Neuroimaging clinics of North America
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Neuroimaging Clin. N. Am. · Aug 2018
ReviewThe Adult Patient with Acute Neurologic Deficit: An Update on Imaging Trends.
Stroke is the clinical syndrome of abrupt onset of acute neurologic deficit owing to decreased oxygen delivery to the brain, resulting in ischemia or infarction. Approximately 87% of strokes are ischemic and 13% are hemorrhagic. Improved awareness of the neuroimaging findings highlighted in recent stroke clinical trials, as well as of their role in patient selection for novel treatment options-including "late window" (8-24 hours post-ictus!) intraarterial thrombectomy-has become increasingly important. This article focuses on the role of neuroimaging in the assessment and management of patients with acute ischemic stroke.
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Thunderclap headache is a common presentation in the emergency department and, although multiple causes have been described, subarachnoid hemorrhage (SAH) is the primary concern and early diagnosis is critical. CT is highly sensitive if performed within 6 hours of onset. ⋯ Further work-up should be guided by the pattern of blood. Patients with negative CT angiography may be further evaluated with MR imaging, especially patients with peripheral convexity SAH.
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Neuroimaging Clin. N. Am. · Aug 2018
ReviewBlunt Craniocervical Trauma: Does the Patient Have a Cerebral Vascular Injury?
Blunt cerebrovascular injury involves injury to the carotid and/or vertebral arteries sustained via generalized multitrauma or directed blunt craniocervical trauma. Stroke remains the most consequential outcome. ⋯ Discussion centers on the increasing reliance on multidetector computed tomography angiography for screening, considering relevant clinical criteria for determining screening. Imaging protocols, imaging findings, injury grading, pearls, and pitfalls are discussed.
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Computed tomography is often the first-line diagnostic imaging modality in the evaluation of patients with neurologic emergencies. A patient-centered approach to radiation dose management in emergent neuroimaging thus revolves around the appropriate use of computed tomography, including clinical decision support for ordering providers, thoughtful protocol design, the use of available technological advances in computed tomography, and radiation exposure monitoring at a population level. A multifaceted approach can help to minimize radiation exposure to individual patients while preserving diagnostic quality imaging.
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Neuroimaging Clin. N. Am. · Aug 2018
ReviewApproach to Imaging in Patients with Spontaneous Intracranial Hemorrhage.
Spontaneous intracranial hemorrhage is a commonly encountered neurologic emergency. Imaging plays important roles in both guiding the emergent stabilization of patients with ICH and in elucidating the etiology of the hemorrhage to prevent rebleeding. A thorough understanding of the factors that have an impact on immediate management, the causes of hemorrhage, and the strengths of various imaging techniques in addressing these 2 concerns is vital to crafting a patient-centered approach to this condition.