Prevalence and Reporting Rates of Incidental Dental Disease on Head CT Examinations.

RATIONALE AND OBJECTIVES: Routine head computed tomography (CT) examinations often inadvertently include dental pathology which is often overlooked. The purpose of this study is to examine the prevalence of dental disease incidentally present and detected on head CT examinations, and to determine the effect of the institution of a dental disease field or macro in a standardized head CT dictation template on the rate of reporting dental disease. MATERIALS AND METHODS: Head CT examinations were retrospectively and randomly selected from all examinations performed 6 months before, and 6 months after the institution of a dental disease field in a standardized head CT template. Dental findings were recorded from the initial finalized report. Examination images were subsequently reviewed for the presence of dental disease by two neuroradiologists who were blinded to the original reports and to each other's findings. RESULTS: One hundred examinations were reviewed in the analysis. At our institution, 33% of the randomly selected head CT examinations included the level of the teeth (100/307). Dental disease was determined to be present in 40%-41% of these cases. Only 11% of the initial reports mentioned dental disease (P < .01). Addition of a dental disease field in the dictation template resulted in no significant difference in reporting dental disease (14% vs 8%, P = .371). CONCLUSIONS: Incidental dental disease is common and frequently underreported. Inclusion of a dental disease field in a standardized template does not significantly improve the rate of reporting dental disease.

What is the diagnostic value of head MRI after negative head CT in ED patients presenting with symptoms atypical of stroke?

The diagnostic value of head magnetic resonance imaging after negative head computed tomography for emergency department patients with vague neurologic symptoms, such as dizziness and altered mental status, remains an ongoing discussion. The objective of this study is to detect the subgroup of patients with such presentations having minor strokes whom may benefit from primary and secondary stroke prevention. We conducted a retrospective analysis and stratified patient risk factors associated with positive findings on subsequent head MRI ordered by the emergency department physician following a normal head CT. Two hundred fifty-two patients presenting with atypical stroke symptoms to the emergency department had a negative head CT followed by head MRI within 24 h ordered by emergency department clinician (123 males and 129 females; mean age of 59.4). Twenty nine of the 252 patients (11.5 %) had findings of acute to subacute infarct on the subsequent MRI. Positive MRI findings were statistically correlated with the following variables: age (p < 0.001), history of hyperlipidemia (p = 0.019), hypertension (p < 0.001), diabetes (p = 0.004), anticoagulation use (p = 0.029), and prior transient ischemic attack or stroke (p < 0.001). The mean age of the MRI-positive group was 74.1 years, with a mean difference of 16.7 ± 2.4 years more than the MRI-negative group (95 % CI, 11.8-21.5 years) (t = 6.8, p < 0.001). Emergency physicians caring for patients with vague neurologic complaints should maintain a lower threshold for ordering a head MRI despite a negative head CT for elderly patients with a history of prior stroke or transient ischemic attack to exclude a CT occult or minor ischemic stroke.

Congenital cystic lesions of the head and neck.

This article presents clinical characteristics and radiologic features of congenital cervical cystic masses, among them thyroglossal duct cysts, cystic hygromas, branchial cleft cysts, and the some of the rare congenital cysts, such as thymic and cervical bronchogenic cysts. The imaging options and the value of each for particular masses, as well as present clinical and radiologic images for each, are discussed.

Extracorporeal shock wave lithotripsy in impacted upper ureteral stones: a prospective randomized comparison between stented and non-stented techniques.

OBJECTIVES: To assess the need for pre-extracorporeal shock wave lithotripsy (pre-ESWL) stenting in management of impacted upper ureteral stones of size < or = 2 cm and to verify whether stenting would influence the success of therapy. METHODS: Between 2007 and 2008, a total of 60 patients with solitary, radio-opaque impacted upper ureteral stones measuring < or = 2 cm were divided into 2 equal groups: a stented group with a Double-J stent fixed pre-ESWL and a non-stented group treated by in situ ESWL. All patients were treated by ESWL using Dornier Doli S lithotripter. Results were compared in terms of clearance rates, number of shock waves and sessions, morbidity, and incidence of complications. Pretreatment KUB (kidneys, ureters, and bladder) and intravenous pyelogram and post-treatment KUB were used to evaluate fragmentation and clearance. RESULTS: Overall stone-free rate was 88.3%. No significant statistical difference was observed in stone-free rate between the stented and non-stented groups being 90% and 86.7%, respectively (P = .346). One session was required in 28.3% of patients, whereas multiple sessions were required in 71.7% of patients. No significant statistical difference was noted in re-treatment rate in the 2 groups. Patients in the stented group significantly complained of side effects attributable to the stent predominantly dysuria, urgency, frequency, and suprapubic pain. CONCLUSIONS: ESWL is an effective and reasonable initial therapy in the management of impacted upper ureteral stones measuring < or = 2 cm. Pre-ESWL ureteral stenting provides no additional benefit over in situ ESWL. Moreover, ureteral stents are associated with significant patient discomfort and morbidity.

Multifocal paraneoplastic cortical encephalitis associated with myasthenia gravis and thymoma.

OBJECTIVES: To report a case of multifocal cortical encephalitis associated with thymoma and to establish an association of this thymoma-related paraneoplastic syndrome with voltage-gated potassium channel antibodies. DESIGN: Case report. SETTING: University hospital. PATIENT: A 43-year-old woman with a history of seropositive myasthenia gravis and successfully treated invasive thymoma. Four years after thymectomy, she presented with seizure and rapidly progressive confusion and aphasia. Myasthenia gravis remained in pharmacological remission. Magnetic resonance imaging of the brain showed innumerable cortically based signal abnormalities as well as extensive left mesial temporal lobe abnormality with minimal enhancement. RESULTS: Chest computed tomography showed abnormal pleural thickening of the left lung, which proved to be recurrent metastatic thymoma. Results of serological evaluation were positive for acetylcholine receptor, striational, and voltage-gated potassium channel antibodies. She showed partial improvement in response to immunotherapy and chemotherapy but ultimately died 2 months later of tumor complications. CONCLUSIONS: Thymoma and myasthenia gravis may be associated with other autoimmune neurological disorders including paraneoplastic encephalitis. This second case of thymoma-associated multifocal cortical encephalitis demonstrates that autoimmune encephalitis can extend to cortical regions outside the limbic system. Autoimmune encephalitis should be considered in the differential diagnosis of patients with myasthenia gravis or thymoma who develop new cognitive symptoms.