Imaging of the Nervous System PDF
Preview Imaging of the Nervous System
Clinical Medicine and the Nervous System Series Editors: John P. Conomy and Michael Swash Titles in the series -already published Headache Richard Peatfield Epilepsy: Electroclinical Syndromes Edited by Hans Liiders and Ronald P. Lesser The Heart and Stroke Edited by Anthony J. Furlan Hierarchies in Neurology Edited by Christopher Kennard and Michael Swash Forthcoming titles in the series Guillain-Barre Syndrome Richard Hughes Dizziness and Disequilibrium Thomas Brandt Malignant Brain Tumours Edited by David G. T. Thomas aQd D.1. Graham Diseases of the Spinal Cord Edited by E. M. Critchley and A. Eisen Electrophysiological Diagnosis E. M. Sedgwick Hydrocephalus and the Cerebrospinal Fluid J. D. Pickard Imaging of the Nervous System Edited by Paul Butler With 334 Figures Springer-Verlag London Berlin Heidelberg New York Paris Tokyo Hong Kong Paul Butler, MRCP, FRCR Consultant Neuroradiologist, The London Hospital, Whitechapel, London EIIBB, UK Series Editors: John P. Conomy, MD, Head, Department of Neurology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA Michael Swash, MD, FRCP, MRCPath, Consultant Neurologist, The London Hospital, Whitechapel, London, UK Front Cover Illustrations: Cranial CT with intravenous contrast. Multiple tuberculomata. Vertebral arterial DSA. Aneurysm of the posterior inferior cerebellar artery. Cranial MRI (sagittal section) - TI weighted image. Pituitary tumour. ISBN-I3:978-1-4471-1639-4 e-ISBN-I3:978-1-4471-1637-0 DOl: 10.1007/978-1-4471-1637-0 British Library Cataloguing in Publication Data Imaging of the nervous system. I. Man. Nervous system. Diagnosis. Imaging I. Butler, Paul, 1952- II. Series 616.8'047575 ISBN-I3:978-1-4471-1639-4 Library of Congress Cataloging-in-Publication Data Imaging of the nervous system/Paul Butler (ed.). p. cm.-(Clinical medicine and the nervous system) ISBN-I3:978-1-4471-1639-4 (alk. paper) I. Nervous system - Imaging. 2. Nervous system - Diseases'---Diagnosis. I. Butler, Paul, 1952 June 4- II. Series. [DNLM: I. Magnetic Resonance Imaging. 2. Nervous System Diseases-diagnosis. 3. Tomogra phy, X-ray Computed. WL 141 1315] RC349.D52143 1990 616.8'0475-dc20 DNLM/DLC. 89-26083 for Library of Congress CIP Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the Copyright, Designs and Patents Act 1988, this publication may only be reproduced, stored or transmitted, in any form or by any means, with the prior permission in writing of the publishers, or in the case of reprographic reproduction in accordance with the terms of licences issued by the Copyright Licensing Agency. Enquiries concerning reproduction outside those terms should be sent to the publishers. © Springer-Verlag London Limited 1990 Softcover reprint of the hardcover 1st edition 1990 The use of registered names, trademarks etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant laws and regulations and therefore free for general use. Product Liability: The publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check its accuracy by consulting other pharmaceutical literature. 2128/3916--543210. Printed on acid-free paper Series Editors' Foreword Traditionally, investigation of the nervous system has been primarily a clinical matter. The great era of clinical assessment of patients with neurological disease in the first half of the century was determined by the necessity both to understand the phenomena of neurological disease in relation to structure and function and to localise lesions, in order to facilitate the twin processes of diagnosis and management. Over the years diverse techniques have been applied to clinical practice in order to improve the accuracy of diagnosis. These have comprised extensions of clinical method, for example clinical neuropsychology, electro encephalography, radiography of the skull and spine, angiography and other contrast procedures, including the now abandoned technique of air encephalography, and myel ography, perhaps itself soon to be little used. Isotope studies of the brain have possibly not realised their full potential in clinical neurology. All these different investigations found an integrated place in clinical management, enhancing the classical clinical database and its associated information, derived from biochemical, immunological and haematological studies. The advent of computerised tomographic X-ray scanning changed all this. The quality of the images derived from CT scanning was so much superior to that obtainable by conventional X-ray methods, and the method was so non-invasive in its conception, that clinical practice in both medical and surgical neurology changed profoundly. An image of the affected part of the nervous system was now available that could be used to study the location and X-ray absorbence characteristics of a lesion in the brain, and that could be applied to medical treatment or used to direct the surgical approach with hitherto undreamt of accuracy. The development of magnetic resonance imaging, digital angiography, and also of positron emission tomography and SPECT imaging, has further refined the role of imaging in clinical neurology. Some long-cherished beliefs about lesion location and size in relation to certain clinical phenomena have been abandoned, the diagnosis of many previously difficult disorders has been simplified, and otherwise unrecognisable lesions have come to be seen as important. Nonetheless, the image is not yet everything in clinical neurology and neurosurgery. Indeed, although clinical problem solving has been greatly enhanced by modern imaging, and has changed its emphasis, some of the commonest clinical problems, for example headache and epilepsy, are relatively unlikely to yield information to the imager. In this book Paul Butler has set out to provide a review of most of what matters to clinicians about neuro-imaging within a relatively short volume commensurate with the aims of the Clinical Medicine and the Nervous System series. We trust that the book will find its way onto the bookshelves of neurologists and neurosurgeons everywhere, and that they will find it useful and informative in their everyday clinical practice and, in the case of younger physicians and surgeons, in their training. The format of the book is such that it should also be useful to general physicians and surgeons, and to general radiologists, as a source of information about the nervous system. London, UK Michael Swash Cleveland, Ohio John P. Conomy March 1990 Preface The introduction of computed tomographic (CT) scanning in the late 1970s brought with it the prospect of less-invasive neuroimaging and soon led to the welcome demise of air encephalography (a rare example of one radiological technique truly replacing another). This trend has been continued with magnetic resonance imaging (MRI) which provides quite remarkable displays of the neuraxis without the use of ionising radiation. How the two techniques are best used is still emerging but each has its own peculiar advantages and in many instances they are complementary. Their relative simplicity also allows repeated examinations to follow the progress of disease and monitor therapeutic response. Conversely cerebrovascular imaging remains largely invasive although screening for degenerative cervical arterial disease is now undertaken in many centres using real time "B" mode ultrasound in combination with Doppler studies (duplex sonography). Digital subtraction techniques have gone some way to make angiography both safer and less unpleasant for the patient, but early enthusiasm has been dampened by problems with spatial resolution. CT and MRI have made a great contribution to spinal imaging. CT obviates myelography in many cases of lumbar degenerative disease and complements it elsewhere in the spine, but in many centres MRI has led to the near total abandonment of myelography. Para doxically MRI may lead to a renaissance of the plain radiograph, which has been rather neglected in the age of CT. There is increasing interest in functional radioisotope studies of the central nervous system and, coupled with the development of more "user friendly" radiopharmaceuticals, nuclear medicine has also experienced something of a revival in recent years. This text provides an overview of current neuroradiological practice and demonstrates the appearances of a wide range of craniospinal pathology using modern techniques. It is intended primarily for residents in neurology, neurosurgery and radiology, but it is hoped that their senior colleagues and those in related specialties will also find it relevant. A detailed account of MRI technology is considered beyond the scope of this book, but the interested reader is referred to the excellent and concise account "Magnetic Resonance Imaging" by Sigal, Doyon, Ph Halimi and Atlan (Springer-Verlag, 1988). A number of illustrations have been inserted by the editor (denoted by P.B. in the legends) in chapters other than his own; for these and many of the other illustrations I would like to express my thanks to the Department of Medical Illustration at The London Hospital. I am also grateful to the series editor, Michael Swash and the publisher, Michael Jackson, for their patient advice and to the contributors for their tolerance. London Paul Butler September 1989 Contents List of Contributors . xi 1 Cerebrovascular Disease Paul Butler . Duplex Sonography of Carotid Arteries Margaret D. Hourihan. 29 2 Intracranial Tumours Charles E. L. Freer . 39 3 Hydrocephalus and Degenerative Cerebral Disease W. St Clair Forbes. 63 4 Radiological Aspects of Head and Spinal Trauma Evelyn Teasdale . 85 5 Infections of the Central Nervous System John M. Stevens. 107 6 Paediatric Neuro-imaging Ian W. Turnbull . 131 7 The Spine Nagui M. Antoun 159 8 Imaging the Orbit Glyn A. S. Lloyd. 201 9 The Petrous Bone Philip L. Anslow. 219 10 Muscle and the Peripheral Nervous System Chandra H. Thakkar and Michael Swash 231 11 Isotope Brain Imaging Neil W. Garvie . 241 12 Contrast Media and the Central Nervous System Peter Dawson 253 Subject Index. 267 Contributors Philip L. Anslow, MA, FRCR Consultant Neuroradiologist, Radcliffe Infirmary, Oxford OX26HE, UK Nagui M. Antoun, MRCP, FRCR Consultant Neuroradiologist, Addenbrooke's Hospital, Cambridge CB22QQ, UK Paul Butler, MRCP, FRCR Consultant Neuroradiologist, The London Hospital, Whitechapel, London EIIBB Peter Dawson, PhD, MRCP, FRCR Senior Lecturer and Honorary Consultant Radiologist, The Royal Postgraduate Medical School, Hammersmith Hospital, London W12 OHS W. St Clair Forbes, MA, MB, BCh, DMRD, FRCR Consultant Neuroradiologist, Hope Hospital, Salford M6 8HD, UK Charles E. L. Freer, MRCP, FRCR Consultant Neuroradiologist, Addenbrooke's Hospital, Cambridge CB2 2QQ, UK Neil W. Garvie, MA, MSc, MRCP, FRCR Consultant in Radiology and Nuclear Medicine, The London Hospital, Whitechapel, London EIIBB Margaret D. Hourihan, MRCP, FRCR Consultant Neuroradiologist, University Hospital of Wales, Heath Park, Cardiff CF44XW, UK Glyn A. S. Lloyd, DM, FRCR Consultant Radiologist, The Royal National Throat, Nose and Ear Hospital, London WCIX8DA John M. Stevens, DRACR, FRCR Consultant Radiologist, St Mary's Hospital and The Hospital for Nervous Diseases, Maida Vale, London W9lTO Michael Swash, MD, FRCP, MRCPath Consultant Neurologist, The London Hospital, Whitechapel, London EIIBB Evelyn Teasdale, BSc, MRCP, FRCR Consultant Radiologist, Institute of Neurological Sciences, Southern General Hospital, Glasgow GS14TF, UK xii Contributors Chandra H. Thakkar, MD, FRCR Consultant Neuroradiologist, The London Hospital, Whitechapel, London EIIBB Ian W. Turnbull, FRCR Consultant Neuroradiologist, North Manchester General Hospital, Manchester M8 6RB, UK Chapter 1 Cerebrovascular Disease Paul Butler CEREBRAL ISCHAEMIA nections occur especially in children between cort ical and meningeal arteries. Embolisation from carotid bifurcation disease may cause distal cerebral arterial occlusion either Arterial Disease of a permanent or a temporary nature. Barnett (1980) states that stenotic or ulcerative lesions of Pathogenesis of Stroke the extracranial carotid arteries are the principal The Harvard Stroke Registry Group found that the most common cause of stroke was cerebral arteriosclerosis with thrombotic or throm boembolic occlusion (Mohr et al. 1978). In the craniocervical arterial tree the sites of pre dilection for arteriosclerosis include the carotid bifurcation (Fig. 1.1), the carotid siphons and the basal intracranial arteries, particularly the middle cerebral. Rarely the process can be diffuse. The early changes of intimal and subintimal infiltration cause minor irregularity of the opacified vessel lumen at angiography. Stenosis then develops which may be smooth and regular but which is more often irregular and ulcerated. Platelet aggre gation can be provoked causing local thrombus formation which may lead ultimately to arterial occlusion or embolism. The consequence of any vascular occlusion will depend on its site and the adequacy of the collateral circulation. Thrombotic occlusion of the internal carotid artery can lead to major cerebral infarction and death but if the occlusion is gradual and col lateral pathways are available, neurological deficit need not be severe. Anastomoses exist between the internal and external carotid arteries - notably via the maxillary and ophthalmic arteries - and between the external carotid and vertebral arteries. Intracranially the Circle of Willis links the internal carotid arteries and the basilar artery. Surface cort ical anastomoses are seen between anterior, middle Fig. 1.1. Carotid arterial DSA with atheromatous disease of the and posterior cerebral arteries and transdural con- cervical carotid bifurcation.
The list of books you might like
