June Journal Round-Up

Welcome to the June journal round-up! A reminder before we start that registration for the BSNR Annual Meeting is open, with the Trainee day preceding it on the 11th October which will have a diagnostic neurovascular focus. And also for UK trainees, if you haven’t already filled out the BSNR trainee survey please do! It’s available here.

Emergency – Spontaneous intracranial haemorrhage is a common presentation and the differential diagnosis is wide; Kranz et al. have written a helpful overview identifying key features to report and how to narrow the differential. Their mnemonic ‘BLEED’ for the key reporting features in ICH (how Big, Location, Edema, Extension, Displacement) is also useful, particularly in teaching junior registrars what to include.

Vascular – There were plenty of useful neurovascular articles published last month, and it seems appropriate to start with Lin et al.’s comprehensive discussion of neurovascular imaging techniques in Neurosurgery, which concisely covers the logic behind using different vascular imaging techniques for different pathologies and examines their particular uses in clinical scenarios.

Adam et al. in Insights into Imaging consider stroke mimics, covering the major differential diagnoses and how to use different MRI sequences in order to diagnose these appropriately. Their flowchart in figure 1 is a useful reference for specific imaging features for the numerous mimics.

Now that thrombectomy is being widely used for proximal large vessel occlusions, the obvious next step which many are taking is to chase the more distal occlusions and Grossberg et al. in Stroke provide some data to support this approach. In their cohort of 69 patients, there was only a slightly lower mRS 0-2 outcome compared with their larger proximal thrombectomy cohort (32% vs 44%) and a similar mortality, and a good reperfusion rate of 83% (TICI 2b-3), suggesting this may be a safe and effective treatment option although larger cohorts are required.

Cerebral venous sinus thrombosis is thought to be underdiagnosed and is often missed initially, so Dytriw et al.’s review in Neuroradiology is a good opportunity to review the clinical, pathophysiological and imaging features of this condition, outlining the utility and drawbacks of different imaging modalities and the role of radiologists in treatment and follow-up.

Neoplastic – Glioma imaging varies widely between different centres and there is little guidance on best practice in this area. Thust et al. performed a survey to evaluate the practice across Europe and provide focused guidance for setting up glioma imaging protocols, and is essential reading for trainees because of the justification for each sequence and the specific problem each of them addresses.

Inflammatory – The search for a biomarker to significantly enhance the specificity of diagnostic criteria for MS continues, and a further addition to the potential candidates is the use of the so-called ‘dark rim’ sign using a double inversion recovery technique. Tillema et al. found that the use of this sign, which was seen in 35% of lesions in patients with MS and 1% of lesions in those without, increase the specificity of the 2010 McDonald criteria (from 17% without to 78% with at least 1 rim lesion and 97% with two or more). Although the pathophysiology of the sign remains to be determined it may be a useful addition, although necessitates incorporating an additional sequence into diagnostic MS studies.

Degenerative – In Radiology this month Enkirch et al. presented their scoring system for assessment of the entorhinal cortex in Alzheimer’s disease, known as the ERICA score, which had increased diagnostic accuracy when compared to the medial temporal atrophy score and had a high interrater reliability. This is a easy to apply visual scoring system and may potentially become the dominant rating scale in future.

Cerebellar ataxias are rare but important entities and there are a wide variety of inherited syndromes. Heidelberg et al. present a useful pictorial review of the major differential diagnoses and key imaging features to differentiate them.

Miscellaneous – Finally, for those needing any justification in ditching their tie, Luddecke et al. demonstrated that wearing a necktie reduces your cerebral blood flow. Having said this, it was with a ‘tightened’ necktie and did not reduce it below the normal range, so you probably don’t need to worry about tie-related strokes just yet.

That’s all for this month, enjoy the summer and see you next time.

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