We conclude that CTA does not significantly increase the time of the diagnostic workup of the patient with injuries caused by blunt trauma. The introduction of CTA at our institution was associated with an increase in the detection rate of CAI. Earlier detection of CAI may allow for more timely therapeutic intervention and potentially prevent permanent neurologic sequelae.

POBJECTIVE. The purpose of this study was to compare CT angiography with digital subtraction angiography (DSA) in the detection and measurement of intracranial aneurysms in patients with acute subarachnoid hemorrhage. SUBJECTS AND METHODS. Thirty consecutive patients with recent subarachnoid hemorrhage shown by unenhanced CT scanning or lumbar puncture were studied with CT angiography and DSA. Using a shaded surface display format and source images, two reviewers working independently blindly interpreted CT angiograms for presence and size of aneurysms. Sensitivity and specificity for aneurysm detection were calculated for each reviewer. Aneurysm size measurements were compared between reviewers and between the two imaging techniques. RESULTS. Thirty aneurysms were found in 22 patients with DSA; eight patients had no aneurysms. The sensitivity and specificity of CT angiography for reviewerA were 0.97 and I .0, respectively. For reviewer B, the sensitivity and specificity were 0.77 and 0.87, respec

MRI of the brain of a 3-year-old boy performed 3 days after the onset of hemichorea (Sydenham Chorea) revealed abnormal signal and enlargement of the contralateral caudate and putamen. Follow-up imaging 40 months later showed a persistent cystic appearance of the caudate and putamen. This case is the first report of permanent MRI abnormalities after Sydenham Chorea.

Primary germ cell tumors confined to the optic nerves and chiasm without suprasellar extension are uncommon. These tumors appear similar to chiasmatic gliomas on both computed tomography and magnetic resonance imaging, potentially resulting in treatment errors if the diagnosis is based on radio-logic criteria alone. Unlike chiasmatic gliomas, suprasellar germinomas characteristically present with a clinical triad of endocrine abnormalities, diabetes insipidus, and visual complaints. We report the case of a 9-year-old boy who presented with a 5-month history of fatigue, 16-pound weight gain, polydipsia, polyuria, visual complaints, and intermittent headache. Imaging studies demonstrated findings consistent with a glioma of the chiasm with infiltration into the optic tracts. At surgery, the chiasm and optic tracts were diffusely enlarged with no other suprasellar abnormalities. Biopsy specimens were characteristic of germ cell tumor. Based on this result, the patient received a treatment regimen different from that used at our institution for chiasmatic gliomas. We feel it is imperative to biopsy chiasmatic lesions that radiologically appear to be gliomas if symptoms do not adhere to the classical clinical presentation.