its cause (Fig. 2.10). Differentiation must be made between raised intracranial pressure and cerebral atrophy. Ultrasound may guide neuro-
surgical shunting procedures, while also monitoring subsequent progress.
Multicenter, randomized clinical trials of carotid endarterectomy have shown that the operation significantly reduces the risk of stroke in patients with severe (>70%) internal carotid artery stenosis .
Whilst angiography is accepted as the "gold standard" modality for diagnosing a significant stenosis, carotid duplex imaging, in conjunction with color and power imaging, is now recognized as the better initial test and often the only test necessary. Not only does ultrasound have the great advantage of being non-invasive, but it is also in general the most cost effective of the possible relevant investigations. Ultrasound has been shown to be very accurate in assessing the degree of stenosis, as assessed by pathological review of endarterectomy specimens, although it must be noted that the degree of operator skill is of crucial importance. Angiography is required where the duplex study is equivocal or if there is any doubt about total vessel occlusion.
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The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.