Clinical presentation of cervical arterial dissection is highly variable, but headache or neck pain is frequently observed. Both invasive and noninvasive imaging are used to confirm the diagnosis but noninvasive techniques overshadow traditional digital subtraction angiography (DSA), which should be reserved for cases where invasive procedures are planned. In spite of the accumulated clinical, diagnostic, and etiological data on cervical arterial dissections in recent years, there is no evidence to support the use of a particular class of antithrombotic agents in these patients. Different pathophysiology of brain ischemia in acute and chronic states of dissection may advocate different treatment strategies, including surgical. There are also no imaging follow-up guidelines, both in terms of frequency and modality, further affecting secondary stroke prevention uncertainties.
Key words: arterial dissection, cervical, stroke, carotid, vertebral.
Nariman Malik, BSc
Gynaecologic cancers remain a leading cause of cancer-related deaths in Canadian women. The three malignancies focussed on in this article, endometrial cancer, ovarian cancer and cervical cancer, have good prognoses if they are detected in their early stages. As such, it is of utmost importance that primary health care physicians be aware of Canadian guidelines for detecting these conditions and their limitations.
When diagnosed early, endometrial cancer is highly treatable and has a high survival rate. Stage I, grade I endometrial cancer has a five-year survival rate of 98%. This type of cancer most often presents as post-menopausal vaginal bleeding early in the course of the disease. Any woman who presents with unexplained post-menopausal bleeding should undergo endometrial assessment which can lead to early detection and improve the chances for a cure.
To identify women at risk of developing endometrial cancer, the progesterone challenge test can be used. In the United States, it had been recommended that all post-menopausal women should undergo this test at each annual examination. There are currently no Canadian recommendations regarding this test.
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