Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes
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A retrospective study was performed at two teaching hospitals--one in the United States and one in Canada--to determine the results of computed tomography (CT) examinations of the head in patients with nontraumatic headache. Of 1111 examinations performed over a 3-year period, 120 (10.8%) demonstrated an acute intracranial abnormality, such as hemorrhage, infarction or tumour; the frequency of such abnormalities was highest among inpatients and subjects over 40 years of age. ⋯ Chronic abnormalities, such as cerebral atrophy or remote infarction, were the most significant findings in 202 (18.2%) of the cases. The cost of finding each case of acute intracranial abnormality was $5962 (US); for subarachnoid hemorrhage among patients in the emergency department, it was $15,837 (US).
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This case report describes a patient with posteromedial dislocation of the ankle without fracture and without disruption of the tibiofibular syndesmosis. The pathogenesis of this uncommon lesion is discussed.
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Case Reports
Subarachnoid hemorrhage resulting from methanol intoxication: demonstration by computed tomography.
Subarachnoid hemorrhage developed in a patient intoxicated with methanol. Computed tomography performed at the time of admission suggested this complication. The hemorrhage was definite and extensive by the 5th day after admission and was accompanied by left caudate and pontine hemorrhage, as well as severe cerebral edema. The authors are unaware of any previous reports of subarachnoid hemorrhage associated with ingestion of methanol.
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The association of pulmonary edema with upper airway obstruction occurs in three clinical settings: acute and chronic upper airway obstruction and immediately after the relief of acute upper airway obstruction. Iatrogenic causes, such as adenotonsillectomy and tracheal intubation, were the most frequently encountered in the authors' series of 21 pediatric patients with such an association. The pathogenesis of this kind of pulmonary edema is multifactorial. The application of moderate continuous positive airway pressure in conjunction with the administration of diuretics rapidly clears pulmonary edema in all three clinical settings, usually within 24 hours, and can probably prevent pulmonary edema immediately after acute obstruction is relieved.
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The causes of tinnitus can be grouped according to whether the noise is continuous or pulsatile, whether it is subjective or objective and whether there is a retrotympanic mass. Imaging algorithms can be based on these symptoms and signs. ⋯ If the bruit is objective and the tympanic membrane normal, selective cerebral angiography should be the initial investigation, because most such patients have an acquired vascular abnormality, usually a dural arteriovenous fistula. If there is pulsatile tinnitus and a retrotympanic mass, HRCT should be the first examination because this technique allows differentiation of a vascular variation, such as an aberrant carotid artery or jugular dehiscence, from a paraganglioma.