A comprehensive survey of best practice in using diagnostic imaging in acute neurologic conditions. The symptom-based approach guides the choice of the available imaging tools for efficient, accurate, and cost-effective diagnosis. Effective examination algorithms integrate neurological and imaging concepts with the practical demands and constraints of emergency care.

Spinal dysraphism (SD) is a congenital malformation that to a varying extent, often severely, affects the life of the child and the family. Most individuals with SD suffer from neurogenic bladder and bowel dysfunction—with the risk of urinary tract infections, renal deterioration, urinary and fecal incontinence—that affects social participation and quality of life negatively. In newborns with SD, early detection of neurogenic bladder dysfunction and determination of post-void residual urine are required to determine the need of clean intermittent catheterization (CIC) and follow-up. The non-invasive method of four-hour voiding observation with provocation test (VOP) was used to evaluate bladder function in 50 newborn children with SD. Voiding patterns for the children were described and compared with those of 50 healthy newborns evaluated with VOP in an earlier study. Comparison revealed significant differences among several variables. In particular, leakage at provocation test and not voiding with a stream were common in newborns with SD but did not occur in healthy newborns. VOP is a non-invasive standardized method to determine residual urine in newborns with SD. It also adds information on voiding pattern, frequency, voiding with a stream and leakage at provocation. Findings in neonatal VOP of the same cohort of newborns with SD were then related to radiology, presence of urinary tract infections during the first year, and urodynamic findings and use of CIC at the age of one year. It was found that, in children with SD, not voiding with a stream may have a predictive value for the need of CIC at the age of one year, followed probably by lifelong CIC. Despite this, the presence of an open SD per se has stronger predictive value, and each child needs to be evaluated individually while considering a number of factors. The main value of VOP may be as a structured non-invasive screening method to uncover neurogenic bladder-sphincter dysfunction in the newborn. Studies with a larger number of subjects than the present are needed to evaluate the potential of VOP in newborns with closed spinal dysraphism in whom the neurological consequences vary. A retrospective analysis detected renal damage on DMSA scintigraphy in 5 of 41 children with SD who were followed according to a proactive national program with minimal use of surgery. Median follow-up time was 10 years. High baseline pressure was confirmed as a risk factor for renal damage. Compliance with treatment and follow-up is likely to be an important factor for renal health. Therefore, efforts to support children and their families are crucial. A questionnaire-based study of 107 children with SD (age 6–16y) in Sweden and Norway examined aspects of treatment for neurogenic bowel dysfunction focusing on incontinence, independence, general satisfaction and quality of life. It was found that transanal irrigation (TAI) and antegrade colonic enemas (ACE) are effective treatments, but are time-consuming and difficult to perform independently. The majority of children using TAI (72%) and ACE (63%) never went to the toilet alone to empty their bowels. As children achieving independence on the toilet reported higher quality of life, efforts to support independence are beneficial. Continent, self-managing children with healthy kidneys enjoy high quality of life and contribute more fully to society. Therefore, further research is required to investigate and develop existing and new technologies and methods that mitigate the problems related to SD, and to make them accessible to all children with spinal dysraphism. Under de senaste 50 åren har det skett en enastående utveckling av möjligheterna för barn som föds med ryggmärgsbråck. Tidigare har majoriteten av barn med ryggmärgsbråck avlidit redan som spädbarn men idag överlever de flesta till vuxen ålder. Utan aktiva insatser och uppföljning är dock risken för medicinska problem och allvarlig påverkan på livet mycket stor. Nu när nästan alla barn överlever ligger fokus på att också nå okad livskvalitet och självständighet för personer med ryggmärgsbråck. Nästan alla med ryggmärgsbråck måste hantera en allvarlig påverkan på blåsan och tarmen med risk för njurskador, inkontinens och förstoppning. I avhandlingens två första studier värderade vi en metod att, med minimalt obehag för barnet, bedöma blåsfunktionen. Detta för att kunna skilja ut de barn som behöver genomgå mer avancerade undersökningar och få hjälp med blåstömningen genom täta tappningar med kateter, sa kallad ren intermittent kateterisering, RIK. När vi jämförde resultatet av testet för 50 nyfödda med ryggmärgsbråck med samma undersökning av 50 friska nyfödda fann vi stora skillnader. Mest tydligt var att de flesta nyfödda med ryggmärgsbråck (69%) men inga friska nyfödda läckte urin när man tryckte över blåsan. Av nyfödda med ryggmärgsbråck kissade de flesta (74%) inte med stråle vilket alla friska nyfödda gjorde. Att inte kissa med stråle talade också starkt för att barnet skulle komma att behöva hjälp med RIK för att tomma blåsan vid ett ars ålder, och då sannolikt livet ut. Sammantaget visade avhandlingens två första arbeten att den metod för bedömning av blåsfunktion vi undersökt kan användas för att styra uppföljning och behandling av nyfödda med ryggmärgsbråck. Avhandlingens tredje studie visade att aktiv uppföljning av barnen enligt ett nationellt vårdprogram lyckades förhindra njurskador hos de flesta, men att höga tryck i urinblåsan och återkommande urinvägsinfektioner ökade risken för skador. Även familjernas förmåga att i en pressad vardag klara av att genomföra de ofta krävande behandlingar och undersökningar som rekommenderas verkade vara viktig för att förhindra njurskador. Stöttning av familjerna är därför viktig. Avhandlingens fjärde arbete berörde tarmen som nästan alltid är påverkad vid ryggmärgsbråck, med risk för svår förstoppning och avföringsläckage. Detta har påtaglig påverkan på barnen och deras familjer. En tredjedel av de 107 familjerna i vår enkätundersökning i Sverige och Norge (barn 6-16 år) beskrev att man fått avstå från aktiviteter såsom resor på grund av barnets tarmproblem och de barn som hade avföringsläckage rapporterade tydligt lägre livskvalitet än andra. Trots denna allvarliga påverkan finns det hittills inga studier som jämför de olika behandlingar som barnet kan använda. I vår enkät kartlade vi därför vilka metoder som användes och hur bra de fungerade. Vi ställde frågor till både barn och föräldrar, särskilt om avföringsläckage, hur nöjd man var med metoden, barnens livskvalitet och självständighet på toaletten. Det var utifrån svaren tydligt att båda de vanligaste typerna av tarmsköljning var effektiva men tidskrävande och svara för barn och ungdomar att klara att utföra på egen hand. Ingen metod visade sig överlägsen den andra men de barn som klarade att skota tarmtomningen själva skattade sin livskvalitet klart högre än övriga. Vi drar därför slutsatsen att det är viktigt att vårdpersonal diskuterar de olika behandlingsalternativen med barn och föräldrar, och tillsammans med dem väljer den metod som passar det enskilda barnet bäst. Då skapas bästa förutsättningar för att gemensamt arbeta vidare för att uppnå största möjliga självständighet. Självständiga individer, med friska njurar och utan urin- och avföringsinkontinens upplever högre livskvalitet och behöver mindre sjukvård och andra samhällsinsatser. Det behövs mer forskning för att utveckla existerande och nya metoder att hantera de allvarliga komplikationer som riskerar att drabba barn och vuxna med ryggmärgsbråck.

This is the first comprehensive book exclusively dedicated to anorectal physiology and the importance of diagnostic tools in guiding the evaluation and treatment of anorectal dysfunction. Functional disorders, and specifically fecal incontinence and evacuatory disorders, are prevalent in the general population, affecting up to 20% of individuals. As many of these conditions have extremely complex mechanisms, a thorough understanding of anorectal physiology is a crucial element in the surgeon’s “arsenal" to ensure accurate evaluation and to inform treatment. At this time, there is no other title that specifically addresses all aspects of anorectal physiology, as well as anorectal and pelvic floor disorders, including fecal incontinence and defecation disorders. Specifically, the book provides detailed descriptions of diagnostic methods and treatment algorithms for a range of anorectal conditions, including modern treatment modalities such as sacral neuromodulation. A unique and comprehensive reference covering all aspects of the evaluation and treatment of anorectal disorders, Anorectal Physiology – A Clinical and Surgical Perspective will be of significant interest to proctologists and coloproctologists, gastroenterologists, colorectal surgeons, gynecologists and all other professionals interested in anorectal physiology.

Pediatric incontinence: evaluation and clinical management offers urologists practical, 'how-to' clinical guidance to what is a very common problem affecting up to 15% of children aged 6 years old. Introductory chapters cover the neurophysiology, psychological and genetic aspects, as well as the urodynamics of incontinence, before it moves on to its core focus, namely the evaluation and management of the problem. All types of management methods will be covered, including behavioural, psychological, medical and surgical, thus providing the reader with a solution to every patient's specific problem. The outstanding editor team led by Professor Israel Franco, one of the world’s leading gurus of pediatric urology, have recruited a truly stellar team of contributors each of whom have provided first-rate, high-quality contributions on their specific areas of expertise. Clear management algorithms for each form of treatment support the text, topics of controversy are covered openly, and the latest guidelines from the ICCS, AUA and EAU are included throughout. Perfect to refer to prior to seeing patients on the wards and in the clinics, this is the ideal guide to the topic and an essential purchase for all urologists, pediatric urologists and paediatricians managing children suffering from incontinence.

This practical handbook for clinicians covers pharmacological and non-pharmacological treatment options in neurological rehabilitation.

This book introduce neurourology as an emerging interdisciplinary area that covers the basic and clinical studies of the neural control on the normal lower urinary tract and the lower/upper urinary tract dysfunction due to neuropathy disorders. It systematically describes all aspects of neurourology from the epidemiology of the neurogenic bladder; to the pathology and pathophysiology of the lower urinary tract; to the diagnosis and treatment of the neurogenic bladder by conservative therapies or surgeries. This book provides a useful resource for medical doctors, nurses and students in the field of neurourological conditions. All the topics are written by internationally recognized specialists in their field.

This comprehensive and practical reference is the perfect resource for the medical specialist treating persons with spinal cord injuries. The book provides detail about all aspects of spinal cord injury and disease. The initial seven chapters present the history, anatomy, imaging, epidemiology, and general acute management of spinal cord injury. The next eleven chapters deal with medical aspects of spinal cord damage, such as pulmonary management and the neurogenic bladder. Chapters on rehabilitation are followed by nine chapters dealing with diseases that cause non-traumatic spinal cord injury. A comprehensive imaging chapter is included with 30 figures which provide the reader with an excellent resource to understand the complex issues of imaging the spine and spinal cord.

The purpose of this book is to present a focused approach to the pathophysiology, diagnosis, and management of the most common autonomic disorders that may present to the clinical neurologist. Autonomic Neurology is divided into 3 sections. The first section includes 5 chapters reviewing the anatomical and biochemical mechanisms of central and peripheral nervous system control of autonomic function, principles of autonomic pharmacology, and a clinical and laboratory approach to the diagnosis of autonomic disorders. The second section focuses on the pathophysiology and management of orthostatic hypotension, postural tachycardia, baroreflex failure; syncope, disorders of sweating, neurogenic bladder and sexual dysfunction, gastrointestinal dysmotility, and autonomic hyperactivity. The final section is devoted to specific autonomic disorders, including central neurodegenerative disorders; common peripheral neuropathies with prominent autonomic failure; painful small fiber neuropathies; autoimmune autonomic ganglionopathies and neuropathies; focal brain disorders; focal spinal cord disorders; and chronic pain disorders with autonomic manifestations. This book is the product of the extensive experience of its contributors in the evaluation and management of the many patients with autonomic symptoms who are referred for neurologic consultation at Mayo Clinic in Rochester, Minnesota. Autonomic Neurology focuses on clinical scenarios and presentation of clinical cases and includes several figures showing the results of normal and abnormal autonomic testing in typical conditions. Its abundance of tables summarizing the differential diagnosis, testing, and management of autonomic disorders also help set this book apart from other books focused on the autonomic nervous system.

Although pediatric surgery is a distinct and evolving specialty, it still remains an integral part of most general surgical and paediatric medical practice. Nevertheless, surgery in children does differ from adult practice in various fundamental ways, and there are key physiological and anatomical differences that constantly need underlining. Progress and improvement in outcome has also been rapid but it is sometimes difficult for practitioners to keep themselves up-to-date with the usual surgical or paediatric text books. This book will give a concise overview of all important topics and is designed to provide information in order to recognise the common surgical conditions; namely typical symptoms and signs, investigation and then treatment management. It will also provide an anatomical and physiological background to aid understanding, in addition to emphasising logical, and where possible, evidence-based practice by the use of flow charts, tables and algorithms. Authored by an international range of leading contributors, this is the first book of its kind to offer comprehensive coverage to this topic in a quick reference, pocket-book format.

This book provides a detailed review of neurogenic pelvic dysfunctions following a suprapontine lesion, since a clear understanding of the pathogenesis of vesical and bowel dysfunctions has become increasingly important in medical education. It covers both urinary incontinence and retention, constipation and faecal incontinence resulting from ischemic, haemorrhagic and traumatic brain injury and Parkinson’s disease. It also offers a concise yet comprehensive summary of the neurologic examination of the pelvis: all chapters include the most up-to-date scientific and clinical information with the relevant level of clinical evidence. The book is divided into three sections, which integrate basic science with clinical medicine. The first section features a general introduction and essential background into micturition and bowel neural control, focusing on cortical control. Section 2 is devoted to common clinical problems regarding the neurologic assessment of the perineum, while the last section summarises urological and bowel dysfunction in suprapontine lesions. Providing a clear, concise and informative introduction to urology, it is a practical guide for professionals, medical students and residents in Physical Medicine and Rehabilitation, Urology and Neurology.