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Standard treatment of idiopathic intracranial hypertension (IIH) involves reduction of intracranial pressure (ICP) to normal range, often via a ventriculoperitoneal shunt (VPS). We describe a case of a middle-aged man who presented with symptoms consistent with IIH. After ICP was normalized with a VPS, the patient had neurologic deterioration into a coma. He completely recovered after a month when his ICP was allowed to increase and remain above the normal range. A 50-year-old man presented with daily headaches, visual loss (right > left), and increased lumbar opening pressure consistent with IIH. A VPS was inserted using a Strata II valve with a pressure setting of 1.5, lowering ICP into the normal range. The patient initially had a normal postoperative course, but then became comatose and developed imaging signs consistent with intracranial hypotension. A Codman Certas valve was placed at a setting of 7 and a distal slit-cut peritoneal catheter was used (as opposed to standard open output). This custom system drained at pressure >26 mm Hg based on intraoperative manometry. The patient tolerated this well and is currently planned for a gradual reduction in ICP with valve setting adjustments as an outpatient. In patients with chronic IIH, reduction to normal ICP may unexpectedly lead to encephalopathic changes. Personalized shunts may facilitate reduction of ICP to still elevated but tolerable levels in these patients. [ABSTRACT FROM AUTHOR]

Endovascular aneurysm repair has been used to repair abdominal aortic aneurysms but necessitates surveillance to diagnose the delayed possibility of endoleak formation. Multi-detector computer tomography (MDCT) of the abdomen is one imaging technique used to diagnose enlargement of the aneurysm sac thatmay be indicative of endoleaks. MDCT has a role in identifying the initial endoleak formation and providing signs suggestive of the specific endoleak subtype; thus it is necessary for radiologists to be familiar with the findings of endoleak seen on MDCT. In this pictorial review, we explore the various types of endoleaks and their appearance on MDCT. [ABSTRACT FROM AUTHOR]

Prospectively triggered (PT) cardiac computed tomography (CT), whereby radiation is administered only at a predefined phase of the cardiac cycle, has been shown to substantially decrease radiation dose. The aim of our study was to assess the use of this technique in a clinical population using dual-source cardiac CT. Of 312 consecutive patients referred for a dual-source cardiac computed tomographic examination, PT was used in 42 patients for whom, based on physician judgment, it was decided to minimize radiation, whereas retrospective gating was used for 188 patients (coronary artery bypass grafting and pulmonary vein studies were excluded). Kilovolt and milliampere per second were chosen for each patient based on assessment of body habitus and effective radiation dose was calculated. Analysis of nonevaluable vessels was based on clinical readings. For each study, image quality (IQ) was rated on a subjective IQ score and contrast-to-noise and signal-to-noise ratios were calculated. Of the 42 PT examinations (mean age 44.3 years, body mass index 27.8 kg/m2, 62% men), 28 were referred for coronary evaluation, 11 for aortic disease with/without coronaries, and 3 for other reasons (i.e., suspected mass and congenital disease). Average heart rate was 64.5 beats/min. Average radiation dose of all 42 PT scans was 3.2 ± 1.6 vs 13.4 ± 7.8 mSv for the 188 non-PT scans. There was no significant difference in IQ score and contrast-to-noise and signal-to-noise ratios between the 2 groups. Furthermore, the incidence of limited right coronary artery evaluation and of limitations related to right coronary artery motion did not differ between PT and non-PT scans. In conclusion, in selected patients, prospective triggering with dual-source cardiac CT is feasible and results in a dramatic decrease of radiation dose without compromising IQ. Future advances in cardiac CT may further improve this technique, thus allowing for wider use. [Copyright &y& Elsevier]

Cardiovascular involvement is a common complication of COVID-19 infection and is associated to increased risk of unfavorable outcome. Advanced imaging modalities (coronary CT angiography and Cardiac Magnetic Resonance) play a crucial role in the diagnosis, follow-up and risk stratification of patients affected by COVID-19 pneumonia with suspected cardiovascular involvement. In the present manuscript we firstly review current knowledge on the mechanisms by which SARS-CoV-2 can trigger endothelial and myocardial damage. Secondly, the implications of the cardiovascular damage on patient's prognosis are presented. Finally, we provide an overview of the main findings at advanced cardiac imaging characterizing COVID-19 in the acute setting, in the post-acute syndrome, and after vaccination, emphasizing the potentiality of CT and CMR, the indication and their clinical implications. • Cardiovascular involvement is common in COVID-19 and is associated with unfavorable prognosis. • CT can exclude coronary disease and pulmonary embolism, providing ancillary information for risk stratification. • CMR is useful to characterize myocardial alteration related to acute COVID-19, post-acute sequelae and vaccination. [ABSTRACT FROM AUTHOR]