• An actuarial analysis showed the risk of intracranial hemorrhage among patients with coexisting aneurysm and AVM to be 7% per year at 5 years following diagnosis compared to 1.7% for patients with AVM alone. (thejns.org)
  • Brain CT (computed tomography) scan ruled out a cerebrovascular accident, intracranial hemorrhage, or mass lesion in the brain. (increaseheight.eu)
  • 4.5 hours is a narrow therapeutic time window and many contraindications such as recent surgery, coagulation abnormalities, and history of intracranial hemorrhage inhibit many patients from receiving systemic thrombolysis. (rebelem.com)
  • Intracranial hemorrhage can be divided into epidural, subdural, and subarachnoid. (orthopaedicclinic.com.sg)
  • Primary injuries arise from an initial traumatic event and include scalp and skull injuries, extraparenchymal hemorrhage, cortical contusion, concussion, and diffuse axonal injury. (orthopaedicclinic.com.sg)
  • Genetic Causal Association Between the Gut Microbiome and Intracranial Aneurysm and Subarachnoid Hemorrhage: A Two-Sample Mendelian Randomization Study. (cdc.gov)
  • Meningiomas are the most commonly reported intracranial tumor. (medscape.com)
  • Flat tumors, termed en plaque, infiltrate the dura and grow as a thin carpet or sheet of tumor along the convexity dura, falx, or tentorium. (medscape.com)
  • On histopathological evaluation, it was found to be a polymorphous low-grade neuroepithelial tumor of the young (PLNTY) - a rare, recently reported entity that can mimic an intracranial granuloma on imaging. (thieme-connect.com)
  • Cerebral meningioma is the most frequently reported primary brain tumor of cats and accounts for almost 10% of all nonhematopoietic neoplasms. (vin.com)
  • Secondary tumors are metastasis from a primary tumor located outside the nervous system, or occur by local invasion from adjacent non- neural tissues (e.g., bone). (vin.com)
  • Li L, Patel M, Nguyen HS, Doan N, Sharma A, Maiman D. Primary atypical teratoid/rhabdoid tumor of the spine in an adult patient. (surgicalneurologyint.com)
  • Three months later, a cervical MRI showed progression of the tumor, along with new lesions in the thoracic/lumbar spine plus intracranial punctate nodular tumors. (surgicalneurologyint.com)
  • She underwent disease reevaluation 4 weeks after the completion of radiation, which showed improvement in the spinal tumor and no new metastatic lesions. (surgicalneurologyint.com)
  • Clinical and demographic data, with special attention to sex, age, primary tumor, brain tumor-related epilepsy (BTRE), number and brain location of BMs, Karnofsky Performance Status (KPS), the updated DS-GPA prognostic index and the survival estimated according to the Kaplan-Meier model from the date of radiosurgery were analyzed. (preprints.org)
  • In the univariate analysis, primary tumor, age and the presence of metastases in the posterior fossa (PFBMs) were also significative. (preprints.org)
  • Other variables such as the type of primary tumor, age and PFBMs could also influence survival, although further studies are needed. (preprints.org)
  • In all patients, the tumor became manifest in symptoms resembling a primary extradural entity, like chronic sinusitis, chordoma or nasal polyposis. (biomedcentral.com)
  • Methods Fusiform dilatations of internal carotid artery were diagnosed on three pediatric patients during follow-up imaging after primary surgery for suprasellar-parasellar tumor. (unicatt.it)
  • Unfortunately, the tumor progressed after radiotherapy, and the patient died 3 months later of intracranial hypertension syndrome. (medscape.com)
  • In all of the patients, the lesions appeared as large symmetrical masses on both sides of the third ventricle, a feature that seems to further exclude the contralateral growth of a previously unilateral tumor. (nih.gov)
  • Gamma Knife to the surgical resection bed for intracranial metastases: do tumor diameter and treatment volume matter? (world-sci.com)
  • Although such a tumor typically presents with a focal mass lesion. (kbco.hr)
  • The majority were confirmed by biopsy, and all of them showed histological features similar to the primary tumor. (hindawi.com)
  • 6. History or presence of significant thyroid disease, adrenal dysfunction, organic intracranial lesion such as pituitary tumor. (who.int)
  • Most primary brain tumors are solitary, but multiple primary brain tumors have been reported. (vin.com)
  • Secondary or metastatic tumors appear to be less common and may result from local extension (e.g., nasal adenocarcinoma) or metastases from primary tumors elsewhere. (vin.com)
  • Primary tumors other than meningiomas appear to be less common in cats than in dogs. (vin.com)
  • Primary brain tumors originate from cells normally found within the brain and meninges. (vin.com)
  • Secondary effects of brain tumors include hydrocephalus, increased intracranial pressure (ICP), cerebral edema, and brain herniation. (vin.com)
  • Primary brain tumors often are slow growing and the brain adapts to the slow increase in ICP. (vin.com)
  • I'm a board certified neuro-oncologist who treats both primary brain tumors as well as metastatic disease to the brain and nervous system. (stanford.edu)
  • We present three cases of common intracranial tumors, with purely extracranial extension. (biomedcentral.com)
  • The three described cases demonstrate, that preoperative MRI and CT imaging is important for differential diagnosis to exclude intracranial connections of the tumors. (biomedcentral.com)
  • In the present paper we report 4 new pediatric cases of primary bilateral thalamic tumors (PBTTs) observed in the Pediatric Neurosurgery Section at the Catholic University Medical School, Rome. (nih.gov)
  • Primary tumors were staged according to the 1992 Fuzhou staging system [ 6 ] as they were diagnosed, a system approved and recommended by the Chinese Association of Radiation Oncology in Fuzhou and widely used in mainland China since 1992. (hindawi.com)
  • Those metastases can be further classified according to their extension toward the subdural or extradural space and can frequently simulate other pathologic conditions including chronic subdural hematomas, abscess, and primary bone tumors. (uniba.it)
  • Discussions and voting were organised around six pre-specified themes: (1) primary DC for mass lesions, (2) secondary DC for intracranial hypertension, (3) peri-operative care, (4) surgical technique, (5) cranial reconstruction and (6) DC in low- and middle-income countries. (uib.no)
  • In conjunction with hCG for stimulation of spermatogenesis in primary or secondary hypogonadotropic hypogonadism caused by a congenital factor or prepubertal hypophysectomy and in secondary hypogonadotropic hypogonadism caused by hypophysectomy, craniopharyngioma, cerebral aneurysm, or chromophobe adenoma. (medicscientist.com)
  • The secondary endpoints include quality of life measured by EQ-5D, mortality, complications, intracranial pressure and cerebral perfusion pressure control and incidence of salvage craniectomy in craniotomy patients at each investigation time point. (biomedcentral.com)
  • Headaches are broadly classified as primary or secondary. (nih.gov)
  • Whole-body computed tomography scan and 18 F-fluorodeoxyglucose positron emission tomography/computed tomography scan excluded a secondary lesion from a cancer arising elsewhere in the body, suggesting a primary sellar or suprasellar lesion. (medscape.com)
  • Preconceptional immunity is protective against vertical transmission, with a rate of intrauterine transmission following primary infection during pregnancy of 30 - 40%, compared with only 1% following secondary infection [1] . (ommegaonline.org)
  • Traumatic events can lead to both primary injuries [e.g. scalp lacerations, intracranial bleeds, skull fractures, concussion, and diffuse axonal injury, (DAI)] and later, secondary injuries (e.g. herniation syndromes, diffuse edema, and hypoxic/ischemic injuries). (orthopaedicclinic.com.sg)
  • The fundamental goals in treating head injury are to recognize primary injuries and to prevent secondary lesions. (orthopaedicclinic.com.sg)
  • sified as primary or secondary. (who.int)
  • Weakness and sensory abnormalities often are seen with a lesion in the cerebral frontoparietal regions or their deeper pathways. (vin.com)
  • Radiographic lesions were found in the basal ganglia, thalami, and cerebral cortex. (cdc.gov)
  • Primary multiple temporal cystic lesion, minimally en- human infection are E. granulosus and cerebral hydatid cysts are quite unu- hanced after contrast. (who.int)
  • Association of gut microbiome with risk of intracranial aneurysm: a mendelian randomization study. (cdc.gov)
  • Twenty-six patients (87%) had no prior history of intracranial surgery or radiation. (world-sci.com)
  • Notably, responses in intracranial lesions were observed among patients with measurable CNS metastases at baseline. (ipharmacenter.com)
  • Stereotactic radiosurgery (SRS) is an emerging alternative to whole brain irradiation (WBI) after resection of intracranial metastases. (world-sci.com)
  • We retrospectively reviewed the SRS experience for intracranial metastases at Pennsylvania Hospital from 2006-2010. (world-sci.com)
  • Methods: A series of consecutive patients admitted during a 12-year period through our oncall pathway for subdural/extradural collections or intraparenchymal lesions found, on histologic analysis, to represent intracranial prostate cancer metastases was retrospectively reviewed. (uniba.it)
  • Metastases could be classified as pure subdural space lesions, dural-based lesions, extradural/bony lesions, and pure intraparenchymal lesions. (uniba.it)
  • All patients with subdural metastases and 3 out of 5 patients with dural-based lesions required an emergency intervention due to rapidly deteriorating neurologic status. (uniba.it)
  • Most of NET patients with brain metastasis showed the primary lesion of NEC in the lungs, and they had multiple metastases to the liver, lymph nodes, bones, and so forth at the time of diagnosis of brain metastasis. (biomedcentral.com)
  • A definitive pathological diagnosis was obtained in 2 dogs: a primary intracranial neoplasm and a metastatic intracranial neoplasm. (avmi.net)
  • A definitive diagnosis was obtained in 6 cats: metastatic neoplasm (n = 1), primary intracranial neoplasm (n = 1), primary intracranial infectious disease (n = 2), and associated systemic infectious disease (n = 2). (avmi.net)
  • INTRODUCTION: Primary central nervous system lymphoma (PCNSL) of T-cell origin is an exceptionally rare, highly malignant intracranial neoplasm. (kbco.hr)
  • Headaches are most commonly signs of primary headache disorders, but may also be symptoms of intracranial abnormalities. (ntnu.no)
  • First, we examined whether the potential results were generalizable to the population at large, thereafter, we examined whether headache was associated with intracranial abnormalities in general, and WMH in particular. (ntnu.no)
  • The ACC/AHA guidelines continue to emphasize the importance of primary prevention of ACS by decreasing coronary artery disease risk factors, including hypertension, hypercholesterolemia, diabetes mellitus, and smoking. (aafp.org)
  • Cerebrospinal fluid pathways can be restored by ETV or septum pellucidotomy (65%) to control intracranial hypertension. (thejns.org)
  • Decompressive craniectomy, which involves expansion of fixed cranial cavity, is used to treat intra-operative brain swelling and post-operative malignant intracranial hypertension. (biomedcentral.com)
  • Salvage decompressive craniectomy will be performed for craniotomy patients once there is evidence of imaging deterioration and post-operative malignant intracranial hypertension. (biomedcentral.com)
  • A 72-year-old woman presented in the emergency unit of Saint-Joseph Hospital, Paris, France, with subacute intracranial hypertension syndrome evolving over the last 2 weeks. (medscape.com)
  • These data suggest that the intracranial AVM's predispose to aneurysm formation within AVM feeding systems and that the mechanism is not simply based upon the high blood flow or high arteriovenous shunt in these systems. (thejns.org)
  • Even though radiological diagnosis is easy, the management of iatrogenic intracranial aneurysm is still a subject for discussion. (unicatt.it)
  • Use of Tirofiban to Prevent Ischemic Events in Patients with CYP2C19 Loss-of-Function Alleles during Flow Diversion of Intracranial Aneurysm: A Multicenter Cohort Study. (cdc.gov)
  • A Mendelian randomisation, propensity score matching study to investigate causal association between serum homocysteine and intracranial aneurysm. (cdc.gov)
  • Vascular markers allowed us in this case to make the unusual diagnosis of primary epithelioid angiosarcoma. (medscape.com)
  • Intracranial abscess is a rare yet potentially devastating disease process that can often be difficult to diagnosis, with an incidence of about 0.4-0.9 cases per 100,000 people. (jetem.org)
  • The median period from onset of the primary lesion up to diagnosis of brain metastasis was 12.8 months, and the brain lesion preceded brain metastasis in 6 patients. (biomedcentral.com)
  • The median survival period from diagnosis of brain metastasis was 8.1 months, and the major cause of death was aggravation of the primary lesion or metastatic lesions in other organs. (biomedcentral.com)
  • Computed tomography (CT) scanning and MRI studies of the brain may be important in ruling out intracranial lesions when the diagnosis of hepatic encephalopathy is in question. (medscape.com)
  • 1 It is important for primary care physicians to be able to diagnose and manage acute coronary syndrome (ACS), which comprises two clinical presentations: ST elevation myocardial infarction (STEMI) and non-ST elevation acute coronary syndrome (NSTE-ACS). (aafp.org)
  • Therefore, over the past several years, research has been directed to limit the brain lesions produced by acute ischemia (neuroprotection) and to increase the recovery, plasticity and neuroregenerative processes that complement rehabilitation and enhance the possibility of recovery and return to normal functions (neurorepair). (mdpi.com)
  • It is indicated for reduction of thrombotic cardiovascular events (including stent thrombosis) in patients with acute coronary syndrome (ACS) managed by means of percutaneous coronary intervention (PCI) who have either (a) unstable angina or non-ST-elevation MI (NSTEMI) or (b) ST-elevation MI (STEMI) when managed with primary or delayed PCI. (medscape.com)
  • Three months later, however, an MRI of the cervical spine demonstrated progression of her cervical lesion. (surgicalneurologyint.com)
  • Results No participant showed retrograde flow of cervical or intracranial veins. (bmj.com)
  • Most patients had undergone primary RT using a two-dimensional technique with two lateral opposing faciocervical fields in the first treatment phase, followed by two lateral opposing fields in the second phase to cover the nasopharynx, matched with a single anterior cervical field to cover the neck. (hindawi.com)
  • [2] The primary role of the emergency provider (EP) is to carefully analyze specific aspects of the history and physical exam to determine which patients are at risk for serious underlying pathology. (nih.gov)
  • CASE REPORT: Past medical history of a 26-year-old male patient with a PCNS lymphoma of T-cell origin was not suggestive of intracranial pathology or any disorder of other organs and organic systems. (kbco.hr)
  • In this article, we discussed the case of a young woman patient with refractory seizures who was presumed to have an intracranial granuloma as an epileptogenic focus, based on neuroimaging, but on histopathology it was diagnosed as PLNTY. (thieme-connect.com)
  • Cerebel lomedullary cisternae cerebrospinal fluid analysis in 6 animals was useful as a sensitivebut nonspecific diagnostic test of an intracranial inflammatory or neoplastic lesion. (avmi.net)
  • These lesions may be a sign of vascular disease and several migraine-specific hypotheses linking WMH and headache have been proposed. (ntnu.no)
  • This case shows that vascular markers should be done in front of an aggressive sellar lesion with unexpected histologic features. (medscape.com)
  • For radiological quantification, lesions were counted at 10 pre-specified levels. (biomedcentral.com)
  • Only those with recurrence at inaccessible sites such as the skull base, the cavernous sinus, and the intracranial area were diagnosed by radiological features. (hindawi.com)
  • All cats had initial signs referable to a left CSS lesion (one had bilateral CSS), whereas in all dogs the lesions were localized to the right cavernous sinus. (avmi.net)
  • The most common mechanisms for formation of intracranial abscesses include direct spread from local infections (odontogenic infections or sinusitis), hematogenous spread (congenital heart disease, endocarditis, dental procedures, or intrapulmonary shunting), or penetrating trauma. (jetem.org)
  • 2 Intracranial abscesses are more likely to occur in severely immunosuppressed patients, after neurosurgical procedures, or in head trauma. (jetem.org)
  • Local (intra-articular or intralesional) injection of [CV004 trade name] may be given as part of the short-term management of inflammatory joint and tendon disorders, and localised inflammatory and hypertrophic skin lesions including those of lichen simplex, lichen planus, granuloma annulare, discoid lupus erythematosus, and keloids. (who.int)
  • In view of concordant electroclinical and imaging data on presurgical evaluation, the lesion was excised and the patient was seizure free. (thieme-connect.com)
  • Statistical analysis was done to estimate the difference in seizure frequency and lesion load. (biomedcentral.com)
  • They represent approximately 38% of all intracranial neoplasms in females and 20% in males. (medscape.com)
  • The contrast-enhanced brain CT revealed a large rim-enhancing left parietal lesion. (jetem.org)
  • A non-contrast CT (Figure 1) revealed a large hypoattenuating left parietal lesion. (jetem.org)
  • Primary cysts of the brain showed a left parietal- common Echinococcus species causing are usually solitary. (who.int)
  • Reperfusion therapy, preferably primary PCI, should be administered to eligible patients with STEMI and symptom onset within the previous 12 hours. (aafp.org)
  • This series represents a subset of a prospective case registry of all patients with lesions suitable for PED treated at 3 Australian neurointerventional centers between August 2009 and August 2010. (ajnr.org)
  • In the present study, we designed a prospective, randomized, controlled trial to clarify the effect of decompressive craniectomy in severe traumatic brain injury patients with mass lesions. (biomedcentral.com)
  • In this trial, 336 patients with traumatic mass lesions will be randomly allocated to a therapeutic decompressive craniectomy group or a prophylactic decompressive craniectomy group. (biomedcentral.com)
  • 5-7 In a recent study 5 based on duplex sonographic and venographic assessment of extracranial and intracranial veins of 65 MS patients and 235 controls, Zamboni et al claimed a perfect coincidence of MS and venous stenoses in various locations. (bmj.com)
  • For TKI-naïve patients (n=71), the primary endpoint of objective response rate (ORR) was an impressive 79%, with a median duration of response (mDOR) reaching 34.1 months. (ipharmacenter.com)
  • Signs and symptoms of increased intracranial pressure (3 cases) and movement disorders (tremor, 2 cases) were the presenting clinical manifestations in our 4 patients. (nih.gov)
  • Of 435 total patients, 34 received Gamma Knife (GK) to the resection bed after removal of a single lesion. (world-sci.com)
  • Patients who had complete response but developed recurrence at the primary site more than 4 months following completion of radical radiotherapy with or without chemotherapy were identified as having a recurrence. (hindawi.com)
  • Results: A total of 19 patients were included, but only 3 were diagnosed with small cell prostate carcinoma, while the majority had a primary prostate adenocarcinoma. (uniba.it)
  • The primary lesion was in the lungs in 26 patients (83.9 %), and the mammary glands, esophagus, and uterus in 1 patient each. (biomedcentral.com)
  • Primary lesions were unknown in 2 patients, including 1 patient in whom NETs were detected in the lymph nodes alone. (biomedcentral.com)
  • Pathological classification of the primary lesion was NET Grade 2 (Ki-67: 3 to 20 %) in 3 patients and neuroendocrine carcinoma (NEC, Ki-67: ≥21 %) in 26 patients. (biomedcentral.com)
  • The term "carcinoid" was used for a long time because patients with a primary lesion in the gastrointestinal tract were mainly examined and the course was relatively favorable [ 1 ]. (biomedcentral.com)
  • Le succès de cette étape nécessite également le rapprochement entre pédiatres et médecins d'adultes pour une prise en charge optimal des patients. (bvsalud.org)
  • these include a new headache occurring with another lesion capable of causing it. (gpnotebook.com)
  • In addition to diagnosing and managing life-threatening causes of headaches, the EP must be well versed in treating common primary headache disorders, as proper management of the natural course of the disease may improve patient outcomes. (nih.gov)
  • Action Stimulates ovarian follicular growth in women who do not have primary ovarian failure. (medicscientist.com)
  • A reactive brain edema was seen around the mass on the axial T2 and coronal fluid-attenuated inversion recovery sequences, which is not a typical feature of macroadenoma and could suggest, although rather nonspecific, an unusual lesion. (medscape.com)
  • Nevertheless, in rare cases these entities may occur solely as extracranial lesions that may present as intranasal/sinusoidal masses, with headaches and nasal obstruction. (biomedcentral.com)
  • Extra- and intracranial venous flow direction was assessed by colour-coded duplex sonography, and extracranial venous cross-sectional area (VCSA) of the internal jugular and vertebral veins (IJV/VV) was measured in B-mode to assess the five previously proposed CCSVI criteria. (bmj.com)
  • Stereotactic radiosurgery is used for obliterating DAVFs sometimes in conjunction with embolization or surgery, and is considered an important adjunct and sometimes a primary treatment method for non-aggressive DAVFs. (wikipedia.org)
  • In this case, the patient underwent operative stereotactic drainage of the lesion. (jetem.org)
  • Longer survival was related to female, younger than 60 years, breast cancer primary tumour, steroid response , RPA class, and higher performance and neurocognitive score tools. (her2support.org)
  • When the CT was enhanced with intravenous contrast (Figure 2), the same lesion showed peripheral rim enhancement, suggestive of a brain abscess. (jetem.org)
  • Primary cysts are fertile, containing logical examination revealed bilateral a clear follow-up CT brain scan. (who.int)
  • they occur during childhood case of primary multiple hydatid cysts without loss of cortical sensation. (who.int)
  • A craniotomy was done, and six mary intracranial hydatid cyst results parents gave a history of unexplained cysts were evacuated. (who.int)
  • To simplify the above systems of DAVF classification, the two main factors that should be considered to determine aggressiveness of these lesions are: DAVF that have bleed (as opposed to those that have not before) DAVF resulting in cortical venous reflux Treatment decisions are more complicated and require consultation with a neurosurgeon and team familiar with these lesions. (wikipedia.org)
  • Meningioma, craniopharyngeoma and glioma are mainly intracranial lesions. (biomedcentral.com)
  • There was no evidence of a connection of this sinonasal meningioma to other intracranial masses, as indicated in CT scan in bone window and MR imaging (Fig. 2 ). (biomedcentral.com)
  • In front of an aggressive sellar and suprasellar lesion with a subacute clinical presentation, the main diagnoses are a pituitary carcinoma or aggressive adenoma, a pituitary metastasis of a carcinoma of unknown origin, or a solid craniopharyngioma. (medscape.com)
  • The hallmark of MS is the perivenous white-matter lesion, 1 characterised by local inflammation, de- and remyelination, and local astrogliosis. (bmj.com)
  • Rapid reperfusion with primary percutaneous coronary intervention is the goal with either clinical presentation. (aafp.org)
  • A portfolio of 148 pre- and post treatment images of 37 cases of proximal anterior circulation occlusions was electronically sent to 12 expert observers who were asked to grade treatment outcomes according to recanalization (of arterial occlusive lesion) or reperfusion (TICI) scales. (ajnr.org)
  • Brain magnetic resonance imaging revealed a 4-cm heterogeneous enhancing sellar and suprasellar lesion, with substantial mass effect on the chiasm and third ventricle (Fig. 1). (medscape.com)
  • Focal neurological signs usually are indicative of a fairly well developed mass lesion. (vin.com)
  • For cases of severe traumatic brain injury, during primary operation, neurosurgeons usually face a dilemma of whether or not to remove the bone flap after mass lesion evacuation. (biomedcentral.com)
  • In the prophylactic decompressive craniectomy group, the bone flap will be removed after mass lesion evacuation. (biomedcentral.com)
  • This study will provide evidence to optimize primary decompressive craniectomy application and assess outcomes and risks for mass lesions in severe traumatic brain injury. (biomedcentral.com)
  • Axial T2 weighted images (B), T1 weighted images before (C) and after contrast administration (E, F) show a contrast enhancing soft tissue mass being slightly inhomogeneous in the left frontal sinus without any intracranial meningeal enhancement. (biomedcentral.com)
  • The mass was transsphenoidally partially resected, and the patient received gamma-knife radiotherapy on the residual lesion. (medscape.com)
  • A) Axial, (B) coronal, and (C and D) sagittal sections of (A) T2 fluid-attenuated inversion recovery, (B) T2, (C) T1 pregadolinium, and (D) postgadolinium, showing a 4-cm heterogeneous enhancing sellar and suprasellar lesion, with substantial mass effect to the chiasma and third ventricle. (medscape.com)
  • We have also identified areas of uncertainty, where further research is required, including the role of primary DC, the role of hinge craniotomy and the optimal timing and material for skull reconstruction. (uib.no)
  • Severe primary injury and exasperate condition necessitate emergent surgical intervention. (biomedcentral.com)
  • Several angiographic and clinical parameters were investigated to better understand the relationship of these lesions. (thejns.org)
  • A whole-body clinical examination, particularly of the skin and mucous membranes, did not find any specific lesion. (medscape.com)
  • Domestic and foreign studies have indicated that the clinical features of recurrent NPC may be different from primary NPC. (hindawi.com)
  • A bite-sized, regular chat for all healthcare professionals working in primary care. (gpnotebook.com)
  • These recommendations are applicable to healthcare providers working in: inpatient, emergency, primary, and outpatient care settings. (cdc.gov)