ; Hematoma, Epidural, Spinal ; Humans ; Low Back Pain ; Magnetic Resonance Imaging ; Male ; Metrizamide ; Myelography ; Paraparesis

Hypertrophied ligamentum flavum is not a common cause of myelopathy. Only a minority of cases in the previous reports of myelopathy or radiculopathy secondary to thickening of the ligamentum f lavum had calcification of the ligamentum. We report two cases of thoracic myelopathy caused by ossified ligamentum flavum. One case was a twenty-five year old female who complained of weakness of lower limbs. The other was a fifty-three year old male who complained of tingling sensation on both lower extremities and weakness of right leg. These two patients showed weakness of lower extremities associated with hypesthesia below the level of calcified ligamentum flavum, positive ankle clonus, extensor plantar response, and hyperreflexia. Magnetic resonance imaging (MRI) showed clearly the spinal cord compression at the second to fourth thoracic level by a low-intensity-signal lesion. Metrizamide myelography with computerized tomography showed precise preoperative diagnosis and anatomic localization of the lesion. About one month after laminectomy and removal of the ossified ligaments flava, there was improvement of weakness, hypesthesia and ankle clonus.
Ankle ; Diagnosis ; Female ; Humans ; Hypesthesia ; Laminectomy ; Leg ; Ligaments ; Ligamentum Flavum* ; Lower Extremity ; Magnetic Resonance Imaging ; Male ; Metrizamide ; Myelography ; Radiculopathy ; Reflex, Abnormal ; Reflex, Babinski ; Sensation ; Spinal Cord Compression ; Spinal Cord Diseases*

For evaluating the lumbar disc space, the fact that the postmyelography computed tomography was more accurate than computed tomography or myelography is well-known. But the technical difficulty is limitation of gantry angle. The prone position scanning may help to lessen this trouble. A prospective computed tomographic scanning was performed in both the prone and supine position on 43 patients, who had low back pain. The angle between the vertebral end plate and vertical line was measured in both position at L3-4, L4-5 and L5-S1 interspaces. The advantages of prone scanning in spinal aligment was noted at L5-S1 disc space(79.1%) and also more desirable if computed tomography was performed with metrizamide. With above advantages, the evaluation of bulging annulus was became more easier.
Humans ; Low Back Pain ; Metrizamide ; Myelography ; Prone Position* ; Prospective Studies ; Spine* ; Supine Position

Ossification of ligamentum flavum is a very rare disease and one of the new disease entities in myelopathy. We report three cases of ossification of ligamentum flavum in thoracic spine causing thoracic myelopathy. Main symptoms of this disease are numbness of both legs and feet, gait disturbance and spastic motor weakness. Simple spine X-ray, metrizamide myelogram, CT and MRI are most useful diagnostic tools. Sufficient decompressive laminectomy and facetectomy are treatment of choice.
Foot ; Gait ; Hypesthesia ; Laminectomy ; Leg ; Ligamentum Flavum* ; Magnetic Resonance Imaging ; Metrizamide ; Muscle Spasticity ; Rare Diseases ; Spinal Cord Diseases* ; Spine

The authors report three cases of ossification of ligamentum flavum causing thoracic myelopathy. The symptoms of all cases were numbness in the legs and feet and motor weakness. Preoperative diagnosis were simple spine X-ray, metrizamide CT and magnetic resonance imaging. There was satisfactory improvement in all cases after total laminectomy and medial facetectomy.
Diagnosis ; Foot ; Hypesthesia ; Laminectomy ; Leg ; Ligamentum Flavum* ; Magnetic Resonance Imaging ; Metrizamide ; Spinal Cord Diseases* ; Spine

This report describes five cases of cerebrospinal fluid(CSF) rhinorrhea which were caused by head injury in four cases and developed after surgical removal of brain tumor in one case. Intrathecally-enhanced brain computerized tomography(CT) with metrizamide, in addition to isotope cisternography, was helpful in localization of the CSF leakage site. All five cases which could not be managed conservatively were successfully repaired by surgical means using biological fibrin glue.
Brain ; Brain Neoplasms ; Cerebrospinal Fluid Rhinorrhea* ; Cerebrospinal Fluid* ; Craniocerebral Trauma ; Fibrin Tissue Adhesive ; Metrizamide