Thyroid ppt

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Thyroid ppt

  1. 1. ARTERIO-VENOUS MALFORMATION
  2. 2. Definition  Arteriovenous malformations (AVM) of the brain and spinal cord are tangles of abnormal blood vessels.They can form wherever arteries and veins exist.
  3. 3. Causes  The exact cause of arteriovenous malformations is unknown.
  4. 4. Risks  Family history—some types of arteriovenous malformations are from genetic defects that can be passed on from one generation to the next.  History of bleeding—some types of arteriovenous malformations are linked to an increased risk of bleeding. People with unexplained recurrent bleeding may be at higher risk of having arteriovenous malformations.  Smoking
  5. 5. Symptoms  Seizures  Headache, especially on one side of the head  Muscle weakness  Lightheadedness  Loss of coordination, especially when walking  Difficulty speaking or understanding language  Loss of senses /Visual problems  Memory loss  Difficulty thinking or mental confusion  Hallucinations
  6. 6. Diagnosis  Angiography or arteriography  Computed axial tomography (CT scan)  Magnetic resonance imaging (MRI)  Magnetic resonance angiogram (MRA)
  7. 7. Treatment  Microsurgery  Radiosurgery  Endovascular (embolization)
  8. 8. Radiosurgery  very successful at treating small to medium- sized AVMs.  Obliteration (destruction) rates for AVMs less than 3 cm in diameter are about 80 to 85%.
  9. 9. Microsurgery
  10. 10. Endovascular Treatment  Associated symptoms
  11. 11. Examination  Vital signs  Physical examination  Neurologic Examination
  12. 12. Glasgow Coma Scale
  13. 13. ER Management  ABCs of resuscitation  IVF  Blood glucose level  Medical or structural cause?
  14. 14. Medical Cause  Additional laboratory and radiologic tests  Infectious  Metabolic  Toxicologic
  15. 15. Structural Cause  Cranial CT scan  Refer to neurosurgeon
  16. 16. Case Scenario  Chief Complaint: vomiting and loose stools.  History: fever, vomiting, irritable , (-) fall/trauma  Physical Examination:  drowsy, irritable, (+) seizure  BP80/60 PR 130 RR 38 Temp 39oC CBG 40mg/dL  soft-tissue contusion over the left scalp and ecchymosis  Chest: clear breath sounds  Abdomen: globular, hyperactive BS, soft, non tender, (+)multiple 1- peso-like marks on the anterior abdomen  Extremities are cool and mottled.
  17. 17. Additional Information  History  Bleeding tendencies  Associated medical problems  Neurologic Exam  Pupils  Funduscopic findings  Motors: preferential movement  Social History  Caregiver  Socio-economic status  Educational attainment of parents/caregiver
  18. 18. DIAGNOSIS?
  19. 19. Differentials Medical Structural  Electrolyte abnormality  Encephalopathy  Infection (sepsis)  Intussusception  Meningitis and encephalitis  Uremia (hemolytic-uremic syndrome)  Cerebral vascular accident  Cerebral vein thrombosis  Hydrocephalus  Intracerebral tumor  Subdural empyema  Trauma (intracranial hemorrhage, diffuse cerebral swelling, shaken baby syndrome)
  20. 20. Management  Blood work-up  Imaging  Cranial CT scan  Xrays
  21. 21. CHILD ABUSE
  22. 22. Shaken Baby Syndrome  Definition: SBS is the vigorous manual shaking of an infant who is being held by the extremities or shoulders  Whiplash-induced intracranial and intraocular hemorrhage  No external signs of head injury
  23. 23. Presenting Symptoms  Frequently non-specific  May be seen first in the outpatient setting  URTI, vomiting, irritability (23%)  Respiratory distress  Diarrhea, poor feeding  Lethargy/decreased level of consciousness  Apnea, seizure, history of minor trauma
  24. 24. Symptoms  History must match physical findings  High index of suspicion when non-specific symptoms and history are at odds
  25. 25. Signs on Physical Exam  Retinal hemorrhage  Bulging fontanel  Pupillary changes  Other physical injuries:  Fractures, soft tissue injuries, bruises  Mechanism of injury/history does not coincide with presenting signs
  26. 26. Diagnosis  CT scan – method of choice
  27. 27. Diagnosis  Ophthalmologic consult  Retinal hemorrhage (75-90%)  Minimal external signs (one of the hallmarks of SBS)  Bulging fontanelle in 55% of infants with subdural hematoma
  28. 28. Findings The Brain  Subdural hemorrhage  Subarachnoid hemorrhage  Diffuse axonal injury  Edema/infarction  Parenchymal contusion  Parenchymal hemorrhage
  29. 29. The Eye  Retinal hemorrhage  Vitreous hemorrhage  Papilledema  Retinal detachment  Disruption of eye contents
  30. 30. The Bones  Rib fractures  Skull fractures  Long bone injuries:  Periosteal stripping  Metaphyseal fractures  Shaft fractures
  31. 31. Prognosis  Significant morbidity (50%) and mortality (15%)
  32. 32. SBS Complications  Developmental delays  Behavioral problems  Mental retardation  Post-traumatic hydrocephalus, cerebral atrophy  Permanent brain damage  Seizures  Paralysis  Blindness  Deafness
  33. 33. THANK YOU

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