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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThis article addresses an array of emergency situations and the associated best imaging practices, as well as nontraumatic spine emergency, and the differential diagnosis of intracranial hemorrhage, its appearance on computed tomography and magnetic resonance imaging, and its complications.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Ecritical care\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Etomography\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eneuroimaging\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eneuroimaging\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eischemia\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Emagnetic resonance imaging\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003EWendy R. K. Smoker, MD, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA, addressed an array of emergency situations, including orbital pathologies affecting vision, neck infections that may affect the airway, odontogenic infections, and intracranial complications of acute sinusitis.\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003ETraumatic vision loss can be caused by open globe injuries, lens dislocation, retinal detachment, or orbital fractures. Other emergency orbital conditions include acute orbital infection, pseudotumor, subperiosteal orbital hematoma, and carotid-cavernous fistula (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E).\u003C\/p\u003E\n         \u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/16493\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/16493\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16493\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-4\u0022 class=\u0022first-child\u0022\u003EAcute Orbital Conditions Causing Vision Loss\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-5\u0022\u003ESeveral types of throat and neck conditions can threaten the airway (\u003Ca id=\u0022xref-table-wrap-2-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T2\u0022\u003ETable 2\u003C\/a\u003E). Dr Smoker emphasized the importance of butterfly imaging for these conditions. In patients with amalgams causing artifacts in areas of interest, it is important to get angle or butterfly images to see behind the amalgams.\u003C\/p\u003E\n         \u003Cdiv id=\u0022T2\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/16405\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/16405\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16405\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 2.\u003C\/span\u003E \n               \u003Cp id=\u0022p-6\u0022 class=\u0022first-child\u0022\u003EThroat and Neck Emergencies That Threaten the Airway\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-8\u0022\u003EFrontal or ethmoid and sphenoid sinusitis infections have the potential for intracranial complications, but direct extension from the maxillary sinus to critical structures is rare. Acute sphenoid sinusitis can be complicated by epidural abscess in the middle cranial fossa and extend into the masticator space. Superior ophthalmic vein thrombosis or cavernous sinus thrombosis can be seen in sphenoid sinus disease. Acute frontal sinusitis can be complicated with Pott puffy tumor or intracerebral abscess.\u003C\/p\u003E\n         \u003Cp id=\u0022p-9\u0022\u003EPatrick Turski, MD, University of Wisconsin, Madison, Wisconsin, USA, discussed the differential diagnosis of intracranial hemorrhage, its appearance on computed tomography (CT) and magnetic resonance imaging (MRI), and its complications. Spontaneous primary intracranial hemorrhage is caused by hypertension (36%) or amyloid angiopathy, whereas secondary intracranial hemorrhage can be due to aneurysm (36%), arteriovenous malformation (AVM), and other (17%), including hemorrhagic transformation of ischemic infarction, venous thrombosis, hemorrhagic neoplasms, and vasculitis. \u003Ca id=\u0022xref-table-wrap-3-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T3\u0022\u003ETable 3\u003C\/a\u003E summarizes the imaging evaluation of intracranial hemorrhage.\u003C\/p\u003E\n         \u003Cdiv id=\u0022T3\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/16494\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/16494\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16494\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 3.\u003C\/span\u003E \n               \u003Cp id=\u0022p-10\u0022 class=\u0022first-child\u0022\u003EImaging Evaluation of Intracranial Hemorrhage\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-12\u0022\u003EHypertension leads to arteriolar degeneration, resulting in lacunar infarcts caused by arteriolar sclerosis or Charcot-Bouchard aneurysms caused by arteriolar dilatation. A focal area of enhancement \u0026gt; 1.5 mm indicates a Charcot-Bouchard aneurysm. The most common location of hypertensive hemorrhage is the putamen and external capsule (60%), followed by the thalamus (20%), pons (10%), cerebellum (5%), and subcortical white matter (5%). A poor prognosis is associated with age \u0026gt; 80 years, hemorrhage volume \u0026gt; 30 cc, and posterior fossa or intraventricular extension. CT of a hematoma over time shows increasing attenuation due to clot retraction, cells, and platelets (50 to 60 HU), followed by a 1.5-HU\/d decrease in attenuation due to increased hydration. Rim enhancement appears in 1 week and persists for 8 to 12 weeks.\u003C\/p\u003E\n         \u003Cp id=\u0022p-13\u0022\u003ECerebral amyloid angiopathy (CAA) accounts for about 20% of spontaneous hemorrhages in the elderly. It is associated with amyloid deposition in the vessel walls and surrounding tissues. Patients aged \u0026gt; 55 years with lobar, cortical, or subcortical microhemorrhages meet the Boston criteria for probable CAA.\u003C\/p\u003E\n         \u003Cp id=\u0022p-14\u0022\u003EIn a study of aneurysm growth and rupture, 18% of all aneurysms grew during the follow-up of 2.4 years [Villablanca JP et al. \u003Cem\u003ERadiology.\u003C\/em\u003E 2013]. There was a 12-fold increase in rupture for growing aneurysms of all sizes. Other risk factors were smoking and aneurysm size \u0026gt; 5 mm at presentation.\u003C\/p\u003E\n         \u003Cp id=\u0022p-15\u0022\u003EVascular malformations that can lead to hemorrhage include pial AVM, dural arteriovenous fistula, cavernoma, and developmental venous anomaly. Ischemic infarction can undergo hemorrhagic transformation. The risk is increased following therapy, with increased permeability of the infarct core. Venous thrombosis can occur in a variety of conditions, including Crohn disease, transverse sinus\u2013vein of Labbe thrombosis, and cerebritis. Vasculitis can be primary or secondary due to autoimmune diseases, drug use, or other causes.\u003C\/p\u003E\n         \u003Cp id=\u0022p-16\u0022\u003EIn conclusion, CT and CT angiography are the primary tools for diagnosing nontraumatic central nervous system hemorrhage. MRI with susceptibility-weighted imaging is used for amyloid angiopathy. Imaging studies should be used to determine the location, look for evidence of active bleeding, identify underlying lesions, and determine the size of hematomas and mass effect.\u003C\/p\u003E\n         \u003Cp id=\u0022p-17\u0022\u003EAccording to E. Turgut Tali, MD, Gazi University School of Medicine, Ankara, Turkey, nontraumatic spine emergency (NTSE) should be considered in patients with spontaneous limb weakness, paresthesia, progressive inability to ambulate, cauda equina syndrome, or rapid onset of a severe neurologic syndrome. The NTSE incidence rate varies from 11 to 70 per million in different countries and may result from a variety of causes [van den Berg MEL et al. \u003Cem\u003ENeuroepidemiology.\u003C\/em\u003E 2010]. Clinical findings and symptoms are often nonspecific. The most common causes are tumors, inflammation, and infections. Types of NTSE conditions include congenital disorders, degenerative diseases, inflammation, neoplasms, tumor-like lesions, vascular disorders, hematologic diseases, and metabolic diseases.\u003C\/p\u003E\n         \u003Cp id=\u0022p-18\u0022\u003EThe pathophysiology of myelopathy involves both static factors causing compression and dynamic factors resulting in repetitive spinal cord injury. A history and physical examination often localize the abnormality to the spine. Prompt imaging of the spine, spinal cord, and roots is necessary to evaluate the abnormality. MRI is the modality of choice, with the addition of fat-suppressed and contrast-enhanced sequences. Digital subtraction angiography is useful for evaluating vascular emergencies.\u003C\/p\u003E\n         \u003Cp id=\u0022p-19\u0022\u003EConventional MRI sequences cannot reliably differentiate between benign compressions and those secondary to myelomatous infiltration. Diffusion-weighted imaging may be useful in such cases. Early imaging diagnosis of spondylitis, discitis, and epidural infection facilitates prompt treatment. Spinal cord injury caused by rheumatoid arthritis is characterized by transverse atlantal ligament laxity and atlantoaxial subluxation, vertical subluxation, odontoid erosion, and pannus around the odontoid.\u003C\/p\u003E\n         \u003Cp id=\u0022p-20\u0022\u003ESpinal cord involvement in multiple sclerosis typically occurs in the dorsolateral regions of the cervical cord. Neuromyelitis optica is characterized by lesions extending contiguously over \u2265 3 vertebral segments. Acute transverse myelitis affects \u0026gt; 2 vertebral segments and involves smooth cord expansion in the central cord location. In Guillain-Barr\u00e9 syndrome, imaging shows a normal conus\/slight prominence of root size, avid enhancement of the pial surface of the distal core, and cauda equina demyelination. Mass effect of vasogenic edema, slight cord swelling, and variable enhancement are seen in acute disseminated encephalomyelitis.\u003C\/p\u003E\n         \u003Cp id=\u0022p-21\u0022\u003ESchwannoma is the most common intradural extra-medullary mass. Imaging shows cord displacement, meniscus sign, and marked enhancement. Ependymomas occur in the central canal, most commonly in the cervical, thoracal, and filar regions. In patients with intracranial hypotension due to cerebrospinal fluid (CSF) leakage, radionuclide and CT cisternography can localize the CSF leak. Magnetic resonance cisternomyelography with intrathecal gadolinium has 90% sensitivity for CSF leakage [Algin O et al. \u003Cem\u003ENeuroradiol.\u003C\/em\u003E 2011].\u003C\/p\u003E\n         \u003Cp id=\u0022p-22\u0022\u003ENontraumatic causes of spine injury should be considered when a patient presents with acute spine symptoms. The primary diagnostic challenge is to identify a treatable abnormality.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/53\/28.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzlsn2\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzlsn2\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}