Latest techniques in head and neck CT angiography

Abstract : Continuous evolution of multi row CT is increasingly making CT angiography a viable imaging modality for assessment of the supraaortic and intracranial vessels as an anatomically and functionally coherent vascular system. Extended non-invasive examinations with reduced contrast volume have become feasible with the availability of 16 and 64 row MDCT scanners. Prerequisites to obtain high resolution CT angiographies of the head and neck vessels with superior detail include the administration of low contrast volume, high contrast density (400 mg I/ml) contrast media, adequate timing and data acquisition, optimal flow rate (4 ml/s) and saline flushing. Non-invasiveness, delineation of vessel calcification, virtual independence from hemodynamic conditions, and the ability to provide quantification without needing to correct for magnification are all attributes that favour CT angiography over digital subtraction angiography and to some extent even magnetic resonance angiography as an alternative non-invasive technique. CT angiography is established as a modality of choice for the assessment of patients with acute stroke and chronic steno-occlusive disease. CT angiography may indicate the presence of extra- or intracranial acute vessel occlusion and dissection, predisposing atherosclerotic steno-occlusive disease and thus indicate thrombo-embolism or local appositional thrombosis as the principle pathogenic factor. CT angiography is used to assess anatomy, and to depict the presence, location and extent of calcified and non-calcified plaque as a cause of high grade stenosis. Despite relatively limited sensitivity CT angiography is indicated for suspected or confirmed aneurysms that demand further verification of their presence, geometry, or relationship to parent artery branches and osseous anatomic landmarks. Low volume high density contrast media have substantially increased the ability of CT angiography to depict small aneurysms, small branches, and collateral vessels, and to recognize the residual lumen in vessels with high grade stenosis or conditions such as dissection or pseudo-occlusion. Superior detail high resolution CT angiography is thus a viable alternative to DSA, relegating the latter technique to endovascular treatment applications onl

Aberrierende A.carotis interna als Ursache eines pulssynchronen Tinnitus: Schwierige Diagnose in der MRT?

Zusammenfassung: Wir präsentieren einen Fall eines 43 jährigen Patienten mit einseitiger sensorineuraler Schwerhörigkeit und Zufallsbefund einer aberrierende A.carotis interna im linken Mittelohr, welche einen pulsierenden Tinnitus verursacht. Das aberrierende Gefäß war inital bei einer Magnetresonanztomographie (MRT) nicht zu sehen und konnte erst mittels Computertomographie und MR-Angiographie (MRA) nachgewiesen werden. Um den aberrierenden Verlauf einer A.carotis interna zu erkennen, ist häufig neben einer konventionellen MRT eine MRA nötig, um die Diagnose zu sichern und andere Differenzialdiagnosen auszuschließe

Solitary fibrous tumor of the orbit—two cases and a review of the literature

Solitary fibrous tumors of the orbit (SFT) are mesenchymal lesions that can develop either as malignant or benign neoplasias. We describe the histological features leading to the diagnosis in two females and review the current literature. Diagnosis of SFT only can be performed by histological examination, since clinical signs and radiological features are not specific enough. Even a malignant or benign course cannot be predicted, since clinical and radiological features do not correlate with histological signs of malignancy and vice versa. Radical resection is the treatment of choice, since no other treatment option has been proven to be efficien

Severe Hypothermia in a Patient withCerebral Relapse of Whipple's Disease

Abstract. : The diagnosis of cerebral relapse of Whipple's disease in a 67-year-old patient was made after he presented with somnolence and severe hypothermia 4 months after discontinuing treatment with cotrimoxazole. Hypothermia is a rare hypothalamic manifestation of cerebral Whipple's diseas

Cervical emphysema: an unusual presentation of laryngeal cancer

Abstract Background: Acute respiratory decompensation can occur on a background of slowly progressive airway compromise, for example in laryngeal squamous cell cancer. Surgeons in ENT, together with anaesthetists, are often asked to evaluate airway risk and as yet there is no widely adopted standardised approach. Case report: This paper reports the case of an 82-year-old male, who presented with acute airway compromise due to both endolaryngeal obstruction from a squamous cell cancer and extralaryngeal compression from massive subcutaneous emphysema. Results: Primary total laryngectomy was performed, but the patient declined adjuvant radiotherapy. He died a year later from a heart attack without evidence of recurrence. Conclusion: To the best of our knowledge, this is the first case report of acute airway compromise from extralaryngeal subcutaneous emphysema secondary to laryngeal cancer. Options for acute airway management are discusse

Tumor or Hematoma?: An Unusual Case of an Extradural Lesion of the Lumbar Spine

Purpose: Spinal epidural hematoma is a rare clinical entity. We present a case of atypical contrast enhancement pattern in a chronic epidural hematoma of the lumbar spine mimicking an extradural tumor. Case Report: A 76-year-old man on treatment with oral anticoagulants presented with a 1-month history of lower back pain radiating into his right upper thigh accompanied by spinal claudication. Preoperative MRI showed a posterior epidural lesion compressing the cauda equina with almost homogeneous contrast enhancement. Surgery was performed under the presumptive diagnosis of spinal extradural neoplasm. Intraoperative and histological findings were consistent with a chronic spinal epidural hematoma. Postoperatively, the patient had instant relief of his symptoms. Conclusion: Chronic spinal epidural hematoma may resemble an extradural tumor, requiring surgery for histological confirmation and decompressio

Flexibility within the middle ears of vertebrates

Introduction and aims: Tympanic middle ears have evolved multiple times independently among vertebrates, and share common features. We review flexibility within tympanic middle ears and consider its physiological and clinical implications. Comparative anatomy: The chain of conducting elements is flexible: even the ‘single ossicle’ ears of most non-mammalian tetrapods are functionally ‘double ossicle’ ears due to mobile articulations between the stapes and extrastapes; there may also be bending within individual elements. Simple models: Simple models suggest that flexibility will generally reduce the transmission of sound energy through the middle ear, although in certain theoretical situations flexibility within or between conducting elements might improve transmission. The most obvious role of middle-ear flexibility is to protect the inner ear from high-amplitude displacements. Clinical implications: Inter-ossicular joint dysfunction is associated with a number of pathologies in humans. We examine attempts to improve prosthesis design by incorporating flexible components

Hypertrophy of the inferior olivary nucleus impacts perception of gravity

Interruption of the dentato-olivary projections, interconnecting the dentate nucleus (DN) and the contralateral inferior olivary nucleus (ION), is predicted to interfere with the DN' role in estimating direction of gravity. In a patient with pendular nystagmus due to hypertrophy of the ION secondary to predominantly right-sided ponto-mesencephalic hemorrhage, perceived vertical shifted from clockwise to counter-clockwise deviations within 4 months. We hypothesize that synchronized oscillations of ION neurons induce a loss of inhibitory control, leading to hyperactivity of the contralateral DN and, as a result, to perceived vertical roll-tilt to the side of the over-active DN