Clinical Reasoning: A 24-Year-Old Woman With Penetrating Neck Injury From a Needlefish.

Evaluating patients with a traumatic spinal cord injury can be complicated by other injuries. In this case, a 24-year-old woman injured by a needlefish presented with combined motor and sensory defects, cranial nerve deficits, and a blunt vascular injury. This case highlights the importance of neurologic and vascular localizations and an understanding of spinal cord injuries involving various ascending and descending tracts. Appreciation of these anatomical considerations through this case illustrates the diagnostic approach to neurologic evaluation. While we present a traumatic etiology for multiple neurologic syndromes, this case gives readers an opportunity to develop a comprehensive differential diagnosis and tailor investigations for other relevant etiologies. Readers walking through this stepwise process will ultimately arrive at several distinct but related diagnoses.

Direct Puncture of the Superficial Temporal Artery in Embolization of a Scalp Arteriovenous Fistula: A Case Report.

We describe a minimally invasive endovascular approach to treat an arteriovenous fistula of the scalp. We performed a direct puncture of the lesion through the patient's scalp for liquid embolic agent injection along with external compression of the superficial temporal artery to perform a "manual pressure-cooker technique." The combination of these minimally invasive techniques resulted in an excellent clinical and radiographic outcome.

The Impact of Virtual Monoenergetic Imaging on Visualization of the Cervical Spinal Canal.

RATIONALE AND OBJECTIVES: Our purpose is to explore the role of dual-energy computed tomography (DECT) and virtual monoenergetic energy levels in reducing shoulder artifact to improve visualization of the cervical spinal canal. MATERIALS AND METHODS: A retrospective review of 171 consecutive DECT scans of the neck (95 male, 65 female; mean age, 60.9 years, ranging from 18 to 88 years; with 11 excluded because of nondiagnostic image quality) during an 8-month period was performed with postprocessing of monoenergetic images at 50, 70, 100, and 140 keV. Subjective comparisons and objective image noise between the monoenergetic images and standard computed tomography (CT) were analyzed by 1-way analysis of variance to determine the optimal DECT energy level with the highest image quality. RESULTS: Subjectively, 100-keV DECT best visualizes the spinal canal relative to standard CT, 50 and 70 keV ( P < 0.01), and was superior to 140 keV for reader 1 ( P < 0.01). Objectively, 100 keV demonstrated less noise relative to 50 keV (72.02; P < 0.01). There was no difference in noise between 100 keV and 70 keV, or between 100 keV and standard CT, which also demonstrated lower noise relative to 50-, 70-, and 140-keV levels (91.53, P < 0.01; 29.84, P < 0.01; and 22.66, P < 0.03). CONCLUSION: Dual-energy CT at 100 keV may be the preferred DECT monoenergetic level for soft tissue assessment. Increasing energy level is associated with reduction in shoulder artifact, with no difference in noise between 100 keV and standard CT, although 100-keV images may be subjectively better.

Association between vascular calcification in intracranial vertebrobasilar circulation and luminal stenosis.

INTRODUCTION: The study aims to assess the correlation and association between calcium burden and luminal stenosis in the vertebrobasilar circulation. METHODS: We evaluated 166 patients [mean age, 79.8 ± 8.8 (SD) with 93 males] with stroke symptoms. The calcification patterns were assessed on non-contrast CT (NCCT); quantitative calcium burden [Agatston-Janowitz (AJ) calcium score, volume, and mass] on the initial non-contrast phase of CT perfusion (CTP); and the qualitative and quantitative luminal stenosis on CT angiography (CTA) studies. We calculated the correlation coefficient and association between measures of calcium burden and luminal stenosis. RESULTS: Two hundred twenty-eight of 498 arteries (45.8%) had detectable calcification on NCCT and measurable stenosis in 169 of 498 arteries (33.9%) on CTA. We found a moderate correlation between qualitative calcium burden and qualitative (0.51 for R1 and 0.62 for R2, p < 0.01) as well as quantitative luminal stenosis (0.67 for R1 and 0.69 for R2, p < 0.01). There was a moderate correlation of AJ score (0.66), volume (0.68), and mass of calcification (0.60, p < 0.01) with luminal stenosis measurements. The quantitative calcium burden and luminal stenosis showed statistically significant differences between different qualitative categories of calcium burden (p < 0.001 in both readers). However, severe stenosis was not seen even with the advanced circumferential wall calcification (mean stenosis of 35.3-40.7%). CONCLUSION: Our study showed a moderate correlation between higher burden of vascular calcification and the degree of luminal stenosis. However, higher calcium burden and circumferential wall calcification were not associated with severe luminal stenosis.