Computerized axial tomography in the detection of brain damage. 2. Epilepsy, migraine, and general medical disorders

The cranial computerized axial tomography (CAT) findings in groups of patients with epilepsy, migraine, hypertension, and other general medical disorders have been reviewed to assess the frequency and patterns of focal and diffuse brain damage. In addition to demonstrating focal lesions in a proportion of patients with seizures and in patients presenting with a stroke, the CAT scan showed a premature degree of cerebral atrophy in an appreciable proportion of patients with long-standing epilepsy, hypertension and diabetes, and in some patients with migraine, valvular and ischaemic, heart disease, chronic obstructive airways disease, and chronic renal failure. The value of CAT as a means of screening for brain damage in groups of individuals at risk is discussed

Computerized tomography in chronic alcoholics

Computerized tomography (CT) has made it possible to study the gross anatomy of the brain during life without significant risks or discomfort to the subject. While its main role has been in the diagnosis of intercranial space-occupying lesions and hydrocephalus, over the past 5 yr the technique has been used increasingly in the diagnostic evaluation and study of patients with vascular, demyelinating and degenerative brain diseases and in the detection of brain damage due to exogenous agents such as alcohol. As a result, CT studies carried out in Australia, Canada, and Europe have shown a high incidence of brain atrophy in chronic alcoholics and have provided important insights into the natural history of alcohol-related brain damag

Nuclear magnetic resonance imaging (NMR) and computerised tomography (CT) in multiple sclerosis

Letter to the Edito

Computed tomography of the brain in multiple sclerosis

The subject of computed tomography has received considerable publicity of late, with the 1979 Nobel prize being awarded to the originators of this technology. In this article, the use of computed tomography as a diagnostic tool is introduced, and the authors' experience in its use in multiple sclerosis is described

Computerized axial tomography in the detection of brain damage: 1. Alcohol, nutritional deficiency and drugs of addiction

The severity and extent of cerebral atrophy was assessed on cranial computerized axial tomographic (CAT) scans in 240 alcoholics in whom this investigation had been performed for diagnostic purposes, and in a group of 59 male heavy social drinkers who were studied prospectively. Findings were compared with those in a group of 115 normal volunteers who were either total abstainers or light infrequent drinkers. Only 12 (5%) of the 240 alcoholics and 20 (33%) of the 59 social drinkers had a normal CAT scan. The remainder all showed a degree of cerebral and/or cerebellar atrophy in excess of that found in the normal subjects in a comparable age bracket. Atrophy was most frequent and most severe in the frontal lobes and superior vermis of the cerebellum, but, in most cases, there was more widespread cerebral and cerebellar cortical atrophy. The CAT scans of four patients with anorexia nervosa, two of whom showed an excessive degree of cerebral cortical atrophy for the patient's age, and of eight young people addicted to heroin, cannabis, lysergic acid or barbiturates, six of whom showed varying degrees of premature cerebral atrophy, were also studied

Computerised tomography findings in multiple sclerosis and Schilder's disease

Computerised tomography of the brain was performed in 95 patients with multiple sclerosis and in a single patient with Schilder's disease. CT of the orbits was also carried out in 53 of these cases to examine the optic nerves. In 51% of the multiple sclerosis cases low density areas compatible with plaques of demyelination were found in the white matter of the cerebral hemispheres, and less frequently in the brain-stem. A much larger area of reduced intensity was found in the occipital white matter in the patient with Schilder's disease. Varying degrees of central and/or cortical cerebral atrophy were found in 45% of the multiple sclerosis patients, the more severe degrees being found in patients with long-standing disease. Serial observations in 15 patients who were examined on more than one occasion are also presented. Small low density areas were identified in one or both optic nerves in 52% of the multiple sclerosis cases. While these may represent demyelinating lesions their significance is uncertain

Computerized axial tomography findings in a group of patients with migrainous headaches

Computerized axial tomography of the cranium has been carried out in 46 patients referred because recurring migrainous headaches. Increasing frequency or severity of headaches or a change in headache pattern were the usual reasons for referral. Abnormalities were found in 37 cases and fell into 4 categories. The most frequent (21 cases) consisted of a mild degree of oedema in the white matter of one or both cerebral hemispheres. This was usually bi-frontal (15 patients) but was more extensive in 2 patients. Varying degrees of cerebral atrophy, as determined by widening of the Sylvian, brain-stem and interhemispheric cisterns, and/or widening of the third and lateral ventricles as compared to a group of normal scans, was found in 8 cases. Areas of occipital infarction were found in 4 patients with permanent visual field defects. Unexpected small areas of infarction were found in the temporal lobe in 2 other cases. Cerebral tumours were found in 2 cases. The significance of these findings is discussed, as well as the possible role of migrainous vaso-spasm with consequent changes in cerebral blood flow in the pathogenesis of oedema and atrophy in migraine subjects

Localisation of stereotactic radiofrequency thalamic lesions by computerised axial tomography

Letter to the Edito

Computerised tomography of the cranium in patients with epilepsy: A preliminary report

The findings are presented in 366 patients with seizures who were studied by computerised tomography of the cranium. The relative frequency of normal scans, cerebral tumours, atrophy and other pathological lesions is indicated. A more detailed analysis of the group of patients with atrophy was carried out. The frequency and severity of atrophy correlated significantly with age but not with length of seizure history. However, the more marked degrees of atrophy were found among patients with long-standing or poorly controlled epilepsy, an observation which has important implications with regard to the adequacy of seizure control in epileptic patients

Computerized tomography of brain and optic nerve in multiple sclerosis

Computerized tomography (CT) of the brain was carried out in 100 patients with established or suspected multiple sclerosis (MS). The optic nerves were also examined in 53 of these patients. Areas compatible with demyelinating lesions were found in the cerebral hemisphere white matter and less frequently in the brain stem in 47% of cases. The hemisphere lesions were commonly multiple, typically situated in the deep white matter and periventricular regions, and were often asymptomatic. Small areas with unduly low attenuation coefficients were found in one or both optic nerves in 52% of patients in whom the optic nerves were examined. While these areas may represent demyelinating lesions their significance remains uncertain in view of poor correlation with clinical and electrophysiological parameters of optic nerve damage. Cerebral cortical atrophy and/or ventricular dilatation was found in 44% of cases, the frequency and severity of atrophy increasing with age and duration of disease. Serial studies after intervals of up to 21 months were performed in 16 patients, providing the opportunity to study the natural history of the cerebral lesions. While in some cases no significant change occurred, in others white matter lesions underwent an increase, or a reduction in size, and in some cases new lesions appeared. In some patients minor degrees of atrophy became apparent over the period of the study. The value of CT in the investigation of patients with suspected MS and as a means of studying the natural history of the disease is discussed