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They are also helpful incounteracting opiate sedation, and they potentiate opiate analgesia. His lawyer brought suit against the clinic for improper treatment and inadequate information.

The court rejected the suit as without foundation, basing its reasoning essentially on the statements of the neuroradiologic expert.

Kategorie Correspondence DOI They can present either with unusual imaging appearance in the form of unusual signals or in uncommon locations.

Epidermoid cyst and abscess are among those lesions which are usually hypointense on T1-weighted imaging T1-WI but rarely can be hyperintense on T1-WI and can mimic each other in different pulse sequences including diffusion-weighted imaging DWI.

When they are present in an uncommon location, they can be confused with each other, especially when one is situated in a location considered more characteristic of the other.

Here, we describe this potential confusing scenario in the form of two cases. Taschner Clinical Case A year-old farmer presented with complex partial seizures and headache for 9 months.

An initial magnetic resonance imaging MRI exam revealed an infiltrating lesion within the left frontotemporal region and the right temporal lobe Figure 1.

A stereotactic brain biopsy in September yielded unspecific findings with diffuse hypercellularity and reactive changes.

Therefore, no therapy was initiated. The patient was readmitted in May , after he had suffered a generalized seizure.

Upon admission he was comatose with a fixed and dilated left pupil. Emergency intubation was performed, a ventricular drainage was placed, and steroids and osmotherapy were given because of increased intracranial pressure ICP and signs of uncal herniation.

A second MRI was performed revealing an increase of the space-occupying effect as well as a new lesion within the left-sided inferior temporal gyrus Figure 2.

Hattingen, S. Blasel, M. Nichtweiss, F. Zanella and S. Weidauer Abstract The spectrum of pathologic processes affecting the midbrain features some differences to other brain areas.

The midbrain is exposed to traumatic alterations due to its position between the tentorial edges, and some neurodegenerative and metabolic-toxic diseases may typically involve the midbrain.

Primary midbrain tumors are also infrequent and often show a benign clinical course. Apart from multiple sclerosis other inflammatory autoimmune processes and some infectious agents predominantly affect the brainstem including the midbrain.

This review discusses the different pathologic processes of the midbrain, i. Obschon regelhaft eine mesenzephale Beteiligung beim Basilarisspitzensyndrom vorliegt, sind isolierte Mittelhirninfarkte selten.

Flacke, H. Tschampa, D. Hadizadeh, S. Greschus, H. Clusmann, R. Kristof and H. Urbach Abstract Background and Purpose: Streak artifacts caused by aneurysm clips and coils impede image quality in multidetector computed tomography MDCT.

The authors propose a technique to minimize these artifacts by gated data reconstruction and shifting the reconstruction window.

Patients and Methods: Intracranial CT angiograms were acquired in the follow-up of six patients with clipped and coiled intracranial aneurysms, respectively.

Data acquisition was gated via an external pacemaker cable-connected to the scanner. Results: Artifact orientation could be rotated by shifting the reconstruction window and interesting vessel segments visualized without disturbing streak artifacts.

This allowed to assess the posterior communicating artery origin in two cases and a middle cerebral artery aneurysm remnant in another case, respectively.

However, due to a higher noise interesting vessel segments were not adjustable in another three patients. Conclusion: Gated MDCT is a promising technique to reduce the amount and to change the position of artifacts induced by clips or coils.

Wir stellen eine neue Methode zur Artefaktreduktion vor durch Verwendung einer getriggerten Datenakquisition und durch Verschiebung des Rekonstruktionsintervalls.

Material und Methodik: Sechs Patienten mit geclippten bzw. After endovascular therapy by coiling, a hemiparesis was observed following extubation.

Disturbance of speech and disorientation added later. An infarct of the lenticular nucleus was found. The angiography showed an occlusion of a frontal opercular branch of the left middle cerebral artery.

The fact-finding board for medical liability should investigate, if the infarct with continuous neurological deficits is explained by improper treatment and if the following management of complication was adequate.

A neuroradiologic opinion was requested. Based on that, the board came to the result that no incorrect medical treatment was done.

Im Computertomogramm stellte sich ein frischer Linsenkerninfarkt dar. Die Angiographie zeigte einen Verschluss eines frontalen operkularen Astes der A.

Es wurde ein neuroradiologisches Gutachten angefordert. Urbach, A. Grote, P. Niehusmann, L. Roesseler and K. Kuchelmeister Introduction The choroid plexus of the 4th ventricle is a T-like, doubled-layered, secretory epithelium attached to the inferior roof and extending into the lateral recesses and foramina of Luschka.

It often calcifies or appears lobulated or cystic. In its normal state, the choroid plexus state shows a papillary or villous architecture supported by a ramifying thin fibrovascular stroma.

We report on a year-old patient with a choroid plexus adenoma in the 4th ventricle and discuss differential diagnoses.

Fischer, C. Schul, P. Lanzer and H. Cervical spondylosis and osteophyte formation affecting the foramina transversaria have been associated primarily with vertebrobasilar insufficiency.

Diagnostic work-up of patients presenting with a suspected cerebral artery dissection includes diffusion-weighted imaging, magnetic resonance imaging MRI , magnetic resonance angiography MRA , and, in most cases, a selective digital subtraction angiography DSA.

Recommended treatment includes therapeutic anticoagulation to prevent thrombus formation and endovascular revascularization to restore patency [3].

Recurrent stenosis due to intimal hyperplasia or other mechanisms remains a major concern. Here, we report a case of vertebral artery dissection and recurrent in-stent stenoses due to external vessel compression caused by an adjacent vertebral osteophyte.

Dorn, A. Milkereit, P. Berlit and T. Liebig Introduction Local or regional inflammatory disease in the head and neck region is a common and usually benign condition.

We present three cases of ischemic brain infarctions that occurred due to transmural involvement of the internal carotid artery ICA as a complication of sinusitis and otitis and discuss endovascular treatment options.

Rossitti Introduction This communication concerns a case of severe intracerebral hematoma and intraventricular hemorrhage in a young man, with continuous hemorrhage shown on angiography that was controlled by transarterial occlusion of a bleeding thalamoperforating artery.

The pathophysiology of continuous intracranial bleeding in this particular case is discussed. Moske-Eick, C. Taschner, S. Krauss, J. Kirschner, V.

Rottenburger, J. Prinz Clinical Case In October , a year-old previously healthy boy was referred to our hospital with paresthesia of the left leg for several weeks and new onset of mild proximal weakness of the right arm and leg.

There was no history of trauma or previous infection. On clinical examination, the child presented discrete hemiparesis with increased deep tendon reflexes and a positive Babinski sign on the right side.

Analysis of the cerebrospinal fluid showed no abnormal findings. The initial postoperative course was uneventful.

A combined therapy of local irradiation and temozolomide chemotherapy was started [1]. Four weeks after the termination of radiotherapy, the patient showed clinical progression with tetraparesis and neurological bladder dysfunction.

Fesl, M. Demmel, J. Albrecht, R. Kopietz, V. Schoepf, A. Kleemann, O. Pollatos, A. Anzinger, T. Schreder, H. Brueckmann and M. Material and Methods: Twenty-nine healthy subjects participated in three functional magnetic resonance imaging fMRI sessions each.

The sessions differed regarding emotional states, which were induced by standardized pleasant positive condition, POS , unpleasant negative condition, NEG , or neutral neutral condition, NEU pictures taken from the International Affective Picture System IAPS while the subjects performed a finger-tapping task right index-to-thumb opposition.

After each session, the subjects had to rate their actual mood and the pleasantness of the presented pictures. Furthermore, their state anxiety was assessed.

Behavioral data were evaluated with SPSS. Functional imaging data were processed using statistical parametric mapping SPM2 and were analyzed for main effects of emotional stimulation using an analysis of variance ANOVA.

The local maximum of interest was analyzed by a signal change analysis. Results: Compared to the neutral emotional state, the positive and the negative emotional states caused a reduction of signal intensity changes within the primary sensorimotor hand area during simple finger tapping.

The behavioral data indicated that the unpleasant pictures had a stronger effect on the emotional state than the pleasant images.

Conclusion: This study showed that the emotional state of a test person is indeed influencing fMRI results and that well-balanced subjects in a neutral mood achieve the best fMRI results.

Becker Abstract Report of a year-old woman who had sudden vision problems and homonymous hemianopia on the left.

A cranial computed tomography CCT was carried out in a radiologic practice. A native homogeneous, smooth-edged hyperdense intracerebral mass of about 5.

Following intravenous administration of contrast medium, a patchy increase in density of about 1 cm was seen. The mass had only a thin hypodense rim.

The patient was informed that she had a tumor. Three days later, magnetic resonance imaging was to be done for further evaluation.

After the patient had returned home, she had headaches, nausea and vomiting in the evening. At night, she was admitted to a hospital as emergency case.

With further increase of intracranial pressure, a craniotomy was done and a hemorrhage was removed. Histologically, a bleeding of a cavernous hemangioma was found.

The patient appealed to the fact-finding board for medical liability questions because she had not been admitted to a hospital immediately after the CCT.

Therefore, surgery was done delayed. The board found that the behavior of the radiologist was wrong. However, it cannot be proven that this medical malpractice is of importance for the existing postoperative complaints.

Dabei fand sich eine nativ homogene, glatt berandete hyperdense intrazerebrale Raumforderung von ca. Nur ein kleiner Anteil von ca.

Es bestand nur ein schmaler hypodenser Randsaum. Der Patientin wurde mitgeteilt, dass sie einen Tumor habe. Nachts erfolgte die Notfallaufnahme in eine Klinik.

Die Schlichtungsstelle kam zu dem Ergebnis, dass das Verhalten des Radiologen fehlerhaft war. Miloslavski, Z. Vajda, J. Peters, H. Henkes Introduction Intracranial arterial stenosis is a frequent cause of major stroke [1].

Medical treatment with either platelet antiaggregation or anticoagulation may be an option for asymptomatic patients and for those not suitable for endovascular therapy.

In patients with high-grade symptomatic stenoses, balloon dilatation using coronary stents [2], neurovascular variants thereof [3], or self-expanding stents [4] offers better protection from stroke.

In dedicated centers, these procedures are carried out safely and efficiently. The long-term course, however, remains a concern.

The dilemma is that drug-eluting stents DES provide good long-term results, but are just too stiff for elongated vessels. In the past, conventional balloon dilatation or the deployment of a second stent was established clinical practice.

Some years ago, Scheller et al. Angioplasty of coronary ISR performed with iopromideand paclitaxel-coated balloons drug-eluting balloon [DEB] prevents restenosis more frequently and longer than the use of bare-surface balloons [6].

We report the clinical history of a young patient with a symptomatic, presumably inflammatory proximal middle cerebral artery MCA plaque, which was treated by balloon dilatation and self-expanding stent deployment, followed by recurrent intracranial ISR.

Three retreatments with conventional balloons were again followed by severe intimal hyperplasia. Oran Introduction Serious complications can occur during or after the scuba diving.

Most of the patients suffer strokes because of dysbaric air embolisms [1]. Dissections of cervical arteries in scuba divers have rarely been described in the literature [2].

The cases reported include pointed internal carotid artery ICA and vertebral artery dissections. According to our knowledge, however, isolated posterior inferior cerebellar artery PICA dissection after scuba diving has not been reported in literature.

We present an isolated PICA dissection that occurred as an unusual complication of scuba diving. Jensen, C. Werner and O. Jansen Introduction Congenital anomalies of the atlas are rare [1].

In most cases, they do not cause symptoms and typically only become apparent in routine or emergency evaluation.

Sometimes, the distinction between an acute fracture and a congenital anomaly can be demanding. Here, we present a case of a rare finding in the setting of acute trauma.

Taschner, O. Staszewski, V. Steinhoff, I. Mader and M. Prinz Clinical Case A year-old woman presenting symptomatic epilepsy with simple and complex partial seizures since the age of 13 years was referred to our hospital for epilepsy surgery.

Presurgical epileptic work-up had included electroencephalography monitoring, neuropsychological investigations, fluorodeoxyglucose positron emission tomography, and neuroradiologic evaluation.

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Apart from gait ataxia the neurologic examination was normal. The ophthalmologic examination was normal. Magnetic resonance imaging MRI showed a contrast-enhancing lesion in both hypothalami with suprasellar extension.

A histopathologic diagnosis could be established after stereotactic biopsy of the lesion. Their classification depends on the differentiation of shunting versus nonshunting lesions, the latter being the spinal cord cavernomas.

In the shunting lesions, the next step in the proposed classification scheme is related to the feeding artery which can subdivide the dural vascular shunts from the pial vascular malformations: while those shunts that are fed by radiculomeningeal arteries i.

Depending on the type of transition between artery and vein, the latter pial AVMs can be further subdivided into glomerular plexiform or nidus-type AVMs with a network of intervening vessels in between the artery and vein and the fistulous pial AVMs.

The proposed classification is therefore based on a stepwise analysis of the shunt including its arterial anatomy, its nidus architecture and its flow-volume evaluation.

The major advantage of this approach is that it leads to a subclassification with direct implications on the choice of treatment, thereby constituting a simple and practical approach to evaluate these rare diseases.

It occurs in all age groups, but affects predominately young and middle-aged females. The symptoms of CVST are highly variable, thus, diagnosis is often made with a considerable delay.

This review first presents a short summary of the epidemiology, risk factors, clinical signs, and prognosis of CVST. Der Schwerpunkt der Arbeit liegt auf der neuroradiologischen Diagnose der Erkrankung.

CT was used as gold standard. CSF flow artifacts occurred predominantly in the third and fourth ventricles.

Der CT-Befund wurde als Goldstandard herangezogen. Despite the nonspecific and variable clinical presentation of these patients, they show typical radiologic findings.

Previous studies evaluated typical radiologic findings with symmetric infratentorial hyperintense signal changes and similar alteration in the posterior limb of the internal capsule, the splenium of corpus callosum, the medial lemniscus and the lateral brainstem.

In context with the reviewed literature, a series of another three cases with toxic leukoencephalopathy after heroin abuse other than vapor inhalation is presented.

Patients and Methods: All three patients underwent magnet resonance imaging MRI including additional diffusion- weighted imaging and apparent diffusion coefficient maps.

Clinical and laboratory findings were recorded. Results: MRI of all three patients revealed similar symmetric supratentorial hyperintense signal changes involving the frontal, parietal, occipital and temporal lobes.

The cortex was spared and the subcortical U fibers were partially involved. Further, the brainstem and the cerebellar white matter were not affected.

Conclusion: Toxic leukoencephalopathy without involvement of the cerebellum and brainstem is a rare complication of heroin abuse.

The pattern of heroin-induced toxic leukoencephalopathy on MRI might not only be related to an unknown adulterant, but also to the mode of drug administration.

Der Kortex war komplett und die subkortikalen U-Fasern waren partiell ausgespart. Schlussfolgerung: Die toxische Leukoenzephalopathie ohne Einbezug des Cerebellums und des Hirnstamms ist eine seltene Komplikation bei Heroinabusus.

The authors present their initial experience with a self-expanding stent for use in intracranial vascular reconstruction, permitting immediate recanalization of acute thromboembolic occlusions of the anterior circulation.

Treatment comprised systemic and intraarterial thrombolysis, mechanical thrombectomy, and stent placement.

Neither distal emboli nor any procedure-related complications were encountered. One patient developed symptomatic intracerebral hemorrhage and two patients needed decompressive craniectomy after treatment.

The use of antiplatelet therapy after treatment may, however, increase the risk of reperfusion intracerebral hemorrhage. Ergebnisse: Sechs Patienten wurden eingeschlossen.

Distale Emboli und prozedurale Komplikationen traten nicht auf. Im Verlauf erlitt ein Patient eine symptomatische intrazerebrale Blutung, zwei weitere Patienten mussten zur Druckentlastung kraniektomiert werden.

In dieser Serie zeigt sich eine hohe Effizienz mit Reperfusion bei allen Patienten. After interdisciplinary consultation, combined treatment with endovascular embolization and subsequent stereotactic irradiation was recommended.

Once the patient had survived the acute phase with application of external drainage and later implantation of a shunt system, he was left with an organic brain syndrome.

His lawyer brought suit against the clinic for improper treatment and inadequate information. The court rejected the suit as without foundation, basing its reasoning essentially on the statements of the neuroradiologic expert.

Kategorie Correspondence DOI They can present either with unusual imaging appearance in the form of unusual signals or in uncommon locations.

Epidermoid cyst and abscess are among those lesions which are usually hypointense on T1-weighted imaging T1-WI but rarely can be hyperintense on T1-WI and can mimic each other in different pulse sequences including diffusion-weighted imaging DWI.

When they are present in an uncommon location, they can be confused with each other, especially when one is situated in a location considered more characteristic of the other.

Here, we describe this potential confusing scenario in the form of two cases. Taschner Clinical Case A year-old farmer presented with complex partial seizures and headache for 9 months.

An initial magnetic resonance imaging MRI exam revealed an infiltrating lesion within the left frontotemporal region and the right temporal lobe Figure 1.

A stereotactic brain biopsy in September yielded unspecific findings with diffuse hypercellularity and reactive changes. Therefore, no therapy was initiated.

The patient was readmitted in May , after he had suffered a generalized seizure. Upon admission he was comatose with a fixed and dilated left pupil.

Emergency intubation was performed, a ventricular drainage was placed, and steroids and osmotherapy were given because of increased intracranial pressure ICP and signs of uncal herniation.

A second MRI was performed revealing an increase of the space-occupying effect as well as a new lesion within the left-sided inferior temporal gyrus Figure 2.

Hattingen, S. Blasel, M. Nichtweiss, F. Zanella and S. Weidauer Abstract The spectrum of pathologic processes affecting the midbrain features some differences to other brain areas.

The midbrain is exposed to traumatic alterations due to its position between the tentorial edges, and some neurodegenerative and metabolic-toxic diseases may typically involve the midbrain.

Primary midbrain tumors are also infrequent and often show a benign clinical course. Apart from multiple sclerosis other inflammatory autoimmune processes and some infectious agents predominantly affect the brainstem including the midbrain.

This review discusses the different pathologic processes of the midbrain, i. Obschon regelhaft eine mesenzephale Beteiligung beim Basilarisspitzensyndrom vorliegt, sind isolierte Mittelhirninfarkte selten.

Flacke, H. Tschampa, D. Hadizadeh, S. Greschus, H. Clusmann, R. Kristof and H. Urbach Abstract Background and Purpose: Streak artifacts caused by aneurysm clips and coils impede image quality in multidetector computed tomography MDCT.

The authors propose a technique to minimize these artifacts by gated data reconstruction and shifting the reconstruction window. Patients and Methods: Intracranial CT angiograms were acquired in the follow-up of six patients with clipped and coiled intracranial aneurysms, respectively.

Data acquisition was gated via an external pacemaker cable-connected to the scanner. Results: Artifact orientation could be rotated by shifting the reconstruction window and interesting vessel segments visualized without disturbing streak artifacts.

This allowed to assess the posterior communicating artery origin in two cases and a middle cerebral artery aneurysm remnant in another case, respectively.

However, due to a higher noise interesting vessel segments were not adjustable in another three patients. Conclusion: Gated MDCT is a promising technique to reduce the amount and to change the position of artifacts induced by clips or coils.

Wir stellen eine neue Methode zur Artefaktreduktion vor durch Verwendung einer getriggerten Datenakquisition und durch Verschiebung des Rekonstruktionsintervalls.

Material und Methodik: Sechs Patienten mit geclippten bzw. After endovascular therapy by coiling, a hemiparesis was observed following extubation.

Disturbance of speech and disorientation added later. An infarct of the lenticular nucleus was found. The angiography showed an occlusion of a frontal opercular branch of the left middle cerebral artery.

The fact-finding board for medical liability should investigate, if the infarct with continuous neurological deficits is explained by improper treatment and if the following management of complication was adequate.

A neuroradiologic opinion was requested. Based on that, the board came to the result that no incorrect medical treatment was done.

Im Computertomogramm stellte sich ein frischer Linsenkerninfarkt dar. Die Angiographie zeigte einen Verschluss eines frontalen operkularen Astes der A.

Es wurde ein neuroradiologisches Gutachten angefordert. Urbach, A. Grote, P. Niehusmann, L. Roesseler and K. Kuchelmeister Introduction The choroid plexus of the 4th ventricle is a T-like, doubled-layered, secretory epithelium attached to the inferior roof and extending into the lateral recesses and foramina of Luschka.

It often calcifies or appears lobulated or cystic. In its normal state, the choroid plexus state shows a papillary or villous architecture supported by a ramifying thin fibrovascular stroma.

We report on a year-old patient with a choroid plexus adenoma in the 4th ventricle and discuss differential diagnoses.

Fischer, C. Schul, P. Lanzer and H. Cervical spondylosis and osteophyte formation affecting the foramina transversaria have been associated primarily with vertebrobasilar insufficiency.

Diagnostic work-up of patients presenting with a suspected cerebral artery dissection includes diffusion-weighted imaging, magnetic resonance imaging MRI , magnetic resonance angiography MRA , and, in most cases, a selective digital subtraction angiography DSA.

Recommended treatment includes therapeutic anticoagulation to prevent thrombus formation and endovascular revascularization to restore patency [3].

Recurrent stenosis due to intimal hyperplasia or other mechanisms remains a major concern. Here, we report a case of vertebral artery dissection and recurrent in-stent stenoses due to external vessel compression caused by an adjacent vertebral osteophyte.

Dorn, A. Milkereit, P. Berlit and T. Liebig Introduction Local or regional inflammatory disease in the head and neck region is a common and usually benign condition.

We present three cases of ischemic brain infarctions that occurred due to transmural involvement of the internal carotid artery ICA as a complication of sinusitis and otitis and discuss endovascular treatment options.

Rossitti Introduction This communication concerns a case of severe intracerebral hematoma and intraventricular hemorrhage in a young man, with continuous hemorrhage shown on angiography that was controlled by transarterial occlusion of a bleeding thalamoperforating artery.

The pathophysiology of continuous intracranial bleeding in this particular case is discussed. Moske-Eick, C. Taschner, S.

Krauss, J. Kirschner, V. Rottenburger, J. Prinz Clinical Case In October , a year-old previously healthy boy was referred to our hospital with paresthesia of the left leg for several weeks and new onset of mild proximal weakness of the right arm and leg.

There was no history of trauma or previous infection. On clinical examination, the child presented discrete hemiparesis with increased deep tendon reflexes and a positive Babinski sign on the right side.

Analysis of the cerebrospinal fluid showed no abnormal findings. The initial postoperative course was uneventful.

A combined therapy of local irradiation and temozolomide chemotherapy was started [1]. Four weeks after the termination of radiotherapy, the patient showed clinical progression with tetraparesis and neurological bladder dysfunction.

Fesl, M. Demmel, J. Albrecht, R. Kopietz, V. Schoepf, A. Kleemann, O. Pollatos, A. Anzinger, T. Schreder, H.

Brueckmann and M. Material and Methods: Twenty-nine healthy subjects participated in three functional magnetic resonance imaging fMRI sessions each.

The sessions differed regarding emotional states, which were induced by standardized pleasant positive condition, POS , unpleasant negative condition, NEG , or neutral neutral condition, NEU pictures taken from the International Affective Picture System IAPS while the subjects performed a finger-tapping task right index-to-thumb opposition.

After each session, the subjects had to rate their actual mood and the pleasantness of the presented pictures.

Furthermore, their state anxiety was assessed. Behavioral data were evaluated with SPSS. Functional imaging data were processed using statistical parametric mapping SPM2 and were analyzed for main effects of emotional stimulation using an analysis of variance ANOVA.

The local maximum of interest was analyzed by a signal change analysis. Results: Compared to the neutral emotional state, the positive and the negative emotional states caused a reduction of signal intensity changes within the primary sensorimotor hand area during simple finger tapping.

The behavioral data indicated that the unpleasant pictures had a stronger effect on the emotional state than the pleasant images. Conclusion: This study showed that the emotional state of a test person is indeed influencing fMRI results and that well-balanced subjects in a neutral mood achieve the best fMRI results.

Becker Abstract Report of a year-old woman who had sudden vision problems and homonymous hemianopia on the left. A cranial computed tomography CCT was carried out in a radiologic practice.

A native homogeneous, smooth-edged hyperdense intracerebral mass of about 5. Following intravenous administration of contrast medium, a patchy increase in density of about 1 cm was seen.

The mass had only a thin hypodense rim. The patient was informed that she had a tumor. Three days later, magnetic resonance imaging was to be done for further evaluation.

After the patient had returned home, she had headaches, nausea and vomiting in the evening. At night, she was admitted to a hospital as emergency case.

With further increase of intracranial pressure, a craniotomy was done and a hemorrhage was removed. Histologically, a bleeding of a cavernous hemangioma was found.

The patient appealed to the fact-finding board for medical liability questions because she had not been admitted to a hospital immediately after the CCT.

Therefore, surgery was done delayed. The board found that the behavior of the radiologist was wrong. However, it cannot be proven that this medical malpractice is of importance for the existing postoperative complaints.

Dabei fand sich eine nativ homogene, glatt berandete hyperdense intrazerebrale Raumforderung von ca. Nur ein kleiner Anteil von ca.

Es bestand nur ein schmaler hypodenser Randsaum. Der Patientin wurde mitgeteilt, dass sie einen Tumor habe. Nachts erfolgte die Notfallaufnahme in eine Klinik.

Die Schlichtungsstelle kam zu dem Ergebnis, dass das Verhalten des Radiologen fehlerhaft war. Miloslavski, Z. Vajda, J. Peters, H.

Henkes Introduction Intracranial arterial stenosis is a frequent cause of major stroke [1]. Medical treatment with either platelet antiaggregation or anticoagulation may be an option for asymptomatic patients and for those not suitable for endovascular therapy.

In patients with high-grade symptomatic stenoses, balloon dilatation using coronary stents [2], neurovascular variants thereof [3], or self-expanding stents [4] offers better protection from stroke.

In dedicated centers, these procedures are carried out safely and efficiently. The long-term course, however, remains a concern. The dilemma is that drug-eluting stents DES provide good long-term results, but are just too stiff for elongated vessels.

In the past, conventional balloon dilatation or the deployment of a second stent was established clinical practice. Some years ago, Scheller et al.

Angioplasty of coronary ISR performed with iopromideand paclitaxel-coated balloons drug-eluting balloon [DEB] prevents restenosis more frequently and longer than the use of bare-surface balloons [6].

We report the clinical history of a young patient with a symptomatic, presumably inflammatory proximal middle cerebral artery MCA plaque, which was treated by balloon dilatation and self-expanding stent deployment, followed by recurrent intracranial ISR.

Three retreatments with conventional balloons were again followed by severe intimal hyperplasia. Oran Introduction Serious complications can occur during or after the scuba diving.

Most of the patients suffer strokes because of dysbaric air embolisms [1]. Dissections of cervical arteries in scuba divers have rarely been described in the literature [2].

The cases reported include pointed internal carotid artery ICA and vertebral artery dissections. According to our knowledge, however, isolated posterior inferior cerebellar artery PICA dissection after scuba diving has not been reported in literature.

We present an isolated PICA dissection that occurred as an unusual complication of scuba diving. Jensen, C. Werner and O. Jansen Introduction Congenital anomalies of the atlas are rare [1].

In most cases, they do not cause symptoms and typically only become apparent in routine or emergency evaluation.

Sometimes, the distinction between an acute fracture and a congenital anomaly can be demanding. Here, we present a case of a rare finding in the setting of acute trauma.

Taschner, O. Staszewski, V. Steinhoff, I. Mader and M. Prinz Clinical Case A year-old woman presenting symptomatic epilepsy with simple and complex partial seizures since the age of 13 years was referred to our hospital for epilepsy surgery.

Presurgical epileptic work-up had included electroencephalography monitoring, neuropsychological investigations, fluorodeoxyglucose positron emission tomography, and neuroradiologic evaluation.

Magnetic resonance imaging MRI of the brain showed a lesion of the left medial temporal lobe Fig. Based on the results of presurgical evaluation, two-thirds resection of the temporal lobe with amygdalohippocampectomy was suggested.

Epilepsy surgery was performed via a left frontotemporal approach with progressive removal of the lateral temporal cortex. During surgery, the hippocampus appeared very hard with dorsal calcifications.

The arachnoid overlying the brainstem was abnormally thick and extremely adherent. However, the temporomesial mass could finally be resected in toto.

Postoperative neurological examination revealed a slight hemiparesis and a hemianopsia. The computed tomography CT scan demonstrated a small dorsal thalamic infarction not shown.

The hemiparesis normalized during the following days. Albrecht, M. Burke, K. Haegler, V. Kleemann, M.

Paolini, M. Wiesmann and J. Linn Abstract Purpose The authors investigated the potential of a channel 32ch receiving head coil for functional magnetic resonance imaging fMRI compared to a standard eight-channel 8ch coil using a motor task.

Material and Methods Brain activation was analyzed in 14 healthy right-handed subjects performing finger tapping with the right index finger block design during two experimental sessions, one with the 8ch and one with the 32ch coil applied in a pseudorandomized order.

Additionally, a phantom study was performed to compare signal-to-noise ratios SNRs of both coils. Application of the 32ch coil obtained additional activation clusters in the right cerebellum, left superior frontal gyrus SMA , left supramarginal gyrus, and left postcentral gyrus.

The phantom study revealed a significantly higher SNR for the 32ch coil compared to the 8ch coil in superficial cortical areas located near the surface of the brain.

Conclusion The 32ch technology has a potential impact on fMRI studies, especially in paradigms that result in activation of cortical areas located near the surface of the brain.

Brockmann, J. Scharf, I. Seiz, C. Groden and M. Brockmann Abstract Purpose: The aim was to assess the feasibility of dual-energy computed tomography DE-CT for detection of peri-interventional re-bleeding in patients with aneurysmal subarachnoid hemorrhage reSAH.

Methods: For in vitro-analyses DE-CT of partially clotted blood intermixed with fresh blood containing contrast agent was performed. Results: In vitro experiments demonstrated the feasibility of DE-CT to discriminate between blood with and without contrast agent.

In all patients peri-interventional re-SAH was confirmed by detection of extravasated iodine within the subarachnoid spaces in post-interventional DE-CT.

After subtraction of the iodine-related high density signal, VNC images optimized the estimation of the true amount of subarachnoid blood.

Conclusion: Dual-energy CT allows the discrimination and subtraction of blood and iodine mixed within the subarachnoid spaces in patients with peri-interventional re-SAH.

It helps to avoid overestimation of SAH after peri-interventional re-bleeding and therefore is a potentially valuable tool in the assessment of peri-interventional re-SAH.

Die DE-CT erlaubte eine Diskriminierung von alten Blutkoageln und periinterventionell neu hinzugekommenem kontrastmittelhaltigem Blut; dies ging mit einer besseren Beurteilbarkeit der Bilder einher.

Dangerous vascular anastomoses were not previously recognized in a superselective angiography. Aphasia and hemiparesis on the right side occurred immediately after the embolization.

A cerebral infarct was seen in the region of the left pericallosal artery. The patient applied to the fact-finding board for medical liability and a neuroradiologic opinion was requested.

The board came to the conclusion that no incorrect medical treatment had been carried out. Unmittelbar nach der Embolisation kam es zu einer Aphasie und rechtsseitigen Hemiparese.

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