Small Vessel Disease, a Marker of Brain Health: What the Radiologist Needs to Know.

Small vessel disease, a disorder of cerebral microvessels, is an expanding epidemic and a common cause of stroke and dementia. Despite being almost ubiquitous in brain imaging, the clinicoradiologic association of small vessel disease is weak, and the underlying pathogenesis is poorly understood. The STandards for ReportIng Vascular changes on nEuroimaging (STRIVE) criteria have standardized the nomenclature. These include white matter hyperintensities of presumed vascular origin, recent small subcortical infarcts, lacunes of presumed vascular origin, prominent perivascular spaces, cerebral microbleeds, superficial siderosis, cortical microinfarcts, and brain atrophy. Recently, the rigid categories among cognitive impairment, vascular dementia, stroke, and small vessel disease have become outdated, with a greater emphasis on brain health. Conventional and advanced small vessel disease imaging markers allow a comprehensive assessment of global brain heath. In this review, we discuss the pathophysiology of small vessel disease neuroimaging nomenclature by means of the STRIVE criteria, clinical implications, the role of advanced imaging, and future directions.

Effects of vagus nerve stimulation on progressive myoclonus epilepsy of Unverricht-Lundborg type.

PURPOSE: A 34-year-old woman with progressive myoclonus epilepsy of Unverricht-Lundborg type was considered for vagus nerve stimulation (VNS) therapy. METHODS: After demonstration of intractability to multiple antiepileptic regimens and progressive deterioration in cerebellar function, the patient was implanted with a vagus nerve stimulator and followed for 1 year. Neurological status, seizure frequency, and parameter changes were analyzed. RESULTS: VNS therapy resulted in reduction of seizures (more than 90%) and a significant improvement in cerebellar function demonstrated on neurological examination. The patient reported improved quality of life based in part on her ability to perform activities of daily living. CONCLUSIONS: VNS therapy may be considered a treatment option for progressive myoclonus epilepsy. The effects of VNS on seizure control and cerebellar dysfunction may provide clues to the underlying mechanism(s) of action.

Pregnancy complicated by the Klippel-Trenaunay syndrome. A case report.

A primigravida with the Klippel-Trenaunay syndrome was admitted to the hospital at 34 weeks' gestation with a complaint of right calf pain. Superficial thrombophlebitis was diagnosed, and she was treated with compresses and analgesia. Speculum examination failed to reveal the presence of lower genitourinary tract arteriovenous malformations. Color flow mapping of the uterus did not identify any arteriovenous malformations. The patient delivered vaginally at term, and the postpartum course was unremarkable. Pregnancies complicated by the Klippel-Trenaunay syndrome are at increased risk of adverse perinatal outcomes, related primarily to the increased risk of hemorrhagic diathesis. The mode of delivery should be considered carefully in an attempt to minimize the risk to both mother and fetus.

Cervical cytology with the Papette sampler.

The most reliable cervical smears for the detection of cervical cancer and its precursors are those which contain cells from the transformation zone and endocervical canal. To verify that these regions have been sampled, the cytologist must recognize either endocervical cells or immature squamous metaplastic cells on the smears. We performed an open clinical trial with a new device, the Papette, which simultaneously samples both the exocervix and endocervix. The overall cytologic quality of the smears and the device's acceptability to physicians were assessed in 1,000 women seen consecutively. The smears were compared with those collected from 1,000 women immediately after the trial using the Ayre spatula-Zelsmyr Cytobrush technique. Both the Papette and the spatula-Cytobrush obtained satisfactory smears in 91.4% and 96.0% of cases, respectively. Cell transfer onto glass slides was easier and bleeding observed less frequently with the Papette than with the spatula-Cytobrush, but the latter was more suitable for patients with a retroflexed uterus and narrow external os. Overall, the Papette harvested high-quality cellular samples and may be an option for cervical cytology.

The antenatal use of betamethasone in the prevention of respiratory distress syndrome: a controlled double-blind study.

One hundred forty-six pregnant women were enrolled in a prospective double-blind study to assess the effectiveness and side-effects of antenatal administration of betamethasone in the prevention of respiratory distress syndrome (RDS) in potentially premature infants. On admission to the study, the women were given, at random, either 12 mg of betamethasone or placebo. The same dose was repeated 24 hours later and then weekly up to 34 weeks of gestation. Gestational age of the infants ranged from 25 to 34 weeks, and birth weights ranged between 730 and 2,650 gm. Statistically significant differences in favor of the infants in the betamethasone group were found in the incidence of RDS, 20.7% in the betamethasone group compared with 59.5% in the control group (P less than .005); in the severity of RDS (P less than .05); and in the death rate (P less than .05). A higher incidence of hypoglycemia was found among infants in the betamethasone group (P less than .05). Prolonged rupture of the membranes played no protective role against RDS, and the incidence of infection was similar in both groups.

Specialized perinatal care: impact on perinatal mortality.

A neonatal intensive care unit was established at one hospital in 1972 when the neonatal mortality was 7.6 and the perinatal mortality 20.9 per 1000 deliveries. In 1973, with full operation of that unit and partial introduction of a high-risk pregnancy unit for fetal monitoring, the rates decreased to 6.4 and 14.9, respectively. With full operation of both units the rates decreased further, to 3.4 and 9.0 in 1974 and 3.8 and 8.9 in 1975. The frequency of cesarean section was 10.1% in 1972-73 and 11.6% in 1974-75. It is concluded that the centralization of obstetric and neonatal care, together with the development of qualified medical and nursing teams, had a major impact in reducing perinatal mortality, and that the frequency of cesarean section was not affected by the introduction of fetal monitoring, although the indications for this precedure became more specific.

Blood group incompatibilities in pregnancy.

Hemolytic disease is the result of red blood cell antibody transfer from mother to fetus causing destruction of fetal red blood cells. Cell destruction is due to the antigen-antibody reaction. While Rh incompatibility has been rendered preventible, there are many other blood groups which can cause the same disease. The author prescribes a plan of management aimed at prevention of the disease, or at least minimization of its effects. He notes that there is no good method of evaluating ABO compatibility antenatally, hence the need for organization of medical manpower, laboratory facilities and technicians to combat the disease.