An asthma collaboration to reduce childhood asthma disparities on the Navajo Nation: Trial protocol for the Community Asthma Program.

Navajo children disproportionately experience poor asthma outcomes. Following a one-year community engagement period with key stakeholders from the Navajo Nation, the Community Asthma Program (CAP) was created using evidenced based programs with the goal of reducing asthma disparities among Navajo children. CAP is being evaluated with a six-year, multi-site step-wedge design in three Navajo communities: Tuba City, Chinle and Fort Defiance, Arizona. The primary outcome is asthma exacerbations defined as use of systemic oral corticosteroids, asthma hospitalizations, asthma related ED visits, and ICU admissions. Asthma exacerbations will be measured using data from the electronic medical records of the three community health care centers. Secondary outcomes include will changes in asthma-related events and asthma control. The RE-AIM ( R each and representativeness, 2) E ffectiveness, 3) A doption, 4) I mplementation, and 5) M aintenance) framework is being used to guide the implementation evaluation which includes iterative collection and analysis of process data to identify facilitators and barriers, describe relevant organizational contexts, and inform strategies for dissemination. The CAP intervention requires community engagement and participation, building community capacity, incorporating evidenced-based guidelines and practices while ensuring program strategies actively involve Navajo community members during all steps of the intervention. The outcome of this trial will allow us to determine the effectiveness of a multi-component, community-focused intervention to improve asthma in a tribal community.

Digital Communication Technology: Does Offering a Choice of Modality Improve Medication Adherence and Outcomes in a Persistent Asthma Population?

BACKGROUND: Use of digital communication technology has shown potential to improve asthma adherence and outcomes. Few studies have looked at patient preference around mode of medication reminders used to improve and maintain asthma medication adherence. OBJECTIVE: To determine if, in a population already receiving automated medication reminders, offering a choice for preferred mode of reminder (text, email, phone) would improve their adherence and asthma outcomes over a 1-year period. METHODS: This was a pragmatic, randomized controlled trial conducted at Kaiser Permanente Colorado involving 7522 adult patients with persistent asthma. Study patients were randomized to receive usual care or their choice of medication reminder. Differences between the 2 groups in both medication adherence and asthma outcomes were then assessed over the following year. RESULTS: Only 30% of those offered a choice of medication reminder modality responded by making a choice, with 52% preferring text messaging. There was less of a decrease in adherence rate over the 1-year period in those who made a choice regarding the mode of medication refill reminder. There was no difference in asthma outcomes between those who did make a choice compared with those who did not make a choice regarding the mode of medication refill reminder. CONCLUSION: In a patient population already receiving medication reminders, offering a choice about what type of technology-enabled asthma medication reminder patients wanted did not improve outcomes but did enable a subgroup to better maintain their medication adherence.

Recurrent ischaemic cerebrovascular events as presenting manifestations of myeloproliferative neoplasms.

BACKGROUND AND PURPOSE: Myeloproliferative neoplasms (MPNs) - polycythemia vera, essential thrombocythemia and primary myelofibrosis - are associated with increased risk for ischaemic cerebrovascular events (ICVEs). Due to their low prevalence, MPNs often remain undiagnosed as the cause of ICVEs. METHODS: Case records at the University of Tübingen between 2014 and 2017 were screened to identify patients with MPN-related ICVEs. Clinical features, brain imaging, laboratory findings, applied treatments and neurological outcomes were assessed. RESULTS: In all, 3318 patients with ICVEs were identified, and amongst them 17 patients with MPN-related ICVEs were included in a retrospective study. In 58% of these patients, ICVEs were the first manifestation of the underlying MPN; 24% presented with transient ischaemic attack and 76% with ischaemic stroke. Potentially concurrent ICVE etiologies were noted in 70% of the patients. The majority (94%) of patients were positive for the JAK2 V617F mutation, whilst in 29% recurrent ICVEs (range two to three) were noted prior to MPN diagnosis. Early MPN diagnosis and management was the only significant prognostic factor for ICVE recurrence (P < 0.001). DISCUSSION: Evidence is provided that, although rare, MPNs represent an underdiagnosed cause of recurrent ICVEs. High clinical awareness is warranted to identify an underlying MPN in patients presenting with sustained, abnormal blood count findings. Clinical algorithms for prompt MPN diagnosis and initiation of MPN treatment (e.g. cytoreductive therapy, phlebotomy) are required. As MPN management comprises a significant protective factor against ICVE recurrence, induction of MPN treatment should be regarded as an integral component of secondary stroke prevention in MPN-associated ICVEs.

Depiction of the Superior Petrosal Vein Complex by 3D Contrast-Enhanced MR Angiography.

BACKGROUND AND PURPOSE: Intraoperative obliteration of the superior petrosal vein complex has a relevant risk of postoperative complications. A large venous diameter and the absence of anastomoses have been previously suggested as possible risk factors. 3D contrast-enhanced MRA was evaluated for the identification of superior petrosal vein anatomy. MATERIALS AND METHODS: Twenty-five patients (10 men; age, 20-77 years) with a 3D-MRA (voxel size, 0.4 × 0.4 × 0.5 mm3) at 3T, including the posterior fossa, were retrospectively identified. Image evaluation was performed independently by 2 neuroradiologists with respect to overall image quality and the presence, location, size, tributaries, and anastomotic veins of the superior petrosal vein complex. Additionally, 8 neurosurgical cases with intraoperative validation of the venous anatomy were examined. RESULTS: All studies were of diagnostic image quality. Interobserver agreement was excellent for image-quality measurements (r = 0.751-0.982) and good for measured vessel size (r = 0.563-0.828). A total of 83 superior petrosal veins were identified. The distribution of drainage locations and identification of tributaries and anastomotic veins were consistent with previous anatomic studies. The results showed that 4.8% of superior petrosal veins had a diameter of >2 mm and lacked a visible anastomosis. All surgical cases showed excellent agreement between the MRA and the intraoperative observations. CONCLUSIONS: 3D-MRA with high resolution is appropriate for analyzing the size, course, tributaries, and anastomoses of the superior petrosal vein. A total of 4.8% of the identified superior petrosal veins had to be classified as potential high-risk veins. The measurements correlated with the intraoperative findings.

Systematic Assessment of Multispectral Voxel-Based Morphometry in Previously MRI-Negative Focal Epilepsy.

BACKGROUND AND PURPOSE: Voxel-based morphometry is widely used for detecting gray matter abnormalities in epilepsy. However, its performance with changing parameters, smoothing and statistical threshold, is debatable. More important, the potential yield of combining multiple MR imaging contrasts (multispectral voxel-based morphometry) is still unclear. Our aim was to objectify smoothing and statistical cutoffs and systematically compare the performance of multispectral voxel-based morphometry with existing T1 voxel-based morphometry in patients with focal epilepsy and previously negative MRI. MATERIALS AND METHODS: 3D T1-, T2-, and T2-weighted FLAIR scans were acquired for 62 healthy volunteers and 13 patients with MR imaging negative for focal epilepsy on a Magnetom Skyra 3T scanner with an isotropic resolution of 0.9 mm3. We systematically optimized the main voxel-based morphometry parameters, smoothing level and statistical cutoff, with T1 voxel-based morphometry as a reference. As a next step, the performance of multispectral voxel-based morphometry models, T1+T2, T1+FLAIR, and T1+T2+FLAIR, was compared with that of T1 voxel-based morphometry using gray matter concentration and gray matter volume analysis. RESULTS: We found the best performance of T1 at 12 mm and a T-threshold (statistical cutoff) of 3.7 for gray matter concentration analysis. When we incorporated these parameters, after expert visual interpretation of concordant and discordant findings, we identified T1+FLAIR as the best model with a concordant rate of 46.2% and a concordant rate/discordant rate of 1.20 compared with T1 with 30.8% and 0.67, respectively. Visual interpretation of voxel-based morphometry findings decreased concordant rates from 38.5%-46.2% to 15.4%-46.2% and discordant rates from 53.8%-84.6% to 30.8%-46.2% and increased specificity across models from 33.9%-40.3% to 46.8%-54.8%. CONCLUSIONS: Multispectral voxel-based morphometry, especially T1+FLAIR, can yield superior results over single-channel T1 in focal epilepsy patients with a negative conventional MR imaging.

A novel frameshift variant in the CADASIL gene NOTCH3: pathogenic or not?

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL) represents the most common monogenic cause of adult-onset ischemic stroke and vascular dementia. It is caused by heterozygous missense mutations in the NOTCH3 gene, encoding a transmembrane receptor protein on vascular smooth muscle cells. Classical CADASIL mutations affect conserved cysteine residues of the Notch3 protein. By contrast, the role of non-canonical genetic variation in NOTCH3, in particular of variants causing a hypomorphic Notch3 protein, is subject to an ongoing scientific debate. In this context, we here report a novel NOTCH3 frameshift variant in exon 18 (NM_000435.2: c.2853_2857delTCCCG), causing a frameshift and introducing a premature stop codon, which was detected in a 43-year-old woman and her father. Both carriers of the variant were carefully evaluated, including serial follow-up in the index. Neither clinical nor imaging features provided convincing evidence for a classical CADASIL phenotype, thus reinforcing the concept of hypomorphic NOTCH3 variants most likely not being causative for CADASIL. Our finding, which is discussed in the light of the published literature, has practical implications for interpreting results of NOTCH3 molecular genetic testing as well as patient counseling.

In vivo assessment of tumor heterogeneity in WHO 2016 glioma grades using diffusion kurtosis imaging: Diagnostic performance and improvement of feasibility in routine clinical practice.

PURPOSE: To assess the diagnostic performance of normalized and non-normalized diffusion kurtosis imaging (DKI) metrics extracted from different tumor volume data for grading glioma according to the integrated approach of the revised 2016 WHO classification. MATERIALS AND METHODS: Sixty patients with histopathologically confirmed glioma, who provided written informed consent, were retrospectively assessed between 01/2013 and 08/2016 from a prospective trial approved by the local institutional review board. Mean kurtosis (MK) and mean diffusivity (MD) metrics from DKI were assessed by two blinded physicians from four different volumes of interest (VOI): whole solid tumor including (VOItu-ed) and excluding perifocal edema (VOItu), infiltrative zone (VOIed), and single slice of solid tumor core (VOIslice). Intra-class correlation coefficient (ICC) was calculated to assess inter-rater agreement. One-way ANOVA was used to compare MK between 2016 CNS WHO tumor grades. Friedman's test compared MK and MD of each VOI. Spearman's correlation coefficient was used to correlate MK with 2016 CNS WHO tumor grades. ROC analysis was performed on MK for significant results. RESULTS: The MK assessment showed excellent inter-rater agreement for each VOI (ICC, 0.906-0.955). MK was significantly lower in IDHmutant astrocytoma (0.40±0.07), than in 1p/19q-confirmed oligodendroglioma (0.54±0.10, P=0.001) or IDHwild-type glioblastoma (0.68±0.13, P<0.001). MK and 2016 WHO tumor grades were strongly and positively correlated (VOItu-ed, r=0.684; VOItu, r=0.734; VOIed, r=0.625; VOIslice, r=0.698; P<0.001). CONCLUSIONS: Non-normalized MK values obtained from VOItu and VOIslice showed the best reproducibility and highest diagnostic performance for stratifying glioma according to the integrated approach of the recent 2016 WHO classification.

Growth responses and accumulation of soluble sugars in Inga marginata Wild. (Fabaceae) subjected to flooding under contrasting light conditions / Respostas de crescimento e acúmulo de açúcares solúveis em Inga marginata Willd. (Fabaceae) submetida ao alagamento e sob condições contrastantes de luminosidade

Abstract Flood events in riparian forests of southern Brazil, can be characterized as unpredictable and of low magnitude with an average duration of less than 15 days. Inga marginata is an evergreen tree which grows in Southeast South America on a wide range of environments, including riparian forests. In this paper, the interactive effects of the light environment and soil flooding on morphological parameters of I. marginata were examined. Seedlings were acclimated in two contrasting light conditions: sun or shade for 30 days. Sun and shade plants were subjected to soil flooding for two periods; five or 15 days. After 5 days, the interaction between flooding and light did not affect growth, chlorophyll content and dry mass or the root-shoot ratio. After 15 days, flooded plants from the sunny treatment had a lower shoot dry mass compared to control sun plants and flooded plants from the shaded treatment. Moreover, the higher dry mass observed for shade plants compared to sun plants, following flooding, can also be directly associated with a higher content of soluble sugars. Shade plants of I. marginata showed a greater acclimation to soil waterlogging. This acclimation appears to be associated with a larger accumulation of soluble sugars compared to non-flooded plants. The responses observed on the shade plants appear to be decisive to indicate the use of I. marginata in degraded areas.

Resumo As inundações em florestas ripárias do Sul do Brasil, podem ser caracterizadas como imprevisíveis e de baixa magnitude com uma duração média de menos de 15 dias. Inga marginata é uma árvore que cresce no sudeste da América do Sul em uma grande variedade de ambientes, incluindo matas ciliares. Neste trabalho, os efeitos combinados da luminosidade e do e alagamento do solo nos parâmetros morfológicos de I. marginata foram examinados. As plântulas foram aclimatadas em duas condições contrastantes de luminosidade: sol e sombra por 30 dias. Plantas de sol e sombra foram submetidas ao alagamento do solo por dois períodos; cinco ou 15 dias. Após 5 dias, a interação entre a inundação e luminosidade não afetou o crescimento, teor de clorofila e massa seca e a razão raiz-parte aérea. Após 15 dias, plantas de sol sob inundação apresentaram menor massa seca na parte aérea em relação as plantas controle de sol e as plantas alagadas de sombra. Além disso, a maior massa seca observada nas plantas de sombra em comparação com plantas de sol, sob inundação, pode ser diretamente associado com um maior teor de açúcares solúveis. Plantas de sombra de I. marginata mostraram uma maior aclimatação ao encharcamento do solo. Esta aclimatação parece estar associada com um maior acúmulo de açúcares solúveis em comparação com as plantas não-inundadas. As respostas observadas nas plantas de sombra parecem ser determinantes para a indicação do uso de I. marginata em áreas degradadas.

The effect of video-assisted oral feedback versus oral feedback on surgical communicative competences in undergraduate training.

PURPOSE: Feedback can significantly improve future performance. Reviewing one's performance by video is discussed as useful adjunct to debriefing, particularly for non-technical skills. Communicative competencies are an essential part of daily clinical practice; thus should be taught and assessed during undergraduate training. The aim of this study was to compare the educational value of video-assisted feedback versus oral feedback in communicative competencies in the surgical context. METHODS: Fourth-year medical students completed a 210-min training unit of 'taking patient's history and obtaining informed consents prior to surgery' using role plays. Oral feedback was received directly thereafter using agenda-led, outcome-based guidelines (ALOBA). In the study group, the role plays were video-taped and reviewed thereafter. Afterwards, students completed two OSCE stations, where they were assessed regarding their communicative competencies and the content of the clinical scenario. RESULTS: One-hundred students (49 receiving video-assisted feedback, 51 oral) participated in the study. Those receiving video-assisted feedback performed significantly better in overall score in both OSCE stations (p < 0.001), in all five assessed communicative competencies at taking patient history (p = 0.029 or better), and in 2 of 5 items at obtaining informed consent (p = 0.008, <0.001). The educational effect size for both tasks was large. CONCLUSION: Using our methodology, video-assisted feedback offered a significant educational benefit over oral feedback alone during a simulated patient encounter in a surgical context.

Growth responses and accumulation of soluble sugars in Inga marginata Wild. (Fabaceae) subjected to flooding under contrasting light conditions.

Flood events in riparian forests of southern Brazil, can be characterized as unpredictable and of low magnitude with an average duration of less than 15 days. Inga marginata is an evergreen tree which grows in Southeast South America on a wide range of environments, including riparian forests. In this paper, the interactive effects of the light environment and soil flooding on morphological parameters of I. marginata were examined. Seedlings were acclimated in two contrasting light conditions: sun or shade for 30 days. Sun and shade plants were subjected to soil flooding for two periods; five or 15 days. After 5 days, the interaction between flooding and light did not affect growth, chlorophyll content and dry mass or the root-shoot ratio. After 15 days, flooded plants from the sunny treatment had a lower shoot dry mass compared to control sun plants and flooded plants from the shaded treatment. Moreover, the higher dry mass observed for shade plants compared to sun plants, following flooding, can also be directly associated with a higher content of soluble sugars. Shade plants of I. marginata showed a greater acclimation to soil waterlogging. This acclimation appears to be associated with a larger accumulation of soluble sugars compared to non-flooded plants. The responses observed on the shade plants appear to be decisive to indicate the use of I. marginata in degraded areas.

[Upper Airway Stimulation in OSA]. / Hypoglossusstimulation bei OSAS.

Anatomical basis of obstructive sleep apnea (OSA) is the collapse of the pharynx during sleep. It is considered as a result of complex interactions of structural and neuromuscular factors. Depth of sleep and body position have modulating effects. Although different areas of obstruction were identified, studies show that the sleep-mediated obstruction frequently occurs in the base of tongue area.Continuous positive airway pressure (CPAP) is the standard treatment for obstructive sleep apnea syndrome (OSAS) since more than 30 years. In several studies, treatment compliance was approximately 70%. So CPAP intolerance requires alternative surgical and non-surgical treatments.Functional electrical stimulation of upper airway muscles was investigated in the early 1980s. Studies have shown that stimulation of certain muscle groups increases the upper airway lumen. The major role of the hypoglossal nerve in upper airway obstruction was detected. The XII. cranial nerve innervates the genioglossus muscle, which stabilizes the anterior oropharynx substantially. Whereas a complete stimulation of the nerve leads to co-activation of other muscles including constrictors, the selective stimulation of anterior nerve branches causes advancement of the genioglossus.For hypoglossal nerve stimulation (HNS), the Inspire™ system and the ImThera™ device are currently approved in Europe. After extensive studies in animals and clinical examination of the concept of hypoglossal nerve stimulation (HNS), the results of the multicenter, prospective STAR study (Stimulation Therapy for Apnea Reduction) with the Inspire system were recently published. This study revealed that HNS can prevent the pharyngeal collapse without waking up the patient from sleep. The HNS with this device resulted in a significant improvement of both objective and subjective parameters of the severity of OSA.Electrical stimulation of the hypoglossal nerve is a new treatment for patients with moderate to severe OSA, who do not tolerate standard treatment.

Potential of combining iterative reconstruction with noise efficient detector design: aggressive dose reduction in head CT.

OBJECTIVE: With further increase of CT numbers and their dominant contribution to medical exposure, there is a recent quest for more effective dose control. While reintroduction of iterative reconstruction (IR) has proved its potential in many applications, a novel focus is placed on more noise efficient detectors. Our purpose was to assess the potential of IR in combination with an integrated circuit detector (ICD) for aggressive dose reduction in head CT. METHODS: Non-contrast low-dose head CT [190 mAs; weighted volume CT dose index (CTDIvol), 33.2 mGy] was performed in 50 consecutive patients, using a new noise efficient detector and IR. Images were assessed in terms of quantitative and qualitative image quality and compared with standard dose acquisitions (320 mAs; CTDIvol, 59.7 mGy) using a conventional detector and filtered back projection. RESULTS: By combining ICD and IR in low-dose examinations, the signal to noise was improved by about 13% above the baseline level in the standard-dose control group. Both, contrast-to-noise ratio (2.02 ± 0.6 vs 1.88 ± 0.4; p = 0.18) and objective measurements of image sharpness (695 ± 84 vs 705 ± 151 change in Hounsfield units per pixel; p = 0.79) were fully preserved in the low-dose group. Likewise, there was no significant difference in the grading of several subjective image quality parameters when both noise-reducing strategies were used in low-dose examinations. CONCLUSION: Combination of noise efficient detector with IR allows for meaningful dose reduction in head CT without compromise of standard image quality. ADVANCES IN KNOWLEDGE: Our study demonstrates the feasibility of almost 50% dose reduction in head CT dose (1.1 mSv per scan) through combination of novel dose-reducing strategies.

Recombinant human tissue non-specific alkaline phosphatase successfully counteracts lipopolysaccharide induced sepsis in mice.

Sepsis is a life threatening condition that arises when the body's response to an infection injures its own tissues and organs. Sepsis can lead to shock, multiple organ failure and death especially if not recognized early and treated promptly. Molecular mechanisms underlying the systemic inflammatory response syndrome associated with sepsis are still not completely defined and most therapies developed to target the acute inflammatory component of the disease are insufficient. In this study we investigated a possibility of combating sepsis in a mouse model by intravenous treatment with recombinant human tissue non-specific alkaline phosphatase (rhTNAP) derived from transgenic rabbit milk. We induced sepsis in mice by intraperitoneal injection of LPS and three hours later treated experimental group of mice by intravenous injection with rhTNAP derived from transgenic rabbits. Such treatment was proved to be physiologically effective in this model, as administration of recombinant rhTNAP successfully combated the decrease in body temperature and resulted in increased survival of mice (80 % vs. 30 % in a control group). In a control experiment, also the administration of bovine intestinal alkaline phosphatase by intravenous injection proved to be effective in increasing survival of mice treated with LPS. Altogether, present work demonstrates the redeeming effect of the recombinant tissue non-specific AP derived from milk of genetically modified rabbits in combating sepsis induced by LPS.

Grading of carotid artery stenosis in the presence of extensive calcifications: dual-energy CT angiography in comparison with contrast-enhanced MR angiography.

PURPOSE: We investigated the agreement of dual-energy computed tomography angiography (DE-CTA) and contrast-enhanced magnetic resonance angiography (CE-MRA)in the quantitative measurement of stenoses of the internal carotid artery in comparison with digital subtraction angiography (DSA). METHODS: A total of 21 patients with stenoses of the external carotid artery were investigated with a DE-CTA and CE-MRA before undergoing carotid angioplasty. The grade of the stenoses was assessed in axial multiplanar reformations (MPR) before and multi-intensity projections (MIP) after plaque subtraction (PS) and compared with results from CE-MRA and DSA according to the North American Symptomatic Carotid Endarterectomy Trial. RESULTS: Average grades of stenoses were 80.7 ± 16.1 % (DSA), 81.4 ± 15.3 % (MRA), 80.0 ± 16.7 % (DE-CTA-MPR), and 85.2 ± 14.7 % (DE-CTA-PS-MIP). Of 21 stenoses, 6 were filiform (stenosis grade, 99 %) in the DSA examination. Five of these cases were identified as pseudo-occlusions in MRA, while four were considered as occlusions in DE-CTA-PS-MIP. Another four cases were identified as pseudo-occlusion in DE-CTA-PS-MIP, which were identified as 90 % stenosis in the DSA examination. CONCLUSIONS: In comparison with the gold standard DSA, DE-CTA-MPR had a slightly better agreement in measuring the degree of stenosis of the internal carotid arteries than CE-MRA. In DE-CTA-PS-MIP images, a systematic overestimation has to be taken into account due to partial extinction of the lumen by the PS algorithm. Nevertheless, DE-CTA should be preferred in imaging patients with carotid artery stenosis in the presence of extensive calcifications.

No association between obesity and post-tonsillectomy haemorrhage.

BACKGROUND: The prevalence of overweight and obesity is increasing worldwide. The impact of overweight on post-tonsillectomy haemorrhage rates in children and adults is unclear. METHODS: Body mass index and post-tonsillectomy haemorrhage were evaluated in all patients treated with tonsillectomy within one year in a tertiary referral centre. Bleeding episodes were categorised according to the Austrian Tonsil Study. RESULTS: Between June 2011 and June 2012, 300 adults and children underwent tonsillectomy. Post-tonsillectomy haemorrhage occurred in 55 patients. Of those, 29 were type A (history of blood in saliva only, no active bleeding), 15 were type B (active bleeding, treatment under local anaesthesia) and 11 were type C (active bleeding, treatment under general anaesthesia). The return to operating theatre rate was 3.7 per cent. Post-tonsillectomy haemorrhage was more frequent in adolescents and adults than in children. Overweight or obesity was positively correlated with age. Post-tonsillectomy bleeding was recorded in 11.1 per cent of underweight patients, 18.9 per cent of normal weight patients and 18.7 per cent of overweight patients (p = 0.7). Data stratification (according to age and weight) did not alter the post-tonsillectomy bleeding risk (p = 0.8). CONCLUSION: Overweight or obesity did not increase the risk of post-tonsillectomy haemorrhage in either children or adults.

Clinical and imaging findings in children with non-syndromic lambdoid synostosis.

UNLABELLED: True unilateral lambdoid synostosis is a very rare type of craniosynostosis. Patients present with unilateral posterior plagiocephaly. The differentiation between frequent, simple positional (deformational) posterior plagiocephaly and lambdoid synostosis is not easy and to date subject of controversy. Accurate and early diagnosis is important, because treatment is different. Simple positional plagiocephaly responds to conservative treatment, but craniosynostosis may require neurosurgical intervention. We analyzed clinical presentation of five patients in whom non-syndromic lambdoid synostosis was confirmed by CT imaging, in one additionally by high-resolution ultrasound, and finally neurosurgical intervention. However, clinical inspection alone did not reliably identify infants with lambdoid synostosis. CONCLUSION: Diagnosis of lambdoid synostosis is not always possible based on clinical inspection alone. To confirm the diagnosis imaging is recommended. There is evidence that high-resolution ultrasound can be used first-line in the future.