Initial CT Imaging Research Articles

Ophthalmoplegia and Lid Retraction With Normal Initial Orbit CT Imaging in Extraocular Muscle Metastases as the Presenting Sign of Breast Carcinoma

Ophthalmoplegia and Lid Retraction With Normal Initial Orbit CT Imaging in Extraocular Muscle Metastases as the Presenting Sign of Breast Carcinoma

Suppurative intracranial complications of sinusitis in children

Objective: A review of suppurative intracranial complications of sinusitis in children. Methods: Case series review over a two-year period from 1998 to 1999 in a children's hospital, Singapore. Results: There were seven cases, all male, and age range 9 to 14. Six had subdural empyemas and one had meningitis. The most common presenting symptoms included fever, headache and vomiting. Sinusitis was suspected as the cause in only one patient initially. The intracranial infections were not apparent from the initial brain CT of two patients and were only confirmed later on repeated imaging. Four patients had lumbar punctures without any adverse effects. All seven children had infections involving the frontal, ethmoid and maxillary sinuses and two also had sphenoid involvements. All were treated with high-dose intravenous antibiotics together with drainage of both the intracranial (n=six) and sinus (n=seven) suppurations. Five needed repeated intracranial drainages. Streptococcus species were isolated in five cases. Three patients developed seizures post-operatively which resolved on follow-up. One patient needed a ventriculo-peritoneal shunt for hydrocephalus. All patients had a good Glasgow Outcome Score. The hospital stay ranged from 30 to 89 days with a median of 43 days. Conclusions: Only males were identified in this review, collaborating the feeling that teenage males are at greatest risk of developing intracranial infections from sinusitis. We recommend that radiologic imaging of the brain for suspected intracranial infection should always include the sinuses as this aids early identification of actual cause. Initial CT imaging may be negative and hence repeated scans are warranted if the index of suspicion is high. The successful outcome of the children in this series supports the opinion that combined aggressive surgical and medical treatment is preferable in this patient population.

Hemispheric Infarct Volume Prediction by CT perfusion imaging

P24 Objective: The ability to predict infarct volume when evaluating acute stroke patients is difficult. Bolus contrast CT perfusion imaging (CTP) with fast helical scanning, can identify that portion of ischemic brain with vasculature that does not fill with CT contrast. We evaluated the ability of this acute CTP lesion volume to predict final infarct volume. Methods: 18 patients were selected from our acute stroke database. Inclusion criteria were a CT Angiogram within 6 hours of a major stroke-like symptoms, a follow up brain imaging study no later than 30 days and no earlier than 36 hours, no thrombolytic treatment, and a hemispheric infarct. Initial non-contrast CT (NCCT), CTP and follow-up imaging volumes were measured using image analysis software. Results: Volume of infarct as determined by follow-up brain imaging is significantly predicted by CTP volume with a p value <0.001. The slope of the regression line was 2.02 and r 2 equal to 0.660. NCCT volume also predicted follow-up infarct volume, p<0.001, slope 2.13 and r 2 0.193. Conclusion: The volume of the infarct is surprisingly well predicted by the measured volume of CTP deficit. This occurs despite the variability due to secondary vascular events, edema and spontaneous reperfusion. NCCT also predicts the infarct volume but with much greater variability than the CTP. CT perfusion is a widely available technique to predict final infarct size in the acute setting.

Cerebral complications of nonaccidental head injury in childhood

Patterns of cerebral parenchymal injury and their relationship to outcome morbidity are evaluated in this retrospective study of 14 children with confirmed nonaccidental head injury (NAHI). The mean age at time of injury was 12 months 6 days, mean Children’s Coma Score was 5.36, and mean postinjury follow-up was 17 months 12 days. All patients had acute subdural hematoma (interhemispheric or convexity) on initial CT imaging. Two major groups of children were identified from initial CT scans; those with diffuse cerebral hypoattenuation (n = 7) and those with focal cerebral hypoattenuation (n = 7). The two groups differed significantly by age (diffuse group, mean age 5 months 9 days ± 36 days; focal group, mean age 19 months 3 days ± 6 months 9 days; P < 0.01) and ultimate type and extent of parenchymal damage. Outcome was generally poor in both groups (mean Children’s Outcome Score of III/IV). Cerebral infarction developed in all survivors. Most common were hemispheric necrosis after hemispheric swelling subjacent to an ipsilateral convexity acute subdural hematoma (n = 5); distribution of the posterior cerebral artery (n = 4) or callosomarginal branch of the anterior cerebral artery (n = 4); and borderzone infarctions (n = 4). Of 14 children, 11 (79%) had early posttraumatic seizures (EPTS). Clinical progression of symptoms was confirmed in nine patients (mean Childrens Coma Score was 4.0 ± 0.33). None had a lucid interval. This is the first study using strict inclusion criteria that documents the range of infarction patterns and potential age-dependent differences in postinjury response cascades after nonaccidental head injury.