Neuroimaging Clinics of North America: Neuroradiology Emergencies

Mukherji SK, Cons. Ed.  Gean AD, Guest Ed.  Neuroimaging Clinics of North America: Neuroradiology Emergencies. Volume 20, Number 4, November 2010.  Theclinics.com, pages 455-690, 12 month subscription $314.00.

In this issue of the Neuroimaging Clinics of North America, Alisa Gean has solicited and edited 12 chapters dealing with the commonly encountered emergencies in which neuroradiology is required. The topics covered are Imaging of Acute Ischemic Stroke (incidentally to be the topic of an entire Neuroimaging Clinics of North America in 2011), Non-traumatic Intracranial Hemorrhage, Neurointerventional, Therapies, Acute Sinusitis and its Complications, Head Trauma, CNS Infections, Mid Face Fractures, Intracranial Hypotension and Hypertension, Seizures, Vascular and Infectious Causes of Spine Emergencies, Infectious and Inflammatory Causes of Head and Neck Emergencies, Pediatric CNS Emergencies. Twenty-four authors have contributed to these chapters.

This issue summarizes important topics with which all neuroradiologists should be familiar. Starting with ischemic stroke, the authors (Leiva-Salinas and Wintermark) explain and demonstrate the use of CT and MR in this condition. After the basic concepts of irreversible ischemic are explained, there follows the  technical parameters and protocols used for both modalities, the rationale for treatment  and added clinical examples of the use of CT and MR metrics to evaluate the core infarction and the surrounding tissue at risk. This chapter is nicely followed (2 chapters later) by a chapter by Drs. Hetts and English on neurointerventional therapies, the first part of which deals with cerebral ischemic disease. Together these two chapters solidify present day concepts in ischemic stroke. The authors describe not only the commonly appreciated diffusion/perfusion mismatch but the less commonly appreciated early diffusion/perfusion match. The imaging chapter nicely compares the use of CT and MR in deriving critical metrics (although the jury is still out on this, the immediate availability of CT combined with the increasing number of detectors to allow better brain coverage appears to favor CT evaluation). The chapter on non-traumatic intracranial hemorrhage (24 pages) goes over not only the various etiologies of such hemorrhages but summarizes the evolving appearances of blood on MR, the Spetzler -Martin AVM grading system, and the classification of dural AVFS (Borden and Cognard Classification). The images are crisp, well selected, and educational and include a case of reversible cerebral vasoconstriction (RCVS) associated with a parenchymal hemorrhage, an entity which is not widely known. The chapter on midface fractures is worth more than a glance at the images because the chapter contains substantial clinical ENT input. This is important since one often wonders what the incremental value of a radiology report might be when these images are viewed by an experienced and knowledgeable facial surgeon. Therefore a table showing a check list of zygomatic maxillary complex fractures, and why the reporting of certain findings is helpful to the surgeons, and why exactly 3D reformats in addition to MPRs are desirable in all these fracture cases, is a nice addition to this chapter.

Another chapter worth nothing is the one by Yuh and Dillon on Intracranial Hypotension and Hypertension. We are reminded of the normal variations of intracranial/intraspinal pressures, of the often subtle spinal findings seen in SIH (spontaneous intracranial/intraspinal hypertension), the theoretical reasons behind the frequent observation of the false localizing sign of a site of CSF leak with retrospinal fluid at the CI-C3 levels, the physiological reason for the formation of intracranial subdural fluid collections in SIH, the role of disc/osteophytes in causing CSF leaks, MR and CT protocols for leak detection, and treatment methods.

The chapter on Head Trauma by Gean and Fischbein pulls together not only the well recognized features of trauma but adds some adjunct information and imaging such as the value of CTP in what appears to be a limited area of cerebral contusion, what the authors term a pseudoanatonic display of white matter tracts in TBI (good explanation of this), fMR in concussion (not contusion). What is particularly nice about this whole chapter are the extensive legend for each figure—it makes understanding the illustrations easy. This is about as good a summary of head trauma as you will find anywhere.

The chapter on Seizures in emergency situations (Hess and Barkovich) brings to the reader information and descriptions of conditions which may not be widely appreciated. Both primary causes of seizures and secondary manifestations of them are illustrated and explained. In addition, MR seizures protocols are displayed in a Table—and as all readers of the AJNR are aware, high resolution images are frequently needed to detect the cause of or effect of epilepsy.

To understand how complete this issue is, one needs only to see that emergency spinal conditions (Wang, Chou, Chin) and emergencies in the head and neck (McKellop, Bou-Assaly, Mukherji) are included and both summarize these critical situations well. In fact, as one thinks about the work a neuroradiologist does on a daily basis, much of it (not all, obviously) can be considered emergent under the proper conditions—this issue of the Neuroimaging Clinics of North America accentuates that fact. This, therefore, is a highly recommended volume because the most important problems a neuroradiologist deals with are emergency or near emergency situations.

To add a whimsical note, the Guest Editor (Alisa Gean), admits in her written preface that she cannot recall ever having read any preface to any book in the past. This issue should either be purchased individually or as a minimum be part of a sections’ library.

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