Faculty Bibliography

Cardiac complications are well known after aneurysmal subarachnoid hemorrhage. Electrocardiographic changes occur in 50% to 100% of such cases. Arrhythmias, left ventricular dysfunction, and frank myocardial infarction are infrequently observed. Myocardial infarction must be differentiated from neurogenic stunned myocardium, which is a reversible condition. From 1996 to 2001, 105 patients with aneurysmal subarachnoid hemorrhage underwent endovascular treatment at the University of Michigan. Of these, four patients with no history of cardiac disease experienced cardiac failure related to neurogenic stunned myocardium. All had signs of left ventricular dysfunction, electrocardiographic changes, and elevated cardiac enzymes. Three had pulmonary edema at presentation. All were diagnosed with myocardial infarction. One underwent coronary angiography, which was normal. All were considered poor surgical candidates and underwent endovascular treatment of the aneurysms. Three of four patients developed symptomatic vasospasm, and two required balloon angioplasty. Three patients achieved good outcomes. The eldest died from severe vasospasm that was unresponsive to angioplasty. Reversible cardiac failure associated with subarachnoid hemorrhage may be due the neurogenic stunned myocardium. Frequent symptomatic vasospasm occurs, possibly related to poor cardiac output and the inability to optimize hyperdynamic hypervolemic therapy, particularly with compromised volume status. These patients can be treated with endovascular therapy of the aneurysms and balloon angioplasty as needed. With aggressive management, patients can recover from these reversible cardiac complications.

Cerebral vasculitis presenting with intracranial hemorrhage is a rare but known entity. We discuss here the case of a 61-year-old woman presenting with subarachnoid hemorrhage. Cerebral angiography showed vasculitic changes involving the small and medium-sized vessels. She also had a concomitant herpes zoster rash on her back. A 3-month follow-up angiogram revealed partial resolution of the vasculitic changes.

Cochlear implant (CI) is an electronic device used to rehabilitate patients with sensorineural hearing loss. The intent of this review is to demonstrate the normal position of the electrode on computed tomography (CT) and contrast this with various examples of the electrode malpositioning. Post-implantation CT is performed to localize the cause of implant failure in patients in which radiographs suggest an anomalous course of the electrode. A common cause of device failure is extrusion or malpositioning of the electrode. It is important for the radiologists to recognize this important aspect of device failure. Post-implant CT can help identify patients with malpositioned electrode in whom another attempt can be made by correctly re-implanting the electrode.

A 5-year-old girl with no preexisting systemic or CNS neoplasm presented with a large right temporal mass lesion, the histopathology of which proved to be a poorly differentiated adenosquamous carcinoma, a highly unusual primary intracranial tumor. The tumor recurred despite radical resection, chemotherapy, and radiation therapy.

BACKGROUND: Neurenteric cysts are rare congenital lesions of the spine and are lined with entodermal epithelium. They result from anomalous endodermal-neuroectodermal adhesion in the 3rd week of embryonic life with persistence of canal of Kovalevsky. The nature of the eventual abnormality depends on the extent to which this adhesion subsequently disappears. Persistence of the entire tract results in the extreme form of combined anterior and posterior spina bifida with dorsal enteric fistula and persistence of only a part of the tract producing the isolated intraspinal cyst. The most common location is the cervico-dorsal region, and usually it lies ventral to the spinal cord. The lumbosacral location is uncommon. Associated vertebral anomalies, gut cysts, bowel duplication, the presence of keratin markers and mucin-secreting cuboidal or columnar intestinal epithelium in their walls confirm their entodermal origin. PATIENTS: We describe here three unusual cases of neurenteric cysts in patients aged 5-18 years who had already had symptoms for some time. One of these had a cyst sited predominantly in the sacral canal, another presented with a lumbar neurenteric cyst, and the third patient had an intradural extramedullary thoracic lesion. Two of these children had associated anomalies, the one with lumbar cyst also having a lipomeningomyelocele and spina bifida while the other also had deformed vertebrae. All three patients underwent laminectomy and gross excision of the cysts through a posterior approach. RESULTS AND CONCLUSION: The diagnosis of neurenteric cysts was confirmed by demonstrating mucin-producing cuboidal or columnar epithelium lining the cystic cavity.

Suprasellar tuberculomas are exceptionally rare and are even rarer in children. A case of suprasellar tuberculoma in a five year old male child who presented with diabetes insipidus, hypothyroidism and visual field defect is described. Deranged CSF parameters, imaging findings of a suprasellar rounded, peripherally enhancing lesion with thickening of the pituitary stalk, led to an accurate diagnosis of tuberculosis. The patient responded well to antituberculous treatment and an unnecessary surgery was avoided.

PURPOSE: The purpose of the current study was to prospectively evaluate the role of corrected gradient echo phase imaging in differentiation of calcified granuloma from chronic hemorrhage. METHOD: Eighty-five patients with single/multiple calcifications and hemorrhages irrespective of their location were studied with corrected gradient echo phase imaging. In all the cases, CT was used as the gold standard for the presence/absence of calcification. RESULTS: All calcified lesions showed positive phase, whereas chronic hemorrhages showed negative phase in all cases. Five calcified lesions showed no phase shift at TE =15 ms and positive shift at TE = 35 ms. Heterogeneous phase shift was observed in three calcified lesions at TE = 35 ms; all three lesions showed positive phase shift at TE = 15 ms. There was no site-specific problem in differentiation of calcification from chronic hemorrhage including in the basal ganglia. CONCLUSION: We conclude that calcified granuloma can be easily differentiated from chronic hemorrhage with corrected gradient echo phase imaging, which may obviate the need for CT for its confirmation.

The management of a patient with haematuria following percutaneous nephrolithotomy is described. The patient underwent renal angiography to assess the cause of bleeding. A pseudoaneurysm arising from first left lumbar artery was incidentally discovered, which was then successfully embolized using an indigenously fabricated metallic coil and gel foam particles in the same sitting.