Faculty Bibliography

Computed tomographic findings in developmental brain anomalies are more easily classified when the system used is based on embryogenesis related to morphology. Analysis of computed tomographic findings in a series of 154 patients with brain anomalies (Chiari malformation not included) revealed that specific examples of abnormalities occurring in major stages of brain development may be recognized by computed tomography. This paper deals with a group of patients with abnormalities that reflect a disturbance in neuronal migration

Two patients treated with high dose methotrexate otrexate with citrovorum rescue (HDMTX-CF) for osteogenic sarcoma developed the acute onset of neurologic deficits. Prior to the onset of symptoms, one child suffered brief episodes of altered consciousness. Both patients developed hemiparesis and then steadily improved over 72 hours. Laboratory evaluations disclosed normal coagulation parameters and nontoxic serum methotrexate levels at onset of symptoms. Computed tomography in one child disclosed a large low absorption abnormality. This patient represents the first reported case of positive radiologic findings associated with this syndrome. The two patients recovered completely and received further HDMTX-CF without sequelae. This condition may result from transient demyelination or embolic cerebrovascular disease

Cerebral aspergillosis currently occurs most frequently with disseminated aspergillosis in immunocompromised hosts. Twelve patients with cerebral aspergillosis in this setting were seen over 10 years. Underlying illnesses were renal transplantation in six cases and one case each of subacute hepatic necrosis, head trauma, glioblastoma, microglioma, and esthesioneuroblastoma. All patients were receiving high dose steroid therapy except one who had ectopic ACTH syndrome. Eleven patients were receiving broad spectrum antibiotics. All patients were febrile and developed progressive pulmonary infiltrates preceding or coincident with neurologic symptoms. Sudden onset of neurologic deficits or seizures occurred in nine of 11 clinically analyzable cases. Brainstem or cerebellar signs and symptoms were a presenting feature in three cases and were eventually seen in five cases. Cranial computerized tomography in four cases showed low absorption areas with minimal enhancement and little mass effect. Neurologic deterioration was rapid with nine of 11 patients dying within 6 days of onset. Neuropathologic examination showed multiple abscess formation in 11 cases and prominent blood vessel invasion in all cases. The sudden onset of stroke-like deficits and brainstem findings in a febrile immunocompromised host with pulmonary infiltrates suggests the diagnosis of cerebral aspergillosis. Two cases of aspergillus meningitis were also seen, one postoperatively

Cranial computed tomography (CT) scans were analyzed in five patients with autopsy documented intracranial aspergillosis. All infections occurred in immunocompromised hosts. Our findings included subtle low attenuation abnormalities, minimal mass effect, and poor contrast enhancement without ring configuration, in the clinical setting of lethargy, fever, and pulmonary infection. The benign CT picture did not clearly depict the aggressive intracranial parenchymal destruction

Cranial computed tomography (CT) in a 58-year-old man disclosed enhancing lesions in the medial right temporal lobe and the right pons. Biopsy of the sural nerve was positive for Whipple's disease, and one of the temporal lobe lesions showed unprecedented histological findings. This case, to our knowledge, is unique in its demonstration of cranial CT findings in association with Whipple's disease. It is suggested that a cranial CT scan with the use of intravenous contrast material should be performed in patients presenting with the signs or symptoms of Whipple's disease