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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Neuroimaging Clin. N. Am. · Aug 2018
ReviewEmergent Neuroimaging During Pregnancy and the Postpartum Period.
Acute neurologic emergencies in pregnancy often require neuroimaging to guide diagnosis and treatment. Implementation of a patient-centered care model in radiology can alleviate a patient's stress, reinforce appropriate imaging workup, improve patient satisfaction, and lead to improved outcomes. The authors present the evaluation, differential diagnosis, and recommended imaging protocols for the three most common acute neurologic symptoms in pregnancy and the postpartum period: headache, seizure, and focal neurologic deficits. With the patient's symptoms as a reference point, the referring physician in consultation with the radiologist can effectively implement the optimal imaging procedures.
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Maxillofacial injuries account for a large portion of emergency department visits and often result in surgical consultation. Although many of the principles of fracture detection and repair are basic, the evolution of technology and therapeutic strategies has led to improved patient outcomes. This article aims to provide a clinical review of imaging aspects involved in maxillofacial trauma and to delineate its relevance to patient management.
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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.