Neuroimaging clinics of North America
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Neuroimaging Clin. N. Am. · May 2003
ReviewOccult spinal dysraphism: evidence-based diagnosis and treatment.
This article reviews the scientific evidence behind the diagnostic tools available for the appropriate workup and management of patients with occult spinal dysraphism (OSD). The diagnostic tools include the use of detailed history and physical examination, plain films, ultrasound, MR imaging, and neurophysiologic tests. In addition, the article discusses the epidemiology of the most common causes of OSD in children, which will allow physicians caring for children to develop a pretest probability of disease and make a more educated decision as to when additional diagnostic testing is required.
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This article summarizes the evidence behind the imaging evaluation of scoliosis, which is primarily performed with plain radiographs and MR imaging. Issues related to the radiographic evaluation of spinal curvature include interobserver variability of scoliosis measurements and the radiologist's detection of unexpected findings. The effects of radiation exposure during scoliosis evaluation and strategies to minimize radiation dose are summarized. The use of MR imaging in idiopathic scoliosis is discussed, with special attention to imaging groups at higher risk for underlying pathology of the neural axis.
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Neuroimaging Clin. N. Am. · May 2003
ReviewSickle cell disease and stroke in a pediatric population. Evidence-based diagnostic evaluation.
Cerebrovascular complications are common in SCD and constitute a major source of concern to the pediatric hematologist. These complications can be either clinically overt or covert. ⋯ Imaging guidelines for children have emerged based on the available level 2 and 3 literature, however, CT and MR imaging remain the initial tests of choice for stroke assessment, and TCD is the imaging tool of choice for stroke prevention. Based on guidelines handed down from the NIH, TCD has become a part of routine continuing care of children with SCD.
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Evidence-based medicine is useful in epilepsy and neuroimaging (Figs. 1 and 2). An understanding of the pretest probability suggests that focal neurologic deficits are important in predicting the outcome of neuroimaging examinations. In cases of nonacute symptomatic seizures, confusion and postictal deficits should prompt MR evaluation. ⋯ Evidence-based medicine can only work if there is physician communication. The pretest probability is helpful only when an accurate history is provided to the consulting physician. This field will flourish if physicians can develop accurate methods of collating information and reporting it in a timely fashion in the literature.
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Neuroimaging Clin. N. Am. · Feb 2003
ReviewCerebral venous thrombosis in adults: the role of imaging evaluation and management.
Clinical suspicion and excellent neuroimaging are crucial in making a diagnosis of CVT. Intravascular or dural sinus thrombus can be visualized on CT and MRI. ⋯ Heparin treatment is accepted as the first-line treatment of CVT. Endovascular treatment for management of CVT is usually reserved for selected cases after failure of anticoagulation.