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The trigeminal nerve is the largest of the cranial nerves. It provides sensory input from the face and motor innervation to the muscles of mastication. The facial nerve is the cranial nerve with the longest extracranial course, and its main functions include motor innervation to the muscles of facial expression, sensory control of lacrimation and salivation, control of the stapedial reflex and to carry taste sensation from the anterior two-thirds of the tongue. In order to be able adequately to image and follow the course of these cranial nerves and their main branches, a detailed knowledge of neuroanatomy is required. As we are dealing with very small anatomic structures, high resolution dedicated imaging studies are required to pick up normal and pathologic nerves. Whereas CT is best suited to demonstrate bony neurovascular foramina and canals, MRI is preferred to directly visualize the nerve. It is also the single technique able to detect pathologic processes afflicting the nerve without causing considerable expansion such as is usually the case in certain inflammatory/infectious conditions, perineural spread of malignancies and in very small intrinsic tumours. Because a long course from the brainstem nuclei to the peripheral branches is seen, it is useful to subdivide the nerve in several segments and then tailor the imaging modality and the imaging study to that specific segment. This is particularly true in cases where topographic diagnosis can be used to locate a lesion in the course of these nerves.

External pneumatic compression (EPC) use in athletics is increasing. However, there is a paucity of evidence supporting the effectiveness of EPC in aiding recovery and performance. We sought to determine the efficacy of EPC for acute recovery of anaerobic power and lactate clearance following a fatigue protocol. Fourteen (n = 14; women = 7 and men = 7), apparently healthy, active subjects (aged 22.73 ± 4.05 years) were enrolled in this randomized crossover design study. After familiarization sessions, subjects completed 2 study trials separated by 3-7 days. Trials consisted of a fatigue protocol (two 30-second Wingate anaerobic tests (WAnTs) on a cycle ergometer separated by 3 minutes of rest), 30 minutes of treatment with EPC or sham, and, finally, a single 30-second WAnT. A peristaltic pulse EPC device was used with target inflation pressures of ∼70 mm Hg applied to the lower limbs. Peak power (PkP), average power (AP), and the fatigue index (FI) were recorded for each WAnT. Moreover, blood lactate concentration (BLa) was evaluated at baseline and at regular intervals during recovery (5, 15, 25, and 35 minutes postfatigue protocol). No significant differences in PkP, AP, and FI were observed. However, BLa was significantly lower at 25 and 35 minutes of recovery (8.91 ± 3.12 vs. 10.66 ± 3.44 mmol·L(-1) [p = 0.021] and 6.44 ± 2.14 vs. 7.89 ± 2.37 mmol·L(-1) [p = 0.006] for EPC vs. sham, respectively). Application of EPC during recovery may be a viable alternative when "inactive" recovery is desirable.

No abstract

Many disease processes manifest either primarily or secondarily by cranial nerve deficits. Neurologists, ENT surgeons, ophthalmologists and maxillo-facial surgeons are often confronted with patients with symptoms and signs of cranial nerve dysfunction. Seeking the cause of this dysfunction is a common indication for imaging. In recent decades we have witnessed an unprecedented improvement in imaging techniques, allowing direct visualization of increasingly small anatomic structures. The emergence of volumetric CT scanners, higher field MR scanners in clinical practice and higher resolution MR sequences has made a tremendous contribution to the development of cranial nerve imaging. The use of surface coils and parallel imaging allows sub-millimetric visualization of nerve branches and volumetric 3D imaging. Both with CT and MR, multiplanar and curved reconstructions can follow the entire course of a cranial nerve or branch, improving tremendously our diagnostic yield of neural pathology. This review article will focus on the contribution of current imaging techniques in the depiction of normal anatomy and on infectious and inflammatory, traumatic and congenital pathology affecting the cranial nerves. A detailed discussion of individual cranial nerves lesions is beyond the scope of this article.

A 70-year-old man with a long-standing history of increased neck volume was examined in the Ear, Nose, Throat Clinic because he was complaining of dysphagia and dyspnea on exertion. His medical history was irrelevant except for a family history of goiter in several relatives. At clinical examination, an enlarged right thyroid gland lobe with a lobulated surface that was soft was detected. The gland was mobile with deglutition, but the inferior limit of the right lobe could not be palpated.Laboratory findings disclosed normal thyrotropin, triiodothyronine, and thyroxine levels, and no antithyroid antibodies were detected. Fine-needle aspiration biopsy of the right lobe of the thyroid gland was performed without imaging guidance and revealed normal follicular cells and colloid and no neoplastic cells. Scintigraphic findings disclosed absence of activity at the site of the nodule.The patient then underwent neck and mediastinal computed tomography (CT) to evaluate for intrathoracic component and airway patency. Additionally, magnetic resonance (MR) imaging of the neck and ultrasonography (US)-guided fine-needle aspiration biopsy were performed. IMAGING FINDINGSTransverse CT scans (Fig 1) showed a large nonhomogeneous nodule partially replacing the right lobe of the thyroid gland and extending inferiorly into the superior mediastinum along the prevascular space. This nodule had well-defined margins and contained several areas of low attenuation, which suggested fat, and a small calcification. There was slight tracheal displacement to the left side and a slight decrease in the transverse diameter of the tracheal lumen. The lesion was clearly separate from the esophagus. The left lobe of the thyroid gland showed no abnormalities.The possible presence of fat within the nodule put the initial diagnosis of colloid goiter in question, and additional MR imaging and US-guided fine-needle aspiration biopsy were performed to further characterize this lesion. At MR imaging (Fig 2a, 2b), a large heterogeneous nodule was seen replacing the right lobe of the thyroid gland. This nodule contained large irregular areas of T1-weighted hyperintensity that became hypointense on the fat-suppressed transverse spectral presaturation inversion-recovery T1-weighted MR image (Fig 2c), and these findings further indicated the presence of fat. The MR image showed the intrathyroid location of the lesion, its welldefined borders, and clear cleavage planes with adjacent anatomic structures.No cervical, supraclavicular, or superior mediastinal lymphadenopathy was detected. A scan obtained at US-guided fineneedle aspiration biopsy (Fig 3) showed the heterogeneity of the nodule of the right lobe of the thyroid gland and large hyperechoic areas within the nodule, which reflected the fatty component. A reverberation artifact caused by the tip of the needle was seen in the middle of the hyperechoic component of the lesion.

No abstract

Our study, which is one of the largest to date on the topic, shows that FHD lesions are a common complication after radiotherapy for childhood PCNST. The young brain is probably more susceptible to radiation-induced late cerebrovascular injury. Diffuse small vessel disease and ceiling effect may account for the low topographic concordance we found. The clinical implications of FHD lesions in this specific population are yet to be clarified.