Cranial Computed Tomography Scan Research Articles

Age estimation by multidetector computed tomography of cranial sutures in Chinese male adults

This study aimed to explore whether computed tomography (CT) images of cranial sutures can contribute to adult age estimation in Chinese Han individuals. This study was based on cranial CT scans of 230 Chinese Han males aged 23.33-76.93 years. A total of 160 images from 16 suture segments were scored after volume reformation and multiplanar reconstruction in each individual. Decision tree regression, linear support vector regression, Bayesian ridge regression, and gradient boosting regression were developed for adult age estimation by a training set using leave-one-out cross-validation and further evaluated by the test set. The inaccuracy and bias were calculated to evaluate the four models and the previously used models from the literature. The degree of suture closure was associated with adult age. The minimum inaccuracy of the test set was 7.73 years obtained by linear support vector regression, while the inaccuracy of previous simple linear regression models was 13.09 and 10.97 years. The accuracy was higher in the age group from 40.00 to 59.99 years compared to the other age groups. The accuracy of our models for adult age estimation was superior to those in previous studies based on cranial sutures. Hence, the application of novel statistical data mining tools helps to improve aging issues. Nevertheless, age estimation of adults should be combined with other methods, since the accuracy level is still not satisfactory.

Leiomiosarcoma de fosa nasal. A propósito de un caso

A 54-year-old female patient presented with a left nasal obstruction. On physical examination a pink delimited mass in the left nostril was observed. A cranial computed tomography scan revealed an expansive mass in the upper anterior third of the left nasal fossa, partially obstructing it. Endoscopic resection of the mass was performed. Histopathology revealed an atypical mesenchymal proliferation formed by cells disposed in disorganized and interconnected long bundles. Tumor cells had abundant eosinophilic cytoplasm and an oval, vesicular and hyperchromatic nucleus. Frequent mitotic figures were observed, many of them atypical. Necrosis was not observed. Immunohistochemistry showed tumor cells to be positive for calponin, muscle specific actin, caldesmon and smooth muscle specific myosin. Ki-67 index proliferation was 30%. A diagnosis of leiomyosarcoma of the nasal fossa was established.

Children With Minor Blunt Head Trauma Presenting to the Emergency Department

In our state-of-the-art review, we summarize the best-available evidence for the optimal emergency department management of children with minor blunt head trauma. Minor blunt head trauma in children is a common reason for emergency department evaluation, although clinically important traumatic brain injuries (TBIs) as a result are uncommon. Cranial computed tomography (CT) scanning is the reference standard for the diagnosis of TBIs, although they should be used judiciously because of the risk of lethal malignancy from ionizing radiation exposure, with the greatest risk to the youngest children. Available TBI prediction rules can assist with CT decision-making by identifying patients at either low risk for TBI, for whom CT scans may safely be obviated, or at high risk, for whom CT scans may be indicated. For clinical prediction rules to change practice, however, they require active implementation. Observation before CT decision-making in selected patients may further reduce CT rates without missing children with clinically important TBIs. Future work is also needed to incorporate patient and family preferences into these decision-making algorithms when the course of action is not clear.

Fahr's Disease Presenting with Pure Dementia: A Case Report and Literature Review

Fahr's disease (FD) is a rare inherited or sporadic disorder characterized by symmetrical calcium deposits in the basal ganglia and dentate nuclei with the absence of biochemical abnormalities. Clinical manifestations can start at different ages with a variety of presentations. We report a case of a 68-year-old male who presented to our service with clinical signs and symptoms of pure and progressive dementia. Afterward, he developed mood changes, and finally, movement disorders, probably due to a sporadic form of FD. Noncontrast cranial computed tomography scan demonstrated scattered brain parenchyma, bilateral calcifications in the basal ganglia, and dentate nuclei. Standard blood tests were within the normal limits. In this way, FD can present with pure dementia at onset, reflecting a wide range of neurological manifestations. The diagnosis is challenging, and we proposed an acronym to facilitate the learning of the diagnostic criteria.

Efficacy and safety of high-dose fluconazole in the initial treatment of non-human immunodeficiency virus-related cryptococcal meningitis

Objective To evaluate the efficacy and safety of high-dose fluconazole alone or combined with flucytosine as initial therapy for cryptococcal meningitis (CM) in non-human immunodeficiency virus (HIV)-related patients. Methods Twenty-five non-HIV-infected patients with CM from June 2015 to September 2018 in Huashan Hospital, Fudan University, who were initially treated with high-dose fluconazole with or without flucytosine for at least seven days were retrospectively reviewed.Clinical features and antifungal (600-800 mg/d) regimens were recorded, clinical responses and drug-related adverse events were evaluated. Mann-Whitney test and Fisher′s exact probabilities test were applied to compare variables between groups. Results Of the 25 patients enrolled in this study, 15 had predisposing factors. Headache (25 cases), fever (21 cases), vomiting (13 cases) and neck stiffness (13 cases) were common manifestations. Abnormalities of cranial computed tomography (CT) scan and/or magnetic resonance imaging (MRI) were found in 22 cases.Nineteen patients were treated with high-dose fluconazole plus flucytosine for initial therapy, and six patients were treated with high-dose fluconazole alone. The course of initial regimens with high-dose fluconazole was 42 (29, 120) days. At the end of initial therapy, partial response in 20 patients, stable response in three patients and death in two patients were observed, and the overall effective rate was 80%(20/25). In treatment failure group of initial treatment, the proportion of patients with baseline cerebrospinal fluid opening pressure over 300 mmH2O (1 mmH2O=0.009 8 kPa) and with altered mental status were both significantly higher compared with those in treatment success group. Fluconazole related adverse drug events were observed including elevated transaminases (one case), gastrointestinal symptoms combined with hypokalemia (two cases), and systemic rash (three cases). Except for three patients with rash reduced the dosage of fluconazole, no other patients were given dosage adjustment. Conclusion High-dose fluconazole alone or combined with flucytosine is effective and safe for the initial therapy of non-HIV-related CM patients. Key words: Meningitis, cryptococcal; Fluconazole; Initial therapy; High-dose

Assessment of intracranial pressure monitoring in patients with moderate traumatic brain injury: A retrospective cohort study

Objectivesintracranial pressure (ICP) monitoring has now been a standard technique for the treatment of severe traumatic brain injury (sTBI), while the effect of ICP monitoring for moderate traumatic brain injury (mTBI) is not clear. Moreover, evidence comparing the two types of ICP monitoring: ventricular drainage (VD) catheter and intraparenchymal (IP) catheter is scarce. Patients and methods91 patients with mTBI were reviewed retrospectively. They were divided into VD, IP and Non-ICP group. Baseline parameters were recorded. The clinical outcome was reflected by Glasgow Outcome Scale (GOS) and mortality at discharge and six months after injury. The rate of surgical decompression, refractory intracranial hypertension, neuroworsening, dose of mannitol and cranial CT were recorded. Meningitis and intracranial hematoma, two major complications of ICP monitoring, were also collected. Resultsthe three groups showed no significant difference in GOS at discharge and six months after injury. The mortality was similar among the three groups at six months after injury, while the Non-ICP group had the highest mortality at discharge. The Non-ICP group was administered the most mannitol while the VD group was administered the least. The Non-ICP group also received the most cranial CT scans among the three groups. Incidence of meningitis and intracranial hematoma were not significantly different among the VD and IP group. Conclusionuse of ICP monitoring could hardly improve the functional outcome of mTBI, but may possibly reduce the in-hospital mortality. By using ICP monitoring, the dose of mannitol and cranial CT scan for mTBI patients may be decreased.

Central nervous system disorders after hematopoietic stem cell transplantation: a prospective study of the Infectious Diseases Working Party of EBMT.

We performed a prospective study to evaluate the types and characteristics of central nervous system (CNS) disorders in patients after hematopoietic stem cell transplantation. The study included 163 episodes of CNS disorders of which 58 (36%) were infections. Proven or probable infections were documented in 34 patients and included fungi (n = 10, 29%), viruses (n = 12, 35%), Toxoplasma spp. (n = 9, 27%) and bacteria (n = 3, 9%). Non-infectious neurological disorders (n = 105, 64%) frequently encompassed metabolic/drug-induced abnormalities (n = 28, 27%) or cerebral vascular events (n = 22, 21%). Median onset times were later for infectious (day + 101) vs non-infectious neurological disorders (day + 50, p = 0.009). An unremarkable cranial CT scan was found in 33% of infection episodes. Absence of cerebrospinal fluid pleocytosis despite a normal or increased peripheral blood white blood cell count occurred in 26% of infections. Day-30 mortality rates were significantly higher for fungal (87%) vs non-fungal infections (40%, p < 0.001). Significantly higher mortality rates were also documented for cerebral vascular events than for other non-infectious disorders (86% vs 34%, p < 0.001). Our prospective study shows that diagnostic findings in CNS infections might differ between hematopoietic stem cell transplant recipients and immunocompetent hosts. Special awareness and timely initiation of adequate diagnostics are crucial to improve the prognosis of these patients.

Craniometric variation and ancestry estimation in two contemporary Caribbean populations

Ancestry estimation of skeletonized remains by forensic anthropologists is conducted through comparative means, and a lack of population-specific data results in possible misclassifications. This is especially germane to individuals of Latin American ancestry. Generally, each country in Latin America can trace their ancestral lineage through three main parental groups: Indigenous, European, and African. However, grouping all Latin American individuals under the broad “Hispanic” category ignores the specific genetic contributions from each parental group, which is variable and dependent on the population histories and sociocultural dynamics of each country. This study analyzes the craniometric ancestry of Hispaniola (the Dominican Republic and Haiti) using 190 cranial Computed Tomography (CT) scans (f=103; m=87), along with the island’s history, to explore similarities and differences between the two groups. MANOVA results indicate that 53.6% and 71.4% of the 28 cranial measurements differ between the ancestries and sexes, respectively; and intraobserver error analyses demonstrate that 85.7% of measurements from CT scans are good-excellent in reliability. Further, a total of 12 canonical discriminant function analyses produced cross-validated classification accuracies of 73.7–78.6% for females, 71.8–87.5% for males, and 72.0–77.8% for pooled sex. This study demonstrates that, despite sharing a small island, Dominican and Haitian individuals can be differentiated with a fair amount of statistical certainty, which is possible due to complex socio-cultural, -political, and -demographic factors that have produced and maintained genetic heterogeneity. Moreover, the discriminant functions provided here can be used by the international forensic science community to identify individuals living on Hispaniola.

Delayed Intracranial Hemorrhage in Patients with Head Trauma and Antithrombotic Therapy.

Background: Delayed intracranial hemorrhage can occur up to several weeks after head trauma and was reported more frequently in patients with antithrombotic therapy. Due to the risk of delayed intracranial hemorrhage, some hospitals follow extensive observation and cranial computed tomography (CT) protocols for patients with head trauma, while others discharge asymptomatic patients after negative CT. Methods: We retrospectively analyzed data on patients with head trauma and antithrombotic therapy without pathologies on their initial CT. During the observation period, we followed a protocol of routine repeat CT before discharge for patients using vitamin K antagonists, clopidogrel or direct oral anticoagulants. Results: 793 patients fulfilled the inclusion criteria. Acetylsalicylic acid (ASA) was the most common antithrombotic therapy (46.4%), followed by vitamin K antagonists (VKA) (32.2%) and Clopidogrel (10.8%). We observed 11 delayed hemorrhages (1.2%) in total. The group of 390 patients receiving routine repeat CT showed nine delayed hemorrhages (2.3%). VKA were used in 6 of these 11 patients. One patient needed an urgent decompressive craniectomy while the other patients were discharged after an extended observation period. The patient requiring surgical intervention due to delayed hemorrhage showed neurological deterioration during the observation period. Conclusions: Routine repeat CT scans without neurological deterioration are not necessary if patients are observed in a clinical setting. Patients using ASA as single antithrombotic therapy do not require in-hospital observation after a negative CT scan.

HEMATOMA EXTRADURAL DE VÉRTEX: A PROPÓSITO DE UM CASO CLÍNICO

Hematomas extradurais de vértex (HEVs) são entidades raras e que apresentam taxa de mortalidade entre 18 e 50%. Os HEVs são altamente associados às fraturas de vértice e diástase das suturas cranianas. Apresentamos o caso de um paciente jovem, masculino, que apresentou TCE após queda de própria altura durante atividade física coletiva, resultando em perda da consciência seguida de cefaleia intensa e vômitos persistentes. Foi realizada TC de crânio, a qual evidenciou HEV e fratura do tipo diastásica da sutura sagital, associada a contusão hemorrágica frontobasal e bifrontal. Foi optado por realizar tratamento conservador em unidade de terapia intensiva, realizando exames neurológico e de imagem seriados. O paciente manteve cefaleia durante todo o internamento, evoluindo com paresia incompleta do nervo abducente à direita, com resolução completa da paresia ao 10° dia. Após alta hospitalar, o paciente manteve acompanhamento ambulatorial, apresentando resolução completa do hematoma após 60 dias; no entanto, apresentou-se com anosmia bilateral durante todo o período em que esteve em acompanhamento.

HINTS IN THE ER- case report

Vertigo is a false sense of motion of either the environment or self and is diagnosed in approximately half of the patients with dizziness. Acute spontaneous onset of vertigo is called acute vestibular neuritis (AVN). It is caused by peripheral lesion and requires symptomatic treatment. The symptoms of AVN can mimic a central pathology like cerebellar or brainstem infarction with no concomitant red-flag manifestation. Magnetic Resonance Neuroimaging with Diffusion-weighted imaging (MRI-DWI) as well as Computed Tomography (CT) scan delivers false negatives results what significantly delays stroke treatment. HINTS is an acronym for the battery of three bedside tests of ocular motor physiology. The method is more sensitive in diagnosing posterior circulation infarct than MRI-DWI with specificity -96 %. We present a case of a patient with vertigo who underwent two cranial CT scans and neurological examination. HINTS was worrisome. The brainstem infarct diagnosis was confirmed by MRI-DWI.

Implementation of a Computerized Decision Support System for Computed Tomography Scan Requests for Nontraumatic Headache in the Emergency Department.

Nontraumatic headache is a frequent complaint in the emergency department (ED). Cranial computed tomography (CT) is a widely available test for the diagnostic work-up, despite the risk of exposure to ionizing radiation. We sought to develop and evaluate a cranial CT request computerized decision support system (CDSS) for adults with their first presentation of unusual severe nontraumatic headache in the ED. Electronic database searches identified clinical decision and prediction rules and studies delineating risk factors in nontraumatic headache. A long list of risk factors extracted from these articles was reduced by a 30-member multidisciplinary expert panel (radiologists, emergency physicians, methodologists), using a 90% agreement threshold. This shortlist was used to develop the algorithm for the cranial CT request CDSS, which was implemented in March 2016. Impact evaluation compared CT scan frequency and diagnostic yield of pathologic findings before (March-August 2015) and after (March-August 2016) implementation. From the 10 selected studies, 10 risk factors were shortlisted to activate a request for cranial CT. Before implementation, 377 cranial CTs were ordered (15.3% of 2469 CT scans) compared with 244 after (9.5% of 2561 CT scans; pre-post difference 5.74%; 95% confidence interval [CI] 3.92-7.56%; p<0.001), corresponding to a 37.6% relative reduction in the test ordering rate (95% CI 25.7-49.5%; p<0.001). Despite the reduction in cranial CT scans, we did not observe an increase in pathological findings after introducing the decision support system (70 cases before [18.5%] vs. 35 cases after [14.3%]; pre-post difference -4.0% [95% CI -10.0 to 1.6%]; p=0.170). In nontraumatic headache amongadults seen in the ED, CDSS decreased the cranial CT request rate but the diagnostic yield did not improve.

Herpes simplex virus limbic encephalitis in a Filipino man with advanced stage testicular cancer: A case report

A 66-year-old Filipino Male, Hypertensive, Diabetic, diagnosed with Advanced Testicular Cancer presented with a five day history of fever, productive cough associated with sudden onset of behavioral changes, memory lapses and disorientation. On admission, the patient was disoriented, with poor comprehension and inability to follow commands. There were no focal motor deficits or signs of meningeal irritation. Cranial CT scan and serum electrolytes were unremarkable. CBC showed leukocytosis with predominant neutrophils, chest xray revealed pneumonia. Piperacillin+ Tazobactam and Azithromycin was started On the second hospital day, he had seizures manifested as blank stares, teeth grinding, lip smacking and fidgety movement of the right hand. Electroencephalogram showed epileptiform discharges in both frontal-prefrontal and both frontal-central regions. A cranial MRI with Contrast revealed high T2W and FLAIR signal changes and edema in the mesial temporal lobes and right insula (Figure 1) and right lentiform nucleus (Figure 2). EEG and MRI findings are consistent with Limbic Encephalitis based on the diagnostic criteria by Gultekin et al.1(2014). A lumbar puncture yielded a colorless cerebrospinal fluid (CSF) with normal opening pressure, normal RBC and WBC, lymphocytic predominance (96%), elevated CSF protein and normal CSF glucose. CSF Acid Fast Bacilli (AFB), KOH and India Ink were all negative. Further CSF analysis for neuronal autoantibodies specifically Anti-NMDA, Anti- Hu and Anti- Ma2 were likewise negative. Polymerase Chain Reaction (PCR) assay for Herpes Simplex Virus was positive for HSV-1. Intravenous Acyclovir was started at 15mg/kg per day. After three weeks of antiviral therapy the patient's condition improved.

Paraneoplastic myasthenia gravis in a 62 year old Filipino woman with a well-differentiated retroperitoneal liposarcoma: A case report

V.G., is a 62 year old woman, housewife, known hypertensive and asthmatic, from Cebu City admitted due to ptosis and an enlarging abdominal mass. Two years PTA, patient had onset of bilateral ptosis associated with occasional diplopia. She just tolerated the condition and no consult was done. Eighteen months PTA, she noted a soft, palpable, non tender, round mass on the right lower abdominal area. There were no associated changes in bowel and bladder pattern or weight loss. Two weeks PTA, abdominal girth increased causing occasional exertional dyspnea. She sought consult with a gastroenterologist. Computed tomography scan of the whole abdomen revealed a large retroperitoneal mass, suggestive of a large Liposarcoma. She underwent an exploratory laparotomy, adhesiolysis, and radical excision of the retroperitoneal mass. Histopathologic gross examination of the specimen revealed that the mass weighed 800 grams, and measured 441 X 331 X 120 cm. Microscopic examination showed a neoplasm consisting of lobules of adipose cells, which were traversed by fibrocollagenous septae of varied thickness consistent with a well differentiated Liposarcoma. Three years after surgey, she noted progression of bilateral ptosis now associated with facial weakness and generalized muscle fatigue that markedly improved with rest. She was admitted at a local hospital where Paraneoplastic Myasthenia Gravis with a Liposarcoma was considered. Cranial and Chest CT scans were unremarkable. Pyridostigmine test was positive with improvement of ptosis, diplopia, and muscle weakness. Anti-acetylcholine receptor radioimmunoassay was positive for AchR antibodies. She was treated with intravenous immunoglobulin (IVIG) and was discharged with Pyridostigmine (Mestinon) as maintenance.

Multiple intracerebral hemorrhage as initial presentation of acute leukemia: A case report

Intracerebral Hemorrhage had been a harbinger of morbidity and mortality in patients diagnosed with hematologic malignancy. Spontaneous Intracerebral hemorrhage prior to diagnosis is Leukemia however, is very rare and to our knowledge, only 6 have been reported. This is a case of a 21-year-old female, who was rushed to the emergency department due to decrease in sensorium. Patient had no significant headaches, no signs of increased intracranial pressure, and no signs of bruising or bleeding prior. Plain cranial CT scan revealed multiple intracerebral Hemorrhages of at least 18 in number. The Results of cytology revealed Acute Myeloid Leukemia. Several factors from previous comprehensive studies have been highlighted to increase the risk of Intracerebral Hemorrhage amongst these populations. Approximately 5% of patients with Acute leukemia will develop intracerebral hemorrhage and predictors for mortality have different in reported studies. Hyperleukocytosis is a strong consideration for increased mortality, the level of which still undetermined due to lack of literature. Although a probable association between Hyperleukocytosis and survival has been theorized, there is still insufficient data to conclude with certainty. More case reports or retrospective studies are needed so that an association may be established that can help in acute management of these patients.

Early autologous cranioplasty: complications and identification of risk factors using virtual reality visualisation technique

Background: Cranioplasty (CP) of autologous bone flap after decompressive craniectomy (DC) is known to be associated with a high complication rate, particularly bone flap resorption (BFR). In a retrospective study, we used a novel virtual reality (VR) visualisation technique to identify and evaluate risk factors associated with CP.Method: Twenty-five patients underwent early autologous CP. All complications were recorded. Cranial computed tomography scans were visualised via the VR software to access the fitting accuracy of the bone flap (bone flap size, gap width at trepanation cutting edge, extent of osteoclastic extension).Results: An overall complication rate of 44% was seen, and BFR was the most common (36%). Only ‘osteoclastic extension of trepanation’ (p = .04) was a significant risk factor for BFR. The factors ‘indication for DC’ (p = .09) and ‘size of bone flap’ (p = .09) had a tendency towards influencing the rate of BFR, while ‘age’ (p = .68), ‘time interval between DC and CP’ (p = 1.00), and ‘gap width’ (p = .50) were not considered to influence the BFR rate.Conclusions: DC and subsequent CP is a complication-prone procedure. Therefore, it is relevant to identify and quantify probable risk factors for the most common complications, such as BFR. Here, we found that the extent of osteoclastic extension may impair the patient’s healing process. Our investigation was made considerably easier by using the novel VR visualisation technique, which allows parallax free measurements of distances in 3D space.

Validation of the PECARN head trauma prediction rules in Japan: A multicenter prospective study

BackgroundHead trauma in children is one of the most common causes for emergency department visits. Although most trauma cases are minor, identifying those patients who have clinically important traumatic brain injury (ciTBI) is challenging. The Pediatric Emergency Care Applied Research Network (PECARN) head trauma prediction rules identifying children who do not require cranial computed tomography (CT) were validated and are used all over the world. However, these rules have not been validated with large cohort multicenter studies in Asia. ObjectivesTo investigate whether the PECARN rules can be safely applied to Japanese children. MethodsWe conducted a multicenter, prospective, observational cohort study. We included children younger than 16 with minor head trauma (Glasgow Coma Scale ≥14) who presented to the six participating centers within 24 h of their injuries between June 2016 and September 2017.The primary analysis was set to calculate the negative predictive value of the patients with very low risk by the PECARN rules, compared with a preset threshold of 99.85%. ResultsWe included 6585 children of which 463 (7.0%) had head CT scans performed and 23 (0.35%) had ciTBI. There were two patients with ciTBI who were classified as very low risk. The negative predictive value, calculated as 99.96% (95%CI: 99.86–100.00; P = .019), was significantly superior compared with the preset threshold of 99.85%. ConclusionsThe PECARN head trauma prediction rules seemed to be safely applicable to Japanese children. Further studies are needed to determine safety in hospitals where physicians do not have expertise in managing children.

Evaluation of safety, effectiveness and reproducibility of telemedicine for neurosurgical screening.

ABSTRACTObjective:To ascertain the safety, effectiveness and reproducibility of screening potential neurosurgical patients by means of smartphones.Methods:This is a retrospective and multicentric study. Data were collected from the medical records of patients subjected to real emergency neurosurgical evaluations and compared with assessments by neurosurgeons using smartphones to determine the feasibility of identifying changes in cranial computed tomography scans, potentially serious conditions of patients, and the need for transfer to reference centers.Results:We analyzed 232 cases. The main diagnosis was traumatic brain injury, with 119 cases (51.3%). Of this, 105 (45.3%) patients were discharged immediately after the assessment. The telemedicine evaluators presented 95.69% accuracy in the identification of changes in computed tomography scans, with 0.858 concordance. Accuracy in the identification of severity was 95.26%, with 0.858 concordance. As for procedure, the concordance among evaluators was 0.672, increasing to 100% in cases that required surgical treatment.Conclusion:Our study indicated that the use of telemedicine for screening patients with acute neurological disorders was safe, effective and reproducible. Implementation of the method shows a promising potential to improve the patient's outcome by reducing unnecessary transfers and decreasing the time elapsed until a specialist can be consulted.

Rare case of iatrogenic tension pneumocephalus

Background: Pneumocephalus is a common complication of craniotomies. Since it has little or no clinical significance, it usually requires no treatment. However, tension pneumocephalus could also be associated with raised intracranial pressure and neurological deterioration. This emergency requires immediate radical approach to achieve surgical decompression.Objectives: To create awareness that the onset of post craniotomy tension pneumocephalus may be delayed and also to show that the radiological appearance may deviate from the classical Mount Fuji model.Case Description: A pituitary mass was successfully removed overseas from a 49-year-old man by transcranial approach. He improved, returned home and presented himself for clinical review on arrival without any significant complaint. The patient was brought back in coma two weeks later with blood pressure of 150/100 mmHg and aseptic CSF rhinorrhoea. The cranial CT scan showed marked dilatation of the lateral ventricles with obvious gas lucencies (Hounsfield unit = -1000HU).Concluson: High index of suspicion of tension pneumocephalus should be borne in mind in post operative reviews of craniotomy patients, as timely appropriate intervention is imperative.

Efficiency of Dexamethasone for Treatment of Vasogenic Edema in Brain Metastasis Patients: A Radiographic Approach.

Background and Purpose: To date, imaging studies quantifying the amount of vasogenic edema reduction (VE) in patients with brain metastases (BM) treated with glucocorticoids (GC) have included a very limited number of patients and showed ambiguous results. Here, we aim to determine the radiological effect of GC on VE in BM patients in a large cohort with multiple primary tumor entities in a cross-sectional approach.Materials and Methods: This monocentric retrospective study includes 299 patients first-ever diagnosed with 2,759 intra-axial BM on the respective MRI. 126/299 patients received GC prior to MRI due to mass effect of edema on cranial CT scan and clinical symptoms (GC-pos) and 173 patients did not (GC-neg). GC dose was documented in 85/126 patients. All BM and their respective VE were semi-automatically segmented on post-contrast T1-weighted images.Results: VE volumes were higher in GC-pos compared to GC-neg (p = 0.009) and did not correlate with GC dose. Multivariate linear regression analysis with interaction terms on the assumption that BM volume and BM number influence the probability of GC administration shows that large and higher numbers of BM under GC treatment generate less VE than without (p < 0.001 and p = 0.038, respectively). The primary tumor type and total BM volume did not influence VE volume.Conclusion: Use of GC is especially effective for treatment of VE formation in patients with larger and multiple BM regardless of primary tumor type and dosage. However, based on the present data a direct causative relationship between GC and VE cannot be proven.