Neuroradiological diagnostics – brain anoxia


Neuroradiological study of human brain in the

Fetal period

Masami imanishi, MD, tatsuo tanikake, MD, kikuo

Kyoi, MD, shozaburo utsumi, MD, akio fukuzumi,

MD, satoru iwasaki, MD and ryoichi otani, MD

Departments of neurosurgery (MI, IT, KK, SU) and

Radiology (AF, SI, RO), nara medical university,


Our presentation intends to clarify development

Of the fetal brain as seen on CT.

The materials were 33 cases in total consisting of

Embryos, fetuses and newborns. Cranio-cerebral CT

Scans were performed in all cases within 12 hours

After delivery . Fetuses were divided into 3 stages.

The first stage ranged from the 9th gestational week

To the 12th gestational week, and the second stage

From the 13th to 24th week.Brain anoxia beyond 25 gestational

Weeks, fetuses were classified as the third stage. In

Cases of the first stage, for instance at the 12th ges-

Tational week, it is difficult to recognize the intra-

Cranial structure on CT. We consider that this stage

Is the limit for recognition of the intracranial structure

Of fetuses with CT scanners in general use. In the

Second stage, the intracranial structures on CT become

Clearer in comparison with those in the first stage.

The anterior horn and anterior part of the trigon

Of lateral ventricles are in a high density area . The

High density area on CT corresponds to the germinal

Matrix which can be stained with hematoxylin. The

Germinal matrix consisted of many granular cells and

brain anoxia

There were abundant capillaries. This is the reason

Why the germinal matrix shows a high density on CT.

However, in fetuses beyond 25 weeks, that is at the

Third stage, the high density area around the ventricles

Disappears on CT. The germinal matrix on CT at the

Second stage shows a symmetrical high density area,

Which then disappears. On the contrary, a hemor-

Rhagic case at the same stage shows an asymmetrical

High density area and also niveau formation would

Be found. Thus, the germinal matrix and hemorrhage

In fetuses are easily differentiated based upon the

CT findings.

Key words: fetus, cranio-cerebral CT scan, germinal


170 brain development, vol 6, no 2, 1984


The morphometrical changes seen on com-

brain anoxia

Puted tomography with increasing age in

Down syndrome: small posterior fossa and

Calcification of the globus pallidus

Atsushi ieshima, MD, toshiro kisa, MD, kunio

Yoshino, MD, sachio takashima, MD and kenzo

Takeshita, MD

Division of child neurology, tottori university

School of medicine, yonago, tottori (AI, KY, ST,

KT), department of pediatrics, shimane prefectural

Hospital, izumo, shimane (TK)

We investigated the characteristic and morphometrical

Changes seen on cranial computed tomography (CT)

With increasing age in down syndrome.

The study was conducted by CT examination of

56 patients with down syndrome aged from 0 month

To 37 years. All patients were divided into seven age

Groups and compared with 142 normal controls aged

brain anoxia

O month to 59 years. CT scans were done at several

Institutes because of headache, head trauma, febrile

Convulsions and infantile convulsions.

Morphometry on CT was done for the width of the

Ventricles, posterior fossa, pons, sylvianâ· fissures,

Cisterna magna and superior cerebellar cistern. Statis-

Tical analysis was performed using the t test between

Down cases and controls. The incidence of midline

Extra-cavities (cavum septi pellucidi, cavum vergae

And cavum veli interpositi) and a high density in the

Globus pallidus were seen.

The results obtained were as follows:

1) the relative size of the fourth ventricle increased

Significantly in each age group of down syndrome

Compared with those of controls.

2) the relative size of the posterior fossa and the

brain anoxia

Pons significantly decreased in down syndrome.

3) there were no significant differences in the ven-

Tricles between down syndrome and controls.

The anterior horn ratio decreased at above five

Years of age in down syndrome.

4) the sylvian fissures were relatively wide in down

Syndrome especially under one year of age.

5) the incidences of midline extra-cavities and

Cisterna magna were significantly increased in

Down syndrome.

6) symmetrical high densities of the globus pallidus

Were observed in 6 cases with down syndrome

Above 8 years of age (10.6%) and in a control

Case with headache (0.7%).

CT scanning of down syndrome showed a relative-

Ly small cerebellum and brain stem, accompanying

The small posterior fossa and relatively dilated sylvian

brain anoxia

Fissures,. Which were compatible with the previous

Neuropathological findings. There were no morpho-

Metrical changes seen on CT with advancing age

Until the fourth decade. Calcification of the globus

Pallidus can be observed more frequently in down

Syndrome from a younger age than in controls.

Key words: down syndrome, CT scanning, premature

Aging, calcification of the basal ganglia.


Subdural effusion (hematoma) accompanied

By enlargement of subarachnoid spaces in


Nobuhiko aoki, MD, hideaki masuzawa, MD, lin-

Ichi sofo, MD

Department of neurosurgery, fuchu metropolitan

Hospital, tokyo (NA), department of neurosurgery,

Kanto teishin hospital, tokyo (HM, IS)

It is often difficult to distinguish subdural effusion

brain anoxia

(hematoma) from enlargement of subarachnoid spaces

In infant cases with low density areas over the cerebral

Hemispheres seen on computed tomography (CT).

We have determined the nature of the fluid content,

Based on the CT number of subdural effusion. In this

Paper, we presented a p athological condition referred

To as subdural effusion accompanied by enlargement

Of subarachnoid spaces, which had been paid little

Attention beforehand.

Materials and methods

Twenty CT scans in 16 cases of infantile acute and

Chronic subdural hematomas were carefully reviewed

With particular emphasis on their densities. In all

Cases, subdural hematomas were confirmed by craniot-

Omy or subdural tapping. Type 1 represented cases

brain anoxia

Who showed accumulation of CSF-dense fluid over

The hemispheres, as well as in the cerebral sulci and

Cisterns, which were clearly demarcated from the

Overlying, rather hyperdense, subdural hematomas.

In type 2, CT scans showed homogeneous, hypodense

Areas over the hemispheres, along with a sulcal pattern.


In cases with acute subdural hematomas, 6 CT scans

Out of 7 were type 1, and the other was type 2. Out

Of 13 CT scans in chronic subdural hematomas, 6

Were type 1 and 7 were type 2. While 4 CT scans out

Of the 12 of type 1 showed a sulcal pattern, the re-

Maining 8 CT scans revealed linear, CSF-dense zones

Adjacent to the cortex.

By means of metrizamide CT subdurography, it

Was easy to distinguish the subdural spaces from the

brain anoxia

Subarachnoid spaces.


In cases with a sulcal pattern, it is clinically worth-

While making differential diagnosis between brain

Atrophy, benign enlargement of the subarachnoid

Spaces, and subdural effusion accompanied by en-

Largement of subarachnoid spaces, because the treat-

Ments and clinical courses differ from each other.

Key words: subdural hematoma, subdural effusion,

Subarachnoid space, computed tomography.


Evaluation of shunt patency

Linichi soto, MD, hideaki masuzawa, MD, tatsuo

Mima, MD and tomio inoue, MD

Departments of neurosurgery (IS, HM, TM) and

Radiology (TI) , kanto teishin hospital, tokyo

Thirteen CSF -sh un ted pa tien ts, 4 children and 9

Adults, were subjected to shunt function tests, includ-

brain anoxia

Ing radioisotope shuntography (RSG) 18 times and

Metrizamide shuntography (MSG) 11 times.

Subsequent surgery confirmed shunt malfunction

In 7 cases. These 7 patients presented either progres-

Sive lowering of the consciousness level, or recurrent

Bouts of a transient decrease of consciousness and/

Or headache. CT scans showed mild to moderate

Ventricular enlargement in all cases with occasional

Widening of subarachnoid spaces. Manual compression

Of the reservoir yielded normal refilling in 6 cases.

RSG was performed using 1 mci of 99 mtco~ 0.1 ml

In amount according to the method of french et al.

MSG was done using 3 ml of 190 mgi/ml metriz-

Amide solution. In four cases, all adults, both RSG

And MSG were abnormal and peritoneal end obstruc-

brain anoxia

Tion was found at surgery. Fn the remaining three,

All children, RSG was normal. In one of them, MSG

Showed disconnection at a connector site in the

Abdominal wall, although the dye entered the intra-

Abdominal cavity . In another, MSG showed kinking

And stenosis of the subcutaneous portion of the

Peritoneal tube. In the third, ventricular tube stenosis

Was shown by MSG. Among six cases who showed

Normal findings on RSG and MSG, four were con-

Servatively followed with fair to good results. One

Case received surgery which was unsuccessful. Thus,

MSG was a useful method in correctly delineating

Shunt function. RSG was unable to locate incomplete

Obstruction of the peritoneal tube in two cases, al-

Though it could prevent false positive results which

brain anoxia

Are known to occur frequently in simple flowmetries

Such as the thermister method.

In conclusion, clinical manifestations suggesting

Shunt malfunction need careful surveying including

CT scans and rnetrizarnide shuntography as a de-

Finitive measure.

Key words: hydrocephalus, radioisotope shuntogra-

Phy, metrizamide shuntography.

Brain development, vol 6. No 2, 1984 1 71


Classification of low density areas in the

White matter on computerized tomography

Osamu narazaki, MD, toshio hanai, MD and miho


Departments of pediatric neurology (ON, TH) and

Radiology (MF) , fukuoka children’s hopspital medi-

Cal center, fukuoka

On computerized tomography, a low density area

(LD) in the white matter can be seen in various

brain anoxia

Conditions. The classification of LD is considered

To be useful for understanding many CNS diseases.


By the pathology , we classified LD as follows: group

1, the conditions of increased water content ; group

2-a, demyelinating diseases (destruction of myelin);

Group 2-b-l, dysmyelinating diseases (abnormal forma-

Tion or maintenance of myelin due to enzymatic

Disturbance); group 2-b-2, intrauterine infection

(delayed myelination). The whole of group 2 can be

Called white matter disease, because the lesion

Is in the myelin sheath. We evaluated LD for distribu-

Tion, CT value, degree of contrast enhancement and

Chronological change in each group.


For the past three years, we observed LD in thirty

brain anoxia

Patients; nine with anoxic encephalopathy after birth

Asphyxia, one with brain edema due to head injury,

Seven with hydrocephalus, two with purulent menin-

Gitis, one with multiple sclerosis (MS), two with acute

Disseminated encephalomyelitis (ADEM), one with

Schilder disease, two with congenital rubella syndrome

(CRS), one with congenital cytomegalovirus infection

(CMV) and four with fukuyama type congenital

Muscular dystrophy (F-CMD). Also , LD was frequent-

Ly seen in newborns without CNS involvement (nor-

Mal newborns). LD observed in purulent meningitis

Could not be classified, because it was considered to

Represent edema, cerebritis, infarction and demyelina-

Tion or a combination of these. Group 1 included

brain anoxia

Normal newborns, and cases of birth asphyxia,

Head injury and hydrocephalus with intracranial

Hypertention. As compared to the findings of frontal

Low density in normal newborns, LD was wide-

Spread throughout the white matter in birth asphyxia.

In group 2-a, LD was observed multifocally in MS and

ADEM, and in bioccipital areas in schilder disease,

With all diseases showing abnormal contrast enhance-

Ment. Only ADEM showed a mass effect. It is re-

Ported that diffuse white matter changes are extensive

And without abnormal enhancement in group 2-b-i,

Such as metachromatic leucodystrophy, krabbe

Disease, etc. We have not experienced such cases.

Periventricular LD was observed in group 2-b-2, such

As CRS and CMV, and they were resolved in the

brain anoxia

Follow-up CT. Also in F-CMD, marked LD has chrono-

Logically been resolved.


Evaluating LD for distribution, CT value, degree of

Contrast enhancement and chronological change is

Helpful for understanding its pathology.

Key words: CT, low density area, white matter, clas-


1 72 brain development, vol 6, no 2, 1984


Positron emission CT in childhood epilepsy

Narumi michihiro, MD, yasubumi utsumi, MD,

Motomizu ariizumi, MD, katsuhiko sato, MD and

Masaaki lio, MD

Departments of pediatrics (NM, YU, MA) and radi-

Ology (KS), nihon university school of medicine,

Tokyo; department of radiology, national nakano

Chest hospital, tokyo (ml)

Although the metabolic rate of epileptic focus in the

Ictal phase is accelerated, it appears to show different

brain anoxia

Patterns in the interictal state. Positron emission CT

(PET) was performed to investigate the blood per-

Fusion and glucose metabolism in epileptic focus and

The correlation of the PET pictures to EEG and XCT.

Materials and methods

The patients in this study were 8 children with epilep-

Sy (partial seizure 3, myoclonic seizure 3, west syn-

Drome I and secondary generalized seizure 1), aged

I to 16 years. PET was performed with a headtome

II, using lico, and lic-glucose as tracers.


In 2 of the 3 patients with partial seizures, PET

Revealed low uptake in the focus recorded on EEG.

Of 3 patients with myoclonic seizures and diffuse

Polyspike and wave complexes, 2 showed low uptake

Areas on PET in the focus detected by EEG.Brain anoxia

The patient with west syndrome had a typical

Seizure associated with hypsarhythmia at the onset,

And later no clinical seizures in spite of the existence

Of electrical seizures in the bilateral occipital regions.

In this patient, PET showed low uptake in the left

Occipital region.

In the case with secondary generalized seizures,

EEG showed spike and wave complexes arising from

The right temporal region which secondarily spread

To all leads. PET disclosed low uptake in the right

Temporal region .

XCT was performed in all patients. Seven showed

Normal scans and the other one an atrophic region

Distant from the epileptic focus.


The PET picture using lico, and lie-glucose reveals

The blood perfusion and the metabolic rate of glucose

brain anoxia

In the brain. PET using 11eo, and lie-glucose in our

Patients showed low uptake areas in correspondence

With the epileptic focus on EEG and the expanded

Region larger than that of the EEG focus.

These findings suggest that the electrical epileptic

Focus exhibits hypometabolism and hypoperfusion

In the more expanded region in the interictal state.

Key words: positron emission CT, epilepsy, glucose

Metabolism, blood perfusion.