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Martelletti P, Leonardi M, Ashina M, Burstein R, Cho SJ, Charway-Felli A, Dodick DW, Gil-Gouveia R, Grazzi L, Lampl C, MaassenVanDenBrink A, Minen MT, Mitsikostas DD, Olesen J, Owolabi MO, Reuter U, Ruiz de la Torre E, Sacco S, Schwedt TJ, Serafini G, Surya N, Tassorelli C, Wang SJ, Wang Y, Wijeratne T, Raggi A. Rethinking headache as a global public health case model for reaching the SDG 3 HEALTH by 2030. J Headache Pain 2023; 24:140. [PMID: 37884869 PMCID: PMC10604921 DOI: 10.1186/s10194-023-01666-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/05/2023] [Indexed: 10/28/2023] Open
Abstract
The 2030 Agenda for Sustainable Development sets out, through 17 Sustainable Development Goals (SDGs), a path for the prosperity of people and the planet. SDG 3 in particular aims to ensure healthy lives and promote well-being for all at all ages and includes several targets to enhance health. This review presents a "headache-tailored" perspective on how to achieve SDG 3 by focusing on six specific actions: targeting chronic headaches; reducing the overuse of acute pain-relieving medications; promoting the education of healthcare professionals; granting access to medication in low- and middle-income countries (LMIC); implementing training and educational opportunities for healthcare professionals in low and middle income countries; building a global alliance against headache disorders. Addressing the burden of headache disorders directly impacts on populations' health, as well as on the possibility to improve the productivity of people aged below 50, women in particular. Our analysis pointed out several elements, and included: moving forward from frequency-based parameters to define headache severity; recognizing and managing comorbid diseases and risk factors; implementing a disease management multi-modal management model that incorporates pharmacological and non-pharmacological treatments; early recognizing and managing the overuse of acute pain-relieving medications; promoting undergraduate, postgraduate, and continuing medical education of healthcare professionals with specific training on headache; and promoting a culture that favors the recognition of headaches as diseases with a neurobiological basis, where this is not yet recognized. Making headache care more sustainable is an achievable objective, which will require multi-stakeholder collaborations across all sectors of society, both health-related and not health-related. Robust investments will be needed; however, considering the high prevalence of headache disorders and the associated disability, these investments will surely improve multiple health outcomes and lift development and well-being globally.
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Affiliation(s)
- Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | - Matilde Leonardi
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, Milan, 20133, Italy
| | - Messoud Ashina
- Department of Neurology, Danish Headache Center, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rami Burstein
- John Hedley-Whyte Professor of Anesthesia and Neuroscience at the Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Soo-Jin Cho
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Military Hospital, Hwaseong, Korea
| | | | - David W Dodick
- Department of Neurology, Mayo Clinic, Scottsdale, AZ, USA
| | - Raquel Gil-Gouveia
- Neurology Department, Hospital da Luz Headache Center, Hospital da Luz Lisboa., Lisbon, Portugal
- Center for Interdisciplinary Research in Health, Universidade Católica Portuguesa, Lisbon, Portugal
| | - Licia Grazzi
- Neuroalgology Unit and Headache Center, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Christian Lampl
- Department of Neurology and Stroke Unit, Koventhospital Barmherzige Brüder Linz, Linz, Austria
- Headache Medical Center Linz, Linz, Austria
| | - Antoinette MaassenVanDenBrink
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Mia T Minen
- Department of Neurology, NYU Langone Health, NY, New York, USA
| | - Dimos Dimitrios Mitsikostas
- 1st Neurology Department, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Jes Olesen
- Department of Neurology, Danish Headache Center, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mayowa Ojo Owolabi
- Faculty of Clinical Sciences; Center for Genomic and Precision Medicine, College of Medicine,, University of Ibadan, Ibadan, Nigeria
| | - Uwe Reuter
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
- Universitätsmedizin Greifswald, Greifswald, Germany
| | | | - Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Todd J Schwedt
- Department of Neurology, Mayo Clinic, Scottsdale, AZ, USA
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Cristina Tassorelli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Shuu-Jiun Wang
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Neurology, The Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yonggang Wang
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tissa Wijeratne
- Department of Neurology, Sunshine Hospital, St Albans, VIC, Australia
| | - Alberto Raggi
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, Milan, 20133, Italy.
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Vazirian S, Ho T, Weideman RA, Salinas MR, Hurd PW, Stuve O. Utilization of a neurology specialty service by primary care providers for headache management at a tertiary care hospital. J Cent Nerv Syst Dis 2022; 14:11795735221113102. [PMID: 35860714 PMCID: PMC9290155 DOI: 10.1177/11795735221113102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Recent data indicate that the three-month prevalence of severe headaches or migraines in the US general population is close to 25%. Participation of primary care providers will therefore be critical in providing care to affected individuals. Objective To determine the number of headache disorder consult requests to a neurology outpatient service in a tertiary medical center, the appropriateness of the consult requests, and the effectiveness of a lecture series on headache diagnosis and management in preventing inappropriate consult requests from non-neurology providers. Methods Clinical data on US Veterans is captured and documented in the Veterans Health Information Systems and Technology Architecture (VISTA). The Computerized Patient Record System (CPRS) electronic medical record (EMR) was used for data entry and retrieval. All consult requests for the study period within the VA North Texas Health Care System were identified in VISTA, and the clinical information reviewed in CPRS. Based on a defined algorithm, headache consult request were categorized as appropriate or inappropriate. A board-certified neurologist provided four in-person/virtual lectures to ambulatory care providers, primary care providers, internal medicine residents, and emergency room providers within the VA North Texas Health Care System on the diagnosis and management of headaches. Prior and post the lecture series, the total number of headache consults per day was assessed over 45-day periods. Results The number of daily headache consult requests in the 45-day period prior to the lecture series was 3.6 per day (standard deviation 2.7), and 6.0 per day after the lecture series (standard deviation 2.1). The difference was not statistically significant. There were as many inappropriate headache consult requests after the lecture series as appropriate ones (50% each). Conclusion We found that a short-term educational initiative that instructed primary care providers on the diagnosis and management of common headache disorders did not reduce the number of consultation requests and, surprisingly, it did not improve the appropriateness of the consults. Given the prevalence of headaches in the general population, better training of all primary care providers in headache management should be pursued.
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Affiliation(s)
- Samra Vazirian
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Travis Ho
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rick A Weideman
- Pharmacy Service, VA North Texas Health Care System, Dallas, TX, USA
| | - Meagen R Salinas
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Neurology Section, VA North Texas Health Care System, Dallas, TX, USA
| | - Paul W Hurd
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Pharmacy Service, VA North Texas Health Care System, Dallas, TX, USA
| | - Olaf Stuve
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Neurology Section, VA North Texas Health Care System, Dallas, TX, USA
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Kristoffersen ES, Faiz KW, Hansen JM, Tronvik EA, Frich JC, Lundqvist C, Winsvold BS. The management and clinical knowledge of headache disorders among general practitioners in Norway: a questionnaire survey. J Headache Pain 2021; 22:136. [PMID: 34763647 PMCID: PMC8582095 DOI: 10.1186/s10194-021-01350-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 10/28/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND General practitioners (GPs) diagnose and manage a majority of headache patients seeking health care. With the aim to understand the potential for clinical improvement and educational needs, we performed a study to investigate Norwegian GPs knowledge about headache and its clinical management. METHODS We invited GPs from a random sample of 130 Norwegian continuous medical education (CME) groups to respond to an anonymous questionnaire survey. RESULTS 367 GPs responded to the survey (73% of invited CME groups, 7.6% of all GPs in Norway). Mean age was 46 (SD 11) years, with an average of 18 (SD 10) years of clinical experience. In general the national treatment recommendations were followed, while the International Classification of Headache Disorders and other international guidelines were rarely used. Overall, 80% (n = 292) of the GPs suggested adequate prophylactic medication for frequent episodic migraine, while 28% (n = 101) suggested adequate prophylactic medication for chronic tension-type headache (CTTH). Half (52%, n = 191)) of the respondents were aware that different types of acute headache medication can lead to medication-overuse headache (MOH), and 59% (n = 217) knew that prophylactic headache medication does not lead to MOH. GPs often used MRI in the diagnostic work-up. GPs reported that lack of good treatment options was a main barrier to more optimized treatment of headache patients. CONCLUSION The knowledge of management of CTTH and MOH was moderate compared to migraine among Norwegian GPs.
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Affiliation(s)
- Espen Saxhaug Kristoffersen
- Department of General Practice, University of Oslo, PO Box 1130, Blindern, 0318, Oslo, Norway. .,Department of Neurology, Akershus University Hospital, Lørenskog, Norway. .,Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway.
| | - Kashif Waqar Faiz
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
| | - Jakob Møller Hansen
- Danish Knowledge Centre on Headache Disorders, Rigshospitalet-Glostrup, University, of Copenhagen, Glostrup, Denmark
| | - Erling Andreas Tronvik
- Department of Neuromedicine and Movement Science, NTNU Norwegian University of Science and Technology, Trondheim, Norway.,Department of Neurology, National Advisory Unit on Headaches, St. Olavs Hospital, Trondheim, Norway
| | - Jan C Frich
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Christofer Lundqvist
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway.,Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Bendik Slagsvold Winsvold
- Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway.,Department of Neurology, Oslo University Hospital, Oslo, Norway
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Thiele A, Strauß S, Angermaier A, Klehr L, Bartsch L, Kronenbuerger M, Schmidt S, Fleischmann R. Treatment Realities of Headache Disorders in Rural Germany by the Example of the Region of Western Pomerania. Brain Sci 2021; 11:brainsci11070839. [PMID: 34202861 PMCID: PMC8301947 DOI: 10.3390/brainsci11070839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/19/2021] [Accepted: 06/23/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Headache disorders are among the most disabling medical conditions but the supply with experienced providers is outpaced by the demand for service. It is unclear to what extent particularly patients in rural regions are affected by limited access to comprehensive care. Furthermore, it is unknown what role general practitioners (GPs) play in headache care. (2) Methods: First-time consultations to a specialised headache clinic at a tertiary care centre were asked to participate. Their socio-demographic background, general and headache-specific medical history, disability and quality of life (QoL) were assessed. Additionally, 176 GPs in neighbouring districts were contacted regarding headache management. (3) Results: We assessed 162 patients with first-time consultations (age 46.1 ± 17.0 years, 78.1% female), who suffered from migraine (72%), tension type, cluster and secondary headaches (each 5-10%). About 50% of patients received a new headache-diagnosis and 60% had treatment inconsistent with national guidelines. QoL was significantly worse in all domains compared to the general population. About 75% of GPs see headache patients at least several times per week, and mostly treat them by themself. (4) Conclusions: More than every second headache patient was neither correctly diagnosed nor received guideline adherent treatment. Headache-related disability is inferior to what is expected from previous studies. Access to specialised health care is more limited in rural than in urban regions in Germany and GPs request more training.
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Affiliation(s)
- Anne Thiele
- Department of Neurology, University Medicine Greifswald, 17475 Greifswald, Germany; (A.T.); (S.S.); (A.A.); (L.K.); (L.B.); (M.K.)
| | - Sebastian Strauß
- Department of Neurology, University Medicine Greifswald, 17475 Greifswald, Germany; (A.T.); (S.S.); (A.A.); (L.K.); (L.B.); (M.K.)
| | - Anselm Angermaier
- Department of Neurology, University Medicine Greifswald, 17475 Greifswald, Germany; (A.T.); (S.S.); (A.A.); (L.K.); (L.B.); (M.K.)
| | - Lara Klehr
- Department of Neurology, University Medicine Greifswald, 17475 Greifswald, Germany; (A.T.); (S.S.); (A.A.); (L.K.); (L.B.); (M.K.)
| | - Luise Bartsch
- Department of Neurology, University Medicine Greifswald, 17475 Greifswald, Germany; (A.T.); (S.S.); (A.A.); (L.K.); (L.B.); (M.K.)
| | - Martin Kronenbuerger
- Department of Neurology, University Medicine Greifswald, 17475 Greifswald, Germany; (A.T.); (S.S.); (A.A.); (L.K.); (L.B.); (M.K.)
- Medical School OWL, University of Bielefeld, 33615 Bielefeld, Germany
| | - Sein Schmidt
- Clinical Research Unit, Charité Campus Mitte, Berlin Institute of Health, 10117 Berlin, Germany;
| | - Robert Fleischmann
- Department of Neurology, University Medicine Greifswald, 17475 Greifswald, Germany; (A.T.); (S.S.); (A.A.); (L.K.); (L.B.); (M.K.)
- Correspondence:
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AlQarni MA, Fayi KA, Al-Sharif MN, Siddiqui AF, Alhazzani AA. Prevalence of migraine and non-migraine headache and its relation with other diseases in the adults of Aseer Region, Saudi Arabia. J Family Med Prim Care 2020; 9:1567-1572. [PMID: 32509651 PMCID: PMC7266241 DOI: 10.4103/jfmpc.jfmpc_962_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 02/08/2020] [Accepted: 02/11/2020] [Indexed: 01/03/2023] Open
Abstract
Background and Aims: Headache is a common yet neglected health problem. There is a lack of information about its distribution, disease characteristics and associated co morbidities in Aseer region of KSA. This study aims to estimate the migraine and headache prevalence, its epidemiological and disease characteristics and relation with other co morbid conditions among general population of Aseer region, Saudi Arabia. Methods: A descriptive cross-sectional survey of 1123 adult participants during the period from Apr 2018 to Dec 2018. The questionnaire was sent to total of 1420 participants, but only 1123 agreed to participate and completed the questions (response rate 79.1%). Participants were recruited through an online survey from 4 main cities in Aseer region. Participants who refused were excluded. Adults were invited to answer a 25-question electronic survey to assess the prevalence of headache (migraine and non-migraine) and its relations with other diseases. Results: The participant's ages ranged from 17 to 60 years old, with mean age of 32.4 ± 10 years. No history of frequent headaches was reported by 152 (13.5%) while 833 (74.2%) had non-migraine headache (NMH) and 138 (12.3%) had migraine headache (MH). Female gender (2:1), poor sleep duration, cerebrovascular disease, dyslipidemia, chronic sinusitis and depression showed a significant association with migraine. Conclusions and Recommendations: The current research revealed a high prevalence of headache either migraine or non-migraine, twice as common in females and in those with insufficient sleeping hours. Most headache attacks were associated mainly with light in form of flashes, sensitivity or aggravated episodes.
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Affiliation(s)
| | - Khalid Ali Fayi
- College of Medicine, King Khalid University, Abha, Saudi Arabia
| | | | | | - Adel Ali Alhazzani
- Neurology Section, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Peeters MCM, Dirven L, Koekkoek JAF, Gortmaker EG, Fritz L, Vos MJ, Taphoorn MJB. Prediagnostic symptoms and signs of adult glioma: the patients' view. J Neurooncol 2020; 146:293-301. [PMID: 31894516 DOI: 10.1007/s11060-019-03373-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 12/14/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Little is known about the symptoms glioma patients experience in the year before diagnosis, either or not resulting in health care usage. This study aimed to determine the incidence of symptoms glioma patients experienced in the year prior to diagnosis, and subsequent visits to a general practitioner (GP). METHODS Glioma patients were asked to complete a 30-item study-specific questionnaire focusing on symptoms they experienced in the 12 months before diagnosis. For each indicated symptom, patients were asked whether they consulted the GP for this issue. RESULTS Fifty-nine patients completed the questionnaires, 54 (93%) with input of a proxy. The median time since diagnosis was 4 months (range 1-12). The median number of symptoms experienced in the year before diagnosis was similar between gliomas with favourable and poor prognosis, i.e. 6 (range 0-24), as were the five most frequently mentioned problems: fatigue (n = 34, 58%), mental tiredness (n = 30, 51%), sleeping disorder (n = 24, 41%), headache (n = 23, 39%) and stress (n = 20, 34%). Twenty-six (44%) patients visited the GP with at least one issue. Patients who did consult their GP reported significantly more often muscle weakness (11 vs 3, p = 0.003) than patients who did not, which remained significant after correction for multiple testing, which was not the case for paralysis in hand/leg (10 vs 4), focussing (11 vs 6) or a change in awareness (9 vs 4). CONCLUSIONS Glioma patients experience a range of non-specific problems in the year prior to diagnosis, but only patients who consult the GP report more often neurological problems.
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Affiliation(s)
- Marthe C M Peeters
- Department of Neurology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.,Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Johan A F Koekkoek
- Department of Neurology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.,Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Ellen G Gortmaker
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Lara Fritz
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Maaike J Vos
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.,Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
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George E, Guenette JP, Lee TC. Introduction to Neuroimaging. Am J Med 2018; 131:346-356. [PMID: 29191488 DOI: 10.1016/j.amjmed.2017.11.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 11/07/2017] [Accepted: 11/10/2017] [Indexed: 12/14/2022]
Abstract
Primary care physicians are often tasked with evaluating neurologic symptoms, and imaging plays a critical role in neurologic diagnoses. Neuroradiology routinely employs advanced imaging modalities, and hence, determination of the appropriate imaging test and interpretation of findings in the clinical context can understandably be overwhelming. In this review article, we introduce resources that can guide physicians in the selection of neuroimaging tests and summarize guidelines on contrast agent administration. Key concepts on imaging techniques and terminology are reviewed, as is relevant for the primary care physician. We then present an overview of the typical imaging manifestations of brain pathologies, including stroke, traumatic injuries, infections, demyelinating and neurodegenerative processes, and neoplasms. Spine imaging is often considered for the evaluation of degenerative, infectious, or neoplastic etiologies, and the typical imaging findings in these scenarios are also summarized.
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Affiliation(s)
- Elizabeth George
- Department of Radiology, Brigham and Women's Hospital, Boston, Mass.
| | | | - Thomas C Lee
- Department of Radiology, Brigham and Women's Hospital, Boston, Mass
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