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2 results

  • 39 - MRI of the Brain

  • from PART IV - MAGNETIC RESONANCE IMAGING
  • Edited by J. Christian Fox, University of California, Irvine
  • Book:
    Clinical Emergency Radiology
    Published online:
    07 December 2009
    Print publication:
    29 September 2008, pp 521-537

  • Summary

    Magnetic resonance imaging (MRI) represents a breakthrough in medical diagnostics and research, and is becoming especially valuable in the evaluation of neurological and musculoskeletal pathology. It remains indispensable in the evaluation of brain tumors, strokes, and chronic demyelinating disorders, including multiple sclerosis. The fundamental concept of MRI is based on resonance; specifically, nuclei of certain atoms, most commonly hydrogen atoms, resonate when placed in powerful magnetic fields. A growing area in the emergent setting that uses MRI involves aortic dissection. MRI is superior to computed tomography (CT) in detecting injuries to soft tissues such as the brain and spinal cord. The lack of widespread availability of MRI and the high cost compared to CT scanning make its use limited in the ED. Additionally, the risk of allergic reaction to the contrast agent (gadolinium) does exist in MRI.

  • 12 - Management of spasticity in children

    • By Rachael Hutchinson, Consultant Paediatric Orthopaedic Surgeon Norfolk and Norwich University Hospital NHS Trust, Norfolk, UK, H. Kerr Graham, Professor of Orthopaedic Surgery Royal Children's Hospital, Melbourne, Australia
  • Edited by Michael P. Barnes, University of Newcastle upon Tyne, Garth R. Johnson, University of Newcastle upon Tyne
  • Book:
    Upper Motor Neurone Syndrome and Spasticity
    Published online:
    22 August 2009
    Print publication:
    24 April 2008, pp 214-240

  • Summary

    Spasticity in children continues to be a common and challenging problem for the foreseeable future. While reduction in the incidence of cerebral palsy would have the most impact in reducing the overall incidence of spasticity in children, prevention of traumatic brain injury and spinal cord injury is probably more realistic. Fixed musculoskeletal pathology in cerebral palsy is acquired during childhood. Children with cerebral palsy do not have contractures, dislocated hips or scoliosis at birth. These common deformities are acquired during childhood. There are few useful clinical measures of spasticity and none validated for use in children. The Ashworth and modified Ashworth scales are blunt and unresponsive tools in the assessment of the child with cerebral palsy. Botulinum toxin A (BoNT-A) is a reversible, focal agent which has been under evaluation since the early 1990s in the management of spasticity in children.