Cervical Spine Fractures: Who Really Needs CT Angiography?

Study Design. Retrospective cohort study. Objective. Compare a novel two-step algorithm for indicating a computed tomography angiography (CTA) in the setting of a cervical spine fracture with established gold standard criteria. Summary of Background Data. As CTA permits the rapid detection of blunt cerebrovascular injuries (BCVI), screening criteria for its use have broadened. However, more recent work warns of the potential for the overdiagnosis of BCVI, which must be considered with the adoption of broad criteria. Methods. A novel two-step metric for indicating CTA screening was compared with the American College of Surgeons guidelines and the expanded Denver Criteria using patients who presented with cervical spine fractures to a tertiary-level 1 trauma center from January 1, 2012 to January 1, 2016. The ability for each metric to identify BCVI and posterior circulation strokes that occurred during this period was assessed. Results. A total of 721 patients with cervical fractures were included, of whom 417 underwent CTAs (57.8%). Sixty-eight BCVIs and seven strokes were diagnosed in this cohort. All algorithms detected an equivalent number of BCVIs (52 with the novel metric, 54 with the ACS and Denver Criteria, Pā€Š=ā€Š0.84) and strokes (7/7, 100% with the novel metric, 6/7, 85.7% with the ACS and Denver Criteria, Pā€Š=ā€Š1.0). However, 63% fewer scans would have been needed with the proposed screening algorithm compared with the ACS or Denver Criteria (261/7...
Source: Spine - Category: Orthopaedics Tags: DIAGNOSTICS Source Type: research

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Publication date: Available online 16 October 2019Source: Epilepsy &BehaviorAuthor(s): Giada Pauletto, Francesco Bax, Gian Luigi Gigli, Simone Lorenzut, Lorenzo Verriello, Elisa Corazza, Mariarosaria ValenteAbstractAim of the studyThe aim of the study was to evaluate the clinical characteristics of patients with previous stroke (either ischemic or hemorrhagic), who developed status epilepticus (SE) mimicking a stroke relapse.Materials and methodsWe performed a retrospective cohort study of patients brought to hospital by the emergency service between December 2016 and January 2018 with a stroke code as possible candida...
Source: Epilepsy and Behavior - Category: Neurology Source Type: research
Abstract AIM OF THE STUDY: The aim of the study was to evaluate the clinical characteristics of patients with previous stroke (either ischemic or hemorrhagic), who developed status epilepticus (SE) mimicking a stroke relapse. MATERIALS AND METHODS: We performed a retrospective cohort study of patients brought to hospital by the emergency service between December 2016 and January 2018 with a stroke code as possible candidates for intravenous thrombolysis and who had already have a previous stroke. Among them, patients admitted for negative symptoms and finally discharged with a diagnosis of SE mimicking stroke...
Source: Epilepsy and Behaviour - Category: Neurology Authors: Tags: Epilepsy Behav Source Type: research
Duplex ultrasound examination, computed tomography scans, and magnetic resonance angiography have traditionally been used as noninvasive methods to assess carotid stenosis severity. The degree of stenosis in asymptomatic patients has often been used as the main criterion to assess risk for plaque embolization and stroke. There has been an effort to find alternate methods to assess vulnerable plaques. This has included many modalities, including magnetic resonance imaging and other ultrasound techniques.
Source: Journal of Vascular Surgery - Category: Surgery Authors: Tags: Invited commentary Source Type: research
ConclusionStroke CT will continue to increase the out of hours work load for CT departments across the country especially with our ageing population. It is vital that services, particularly in level 3 stroke centres, are adequately equipped in terms of staffing to meet the highest standard of care in the management of acute stroke.
Source: Age and Ageing - Category: Geriatrics Source Type: research
AbstractThis technical note describes a novel CT scan protocol that includes a non-enhanced CT, dynamic CTA, and perfusion of the whole brain and CTA of the carotid arteries using a 320-row area detector CT scanner, with a unique contrast injection and acceptable radiation exposure dose in patients presenting with acute ischemic stroke. The acquisition parameters and reconstruction parameters will be discussed including the use of model-based iterative reconstruction (MBIR), time summing (tMIP), and subtraction techniques to optimize the results of this protocol.Key Points• Scanning on a 320-row area detector CT can a...
Source: European Radiology - Category: Radiology Source Type: research
ConclusionThe bovine aortic arch, particularly the bovine arch subtype B, was significantly more common among embolic stroke patients. This might be due to altered hemodynamic properties within the bovine arch.
Source: Neuroradiology - Category: Radiology Source Type: research
CONCLUSION: LDS is characterized by genetic and clinical variability. Our report suggests that this genetically-determined connective tissue disorder is probably underestimated, as it might firstly show up with cerebrovascular events, although mild systemic manifestations. These findings could lead to identify people at risk of severe vascular complications (i.e., through genetic consult on asymptomatic relatives), in order to perform adequate vascular assessments and follow-up to prevent complications such as stroke. PMID: 31326520 [PubMed - as supplied by publisher]
Source: European Journal of Medical Genetics - Category: Genetics & Stem Cells Authors: Tags: Eur J Med Genet Source Type: research
iSchemaView today announced that it received registration approval in Japan for its Rapid imaging platform. The company received registration approval through the Japanese Pharmaceutical Affairs Law and through a third party review by the Japanese Assn. for the Advancement of Medical Equipment for the Rapid imaging platform. Rapid is designed to give physicians a fast, fully automated and easy-to-interpret imaging system that can help doctors make clinical decisions about stroke. “Stroke remains the fourth most common cause of death in Japan, and as the population ages, stroke is likely to become an increasing health...
Source: Mass Device - Category: Medical Devices Authors: Tags: Cardiovascular Hospital Care Imaging ischemaview Source Type: news
AbstractLarge vessel vasculitis (LVV) is the most common form of primary vasculitis comprising of giant cell arteritis (GCA), Takayasu ’s arteritis (TAK) and idiopathic aortitis. Early diagnosis and treatment of LVV are paramount to reduce the risk of ischemic complications such as visual loss and strokes, vascular stenosis and occlusion, and aortic aneurysm formation. Use of imaging modalities [ultrasound (US), magnetic resonanc e imaging (MRI), computed tomography (CT) and [18F]-fluorodeoxyglucose positron emission tomography (PET)] has steadily increased to enable assessment of cranial and extracranial arteries, a...
Source: La Radiologia Medica - Category: Radiology Source Type: research
In conclusion, ­e-CTA provides a real-time and fully automated approach to collateral scoring with the potential to improve consistency of image interpretation and to independently quantify collateral scores even without expert rater input.Cerebrovasc Dis
Source: Cerebrovascular Diseases - Category: Neurology Source Type: research
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