J Neuroradiology
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Medical practice changes constantly. Ethical imperatives are however incorrigible. How can we reconcile ethics, practice and progress? Some bioethicians argue that research and care should be disentangled to minimize the 'therapeutic misconception', a clinical propensity to believe that patients are the object of medical care, while in fact they are the subjects of a scientific experiment. ⋯ But both therapeutic misconception and mirage are possible because of a misunderstanding of either research or clinical practice. In this essay we review ethical principles behind clinical trial methodology and attempt to reconcile ethics, science and clinical practice. Not only should clinical research be integrated to the good practice of medicine, it should also be part of training in our specialty.
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Case Reports
MRI and FDG PET/CT findings in a case of probable Heidenhain variant Creutzfeldt-Jakob disease.
Creutzfeldt-Jakob disease (CJD) is a neurodegenerative disease caused by the accumulation of a pathogenic isoform of a prion protein in neurons that is responsible for subacute dementia. The Heidenhain variant is an atypical form of CJD in which visual signs are predominant. This is a report of the case of a 65-year-old man with probable CJD of the Heidenhain variant, with topographical concordance between findings on magnetic resonance imaging (MRI) and 18F-fluorodeoxyglucose (FDG) photopenic areas on positron emission tomography (PET)/computed tomography (CT) for cortical parietooccipital lesions.
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Paranasal sinus injuries by foreign bodies have a lower incidence compared with facial injuries. Among them, penetrating maxillofacial injuries to the sphenoid sinus and skull base remain rare. ⋯ The foreign object was successfully extracted through a transmaxillary sublabial approach with a good outcome. We discuss the extensive preoperative evaluation and interdisciplinary management of this unusual injury.
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Comparative Study
Treatment decision in ruptured intracranial aneurysms: comparison between multi-detector row CT angiography and digital subtraction angiography.
The aim of this study was to determine the accuracy of multi-detector row computed tomography angiography (CTA) for the triage of patients with acutely ruptured aneurysms, and to assess how therapeutic decisions based on this method compared with digital subtraction angiography (DSA). ⋯ Multi-detector row CTA provides accurate anatomic information for aneurysm location as well as sac and neck sizes; however, the technique appears to have a low sensitivity in detecting branches incorporated into the aneurysmal sac.
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Interest in the identification of cognitive decline in its earliest manifestations and the heterogeneity of clinically diagnosed Alzheimer's disease (AD) explain the growing number of neuroimaging studies of AD. Alzheimer-type lesions are associated with loss of neurons, and magnetic resonance imaging (MRI) can detect predominantly left atrophic changes in the entorhinal cortex, amygdala and anterior hippocampus several years before the onset of clinical symptoms. Cerebrovascular disease can mimic AD in the elderly whereas MR markers of subcortical vascular disease-leukoaraiosis, lacunar infarcts, microbleeds, ventricular enlargement, cortical and hippocampal atrophy-appear to be structural changes associated with vascular-related cognitive impairment. ⋯ Mesiotemporal atrophy on MRI predicts late-onset DAT, but the current rating scales or measurements of mesiotemporal atrophy do not differentiate anteromesial temporal atrophy that is highly suggestive of AD from predominantly hippocampal atrophy, suggestive of non-AD damage and, usually, vascular disease. The other, most common MRI predictors of late-onset DAT may be considered indirect markers of arterial senescence whereas brain atrophy is diffusely milder and MR markers of small-vessel disease more frequent in late-onset, compared with early-onset, DAT. Thus, MRI suggests an overestimation of AD pathology while underestimating 'arteriosclerotic brain degeneration' in the clinical picture of 'Alzheimer syndrome'.