Seminars in neurology
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The management of severe brain injury requires a comprehensive approach in which imaging is an indispensable complement to the clinical and physiological information acquired at the bedside. Neuroimaging methods are routinely used in the diagnosis and prognosis of a broad spectrum of patients with acute neurological dysfunction. With incremental theoretical and technological refinements, imaging modalities are helping to unravel fundamental questions regarding the pathophysiology and neuroplasticity associated with critical neurological injury, and it is anticipated that this knowledge will lead to new and effective therapeutic interventions. We review some of the established and emerging structural and physiological imaging methods, and discuss their applications in patients with critical injuries including trauma and encephalopathy due to anoxia, liver failure, and sepsis.
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Acute ischemic stroke is a common disorder with a significant impact on morbidity and mortality in the United States. The number of interventions for acute stroke patients has increased over the past 15 years and patients increasingly require intensive care. There are several issues that are specific to ischemic stroke patients in intensive care unit (ICU) settings, including the care of the postthrombolytic stroke patient, respiratory issues in stroke care, evaluation of worsening or change in neurological status, and attention to factors that affect the ischemic penumbra. The management of the stroke patient in the critical care setting is discussed in this article.
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Imaging of the pediatric brain is challenging. Knowledge of the normal anatomy and appearance of the developing brain at a given age is critical in identifying abnormalities. Brain malformations had been in the domain of the neuropathologist, but with advanced neuroimaging they can be defined in vivo. ⋯ In addition to anatomical magnetic resonance (MR) imaging, metabolic imaging with MR spectroscopy is established in many brain disorders, such as tumors, leukodystrophies, and metabolic conditions. Even though catheter angiography remains the gold standard, MR and computed tomography angiography provide rapid and noninvasive alternatives to evaluate children with vascular lesions. This article presents the classic imaging findings in pediatric neurology, including the commonly seen malformations, metabolic disorders, and trauma in addition to some rarer diseases.
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Head trauma requires several different neuroimaging modalities for adequate evaluation and determination of treatment. This article considers the importance of anatomical and functional imaging modalities in the initial evaluation, treatment planning, and long-term management of patients with head injury. ⋯ Each modality offers specific advantages and potential disadvantages. However, it is important to understand the capabilities of each modality, and how and when each one might provide the most valuable information as one evaluates such patients.
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Nonepileptic paroxysmal events are behavioral, motor, or sensory episodes that do not result from abnormal cortical electrical activity. They can mimic any type of epileptic seizures including simple partial, complex partial, and generalized tonic-clonic seizures. ⋯ In most cases, the clinical history is enough to make a correct diagnosis. The clinical features suggestive of various types of nonepileptic paroxysmal events, together with useful diagnostic tests, will be reviewed.