Subarachnoid hemorrhage: beyond aneurysms.

OBJECTIVE: Spontaneous subarachnoid hemorrhage (SAH) typically prompts a search for an underlying ruptured saccular aneurysm, which is the most common nontraumatic cause. Depending on the clinical presentation and pattern of SAH, the differential diagnosis may include a diverse group of causes other than aneurysm rupture. CONCLUSION: For the purposes of this review, we classify SAH into three main patterns, defined by the distribution of blood on unenhanced CT: diffuse, perimesencephalic, and convexal. The epicenter of the hemorrhage further refines the differential diagnosis and guides subsequent imaging. Additionally, we review multiple clinical conditions that can simulate the appearance of SAH on CT or MRI, an imaging artifact known as pseudo-SAH.

Five steps to cost savings: adjusting ventilator humidification protocols.

Given the current U.S. economy, hospitals are forced to cut expenses. However, these initiatives should not compromise patient safety. William Beaumont Hospital's respiratory care and clinical engineering departments identified a possible cost savings opportunity, which involved adjusting their ventilator humidification techniques. Five steps describe the methodological approach that the departments followed to develop a cost-savings model and to maintain patient safety standards.

Racial differences in the association between carotid plaque and aortic and coronary artery calcification among women transitioning through menopause.

OBJECTIVE: Carotid atherosclerosis is a marker for atherosclerotic disease in other vascular beds; however, racial differences in this association have not been fully examined. The purpose of this report was to evaluate racial differences in the relationship between carotid plaque and calcification in the aorta and coronary arteries among women transitioning through menopause. METHODS: A total of 540 African American and white women with a median age of 50 years were evaluated from the Study of Women's Health Across the Nation. Carotid plaque (none vs. any) was assessed with B-mode ultrasound, and aortic calcification (AC; 0, >0-100, and >100) and coronary artery calcification (CAC; 0, >0-10, and >10) were assessed with CT. RESULTS: For the total cohort, higher prevalence of plaque was significantly associated with higher levels of AC but not CAC. The interaction of race and carotid plaque was significant in models with AC and CAC as dependent variables (P = 0.03 and 0.002, respectively). Among African Americans, there was an inverse relationship, although not significant, between carotid plaque and high AC (>100; odds ratio [OR], 0.75; 95% CI, 0.10-5.48) and between plaque and high CAC (>10; OR, 0.20; 95% CI, 0.03-1.52) in fully adjusted models. In contrast, for whites, significant positive associations existed between carotid plaque and high AC (OR, 4.12; 95% CI, 1.29-13.13) and borderline associations for high CAC (OR, 1.83; 95% CI, 0.66-5.19). CONCLUSIONS: This study demonstrates that the presence of carotid plaque seemed to be a marker for AC and potentially CAC in white women, but not African American middle-aged women, during the menopausal transition.

Diaschisis in cerebral mitochondrial disorder.

PURPOSE: This report highlights the presence of extensive cerebral dysfunction in a patient with cerebral mitochondrial disorder. MATERIALS AND METHODS: The patient is a 10-year-old girl with a history of hemiparesis, encephalopathy, developmental delay, and seizures. She underwent 1H magnetic resonance spectroscopic imaging, magnetic resonance imaging (MRI), and high-resolution regional cerebral blood flow (rCBF) obtained through Tc-99m ethylcysteinate dimer brain SPECT. After 1 year, a follow-up rCBF SPECT scan was obtained. RESULTS: Magnetic resonance spectroscopy showed a relative decrease in N-acetylaspartate in the cerebellar hemispheres and relatively increased choline, indicating increased cerebellar lipid accumulation. MRI findings showed a lack of myelination in the posterior limb of the internal capsule, whereas rCBF showed reduction in the associated gray matter. On parametric statistical analysis of rCBF using 3D-SSP, the reduction in blood flow in both initial and follow-up scans was found to be greater than 3 standard deviations below the mean in the occipital lobes. Cerebral dysfunction could be attributed to an intrinsic abnormality of the gray matter or diaschisis from dysfunctional white matter. CONCLUSIONS: Quantitative assessment of imaging in patients with suspected mitochondrial disorder with only subtle changes on MRI may be better characterized using rCBF and parametric statistical mapping to localize and assess the extent of damage in the brain. Its utility is also valuable when follow-up scans are performed to determine the progression of cerebral change.

Para-hyoid ectopic parathyroid adenoma localized by Tc-99m MIBI SPECT.

A 64-year-old woman with a history of I-131 ablation for Graves hyperthyroidism and bilateral parathyroid exploration with resection of a left inferior parathyroid adenoma presented 2 years after surgery with marked fatigue, irritability, and joint pain. Laboratory testing revealed an elevated calcium and parathyroid hormone levels suspicious for hyperparathyroidism. The ultrasound indicated no evidence of a parathyroid adenoma. Tc-99m-MIBI SPECT demonstrated a focus of uptake posteroinferior to the right submandibular gland, suspicious for a parathyroid adenoma. Repeat ultrasound and CT confirmed the presence of a para-hyoid adenoma inferior to the right submandibular gland.