Craniosynostosis.

Craniosynostosis is a complex condition, characterized by the premature fusion of one of more of the cranial sutures. They can be seen individually or as part of multisystem syndromes. This review uses computed tomography (CT) with three-dimensional reconstructions to help describe some of the types and classifications of craniosynostosis, as well as describing some of the associations and the management of craniosynostosis.

Congenital skull indentation: a case report and review of the literature.

Congenital depressions of the skull are rare in Western countries. The majority relate to obstetric trauma at delivery. We present a case of a congenital depression of a neonate's skull not relating to obstetric trauma.

Infant subcortical cystic leucomalacia: a distinct pathological entity resulting from impaired fluid handling.

Background: In the first months of life the subcortical white matter appears prone to fluid accumulation and cystic change. This condition has generally been considered to be due to hypoxic-ischaemic injury (HII) and is grouped with other forms of white matter disease including periventricular leucomalacia (PVL).

Aims: Our aim was to describe the sequential tissue changes in the formation of subcortical cystic leucomalacia in the infant brain and to delineate this from other forms of white matter disease in order to better understand its pathogenesis and aetiology.

An unusual cause of head drops.

The presence of vertical ocular motor apraxia should prompt a careful assessment to detect an underlying neurometabolic condition. But congenital vertical ocular motor apraxia is a rare entity that may be attributed to perinatal stroke, hypoxia or kernicterus. We report a case of a 5-year old girl with congenital vertical ocular motor apraxia.

Craniosynostosis: a radiological and surgical perspective.

Craniosynostosis is the premature fusion of the cranial sutures. It is identified early in life either due to cosmetic deformity or due to more serious functional complications. Isolated forms of craniosynostosis are much more common and less challenging in their management than their syndromic counterpart.

Imaging of the calvarium.

The skull vault consists of a multitude of flat bones held together by the cranial sutures. Radiologists encounter a vast array of calvarial pathologies that tend to cause abnormalities in thickness, abnormalities in density, focal defects, or an excess of soft tissue or bone tissue. Further anomalies related to the cranial sutures and fontanelles occur in the dynamic pediatric skull.

Imaging of the skin, subcutis, and galea aponeurotica.

An understanding of the anatomy of the layers of the scalp helps to interpret the radiology and therefore differentiate between various pathologic processes. This article describes the anatomy of the scalp and highlights the common, and some less common, pathologies that occur. Computed tomography, magnetic resonance imaging, and ultrasound can all help to categorize a lesion in the scalp.

Substantial observer variability in the differentiation between primary intracerebral hemorrhage and hemorrhagic transformation of infarction on CT brain imaging.

Background And Purpose: CT remains the most commonly used imaging technique in acute stroke but is often delayed after minor stroke. Interobserver reliability in distinguishing hemorrhagic transformation of infarction from intracerebral hemorrhage may depend on delays to CT but has not been reported previously despite the clinical importance of this distinction.

Methods: Initial CT scans with intraparenchymal hematoma from the first 1000 patients with stroke in the Oxford Vascular Study were independently categorized as intracerebral hemorrhage or hemorrhagic transformation of infarction by 5 neuroradiologists, both blinded and unblinded to clinical history.

Implications of a vertex bulge following modified strip craniectomy for sagittal synostosis.

Background: Modified strip craniectomy is a common treatment for early isolated sagittal synostosis. The authors assessed the significance of the development of a progressive vertex bulge following strip craniectomy as a predictor of raised intracranial pressure or multiple suture synostosis.

Methods: All cases of sagittal synostosis treated by modified strip craniectomy (removal of the sagittal suture with lateral barrel staving) at the authors' institution were reviewed.

Intramedullary tumours in patients with neurofibromatosis type 2: MRI features associated with a favourable prognosis.

Aim: To assess the magnetic resonance imaging (MRI) features and natural history of intramedullary tumours in patients with neurofibromatosis type 2 (NF2).

Materials And Methods: Eleven NF2 patients with intramedullary spinal cord tumours were identified from the database of the multidisciplinary NF2 clinic. All the imaging studies of these patients were individually reviewed by two neuroradiologists to evaluate the size, number, location, imaging characteristics, and interval growth of the intramedullary tumours.

Case report of glomus jugulare tumour associated with a posterior fossa cyst.

A subgroup of complex glomus jugulare tumours exists. This includes: multiple, giant or neuropeptide-secreting lesions; those associated with other lesions, such as dural arterio-venous malformation or an adrenal tumour; and tumours in which there has been previous treatment with adverse outcome. To our knowledge, we present the first case of a glomus jugulare tumour associated with a posterior fossa cyst.

Marrow proliferation as a cause of hearing loss in beta-thalassaemia major.

Objective: The aim of this report was to highlight the fact that hearing loss in thalassaemia patients can be related to marrow expansion affecting the ossicles, resulting in a conductive loss.

Case Report: A six-year-old boy with transfusion-dependent beta-thalassaemia developed a unilateral hearing loss shortly after commencing desferrioxamine therapy. Ototoxicity was assumed, but the deficit was later found to be of a conductive nature, due to marrow proliferation within the ossicular chain as a consequence of the disease process--a phenomenon previously unreported in the literature.

Imaging manifestations of neck masses in the immunocompromised host.

Human immunodeficiency virus (HIV) infection, haematological malignancy, and immunosuppression for transplantation and autoimmune disorders have led to a large increase in immunocompromised patients. Neck masses are relatively common in this patient group and include both opportunistic and severe manifestations of common infections, benign hyperplasia, and primary or secondary malignancies. Although biopsy may be necessary for definitive diagnosis, features on cross-sectional imaging may suggest a specific diagnosis or limit the differential diagnosis and facilitate optimal patient management.

MRI and clinical studies of facial and bulbar muscle involvement in MuSK antibody-associated myasthenia gravis.

A proportion of patients with myasthenia gravis (MG) without acetylcholine receptor (AChR) antibodies have antibodies to muscle-specific kinase (MuSK). MG with MuSK antibodies (MuSK-MG) is often associated with persistent bulbar involvement, including marked facial weakness and tongue muscle wasting. The extent of muscle wasting in MuSK-MG, and whether it is also found in the few acetylcholine receptor (AChR-MG) patients who have persistent bulbar involvement, is not clear.

Population-based study of event-rate, incidence, case fatality, and mortality for all acute vascular events in all arterial territories (Oxford Vascular Study).

Background: Acute coronary, cerebrovascular, and peripheral vascular events have common underlying arterial pathology, risk factors, and preventive treatments, but they are rarely studied concurrently. In the Oxford Vascular Study, we determined the comparative epidemiology of different acute vascular syndromes, their current burdens, and the potential effect of the ageing population on future rates.

Methods: We prospectively assessed all individuals presenting with an acute vascular event of any type in any arterial territory irrespective of age in a population of 91 106 in Oxfordshire, UK, in 2002-05.

Immature teratoma arising from a benign cortical abnormality.

Case Report: The authors report the case of an immature teratoma of the left parieto-occipital region in a 13-year-old girl. The patient had a computed tomographic (CT) scan of the brain aged 10 months old, following a minor head injury. This demonstrated an abnormality in the same region, which had been reported as 'a cortical malformation'.

The clinical syndrome associated with lumbar spinal stenosis.

Lumbar spinal stenosis is well defined in patho-anatomical terms but its clinical features are heterogeneous. We carried out a comprehensive retrospective review of the clinical features, radiological changes and outcome of 75 patients with radiologically diagnosed lumbar spinal stenosis in order to define its clinical spectrum. The presenting complaints were of weakness, numbness/tingling, radicular pain and neurogenic claudication in almost equal proportions.

Change in stroke incidence, mortality, case-fatality, severity, and risk factors in Oxfordshire, UK from 1981 to 2004 (Oxford Vascular Study).

Background: The incidence of stroke is predicted to rise because of the rapidly ageing population. However, over the past two decades, findings of randomised trials have identified several interventions that are effective in prevention of stroke. Reliable data on time-trends in stroke incidence, major risk factors, and use of preventive treatments in an ageing population are required to ascertain whether implementation of preventive strategies can offset the predicted rise in stroke incidence.

Cerebral infarct and meningitis secondary to Lemierre's syndrome.

The case is reported of a young man with Fusobacterium necrophorum septicemia who developed cavernous sinus thrombosis, meningitis, carotid artery stenosis and stroke. This article presents the only reported case of arterial stroke in Lemierre's syndrome. Clinical presentation, diagnostic difficulty and treatment are discussed.

Cranial bacterial infection.

Early diagnosis of cranial sepsis is mandatory if morbidity is to be avoided. In the case of structural integrity of the skull, haematogenous spread or extension from adjacent structures, especially the sinuses, are the most common sources of infection. Infections may be limited to compartments by the meninges or spread diffusely.

Brain haemorrhage in five infants with coagulopathy.

Most intracranial haemorrhages in infants after the neonatal period are secondary to non-accidental injury. Occasionally brain haemorrhages in non-mobile infants are due to an inherited coagulopathy. This may often be diagnosed with a coagulation screen on admission.

Differential diagnosis of intracranial lesions with high signal on T1 or low signal on T2-weighted MRI.

Magnetic resonance imaging (MRI) is the preferred technique for examining intracranial pathology in the non-acute setting in most cases. The aim of this review is to demonstrate the imaging appearances on unenhanced spin-echo MRI of lesions that show characteristic, unusual signal changes, which occur due to the presence of fat, cholesterol, paramagnetic substances, rapidly flowing fluids, air, cortical bone or calcification. The nature of the MRI signal, together with the anatomical location of the lesion should allow the provision of a narrow differential diagnosis, before the use of intravenous contrast medium or additional imaging sequences.

Transverse sinus thrombosis and IVIg treatment: a case report and discussion of risk-benefit assessment for immunoglobulin treatment.

A 54 year old woman presented with symptoms resulting from a thrombosis of the lateral transverse and sagittal sinuses the day after an infusion of intravenous immunoglobulin (IVIg) replacement treatment. She had previously suffered a milder episode after IVIg. Following recurrent bacterial chest infections and sinusitis for more than 40 years, a diagnosis of IgG1 deficiency had been made two years earlier, after exclusion of other causes.