Does postcontrast MR enhancement in lumbar disk herniation have prognostic value?

OBJECTIVE

The aim of our study was to evaluate the prognostic value, if any, of Gd-enhanced MR in patients with lumbar disk herniation.

MATERIALS AND METHODS

Fifteen patients undergoing conservative treatment for acute lumbar disk herniation were included in a prospective Gd-DTPA follow-up MR study. In each patient, the size of the herniation was measured, and, according to the changes in pathology that occurred, patients were divided into four categories. In addition, on the basis of the clinical outcome patients were divided into three classes.

RESULTS

In 11 of 15 patients, MR performed in the acute phase of the disease showed Gd-DTPA enhancement around the herniated disk; in all cases, disk herniation was markedly reduced at follow-up MRIs. The clinical outcome was good. In the remaining four cases, no enhancement was evident in the acute phase or at follow-up MRIs; no modification in the size of disk herniation was demonstrated at follow-up in two. Symptoms were unchanged in two patients and mildly improved in one.

CONCLUSION

Epidural enhancement, which is likely related to an inflammatory process, seems to play a role in the modification of the size of disk herniation.

Congenital generalized lipodystrophy associated with multiple sclerosis

We report the case of a 22 year old woman with congenital generalized lipodystrophy who presented a left brachiocrural pyramidal hemisyndrome, bilateral cerebellar signs and a left cranial nerve VI deficit. The clinical pattern had a tendency to regress. MRI brainscan, CSF examination and clinical features led to the diagnosis of "probable demyelinating syndrome". Published data on CNS involvement in patients with congenital generalized lipodystrophy are few and we have found no cases in which a demyelinating syndrome is associated. In the case we report it is tempting to see the disorder of the lipid metabolism underlying the congenital generalized lipodystrophy as underlying the myelin disorder as well.

Conractile responses of guinea-pig ileum to high-frequency electrical field stimulation

The responses of longitudinal muscle-myenteric plexus strips prepared from guinea-pig ileum to high-frequency electrical field stimulation (10-50 Hz) were investigated. The primary high-frequency responses consisted of a cholinergic component that was less susceptible to inhibition by adenyl compounds than the 0.1 Hz twitch response, and a non-cholinergic component which included a considerable degree of direct muscle stimulation which was not affected by adenosine and adenine nucleotides at concentrations up to 100 micro M. High frequency stimulation in the presence of atropine, at concentrations that effectively blocked the contractions produced by high doses of exogenously applied acetylcholine, elicited delayed complex secondary contractions. These contractions were abolished by tetrodotoxin and were inhibited by morphine and adenyl compounds. The secondary contractions were also elicited in choline-free Krebs buffer following treatment with 100 micro M hemicholinium-3 for 2 h; and they were not enhanced by the addition of 1.5 micro M eserine sulphate. By these criteria, it is concluded that the secondary contractions were mediated by a neurogenic, non-cholinergic mechanism. The nature of the spasmogen, which was not identified, is discussed.