Intracranial screening

Danazol has been associated with several cases of benign intracranial hypertension also known as pseudotumor cerebri. Early signs and symptoms of benign intracranial hypertension include papilledema, headache, nausea, and vomiting, and visual disturbances. Screen patients with these symptoms for papilledema and, if present, advise the patients to discontinue danazol immediately and refer them to a neurologist for further diagnosis and care. 

Vasculitis affecting the central nervous system (CNS) represents a heterogeneous group of inflammatory diseases that may be idiopathic or associated with autoimmune diseases, infections, drug exposure, radiation, or cancer. Inflammatory cells invade vessel walls, and neuropeptide release increases vasomotor reactivity. These properties lead to vessel narrowing. There is also loss of normal endothelial anticoagulant properties and vessels have increased susceptibility to thrombosis. Consequently, patients with vasculitis develop ischemic and thrombotic infarctions. There is also altered wall competence, which can result in dissection or vessel wall disruption with intracranial hemorrhage. MRA is clinically used to screen for vasculitis, but is less sensitive than DSA (Fig. 6.20). One study of 14 patients with suspected vasculitis reported that MRA can detect distal stenoses in vasculitis with a... 

ISAT was a randomised, prospective, international, controlled trial of endovascular coiling vs surgical clipping for a selected group of patients with ruptured intracranial aneurysms deemed suitable for both types of therapy. Most patients were treated at high-volume centres in the United Kingdom, with the remainders from other European countries, Australia, Canada, and the United States. The primary endpoint was patient outcome, defined as a modified Rankin scale of 3-6 (dependent or deceased) at 1 year. The primary hypothesis was that endovascular treatment would reduce the proportion of patients dependent or deceased by 25% at 1 year. A total of 9559 patients with SAH were screened... 

Bornstein RA, Weir BK, Petruk KC, Disney LB (1987) Neuropsychological function in patients after subarachnoid hemorrhage. Neurosurgery 21 651-654 Bosmans H, Wilms G, Marchal G, Demaerel P, Baert AL (1995) Characterisation of intracranial aneurysms with MR angiography. Neuroradiology 37 262-266 Bossuyt PM, Raaymakers TW, Bonsel GJ, Rinkel GJ (2005) Screening families for intracranial aneurysms anxiety, perceived risk, and informed choice. Prev Med 41(3/4) 795-799... 

---