Two patients with cirrhosis and portal hypertension had persistent bleeding from caput medusae and ascites. Transjugular intrahepatic portosystemic shunt (TIPS) resulted in regression of the caput medusae and ascites in both cases.
Corpus callosum haematoma is a rare feature in subarachnoid haemorrhage (SAH), which may result from aneurysms of the anterior communicating artery (ACoA) or pericallosal artery (PCA). In 348 patients with aneurysmal SAH, bleeding from ACoA aneurysms in 88 cases produced no abnormality on CT in 7. Blood in the cistern of the lamina terminalis was the most frequent abnormality (76/88); haematomas of the septum pellucidum, confined to patients with ACoA aneurysms, were seen in 26 (30%). Rupture of PCA aneurysms in 12 patients gave rise to blood in the pericallosal cistern, anterior interhemispheric fissure and cistern of the lamina terminalis in 11. There was no blood in the septum pellucidum or the ventricular system in any case, but haematomas in the corpus callosum occurred in 8 (67%). In all of these, blood extended into the anterodorsal aspect of the callosum and spread posteriorly along its dorsal border. An identical, supracallosal pattern was seen in 2 patients (2.5%) with ACoA aneurysms, in whom haemorrhage was more extensive, with a large frontal lobe haematoma extending up from the cistern of the lamina terminalis in 1 and a haematoma of the septum pellucidum, with intraventricular extension in the other. In 8 patients (9%) with ACoA aneurysms a corpus callosum haematoma appeared to result from passage of blood up through the cistern of the lamina terminalis into the septum pellucidum and thence into the ventral aspect of the anterior corpus callosum; blood was present within the cistern, the septum and the ventricles.
Financial constraints and bed shortages led to a re-evaluation of the policy of routine hospital admission for angiography. All patients referred for peripheral and renal angiography over an 8 month period had the procedure performed as an outpatient with a 3 F catheter. Patients were kept supine for 1 h and discharged 2 h after the angiogram. No significant complications resulted from the early mobilization of 219 patients who had outpatient 3 F angiography. It was a safe, well tolerated procedure, resulting in images of consistently adequate quality.
We examined the effect of imaging plane and sequence on the demonstration of lesions at the callosal-septal interface (CSI) by magnetic resonance imaging in 20 patients with known multiple sclerosis. Variable-echo-(VE) T2- and proton density (PD) weighted images were performed in coronal axial and sagittal planes. Sagittal gradient echo (GE) T2- and PD-weighted images were also performed. Lesions at the CSI were seen in all patients and were all demonstrated on both sagittal and coronal VE images. Sagittal PD-weighted GE images were slightly less sensitive but showed good overall agreement with sagittal VE. Axial VE and sagittal T2-weighted GE images demonstrated CSI lesions poorly.
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