Neuroimaging clinics of North America
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Assessment of the orbit for orbital trauma is best achieved expeditiously with CT in the determination of extent of injury and the presence of foreign body. MR imaging has a limited role but is valuable in examining the optic nerve and globe for injury and has proven to be an adjunct modality in the assessment of orbital injury.
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The consequences of cerebral herniation are compression of the brain, cranial nerves, and blood vessels that may result in serious neurologic morbidity, coma, and even death. A thorough understanding of the various patterns of cerebral herniation is essential, and it is important to remember that many of these patterns of herniation overlap. CT and MR imaging are effective at establishing the diagnosis of cerebral herniation, which will guide important decisions regarding therapeutic options and prognosis.
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Head trauma is a very common and sometimes life-threatening medical condition that involves sports medicine physicians, emergency room physicians, neurologists, neurosurgeons, orthopedists, anesthesiologists, rehabilitation physicians, psychiatrists, and radiologists; as well as allied health care workers such as physical, occupational, and speech therapists, clinical psychologists, neuropsychologists, and many others. Head trauma needs to be approached by a mutlidisciplinary team because it is complex. ⋯ These advances have truly revolutionized medicine and it has happened rapidly--pneumoencephalography was the neuroimaging study of choice less than half a century ago. The future of neuroimaging in head trauma will undoubtedly include advances we can not yet foresee but that will allow clinicians to continue to improve patient care.
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Diffuse axonal shear injury is a common traumatic brain injury, with significant neurologic and behavioral impact on patients. Radiologic recognition of this entity and understanding of its sequelae can be of utmost importance in the prediction of outcome and planning for rehabilitation. MRI has proven to be the optimal means of detection and characterization of DAI lesions, with GRE and FLAIR sequences being particularly helpful, and more advanced techniques such as MRS show preliminary evidence of some utility in determining outcome.
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Traumatic vascular injury to the intracranial and extracranial circulation can be sequelae of blunt, penetrating, or iatrogenic insults to the head, face, or neck. Treatment options include conservative medical management, or more invasive surgical or endovascular therapy. ⋯ Need for treatment is partly determined by the collateral circulation to the brain, and the degree to which the lesion is thrombogenic. Advances in endovascular devices and techniques provide us with less invasive alternatives to surgery intervention or allow the interventionalist to treat lesions not treatable by any other modality.