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Journal of the American Animal Hospital... Sep 2023Accurate diagnostic imaging is required for surgical planning of acute thoracolumbar intervertebral disc extrusion. However, data comparing the accuracy of conventional...
Accurate diagnostic imaging is required for surgical planning of acute thoracolumbar intervertebral disc extrusion. However, data comparing the accuracy of conventional IV contrast-injected computed tomography (CT) and myelography CT for hemilaminectomy localization and size assessment are sparse. In this study, IV contrast-injected CT and myelography CT were performed in 48 French bulldogs presenting with acute disc herniation and compared with postsurgical CT. CT images were evaluated by three raters. IV contrast-injected CT erroneously identified the compressive lesion site significantly more often than myelography CT. The length of the compressive lesion was significantly higher using myelography CT compared with conventional CT, but this did not lead to relevant consequences on the surgical opening site length. Myelography CT should therefore be recommended when thoracolumbar disc disease is suspected and multiple compressive lesions are visualized on IV-injected CT in French bulldogs.
Topics: Animals; Dogs; Intervertebral Disc Displacement; Myelography; Tomography, X-Ray Computed; Laminectomy; Intervertebral Disc; Dog Diseases
PubMed: 37708472
DOI: 10.5326/JAAHA-MS-7318 -
Child's Nervous System : ChNS :... Oct 2023Over the last half a century, diagnostic neuroimaging has made tremendous strides following the introduction of computerized tomography (CT) and subsequent magnetic... (Review)
Review
Over the last half a century, diagnostic neuroimaging has made tremendous strides following the introduction of computerized tomography (CT) and subsequent magnetic resonance imaging (MR). Prior to that time, the neurological diagnosis was conducted with careful history taking, physical examinations, and invasive testing such as cerebral angiography, encephalography, and myelography. Techniques and contrast media for these tests have been refined and progressed over time. However, these invasive tests have diminished and are rarely used for daily practice in pediatric neurosurgery since the introduction of CT and MR. Nuclear brain scan and ultrasonography are non-invasive. A nuclear brain scan using radioactive tracers was used to demonstrate the laterality of the lesion without an intact blood-brain barrier, but was rarely performed after the CT era. On the other hand, improved ultrasonography made strides because of its portability and the lack of radiation exposure and sedation. It is often a first-line investigatory tool for neonatal evaluation. This article describes a review of developments and progresses of pediatric neuroimaging in the pre-CT era.
Topics: Infant, Newborn; Humans; Child; Tomography, X-Ray Computed; Magnetic Resonance Imaging; Cerebral Angiography; Neuroimaging; Contrast Media
PubMed: 37314485
DOI: 10.1007/s00381-023-06018-8 -
Spinal Cord Sep 2015To summarize the incidence and spectrum of spinal cord-related complications in patients of tuberculous meningitis. (Review)
Review
OBJECTIVES
To summarize the incidence and spectrum of spinal cord-related complications in patients of tuberculous meningitis.
SETTING
Reports from multiple countries were included.
METHODS
An extensive review of the literature, published in English, was carried out using Scopus, PubMed and Google Scholar databases.
RESULTS
Tuberculous meningitis frequently affects the spinal cord and nerve roots. Initial evidence of spinal cord involvement came from post-mortem examination. Subsequent advancement in neuroimaging like conventional lumbar myelography, computed tomographic myelography and gadolinium-enhanced magnetic resonance-myelography have contributed immensely. Spinal involvement manifests in several forms, like tuberculous radiculomyelitis, spinal tuberculoma, myelitis, syringomyelia, vertebral tuberculosis and very rarely spinal tuberculous abscess. Frequently, tuberculous spinal arachnoiditis develops paradoxically. Infrequently, spinal cord involvement may even be asymptomatic. Spinal cord and spinal nerve involvement is demonstrated by diffuse enhancement of cord parenchyma, nerve roots and meninges on contrast-enhanced magnetic resonance imaging. High cerebrospinal fluid protein content is often a risk factor for arachnoiditis. The most important differential diagnosis of tuberculous arachnoiditis is meningeal carcinomatosis. Anti-tuberculosis therapy is the main stay of treatment for tuberculous meningitis. Higher doses of corticosteroids have been found effective. Surgery should be considered only when pathological confirmation is needed or there is significant spinal cord compression. The outcome in these patients has been unpredictable. Some reports observed excellent recovery and some reported unfavorable outcomes after surgical decompression and debridement.
CONCLUSIONS
Tuberculous meningitis is frequently associated with disabling spinal cord and radicular complications. Available treatment options are far from satisfactory.
Topics: Diagnosis, Differential; Humans; Incidence; Spinal Cord; Spinal Cord Injuries; Tuberculosis, Meningeal
PubMed: 25896347
DOI: 10.1038/sc.2015.58 -
Journal of Clinical Neuroscience :... May 2023Spontaneous intracranial hypotension from spinal cerebrospinal fluid leak is a condition that often presents as orthostatic headaches. Diagnosis and localisation of... (Review)
Review
Spontaneous intracranial hypotension from spinal cerebrospinal fluid leak is a condition that often presents as orthostatic headaches. Diagnosis and localisation of spinal CSF leaks remain difficult despite multiple imaging modalities that can be used to aid identification. These include traditional CT myelography and MRI as well as newer techniques such as dynamic and digital subtraction myelography. Leaks can be classified into types and optimal localisation and management techniques vary by type of leak. Localisation of a leak can aid in targeting treatment such as an epidural blood patch if conservative measures fail. Where unsuccessful, repeated blood patches and novel techniques can be used to improve patient symptoms. Much of this condition is not well understood and evidence is lacking, with many avenues for potential research.
Topics: Humans; Intracranial Hypotension; Cerebrospinal Fluid Leak; Myelography; Tomography, X-Ray Computed; Magnetic Resonance Imaging; Blood Patch, Epidural
PubMed: 36948109
DOI: 10.1016/j.jocn.2023.03.005 -
Neurologic Clinics May 2024Spontaneous intracranial hypotension (SIH) typically presents as an acute orthostatic headache during an upright position, secondary to spinal cerebrospinal fluid leaks.... (Review)
Review
Spontaneous intracranial hypotension (SIH) typically presents as an acute orthostatic headache during an upright position, secondary to spinal cerebrospinal fluid leaks. New evidence indicates that a lumbar puncture may not be essential for diagnosing every patient with SIH. Spinal neuroimaging protocols used for diagnosing and localizing spinal cerebrospinal fluid leaks include brain/spinal MRI, computed tomography myelography, digital subtraction myelography, and radionuclide cisternography. Complications of SIH include subdural hematoma, cerebral venous thrombosis, and superficial siderosis. Treatment options encompass conservative management, epidural blood patches, and surgical interventions. The early application of epidural blood patches in all patients with SIH is suggested.
Topics: Humans; Intracranial Hypotension; Cerebrospinal Fluid Leak; Magnetic Resonance Imaging; Tomography, X-Ray Computed; Neuroimaging; Headache
PubMed: 38575260
DOI: 10.1016/j.ncl.2024.02.002 -
Neuroradiology Feb 2023Spontaneous intracranial hypotension (SIH) is caused by spinal cerebrospinal fluid (CSF) leaks, which result in continued loss of CSF volume and multiple debilitating... (Review)
Review
Spontaneous intracranial hypotension (SIH) is caused by spinal cerebrospinal fluid (CSF) leaks, which result in continued loss of CSF volume and multiple debilitating clinical manifestations. The estimated annual incidence of SIH is 5/100,000. Diagnostic methods have evolved in recent years due to improved understanding of pathophysiology and implementation of advanced myelographic techniques. Here, we synthesize recent updates and contextualize them in an algorithm for diagnosis and treatment of SIH, highlighting basic principles and points of practice variability or continued debate. This discussion includes finer points of SIH diagnosis, CSF leak classification systems, less common types and variants of CSF leaks, brain MRI Bern scoring, potential SIH complications, key technical considerations, and positioning strategies for different types of dynamic myelography. The roles of conservative measures, non-targeted or targeted blood patches, surgery, and recently developed endovascular techniques are presented.
Topics: Humans; Intracranial Hypotension; Cerebrospinal Fluid Leak; Myelography; Magnetic Resonance Imaging; Endovascular Procedures
PubMed: 36336758
DOI: 10.1007/s00234-022-03079-5 -
European Neurology 2020In this article, we commemorate the centenary of myelography, a neuroradiological procedure that, despite certain disadvantages, significantly contributed to the... (Review)
Review
In this article, we commemorate the centenary of myelography, a neuroradiological procedure that, despite certain disadvantages, significantly contributed to the diagnosis and localization of spinal cord lesions during the 20th century. From the start, the use of myelography was characterized by different views regarding the potential dangers associated with the prolonged exposure of a "foreign body" to the central nervous system. Such differences in attitude resulted in divergent myelography practices; its precise indications, technical performance, and adopted contrast material remaining subject to variability until the procedure were eventually replaced by MRI at the close of the 20th century.
Topics: Female; History, 20th Century; History, 21st Century; Humans; Male; Myelography; Spinal Cord Diseases
PubMed: 32871581
DOI: 10.1159/000509863 -
Neuroimaging Clinics of North America Nov 2022The spinal cord is an elegant structure that serves as a conduit for the transfer of information between the brain and the peripheral nervous system. To enable the... (Review)
Review
The spinal cord is an elegant structure that serves as a conduit for the transfer of information between the brain and the peripheral nervous system. To enable the reader to understand its complex microstructural anatomy, we have created a detailed yet approachable anatomic reference for clinicians. We review gross and structural features of the spinal cord, its coverings, and nerves while also discussing spinal cord development, microscopic organization, and common anatomic variants. We detail how this anatomy appears on current neuroimaging techniques, with special attention to MR imaging.
Topics: Humans; Magnetic Resonance Imaging; Spinal Cord
PubMed: 36244730
DOI: 10.1016/j.nic.2022.07.025 -
AJR. American Journal of Roentgenology Feb 2019Lateral C1-C2 puncture can be used for CSF collection, contrast agent injection for myelography, and access for cordotomy. The objective of this article is to describe... (Review)
Review
OBJECTIVE
Lateral C1-C2 puncture can be used for CSF collection, contrast agent injection for myelography, and access for cordotomy. The objective of this article is to describe the indications, technique, and potential complications of this procedure.
CONCLUSION
Radiologists performing lumbar puncture or myelography should be comfortable gaining access to the subarachnoid space via the lateral C1-C2 approach when indicated. Familiarity with the technique and its potential complications is essential for a safe and efficient procedure.
Topics: Cervical Vertebrae; Humans; Spinal Puncture
PubMed: 30512994
DOI: 10.2214/AJR.18.19584 -
Radiologic Clinics of North America Mar 2019This article reviews the role of imaging in the diagnosis, management, and treatment of spontaneous intracranial hypotension (SIH). SIH is a debilitating and often... (Review)
Review
This article reviews the role of imaging in the diagnosis, management, and treatment of spontaneous intracranial hypotension (SIH). SIH is a debilitating and often misdiagnosed condition caused by either a spinal cerebrospinal fluid (CSF) leak or a CSF to venous fistula. This pathologic condition is identified and localized via spinal imaging, including computed tomographic (CT) myelography, dynamic myelography, dynamic (ultrafast) CT myelography, MR imaging, or MR myelography with intrathecal gadolinium. Treatment of SIH involves conservative measures, surgery, or imaging-guided epidural blood patching.
Topics: Humans; Intracranial Hypotension; Magnetic Resonance Imaging; Myelography; Tomography, X-Ray Computed
PubMed: 30709479
DOI: 10.1016/j.rcl.2018.10.004