Recent advances in imaging of cerebrovascular disease

Emergent CT evaluation of stroke

The rapid neuroimaging of a patient that has suffered a stroke is a critical preamble to the emergent initiation of thrombolytic therapy. Emergency physicians must be familiar with normal brain structures as they appear on CT, as well as common stroke patterns. The more facile emergency physicians are at interpreting the head CT, the better they can communicate with consulting specialists and deliver prompt care to patients that present with neurologic emergencies.

Future trends

The landscape of acute stroke care has changed dramatically in the last decade. Even before the approval of tissue plasminogen activator for acute stroke in 1996, organized acute stroke care was initiated at several hospitals and the pharmaceutical industry was deeply entrenched in the search for neuroprotective agents. In the year 2002, acute stroke care continues to demand the attention of neurologists as well emergency physicians. Despite the failures of many neuroprotective agents and the relative lack of use of tPA, the acute treatment of the stroke has gained increasing importance both at an individual and national level. This chapter reviews some of the advances in the acute treatment of stroke, future of acute stroke care and discusses the emerging role of the emergency physician in this area.

A unique case of Bezold's abscess associated with multiple dural sinus thromboses

OBJECTIVES/HYPOTHESIS

Bezold's abscess and dural sinus thromboses are rare complications of otitis media in the era of antibiotics. Although potentially fatal, they are treatable. We present a unique case report of Bezold's abscess in association with multiple dural sinus thromboses.

STUDY DESIGN

Single case report.

METHODS

A young female patient's clinical course is presented and discussed. We review the anatomy, incidence, pathogenesis, and treatment of Bezold's abscess and dural sinus thrombosis.

RESULTS

After mastoidectomy, neck exploration, broad-spectrum intravenous antibiotics, and anticoagulation therapy, the patient recovered fully and has remained asymptomatic since her discharge from the hospital at 12 months' follow-up.

CONCLUSIONS

This is the first reported case of Bezold's abscess associated with a cavernous sinus thrombosis and the third reported case of Bezold's abscess associated with lateral sinus thrombosis. Despite its rarity, Bezold's abscess must be recognized and treated aggressively. Dural sinus thrombosis is relatively more common, and treatment of the underlying cause is essential. The diagnosis and rapid, aggressive treatment of these conditions are essential for an optimal clinical outcome.

Diagnostic evaluation of stroke

Diagnostic testing in patients with ischemic stroke serves many purposes, including confirmation of the diagnosis and providing clues as to possible causes. Evaluation of the cerebral vasculature, the heart, the blood coagulation system, and selected other diagnostic tests may point to a mechanism of stroke which helps determine treatment and prognosis. With the recent advent of acute interventions for ischemic stroke, diagnostic testing is now an important component in the emergency management of stroke. In this article, the authors will review the standard approach to diagnostic testing for patients with ischemic stroke or transient ischemic attack, and new developments in neuro-imaging and their use in acute stroke assessment.