Search

Background: Cerebral small vessel disease (SVD) is a common cause of lacunar stroke, cognitive impairment and dementia. We assessed the association of baseline imaging markers of SVD and 'brain frailty' with functional and cognitive outcomes after acute stroke, including lacunar stroke, in the Efficacy of Nitric Oxide in Stroke (ENOS) trial. Methods: ENOS randomised 4011 patients with acute stroke (

Aim To explore the potential for local delivery of evidence based practice by supplementing a secondary care infant cranial ultrasound protocol with one used at a tertiary referral centre. Method A single practitioner used ‘Practice Development' methodology to learn, implement and evaluate the impact of adding supplementary (postero-lateral) fontanelle scanning to the anterior fontanelle infant cranial ultrasound examination routinely used at one District General Hospital (DGH). Over a 7 week period (March and April 2010) twenty one infants were scanned using both the routine (anterior fontanelle) and the new (additional postero-lateral fontanelle) technique. Images were evaluated by an independent tertiary referral centre expert (consultant neuroradiologist) to compare posterior cranial fossa visualisation and obtain a diagnostic second opinion. Pathology prevalence, posterior fossa visualisation and diagnostic agreement between local and tertiary referral opinions were compared. Results Visualisation of the posterior cranial fossa was considered to be subjectively improved for the multiple fontanelle technique. The required associated increase in overall examination time did not necessitate additional infant handling. This small pilot study did not show any statistically significant improvement in intracranial pathology detection. Conclusion This study suggests that provision of multiple fontanelle scanning is practically feasible in a secondary care setting. Continued monitoring of diagnostic outcomes is required to assess its clinical value.

Impaired tool related action in ideomotor apraxia is normally ascribed to loss of sensorimotor memories for habitual actions (engrams), but this account has not been tested against a hypothesis of a general deficit in representation of hand-object spatial relationships. Rapid reaching for familiar tools was compared with reaching for abstract objects in apraxic patients ( N = 9) and in a control group with right hemisphere posterior stroke. The apraxic patients alone showed an impairment in rotating the wrist to correctly grasp an inverted tool but not when inverting the hand to avoid a barrier and grasp an abstract object, and the severity of the impairment in tool reaching correlated with pantomime of tool-use. A second experiment with two apraxic patients tested whether barrier avoidance was simply less spatially demanding than reaching for a tool. However, the patient with damage limited to the inferior parietal lobe still showed a selective problem for tools. These results demonstrate that some apraxic patients are selectively impaired in their interaction with familiar tools, and this cannot be explained by the demands of the task on postural or spatial representation. However, traditional engram theory cannot account for associated problems with imitation of novel actions nor the absence of any correlated deficit in recognition of the methods of grasp of common tools. A revised theory is presented which follows the dorsal and ventral streams model ( Milner & Goodale, 2008 ) and proposes preservation of motor control by the dorsal stream but impaired modulating input to it from the conceptual systems of the left temporal lobe.

Aim Supine hypotensive syndrome (SHS) can occur in women in the second half of pregnancy due to compression of the aorta and inferior vena cava by the gravid uterus. This results in a decrease in cardiac output with effects ranging from transient asymptomatic hypotension to cardiovascular collapse. SHS can be easily avoided by left lateral tilt positioning. We undertook a nationwide survey to assess the awareness amongst senior computed tomography (CT) radiographers of the potential risk of SHS in women in this patient group, and to identify the extent to which preventative practices and protocols are in place. Methods and materials A questionnaire was sent to superintendent CT radiographers at all acute NHS Trusts in England and Wales examining awareness of the risk of SHS and the preventative practices and protocols currently used. Results Completed questionnaires were received from 64% institutions. Of respondents who scan women in this patient group, only 44% were aware of the risk of SHS. No institution had a written protocol specifying positioning of women in this patient group. Seventy-five percent of institutions never employed oblique positioning. Eighty-five percent felt that specific guidelines from the Society of Radiographers or Royal College of Radiologists would be helpful. Conclusion Current awareness and practices for preventing this easily avoidable but potentially harmful condition are inadequate. Central guidance would be welcomed by a large majority of respondents.

Patients with liver disease frequently develop cerebral complications. The brain may be affected directly by the pathological process or agent responsible for the liver disease, as a consequence of the metabolic and haemodynamic derangement caused by hepatic dysfunction, or as a complication of the treatment of liver disease. Computed tomography (CT) and magnetic resonance imaging (MRI) can be helpful in the diagnosis and management of these complications, and advanced techniques such as diffusion weighted imaging (DWI) and magnetic resonance spectroscopy (MRS) are providing new insights into the underlying pathophysiological processes. We present a radiological overview of the cerebral manifestations of liver disease, categorized as acute presentations, chronic presentations, and conditions occurring in the context of liver transplantation.

Paraneoplastic syndromes are a heterogeneous group of disease presentations caused by underlying tumours. As they are non-metastatic in nature an intensive diagnostic evaluation is warranted to identify potentially curable lesions. The selection of the appropriate method of imaging is important in these cases, especially when history and physical examination are unrevealing. In this review the important paraneoplastic syndromes and underlying malignancies are discussed along with relevant imaging strategies.

Summary Paediatric neuroradiology has become highly specialised over the past 30 years. The power and versatility of the different imaging modalities has grown rapidly over this period, alongside a greater understanding of their limitations. This review considers the current state of paediatric neuroradiology and emphasises the role of imaging in diagnostic problem solving. Five important neurological presentations—large or increasing head circumference, acute encephalopathy, epileptic seizures, symptoms and signs of raised intracranial pressure, and suspected non-accidental head injury—are used to illustrate the value of neuroimaging. The importance of effective communication between paediatricians and neuroradiologists to allow timely, appropriate and effective diagnostic imaging is stressed.