ABSTRACT
This article reviews the various imaging modalities available for the evaluation of patients presenting with a potential stroke syndrome, specifically acute ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. It reviews the various computed tomography (CT) modalities, including noncontrast brain CT (NCCT), CT angiography, and CT perfusion. It discusses multimodal magnetic resonance imaging in the evaluation of patients with acute stroke, including diffusion-weighted imaging, T2-weighted sequences/fluid-attenuated inversion recovery, magnetic resonance angiography, perfusion-weighted imaging, and gradient-recalled echo. At the end of this article, a brief review on how to read an NCCT geared toward the emergency physician is included.
Subject(s)
Neuroimaging , Stroke/diagnostic imaging , Brain/diagnostic imaging , Brain/pathology , Cerebral Angiography , Cerebral Hemorrhage/diagnosis , Cerebral Hemorrhage/diagnostic imaging , Cerebral Hemorrhage/pathology , Diffusion Magnetic Resonance Imaging , Humans , Magnetic Resonance Angiography , Magnetic Resonance Imaging , Neuroimaging/methods , Stroke/diagnosis , Stroke/pathology , Subarachnoid Hemorrhage/diagnosis , Subarachnoid Hemorrhage/diagnostic imaging , Subarachnoid Hemorrhage/pathology , Tomography, X-Ray ComputedABSTRACT
The aims of this study were to (1) define characteristics for the thoracoabdominal injury patient population; (2) describe sequences of surgical interventions with combined procedures (i.e., thoracotomy and laparotomy); and (3) describe pitfalls leading to inappropriate sequencing of surgical interventions for thoracoabdominal injuries. It was a retrospective 4-year study (January 1995 to December 1998) conducted at an urban level I trauma center. The study population comprised 254 patients who had sustained thoracoabdominal injuries requiring surgical intervention: 187 (73%) gunshot wounds (GSWs), 64 (25%) stab wounds (SWs), and 3 (2%) shotgun wounds (STWs). The mean revised (RTS) was 6.04; the mean Injury Severity Score (ISS) was 27; the mean estimated blood loss (EBL) was 3000 ml. The overall survival was 175 of 254 (69%). Of the 254, 51 (20%) underwent emergency department (ED) thoracotomy. Altogether, 73 (29%) underwent combined thoracotomy and laparotomy: 59 (81%) GSW, 13 (18%) SW, 1 (1%) STW (mean RTS 5.2, mean ISS 34, mean EBL 6800 ml). Overall survival was 30 of these 73 (41%). A total of 21 of the 73 (29%) underwent ED thoracotomy. In group I (laparotomy then thoracotomy: Lap + Thor, n = 34) the initial procedure was interrupted in 18 (53%). In group II (thoracotomy then laparotomy: Thor + Lap, n = 39) the initial procedure was interrupted in 14 (36%). Pitfalls leading to inappropriate surgical sequencing were persistent hypotension (13/73, 18%) and misleading chest tube output (8/73, 10%). It was concluded that penetrating thoracoabdominal injuries incur high mortality (31%), and the mortality doubles for patients who require combined procedures (59%). Inappropriate surgical sequencing occurred in 32 of 73 (44%) patients undergoing combined procedures. Persistent hypotension, indicating that the wrong cavity was accessed, and misleading chest tube output are the leading pitfalls in thoracoabdominal injury management.
