The objective of the study was to study the magnetic resonance imaging (MRI) features of Hirayama disease on a 3 Tesla MRI scanner. Nine patients with clinically suspected Hirayama disease were evaluated with neutral position, flexion, contrast-enhanced MRI and fast imaging employing steady-state acquisition (FIESTA) sequences. The spectrum of MRI features was evaluated and correlated with the clinical and electromyography findings. MRI findings of localized lower cervical cord atrophy (C5-C7), abnormal curvature, asymmetric cord flattening, loss of attachment of the dorsal dural sac and subjacent laminae in the neutral position, anterior displacement of the dorsal dura on flexion and a prominent epidural space were revealed in all patients on conventional MRI as well as with the dynamic 3D-FIESTA sequence. Intramedullary hyperintensity was seen in four patients on conventional MRI and on the 3D-FIESTA sequence. Flow voids were seen in four patients on conventional MRI sequences and in all patients with the 3D-FIESTA sequence. Contrast enhancement of the epidural component was noted in all the five patients with thoracic extensions. The time taken for conventional and contrast-enhanced MRI was about 30–40 min, while that for the 3D-FIESTA sequence was 6 min. Neutral and flexion position MRI and the 3D-FIESTA sequence compliment each other in displaying the spectrum of findings in Hirayama disease. A flexion study should form an essential part of the screening protocol in patients with suspected Hirayama disease. Newer sequences such as the 3D-FIESTA may help in reducing imaging time and obviating the need for contrast.

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\s=b\A rapidly progressive, fatal pneumonia occurred during the third week of hospitalization in an immunosuppressed man confined in a laminar airflow room. Respiratory syncytial virus was isolated from open lung biopsy tissue. Epidemiologic data suggested that the virus was community acquired. Respiratory syncytial virus should be considered in the differential diagnosis of pneumonia in severely immunocompromised adults. (JAMA 1981;246:366-368) RESPIRATORY syncytial virus (RSV) is an important lower respira¬ tory tract pathogen of infants and young children and may be a major cause of fatal pneumonia during the first year of life.' In the past, adult disease has been said to be mild, producing an illness like the common cold.' Recently, observations suggest that adult RSV infection can be pro¬ longed and severe, resembling influ¬ enza.2,3 Although a few cases of pneu¬ monia have occurred, mortality in adults, to our knowledge, has not been described.4,5 This article reports a fatal case of RSV pneumonia in a severely immunocompromised man. Although his pneumonia first ap¬ peared during the third week in the hospital, a serological and retrospec¬ tive symptom-survey of his household and hospital contacts suggested com¬ munity acquisition. Patient and Methods A 44-year-old salesman was admitted to the Protected Environment Unit of Har¬ per Hospital in March 1979 for induction chemotherapy of acute myelogenous leuke¬ mia.Three years earlier, he had been treated with combined-modality therapy for stage IIIA-2 Hodgkin's lymphoma, mixed cellu-larity subtype. Radiation treatment and chemotherapy were discontinued when pancytopenia with hypocellular marrow occurred. In January 1979, myeloblasts appeared in his peripheral blood smear. Results of bone marrow aspiration were compatible with acute myelogenous leuke¬ mia.Four days before admission, the patient had daily temperature elevations to 38.9°C , sweats, epistaxis, and severe pain and swelling of the right ear. Other than an anaphylactic reaction to penicillin, his history was unremarkable.The patient was a pale, diaphoretic, acutely ill man. His temperature was 38.9°C. His right external ear and canal were edematous, painful, and red. The tympanic membrane could not be seen. Results of physical examination were unremarkable. His hemoglobin level was 7.5 g/dL; plate¬ let count, 47,000/cu mm; WBC count, 29,000/cu mm, with 880 polymorphonuclear cells per cubic millimeter and 14,660 myeloblasts per cubic millimeter. Serum levels of IgG, IgA, and IgM were normal. Thirty-six percent of his peripheral lym¬ phocytes formed rosettes with unsensitized sheep RBCs (normal, 41% to 81%), and 23% carried IgM surface immunoglobulin. One-way mixed lymphocyte cul¬ tures harvested at five days, using unre¬ lated lymphocytes as stimulating cells, showed a stimulating index of 1:1; in contrast, the reverse stimulating index was 128:1. A Gram's stain of the ear canal exúdate showed rare WBCs and Gramnegative rods, and clusters of Grampositive cocci; culture yielded Staphylococcus aureus....

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