Der Radiologe
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Acute disseminated encephalomyelitis (ADEM) is an acute widespread autoimmune demyelinating condition, which principally affects the white matter of the brain and spinal cord. It usually follows an infection or vaccination. ⋯ MRI is regarded as the diagnostic imaging modality of choice and typically demonstrates involvement of deep cerebral hemispheric and subcortical white matter as well as lesions in the basal ganglia, gray-white junction, diencephalon, brainstem, cerebellum and spinal cord. Unlike multiple sclerosis (MS), ADEM has a monophasic course and a favorable long-term prognosis.
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Accidents do not only cause human harm but also tremendous costs. Prevention of injuries and improvement of management has reduced the mortality in trauma during recent years. ⋯ Appropriate equipment and personnel are necessary to provide an efficient management of trauma patients. A strategy focused on life-threatening injuries and simultaneous diagnostic and therapeutic procedures are critical in the "golden hour of shock".
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Traumatic brain injury (TBI)--either in isolation or within the context of multiple trauma--is a major cause of disability and death in young adults. The prognosis depends not only on the extent and localization of traumatic lesions, but also on the promptness of surgical intervention if indicated. ⋯ In addition to standard CT and MRI techniques, the use of other methods such as perfusion measurements, magnetic resonance spectroscopy or diffusion tensor imaging is briefly discussed. By means of these relatively new techniques it is possible to visualize not only structural changes but also gain information relating to functional and metabolic aspects of traumatic brain injury.
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Cervical spine injuries are a common occurrence in multi-trauma patients and should be taken into account when planning further clinical management. This review describes in detail upper and lower cervical spine injuries and introduces the sub-axial injury classification (SLIC) that is based on three components: injury morphology, integrity of the discoligamentous complex and the neurologic status of the patient. ⋯ If the total is > or =5, operative treatment is indicated as such a score is associated with instability and probably neurologic deficits. The precise diagnosis of the radiologist, which would include the SLIC classification, should facilitate clinical decision-making about further management.