[en] Wallerian degeneration is well known as the anterograde degeneration of axon and their accompanying myelin sheath from injury to the proximal portion of the axon or its cell body. The most common cause of wallerian degeneration is cerebral infarction. Authors experienced three patients with old hemispheric infarct with typical wallerian degeneration in the brain stem, which was demonstrated by magnetic resonance imaging (MRI) in two cases and CT in one case. This report demonstrates the wallerian degeneration in the corticospinal tract in on the MRI and CT with the brief review of literatures

[en] Cowden's disease (CD) is rare multiple hamartoma-neoplasia syndrome. Lhermitte-Duclos disease (LDD) is well known to be a hamartoma of the cerebellum. CD may be accompanied with LDD and other multiple systemic neoplasias. We report here on a case of CD-LDD complex with multiple systemic neoplasia

[en] To evaluate the utility of FLAIR(Fluid Attenuated Inversion Recovery) MR imaging in cerebral infarction by comparing its results with those of T2-weighted spin-echo imaging. We retrospectively evaluated fast FLAIR images and conventional spin echo images of 82 patients (47 men and 20 women ; median age 60.9 years) with cerebral infarction. MR imaging used a 1.5T MR unit with conventional T2(TR 3900, TE 90) and fast FLAIR sequence (TR 8000, TE 105, TI 2400). We analysed the size of the main lesion and number of lesions, and discrimination between old and new lesions and between small infarction and perivascular space. When T2-weighted and FLAIR imaging were compared, the latter showed that the main lesion was larger in 38 cases (46%), similar in 38 (46%), and smaller in six (7%). The number of lesions was greater in 23 cases(28%), similar in 52 (63%), and fewer in seven (9%). FLAIR images discriminated between old and new lesions in 31 cases ; perivascular space and small infarotion were differentiated in eight cases, and CSF inflowing artifact was observed in 66 (80%). In the diagnosis of cerebral infaretion, fast FLAIR provides images that are equal or superior to T2-weighted images. The fast FLAIR sequence may therefore be used as a part of routine MR brain study in the diagnosis of cerebral infarction

[en] To evaluate the surface anatomy of the central sulcus(CS), precentral gyrus(PrCG) and postcentral gyrus(PoCG) on the basis of sulci pattern on MR images. The MR images were obtained in the plane 10 degree angled to the orbitomeatal line. The MR images of 120 subjects(6 months to 79 years) with normal anatomy were analyzed and another four subjects with known space occupying lesions were also reviewed. The identification of gyri was feasible on the axial T1WI from anterior to posterior and from upper to lower images. The STS demonstrated symmetric pattern on both sides in 84 of 120 cases (70%), including two cases of prominent STS pattern. The asymmetric pattern was seen in 36 of 120 cases (30%); 14 of 120 cases (12%) on the right and 22 of 120 cases (18%) on the left at 4.5 cm above the level of the splenium of corpus callosum. The PrCG and PoCG and CS were identified well in all cases with the use of the sulci pattern. The identification of the gyri on the basis of the cerebral sulci pattern on MR images is useful and important when locating the space occupying lesion of the brain

[en] Lymphoma is considered when multiple, nonnecrotic lymph nodes are present in the superficial and deep lymphatic chains, especially if they are large and bilateral, on CT scan. It is reported that combined nodal and extranodal presentation of HD is uncommon. However, we found central low density in involved lymph node of NHL, and combined nodal and extra nodal disease in HD, not infrequently. The purpose of this study is to ascertain whether our findings may be characteristics of NHL and HD. CT findings with contrast enhancement were reviewed in 23 patients with untreated neck lymphoma: 18 NHL and 5 HD. The followings were analyzed in each case: nodal or extra nodal involvement; unilateral or bilateral involvement; presence or absence of central low density with peripheral enhancement in nodal lesion; infiltration into adjacent structures. Nodal and extra nodal lesions were confirmed by pathologic studies. Of 18 patients with NHL, nine cases had nodal disease and the rest had combined nodal and extra nodal disease. Lymphadenopathy was bilateral in ten cases and unilateral in eight. Five cases with HD were composed of three combined nodal and extra nodal diseases and two nodal diseases. Central low density of involved lymph node was shown in eight cases of 18 NHL and in one case of five HD. Central low density with peripheral enhancement was not uncommon in NHL, in contrast to HD. Hence, it is suggested that in case of nodal necrosis, NHL be also considered, besides tuberculous lymphadenitis and metastatic lymphadenopathy. It is not considered that nodal or extra nodal disease, and unilateral or bilateral involvement are of high significance in differentiation of NHL from HD

[en] The CT findings of the acute cerebral infarction are well known. However the CT findings of early stroke within 24 hours of the onset have not been sufficiently reported. The purpose of this study is to evaluate early acute cerebral infarction on CT within 24 hours after ictus. The early and accurate CT diagnosis could lead to the appropriate therapy and improved outcome of the patients. Authors retrospectively analyzed 16 patients with early acute cerebral infarction. Acute cerebral infarction was confirmed by follow-up CT in 11 patients, SPECT in 4 patients, and MRI in 1 patient. The CT findings of early acute cerebral infarction include effacement of cortical sulci or cistern (n = 16, 100%), hyperattenuation of MCA (n = 3), obscuration of lentiform nucleus (n = 6), loss of insular ribbon (n = 6) and subtle low density in hemisphere (n = 5). The most frequent finding was effacement of cortical sulci in our study, and it was thought to be the most important sign of early acute cerebral infarction

[en] Choroid Plexus papilloma is a rare intracranial neoplasm that is most commonly found in the trigone of the lateral ventricle in children or in the fourth ventricle in adult. Extraventricular extension of choroid plexus papilloma has been rarely reported within the cerebellopontine angle (CPA) cistern. Authors report two cases of choroid plexus papilloma in the posterior fossa seen on magnetic resonance imaging (MRI). MRI findings of two cases of choroid plexus papilloma in posterior fossa were retrospectively reviewed. In the first case, the tumor was in the fourth ventricle and extended to the left CPA cistern via the foramen of Luschka. In the second case, the tumor presented as an expansile mass of the of fourth ventricle and right lateral recess. Multiple signal voids of low intensity due to prominent feeding vessels and calcifications within the tumors were noted. This report demonstrates MR findings of choroid plexus papilloma in the posterior fossa with the brief review of the literatures

[en] We report here on a rare case of carotid artery angioplasty and stenting in a patient with spontaneous recanalization after complete occlusion of the proximal internal carotid artery (ICA). The patient initially showed severe stenosis at the left proximal ICA on MR angiography (MRA). Digital subtraction angiography (DSA) performed three days after MRA showed complete occlusion of the proximal ICA. The follow-up DSA after four weeks showed recanalization of the ICA, and then carotid artery stenting was successfully performed. There has been no neurologic complication during more than one year follow-up. cute internal carotid artery (ICA) occlusions may result in profound disability and death (1). An occluded ICA can spontaneously recanalize, but this doesn't happen frequently, and the natural course of a proximal ICA occlusion and its possibility of recanalization, including the exact time of recanalization after occlusion, are not well known (2, 3). A few studies have reported the incidence of spontaneous recanalization of the proximal internal carotid artery, which has mostly occurred in patients with ICA dissections (4 6). A few limited studies have reported a considerable incidence of spontaneous recanalization in patients with underlying atherosclerotic lesion or atherothombotic diseases (2). The possibility of repeated occlusion and repeated cerebral ischemic infarction may exist for the patients exhibiting spontaneous recanalization of the ICA and underlying atherosclerosis. We report here on a case of carotid artery stenting (CAS) in a patient who exhibited underlying atherosclerosis with spontaneous recanalization after complete occlusion of the proximal ICA

[en] The purpose of this study is to evaluate the accompanying abnormal findings of Schmorl's nodes (SN), a normal variant of the lumbar spine. Seventy-five patients with one or more SN, as seen on lumbar spine MRI were studied. Using a 1.5T MR unit, the number and location of SN, their site on the end plate, adjacent disc changes and lesions associated and not associated with SN, and accompanying associated bony spinal stenosis were retrospectively investigated. Among the 75 patients, 230 SN were noted in 375 vertebral bodies; they were relatively frequently located on the second (65, 28.3 %) and third (65, 28.3 %) lumbar vertebrae. The most common end-plate site of SN was the posterior one-third portion (160; 69.6 %). In 450 discs of these 75 patients, 172 lesions were notes; those associated with SN (76/167, 45.5%) were more common than frequently located on intervertebral disc L2-3 or L3-4 (p<0.05). Thirty-seven SN (16.1%) were associated with bony spinal stenosis. Because it is frequently associated with disc lesions and bony spinal stenosis, SN of the lumbar spine may be a pathologic condition rather than a normal variant. (author). 17 refs., 2 tabs., 2 figs

[en] The utilization of CT-guided fine needle aspiration biopsy of bone has been the subject of considerable interest, since the introduction of the CT scanning. The CT-guided needle biopsy of 11 consecutive patients with a variety of 'Etiology Unknown Spinal Disorders' resulted in a 100% yield of positive tissue diagnosis without significant complications. The main advantage of CT guidance is the continuous direct observation of the needle tip position in relation to the target volume, the more precise sampling from smaller and deeper lesion is another advantage. We are confident that localization of pathology by CT is the most accurate method for performing biopsies, and thus replaces the conventional ways of approaches and this could be utilized on the other organ biopsy in the future