We examined diagnostic procedures in mild traumatic brain injury by a systematic literature search. After screening 38,806 abstracts, we critically reviewed 228 diagnostic studies and accepted 73 (32%). The estimated prevalence of intracranial CT scan abnormalities is 5% in patients presenting to hospital with a Glasgow Coma Scale score of 15 and 30% or higher in patients presenting with a score of 13. About 1% of all treated patients with mild traumatic brain injury require neurosurgical intervention. There is strong evidence that clinical factors can predict computerized tomography scan abnormalities and the need for intervention in adults, but no such evidence for mild traumatic brain injury in children. We found evidence that skull fracture is a risk factor for intracranial lesions, but the diagnostic accuracy of radiologically diagnosed skull fracture as an indication of intracranial lesions is poor. There is only a little evidence for the diagnostic validity of cognitive testing and other diagnostic tools for mild traumatic brain injury.

Capsulotomy is effective in reducing OCD symptoms. There is a substantial risk of adverse effects, and the risk may vary between surgical methods. Our findings suggest that smaller lesions are safer and that high radiation doses and multiple procedures should be avoided.

1. We used functional positron emission tomography (PET), measuring regional cerebral blood flow (rCBF) as an index of neuronal activity, to investigate the central processing of itch in 10 healthy volunteers subjected to intracutaneous injections of histamine. 2. The study has unraveled a central representation that depicts a motor intention of the urge to scratch contingent on the perception of unpleasant itch. The coactivation of the anterior cingulate cortex (ACC), supplementary motor area (SMA), premotor area (PM), and inferior parietal lobule (IPL) substantiates that the posterior sector of the ACC (Brodmann 24) is related to the sensorial/affectional aspect of the event. The premotor cortical areas (SMA, PM) and the IPL may participate in the preparation of an intended action.

SUMMARY The angiographic, clinical, and genetic characteristics of fibromuscular dysplasia (FMD) are reviewed in 37 patients (mean age 48 years) selected from a pool of 4000 angiograms of carotid or vertebral arteries. FMD was a neglected pathogenic factor in 28 patients with hemorrhagic or ischemic cerebral lesions. The aneurysms found in 19 patients had conventional appearance and were mainly located in the internal carotid or middle cerebral arteries and on the same side as the most affected cervical artery, which suggests that aneurysms and FMD are pathogenically related. A clinical syndrome is presented where headache, ECGabnormalities, hypertension, mental distress, tinnitus, vertigo, arrhythmia, TIA, and syncope are frequent components. Hemicrania, sometimes combined with ipsilateral Horner's Syndrome, was found in patients with advanced lesions in the carotid artery of the same side. An associated occurrence of stroke in pedigrees, especially among young and middle aged females, indicates that FMD in the majority of cases is inherited as an autosomal dominant trait with reduced penetrance in males.Stroke, Vol 13, No 1,1982 EARLIER reports of fibromuscular dysplasia (FMD), to be reviewed in part two, have essentially contributed the same picture of FMD: an angiopathy often associated with hypertension, most often discovered in middle aged females, characterized by dysplastic vessel wall deformations multifocally spread within branches of the aorta, and a high frequency of intracranial aneurysms. The association of FMD with aneurysmal arterial disease, recognized early 1 as well as with an abundance of congenital abnormalities and an increasing number of reports of familial occurrence, raises the suggestion that FMD is a congenital mesenchymal disorder.In a recent ultrastructural study, Bragin and Chercaso 1979 2 suggest that FMD is based on a uniform morphogenetic process in which the leading role is played by fibroblast-like transformation of smooth muscle cells. Each one of the three major structures of the vessel wall (tunica intima, media, and adventitia) might be deformed by dysplastic lesions. Unfortunately, histological verification of aortocranial lesions is available only in a minority of cases. Thus, the clinical diagnosis in most cases has to be made with angiography. However, the characteristic macroscopic appearance and topography of the lesions are considered pathognomonic in the cervical as well as in the renal arteries.In this study, 37 patients from Karolinska Hospital are reviewed with special regard to the angiographic, clinical, and genetic features. We have found it important to discuss our results in the light of 1100 cases of FMD, with various locations, reported in the literature (part two). Patients and MethodsThirty females and 7 males with FMD (mean age 48 years, range 24-70) were found by scrutinizing 4000Departments of Neurology, Neuroradiology and Clinical Physiology, Karolinska Institute, Stockholm, Sweden.All correspondence should be directed to: Dr. K.L. Mettinger, Depa...

The high incidence of radiation-induced complications does not seem to justify the limited protection the treatment may afford in only exceptional cases. A prospective randomized study is needed before the role of radiosurgery in the management of these lesions can be defined. Until such a study has proved differently, a caveat must be raised for the treatment of CM with GKRS.