Transcranial Doppler Ultrasonography As a Non-Invasive Tool for Diagnosis and Monitoring of Reversible Cerebral Vasoconstriction Syndrome.

BACKGROUND AND PURPOSE: Reversible cerebral vasoconstriction syndrome (RCVS) is a vascular headache disorder characterized by severe headaches with vasospasm of cerebral arteries. Transcranial Doppler ultrasonography (TCD) has been widely applied and validated in studying vasospasm of intracranial vessels, but the role of TCD in the diagnosis and monitoring of RCVS is less well established. We sought to determine the reliability of TCD for diagnosis and monitoring of RCVS. METHODS: Patients admitted to an inpatient neurology service between 2011 and 2014 with a discharge diagnosis of RCVS were retrospectively analyzed for demographics, neuroimaging, and functional outcomes. Baseline and follow-up TCD flow velocities in the middle cerebral artery (Vmca) were compared relative to the final diagnosis. RESULTS: The cohort consisted of fifteen patients (93% females; mean age 46.7 +/- 12.4 years); initial TCD evaluation was performed 10.9 +/- 6.6 (range 1-24) days after headache onset. Fourteen patients (93.3%) had increased flow velocities by initial TCD in at least one major cerebral blood vessel (MCA, ACA, PCA, vertebral, basilar). TCD flow velocities in the middle cerebral artery (Vmca) reached a mean peak of 163 cm/s three to four weeks after the onset of thunderclap headache. CONCLUSION: TCD is a non-invasive neuroimaging modality that may have potential for the initial diagnosis and subsequent monitoring of patients with suspected RCVS. Larger studies will be needed to establish its utility. [Full article available at http://rimed.org/rimedicaljournal-2016-09.asp, free with no login].

Descriptive study of opioid-acetaminophen prescription patterns at the providence VA Medical Center.

BACKGROUND: Prescription opioid-acetaminophen products account for the majority of cases of acetaminophen-related acute liver failure in the United States. We sought to examine the frequency of opioid-acetaminophen overuse at the Providence VA Medical Center and improve the quality and safety of opioid-acetaminophen prescription practices in a system employing electronic health records and e-prescribing. RESULTS: During fiscal year 2011, the Providence VA pharmacy dispensed a total of 19,841 acetaminophen prescriptions to a total of 4455 different patients. There were only 15 acetaminophen prescriptions dispensed in excess of 4g/day, and there were only 14 patients exposed to a potential maximum daily dose of acetaminophen greater than 4g. CONCLUSIONS: The Providence VAMC appears to have a low rate of prescription acetaminophen misuse, in contrast to rates seen in previous studies. The VHA electronic health record, accessible to all healthcare providers, appears to offer considerable benefit in reducing the overuse of acetaminophen containing opioid products.