RESUMEN
AQFThe authors present the guidelines of the French Society of ENT and Head and Neck Surgery (SFORL) regarding the management of Bell's palsy in adults. After a literature review by a multidisciplinary workgroup, guidelines were drawn up based on retrieved articles and group-members' experience, then read over by an independent group to edit the final version. Guidelines were graded A, B, C or "expert opinion" according to decreasing level of evidence. Thorough ENT and neurological clinical examination is recommended in all patients presenting with peripheral facial palsy to confirm diagnosis of Bell's palsy. MRI with gadolinium enhancement should explore the entire course of the facial nerve, if possible within the first month. ENMG should be performed to assess prognosis for recovery. In confirmed Bell's palsy, corticosteroid therapy should be implemented as early as possible (ideally within 72h) at a dose of 1mg/kg/day for 7-10 days. Antiviral therapy should be associated to steroids in patients with severe and early-onset disease and in Ramsay-Hunt syndrome. Isolated antiviral therapy is not recommended. To date, there is no evidence that surgical facial nerve decompression provides benefit.
Asunto(s)
Parálisis de Bell/diagnóstico , Parálisis de Bell/terapia , Enfermedad Aguda , Corticoesteroides/administración & dosificación , Corticoesteroides/uso terapéutico , Antivirales/uso terapéutico , Parálisis de Bell/tratamiento farmacológico , Medios de Contraste , Descompresión Quirúrgica , Esquema de Medicación , Quimioterapia Combinada/métodos , Nervio Facial/diagnóstico por imagen , Parálisis Facial/diagnóstico , Francia , Gadolinio , Herpes Zóster Ótico/tratamiento farmacológico , Humanos , Oxigenoterapia Hiperbárica , Imagen por Resonancia Magnética , Examen Neurológico , Otolaringología , Modalidades de Fisioterapia , Pronóstico , Recuperación de la Función , Sociedades MédicasAsunto(s)
Aumento de la Imagen , Interpretación de Imagen Asistida por Computador , Imagenología Tridimensional , Lipoma/diagnóstico , Imagen por Resonancia Magnética , Neoplasia Endocrina Múltiple Tipo 1/diagnóstico , Neoplasias Primarias Múltiples/diagnóstico , Tomografía de Emisión de Positrones , Neoplasias de los Tejidos Blandos/diagnóstico , Tomografía Computarizada por Rayos X , Tejido Adiposo/patología , Anciano , Biopsia con Aguja Fina , Nalgas/patología , Diagnóstico Diferencial , Femenino , Fluorodesoxiglucosa F18 , Humanos , Biopsia Guiada por Imagen , Lipoma/patología , Neoplasia Endocrina Múltiple Tipo 1/patología , Neoplasias Primarias Múltiples/patología , Neoplasias de los Tejidos Blandos/patologíaRESUMEN
OBJECTIVE: Our aim was to compare image quality, coronary segment assessability and radiation dose in prospectively gated axial (PGA) coronary CT angiography (CTA) and conventional retrospectively gated helical (RGH) coronary CTA. METHODS: Institutional review committee approval and informed consent were obtained. RGH CTA was performed in 41 consecutive patients (33 males, 8 females; mean age 52.6 years), then the PGA CTA technique was evaluated in 41 additional patients (24 males, 17 females; mean age 57.3 years) all with a pre-scan heart rate of ≤70 beats per minute (bpm). Two radiologists, blinded to clinical information, independently scored subjective image quality on a five-point ordinal scale. RESULTS: The mean effective dose in the PGA group was 4.7±0.9 mSv, representing a 69% dose reduction compared with the RGH CTA group (15.1±1.9 mSv, p<0.001). The mean segmental image quality score was significantly higher in the PGA group (3.4 vs 3.2) than in the RGH CTA group (p<0.005). The percentage of assessable segments was 98.1% in the PGA group and 97.3% in the RGH group (p = 0.610). CONCLUSION: PGA CTA offers a significant reduction in radiation dose compared with RGH CTA, with comparable image quality for patients with heart rates below 70 bpm.
Asunto(s)
Angiografía Coronaria/métodos , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Tomografía Computarizada Espiral/métodos , Electrocardiografía/métodos , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Dosis de Radiación , Estudios RetrospectivosRESUMEN
Cerebral amyloid angiopathy (CAA) is characterized by deposition of cerebrovascular amyloid protein in the media of leptomeningeal vessels. (amyloid B protein, cystatin C, transthyretin, gelsolin, and prion protein). It is a cause of cerebrovascular disorders including cerebral hemorrhage, cognitive impairment and unusually transient neurological symptoms. It is the main contributing factor to cerebral hemorrhage after hypertension in the elderly. We aimed to review epidemiological, pathophysiological and clinical and MRI imaging data in CAA.