Diagnostic yield of MRI for audiovestibular dysfunction using contemporary referral criteria: correlation with presenting symptoms and impact on clinical management

2009 ◽  
Vol 64 (2) ◽  
pp. 156-163 ◽  
Author(s):  
C. Vandervelde ◽  
S.E.J. Connor
Keyword(s):  
Clinical Management ◽  
Diagnostic Yield ◽  
Presenting Symptoms ◽  
Referral Criteria

scholarly journals Diagnostic Yield of MRI for Sensorineural Hearing Loss – An Audit

2020 ◽  
Vol 47 (5) ◽  
pp. 656-660
Author(s):  
Helen Wong ◽  
Yaw Amoako-Tuffour ◽  
Khunsa Faiz ◽  
Jai Jai Shiva Shankar
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Diagnostic Yield ◽  
Internal Auditory Canal ◽  
Auditory Brainstem ◽  
Sensorineural Hearing ◽  
Vestibular Evoked Myogenic Potentials ◽  
Clinical Indication ◽  
Presenting Symptoms ◽  
Brainstem Response

ABSTRACT:Purpose:Contrast-enhanced magnetic resonance imaging (CEMRI) of the head is frequently employed in investigations of sensorineural hearing loss (SNHL). The yield of these studies is perceptibly low and seemingly at odds with the aims of wise resource allocation and risk reduction within the Canadian healthcare system. The purpose of our study was to audit the use and diagnostic yield of CEMRI for the clinical indication of SNHL in our institution and to identify characteristics that may be leveraged to improve yield and optimize resource utilization.Materials and methods:The charts of 500 consecutive patients who underwent CEMRI of internal auditory canal for SNHL were categorized as cases with relevant positive findings on CEMRI and those without relevant findings. Demographics, presenting symptoms, interventions and responses, ordering physicians, and investigations performed prior to CEMRI testing were recorded. Chi-squared test and t-test were used to compare proportions and means, respectively.Results:CEMRI studies revealed relevant findings in 20 (6.2%) of 324 subjects meeting the inclusion criteria. Pre-CEMRI testing beyond audiometry was conducted in 35% of those with relevant positive findings compared to 7.3% of those without (p < 0.001). Auditory brainstem response/vestibular-evoked myogenic potentials were abnormal in 35% of those with relevant CEMRI findings compared to 6.3% of those without (p < 0.001).Conclusion:CEMRI is a valuable tool for assessing potential causes of SNHL, but small diagnostic yield at present needs justification for contrast injection for this indication. Our findings suggest preferred referral from otolaryngologists exclusively, and implementation of a non-contrast MRI for SNHL may be a better diagnostic tool.

Diagnostic Yield of Pediatric Colonoscopies Based on Presenting Symptoms in a Secondary Hospital

2011 ◽  
Vol 14 (4) ◽  
pp. 368
Author(s):  
Yun Jung Cho ◽  
Il Hyun Cho ◽  
Hyo Joo Yoo ◽  
Hwang Choi ◽  
Bo-In Lee ◽  
...  
Keyword(s):  
Diagnostic Yield ◽  
Presenting Symptoms ◽  
Secondary Hospital

scholarly journals Whole Exome Sequencing in Neurogenetic Diagnostic Odysseys: An Argentinian Experience

2016 ◽  
Author(s):  
M Córdoba ◽  
SA Rodriguez-Quiroga ◽  
PA Vega ◽  
H Amartino ◽  
C Vázquez-Dusefante ◽  
...  
Keyword(s):  
Exome Sequencing ◽  
Whole Exome Sequencing ◽  
Low Income ◽  
Clinical Management ◽  
Diagnostic Yield ◽  
Genetic Disorders ◽  
Potential Cost ◽  
Low Income Country ◽  
Whole Exome ◽  
Neurogenetic Disorders

ABSTRACTClinical variability is a hallmark of neurogenetic disorders. They involve widespread neurological entities such as neuropathies, ataxias, myopathies, mitochondrial encephalopathies, leukodystrophies, epilepsy and intellectual disabilities. Despite the use of considerable time and resources, the diagnostic yield in this field has been disappointingly low. This etiologic search has been called a “diagnostic odyssey” for many families. Whole exome sequencing (WES) has proved to be useful across a variety of genetic disorders, simplifying the odyssey of many patients and their families and leading to subsequent changes in clinical management in a proportion of them. Although a diagnostic yield of about 30% in neurogenetic disorders can be extrapolated from the results of large series that have included other medical conditions as well, there are not specific reports assessing its utility in a setting such as ours: a neurogeneticist led academic group serving in a low-income country. Herein, we report on a series of our first 40 consecutive cases that were selected for WES in a research-based neurogenetics laboratory. We demonstrated the clinical utility of WES in our patient cohort, obtaining a diagnostic yield of 40% (95% CI, 24.8%-55.2%), describing cases in which clinical management was altered, and suggesting the potential cost-effectiveness of WES as a single test by examining the number and types of tests that were performed prior to WES which added up to a median cost of $3537.6 ($2892 to $5084) for the diagnostic odysseys experienced by our cohort.

scholarly journals Pharmacoepidemiology of ascites and associated complications in hospitalized patients: descriptive observational study

2015 ◽  
Vol 4 (2) ◽  
pp. 343-346 ◽  
Author(s):  
Hirra Tasneem ◽  
Huda Shahbaz ◽  
Bushra Ali Sherazi
Keyword(s):  
Observational Study ◽  
Clinical Management ◽  
Salt Intake ◽  
Tertiary Care ◽  
Pharmaceutical Journal ◽  
Hospitalized Patients ◽  
Dietary Sodium ◽  
Free Fluid ◽  
Presenting Symptoms ◽  
Starting Point

Ascites is the pathological accumulation of free fluid in peritoneal cavity. The aim of the present study was to observe the prevalence, clinical management and the assessment of complications associated with ascites in hospitalized patients. A Descriptive Observational Study was conducted at two tertiary care hospitals of Lahore. The data was collected on a data collection form containing questions regarding basic patient information, presenting symptoms, clinical management and associated complications. Verbal informed consent was taken and confidentiality was maintained. Pilot study was performed prior to performance of a full-scale research project. The results are expressed in the form of frequency and percentages. A total of fifty (50) ascitic patients were evaluated during two months. It was slightly more common in females (58%) as compared to males (42%). Common causes of Ascites were Liver Cirrhosis (80%), Chronic Renal Failure (10%), Peritoneal Malignancy and Peritoneal Tuberculosis (4%) each and Cardiac Failure (2%). The mainstay for the first line treatment in patients with cirrhosis includes education regarding dietary sodium restriction and oral diuretics. The major complications associated with Ascites were Protein malnutrition (87%), Mental Confusion (73%), Hepatorenal Syndrome (21%) and Spontaneous Bacterial Perotinitis (8%). In most patients ascites was being managed successfully by limiting the salt intake and provision of a diuretic regimen. As, ascites is a starting point for more serious complications; so, its early diagnosis should be ensured. Social media and NGOs should play their role in creating the awareness regarding this deadly disease.DOI: http://dx.doi.org/10.3329/icpj.v4i2.21482 International Current Pharmaceutical Journal, January 2015, 4(2): 343-346

Reactions to the Threatened Loss of a Child: A Vulnerable Child Syndrome, by Morris Green, MD, and Albert A. Solnit, MD, Pediatrics, 1964;34:58–66

PEDIATRICS ◽  
1998 ◽  
Vol 102 (Supplement_1) ◽  
pp. 239-241 ◽  
Author(s):  
Jack P. Shonkoff
Keyword(s):  
Primary Prevention ◽  
Clinical Features ◽  
Psychosocial Development ◽  
Clinical Management ◽  
Fatal Outcome ◽  
Parent Child Relationship ◽  
Presenting Symptoms ◽  
Child Relationship ◽  
Child Syndrome ◽  
History Of

This report describes a constellation of clinical features found in 25 children with a history of an illness or accident from which they recovered, despite their parents' anticipation of a fatal outcome. The paper proposes the hypothesis that children who are expected by their parents to die prematurely often react with a disturbance in psychosocial development that is rooted in the parent-child relationship, which the authors characterize as avulnerable child syndrome. The essential features of the proposed syndrome include difficulty with separation, infantile behavior, bodily overconcerns, and school underachievement. The paper provides an overview of predisposing factors and determinants of the presenting symptoms, along with suggestions for both clinical management and primary prevention.

Abstract 8: Early MRI in TIA And Minor Stroke: Do it or Lose it

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Francois Moreau ◽  
Jayesh Modi ◽  
Mohamed Almekhlafi ◽  
Simer Bal ◽  
Mayank Goyal ◽  
...  
Keyword(s):  
Symptom Onset ◽  
Diagnostic Yield ◽  
Lesion Detection ◽  
White Matter Hyperintensity ◽  
Minor Stroke ◽  
Presenting Symptoms ◽  
Lesion Pattern ◽  
Cortical Stroke ◽  
Stroke Lesion ◽  
The Impact

Background: MRI is not always completed early after TIA or minor stroke and this may affect its utility. We measured the impact of scanning an individual patient late versus early in the investigation of TIA and minor stroke. Methods: 263 patients with a TIA or minor stroke (NIHSS <4) from the CATCH study were included in this analysis. To be included in this sub study patients needed to have had a baseline MRI completed within 24 hours of symptom onset and a follow-up MRI at 90 days. All MRI images were acquired on a 3.0 Tesla GE scanner. Baseline and 90 day scans were assessed independently for the presence of any stroke lesion. The presence and pattern of any stroke lesion was then compared at the two time points. Lesion patterns were classified as: no definite stroke, single territory cortical stroke(s), multiple territory cortical strokes, single territory subcortical only stroke(s), multiple territory subcortical only strokes, and multiple strokes in one territory including a cortical stroke Results: Stroke of any age, in any location was more common on the baseline MRI versus 90day MRI (68% versus 58%, p=0.005). A substantial proportion of the negative scans at 90 days had a clearly identifiable stroke on the baseline scan (35/115: 30%) that was missed on the 90day scan. All of these lesions were acute or subacute DWI lesions on the baseline scan showing non-specific white matter hyperintensity or no abnormality on the 90day scan. Among 104 patients with a stroke lesion on the 90 day MRI considered as a cause for the presenting symptoms, this lesion was the correct lesion in only 78 (53%) patients. 89 (34%) patients had a different lesion pattern on the baseline scan versus the 90day scan. The main difference observed was that patients with multiple DWI lesions on the baseline scan were either seen as a single or no lesions on the 90day MRI. Conclusion: Completing an MRI in a delayed fashion after TIA or minor stroke reduces the diagnostic yield of the imaging. Not only does it reduce lesion detection, but also the pattern of the lesions is missed. Conclusions regarding the original event may be false if based only on a delayed MRI. If minor stroke and TIA patients are going to be scanned with MRI this should be completed early after symptom onset.

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