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Lateral radiography of the cervical spine in the trauma patient: looking beyond the spine [Case Report]

Perry JR; Stern EJ; Mann FA; Baxter AB
PMID: 11159078
ISSN: 0361-803x
CID: 42755

Radiologic spectrum of craniocervical distraction injuries

Deliganis AV; Baxter AB; Hanson JA; Fisher DJ; Cohen WA; Wilson AJ; Mann FA
Injuries to the atlanto-occipital region, which range from complete atlanto-occipital or atlantoaxial dislocation to nondisplaced occipital condyle avulsion fractures, are usually of critical clinical importance. At initial cross-table lateral radiography, measurement of the basion-dens and basion-posterior axial line intervals and comparison with normal measurements may help detect injury. Computed tomography (CT) with sagittal and coronal reformatted images permits optimal detection and evaluation of fracture and luxation. CT findings that may suggest atlanto-occipital injury include joint incongruity, focal hematomas, vertebral artery injury, capsular swelling, and, rarely, fractures through cranial nerve canals. Magnetic resonance (MR) imaging of the cervical spine with fat-suppressed gradient-echo T2-weighted or short-inversion-time inversion recovery sequences can demonstrate increased signal intensity in the atlantoaxial and atlanto-occipital joints, craniocervical ligaments, prevertebral soft tissues, and spinal cord. Axial gradient-echo MR images may be particularly useful in assessing the integrity of the transverse atlantal ligament. All imaging studies should be conducted with special attention to bone integrity and the possibility of soft-tissue injury. Atlanto-occipital injuries are now recognized as potentially survivable, although commonly with substantial morbidity. Swift diagnosis by the trauma radiologist is crucial for ensuring prompt, effective treatment and preventing delayed neurologic deficits in patients who survive such injuries
PMID: 11046174
ISSN: 0271-5333
CID: 42756

Traumatic ossicular disruption [Case Report]

Li ST; Baxter AB
PMID: 10789781
ISSN: 0361-803x
CID: 42757

Internal carotid pseudoaneurysm and cerebral infarction from shotgun pellet penetration and embolization [Case Report]

Song JK; Srinivasan J; Gordon DS; Newell DW; Baxter AB
PMID: 10511189
ISSN: 0361-803x
CID: 42759

Extravasation of radiographic contrast is an independent predictor of death in primary intracerebral hemorrhage

Becker KJ; Baxter AB; Bybee HM; Tirschwell DL; Abouelsaad T; Cohen WA
BACKGROUND AND PURPOSE: Hematomas that enlarge following presentation with primary intracerebral hemorrhage (ICH) are associated with increased mortality, but the mechanisms of hematoma enlargement are poorly understood. We interpreted the presence of contrast extravasation into the hematoma after CT angiography (CTA) as evidence of ongoing hemorrhage and sought to identify the clinical significance of contrast extravasation as well as factors associated with the risk of extravasation. METHODS: We reviewed the clinical records and radiographic studies of all patients with intracranial hemorrhage undergoing CTA from 1994 to 1997. Only patients with primary ICH were included in this study. Univariate and multivariate logistic regression analyses were performed to determine the associations between clinical and radiological variables and the risk of hospital death or contrast extravasation. RESULTS: Data were available for 113 patients. Contrast extravasation was seen in 46% of patients at the time of CTA, and the presence of contrast extravasation was associated with increased fatality: 63.5% versus 16.4% in patients without extravasation (P=0.011). There was a trend toward a shorter time (median+/-SD) from symptom onset to CTA in patients with extravasation (4.6+/-19 hours) than in patients with no evidence of extravasation (6.6+/-28 hours; P=0.065). Multivariate analysis revealed that hematoma size (P=0.022), Glasgow Coma Scale (GCS) score (P=0.016), extravasation of contrast (P=0.006), infratentorial ICH (P=0.014), and lack of surgery (P<0.001) were independently associated with hospital death. Variables independently associated with contrast extravasation were hematoma size (P=0.024), MABP >120 mm Hg (P=0.012), and GCS score of </=8 (P<0.005). CONCLUSIONS: Contrast extravasation into the hematoma after ICH is associated with increased fatality. The risk of contrast extravasation is increased with extreme hypertension, depressed consciousness, and large hemorrhages. If contrast extravasation represents ongoing hemorrhage, the findings in this study may have implications for therapy of ICH, particularly with regard to blood pressure management
PMID: 10512902
ISSN: 0039-2499
CID: 42758

Orbital assault with a pencil: evaluating vascular injury [Case Report]

Tenenholz T; Baxter AB; McKhann GM
PMID: 10397115
ISSN: 0361-803x
CID: 42760

Delayed cerebral artery pseudoaneurysm after nail gun injury [Case Report]

Blankenship BA; Baxter AB; McKahn GM 2nd
PMID: 9930820
ISSN: 0361-803x
CID: 42761

Imaging of intracranial aneurysms and subarachnoid hemorrhage

Baxter AB; Cohen WA; Maravilla KR
Advances in CT, MR imaging, and catheter angiography provide the radiologist and neurosurgeon with a variety of imaging options for screening, diagnosis, presurgical evaluation, and postoperative monitoring of patients with intracranial aneurysms. Noninvasive imaging techniques have not replaced conventional angiography for the comprehensive evaluation o aneurysms but are effective in screening patients suspected to have an unruptured aneurysm or for preoperative planning in emergency situations that preclude catheter angiography. CT, CT angiography, MR imaging, and MR angiography can all complement the information obtained with catheter angiography in presurgical planning, and the choice of supplemental studies should be individualized. Rotational and intraoperative angiography are problem-solving options used for selected cases at our institution. Continuous improvements in techniques for CT and MR angiography may someday reach the point where surgery can be undertaken on the basis on noninvasive imaging alone, with catheter angiography reserved for endovascular therapy planning and guidance
PMID: 9668179
ISSN: 1042-3680
CID: 42762

Cerebral infarct in a victim of vehicular polytrauma

Baxter AB; Nevitt AW; Britz GW
PMID: 9456975
ISSN: 0361-803x
CID: 42763

Serial MR in gene therapy for recurrent glioblastoma: initial experience and work in progress

Deliganis AV; Baxter AB; Berger MS; Marcus SG; Maravilla KR
PURPOSE: To describe the MR imaging findings in a pilot study evaluating gene therapy for treatment of patients with recurrent glioblastoma. METHODS: Serial MR examinations were evaluated retrospectively in patients treated with gene therapy that included a retroviral vector containing the herpes simplex virus thymidine kinase gene and intravenous ganciclovir. Images were obtained after tumor resection and after each cycle of treatment, at approximately 40-day intervals. The volume of enhancing tissue was measured on serial MR images. RESULTS: Eleven patients with recurrent glioblastoma were entered into the clinical trial of gene therapy and seven patients completed at least two cycles of treatment. Of these seven, three patients had an early (between 40 and 80 days) increase in the volume of enhancing tissue followed by a decrease or plateau in enhancing tissue volume. A fourth patient had a stable volume of enhancing tissue for 132 days. The remaining three patients had continuous increases in volume of enhancement on all subsequent MR examinations. CONCLUSION: Although animal data show striking tumor regression in response to similar gene therapy, only limited regression was observed among the seven patients we studied. The transient increases in enhancement seen in three of seven patients might reflect an inflammatory response to local injection of the viral vector
PMID: 9296177
ISSN: 0195-6108
CID: 9019