To the Editor: We are prompted by the paper of Inbody and Jankovicl on a unique combination of hy... more To the Editor: We are prompted by the paper of Inbody and Jankovicl on a unique combination of hyperkinesia and mutism to report a patient with similar features but with a different explanation. A 70-year-old woman with a history of hypertension, paroxysmal atrial fibrillation, and attacks was admitted after sudden onset of involuntary movements. She showed continuous orofacial and lingual dyskinesia and continuous ballistic movements of the head, arms, and legs, predominantly on the right. She was alert but without any spontaneous or evoked vocalizations, although she could write and react coherently to written commands. Neurologic examination revealed no gross abnormalities. The gait was slow, clumsy, and unsteady. Sometimes she showed inappropriate and uncontrolled crying. CT demonstrated a lacunar infarct in the head of the caudate nucleus on the left. In the course of 1 month there was an almost complete recovery: the hyperkinesia nearly disappeared and the patient was again able to speak. Inbody and Jankovic regard the aphonia in their patient as the same type as that occurring in akinetic mutism. In analogy to this syndrome, they spoke of “hyperkinetic mutism.” However, akinetic mutism in the usual sense2 is associated with severe deficits of attention and with amnesia from bilateral lesions of the limbic system. In their paper, the authors did not mention the reactions of the patient to written commands or her writing abilities. At any rate, it is difficult to explain speechlessness from bilateral parieto-occipital watershed infarcts, the more so because we could not identify these lesions. Although, behaviorally speaking, our patient resembled the one of Inbody and Jankovic, we should like to stress the symptoms of pseudobulbar palsy, such as the uncontrolled crying. We therefore consider her mutism not as real mutism but as anarthria from pseudobulbar palsy. In view of her history, it seems reasonable to postulate the existence of several small infarctions in the subcortical structures, too small for imaging with our third-generation scanner. These small areas of ischemia in the internal capsule and basal ganglia probably accounted for the anarthria as well as the bilateral ballism. At least in our case we feel the term “hyperkinetic mutism” is not appropriate.
A radiologist's knowledge of MR imaging artifacts is necessary to avoid confusion of artifacts wi... more A radiologist's knowledge of MR imaging artifacts is necessary to avoid confusion of artifacts with pathology and to maintain high image quality.
A radiologist's knowledge of MR imaging artifacts is necessary to avoid confusion of artifacts wi... more A radiologist's knowledge of MR imaging artifacts is necessary to avoid confusion of artifacts with pathology and to maintain high image quality. . Chemical shift, zero line artifacts resulting from system noise, and asymmetric brightness caused by filtering problems are unique to the frequency axis. Truncation artifacts, aliasing, star artifacts, and some of the causes of magnetic field inhomogeneily occur in either the phase or frequency axis. Mechanisms producing metallic artifacts, inhomogeneous brightness resulting from radiofrequency nonuniformity, and bounce point artifacts are unrelated to axis. C U)
Eight patients with Sturge-Weber disease were evaluated by CT (six patients), MR (one patient), o... more Eight patients with Sturge-Weber disease were evaluated by CT (six patients), MR (one patient), or both (one patient). CT scans of five of seven patients showed enlarge-ment and increased enhancement of the choroid plexus on the same side as the facial and intracranial lesions. MRI showed similar findings in both patients examined. This enlargement, seen in six of eight cases of Sturge-Weber disease, is compatible with the presence of angiomatous malformations of the choroid plexus. It appears to be a common finding in this disease. Sturge-Weber disease is a neurocutaneous syndrome characterized by port-wine stain (nevus flammeus) of the face, and leptomeningeal angiomatosis. The disease has been extensively reviewed in the literature [1- 11]. The primary lesions of Sturge-Weber disease are venous angiomas, located mainly in the leptomen-inges. These angiomas have been seen in the lung, gastrointestinal tract, ovaries, pancreas, adrenal glands, pituitary, globe, and choroid plexus. ...
In order to provide a detailed description of the MR appearance of intracranial ependymoma, the M... more In order to provide a detailed description of the MR appearance of intracranial ependymoma, the MR examinations of 12 patients (10 with ependymomas and two with subependymomas) were reviewed and correlated with operative and pathologic reports. Three of 10 ependymomas were intraventricular, two were intraparenchymal, and five were transependymal, extending from CSF spaces into parenchyma. Both subependymomas were intraventricular. Solid ependymomas and subependymomas were isoto hypointense relative to normal white matter on T1-weighted images and hyperintense on proton-densityand T2-weighted images. Foci of signal heterogeneity within solid neoplasms represented methemoglobin, hemosiderin, necrosis, calcification, and encased native vessels or tumor vascularity. Gd-DTPA-enhanced images in two patients differentiated enhancing tumor from surrounding nonenhancing edema and from surrounding normal brain parenchyma. Cystic neoplasms had sharply defined, round or oval margins and uniform...
CT scanning is an innovative method for evaluating bone and soft-tissue pathology in the foot and... more CT scanning is an innovative method for evaluating bone and soft-tissue pathology in the foot and ankle. CT scanning in this area can provide unique information not attainable with other conventional radiologic techniques [1-8]. Individual uses for foot and ankle CT have been published; however, an overview of the wide application of CT to the foot and ankle has not. We review our own and published experience with CT scanning of the foot and ankle and illustrate its usefulness in evaluating abnormalities of the ankle, talus, subtalar articulation, calcaneus, and soft tissues of the foot. Materials and Methods We reviewed 41 CT scans of the foot and ankle performed on 38 patients at the Edward Mallinckrodt Institute of Radiology between March 1 , 1 978, and April 1 , 1 984. Lesions of the distal tibia that did not involve the inferior articular surface were excluded from the series. Thirty-seven of the 41 scans were obtained after March 1 , 1982. One case was performed on an EMI 5005 scanner, 14 cases on an EMI 7070 scanner, and 26 of the more recent cases were performed on a Siemens DR 3 scanner. The Siemens DR 3 scanner has a pixel
Anorexia nervosa (AN) is a serious eating disorder that typically emerges during adolescence and ... more Anorexia nervosa (AN) is a serious eating disorder that typically emerges during adolescence and occurs most frequently in females. To date, very few studies have investigated the possible impact of AN on white matter tissue properties during adolescence, when white matter is still developing. The present study evaluated white matter tissue properties in adolescent girls with AN using diffusion MRI with tractography and T1 relaxometry to measure R1 (1/T1), an index of myelin content. Fifteen adolescent girls with AN (mean age = 16.6 years ± 1.4) were compared to fifteen age-matched girls with normal weight and eating behaviors (mean age = 17.1 years ± 1.3). We identified and segmented 9 bilateral cerebral tracts (18) and 8 callosal fiber tracts in each participant's brain (26 total). Tract profiles were generated by computing measures for fractional anisotropy (FA) and R1 along the trajectory of each tract. Compared to controls, FA in the AN group was significantly decreased in 4 of 26 white matter tracts and significantly increased in 2 of 26 white matter tracts. R1 was significantly decreased in the AN group compared to controls in 11 of 26 white matter tracts. Reduced FA in combination with reduced R1 suggests that the observed white matter differences in AN are likely due to reductions in myelin content. For the majority of tracts, group differences in FA and R1 did not occur within the same tract. The present findings have important implications for understanding the neurobiological factors underlying white matter changes associated with AN and invite further investigations examining associations between white matter properties and specific physiological, cognitive, social, or emotional functions affected in AN.
A radiologist's knowledge of MR imaging artifacts is necessary to avoid confusion of artifacts wi... more A radiologist's knowledge of MR imaging artifacts is necessary to avoid confusion of artifacts with pathology and to maintain high image quality.
To the Editor: We are prompted by the paper of Inbody and Jankovicl on a unique combination of hy... more To the Editor: We are prompted by the paper of Inbody and Jankovicl on a unique combination of hyperkinesia and mutism to report a patient with similar features but with a different explanation. A 70-year-old woman with a history of hypertension, paroxysmal atrial fibrillation, and attacks was admitted after sudden onset of involuntary movements. She showed continuous orofacial and lingual dyskinesia and continuous ballistic movements of the head, arms, and legs, predominantly on the right. She was alert but without any spontaneous or evoked vocalizations, although she could write and react coherently to written commands. Neurologic examination revealed no gross abnormalities. The gait was slow, clumsy, and unsteady. Sometimes she showed inappropriate and uncontrolled crying. CT demonstrated a lacunar infarct in the head of the caudate nucleus on the left. In the course of 1 month there was an almost complete recovery: the hyperkinesia nearly disappeared and the patient was again able to speak. Inbody and Jankovic regard the aphonia in their patient as the same type as that occurring in akinetic mutism. In analogy to this syndrome, they spoke of “hyperkinetic mutism.” However, akinetic mutism in the usual sense2 is associated with severe deficits of attention and with amnesia from bilateral lesions of the limbic system. In their paper, the authors did not mention the reactions of the patient to written commands or her writing abilities. At any rate, it is difficult to explain speechlessness from bilateral parieto-occipital watershed infarcts, the more so because we could not identify these lesions. Although, behaviorally speaking, our patient resembled the one of Inbody and Jankovic, we should like to stress the symptoms of pseudobulbar palsy, such as the uncontrolled crying. We therefore consider her mutism not as real mutism but as anarthria from pseudobulbar palsy. In view of her history, it seems reasonable to postulate the existence of several small infarctions in the subcortical structures, too small for imaging with our third-generation scanner. These small areas of ischemia in the internal capsule and basal ganglia probably accounted for the anarthria as well as the bilateral ballism. At least in our case we feel the term “hyperkinetic mutism” is not appropriate.
A radiologist's knowledge of MR imaging artifacts is necessary to avoid confusion of artifacts wi... more A radiologist's knowledge of MR imaging artifacts is necessary to avoid confusion of artifacts with pathology and to maintain high image quality.
A radiologist's knowledge of MR imaging artifacts is necessary to avoid confusion of artifacts wi... more A radiologist's knowledge of MR imaging artifacts is necessary to avoid confusion of artifacts with pathology and to maintain high image quality. . Chemical shift, zero line artifacts resulting from system noise, and asymmetric brightness caused by filtering problems are unique to the frequency axis. Truncation artifacts, aliasing, star artifacts, and some of the causes of magnetic field inhomogeneily occur in either the phase or frequency axis. Mechanisms producing metallic artifacts, inhomogeneous brightness resulting from radiofrequency nonuniformity, and bounce point artifacts are unrelated to axis. C U)
Eight patients with Sturge-Weber disease were evaluated by CT (six patients), MR (one patient), o... more Eight patients with Sturge-Weber disease were evaluated by CT (six patients), MR (one patient), or both (one patient). CT scans of five of seven patients showed enlarge-ment and increased enhancement of the choroid plexus on the same side as the facial and intracranial lesions. MRI showed similar findings in both patients examined. This enlargement, seen in six of eight cases of Sturge-Weber disease, is compatible with the presence of angiomatous malformations of the choroid plexus. It appears to be a common finding in this disease. Sturge-Weber disease is a neurocutaneous syndrome characterized by port-wine stain (nevus flammeus) of the face, and leptomeningeal angiomatosis. The disease has been extensively reviewed in the literature [1- 11]. The primary lesions of Sturge-Weber disease are venous angiomas, located mainly in the leptomen-inges. These angiomas have been seen in the lung, gastrointestinal tract, ovaries, pancreas, adrenal glands, pituitary, globe, and choroid plexus. ...
In order to provide a detailed description of the MR appearance of intracranial ependymoma, the M... more In order to provide a detailed description of the MR appearance of intracranial ependymoma, the MR examinations of 12 patients (10 with ependymomas and two with subependymomas) were reviewed and correlated with operative and pathologic reports. Three of 10 ependymomas were intraventricular, two were intraparenchymal, and five were transependymal, extending from CSF spaces into parenchyma. Both subependymomas were intraventricular. Solid ependymomas and subependymomas were isoto hypointense relative to normal white matter on T1-weighted images and hyperintense on proton-densityand T2-weighted images. Foci of signal heterogeneity within solid neoplasms represented methemoglobin, hemosiderin, necrosis, calcification, and encased native vessels or tumor vascularity. Gd-DTPA-enhanced images in two patients differentiated enhancing tumor from surrounding nonenhancing edema and from surrounding normal brain parenchyma. Cystic neoplasms had sharply defined, round or oval margins and uniform...
CT scanning is an innovative method for evaluating bone and soft-tissue pathology in the foot and... more CT scanning is an innovative method for evaluating bone and soft-tissue pathology in the foot and ankle. CT scanning in this area can provide unique information not attainable with other conventional radiologic techniques [1-8]. Individual uses for foot and ankle CT have been published; however, an overview of the wide application of CT to the foot and ankle has not. We review our own and published experience with CT scanning of the foot and ankle and illustrate its usefulness in evaluating abnormalities of the ankle, talus, subtalar articulation, calcaneus, and soft tissues of the foot. Materials and Methods We reviewed 41 CT scans of the foot and ankle performed on 38 patients at the Edward Mallinckrodt Institute of Radiology between March 1 , 1 978, and April 1 , 1 984. Lesions of the distal tibia that did not involve the inferior articular surface were excluded from the series. Thirty-seven of the 41 scans were obtained after March 1 , 1982. One case was performed on an EMI 5005 scanner, 14 cases on an EMI 7070 scanner, and 26 of the more recent cases were performed on a Siemens DR 3 scanner. The Siemens DR 3 scanner has a pixel
Anorexia nervosa (AN) is a serious eating disorder that typically emerges during adolescence and ... more Anorexia nervosa (AN) is a serious eating disorder that typically emerges during adolescence and occurs most frequently in females. To date, very few studies have investigated the possible impact of AN on white matter tissue properties during adolescence, when white matter is still developing. The present study evaluated white matter tissue properties in adolescent girls with AN using diffusion MRI with tractography and T1 relaxometry to measure R1 (1/T1), an index of myelin content. Fifteen adolescent girls with AN (mean age = 16.6 years ± 1.4) were compared to fifteen age-matched girls with normal weight and eating behaviors (mean age = 17.1 years ± 1.3). We identified and segmented 9 bilateral cerebral tracts (18) and 8 callosal fiber tracts in each participant's brain (26 total). Tract profiles were generated by computing measures for fractional anisotropy (FA) and R1 along the trajectory of each tract. Compared to controls, FA in the AN group was significantly decreased in 4 of 26 white matter tracts and significantly increased in 2 of 26 white matter tracts. R1 was significantly decreased in the AN group compared to controls in 11 of 26 white matter tracts. Reduced FA in combination with reduced R1 suggests that the observed white matter differences in AN are likely due to reductions in myelin content. For the majority of tracts, group differences in FA and R1 did not occur within the same tract. The present findings have important implications for understanding the neurobiological factors underlying white matter changes associated with AN and invite further investigations examining associations between white matter properties and specific physiological, cognitive, social, or emotional functions affected in AN.
A radiologist's knowledge of MR imaging artifacts is necessary to avoid confusion of artifacts wi... more A radiologist's knowledge of MR imaging artifacts is necessary to avoid confusion of artifacts with pathology and to maintain high image quality.
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Papers by Murray Solomon