RESUMEN
Cervical epidural abscess is an uncommon infectious process of the spinal epidural space. Although this disorder is often unsuspected clinically, the patient's signs and symptoms may suggest other diagnoses that frequently lead to an MR examination. We retrospectively reviewed the MR examinations of five patients with surgically proved cervical epidural abscess in order to assist in the diagnosis of this clinically elusive disorder. Each epidural abscess was evaluated for MR signal intensity, location, extent, delineation, and enhancement pattern. We assessed the spinal cord for compression and signal intensity and analyzed the vertebrae, intervertebral disks, and paraspinal soft tissue. Compared with the spinal cord, the abscess was isointense or hypointense on T1-weighted spin-echo images and hyperintense on T2-weighted images. The abscess was hyperintense or isointense relative to the cord on T2* gradient-echo images. Enhancement of the abscess occurred in the two patients given an IV injection of gadopentetate dimeglumine. The epidural abscess was located anteriorly in three patients, posteriorly in one, and was circumferential in one. The abscess extended from two to nine vertebral bodies in length. In each case, the abscess caused some degree of spinal cord compression, and one patient had bright signal intensity within the cord on T2-weighted images. Three patients had MR changes of accompanying osteomyelitis and paravertebral abscess. MR imaging is useful in diagnosing cervical epidural abscess and in evaluating associated abnormality of the spinal cord, vertebral bodies, intervertebral disks, and paraspinal soft tissue.
Asunto(s)
Absceso/diagnóstico , Imagen por Resonancia Magnética , Enfermedades de la Columna Vertebral/diagnóstico , Absceso/complicaciones , Espacio Epidural , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Compresión de la Médula Espinal/etiología , Enfermedades de la Columna Vertebral/complicacionesRESUMEN
Pulsatile exophthalmos in association with carotid-cavernous sinus fistulas has been well defined anatomically, by angiography. This paper presents the physiological assessment of this entity, as measured with ocular pneumoplethysmography (OPG-Gee). The abnormal arteriovenous communication lowers resistance to arterial flow. This is characterized by a lowered ophthalmic systolic pressure and an increased ocular blood flow. The OPG readily documents the physiological result of therapeutic intervention.
Asunto(s)
Fístula Arteriovenosa/diagnóstico , Enfermedades de las Arterias Carótidas/diagnóstico , Seno Cavernoso , Oftalmodinamometría , Pletismografía , Fístula Arteriovenosa/fisiopatología , Enfermedades de las Arterias Carótidas/fisiopatología , Arteria Carótida Interna , Seno Cavernoso/fisiología , Exoftalmia/diagnóstico , Exoftalmia/fisiopatología , Femenino , Humanos , Persona de Mediana EdadRESUMEN
Severe head injury is frequently associated with multiple trauma. In the comatose patient, endotracheal intubation and ventilator support are often required, if there is associated dyssynchronous spontaneous effort. The latter is managed with therapeutic (drug) paralysis. An elaborate life-support and monitoring system coupled with controlled paralysis limits the mobility of the patient for diagnostic procedures, and a continuing reevaluation of neurological status is difficult. Under these circumstances the ocular pneumoplethysmograph provides a simple rapid noninvasive assessment of ocular blood flow, and this reflects cerebral blood flow and alterations in brain compliance. Alterations in the therapeutic regimen can be based on these observations.
Asunto(s)
Lesiones Encefálicas/diagnóstico , Oftalmodinamometría , Pletismografía , Lesiones Encefálicas/fisiopatología , Lesiones Encefálicas/cirugía , Circulación Cerebrovascular , HumanosRESUMEN
1. Carpal tunnel syndrome independent of uremic polyneuropathy has been described in 4 patients. 2. Operative findings are consistent with intraneural vascular compression related to the forearm A-V fistula. 3. Intraneural neurolysis results in immediate and almost total symptomatic relief.