Macroadenomas and hormone secreting adenomas are not uncommon in patients with pituitary incidentalomas. Macroadenomas should be closely monitored for tumour enlargement. All patients should undergo biochemical assessment and ophthalmological examination, since endocrine dysfunction or visual field defects may be present at the time a pituitary incidentaloma is detected.

In 23 patients with moderate to severe Huntington's disease (HD) and 21 normal volunteers, the regional cerebral metabolic rate of glucose consumption (rCMRGlc) was measured in the cerebellum, thalamus, striatum, and cortex using positron emission tomography and the 18F-deoxyglucose method. In contrast to previous reports, rCMRGlc was reduced not only in the striatum, but also in the cerebral cortex of patients with HD as compared with normal subjects. No significant difference between HD patients and normal subjects was found for thalamic and cerebellar rCMRGlc. To investigate the relationship between the clinical status and rCMRGlc, correlation coefficients for the clinical data were calculated for absolute values of rCMRGlc and for cerebellar ratios (CR) of rCMRGlc. The duration of chorea correlated significantly only with the absolute values of frontoparietal and temporo-occipital rCMRGlc and with the CRs of most cortical regions evaluated. The severity of chorea correlated significantly only with lentiform nucleus rCMRGlc. The severity of dementia correlated significantly only with the frontoparietal and temporo-occipital rCMRGlc, the CRs of most cortical regions, and the CR for the caudate nucleus. The degree of disability correlated significantly with the CRs of all regions evaluated except the occipital and the superior frontal cortex. It appears from this study that there is a reduction not only for the striatum but also for cortical rCMRGlc in patients with manifest HD, and that the cortical reduction of rCMRGlc contributes to the severity of clinical symptoms in these patients. This challenges the concept that dementia in HD is of purely subcortical origin.

Background and Purpose-Our study evaluated noninvasive tests for the diagnosis of atheromatous internal carotid artery (ICA) pseudo-occlusion. Methods-Twenty patients (17 men, 3 women; mean age ϮSD, 64.3Ϯ11.6 years) with angiographically proven atheromatous ICA pseudo-occlusion (20 vessels) were prospectively examined with MR angiography (MRA; 2D and 3D time-of-flight techniques), color Doppler-assisted duplex imaging (CDDI) and power-flow imaging (PFI) with and without an intravenous ultrasonic contrast agent. As a control group, 13 patients (13 men; meanϮSD age, 63.0Ϯ9.0 years) with angiographically proven ICA occlusion (13 vessels) were studied with the same techniques. For the determination of interobserver agreement ( statistics), the findings of each diagnostic technique were read by 2 blinded and independent observers who were not involved in patient recruitment and initial data acquisition. Specificity and sensitivity were calculated for all noninvasive techniques (observer consensus) in comparison to the standard of reference (intra-arterial angiography). Results-Interobserver reliabilities were ϭ0.86 for intra-arterial angiography, ϭ0.90 for unenhanced CDDI,

Chronic carotid dissection can be effectively treated by surgical reconstruction to prevent further ischemic or thromboembolic complications, if medical treatment for 6 months with anticoagulation failed or if carotid aneurysms and/or high-grade carotid stenosis persisted or have newly developed.