Neuroimaging clinics of North America
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Spinal infections are a spectrum of disease comprising spondylitis, diskitis, spondylodiskitis, pyogenic facet arthropathy, epidural infections, meningitis, polyradiculopathy, and myelitis. Inflammation can be caused by pyogenic, granulomatous, autoimmune, idiopathic, and iatrogenic conditions. ⋯ Despite advanced diagnostic technology, diagnosis of this entity and differentiation from degenerative disease, noninfective inflammatory lesions, and spinal neoplasms are difficult. Radiological evaluations play an important role, with contrast-enhanced MR imaging the modality of choice in diagnosis, evaluation, treatment planning, interventional treatment, and treatment monitoring of spinal infections.
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Inflammatory and infectious disorders of the spine in children are less common than in adults, and are usually categorized according to location into (1) those predominantly affecting the spinal cord; (2) those predominantly affecting the nerve roots and meninges; and (3) those predominantly affecting the vertebrae, discs, and epidural space. Disorders primitively involving the spinal cord may be grouped into 2 basic categories: (1) inflammatory (represented by acute transverse myelopathy) and (2) infectious (ie, bacterial, viral, fungal, or parasitic). Inflammatory spinal cord diseases are more common than primitive spinal cord infection.
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Spinal infection is rare. Clinical suspicion is important in patients with nonmechanical neck and/or back pain to make the proper diagnosis in early disease. Before planning surgery, a thorough evaluation of the spinal stability, alignment, and deformity is necessary. ⋯ Biomechanical preservation of the spinal column during and after the infection is a significant issue. Postoperative spine infection is another entity of which spinal surgeons should be aware of. Proper septic conditions with meticulous planning of surgery are essential for successful spine surgery and better outcome.
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Multiple sclerosis (MS) is a common disease of the central nervous system, with various clinical symptoms and a heterogeneous disease course. MRI can depict focal and diffuse manifestations of the disease, and accurately measure progression over time. ⋯ More recent genome-wide association studies have revealed other genes to be related to disease susceptibility and severity, explaining part of the variability in symptoms, radiological manifestations and disease course. Studies relating genetics and imaging in MS are discussed in this paper.
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Gene expression is a process of DNA sequence reading into protein synthesis. In cases of problems in DNA repair/apoptosis mechanisms, cells accumulate genomic abnormalities and pass them through generations of cells. The accumulation of mutations causes diseases and even tumors. ⋯ Some trials are testing patients with epigenetic treatments. Epigenetic therapy must be used with caution because epigenetic processes and changes happen constantly in normal cells, giving rise to drug off-target effects. Scientists are making progress in specifically targeting abnormal cells with minimal damage to normal ones.