For the purposes of this review, we classify SAH into three main patterns, defined by the distribution of blood on unenhanced CT: diffuse, perimesencephalic, and convexal. The epicenter of the hemorrhage further refines the differential diagnosis and guides subsequent imaging. Additionally, we review multiple clinical conditions that can simulate the appearance of SAH on CT or MRI, an imaging artifact known as pseudo-SAH.
Background
Carotid atherosclerosis is a marker for atherosclerotic disease in other vascular beds; however, racial differences in this association have not been fully examined. The purpose of this report is to evaluate racial differences in the relationship between carotid plaque and calcification in the aorta and coronary arteries among women transitioning the menopause.
Methods
540 African American and White women with a median age of 50 years were evaluated from the Study of Women’s Health Across the Nation. Carotid plaque (none versus any) was assessed with B-mode ultrasound and aortic (AC; 0, >0–100, >100) and coronary artery calcification (CAC; 0, >0–10, >10) with computed tomography.
Results
For the total cohort, higher prevalence of plaque was significantly associated with higher levels of AC, but not CAC. The interaction of race and carotid plaque was significant in models with AC and CAC as dependent variables (p=0.03, 0.002, respectively). Among African Americans, there was an inverse relationship, although not significant, between carotid plaque and high AC (>100) (OR 0.75, 95%CI: 0.10–5.48), and between plaque and high CAC (>10) (OR 0.20, 95%CI: 0.03–1.52) in fully adjusted models. In contrast, for Whites, significant positive associations existed between carotid plaque and high AC (OR 4.12, 95%CI: 1.29–13.13) and borderline for high CAC (OR 1.83, 95%CI: 0.66–5.19).
Conclusions
This study demonstrated the presence of carotid plaque appeared to be a marker for AC and potentially CAC in White women during the menopause transition, but not African American middle-aged women.
Quantitative assessment of imaging in patients with suspected mitochondrial disorder with only subtle changes on MRI may be better characterized using rCBF and parametric statistical mapping to localize and assess the extent of damage in the brain. Its utility is also valuable when follow-up scans are performed to determine the progression of cerebral change.
A 64-year-old woman with a history of I-131 ablation for Graves hyperthyroidism and bilateral parathyroid exploration with resection of a left inferior parathyroid adenoma presented 2 years after surgery with marked fatigue, irritability, and joint pain. Laboratory testing revealed an elevated calcium and parathyroid hormone levels suspicious for hyperparathyroidism. The ultrasound indicated no evidence of a parathyroid adenoma. Tc-99m-MIBI SPECT demonstrated a focus of uptake posteroinferior to the right submandibular gland, suspicious for a parathyroid adenoma. Repeat ultrasound and CT confirmed the presence of a para-hyoid adenoma inferior to the right submandibular gland.
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