EMERGENCY NEURORADIOLOGY

EMERGENCY NEURORADIOLOGY

T. SCARABINO

U. SALVOLINI

J.R. JINKINS (Editors)

ii edizione

With 294 Figures in 793 Parts and 10 Tables

EMERGENCY

NEURORADIOLOGY

EDITORS Tommaso Scarabino

Department of Neuroradiology, Scientific Institute “Casa Sollievo della Sofferenza”, San Giovanni Rotondo (FG), ITALY Department of Radiology, ASL BA/1, Hospital of Andria (BA), ITALY

Ugo Salvolini

Neuroradiology and Department of Radiology, University of Ancona, ITALY

J. Randy Jinkins

Department of Radiology, Downstate Medical Center, State University of New York, Brooklyn, NY, USA

This edition of Emergency Neuroradiology by Scarabino – Salvolini – Jinkins is published by arrangement with Casa Editrice Idelson-Gnocchi srl, Naples, Italy

ISBN-10 3-540-29626-3 Springer Berlin Heidelberg New York ISBN-13 978-3-540-29626-3 Springer Berlin Heidelberg New York

Library of Congress Control Number: 2005934099

This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on

microfilm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer-Verlag. Violations are liable for prosecution under the

German Copyright Law.

Springer is a part of Springer Science+Business Media http://www.springeronline.com

© Springer Berlin Heidelberg 2006 Printed in Germany

The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and

regulations and therefore free for general use.

Product liability: The publishers cannot guarantee the accuracy of any information about the application of operative techniques and medications contained in this book. In every individual case the user must check such

information by consulting the relevant literature.

Editor: Dr. Ute Heilmann Desk Editor: Meike Stoeck Production Editor: Joachim W. Schmidt

Cover Design: eStudio Calamar, Spain

Typesetting: FotoSatz Pfeifer GmbH, 82166 Gräfelfing, Germany Printed on acid-free paper – 24/3151 – 5 4 3 2 1 0

CONTRIBUTORS

R. Agati, M. Armillotta, S. Balzano, A. Bertolino, M.G. Bonetti, M. Cammisa, A. Carella, A. Carriero, A. Casillo, M. Caulo, A. Ceddia, G. Cerone, S. Cirillo, P. Ciritella, C. Colosimo, V. D’Angelo, P. D’Aprile, R. De Amicis, G.M. Di Lella, F. Florio, A. Fresina, M. Gallucci, T. Garribba, S. Ghirlanda, G.M. Gianna-

tempo, M. Impagliatelli, A. Lorusso, S. Lorusso, P. Maggi, A. Maggialetti, N. Maggialetti, M. Maiorano, M. Mariano, C. Masciocchi, F. Menichelli, M. Nardella, F. Nemore, M. Pacilli, T. Parracino, U. Pasquini,

L. Pazienza, C. Piana, F. Perfetto, S. Perugini, G. Polonara, T. Popolizio, M. Rollo, B. Rossi, R. Rossi, M. Schiavariello, C. Settecasi, A. Simeone, L. Simonetti, A. Splendiani, A. Stranieri, V. Strizzi, A. Tarantino,

T. Tartaglione, G. Valle, N. Zamponi, N. Zarrelli

FOREWORD

Encouraged by the success of the Italian editions, the Authors have decided to publish an English version taking into account the latest technical and methodological advances and the consequent new acquisitions in clinical practice. The contribution of Professor R. Jinkins has been essential to carry out both these tasks.

The resulting work is an up-to-date technical tool that preserves its original aim of contributing to the training of those radiologists who work in emergency departments.

We hope that this revised and extended English version will have the same success as the previ- ous Italian editions, thereby confirming the validity of our initiative.

The work of all the friends and colleagues who have contributed to the making of this book is gratefully acknowledged.

Tommaso Scarabino

Ugo Salvolini

CONTENTS

I. CEREBROVASCULAR EMERGENCIES 1.1 Clinical and diagnostic summary

Neuroradiological protocol

3

Haemorrhagic stroke

4

Ischaemic stroke

4

Conclusions

6

References

6

1.2 CT in ischaemia Introduction

7

Semeiotics

7

Particular forms of infarction

21

Differential diagnosis

24

Conclusions

25

References

25

1.3 CT in intraparenchymal haemorrhage Introduction

27

The role of CT

28

Causes

29

Semeiotics

34

Particular forms of IPH

46

Conclusions

47

References

47

1.4 CT use in subarachnoid haemorrhage Introduction

49

Semeiotics

49

Causes

52

Complications

58

Postsurgical follow-up

59

Conclusions

60

References

60

1.5 MRI in ischaemia Introduction

63

Semeiotics

64

Possible uses of clinical MR in the diagnosis of emergency ischaemia after the hyperacute phase

70

References

70

1.6 Functional MRI in ischaemia Introduction

73

Diffusion MRI

73

Perfusion MRI

75

MR spectroscopy

80

Conclusions

81

References

82

1.7 MRI in haemorrhage Introduction

83

Semeiotics

83

References

92

1.8 Ultrasound Introduction

93

Pathophysiology

93

Techniques

94

Clinical applications

98

Conclusions

99

References

100

1.9 MR angiography Introduction

101

Techniques

102

MR angiography of the supraaortic vessels

103

Intracranial vessels

105

Clinical applications

107

Conclusions

115

References

116

1.10 Conventional angiography Introduction

117

Clinical indications

117

Techniques

118

Applications

119

Conclusions

126

References

128

II. HEAD INJURIES 2.1 Clinical and diagnostic summary Neuroradiological protocols

132

References

135

2.2 CT in head injuries Introduction

137

Techniques

138

Semeiotics

139

Conclusions

161

References

161

2.3 MRI in head injuries Introduction

163

Drawbacks

163

Semeiotics

166

Conclusions

177

References

177

2.4 CT in facial trauma Introduction

179

X CONTENTS

Techniques

179

Semeiotics

182

References

190

III. INTRACRANIAL HYPERTENSION 3.1 Pathophysiology and imaging Introduction

195

The pathophysiology of intracranial hypertension

196

Pathophysiological classification

201

ICH related to abnormal CSF physiology

203

Hydrocephalus

203

ICH related to vascular causes

210

Aetiological causes of intracranial hypertension

211

References

211

3.2 Neoplastic craniocerebral emergencies Introduction

213

Imaging examination technique

214

Semeiotics

214

Posttherapeutic neoplastic emergencies

226

References

226

3.3 Angiography in brain tumours Introduction

229

Meningiomas

230

Gliomas

233

Other cerebral neoplasms

234

Metastases

236

Conclusions

237

References

237

IV. EMERGENCY NEURORESUSCITATION 4.1 Toxic encephalopathy Introduction

241

Alcoholic encephalopathy

241

Methanol intoxication

246

Ethylene-glycol intoxication

246

Intoxication from narcotic inhalation

246

Intoxication from medicines

247

Carbon monoxide (CO) intoxication

250

References

251

4.2 The neuroradiological approach to patients in coma Introduction

253

Modes of intracranial analysis

253

Technical considerations

258

Acute primary focal cerebral lesions

259

Widespread insult/brain swelling

263

References

264

4.3 Nuclear medicine in neurological emergencies Introduction

265

CONTENTS XI

Measuring CBF

266

Clinical usage of HM-PAO SPECT

267

References

272

4.4 Diagnosing brain death Introduction

275

Pathophysiology

275

Diagnosis

276

References

282

4.5 Postsurgical craniospinal emergencies Introduction

283

Cranial emergencies

284

Hypophysis

288

Spinal emergencies

288

References

292

V. SPINAL EMERGENCIES 5.1 Clinical and diagnostic summary Neuroradiological protocols

297

References

298

5.2 CT in spinal trauma emergencies Introduction

299

Techniques

301

Indications

302

Semeiotics

302

Conclusions

319

References

319

5.3 MRI in emergency spinal trauma cases Introduction

321

Pathogenesis

321

Semeiotics

323

References

334

5.4 Emergency imaging of the spine in the non-trauma patient Introduction

337

Imaging techniques

337

Causes

338

Extradural pathology

338

Other types

343

References

367

VI. NEUROPAEDIATRIC EMERGENCIES Introduction

371

Cerebrovascular disease

371

Head injuries

380

CNS infections

387

Intracranial hypertension

391

References

400

SUBJECT INDEX

403

XII CONTENTS

I

CEREBROVASCULAR EMERGENCIES