Encephalographic cortical atrophy. Relationships to ventricular atrophy and intellectual impairment

Computed tomography findings in 15 cases of Creutzfeldt-Jakob disease with histological verification

Computed tomography (CT) was normal in twelve of fifteen patients with definite Creutzfeldt-Jakob disease. In two patients CT showed mild sulcal widening, while marked ventricular enlargement and moderate cortical atrophy were seen in a patient who had both Creutzfeldt-Jakob disease and normal pressure hydrocephalus. No correspondence was observed between CT findings, severity of the clinical picture and postmorten gross brain examination. According to these results, a normal CT in a demented patient should suggest Creutzfeldt-Jakob disease. Conversely, CT is of value for the diagnosis of other potentially reversible illnesses clinically resembling Creutzfeldt-Jakob disease.

Examination of alcoholics by computed tomographic (CT) scans: a critical review

Neuroradiological studies have consistently demonstrated that alcoholics have morphological abnormalities of cortical, ventricular, and cerebellar structures suggesting brain atrophy. This atrophy is weakly correlated with impaired psychological test performance. Because brain atrophy and intellectual impairment can also be found in normal aging it is necessary to compare alcoholics with age-matched control subjects. It is currently unknown if alcohol-associated brain atrophy and intellectual impairment are the result of conditions preceding alcohol consumption or conditions only indirectly related such as head trauma or other associated diseases. Direct alcohol toxicity would be supported by quantitative alcohol-atrophy dose-response relationships and by a partial reversal of atrophy and functional impairment following abstinence from alcohol. Because of methodological difficulties inherent in neuroradiological research, data on the exact pathogenesis of abnormalities in alcoholics have not been produced. The design of such studies can be improved to increase the probability that the causes of brain atrophy will be elucidated.

Computerized tomography in the diagnosis of cerebral atrophy

Computerized tomograms were studied of 67 adults whose lumbar pneumoencephalograms were normal or showed ventricular dilatation with or without widening of the sulci. The maximum ventricular area, measured from 80 x 80 matrix printouts, correlates well with measures of ventricular size on the pneumoencephalogram. An area of 10 cm2 is suggested as the upper limit of normal. The correlation between measures of sulcal width on computerized tomography and pneumoencephalography is less precise, but normal sulci and gross degrees of cortical atrophy can be identified.

Measurements of the normal hemispheric sulci with computer tomography: a preliminary study on 44 adults

44 normal adults were examined by computer tomography (CT) withe fine matrix EMI scanner. Measurements of the width of the hemispheric sulci were possible in all but one case. An average value of 3.4 mm was found, but no sexual difference or influence of age could be shown statistically. The necessity of larger investigations of the normal population is stressed.

A triad of airencephalographic findings in patients with mental impairment: a controlled prospective study

A controlled prospective study of 82 patients examined consecutively during one year by airencephalography was made. Care was taken to excude bias and to assess observer error. A close correlation was found between mental impairment (as a sign of "organic brain syndrome", resulting from various cerebral diseases), and three airencephalographic findings, namely 1) lack of air filling over the parietal convexities (parietal air block), 2) widening of the lateral and third ventricles and 3) widening of the Sylvian and interhemispheric fissures. Of these, parietal air block was found to be the most sensitive sign. In addition to the patients with normal-pressure hydrocephalus, the majority of patients with presenile dementia and alcoholic encephalopathy had parietal air block. The results are in agreement with those reported in an earlier retrospective study. Leptomeningeal changes may account for the finding of parietal air block in certain patients, but in the majority of cases there is no complete obstruction of the subarachnoid space, as judged from the results of isotope cisternography. Organic changes in the brain and leptomeninges may create special physical conditions for the appearance of convexity air block at airencephalography. Recognition of convexity air blocks seems to have considerable diagnostic and therapeutic implications, since it contributes appreciably to the judgment whether a patient's condition is basically determined by an organic brain syndrome or constitutes a functional mental disorder. The possible pathophysiological association between mental impairment and parietal air block warrants attention.