Tension Pneumocephalus with Diplegia and Deterioration of Consciousness

Tension pneumocephalus results from intracranial air under pressure as a rare complication after head injury or craniofacial surgery. A 58-year-old man underwent ethmoid sinus surgery and subsequently developed rapidly progressive global headache, restlessness, diplegia with sensory loss, and deterioration of the conscious level. A head CT demonstrated extensive pneumocephalus with gross compression of the brain. The frontal retention of air caused widening of the interhemispheric fissure leading to a peaked appearance of the frontal poles, referred to as the ‘Mount Fuji sign’. Surgical revision of a dural air leak resulted in rapid improvement and full clinical resolution. Early diagnosis of tension pneumocephalus and emergent surgical treatment are crucial to prevent life-threatening deterioration

Structural Olfactory Nerve Changes in Patients Suffering from Idiopathic Intracranial Hypertension

BACKGROUND: Complications of idiopathic intracranial hypertension (IIH) are usually caused by elevated intracranial pressure (ICP). In a similar way as in the optic nerve, elevated ICP could also compromise the olfactory nerve system. On the other side, there is growing evidence that an extensive lymphatic network system around the olfactory nerves could be disturbed in cerebrospinal fluid disorders like IIH. The hypothesis that patients with IIH suffer from hyposmia has been suggested in the past. However, this has not been proven in clinical studies yet. This pilot study investigates whether structural changes of the olfactory nerve system can be detected in patients with IIH. METHODOLOGY/PRINCIPAL FINDINGS: Twenty-three patients with IIH and 23 matched controls were included. Olfactory bulb volume (OBV) and sulcus olfactorius (OS) depth were calculated by magnetic resonance techniques. While mean values of total OBV (128.7±38.4 vs. 130.0±32.6 mm(3), p=0.90) and mean OS depth (8.5±1.2 vs. 8.6±1.1 mm, p=0.91) were similar in both groups, Pearson correlation showed that patients with a shorter medical history IIH revealed a smaller OBV (r=0.53, p<0.01). In untreated symptomatic patients (n=7), the effect was greater (r=0.76, p<0.05). Patients who suffered from IIH for less than one year (n=8), total OBV was significantly smaller than in matched controls (116.6±24.3 vs. 149.3±22.2 mm(3), p=0.01). IIH patients with visual disturbances (n=21) revealed a lower OS depth than patients without (8.3±0.9 vs. 10.8±1.0 mm, p<0.01). CONCLUSIONS/SIGNIFICANCE: The results suggest that morphological changes of the olfactory nerve system could be present in IIH patients at an early stage of disease

Reduction of claustrophobia during magnetic resonance imaging: methods and design of the "CLAUSTRO" randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Magnetic resonance (MR) imaging has been described as the most important medical innovation in the last 25 years. Over 80 million MR procedures are now performed each year and on average 2.3% (95% confidence interval: 2.0 to 2.5%) of all patients scheduled for MR imaging suffer from claustrophobia. Thus, prevention of MR imaging by claustrophobia is a common problem and approximately 2,000,000 MR procedures worldwide cannot be completed due to this situation. Patients with claustrophobic anxiety are more likely to be frightened and experience a feeling of confinement or being closed in during MR imaging. In these patients, conscious sedation and additional sequences (after sedation) may be necessary to complete the examinations. Further improvements in MR design appear to be essential to alleviate this situation and broaden the applicability of MR imaging. A more open scanner configuration might help reduce claustrophobic reactions while maintaining image quality and diagnostic accuracy.</p> <p>Methods/Design</p> <p>We propose to analyze the rate of claustrophobic reactions, clinical utility, image quality, patient acceptance, and cost-effectiveness of an open MR scanner in a randomized comparison with a recently designed short-bore but closed scanner with 97% noise reduction. The primary aim of this study is thus to determine whether an open MR scanner can reduce claustrophobic reactions, thereby enabling more examinations of claustrophobic patients without incurring the safety issues associated with conscious sedation. In this manuscript we detail the methods and design of the prospective "CLAUSTRO" trial.</p> <p>Discussion</p> <p>This randomized controlled trial will be the first direct comparison of open vertical and closed short-bore MR systems in regards to claustrophobia and image quality as well as diagnostic utility.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov: <a href="http://www.clinicaltrials.gov/ct2/show/NCT00715806">NCT00715806</a></p

Evaluation neuer radiologischer Bildgebungstechniken in der otologischen Diagnostik

Die Optimierung der Akquisitionstechniken führte zu einer verbesserten Abgrenzbarkeit klinisch relevanter Bilddetails und war gleichzeitig Voraussetzung für die Erzeugung bildqualitativ hochwertiger dreidimensionaler Bildrekonstruktionen. Die Kombination aus hochauflösenden Akquisitionstechniken und der dreidimensionalen Visualisierung mittels Volume Rendering ermöglichte die nicht-invasive endoluminale Darstellung im Sinne einer virtuellen Oto- bzw. Neuroendoskopie. Trotz weitgehender Übereinstimmung zwischen der realen und virtuell dargestellten Pathomorphologie ossikulärer Strukturen in der Mittelohr-Bildgebung zeigten sich methodische Limitationen in der Erfassung der Pathophysiologie. Die 3D-Bildgebung des Innenohrs gewährleistete eine detaillierte Darstellung pathoanatomisch komplexer Veränderungen und erlaubte dadurch Rückschlüsse auf die Pathogenese. Insbesondere in der Bildgebung des Mittelohrs und Kleinhirn-Brückenwinkels erwiesen sich die virtuell-endoskopischen Ansichten als komplementäre Darstellungstechniken, deren Ergebnisse im Zusammenhang mit den primären Schnittbilddaten und den klinischen Untersuchungsergebnissen zu interpretieren sind. Prospektiv ist aufgrund neuer Gerätetechnologien in der Bilddaten-Erfassung (z.B. 16-Schicht-Spiral-CT) sowie höheren Rechnerleistungen in der Daten-Nachverarbeitung von einer zunehmenden Verbreitung dreidimensionaler Bildgebungstechniken auszugehen.Optimized data acquisition resulted in an improved delineation of critical image elements and was a prerequisite for generating 3D reconstructions of high image quality. Combining high-resolution data acquisition and 3D visualization by means of volume rendering allowed for the noninvasive endoluminal assessment known as virtual oto- and neuroendoscopy. Despite a high degree of agreement between the intraoperatively verified ossicular pathomorphology and that visualized by virtual otoscopy in middle ear imaging methodological limitations were encountered with respect to pathophysiological evaluation. 3D imaging provided detailed views of even complex pathoanatomical conditions, thus permitting conclusions regarding the underlying pathogenesis. As far as imaging of the middle ear and cerebellopontine angle was concerned, virtual endoscopic views proved to be complementary visualization techniques whose results have to be interpreted in the context of the primary cross-sectional data and clinical findings. Prospectively, a more widespread use of 3D imaging techniques may be expected from upcoming acquisition technologies (for example 16-slice helical CT) as well as from more powerful computers with improved image data postprocessing capacities

Translabyrinthine Petrous Apex Cholesteatoma Surgery with Hearing Preservation

Sudhoff H, Klingebiel R, Scholtz L-U, Todt I. Translabyrinthine Petrous Apex Cholesteatoma Surgery with Hearing Preservation. Case Reports in Otolaryngology. 2021;2021:1-4.Objective. To introduce a novel surgical approach to petrous apex lesion (PA) with superior semicircular canal plugging for hearing preservation. Patient. A 63-year-old patient presented with a recurrent cholesteatoma of the left petrous apex. The patient had a long-term history of cholesteatoma and MRI with diffusion-weighted imaging (DWI) detected a suspicious lesion in the left petrous apex on follow-up. Intervention. The cholesteatoma could be completely removed from the petrous apex with partial superior semicircular canal plugging and removal with hearing preservation. Outcomes. Cholesteatomas of the temporal bone are managed by surgery with complete excision of the lesion. Results. The translabyrinthine approach, generally useful in nonhearing ears, could be utilized with the additional technique of superior semicircular canal plugging to preserve hearing in this patient. Conclusions. This case highlights the possibility of a hearing preservation strategy for PA cholesteatomas using a translabyrithine approach

Rare encephalitis after vaccination against SARS-CoV-2

Zuhorn F, Graf T, Klingebiel R, Schäbitz W-R, Rogalewski A. Seltene Enzephalitis nach Impfung gegen SARS-CoV-2. Nervenarzt. 2021

Reply to 'Caution regarding conclusions about COVID-19 vaccine and encephalitis'

Zuhorn F, Graf T, Klingebiel R, Schäbitz W-R, Rogalewski A. Reply to 'Caution regarding conclusions about COVID-19 vaccine and encephalitis'. Annals of Neurology . 2022;91(4):578-580

Postvaccinal Encephalitis after ChAdOx1 nCov-19

Zuhorn F, Graf T, Klingebiel R, Schäbitz W-R, Rogalewski A. Postvaccinal Encephalitis after ChAdOx1 nCov-19. Annals of neurology. 2021.The global SARS-CoV-2 pandemic has contributed to more than 163 million confirmed infections and 3.3 million deaths worldwide. The severity of the pandemic has led to an unprecedented effort to develop multiple effective vaccines. Due to excellent safety and efficacy data from clinical trials, several vaccines were approved. We report a case series of postvaccinal encephalitis in temporal correlation to vaccination with ChAdOx1 nCov-19. The diagnostic criteria for possible autoimmune encephalitis were fulfilled. Our patients responded well to immunosuppressive therapy with corticosteroids. The incidence has been estimated to be approximately 8 per 10 million vaccine doses. Complication of postvaccinal encephalitis after ChAdOx1 nCoV-19 vaccination still appear to be very rare, but need to be diagnosed and treated adequately. Large pooled data from observational epidemiologic studies are necessary to verify causality. ANN NEUROL 2021. © 2021 The Authors. Annals of Neurology published by Wiley Periodicals LLC on behalf of American Neurological Association