Reversible cerebral vasoconstriction syndrome: an important and common cause of thunderclap and recurrent headaches.

Reversible cerebral vasoconstriction syndrome is an intracranial vascular manifestation of a wide variety of diseases. It is the second most common cause of thunderclap headache, the most common cause of recurrent severe secondary headaches, and, in patients <60 years of age, has been reported as the commonest cause of isolated convexity subarachnoid haemorrhage. Radiologically, its key feature is vasoconstriction of the intracranial vessels, a dynamic process that is typically maximal at 2 weeks, varies in its distribution over the course of the disease, and typically resolves after 3 months. It can have haemorrhagic and ischaemic complications and sometimes occurs in concert with posterior reversible encephalopathy syndrome. It also has important associations with dissection and migraine. Rarer atypical cases can present with mild headache, no headache at all, or even a comatose state. This paper provides a detailed review of this syndrome, its pathophysiology, differential diagnosis, imaging findings, and work-up. It also describes the role that high-resolution magnetic resonance imaging (MRI) techniques can have in diagnosing the disease and emphasises the central role that all radiologists have in detecting this important and underdiagnosed condition.

A radiological approach to benign and malignant lesions of the mandible.

There is a wide range of pathological conditions that affect the mandible. Although some lesions demonstrate characteristic imaging features, many of the pathological processes encountered in the mandible often exhibit similar imaging appearances resulting in uncertainty for the reporting radiologist. Many mandibular lesions remain impossible to distinguish without histological analysis. Therefore, this review aims to reassure the radiologist that although imaging findings may not always lead to a specific diagnosis, they narrow the differential diagnosis and guide further work-up. In this regard, we aim to provide a clinically useful framework and approach for radiologists to use when they encounter lesions within the mandible.

Imaging findings in recurrent extramedullary leukaemias.

Acute leukaemias are relatively common malignancies. Treatment has advanced significantly in the recent past and there has been improved patient survival. This improved initial response is leading to an increasing number of cases of relapse. Extramedullary relapse occurs in a wide variety of locations with varying presentations, imaging findings and differentials. The pathophysiology and clinical course of recurrent extramedullary myeloid and lymphocytic leukaemias are reviewed in this article. The wide variety of imaging findings associated with many important sites of recurrence and the associated differential diagnosis are discussed and illustrated.

Imaging spectrum of sudden athlete cardiac death.

Sudden athlete death (SAD) is a widely publicized and increasingly reported phenomenon. For many, the athlete population epitomize human physical endeavour and achievement and their unexpected death comes with a significant emotional impact on the public. Sudden deaths within this group are often without prior warning. Preceding symptoms of exertional syncope and chest pain do, however, occur and warrant investigation. Similarly, a positive family history of sudden death in a young person or a known family history of a condition associated with SAD necessitates further tests. Screening programmes aimed at detecting those at risk individuals also exist with the aim of reducing fatalities. In this paper we review the topic of SAD and discuss the epidemiology, aetiology, and clinical presentations. We then proceed to discuss each underlying cause, in turn discussing the pathophysiology of each condition. This is followed by a discussion of useful imaging methods with an emphasis on cardiac magnetic resonance and cardiac computed tomography and how these address the various issues raised by the pathophysiology of each entity. We conclude by proposing imaging algorithms for the investigation of patients considered at risk for these conditions and discuss the various issues raised in screening.

Child temperament, parenting discipline style, and daytime behavior in childhood sleep disorders.

Fifty-two children without significant sleep disturbance seen at a primary care clinic for well-child care were compared on measures of temperament, parenting style, daytime behavior, and overall sleep disturbance to three diagnostic subgroups identified in a pediatric sleep clinic: children with obstructive sleep apnea (n = 33), parasomnias (night terrors, sleepwalking, etc.) (n = 16), and behavioral sleep disorders (limit-setting disorder, etc.) (n = 31). The mean age of the entire sample was 5.7 years. Temperamental emotionality in the behavioral sleep disorders group was associated with a higher level of sleep disturbance (p < .001); parenting laxness was associated with sleep disturbance in the general pediatric population (p < .01); and intense and negative temperament characteristics seemed to be associated with clinically significant behavioral sleep disturbances. Ineffective parenting styles and daytime disruptive behaviors were more likely to be associated with the milder sleep disturbances found in children in a primary care setting.

Relationship between substance use and self-reported injuries among adolescents.

High school students (n = 1983), 14-18 years olds, were surveyed regarding the incidence of injury and substance use at the time of the injury in the prior 6 months. Alcohol or other drugs were reported particularly often for falls, cuts, and gun and assault injuries. Alcohol or other drugs were reported to be involved in a substantial proportion of injuries resulting in medical care, most notably for gunshots (70%), pedestrian injuries (42%) and physical fights (38%).

Risk taking, reported injury, and perception of future injury among adolescents.

Investigated the relationships among self-reported injury, risk taking, and perception of injury risk in a sample of 1,426 adolescents, 14 to 18 years old. Both risk taking and injury were higher in males than females across age groups. Having a friend injured the same way was the strongest predictor of injury, accounting for 28% of the variance. Risk taking accounted for 4% of the variance. Sociodemographic variables-gender, age, and race-accounted for only 1% of the variance. Findings underscore the potential role of pediatric psychologists in both understanding and reducing the incidence of adolescent injury.

Incidence of parasomnias in children with obstructive sleep apnea.

The incidence of parent-reported parasomnias in children with obstructive sleep apnea (OSA) is increased in comparison with a normative age-matched sample of children but is not higher than that for a similar clinical sample of children with a diagnosed behavioral sleep disorder.

Factor analysis of the suicide intent scale with adolescent suicide attempters.

Examined the factor structure of the Suicide Intent Scale (SIS; Beck, Schuyler, & Herman, 1974) when used with adolescent suicide attempters as well as the validity of these factors. Participants consisted of 190 hospitalized adolescent suicide attempters evaluated within 36 hr of the attempt. They responded to multiple self-report measures as part of a standard battery administered in the hospital that included the Suicide Ideation Questionnaire (Reynolds, 1987b), Reynolds Adolescent Depression Scale (Reynolds, 1987a), and the Hopelessness Scale for Children (Kazdin, French, Unis, Esveldt-Dawson, & Sherrick, 1983). A clinician rated suicide intent on the SIS. A common factor analysis, using the items of the SIS, revealed a three-factor solution. Factors were labeled Isolation Behaviors, Expected Outcome, and Planning Activities. The latter two factors correlated modestly with measures of depression, hopelessness, and suicidal ideation. Isolation Behaviors did not correlate with these measures. Results suggest that the Expected Outcome and Planning Activities factors may be more useful with adolescent suicide attempters than the total score.