Neuroimaging clinics of North America
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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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This article discusses all types of traumatic head injury in infants, children and adolescents. Neuroimaging patterns of injury help to make the precise diagnosis and assists in monitoring responses to therapy.
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The imaging of head trauma has been one of the fundamental cornerstones of neuroradiology. As the practice of neuroimaging has matured, great strides have been made in the diagnostic as well as prognostic armamentarium available to physicians. ⋯ Furthermore, these new tools are allowing the imaging specialist to function not only as an interpreter of what is seen but as a 21st century radiographic oracle. We present a comprehensive review of the imaging findings of sequlae of traumatic brain injury and the growing correlation of new neuroimaging techniques and neurotraumatic outcomes.
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In addition to its inability to predict pressure elevation accurately, head CTs done serially even at 12-hour intervals, cannot adequately portray the dynamic, sometimes rapid evolution (usually growth) of a traumatic hematoma. These limitations aside, CT scanning provides adequate imaging for rational surgical treatment of head injury. Whether for monitoring, diagnostic, or therapeutic purposes, cranial procedures for traumatic pathology are guided by CT.
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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.