[en] Regarding CT findings, the authors regard the following three factors as very important in determining the prognosis of a patient with an intracerebral (intraventricular) hemorrhage: the maximum parenchyma-hematoma ratio, the thickness of the hematoma, and the distribution of intraventricular casting. The maximum parenchyma-hematoma ratio is determined by comparing the areas of the brain parenchyma and hematoma by planimetry. The thickness of the hematoma is determined by the numbers of slices of a high density (one slice: 8 mm). The distribution of the intraventricular casting is classified into four types by its extension (as was proposed by Yokota et al.); Type V¹ (no casting, only a high-density area), Type V² (casting in one ventricle), Type V³ (casting in two ventricles), and Type V⁴ (casting in three or more ventricles). (author)

[en] We reported on seven cases of brainstem infarctions of the lateral lower pons and lateral medulla, the sensory deficit manifested over the trunk or the leg namely segmental sensory disturbances. All patients showed dissociated sensory disturbance of pain and temperature with retained deep sensations except two cases in which touch was also slightly impaired. The sensory distribution was classified into two types. The first ''crossed type'', ipsilatral face and contralateral trunk and leg below the level was involved in 4 cases, and the second ''unilateral type'' contralateral face and trunk above the level in 3 cases. Clinico-anatomical evaluation was executed by MRI. Lesions were detected in the lateral lower pons in two cases and in the lateral medulla in one case. The location of lesions by MRI revealed more lateral lesions showed ''crossed type'' of segmental sensory disturbance and more medial lesions ''unilateral type''. It was shown that the segmental sensory disturbance could be explained by the partial involvement of the lateral spinothalamic tract, which is arranged with the fibers from the sacral segments most lateral. We considered it very important to differentiate the segmental sensory disturbance by brainstem lesion in practical clinical diagnosis. We also emphasize the type of segmental sensory disturbance could be a localizing sign in the lateral brainstem as such, ''crossed type'' indicating the lesion of the lateral portion and ''unilateral type'' the medial portion of the lateral lower brainstem. (author)

[en] Two siblings, a 13-year-old girl and a 9-year-old boy, presented a similar progressive extrapyramidal disorder. The onsets were at the age of 4 years and at that of 2 1/2 years respectively, and a certain febrile illness had preceded it for two or three months in both cases. The major clinical features were progressive gait disturbance, dysarthria, and dystonia; they were associated with secondary skeletal deformities in the sister and with abnormal ocular movements in the brother. The CT findings, essentially similar in both cases, were characterized by symmetrical hypodensity lesions and an atrophy of the corpora striata, namely, the putamen and the caudate nucleus. Based on the clinical features and the CT findings, and on a comparison with the previous clinico-pathological reports in the literature, the present cases were diagnosed as bilateral striatal necrosis. The disorder termed ''bilateral striatal necrosis'' has not been widely known; this report stresses the great usefulness of CT examination in the clinical diagnosis of this rare disorder. (author)

[en] An enlarged superior ophthalmic vein (SOV) on computed tomography has been considered by several authors to be a pathognomonic sign of a carotid cavernous sinus fistula (CCF). However, according to some other investigators, SOV has been observed in various orbital and cavernous sinus diseases, and even in normal persons. We reviewed the ordinal axial head and orbital CT results (third generation) of 1293 patients with miscellaneous neurologic diseases in an attempt to ascertain the diagnostic significance of SOV. SOV was observed in 88 patients, unilaterally in 29 and bilaterally in 59. SOV was detected in 65 patients by means of 5-mm-thick slice scanning and in 23, by 10-mm. SOV was observed in 76 cases on plain CT and in 12 on enhanced. The maximal diameter of SOV was 3.3 mm of more in all patients except one with orbital or cavernous sinus desease (a skullbase tumor extending into the cavernous sinus, a case of orbital cellulitis, and a case with CCF) in the present study. On the other hand, the maximal diameter of SOV with diseases other than orbital of cavernous sinus pathology was less than 3.0 mm. In conclusion, a SOV is not pathognomonic on CCF and is observed under various conditions. However, when the diameter of the SOV is 3.3 mm or more one should consider the possibility of orbital or cavernous sinue disease. (author)

[en] Magnetic resonance imaging (MRI) was performed in 7 patients (four males and three females), with Wilson's disease. Their ages ranged from 18 to 28 years, with a mean of 23 years. Abnormalities were detected in all seven cases. The period from the appearance of neurologic symptoms to the MRI study ranged from about 6 months to 20 years. There was, however, no significant relationship between the MRI findings and the disease period stated above. In the MR images, lesions were found with a low intensity in T₁-weighted images and with a high intensity in T₂-weighted images. As supratentorial lesions, cerebral atropy was found in 3 patients. In addition, abnormalities in the signal intensity were found in the putamen in all seven patients, in the caudate nucleus in 1, in the thalamus in 4, and in the subcortical white matter in 2. Meanwhile, as infratentorial lesions, cerebellar atrophy appeared in 2 patients, while abnormalities of the signal intensity were detected in the midbrain in 5 and in the pons in 5. When MRI was compared with CT for the detection of a supratentorial lesion, CT found to detect only abnormal densities in 5 out of the 7 patients. In contrast, MRI showed abnormalities of the signal intensity in all seven cases. As for infratentorial lesions, MRI found abnormal signal intensities in 5 cases. On the contrary, CT showed atrophy, but no abnormal density. Unfortunately, however, no relationship was found between the neurological signs and the lesions as shown by MRI. In conclusion, MRI is superior to CT in imaging the location of Wilson's disease lesions, particularly infratentorial lesions. In one case, however, MRI showed abnormalities in the putamen in spite of the disappearance of extrapyramidal signs after treatment. (author)

[en] Eleven patients with a definite diagnosis of multiple sclerosis were examined in terms of correlations between the clinical features and the results of cranial computed tomography (CT), and magnetic resonance imaging (MRI). Results: In 5 of the 11 patients, both CT and MRI demonstrated lesions consistent with a finding of multiple sclerosis. In 3 patients, only MRI demonstrated lesions. In the remaining 3 patients, neither CT nor MRI revealed any lesion in the brain. All 5 patients who showed abnormal findings on both CT and MRI had clinical signs either of cerebral or brainstem - cerebellar lesions. On the other hand, two of the 3 patients with normal CT and MRI findings had optic-nerve and spinal-cord signs. Therefore, our results suggested relatively good correlations between the clinical features, CT, and MRI. MRI revealed cerebral lesions in two of the four patients with clinical signs of only optic-nerve and spinal-cord lesions. MRI demonstrated sclerotic lesions in 3 of the 6 patients whose plaques were not detected by CT. In conclusion, MRI proved to be more helpful in the demonstration of lesions attributable to chronic multiple sclerosis. (author)

[en] We evaluated the Computed Tomographic (CT) findings of skeletal muscles in 12 cases of amyotrophic lateral sclerosis (ALS), 1 case of spinal progressive muscular atrophy (SPMA), and 1 case of Kugelberg-Welander disease. CT examination was performed in the neck, shoulders, abdomen, pelvis, thighs, and lower legs, 15 muscles were selected for evaluation. The following muscles tended to be affected: m. transversospinalis (12 cases were abnormal), m. deltoideus (10), m. subscapularis (10), m. infraspinatus (10), mm. dorsi (12), hamstring muscles (14), m. tibialis anterior (14), and m. triceps surae (14). On the contrary, the following muscles tended to be preserved: m. sternocleidomastoideus (only 7 cases were abnormal), m. psoas major (7), m. gluteus maximus (7), m. rectus femoris (7), m. sartorius (7) and m. gracilis (6). The distribution of the muscles affected showed neither proximal nor distal dominancy. As the disease advanced, however, all the muscles became affected without any severity. CT findings of skeletal muscles in ALS were characterized by muscle atrophy and fat infiltration, which showed a patchy, linear, or moth-eaten appearance. In mildly affected cases, there was muscle atrophy without internal architectual changes. In moderately affected cases, muscle atrophy advanced and internal architectural changes (patchy, linear, and moth-eaten fat infiltration) became evident. In most advanced cases, every muscle showed a ragged appearance because of severe muscle atrophy and internal architectural changes. These findings were well distinguished from those of SPMA, which resembled the CT pattern of primary muscle diseases. (author)

[en] We evaluated the leg and thigh muscles of 4 control subjects and 10 patients with myotonic dystrophy using computed tomography. Taking previous reports about the skeletal muscle CT of myotonic dystrophy into account, we concluded that the following 5 features are characteristic of myotonic dystrophy: 1. The main change is the appearance of low-density areas in muscles; these areas reflect fat tissue. In addition, the muscle mass decreases in size. 2. The leg is more severely affected than the thigh. 3. In the thigh, although the m. quadriceps femoris, especially the vastus muscles, tends to be affected, the m. adductor longus and magnus tend to be preserved. 4. In the leg, although the m. tibialis anterior and m. triceps surae tend to be affected, the m. peroneus longus, brevis, and m. tibialis posterior tend to be preserved. 5. Compensatory hypertrophy is often observed in the m. rectus femoris, m. adductor longus, m. adductor magnus, m. peroneus longus, and m. peroneus brevis, accompanied by the involvement of their agonist muscles. (author)