The National High Blood Pressure Education Program presents the complete Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Like its predecessors, the purpose is to provide an evidence-based approach to the prevention and management of hypertension. The key messages of this report are these: in those older than age 50, systolic blood pressure (BP) of greater than 140 mm Hg is a more important cardiovascular disease (CVD) risk factor than diastolic BP; beginning at 115/75 mm Hg, CVD risk doubles for each increment of 20/10 mm Hg; those who are normotensive at 55 years of age will have a 90% lifetime risk of developing hypertension; prehypertensive individuals (systolic BP 120-139 mm Hg or diastolic BP 80-89 mm Hg) require health-promoting lifestyle modifications to prevent the progressive rise in blood pressure and CVD; for uncomplicated hypertension, thiazide diuretic should be used in drug treatment for most, either alone or combined with drugs from other classes; this report delineates specific high-risk conditions that are compelling indications for the use of other antihypertensive drug classes (angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, beta-blockers, calcium channel blockers); two or more antihypertensive medications will be required to achieve goal BP (<140/90 mm Hg, or <130/80 mm Hg) for patients with diabetes and chronic kidney disease; for patients whose BP is more than 20 mm Hg above the systolic BP goal or more than 10 mm Hg above the diastolic BP goal, initiation of therapy using two agents, one of which usually will be a thiazide diuretic, should be considered; regardless of therapy or care, hypertension will be controlled only if patients are motivated to stay on their treatment plan. Positive experiences, trust in the clinician, and empathy improve patient motivation and satisfaction. This report serves as a guide, and the committee continues to recognize that the responsible physician's judgment remains paramount.

Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure

Co-Planar Stereotaxic Atlas of the Human Brain—3-Dimensional Proportional System: An Approach to Cerebral Imaging, J. Talairach, P. Tournoux. Georg Thieme Verlag, New York (1988), 122 pp., 130 figs. DM 268

New evidence and consensus has led to further revision of the McDonald Criteria for diagnosis of multiple sclerosis. The use of imaging for demonstration of dissemination of central nervous system lesions in space and time has been simplified, and in some circumstances dissemination in space and time can be established by a single scan. These revisions simplify the Criteria, preserve their diagnostic sensitivity and specificity, address their applicability across populations, and may allow earlier diagnosis and more uniform and widespread use.

/pdf/diagnostic-criteria-for-multiple-sclerosis-2010-revisions-to-24iph50480.pdf

Diagnostic criteria for multiple sclerosis: 2010 Revisions to the McDonald criteria

Background and Purpose—The authors present an overview of the current evidence and management recommendations for evaluation and treatment of adults with acute ischemic stroke. The intended audienc...

/pdf/guidelines-for-the-early-management-of-patients-with-acute-19udbft6e7.pdf

Guidelines for the Early Management of Patients With Acute Ischemic Stroke A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association

The International Panel on MS Diagnosis presents revised diagnostic criteria for multiple sclerosis (MS). The focus remains on the objective demonstration of dissemination of lesions in both time and space. Magnetic resonance imaging is integrated with dinical and other paraclinical diagnostic methods. The revised criteria facilitate the diagnosis of MS in patients with a variety of presentations, including "monosymptomatic" disease suggestive of MS, disease with a typical relapsing-remitting course, and disease with insidious progression, without clear attacks and remissions. Previously used terms such as "clinically definite" and "probable MS" are no longer recommended. The outcome of a diagnostic evaluation is either MS, "possible MS" (for those at risk for MS, but for whom diagnostic evaluation is equivocal), or "not MS."

https://www.onlinelibrary.wiley.com/doi/epdf/10.1002/ana.1032

Recommended diagnostic criteria for multiple sclerosis: Guidelines from the International Panel on the Diagnosis of Multiple Sclerosis

Interleaved EPI: Eine Analyse der Bildartefakte und die Verwendbarkeit in der Neurologischen Diagnostik

Superposition of morphological MR information and functional SPECT images

A 29‐year‐old man had temporary cardiorespiratory arrest. Eight hours later, magnetic resonance imaging (MRI) of the brain revealed scattered hyperintense gyri and a marked high signal intensity of the caudate nuclei and the putamen. Computed tomography (CT) displayed no focal abnormalities but only diffuse brain swelling and blood in the subarachnoid space. The patient died 17 hours after the arrest. Histopathological findings were consistent with early ischemic brain damage. Perivascular infiltrates, probably inflammatory, involved the entire brainstem. Neither MRI nor CT demonstrated brainstem encephalitis, the presumed cause for the arrest. This observation suggests a high sensitivity of MRI for cerebral damage caused by global hypoxemia, yielding valuable diagnostic and prognostic information after resuscitation.

Magnetic Resonance Imaging, Computed Tomography, and Autopsy Findings after Cardiorespiratory Arrest

Functional correlates of impaired working memory in MS patients: a multicentre study

Sl M M A R Y l he purposc of the work was to assess .i iul comp.ire parameter Images for the detection of iv ichia l hcmodynaimc ahnormalities calculated by a ilcconvnlution approuch and by direct inethods using ihc hmc dcpendcnt tissuc signal only. MIC cxplored analysis methods were Singular value ikvomposition, fitting of -variate functions, the iiummimi slope method and the cross-correlation fuiKtion for temporal analysis. The data were taken t Vom 21 consecutive patients with focal neurological symptorns, which had a MR perftision scan in the applicd scan protocol. The investigation was performed on a 1.5 T System using a segmented double echo scquence (TE1 TE2=7.5/28 ms). The first echo was taken tor the determmation of the arterial input funetion. A dose of 0.2 mmol/kg body weight of contrast media was injected with 5ml/s followed by a .M) ml saline flush. The parameter images were mdcpendently classified by five readers. In regard to CBF ratings indicated only a slightly better Performance of the SVD method in comparison to the maximum slope method. Within the different inethods to calculate MTT the Integration of the normalized residue funetion was classified äs the best. However, among all temporal parameters t Jag (cross-correlation funetion) was rated highest. Although quantitative methods should give the most reliable intbrmation about a specific hemodynamic Status it was found that specific relative perfusion parameter maps show abnormalities with the same sensitivity. Furthermore, äs the maximum slope method is not influenced by delay effects it is an attractive candidate for (r)CBF imaging.

Franz Fazekas

Papers

Interleaved EPI: Eine Analyse der Bildartefakte und die Verwendbarkeit in der Neurologischen Diagnostik

Superposition of morphological MR information and functional SPECT images

Magnetic Resonance Imaging, Computed Tomography, and Autopsy Findings after Cardiorespiratory Arrest

Functional correlates of impaired working memory in MS patients: a multicentre study

Vergleich unterschiedlicher auswerteverfahren für das cerebrale mr-perfusionsimaging