Intracranial vascular anomalies in patients with morning glory disk anomaly.

PURPOSE: An association between morning glory disk anomaly (MGDA) and intracranial vascular anomalies including Moyamoya disease has been recognized. We evaluated a series of patients with MGDA to ascertain the frequency of cerebrovascular anomalies. DESIGN: Retrospective observational case series. METHODS: We reviewed the neurologic histories and neuroimaging studies of twenty patients with MGDA at two institutions between 1982 and 2004. Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) of the brain was performed on all patients who had not undergone neuroimaging. MRI/MRA studies done for 40 pediatric patients without MGDA were also evaluated for cerebrovascular anomalies. The prevalence of anomalies in the two groups was compared by Fisher exact test. RESULTS: Nine of 20 patients (45%) with MGDA had cerebrovascular anomalies. Anomalies ranged from agenesis of the A1 segment of the anterior cerebral artery to bilateral stenosis of the internal carotid arteries with moyamoya disease. Three patients underwent revascularization procedures. Ten of 40 patients (25%) in the control group had any intracranial vascular anomaly, whereas only two of 40 (5%) had an abnormality of the anterior circulation, the most common finding in the MGDA group. CONCLUSION: We recommend that all patients with MGDA undergo MRI/MRA or computerized tomographic angiography to detect vascular and structural brain anomalies. It may be unclear whether cerebrovascular anomalies represent isolated congenital anomalies or findings of progressive occlusive cerebrovascular disease. Follow-up imaging should be considered in patients with cerebrovascular anomalies and is clearly indicated if neurologic signs or symptoms are present.

Computed tomography of pediatric stroke.

The causes of stroke in the children are varied. Magnetic resonance imaging (MRI) is generally accepted as the study of choice for definitive diagnosis of ischemic injury. However, often times MRI is not immediately available in the acute setting. This review highlights some of the major causes of stroke in children and the current role of computed tomography (CT), and more specifically, CT angiography in the pediatric setting.

Peri-operative use of oestrogen containing medications and deep vein thrombosis--a national survey.

AIM: To determine the practice of New Zealand orthopaedic surgeons when women taking hormone replacement therapy (HRT) or a combined oral contraceptive pill (COC) present for major surgery. Current practice is compared with recently produced guidelines and manufacturers advice. METHODS: A postal survey was sent to all New Zealand orthopaedic surgeons. RESULTS: The response rate was 80% (118/148). There was wide variation in beliefs surrounding the peri-operative use of both of these medications. 44% of surgeons indicated that they would routinely advise discontinuing the COC pill peri-operatively for major surgery. 24% indicated that they would routinely advise discontinuing HRT peri-operatively. Recently released guidelines recommend that HRT should be stopped for at least 30 days prior to elective surgery and withheld for 90 days following surgery. Less than 3% of surgeons appeared to be routinely following this recommendation. Most manufacturers of COC pills recommend stopping the medication for at least four weeks prior to elective surgery. Only 25% of surgeons routinely practice in accordance with these recommendations. CONCLUSIONS: This survey clearly demonstrates substantial differences between current clinical practice, recently revised HRT guidelines and oral contraceptive manufacturers advice. These differences need to be brought to the attention of surgeons and guideline producers. Particular medico-legal caution in this area is advised.