AJR. American journal of roentgenology
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The purpose of this article is to discuss common elbow injuries found in pediatric athletes who participate in sports that entail overhead movements with focus on mechanism, clinical features, imaging appearance, and treatment options. ⋯ Elbow injuries are commonly seen in pediatric overhead athletes and have been on the rise owing to the increased participation in and demand of youth sports. Imaging plays a critical role in identifying the type and severity of injury, which helps to determine appropriate treatment options.
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AJR Am J Roentgenol · Jul 2017
ReviewThe Lumbar Neural Foramen and Transforaminal Epidural Steroid Injections: An Anatomic Review With Key Safety Considerations in Planning the Percutaneous Approach.
The purpose of this article is to review the anatomy of the lumbar neural foramen and to describe techniques of transforaminal epidural steroid injections with emphasis on safety. Rare cases of paraplegia have been reported. ⋯ Although no consensus currently exists about which approach is the safest, knowledge of the foraminal anatomy is a key consideration when choosing a needle approach for transforaminal epidural steroid injections.
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Abusive head trauma (AHT) is one of the most common subtypes of nonaccidental trauma and is a leading cause of traumatic brain injury in young children. Imaging plays a crucial role in the evaluation of children with suspected AHT and can aid in accurate diagnosis because clinical presentation may be nonspecific. In this article, the CNS injuries that are characteristic of AHT are reviewed with an emphasis on pathophysiology and imaging appearance. ⋯ AHT is a frequent cause of neurologic injury in children, particularly in infants in the first year of life. Imaging evaluation plays a vital role in determining the diagnosis and prognosis. A review of the intracranial injuries that are common in AHT cases has been provided. Understanding the common patterns of abusive head injury can help increase diagnostic accuracy both by increasing recognition of injuries with a high specificity for AHT and by avoiding unwarranted concern in patients with concordant injury patterns and clinical history.
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AJR Am J Roentgenol · Jan 2017
ReviewRevisiting Current Golden Rules in Managing Acute Ischemic Stroke: Evaluation of New Strategies to Further Improve Treatment Selection and Outcome.
Advanced stroke imaging has generated much excitement for the early diagnosis of acute ischemic stroke (AIS) and facilitation of intervention. However, its therapeutic impact has not matched its diagnostic utility; most notably, lacking significant contributions to recent major AIS clinical trials. It is time to reexamine the fundamental hypotheses from the enormous body of imaging research on which clinical practices are based and reassess the current standard clinical and imaging strategies, or golden rules, established over decades for AIS. In this article, we will investigate a possible new window of opportunity in managing AIS through a better understanding of the following: first, the potential limitations of the golden rules; second, the significance of imaging-based parenchymal hypoperfusion (i.e., lower-than-normal relative cerebral blood flow [rCBF] may not be indicative of ischemia); third, the other critical factors (e.g., rCBF, collateral circulation, variable therapeutic window, chronicity of occlusion) that reflect more individual ischemic injury for optimal treatment selection; and, fourth, the need for penumbra validation in successfully reperfused patients (not in untreated patients). ⋯ Individual variations in the therapeutic window, ischemic injury (rCBF), and chronicity of vascular lesion development have not been comprehensively incorporated in the standard algorithms used to manage AIS. The current established imaging parameters have not been consistently validated with successfully reperfused patients and rCBF to quantitatively distinguish between oligemia and ischemia and between penumbra and infarct core within ischemic tissue. A novel paradigm incorporating rCBF values or indirectly incorporating relative rCBF values with higher statistically powered imaging studies to more reliably assess the severity of ischemic injury and differentiate reversibility from viability within the area of imaging-based parenchymal hypoperfusion may provide a more personalized approach to treatment, including no treatment of infarction core, to further enhance outcomes.
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Spinal injections are common pain management procedures using corticosteroids and local anesthetics. Most corticosteroid preparations are particulate suspensions, such as methylprednisolone acetate and triamcinolone acetonide. In the cervical spine, particulate corticosteroids have been linked to catastrophic complications, including blindness, paralysis, and death. Serious neurologic injuries have also been reported at the thoracic, lumbar, and sacral levels. ⋯ Nonparticulate preparations, such as dexamethasone, are safer but have shorter-lived antiinflammatory effects. Local anesthetics are often mixed with corticosteroids in pain management procedures. Although everyday risks are minimal, injection techniques should take into account neural and cardiac toxicities. In this article, we discuss the potential for serious adverse events associated with injected medications. We review the current literature to make conclusions on medication combinations that balance safety and efficacy.