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Cavernous Angiomas: Screening Of A Family Over Three Generations

Cavernous angiomas belong to a group of intracranial vascular malformations that are developmental malformations of the vascular bed. These congenital abnormal vascular connections frequently enlarge over time. The lesions can occur on a familial basis. Patients may be asymptomatic, although they often present with headaches, seizures, or small parenchymal hemorrhages.

In most patients, cavernous angiomas are solitary and asymptomatic. In recent times, increasing MRI has detected several such asymptomatic cases and has prompted a study into the genetics and natural history of this condition.

It is now known that cavernous angiomas have a genetic basis. Familial forms of cavernous angiomas are associated with a set of genes called CCM genes (cerebral cavernous angioma). This is a case report describing the phenotypic expression of a familial form of cavernous angioma.


A 54-year-old man was referred for an MRI of the brain with complaints of headache and seizures. A cranial CT scan revealed few hyperdense lesions. A subsequent cranial MRI scan revealed several lesions with features representing cavernous angiomas.

The patient was offered counseling and was treated conservatively. Genetic testing was not possible due to the high prohibitive cost. However, screening of the family members by MRI was recommended.

Cranial MRI of the immediate family members was performed. Four brothers of the patient and his mother were found to have multiple cavernous angiomas. The father, youngest brother, and his younger sister were found not to have any such lesion. Both children of the patient were also found to be free of these lesions. Incidentally, a meningioma was found in the father of the patient. Read more »

*This blog post was originally published at AJNR Blog*

MRI-Safe Pacemakers Available In U.S. Hospitals Soon: What It Means For Heart Patients

This was the Guest Blog at Scientific American on February 16th, 2011.

New wave of MRI-safe pacemakers set to ship to hospitals

This week Medtronic will begin shipping to hospitals in the United States the first pacemaker approved by the FDA as safe for most MRI scans. For consumers, it is a significant step in what is expected to be a wave of new MRI-compatible implanted cardiac devices.

But this is an example of one technology chasing another and the one being chased, the MRI scanner, is changing and is a step ahead of the new line of pacemakers. The pacemaker approved for U.S. distribution is Medtronic’s first-generation pacemaker with certain limitations, while its second-generation MRI-compatible pacemaker is already in use in Europe where approval for medical devices is not as demanding as it is in the U.S. So let’s check out what this is all about — what it means now for current and future heart patients and where it may be headed.

We are all born with a natural pacemaker that directs our heart to beat 60 to 100 times a minute at rest. The pacemaker is a little mass of muscle fibers the size and shape of an almond known medically as the sinoatrial node located in the right atrium, one of four chambers of the heart. The natural pacemaker can last a lifetime. Or it can become defective. And even if it keeps working normally, some point may not function well along the electrical pathway from the pacemaker to the heart’s ventricles which contract to force blood out to the body.

Millions of people in the world whose hearts beat too fast, too slow, or out of sync because their own pacemaker is not able to do the job right, follow their doctors’ recommendation to get an artificial pacemaker connected to their heart to direct its beating. The battery-run pacemaker in a titanium or titanium alloy case the size of a small cell phone, (why can’t it be the size of an almond?) is implanted in the upper left chest, just under the skin, with one or two insulated wire leads connecting to the heart. It can be programmed to run 24/7 or to only operate when the heart reaches a certain state of irregular beating. Read more »

*This blog post was originally published at HeartSense*

Meditation: How It May Change The Brain

Meditation sounds like a great idea from the perspective of a psychiatrist: Anything that calms and focuses the mind is a good thing (and without pharmaceuticals, even better).

Personally, I tried transcendental meditation as a kid (more to do with my mother than with me) and found it to be boring. I have trouble keeping my thoughts still. They wander to what I want for dinner, and should I write about this on Shrink Rap, and will Clink and Victor ever eat crabcakes with me again, and did I remember to give my last patient informed consent, and a zillion other things. Holding my thoughts still is work.

The New York Times Well blog has an article on meditation and brain changes. In “How Meditation May Change the Brain,” Sindya N. Bhanoo writes:

The researchers report that those who meditated for about 30 minutes a day for eight weeks had measurable changes in gray-matter density in parts of the brain associated with memory, sense of self, empathy and stress. The findings will appear in the Jan. 30 issue of Psychiatry Research: Neuroimaging.

M.R.I. brain scans taken before and after the participants’ meditation regimen found increased gray matter in the hippocampus, an area important for learning and memory. The images also showed a reduction of gray matter in the amygdala, a region connected to anxiety and stress. A control group that did not practice meditation showed no such changes.

Lower stress, lower blood pressure, higher empathy. I may have to give meditation another try.

*This blog post was originally published at Shrink Rap*

Kids With Dyslexia: Predicting Their Reading Skills With MRI

An international team of researchers has developed a rather reliable test that predicts the future improvement of reading abilities in kids with dyslexia. The method uses functional MRI (fMRI) and diffusion tensor magnetic resonance imaging (DTI) to scan the brain, and data crunching software to interpret the data. The researchers hope that the finding will help parents and therapists uniquely identify which learning tools are best for each child.

From the announcement by Vanderbilt University :

The 45 children who took part in the study ranged in age from 11 to 14 years old. Each child first took a battery of tests to determine their reading abilities. Based on these tests, the researchers classified 25 children as having dyslexia, which means that they exhibited significant difficulty learning to read despite having typical intelligence, vision and hearing and access to typical reading instruction.

During the fMRI scan, the youths were shown pairs of printed words and asked to identify pairs that rhymed, even though they might be spelled differently. The researchers investigated activity patterns in a brain area on the right side of the head, near the temple, known as the right inferior frontal gyrus, noting that some of the children with dyslexia activated this area much more than others. DTI scans of these same children revealed stronger connections in the right superior longitudinal fasciculus, a network of brain fibers linking the front and rear of brain. Read more »

*This blog post was originally published at Medgadget*

Live Birth, MRI Style

At the Charité Hospital in Berlin, researchers have built a specialty MRI machine with enough space to fit a woman undergoing labor. The Local, a German newspaper in the English language, is reporting that the first images of a baby moving through the birth canal have been captured, and that the mother and child are doing just fine. The clinicians involved in the project hope to be able to study why some women end up requiring a Caesarian section, while others do not.

More at The Local: MRI scans live birth…

*This blog post was originally published at Medgadget*

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Latest Book Reviews

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

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