Perspectives on Neuroradiology Medical Expert Testimony: Fact and Fiction.

There are numerous misconceptions about serving as a medical malpractice expert witness. By maintaining an objective perspective based in the unbiased interpretation of the images provided (for both sides of the conflict), one can best serve society as a whole. Most cases for which a neuroradiology expert is recruited are the following: 1) not with the radiologist as a defendant, 2) resolved without court testimony, and 3) short-lived if frivolous.

Safety of unilateral endovascular occlusion of the cervical segment of the vertebral artery without antecedent balloon test occlusion.

Background And Purpose: Antecedent balloon test occlusion is often performed prior to vertebral artery sacrifice, but there is limited data to suggest this adds a significant clinical benefit, especially in the setting of trauma. Furthermore, balloon test occlusion can be time-consuming, add to the technical complexity of the procedure, and increase the overall cost of treatment. The purpose of this study was to determine the safety of unilateral vertebral artery occlusion without antecedent balloon test occlusion as part of the treatment regimen in patients with traumatic vertebral artery dissection, cervical tumor, or intracranial aneurysm.

Endovascular repair of traumatic cervical internal carotid artery injuries: a safe and effective treatment option.

Background And Purpose: The appropriate choice of treatment for traumatic extracranial carotid artery injury is still debated. The purpose of this study was to evaluate outcomes of endovascular carotid repair with regard to vessel patency and retreatment rates.

Methods And Methods: We retrospectively reviewed records of patients who underwent endovascular treatment for acute traumatic internal carotid artery dissection with or without pseudoaneurysm formation.

Technical and imaging report: fluoroscopic guidance for diagnosis and treatment of lumbar synovial cyst.

Lumbar synovial cysts can be a source of low back pain with or without radiculopathy depending upon the size and location of the mass. Options for treatment range from analgesics to surgery, depending upon the degree of nerve root or spinal cord impingement. Attempts at minimally invasive treatment such as computed tomography-assisted aspiration and cyst rupture are documented in the radiology literature with varying degrees of reported success.

Embolization of a Cavernous Sinus Dural Arteriovenous Fistula with Onyx via Direct Puncture of the Cavernous Sinus through the Superior Orbital Fissure: Asystole Resulting from the Trigeminocardiac Reflex. A Case Report.

Treatment of cavernous sinus dural arteriovenous fistula (CSDAVF) may be challenging.We describe a patient who had presented with progressive ocular symptoms due to CSDAVF requiring urgent interventional therapy. Initial attempts to embolize the fistula utilizing a transvenous approach through the inferior petrosal sinus failed because of difficult anatomy.

Biomechanics of vertebral bone augmentation.

Percutaneous vertebral augmentation is a successful means of relieving pain and reducing disability after vertebral compression fracture; however, the exact mechanism by which vertebral augmentation eliminates pain remains unproven. Most likely, pain relief is because of stabilization of microfractures. The biomechanical effects of vertebral fracture and subsequent vertebral augmentation therapy, however, are topics for continued investigation.

Mitral valve infective endocarditis: benefit of early operation and aggressive use of repair.

Background: In-hospital mortality rates for left-sided infective endocarditis (IE) exceed 20%. We investigated the outcomes of an aggressive approach to mitral valve IE that emphasizes early surgical intervention and preferential performance of mitral valve repair.

Methods: We reviewed 89 consecutive operations in 87 patients for native mitral valve IE at a single institution from 2002 to 2007.

Epidural abscess due to spinal cord stimulator trial.

Spinal cord stimulation is increasingly utilized as a treatment to alleviate low back pain and lumbar radiculopathy, particularly in patients with failed back surgery syndrome. We present an illustrative case of early, rapidly progressive methicillin-resistant Staphylococcus aureus (MRSA) infection after a brief stimulator trial lead implantation. Operators should maintain a high level of suspicion for deep infection, including epidural abscess, even when only minor symptoms and signs are present.

Percutaneous vertebroplasty and bone cement leakage: clinical experience with a new high-viscosity bone cement and delivery system for vertebral augmentation in benign and malignant compression fractures.

The aim of this study was to assess the feasibility of and venous leakage reduction in percutaneous vertebroplasty (PV) using a new high-viscosity bone cement (PMMA). PV has been used effectively for pain relief in osteoporotic and malignant vertebral fractures. Cement extrusion is a common problem and can lead to complications.

Mechanical thrombectomy of the internal carotid artery and middle cerebral arteries for acute stroke by using the retriever device.

We report a case of mechanical thrombectomy in which a new device, the Retriever, was used for acute cerebral ischemia in the setting of extensive occlusion of the left internal carotid and middle cerebral arteries. Excellent radiographic and clinical results were obtained. The Retriever is currently approved and available for foreign body extraction and for intracranial thrombectomy when used as part of the Mechanical Embolus Removal in Cerebral Ischemia, or MERCI, clinical trial.

Optimizing patient selection in percutaneous vertebroplasty.

Percutaneous vertebroplasty has emerged as an effective technique for treatment of painful vertebral compression fractures (VCFs) caused by osteoporosis, malignancy, and some benign bone tumors. In selecting appropriate patients for vertebroplasty, it is important to distinguish the pain caused by VCF from other numerous causes of back pain. Careful adherence to clinical and imaging selection criteria is crucial to procedural success.

Kyphoplasty.

Kyphoplasty is a relatively new procedure that is indicated for the treatment of osteoporotic or pathologic compression fractures of the thoracic and/or lumbar spine. This minimally invasive procedure requires imaging guidance. Kyphoplasty entails the inflation of a balloon tamp, prior to the injection of opacified acrylic bone cement, within the compressed vertebral body in an attempt to restore vertebral body height and reduce the associated kyphotic deformity.

Percutaneous vertebroplasty: A to Z.

Percutaneous vertebroplasty has been performed in the United States since 1995, and widespread application of the procedure for osteoporotic and neoplastic compression fractures or vertebral infiltration has demonstrated remarkable efficacy with rare complications. Appropriate patient selection criteria and a thorough understanding of safe technique is essential for clinical success; imaging studies must be combined with careful physical examination to direct treatment to the appropriate level in patients with multiple compression deformities. Preoperative consultation with the patient and their family provides an opportunity to clarify the patient's treatment expectations and helps to anticipate and obviate potential obstacles to treatment.

Imaging findings in intracranial aspergillosis.

Rationale And Objectives: The authors' purpose was to elucidate the various computed tomographic (CT) and magnetic resonance (MR) imaging findings in intracranial aspergillosis.

Materials And Methods: Retrospective analysis of cranial imaging findings was performed in eight proved cases of central nervous system aspergillosis. The patients ranged in age from 17 to 75 years.

Percutaneous vertebroplasty for osteoporotic compression fractures: quantitative prospective evaluation of long-term outcomes.

Purpose: Osteoporotic vertebral compression fractures may cause debilitating pain that lasts for weeks or months, and which is often neither quickly nor completely relieved by conventional conservative therapy. Previous retrospective studies have suggested significant and nearly immediate pain relief, as well as rapid and sustained functional recovery, after percutaneous polymethylmethacrylate vertebroplasty (PPV). This prospective, quantitative study with long-term follow-up was designed to evaluate the safety and efficacy of PPV as a new treatment for patients with osteoporotic vertebral body compression fractures of the lumbar and thoracic spine.

An intracranial aspergilloma with low signal on T2-weighted images corresponding to iron accumulation.

We present a case of cerebral aspergillosis in an immunocompetent patient. The MRI signal characteristics were compared with the histologic findings. Irregular low-signal zones were demonstrated between the wall of the abscess and the central necrosis on T2-weighted images; the pathology specimen revealed concentrated iron in these transitional zones but no hemosiderin.

Vertebral artery pseudoaneurysm complicating posterior C1-2 transarticular screw fixation: case report.

Background: Vertebral artery injury during posterior C1-2 transarticular screw fixation occurs in approximately 3% of patients and may remain asymptomatic or result in arteriovenous fistulae, occlusion, narrowing, or dissection of the vertebral artery, and lead to transient ischemic attacks, stroke, or death.

Case Description: This is the first report of a pseudoaneurysm resulting from damage to the vertebral artery during the procedure. This 31-year-old male underwent posterior C1-2 transarticular screw fixation for unstable os odontoideum.

A clinical comparison of the safety and efficacy of MultiHance (gadobenate dimeglumine) and Omniscan (Gadodiamide) in magnetic resonance imaging in patients with central nervous system pathology.

Rationale And Objectives: The safety and diagnostic efficacy of MultiHance (gadobenate dimeglumine) in the central nervous system (CNS) were evaluated in a double-blind, multicenter, phase III clinical trial.

Methods: Two hundred five patients highly suspected of having a CNS lesion (by previous imaging exam) were enrolled at 16 sites in the United States. Patients were randomized to one of three incremental dosing regimens.

Temporal lobe injury in temporal bone fractures.

Objective: To determine the incidence of intracranial injury, specifically in the temporal lobe, in patients with longitudinal fractures of the temporal bone.

Design: Prospective inception cohort.

Setting: University of Maryland Division of Otolaryngology-Head and Neck Surgery and the Maryland Shock Trauma Center, Baltimore.

Surgically confirmed incorporation of a chronically retained neurointerventional microcatheter in the carotid artery.

A woman reported painful thrombosis of the superficial femoral artery 16 months after a transfemoral microcatheter was glued into a cerebral arteriovenous malformation and transected at the groin. When the catheter was removed, a portion was found to be incorporated into the wall of the carotid artery. This case demonstrates that portions of a retained microcatheter may be incorporated into the arterial wall while other portions may remain mobile and cause late peripheral arterial symptoms.

Rhombencephalitis caused by adenovirus: MR imaging appearance.

Encephalitis is a rare manifestation of adenovirus infection. We report the MR imaging findings of a patient with rhombencephalitis caused by adenovirus. Imaging findings included T2 signal abnormalities in the brain stem and cerebellum with mild patchy enhancement and mass effect.