Journal of neuroimaging : official journal of the American Society of Neuroimaging
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Unilateral pain in the cervical region and limitation of neck movements are nonspecific symptoms frequently encountered in daily medical practice. Vertebral artery dissection is rarely considered as a diagnostic possibility unless brainstem or cerebellar ischemia follows the acute pain. Three cases of vertebral artery dissection (VAD) having the sole complaint of pain of acute onset in the posterior neck region are presented. ⋯ Severe neck pain and/or occipital headache frequently accompanies ischemic symptoms in cases with VAD. The cases in this report emphasize that spontaneous and often unilateral posterior cervical pain of acute onset can be the only manifestation of a VAD. A high degree of suspicion especially in young patients with no past history of a similar pain can help to establish the diagnosis, thereby preventing erroneous and potentially hazardous therapeutic interventions such as physiotherapy or neck manipulation.
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Duplex scanning is an accepted method for noninvasive evaluation of carotid stenosis. However, the ultrasound criteria used for the detection of threshold stenoses vary widely between laboratories, and quality assurance measures to allow adjustment of criteria are often lacking. This study was completed using receiver operating characteristic (ROC) analysis to determine Doppler velocity criteria for threshold carotid stenoses, compared to an accepted standard, and to demonstrate methods to allow adjustment of criteria. ⋯ This study showed that duplex scanning is able to detect threshold carotid stenoses. For the best performance, each laboratory should have its own criteria; however, the criteria provided here could be a helpful reference to those laboratories that have not yet established their own criteria. Most important, this study provides an example of how to evaluate the performance criteria, how to modify them, how such changes can affect performance, and how performance can be modified depending on the goals of the laboratory.
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Congenital nasal epidermoid cyst without associated facial dysmorphism is an uncommon anomaly that is often asymptomatic. We report a case of occult nasal epidermoid cyst in a 12-year-old boy with initial nonspecific symptoms of fever, headache, abdominal pain, vomiting, and diarrhea. ⋯ He recovered uneventfully during a 4-week treatment with parentally-administered antibiotics. This significant case report demonstrates the importance of MRI in the early diagnosis of a life-threatening intracranial infection from an otherwise occult infected congenital nasal epidermoid cyst in children.
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Several functional imaging studies have shown that the extent of activation and percentage change in cerebral blood flow in the supplementary motor area (SMA) during a bimanual mirror performance of a simple repetitive movement are almost identical to those during a unimanual movement. The aim of this study was to investigate whether this finding was also applicable to a more complex movement. Eight right-handed, healthy volunteers performed unimanually (with their right and left hands) and bimanually (in a mirror fashion) thumb-finger opposition in a nonconsecutive order (index-middle-index-ring-index-little-index-middle ... fingers). ⋯ This is in accordance with the hypothesis that bimanual movement, even in a mirror fashion, is more difficult than unimanual movement when the task is complex but not when the task is simple. Pre-SMA was inconsistently activated. The results suggest that the SMA proper plays an active role in executive processing during bimanual mirror performance of complex movements.
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Surgical decompression of the vascular loop of the vertebral artery (VA) at the left lateral medulla can reduce blood pressure (BP) in hypertension, and a larger diameter of the left VA has been found in hypertensive patients. Noninvasive evaluation of the VA in hypertension may assist selecting patients for more appropriate diagnosis and treatment. Duplex ultrasonography is used to study the relationship between VA diameter and BP. ⋯ Differences in left-right VA diameter in hypertensive subjects may be a previously unrecognized component of the vascular disturbances associated with the disease and represent an additional criterion for identifying those who may benefit from surgical and medical management.