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Interventional neuro radiology

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To meet the needs of critically ill patients with time-sensitive needs, the University of Maryland Medical Center (UMMC) created the Critical Care Resuscitation Unit (CCRU), a six-bed, short-stay ICU designed to accelerate care to resource-heavy patients who require immediate evaluation and treatment. The CCRU is modeled after UMMC's trauma resuscitation unit, but with resources and staff geared toward non-trauma, critically ill patients, many of whom require life-saving care. The unit is largely staffed by emergency providers who have undergone additional training in critical care...
July 2016: ED Management: the Monthly Update on Emergency Department Management
Xin Hu, Yuan Fang, Xuhui Hui, Yan Jv, Chao You
BACKGROUND: Diffuse brainstem glioma is a devastating disease with very poor prognosis. The most commonly used radiological treatment is conventional fractionated radiation. So far, there is no meta-analysis or systematic review available that assesses the benefits or harms of radiation in people with diffuse brainstem glioma. OBJECTIVES: To assess the effects of conventional fractionated radiotherapy (with or without chemotherapy) versus other therapies (including different radiotherapy techniques) for newly diagnosed diffuse brainstem gliomas in children and young adults aged 0 to 21 years...
2016: Cochrane Database of Systematic Reviews
Tanja Karic, Cecilie Røe, Tonje Haug Nordenmark, Frank Becker, Wilhelm Sorteberg, Angelika Sorteberg
OBJECTIVE Early rehabilitation is effective in an array of acute neurological disorders but it is not established as part of treatment guidelines after aneurysmal subarachnoid hemorrhage (aSAH). This may in part be due to the fear of aggravating the development of cerebral vasospasm, which is the most feared complication of aSAH. The aim of this study was to evaluate the effect of early rehabilitation and mobilization on complications during the acute phase and within 90 days after aSAH. METHODS This was a prospective, interventional study that included patients with aSAH at the neuro-intermediate ward after aneurysm repair...
April 8, 2016: Journal of Neurosurgery
P-L Sadigh, A Clifton, A Toma
INTRODUCTION: Epistaxis secondary to a ruptured cavernous-carotid aneurysm that has eroded into the sphenoid sinus is a life-threatening condition. When it is unilateral, balloon or coil embolization of the parent vessel should be considered. When bilateral, coiling the aneurysm to gain hemostasis followed by stent insertion after anticoagulation has been shown to be successful in achieving stabilization of the aneurysm wall whilst maintaining flow through the artery. CASE REPORT: We present a case of epistaxis secondary to giant bilateral cavernous-carotid aneurysm...
April 2016: European Annals of Otorhinolaryngology, Head and Neck Diseases
Rupesh Masand, Ahmad Ali, Alok Purohit
Brain abscesses occur as an uncommon complication of bacterial meningitis in the neonatal period. A 34 weeks preterm at-risk neonate presented with abnormal breathing pattern and inability to maintain the oxygen saturation in room air. Magnetic resonance imaging (MRI) study revealed intra-parenchymal brain abscesses in the left basal ganglion and bilateral fronto-parietal regions. Intravenous piperacillin - tazobactam was commenced and continued for 6 weeks in Neonatal Intensive Care Unit. No surgical intervention was required...
July 2015: Journal of Pediatric Neurosciences
Sang Hyuk Lee, Ji Hwan Jang, Kyu Hong Kim, Young Zoon Kim
We herein report on a patient with a cerebral aneurysm located at the petrous portion of the internal carotid artery (ICA). An 18-year-old male, previously diagnosed with neurofibromatosis, was referred to our emergency service complaining of severe headache, pulsatile tinnitus, nausea, and vomiting which occurred suddenly. Neuro-radiological studies including computed tomography and magnetic resonance imaging of the cerebral artery showed a large aneurysm arising from the petrous segment of the left ICA. He was treated with a neuro-interventional technique such as intra-arterial stenting and coil embolization for the aneurysm...
September 2015: Journal of Cerebrovascular and Endovascular Neurosurgery
Altin Stafa, Luigi Simonetti, Francesco Di Paola, Marco Leonardi
The authors empirically evaluated the context of intra-procedural physician-patient communication during imaging-guided procedures in a radiology/neuroradiology interventional clinical framework. Different intra-procedural communicative scenarios are reported.They conclude that the quality of intra-procedural physician-patient communication should be considered an important element of individual and team ethical and professional behaviour, able to strongly influence the therapeutic alliance. As for the whole medical communication strategy, an approach which takes into account the psychological and cultural background of the individual patient is preferred...
October 2015: Interventional Neuroradiology
J M Fernandez-Soto, J I Ten, R M Sanchez, M España, X Pifarre, E Vano
The purpose of this article is to present the results of connecting the interventional radiology and cardiology laboratories of five university hospitals to a unique server using an automatic patient dose registry system (Dose On Line for Interventional Radiology, DOLIR) developed in-house, and to evaluate its feasibility more than a year after its introduction. The system receives and stores demographic and dosimetric parameters included in the MPPS DICOM objects sent by the modalities to a database. A web service provides a graphical interface to analyse the information received...
July 2015: Radiation Protection Dosimetry
Aleksandra Yakhkind, Hussam A Yacoub, Jacqueline Grove, Jay D Varrato, John E Castaldo
The clinical and neuroimaging characteristics of brain infections related to Propionibacterium acnes are not well-characterized, making early diagnosis and treatment a challenge. More recently, life-threatening central nervous system infections with P. acnes are being reported with increasing frequency as complications of neurointerventional procedures. We present a rare case of P. acnes cerebritis that occurred as a sequela of bare platinum aneurysm coiling and a contaminant of percutaneous angiographic intervention...
2015: Hospital Practice (Minneapolis)
Shyam Verma, Cr Srinivas, Maria Thomas
A 47-year-old Indian woman with dark hair developed dramatic alopecia of the occipito-vertical area two weeks after a fluoroscopically-guided endovascular procedure for treatment of cerebral aneurysm. There was spontaneous repopulation of hair in 14 weeks. Neuro-radiological intervention procedures are becoming commoner by the day in India, and the rare but documented possibility of such reactions occurring in patients should be kept in mind by the treating surgeon as well as dermatologist. Necessary counseling regarding this uncommon side-effect is of essence, especially when the radiation dose exceeds 3 Gy...
November 2014: Indian Journal of Dermatology
Aghiad Al-Kutoubi
Although clinical involvement by interventional radiologists in the care of their patients was advocated at the inception of the specialty, the change into the clinical paradigm has been slow and patchy for reasons related to pattern of practice, financial remuneration or absence of training. The case for the value of clinical responsibilities has been made in a number of publications and the consequences of not doing so have been manifest in the erosion of the role of the interventional radiologists particularly in the fields of peripheral vascular and neuro intervention...
April 2015: Cardiovascular and Interventional Radiology
M N Islam, R Kuddus, N S Chowdhury, M D Akhter, G Salahuddin, S Parvin
Imaging cerebral infarction in first few hours after the onset of clinical symptoms is a challenge. The role of stroke imaging underwent a paradigm shift from confirmation of infarction from and exclusion of hemorrhage to the detection of the tissue at risk that may be rescued with restoration of circulation. Computed tomography (CT) is generally performed before starting the therapy in order to exclude the presence of bleeding and tumors. Although CT may show findings of infarction as early as 3-6 hours after ictus 30% of CT scans are normal in the first few hours after ischemic insult...
July 2014: Mymensingh Medical Journal: MMJ
Paul T Akins, Yekaterina Axelrod, James W Silverthorn, Kern Guppy, Amit Banerjee, Mark W Hawk
INTRODUCTION: Recognition of severe forms of posterior reversible encephalopathy syndrome (PRES) has improved. Management of these patients remains challenging, particularly in patients with the combination of edema and hemorrhage. METHODS: A prospective inpatient neuro-intensive care database was queried for patients with PRES. Malignant PRES was diagnosed by clinical assessments (GCS less than 8 and clinical decline despite standard medical management for elevated intracranial pressure) and radiographic criteria (edema with associated mass effect; brain hemorrhage exerting mass effect; effacement of basal cisterns, transtentorial, tonsillar, or uncal herniation)...
October 2014: Clinical Neurology and Neurosurgery
J C López Fernández, J Masjuan Vallejo, J Arenillas Lara, M Blanco González, E Botia Paniagua, I Casado Naranjo, E Deyá Arbona, B Escribano Soriano, M M Freijo Guerrero, B Fuentes, J Gállego Cullere, D Geffners Sclarskyi, A Gil Núñez, C Gómez Escalonilla, A Lago Martin, I Legarda Ramírez, J L Maciñeiras Montero, J Maestre Moreno, F Moniche Álvarez, R Muñoz Arrondo, F Purroy García, J M Ramírez Moreno, M Rebollo Álvarez Amandix, J Roquer, F Rubio Borrego, T Segura, M Serrano Ponza, J Tejada García, C Tejero Juste, J A Vidal Sánchez
INTRODUCTION: The Spanish Health System's stroke care strategy (EISNS) is a consensus statement that was drawn up by various government bodies and scientific societies with the aim of improving quality throughout the care process and ensuring equality among regions. Our objective is to analyse existing healthcare resources and establish whether they have met EISNS targets. MATERIAL AND METHODS: The survey on available resources was conducted by a committee of neurologists representing each of Spain's regions; the same committee also conducted the survey of 2008...
September 2014: Neurología: Publicación Oficial de la Sociedad Española de Neurología
Ayle G Mariam, Getachew Assefa
BACKGROUND: Neurological dysfunction in AIDS is common, occurring in as many as eighty percent of children. Thus, it is important to recognize the central nervous system imaging appearance of HIV, in particular those of HIV encephalopathy, as this is an AIDS defining illness and with distinct neuro-imaging features essential for early diagnosis and timely therapeutic intervention AIM: To identify the clinical features in HIV-1 infection of the central nervous system and their associated neuroradiological correlates...
October 2012: Ethiopian Medical Journal
Masayuki Sato, Yasunobu Nakai, Hideo Tsurushima, Masanari Shiigai, Tomohiko Masumoto, Akira Matsumura
Embolic stroke is not a rare complication of cerebral angiography. The risk factors for incidental embolism after cerebral angiography were retrospectively examined using diffusion-weighted magnetic resonance imaging (DWI) in 180 patients who underwent 247 angiography procedures, consisting of 174 diagnostic angiography and 73 interventional procedures, and magnetic resonance imaging including DWI within 72 hours after angiography. The two neuroradiologists in our hospital detected embolism after cerebral angiography as high-intensity lesions (HIL) on DWI...
2013: Neurologia Medico-chirurgica
David Sacks, Carl M Black, Christophe Cognard, John J Connors, Donald Frei, Rishi Gupta, Tudor G Jovin, Bryan Kluck, Philip M Meyers, Kieran J Murphy, Stephen Ramee, Daniel A Rüfenacht, M J Bernadette Stallmeyer, Dierk Vorwerk
PURPOSE: In this international multispecialty document, quality benchmarks for processes of care and clinical outcomes are defined. It is intended that these benchmarks be used in a quality assurance program to assess and improve processes and outcomes in acute stroke revascularization. MATERIALS AND METHODS: Members of the writing group were appointed by the American Society of Neuroradiology, Canadian Interventional Radiology Association, Cardiovascular and Interventional Radiological Society of Europe, Society of Cardiac Angiography and Interventions, Society of Interventional Radiology, Society of Neuro Interventional Surgery, European Society of Minimally Invasive Neurological Therapy, and Society of Vascular and Interventional Neurology...
April 2013: AJNR. American Journal of Neuroradiology
Matthias Holdhoff, Susannah G Yovino, Osei Boadu, Stuart A Grossman
Malignant gliomas remain incurable and present unique challenges to clinicians, radiologists and clinical and translational investigators. One of the major problems in treatment of these tumors is our limited ability to reliably assess tumor response or progression. The most frequently used neuro-imaging studies (contrast-enhanced MRI and CT) rely on changes of blood-brain barrier (BBB) integrity, providing only an indirect assessment of tumor burden. In addition, the BBB can be altered by commonly used interventions including radiation, glucocorticoids and vascular endothelial growth factor inhibitors, further complicating the interpretation of scans...
July 2013: Journal of Neuro-oncology
Kohei Kawasaki, Masaharu Imazeki, Ryota Hasegawa, Shinichi Shiba, Hiroyuki Takahashi, Kazuhiko Sato, Jyoji Ota, Hiroaki Suzuki, Kazuo Awai, Hajime Sakamoto, Osamu Tajima, Atsuko Tsukamoto, Tatsuya Kikuchi, Takahiro Kageyama, Kyoichi Kato
In interventional radiology, dose estimation using the interventional reference point (IRP) is a practical method for obtaining the real-time skin dose of a patient. However, the IRP is defined in terms of adult cardiovascular radiology and is not suitable for dosimetry of the head. In the present study, we defined a new reference point (neuro-IRP) for neuro-interventional procedures. The neuro-IRP was located on the central ray of the X-ray beam, 9 cm from the isocenter, toward the focal spot. To verify whether the neuro-IRP was accurate in dose estimation, we compared calculated doses at the neuro-IRP and actual measured doses at the surface of the head phantom for various directions of the X-ray projection...
July 2013: Radiological Physics and Technology
Eva Platner, Mati Bakon, Ruth Huna-Baron
Carotid-cavernous fistulas (CCFs) are abnormal arteriovenous communications in the cavernous sinus. In many cases of CCF's the primary signs are ocular manifestations, which include: pulsatile proptosis, orbital bruit, chemosis and conjunctival injection, elevated intraocular pressure, venous stasis retinopathy, and cranial nerve pareses. Patients in whom the fistula causes arterial drainage into the cerebral veins and sinuses are at risk for intracranial hemorrhage. The most common treatment for CCF's is endovascular occlusion of the lesion...
February 2013: Harefuah
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