The clinical, radiologic, and neuropathologic findings in 13 patients with central pontine myelinolysis were reviewed. Antemortem computed tomography (CT) had been performed in nine, and ante- or postmortem magnetic resonance (MR) imaging in 11. Chronic alcoholism or rapid correction of hyponatremia was present in over 75% of cases. One CT scan was positive, but only on retrospective review. In all but one patient, MR imaging eventually revealed an abnormality within the pons; in two patients the initial study was normal. The lesions varied in shape, with peripheral involvement in two patients and extrapontine involvement in four. The abnormality was smaller at 6-month follow-up in one patient and unchanged at 1 year in another. One patient never had a demonstrable pontine lesion but did have symmetric basal ganglia abnormalities, which were consistent with extrapontine myelinolysis. MR imaging disclosed similar central pontine alterations resulting from infarct, metastasis, glioma, multiple sclerosis, encephalitis, and radiation or chemotherapy; thus, such changes are not unique.

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The effect of cigarette smoking on extracranial carotid atherosclerosis was studied by obtaining cigarette smoking histories and information on other potential risk factors from consecutive patients undergoing carotid arteriography. At least one extracranial carotid artery was visualized in 752 patients in whom the extent of carotid atherosclerosis was assessed. The total years of cigarette smoking was the most significant independent predictor of the presence of severe carotid atherosclerosis. Other independent predictors, in order of significance, were age, hypertension, diabetes mellitus, male sex, and current systolic blood pressure. By age 60 years, the risk of having severe carotid atherosclerosis for a person who had smoked for 40 years was approximately 3.5 times that for a never smoker. The major benefit of smoking cessation is in limiting the accumulation of smoking years. (Stroke 1990;21:707-714)

Three patients with histologically confirmed sarcoidosis with spinal cord involvement were examined with high-field-strength magnetic resonance imaging (1.5 T) before and after the administration of gadolinium diethylenetriaminepentaacetic acid. In addition to intramedullary expansion, areas of patchy, multifocal, parenchymal enhancement and areas of linear peripheral enhancement were seen in all three patients; these findings have not been previously reported and are unusual for other more common spinal cord lesions. This observation led to a correct diagnosis and a limitation of the extent of biopsy in two of the cases. Unfortunately, this enhancement pattern is not specific for sarcoidosis, as the authors have observed similar findings in two cases of biopsy-proved myelitis and multiple sclerosis. The peripheral enhancement is thought to be located in the leptomeninges due to leptomeningeal involvement, which was proved histologically in one case. This pattern of involvement, while not specific, is certainly consistent with and, in the appropriate clinical setting, highly suggestive of sarcoidosis.