Congenital Arterial and Venous Anomalies of the Brain and Skull Base
Department of Radiology, Johns Hopkins Hospital, Baltimore, MD 21287, USA.Neuroimaging Clinics of North America (Impact Factor: 1.53). 08/2011; 21(3):545-62, vii. DOI: 10.1016/j.nic.2011.05.002
Congenital cerebral vascular anomalies include a spectrum of conditions that result from perturbation of normal developmental processes. Although some of these conditions are asymptomatic and well compensated by collateral circulation, others can cause significant morbidity or produce a range of complications for affected patients. Knowledge of the underlying developmental etiologies and the associated imaging characteristics helps fully elucidate the morphologic and hemodynamic details of these lesions and determine the necessity for any intervention.
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ABSTRACT: This article provides a summary of how to approach the imaging analysis of lesions of the anterior, central, and posterior skull base. The primary focus is tumors and tumor-mimickers, and representative examples are shown to differentiate the features of lesions that can occur in the same location.
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ABSTRACT: Cervical arterial dissection (CAD) is a common cause of stroke in young people under 55 years. It can occur spontaneously or subsequent to minor trauma or infection. The incidence is difficult to determine accurately as not all CAD progress to stroke. CAD is the most catastrophic adverse event associated with cervical manipulative therapy but it is rare. Early features of CAD can mimic a painful musculoskeletal presentation and a patient may present for treatment of neck pain and headache with a dissection in progress. Whether the manipulative technique is responsible for dissection or whether the diagnosis of CAD has been missed is unclear. Identification of individuals at risk, or early recognition of CAD could help expedite medical intervention and avoid inappropriate treatment. The aims of this masterclass are to outline current research into the pathophysiology, aetiology and clinical presentation of CAD, to place the risk in context in a manipulative therapy setting and to discuss its possible clinical recognition. For those patients presenting with recent onset, moderate to severe unusual headache or neck pain, clinicians should perform a careful history, in particular questioning about recent exposure to head/neck trauma or neck strain. Cardiovascular factors may not be particularly useful indicators of risk of dissection. Clinicians should also be alert to reports of transient neurological dysfunction such as visual disturbance and balance deficits, arm paraesthesia and speech deficits, as these may be subtle. If clinicians suspect arterial dissection is in progress patients should be urgently referred for medical evaluation. Copyright © 2015 Elsevier Ltd. All rights reserved.
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