Drs. Faith Meyers and Steven Perry are Emergency Medicine Residents at Carolinas Medical Center and interested in medical education. Along with the guidance of Dr. Michael Gibbs (Chair of Emergency Medicine), Dr. Jonathan Clemente (Chief of the Department of Radiology and Neuroradiology specialist), and Dr. Scott Wait (Chief of Pediatric Neurosurgery) they aim to help educate us on Neuroimaging. In this initial educational slideset, they are also joined by Dr. Andrew Perron, the creator of the “Blood Can Be Very Bad” Head CT interpretation framework. Follow along with the EMGuideWire.com team as they post the CMC Neuroimaging Case Studies.
This set will cover:
- The Neuroimaging Framework “Blood Can Be Very Very Bad.”
This document describes a case of cerebral venous thrombosis (CVT) in a 20-year-old female patient who presented with worsening headache, nausea, dizziness, and blurred vision. It provides details on her medical history, physical exam findings, lab and imaging results. CVT is an uncommon type of stroke more common in young individuals. Risk factors include genetic thrombophilias, acquired conditions like pregnancy/puerperium and cancer. Clinical symptoms vary depending on increased intracranial pressure or focal brain injury. Management involves anticoagulation to stop thrombotic process along with supportive care. Outcomes range from full recovery in 80% of patients to mortality in 6-20% depending on severity of presentation
This document discusses pericardial diseases and various conditions that affect the pericardium. It begins by describing normal pericardial fluid volume and ventricular interdependence under normal conditions. It then discusses the history of using ultrasound to image the pericardium. Various pathological conditions are covered, including increased pericardial thickness in constrictive pericarditis, how intrapericardial pressure changes with fluid volume and pericardial stiffness, and signs of cardiac tamponade seen on echocardiogram like right atrial and ventricular collapse and IVC plethora. Finally, it describes the presentation of effusive-constrictive pericarditis.
Patent Ductus Arteriosus: Clinical manifestation and DiagnosisNinia Kabir
Descriptive and informative facts about Patent Ductus Arteriosus focusing on its clinical features, physical findings, natural course and diagnostic work up. The diagnostic work up does not include Echocardiography in this presentation.
This document discusses complications that can occur during percutaneous coronary intervention (PCI), specifically contrast-induced nephropathy and coronary perforation. It defines contrast-induced nephropathy as acute kidney injury occurring after administration of radiocontrast media. Coronary perforation is defined as extravasation of contrast or blood from the coronary artery during or after PCI. The document discusses risk factors, prevention, diagnosis and management of these complications.
This document provides information on Ebstein's anomaly, a rare congenital heart defect involving abnormal development of the tricuspid valve. It discusses the embryology, anatomy, physiology, clinical presentation and natural history. Key points include:
- Ebstein's anomaly results from a failure of the tricuspid valve leaflets to properly separate from the myocardium during development. This causes downward displacement of the valve and dilation of the right ventricle.
- Clinical presentations vary from fetal cyanosis to incidental murmurs later in life. Arrhythmias are common. Survival depends on severity but most children and adolescents have little disability.
- Long term outcomes are limited but available data shows around 15
The document provides information on electrocardiogram (ECG) findings and their significance in patients presenting with syncope. It discusses diagnostic criteria and risk stratification tools for evaluating causes of syncope, including the CHESS criteria and San Francisco Syncope Rule. Important ECG findings that warrant further investigation or indicate an underlying cardiac condition are highlighted, such as arrhythmias, conduction abnormalities, signs of ischemia, and structural heart disease. Specific arrhythmias and cardiac conditions like long QT syndrome and Brugada syndrome are also reviewed in the context of evaluating syncope.
This document discusses heart failure with preserved ejection fraction (HFpEF), formerly known as diastolic heart failure. It provides background on HFpEF versus systolic heart failure and explores the pathophysiology and management of HFpEF. Key points include:
1) HFpEF is a distinct clinical syndrome from heart failure with reduced ejection fraction (HFrEF), with normal ejection fraction but evidence of diastolic dysfunction.
2) Impaired systolic function can be detected in HFpEF patients using strain imaging, despite preserved global ejection fraction.
3) The pathophysiology of HFpEF is complex and multifactorial, involving microvascular inflammation, cardiomyocyte stiff
The document discusses mitral regurgitation (MR), including the anatomy of the mitral valve, mechanisms and etiologies of MR, assessment of MR severity using echocardiography techniques like Doppler imaging, and consequences and management of MR. It provides details on evaluating MR severity based on vena contracta width, proximal isovelocity surface area, mitral-aortic time velocity integral ratios, and pulmonary venous flow. Primary causes of MR include degenerative diseases of the valve like Barlow's syndrome, while secondary MR is typically functional and due to left ventricular remodeling without structural valve abnormalities.
This document describes a case of cerebral venous thrombosis (CVT) in a 20-year-old female patient who presented with worsening headache, nausea, dizziness, and blurred vision. It provides details on her medical history, physical exam findings, lab and imaging results. CVT is an uncommon type of stroke more common in young individuals. Risk factors include genetic thrombophilias, acquired conditions like pregnancy/puerperium and cancer. Clinical symptoms vary depending on increased intracranial pressure or focal brain injury. Management involves anticoagulation to stop thrombotic process along with supportive care. Outcomes range from full recovery in 80% of patients to mortality in 6-20% depending on severity of presentation
This document discusses pericardial diseases and various conditions that affect the pericardium. It begins by describing normal pericardial fluid volume and ventricular interdependence under normal conditions. It then discusses the history of using ultrasound to image the pericardium. Various pathological conditions are covered, including increased pericardial thickness in constrictive pericarditis, how intrapericardial pressure changes with fluid volume and pericardial stiffness, and signs of cardiac tamponade seen on echocardiogram like right atrial and ventricular collapse and IVC plethora. Finally, it describes the presentation of effusive-constrictive pericarditis.
Patent Ductus Arteriosus: Clinical manifestation and DiagnosisNinia Kabir
Descriptive and informative facts about Patent Ductus Arteriosus focusing on its clinical features, physical findings, natural course and diagnostic work up. The diagnostic work up does not include Echocardiography in this presentation.
This document discusses complications that can occur during percutaneous coronary intervention (PCI), specifically contrast-induced nephropathy and coronary perforation. It defines contrast-induced nephropathy as acute kidney injury occurring after administration of radiocontrast media. Coronary perforation is defined as extravasation of contrast or blood from the coronary artery during or after PCI. The document discusses risk factors, prevention, diagnosis and management of these complications.
This document provides information on Ebstein's anomaly, a rare congenital heart defect involving abnormal development of the tricuspid valve. It discusses the embryology, anatomy, physiology, clinical presentation and natural history. Key points include:
- Ebstein's anomaly results from a failure of the tricuspid valve leaflets to properly separate from the myocardium during development. This causes downward displacement of the valve and dilation of the right ventricle.
- Clinical presentations vary from fetal cyanosis to incidental murmurs later in life. Arrhythmias are common. Survival depends on severity but most children and adolescents have little disability.
- Long term outcomes are limited but available data shows around 15
The document provides information on electrocardiogram (ECG) findings and their significance in patients presenting with syncope. It discusses diagnostic criteria and risk stratification tools for evaluating causes of syncope, including the CHESS criteria and San Francisco Syncope Rule. Important ECG findings that warrant further investigation or indicate an underlying cardiac condition are highlighted, such as arrhythmias, conduction abnormalities, signs of ischemia, and structural heart disease. Specific arrhythmias and cardiac conditions like long QT syndrome and Brugada syndrome are also reviewed in the context of evaluating syncope.
This document discusses heart failure with preserved ejection fraction (HFpEF), formerly known as diastolic heart failure. It provides background on HFpEF versus systolic heart failure and explores the pathophysiology and management of HFpEF. Key points include:
1) HFpEF is a distinct clinical syndrome from heart failure with reduced ejection fraction (HFrEF), with normal ejection fraction but evidence of diastolic dysfunction.
2) Impaired systolic function can be detected in HFpEF patients using strain imaging, despite preserved global ejection fraction.
3) The pathophysiology of HFpEF is complex and multifactorial, involving microvascular inflammation, cardiomyocyte stiff
The document discusses mitral regurgitation (MR), including the anatomy of the mitral valve, mechanisms and etiologies of MR, assessment of MR severity using echocardiography techniques like Doppler imaging, and consequences and management of MR. It provides details on evaluating MR severity based on vena contracta width, proximal isovelocity surface area, mitral-aortic time velocity integral ratios, and pulmonary venous flow. Primary causes of MR include degenerative diseases of the valve like Barlow's syndrome, while secondary MR is typically functional and due to left ventricular remodeling without structural valve abnormalities.
This document discusses pericardial disease and provides information on the anatomy, physiology, and diseases of the pericardium. It covers the following key points in 3 sentences:
The pericardium has inner serous and outer fibrous layers and normally contains 15-35mL of fluid. Diseases of the pericardium include congenital defects, infections, malignancies, and acquired conditions like acute pericarditis which can lead to cardiac tamponade physiology from excess fluid accumulation. Constrictive pericarditis occurs when the pericardium thickens and restricts heart chamber filling, showing signs on echocardiogram like equalized diastolic pressures between chambers.
Echocardiography is the main tool for evaluating prosthetic heart valves. Transthoracic echocardiography (TTE) is generally used to assess normal valve function and identify dysfunction like stenosis or regurgitation. Transesophageal echocardiography (TEE) provides better imaging of valve structure and is helpful for evaluating regurgitation and complications like endocarditis. Echocardiograms establish a baseline after valve implantation and monitor for issues like pannus, thrombus, infection or degeneration over time. TTE and TEE are complementary, with TEE used when TTE is inadequate or clinical suspicion remains after a TTE.
preop TEE assessment of atrial septal defect is very important for making decision for device closure, properly assessed adequate rims of ASD will reduce risk of device embolization to almost nil.
A 63-year-old man presented with syncope, shortness of breath, and other symptoms for 2 years. Examination found dyspnea, tachycardia, low blood pressure, a systolic thrill, and left ventricular hypertrophy. Imaging showed severe aortic stenosis. The patient underwent transcatheter aortic valve implantation and is now doing well.
Pathophysiology of aortic regurgitation and managementSachin Sondhi
This document summarizes a seminar on aortic regurgitation presented by Dr. Sachin Sondhi at IGMC Shimla on 13/08/2018. It discusses the causes and pathology of aortic regurgitation, including degenerative aortic dilation and diseases affecting the aortic valve and root. The pathophysiology and hemodynamic changes in compensated and decompensated aortic regurgitation are explained. Symptoms, physical exam findings, murmurs and natural history are outlined. Indications for surgery include symptomatic patients or asymptomatic patients with reduced ejection fraction or severe left ventricular dilation. Vasodilator therapy may help preserve left ventricular function in some cases.
Mitral stenosis can be evaluated using echocardiography. Key findings include measuring the mitral valve area using planimetry, pressure half-time, and continuity equation methods. Pressure gradients and pulmonary artery systolic pressure can also assess severity. Mild mitral stenosis is defined as a mitral valve area greater than 1.5 cm2, moderate as 1-1.5 cm2, and severe as less than 1 cm2. Stress echocardiography may reveal symptoms in borderline cases by monitoring pressures with exercise.
Echocardiography is a key tool for diagnosing and evaluating mitral stenosis (MS). It is essential to use an integrative approach when grading MS severity by combining Doppler, 2D imaging, and measurements, rather than relying on one alone. Echocardiography plays a major role in MS by confirming diagnosis, quantifying severity, analyzing consequences, and examining valve anatomy. Mitral valve planimetry directly measures valve area and is considered the reference standard, but additional measurements like pressure gradient and half-time are also useful. Echocardiography aids clinical decision making for patients with MS.
This document provides guidelines on the management of pericardial diseases from the ESC. It discusses the etiology, diagnosis, and treatment of various pericardial conditions including pericarditis, cardiac tamponade, constrictive pericarditis. For constrictive pericarditis specifically, it highlights two key pathophysiological characteristics - exaggerated ventricular interdependence and the halting of intrathoracic pressure changes on the ventricles by a thickened pericardium. Surgical pericardiectomy is the definitive treatment for constrictive pericarditis when medical management fails.
COMPARES OPTIMAL MEDICAL THERAPY WITH INVASIVE THERAPY IN A PATIENT WITH STABLE ISCHEMIC HEART DISEASE WITH MODERATE TO SEVERE MYOCARDIAL ISCHEMIA ON NON INVASIVE STRESS TESTING
Hypertrophic cardiomyopathy (HCM) is defined as hypertrophy of the myocardium more than 1.5 cm, without an identifiable cause . Other causes of left ventricular (LV) hypertrophy, such as long-standing hypertension, amyloidosis, and aortic stenosis must first be excluded before HCM can be diagnosed. As our understanding of the genetics of HCM continues to progress, the diagnosis of HCM will continue to incorporate information obtained from genetic testing, while also continuing to rely on transthoracic echocardiography (TTE) for the assessment of the phenotypic manifestations and the overall clinical severity of the disease.
The document is about congenital heart defects (CHDs) from the perspective of parents. It describes the experience of parents whose seemingly healthy newborn develops signs of a CHD like turning blue. The parents must rush their baby to the hospital where they learn the baby has a heart defect. The document discusses the uncertainty and stress parents endure as their child undergoes surgery and treatment for the CHD. It aims to raise awareness of CHDs by sharing personal stories and statistics in order to help more children with CHDs.
This document summarizes the evaluation of aortic valve stenosis using echocardiography. It describes the normal aortic valve anatomy and various types of aortic valve stenosis including calcific, bicuspid, rheumatic, and supravalvular or subvalvular stenosis. Doppler echocardiography is used to evaluate aortic valve stenosis severity based on valve area, mean gradient, and peak jet velocity. Stress echocardiography with dobutamine can help distinguish true severe from pseudo-severe low-flow, low-gradient aortic stenosis.
ST segment elevations can be seen in acute myocardial infarction (AMI) but also have other causes. Non-AMI causes of ST elevation include left bundle branch block, left ventricular hypertrophy, pericarditis, Brugada syndrome, and early repolarization. The morphology, distribution, and magnitude of ST elevations, as well as other ECG features, can help differentiate AMI from other causes of ST elevation. It can be challenging to diagnose AMI using ECG criteria alone, as around half of AMI cases present without typical ST elevation patterns.
1. A ventricular septal defect (VSD) is an opening in the wall separating the ventricles that allows blood to shunt between them.
2. VSDs are the most common congenital heart defect in children and can be classified based on their location as membranous, perimembranous, muscular, inlet, or outlet.
3. A complete echocardiogram is needed to evaluate the location, size, direction of shunting, and effects of the defect. Three-dimensional echocardiography can help further define the anatomy and guide potential transcatheter closure of the VSD.
This document discusses the natural history of ventricular septal defects (VSDs). It covers the incidence, classification, factors influencing outcomes, and potential complications of VSDs over time, including:
1. Cardiac failure in large VSDs due to left-to-right shunting.
2. Spontaneous closure or diminution, which is more common in smaller defects and those under 10 years of age.
3. Complications such as right ventricular outflow tract obstruction, aortic valve prolapse, pulmonary vascular disease, infective endocarditis, and arrhythmias.
The classification, mechanisms of closure, and guidelines for antibiotic prophylaxis for infective endocard
The second heart sound occurs at the end of systole due to closure of the semilunar valves. There are normally two components: A2 from aortic valve closure and P2 from pulmonary valve closure. A2 is typically louder due to higher pressures in the aorta. The components are normally split, with A2 occurring earlier due to differences in vascular resistance and compliance between the pulmonary and systemic circulations. Widening of the split may indicate conduction delays or pulmonary hypertension. Reversed or paradoxical splitting can occur in conditions that delay left ventricular ejection such as left bundle branch block. Single second heart sounds may result from fusion of the components or absence of one.
This document provides an overview of the main types of cardiomyopathy:
1) Dilated cardiomyopathy is the most common type and causes heart chamber dilation and reduced contraction. It can lead to heart failure and arrhythmias.
2) Hypertrophic cardiomyopathy causes thickened heart muscle and potential outflow obstruction. It is a common cause of sudden death in young athletes.
3) Restrictive cardiomyopathy stiffens the heart ventricles and impairs filling. Amyloidosis is a common cause.
4) Arrhythmogenic right ventricular dysplasia replaces parts of the right ventricle with fat and fibrosis and can cause arrhythmias or sudden death.
This document discusses coarctation of the aorta, including:
1. The definition and history of coarctation as a congenital narrowing of the upper descending thoracic aorta.
2. Theories on the pathogenesis of coarctation related to reduced blood flow through the left side of the heart or abnormal ductal tissue.
3. Types of coarctation including preductal and postductal, and surgical techniques for repair such as patch aortoplasty or bypass grafting.
4. Presentation varies from heart failure in neonates to hypertension in older children and adults, with complications including aneurysm and rupture.
Neuroimaging Mastery Project: Presentation #5 Subdural HematomasSean M. Fox
Drs. Faith Meyers, Madison Watts and Steven Perry are Emergency Medicine Residents at Carolinas Medical Center who are interested in medical education. Dr. Rebecca DeCarlo, MD is a Neurosurgical resident at Carolinas Medical Center. Along with the guidance of Dr. Michael Gibbs (Chair of Emergency Medicine), Dr. Jonathan Clemente (Chief of the Department of Radiology and Neuroradiology specialist), Dr. Christa Swisher (Neurocritcal Care Intensivist), and Dr. Scott Wait (Chief of Pediatric Neurosurgery) they aim to help educate us on Neuroimaging. In this presentation they will address Subdural Hematomas. Follow along with the EMGuideWire.com team as they post the CMC Neuroimaging Case Studies.
- Subdural Hematomas
1. The document discusses the diagnosis and treatment of acute ischemic stroke. It outlines the time windows for treatment with intravenous thrombolysis, which is most effective within 4.5 hours of symptom onset.
2. Early diagnosis is critical in stroke care due to the concept of "time is brain". Delays in treatment can lead to further neuronal damage and worse outcomes. The goals are to perform a CT scan within 20 minutes of arrival and initiate thrombolysis within 60 minutes.
3. Post-thrombolytic management focuses on monitoring for hemorrhagic complications and providing supportive care to reduce disability from the stroke.
This document discusses pericardial disease and provides information on the anatomy, physiology, and diseases of the pericardium. It covers the following key points in 3 sentences:
The pericardium has inner serous and outer fibrous layers and normally contains 15-35mL of fluid. Diseases of the pericardium include congenital defects, infections, malignancies, and acquired conditions like acute pericarditis which can lead to cardiac tamponade physiology from excess fluid accumulation. Constrictive pericarditis occurs when the pericardium thickens and restricts heart chamber filling, showing signs on echocardiogram like equalized diastolic pressures between chambers.
Echocardiography is the main tool for evaluating prosthetic heart valves. Transthoracic echocardiography (TTE) is generally used to assess normal valve function and identify dysfunction like stenosis or regurgitation. Transesophageal echocardiography (TEE) provides better imaging of valve structure and is helpful for evaluating regurgitation and complications like endocarditis. Echocardiograms establish a baseline after valve implantation and monitor for issues like pannus, thrombus, infection or degeneration over time. TTE and TEE are complementary, with TEE used when TTE is inadequate or clinical suspicion remains after a TTE.
preop TEE assessment of atrial septal defect is very important for making decision for device closure, properly assessed adequate rims of ASD will reduce risk of device embolization to almost nil.
A 63-year-old man presented with syncope, shortness of breath, and other symptoms for 2 years. Examination found dyspnea, tachycardia, low blood pressure, a systolic thrill, and left ventricular hypertrophy. Imaging showed severe aortic stenosis. The patient underwent transcatheter aortic valve implantation and is now doing well.
Pathophysiology of aortic regurgitation and managementSachin Sondhi
This document summarizes a seminar on aortic regurgitation presented by Dr. Sachin Sondhi at IGMC Shimla on 13/08/2018. It discusses the causes and pathology of aortic regurgitation, including degenerative aortic dilation and diseases affecting the aortic valve and root. The pathophysiology and hemodynamic changes in compensated and decompensated aortic regurgitation are explained. Symptoms, physical exam findings, murmurs and natural history are outlined. Indications for surgery include symptomatic patients or asymptomatic patients with reduced ejection fraction or severe left ventricular dilation. Vasodilator therapy may help preserve left ventricular function in some cases.
Mitral stenosis can be evaluated using echocardiography. Key findings include measuring the mitral valve area using planimetry, pressure half-time, and continuity equation methods. Pressure gradients and pulmonary artery systolic pressure can also assess severity. Mild mitral stenosis is defined as a mitral valve area greater than 1.5 cm2, moderate as 1-1.5 cm2, and severe as less than 1 cm2. Stress echocardiography may reveal symptoms in borderline cases by monitoring pressures with exercise.
Echocardiography is a key tool for diagnosing and evaluating mitral stenosis (MS). It is essential to use an integrative approach when grading MS severity by combining Doppler, 2D imaging, and measurements, rather than relying on one alone. Echocardiography plays a major role in MS by confirming diagnosis, quantifying severity, analyzing consequences, and examining valve anatomy. Mitral valve planimetry directly measures valve area and is considered the reference standard, but additional measurements like pressure gradient and half-time are also useful. Echocardiography aids clinical decision making for patients with MS.
This document provides guidelines on the management of pericardial diseases from the ESC. It discusses the etiology, diagnosis, and treatment of various pericardial conditions including pericarditis, cardiac tamponade, constrictive pericarditis. For constrictive pericarditis specifically, it highlights two key pathophysiological characteristics - exaggerated ventricular interdependence and the halting of intrathoracic pressure changes on the ventricles by a thickened pericardium. Surgical pericardiectomy is the definitive treatment for constrictive pericarditis when medical management fails.
COMPARES OPTIMAL MEDICAL THERAPY WITH INVASIVE THERAPY IN A PATIENT WITH STABLE ISCHEMIC HEART DISEASE WITH MODERATE TO SEVERE MYOCARDIAL ISCHEMIA ON NON INVASIVE STRESS TESTING
Hypertrophic cardiomyopathy (HCM) is defined as hypertrophy of the myocardium more than 1.5 cm, without an identifiable cause . Other causes of left ventricular (LV) hypertrophy, such as long-standing hypertension, amyloidosis, and aortic stenosis must first be excluded before HCM can be diagnosed. As our understanding of the genetics of HCM continues to progress, the diagnosis of HCM will continue to incorporate information obtained from genetic testing, while also continuing to rely on transthoracic echocardiography (TTE) for the assessment of the phenotypic manifestations and the overall clinical severity of the disease.
The document is about congenital heart defects (CHDs) from the perspective of parents. It describes the experience of parents whose seemingly healthy newborn develops signs of a CHD like turning blue. The parents must rush their baby to the hospital where they learn the baby has a heart defect. The document discusses the uncertainty and stress parents endure as their child undergoes surgery and treatment for the CHD. It aims to raise awareness of CHDs by sharing personal stories and statistics in order to help more children with CHDs.
This document summarizes the evaluation of aortic valve stenosis using echocardiography. It describes the normal aortic valve anatomy and various types of aortic valve stenosis including calcific, bicuspid, rheumatic, and supravalvular or subvalvular stenosis. Doppler echocardiography is used to evaluate aortic valve stenosis severity based on valve area, mean gradient, and peak jet velocity. Stress echocardiography with dobutamine can help distinguish true severe from pseudo-severe low-flow, low-gradient aortic stenosis.
ST segment elevations can be seen in acute myocardial infarction (AMI) but also have other causes. Non-AMI causes of ST elevation include left bundle branch block, left ventricular hypertrophy, pericarditis, Brugada syndrome, and early repolarization. The morphology, distribution, and magnitude of ST elevations, as well as other ECG features, can help differentiate AMI from other causes of ST elevation. It can be challenging to diagnose AMI using ECG criteria alone, as around half of AMI cases present without typical ST elevation patterns.
1. A ventricular septal defect (VSD) is an opening in the wall separating the ventricles that allows blood to shunt between them.
2. VSDs are the most common congenital heart defect in children and can be classified based on their location as membranous, perimembranous, muscular, inlet, or outlet.
3. A complete echocardiogram is needed to evaluate the location, size, direction of shunting, and effects of the defect. Three-dimensional echocardiography can help further define the anatomy and guide potential transcatheter closure of the VSD.
This document discusses the natural history of ventricular septal defects (VSDs). It covers the incidence, classification, factors influencing outcomes, and potential complications of VSDs over time, including:
1. Cardiac failure in large VSDs due to left-to-right shunting.
2. Spontaneous closure or diminution, which is more common in smaller defects and those under 10 years of age.
3. Complications such as right ventricular outflow tract obstruction, aortic valve prolapse, pulmonary vascular disease, infective endocarditis, and arrhythmias.
The classification, mechanisms of closure, and guidelines for antibiotic prophylaxis for infective endocard
The second heart sound occurs at the end of systole due to closure of the semilunar valves. There are normally two components: A2 from aortic valve closure and P2 from pulmonary valve closure. A2 is typically louder due to higher pressures in the aorta. The components are normally split, with A2 occurring earlier due to differences in vascular resistance and compliance between the pulmonary and systemic circulations. Widening of the split may indicate conduction delays or pulmonary hypertension. Reversed or paradoxical splitting can occur in conditions that delay left ventricular ejection such as left bundle branch block. Single second heart sounds may result from fusion of the components or absence of one.
This document provides an overview of the main types of cardiomyopathy:
1) Dilated cardiomyopathy is the most common type and causes heart chamber dilation and reduced contraction. It can lead to heart failure and arrhythmias.
2) Hypertrophic cardiomyopathy causes thickened heart muscle and potential outflow obstruction. It is a common cause of sudden death in young athletes.
3) Restrictive cardiomyopathy stiffens the heart ventricles and impairs filling. Amyloidosis is a common cause.
4) Arrhythmogenic right ventricular dysplasia replaces parts of the right ventricle with fat and fibrosis and can cause arrhythmias or sudden death.
This document discusses coarctation of the aorta, including:
1. The definition and history of coarctation as a congenital narrowing of the upper descending thoracic aorta.
2. Theories on the pathogenesis of coarctation related to reduced blood flow through the left side of the heart or abnormal ductal tissue.
3. Types of coarctation including preductal and postductal, and surgical techniques for repair such as patch aortoplasty or bypass grafting.
4. Presentation varies from heart failure in neonates to hypertension in older children and adults, with complications including aneurysm and rupture.
Neuroimaging Mastery Project: Presentation #5 Subdural HematomasSean M. Fox
Drs. Faith Meyers, Madison Watts and Steven Perry are Emergency Medicine Residents at Carolinas Medical Center who are interested in medical education. Dr. Rebecca DeCarlo, MD is a Neurosurgical resident at Carolinas Medical Center. Along with the guidance of Dr. Michael Gibbs (Chair of Emergency Medicine), Dr. Jonathan Clemente (Chief of the Department of Radiology and Neuroradiology specialist), Dr. Christa Swisher (Neurocritcal Care Intensivist), and Dr. Scott Wait (Chief of Pediatric Neurosurgery) they aim to help educate us on Neuroimaging. In this presentation they will address Subdural Hematomas. Follow along with the EMGuideWire.com team as they post the CMC Neuroimaging Case Studies.
- Subdural Hematomas
1. The document discusses the diagnosis and treatment of acute ischemic stroke. It outlines the time windows for treatment with intravenous thrombolysis, which is most effective within 4.5 hours of symptom onset.
2. Early diagnosis is critical in stroke care due to the concept of "time is brain". Delays in treatment can lead to further neuronal damage and worse outcomes. The goals are to perform a CT scan within 20 minutes of arrival and initiate thrombolysis within 60 minutes.
3. Post-thrombolytic management focuses on monitoring for hemorrhagic complications and providing supportive care to reduce disability from the stroke.
CT imaging of Brain in Clinical Practice by Dr. Vaibhav Yawalkarvaibhavyawalkar
Cranial CT is a useful diagnostic tool in the emergency room that physicians need to be able to accurately interpret without specialist assistance. CT imaging works by passing collimated X-rays through the patient which are detected on the other side and assembled into cross-sectional images. Different tissues absorb X-rays to different degrees, appearing as different shades of grey on the image. The "blood can be very bad" mnemonic directs physicians to examine the blood, cisterns, brain, ventricles, and bone for abnormalities such as hemorrhage, increased intracranial pressure, infarcts, and space-occupying lesions. Contrast injection helps identify enhancing lesions including tumors, abscesses, and infections
Transcatheter Aortic Valve Replacement (TAVR) is a transformational and rapidly evolving treatment for the patients with aortic stenosis which require valve replacement surgery. Get more details at website.
For More Information:
http://www.keystoneheart.com/us/clinical-evidence/clinical-studies/
info@keystoneheart.com
1 877 575 4433
This is a review of a case of an infant admitted to pediatric ICU as a case of epidural hematoma after traumatic brain injury. A brief summary of the most important aspects. Part of the residency teaching program for pediatric residents at the pediatric and neonatology department at Istishari Arab Hospital, Ramallah, Palestine.
This document presents a case study of a 44-year-old man diagnosed with spontaneous intracranial hypotension (SIH) secondary to cerebrospinal fluid leaks at C1-C3 and T6-T10. He presented with progressive headache, nausea, vomiting, and intermittent double vision. Imaging showed bilateral subdural hematomas and evidence of subarachnoid hemorrhage. He deteriorated with additional cranial nerve palsies until epidural blood patches were placed, which provided immediate relief and full recovery. SIH is often misdiagnosed but can be identified through characteristic symptoms, lumbar puncture findings and imaging evidence of CSF hypovolemia.
The document contains a clinical history and physical notes for a 52-year-old male patient presenting with cerebral ischemia (ischemic stroke). Key details include:
- The patient experienced sudden severe headache, dizziness, and slurred speech. Exam found facial drooping and difficulties with coordination and swallowing.
- Medical history includes hypertension and hypercholesterolemia. Surgical history includes prior neck surgery.
- Diagnostic tests (CT scan, MRI) found an ischemic stroke in the middle cerebral artery, with signs of intravascular thrombus.
- Assessment identifies the leading diagnosis as cerebral ischemia. Differential diagnoses include hemorrhagic stroke, subdural hemorrhage, and
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Academic Clinical History & Physical Notes for Cerebral Ischemia
Muhammad Aftkhar
Grand Canyon University
December 04th, 2020
Academic Clinical History & Physical Notes for Cerebral Ischemia
I am presenting the academic clinical history and physical notes for the patient of ischemic stroke. Ischemic stroke or cerebral ischemia occurs when one of the cerebral arteries is blocked by the clot leading to diminished blood supply and oxygen to brain cells resulting in damage or death of brain cells (Celik et al., 2020)
History and Physical Note
1.Chief complaint/reason for admission/visit/consult.
A 52 years old male patient came to the acute care hospital with the chief complaint of sudden severe headache, dizziness, and slurred speech.
HPI for the H&P or consult notes.
The patient felt a severe burning and shooting pain in the frontal region of the head while he was reading the newspaper in the morning. The patient said that he developed blurred vision during reading. The patient felt numbness when the pain started (Harriot et al., 2020). The patient said that the pain was not subsiding with the time as it persisted since its onset. The pain scale was nine by 10, started in the frontal region, and radiated towards the temporal region. The associated symptoms with pain are nausea, vomiting, aphasia, dysarthria, apraxia, and vertigo (De Cock, et al., 2020). The symptoms become aggravate in a standing position and become alleviating when he lay down on the bed with 3 pillows. The patient felt a significant change in body posture. He is positive for facial drooping while negative for fever and chills. He finds difficulty in sitting and maintaining coordination. The patient stated that he had a medical history of neck trauma in a road accident. He was hospitalized for 3 weeks after neck surgery.
2.Medical, surgical, family, social, and allergy history.
Medical history
The patient has hypertension and hypercholesterolemia (Haegens, et al., 2018).
Surgical history
The patient underwent neck surgery after neck trauma at the age of 42.
Family history
The patient’s mother is alive and diabetic. The father of the patient died due to a cardiac stroke. His sister is normal. One of the two brothers has hypertension, and the other is normal. Currently, the patient is living with his normal wife.
Social history
The patient has a long history of smoking and boozing, coupled with a sedentary lifestyle.
Allergy history
· Raw fruits and vegetables, Shellfish, Soy.
· Amoxicillin and aspirin.
3.Home medications, including dosages, route, frequency, and current medications, if a consultation note.
Antihypertensive drugs Edarbi & Hygroton.
40 mg oral Edarbi once a day, as the patient is on diuretics, Hygroton. Oral 50 mg Hygroton once in the morning.
Hypercholesterolemic drugs Lipitor
Oral tablet 40 mg once a day. He takes this tablet at night.
4.Review of systems with all body systems for H&P or consult notes. Review of systems i ...
The document provides an overview of brain CT interpretation for radiologists. It begins with how to systematically read a brain CT, covering the gross brain anatomy visible on CT. It then discusses the CT appearance and characteristics of traumatic brain injuries such as extra-axial hemorrhages and intracerebral injuries. Next, it covers ischemic and hemorrhagic strokes, describing the CT signs and distinguishing features. Finally, it discusses various types of non-traumatic intracranial hemorrhages that may be seen on brain CT. The document uses example clinical cases to demonstrate applying the principles of brain CT interpretation.
This document provides an overview of aneurysmal subarachnoid hemorrhage (aSAH) and describes a case study of a patient, Mrs. Jones, who presented with symptoms of aSAH. It discusses:
1) Mrs. Jones' presentation of sudden severe headache, neck discomfort, nausea/vomiting, and photophobia. Imaging revealed diffuse thick SAH from a ruptured right posterior communicating aneurysm and mild-moderate hydrocephalus.
2) The initial management of Mrs. Jones which included intubation in the ED due to decreased level of consciousness, and transfer to the neuro ICU for monitoring and management including neurological assessments and blood pressure control.
3) Diagnostic
This document provides an overview of reversible cerebral vasoconstriction syndrome (RCVS). It begins with a case presentation of a 32-year-old female presenting with altered level of consciousness. It then discusses the history, clinical diagnosis, associated conditions, pathophysiology, neuroimaging, differential diagnosis, and management of RCVS. Key points include that RCVS is characterized by reversible multifocal narrowing of cerebral arteries associated with severe headaches. Imaging may show "sausage on a string" vasoconstriction that typically resolves within 12 weeks. The pathophysiology is thought to involve transient alterations in cerebral vascular tone from sympathetic overactivity, oxidative stress, or endothelial dysfunction.
This document summarizes a neurosciences academic meeting that discussed a case of a 25-year-old female who presented with sudden onset of her worst headache ever. Differential diagnoses for thunderclap headache were discussed. Imaging revealed a subarachnoid hemorrhage from an aneurysm. The meeting discussed CT and MR angiography as diagnostic tools compared to catheter angiography, and yields of CSF analysis for diagnosing aneurysmal subarachnoid hemorrhage. Causes of subarachnoid hemorrhage without an identified aneurysm were also reviewed, as well as a new clinical decision tool to exclude subarachnoid hemorrhage.
CMC Neuroimaging Case Studies - Cerebral Venous Sinus ThrombosisSean M. Fox
Drs. Faith Meyers, Steven Perry, Madison Watts, and Brandon Friedman are Emergency Medicine Residents at Carolinas Medical Center and interested in medical education. Along with the guidance of Dr. Michael Gibbs (Chair of Emergency Medicine), Dr. Jonathan Clemente (Chief of the Department of Radiology and Neuroradiology specialist), Dr. Christa Swisher (Neurocritcal Care Intensivist), and Dr. Scott Wait (Chief of Pediatric Neurosurgery) they aim to help educate us on Neuroimaging. In this presentation they will address Cerebral Venous Sinus Thrombosis. Follow along with the EMGuideWire.com team as they post the CMC Neuroimaging Case Studies.
This set will cover:
- Cerebral Venous Sinus Thrombosis
1
15
Academic Clinical History & Physical Notes for Cerebral Ischemia
I am presenting the academic clinical history and physical notes for the patient of ischemic stroke. Ischemic stroke or cerebral ischemia occurs when one of the cerebral arteries is blocked by the clot leading to diminished blood supply and oxygen to brain cells resulting in damage or death of brain cells (Celik et al., 2020)
History and Physical Note
1.Chief complaint/reason for admission/visit/consult.
A 52 years old male patient came to the acute care hospital with the chief complaint of sudden severe headache, dizziness, and slurred speech.
HPI for the H&P or consult notes.
The patient felt a severe burning and shooting pain in the frontal region of the head while he was reading the newspaper in the morning. The patient said that he developed blurred vision during reading. The patient felt numbness when the pain started (Harriot et al., 2020). The patient said that the pain was not subsiding with the time as it persisted since its onset. The pain scale was nine by 10, started in the frontal region, and radiated towards the temporal region. The associated symptoms with pain are nausea, vomiting, aphasia, dysarthria, apraxia, and vertigo (De Cock, et al., 2020). The symptoms become aggravate in a standing position and become alleviating when he lay down on the bed with 3 pillows. The patient felt a significant change in body posture. He is positive for facial drooping while negative for fever and chills. He finds difficulty in sitting and maintaining coordination. The patient stated that he had a medical history of neck trauma in a road accident. He was hospitalized for 3 weeks after neck surgery.
2.Medical, surgical, family, social, and allergy history.
Medical history
The patient has hypertension and hypercholesterolemia (Haegens, et al., 2018).
Surgical history
The patient underwent neck surgery after neck trauma at the age of 42.
Family history
The patient’s mother is alive and diabetic. The father of the patient died due to a cardiac stroke. His sister is normal. One of the two brothers has hypertension, and the other is normal. Currently, the patient is living with his normal wife.
Social history
The patient has a long history of smoking and boozing, coupled with a sedentary lifestyle.
Allergy history
· Raw fruits and vegetables, Shellfish, Soy.
· Amoxicillin and aspirin.
3.Home medications, including dosages, route, frequency, and current medications, if a consultation note.
Antihypertensive drugs Edarbi & Hygroton.
40 mg oral Edarbi once a day, as the patient is on diuretics, Hygroton. Oral 50 mg Hygroton once in the morning.
Hypercholesterolemic drugs Lipitor
Oral tablet 40 mg once a day. He takes this tablet at night.
4.Review of systems with all body systems for H&P or consult notes. Review of systems is what the patient or family/friends tell you (by body system).
General appearance
The patient shows facial we ...
1
15
Academic Clinical History & Physical Notes for Cerebral Ischemia
I am presenting the academic clinical history and physical notes for the patient of ischemic stroke. Ischemic stroke or cerebral ischemia occurs when one of the cerebral arteries is blocked by the clot leading to diminished blood supply and oxygen to brain cells resulting in damage or death of brain cells (Celik et al., 2020)
History and Physical Note
1.Chief complaint/reason for admission/visit/consult.
A 52 years old male patient came to the acute care hospital with the chief complaint of sudden severe headache, dizziness, and slurred speech.
HPI for the H&P or consult notes.
The patient felt a severe burning and shooting pain in the frontal region of the head while he was reading the newspaper in the morning. The patient said that he developed blurred vision during reading. The patient felt numbness when the pain started (Harriot et al., 2020). The patient said that the pain was not subsiding with the time as it persisted since its onset. The pain scale was nine by 10, started in the frontal region, and radiated towards the temporal region. The associated symptoms with pain are nausea, vomiting, aphasia, dysarthria, apraxia, and vertigo (De Cock, et al., 2020). The symptoms become aggravate in a standing position and become alleviating when he lay down on the bed with 3 pillows. The patient felt a significant change in body posture. He is positive for facial drooping while negative for fever and chills. He finds difficulty in sitting and maintaining coordination. The patient stated that he had a medical history of neck trauma in a road accident. He was hospitalized for 3 weeks after neck surgery.
2.Medical, surgical, family, social, and allergy history.
Medical history
The patient has hypertension and hypercholesterolemia (Haegens, et al., 2018).
Surgical history
The patient underwent neck surgery after neck trauma at the age of 42.
Family history
The patient’s mother is alive and diabetic. The father of the patient died due to a cardiac stroke. His sister is normal. One of the two brothers has hypertension, and the other is normal. Currently, the patient is living with his normal wife.
Social history
The patient has a long history of smoking and boozing, coupled with a sedentary lifestyle.
Allergy history
· Raw fruits and vegetables, Shellfish, Soy.
· Amoxicillin and aspirin.
3.Home medications, including dosages, route, frequency, and current medications, if a consultation note.
Antihypertensive drugs Edarbi & Hygroton.
40 mg oral Edarbi once a day, as the patient is on diuretics, Hygroton. Oral 50 mg Hygroton once in the morning.
Hypercholesterolemic drugs Lipitor
Oral tablet 40 mg once a day. He takes this tablet at night.
4.Review of systems with all body systems for H&P or consult notes. Review of systems is what the patient or family/friends tell you (by body system).
General appearance
The patient shows facial we ...
This document provides an overview of how to systematically analyze a head CT scan. It begins with identifying basic scan details and checking for previous studies. It then reviews CT fundamentals like Hounsfield units and image planes. The document outlines an approach of analyzing midline structures, ventricles, cisterns, brain parenchyma, sulci, sinuses, and bones. It provides examples of common abnormalities and how to identify acute vs. chronic hemorrhages. The goal is to familiarize readers with head CT anatomy and classic abnormalities.
Acute Ischaemic Stroke Mx SCGH - ED UpdateSCGH ED CME
1) Minocycline, a tetracycline antibiotic, may reduce hemorrhagic transformation after acute ischemic stroke when given intravenously with tPA.
2) Endovascular approaches such as intra-arterial thrombolysis and thrombectomy are promising options for treating large vessel occlusions in acute ischemic stroke beyond the current treatment window of 4.5 hours.
3) Pre-hospital administration of therapies such as magnesium may expand the treatment window for acute ischemic stroke if given soon after symptom onset in the field before hospital arrival.
The document discusses the case of a 62-year-old man who experienced a transient ischemic attack. It summarizes the diagnostic workup, including imaging and vascular testing, to determine if the patient had a stroke and the location of any blockages. The document then reviews the evidence and guidelines for treatment of carotid artery disease, including whether the patient is a surgical candidate. Overall, the key information provided is on evaluating and treating patients who experience transient ischemic attacks or minor strokes due to carotid artery disease.
This document discusses traumatic brain injury (TBI). It begins by describing the anatomy of the brain and cerebral blood flow. It then discusses the primary causes and classifications of TBI as well as the primary and secondary injuries that can occur. The remainder of the document focuses on the management of mild, moderate, and severe TBI, including pre-hospital care, treatments to control increased intracranial pressure like hyperventilation and mannitol, and indications for surgical interventions. Key goals in management are preventing secondary brain injury from factors like hypoxia, hypotension, fever or increased intracranial pressure.
Similar to Blood Can Be Very Very Bad - CMC Neuroimaging Case Studies (20)
Implanted Devices - VP Shunts: EMGuidewire's Radiology Reading RoomSean M. Fox
The Department of Emergency Medicine at Carolinas Medical Center is passionate about education! Dr. Michael Gibbs is a world-renowned clinician and educator and has helped guide numerous young clinicians on the long path of Mastery of Emergency Medical Care. With his oversight, the EMGuideWire team aim to help augment our understanding of emergent imaging. You can follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides or you can also use this section to learn more in-depth about specific conditions and diseases. This Radiology Reading Room pertains to Ventriculoperitoneal Shunts and their Complications and is brought to you by Brandon Friedman, MD, Kelsey Patterson, and L. Erin Miller MD. It is has special guest editor: Scott Wait, MD
Sternal Fractures & Dislocations - EMGuidewire Radiology Reading RoomSean M. Fox
The Department of Emergency Medicine at Carolinas Medical Center is passionate about education! Dr. Michael Gibbs is a world-renowned clinician and educator and has helped guide numerous young clinicians on the long path of Mastery of Emergency Medical Care. With his oversight, the EMGuideWire team aim to help augment our understanding of emergent imaging. You can follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides or you can also use this section to learn more in-depth about specific conditions and diseases. This Radiology Reading Room pertains to Sternal Fractures and Dislocations and is brought to you by Carrie Bissell, MD, Aaron Fox, MD, Kendrick Lim, MD, Stephanie Jensen, MD, and Olivia Rice, MD. It is has special guest editor: Sean Dieffenbaugher, MD and Laurence Kempton, MD
Diaphragmatic Injuries - Radiology Reading RoomSean M. Fox
The Department of Emergency Medicine at Carolinas Medical Center is passionate about education! Dr. Michael Gibbs is a world-renowned clinician and educator and has helped guide numerous young clinicians on the long path of Mastery of Emergency Medical Care. With his oversight, the EMGuideWire team aim to help augment our understanding of emergent imaging. You can follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides or you can also use this section to learn more in-depth about specific conditions and diseases. This Radiology Reading Room pertains to Diaphragm Injury and is brought to you by Kylee Brooks, MD, Parker Hambright, MD, Alexis Holland, MD, and William Lorenz, MD. It is has special guest editor: Kyle Cunningham, MD
Acute Chest Syndrome - EMGuidewire's Radiology Reading RoomSean M. Fox
The Department of Emergency Medicine at Carolinas Medical Center is passionate about education! Dr. Michael Gibbs is a world-renowned clinician and educator and has helped guide numerous young clinicians on the long path of Mastery of Emergency Medical Care. With his oversight, the EMGuideWire team aim to help augment our understanding of emergent imaging. You can follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides or you can also use this section to learn more in-depth about specific conditions and diseases. This Radiology Reading Room pertains to Acute Chest Syndrome and is brought to you by Angela Pikus, MD, Mark Baumgarten, MD, Andres Gil Bustamante, and Ahmed Mashal, MD. As always, Michael Gibbs, MD serves as the projects editor.
Adult Orthopedic Imaging Series: Presentation #2 Native Hip DislocationsSean M. Fox
Drs. Carrie Bissell, Aaron Fox, and Kendrick Lim are Emergency Medicine Residents at Carolinas Medical Center and are interested in emergency medicine and medical education. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine and Dr. Laurence Kempton, an Orthopedic Surgeon, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides that focus on Adult Orthopedic cases. This set will cover:
- Hip Dislocations
Neuroimaging Mastery Project Presentation #4: Acute Epidural HematomasSean M. Fox
Drs. Faith Meyers, Madison Watts and Steven Perry are Emergency Medicine Residents at Carolinas Medical Center who are interested in medical education. Along with the guidance of Dr. Michael Gibbs (Chair of Emergency Medicine), Dr. Jonathan Clemente (Chief of the Department of Radiology and Neuroradiology specialist), Dr. Christa Swisher (Neurocritcal Care Intensivist), and Dr. Scott Wait (Chief of Pediatric Neurosurgery) they aim to help educate us on Neuroimaging. In this presentation they will address Atraumatic Neurosurgical Intracranial Infections. Follow along with the EMGuideWire.com team as they post the CMC Neuroimaging Case Studies.
- Acute Epidural Hematomas
Pediatric Orthopedic Imaging Case Studies #7 Pediatric Elbow FracturesSean M. Fox
The document provides an overview of commonly encountered pediatric elbow injuries seen in the emergency department setting. It reviews the anatomy and imaging evaluation of pediatric elbow fractures including the supracondylar humerus, radial neck, lateral condyle, and medial epicondyle fractures. Specific radiographic findings that help identify subtle fractures are discussed. Challenges in pediatric elbow imaging related to ossification centers are also covered. The goal is to help emergency physicians accurately diagnose pediatric elbow fractures on radiographs.
Adult Orthopedic Imaging Mastery Project - Pelvic Ring FracturesSean M. Fox
The document discusses different types of pelvic ring injuries including lateral compression, anterior-posterior compression, and vertical shear fractures. It emphasizes the importance of early resuscitation, pelvic stabilization, and considering advanced measures or angiography to control hemorrhage in unstable patients. The case examples demonstrate imaging features and management approaches for different pelvic fracture patterns.
Neurosurgical Intracranial Infections - FINAL 10-17-23.pptxSean M. Fox
Drs. Faith Meyers and Steven Perry are Emergency Medicine Residents and Trent VanHorn is a Neurosurgical Resident at Carolinas Medical Center who are interested in medical education. Along with the guidance of Dr. Michael Gibbs (Chair of Emergency Medicine), Dr. Jonathan Clemente (Chief of the Department of Radiology and Neuroradiology specialist), Dr. Christa Swisher (Neurocritcal Care Intensivist), and Dr. Scott Wait (Chief of Pediatric Neurosurgery) they aim to help educate us on Neuroimaging. In this presentation they will address Atraumatic Neurosurgical Intracranial Infections. Follow along with the EMGuideWire.com team as they post the CMC Neuroimaging Case Studies.
This set will cover:
Atraumatic Neurosurgical Intracranial Infections
Subdural Empyema and Brain Abscess
Abdominal Imaging Case Studies #27.pptxSean M. Fox
Drs. Kylee Brooks and Parker Hambright are Emergency Medicine Residents and Drs. Alexis Holland and William Lorenz are Surgery Residents at Carolinas Medical Center in Charlotte, NC. They are interested in medical education. With the guidance of Drs. Kyle Cunningham, Brent Matthews, and Michael Gibbs, they aim to help augment our understanding of emergent abdominal imaging. Follow along with the EMGuideWire.com team as they post these monthly educational, self-guided radiology slides. This month’s cases include:
• Iatrogenic Esophageal Perforation
• Emphysematous Cystitis
• Meckel’s Diverticulum
• Paraesophageal Hernia
Drs. Angela Pikus, Alex Blackwell, Mark Baumgarten, Rosa Malloy-Post are Emergency Medicine Residents and interested in medical education. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides. This set will cover:
• Abnormalities of the Thoracic Aorta
o Traumatic aortic disruption
o Thoracic aortic aneurysm with acute dissection
Medical Device Imaging Mastery Project #4: Extracorporeal Membrane OxygenationSean M. Fox
Drs. Kaley El-Arab and Brandon Friedman are Emergency Medicine Residents at Carolinas Medical Center and interested in medical education and Critical Care. They have teamed with Ms. Emily Lipitz a PA with the Sanger Heart & Vascular Institute. Along with the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, and Dr. John Symanski, a cardiologist from the Sanger Heart & Vascular Institute, they aim to help augment our understanding of emergent imaging of implanted devices. Follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides. This set will cover:
- Extracorporeal Membrane Oxygenation
Drs. Pikus, Blackwell, Baumgarten, and Malloy-Posts’s CMC X-Ray Mastery Proje...Sean M. Fox
Drs. Angela Pikus, Alex Blackwell, Mark Baumgarten, Rosa Malloy-Post are Emergency Medicine Residents and interested in medical education. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides. This set will cover:
• Naloxone-Associated Aspiration Pneumonitis & Pulmonary Edema
• Superior Vena Cava Syndrome
• Pulmonary Aspergillosis And The “Air Crescent Sign”
• Needle-Chest Decompression & Recent Pneumothorax Literature
Drs. Brooks, Hambright, Holland, and Lorenz’s CMC Abdominal Imaging Mastery P...Sean M. Fox
Drs. Kylee Brooks and Parker Hambright are Emergency Medicine Residents and Drs. Alexis Holland and William Lorenz are Surgery Residents at Carolinas Medical Center in Charlotte, NC. They are interested in medical education. With the guidance of Drs. Kyle Cunningham, Brent Matthews, and Michael Gibbs, they aim to help augment our understanding of emergent abdominal imaging. Follow along with the EMGuideWire.com team as they post these monthly educational, self-guided radiology slides. This month’s cases include:
- Pyogenic Liver Abscess
- Bladder Rupture
- Sigmoid Volvulus
CMC Pediatric X-Ray Mastery: 27th Case SeriesSean M. Fox
This document presents a series of pediatric chest x-ray cases for interpretation and learning. It discusses six cases, providing images and summaries of the findings. The cases include a clavicle fracture, congenital diaphragmatic hernia, normal thymic shadow, duodenal atresia, Hirschsprung's disease, and malpositioned lines and tubes. The goal is to promote mastery of chest x-ray interpretation through discussion of real cases submitted from various medical centers and countries.
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Dr. Haley Dusek is an Emergency Medicine Resident and interested in pediatric emergency medicine and medical education. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, and supervision of Dr. Danielle Sutton, a Pediatric Emergency Medicine specialist, and Dr. Virginia Casey, a Pediatric Orthopedic Surgeon, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides. This set will cover:
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• Mallet fracture
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• Base fracture
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This document provides an overview of an ongoing chest x-ray interpretation series aimed at promoting mastery of chest x-ray interpretation. It discusses topics covered in prior presentations including peripartum cardiomyopathy, left ventricular assist devices, and pleural effusions. Appendices provide references for articles related to peripartum cardiomyopathy. The document also announces that next month's presentation will cover new diagnoses.
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Drs. Penzler, Ricker, and Ahmad’s CMC Abdominal Imaging Mastery Project: June...Sean M. Fox
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2. For the first case, a 57-year-old female presented with an abdominal wall dog bite and was found to have a 12 cm abdominal wall hematoma with active contrast extravasation.
3. The second case was a 65-year-old female with a history of severe pancreatitis who had a follow up CT showing walled off necrosis of the pancreas.
4. The third case was a 46-year-old male with a history of Ehlers Danlos and recent cocaine usage who presented
🔥🔥🔥🔥🔥🔥🔥🔥🔥
إضغ بين إيديكم من أقوى الملازم التي صممتها
ملزمة تشريح الجهاز الهيكلي (نظري 3)
💀💀💀💀💀💀💀💀💀💀
تتميز هذهِ الملزمة بعِدة مُميزات :
1- مُترجمة ترجمة تُناسب جميع المستويات
2- تحتوي على 78 رسم توضيحي لكل كلمة موجودة بالملزمة (لكل كلمة !!!!)
#فهم_ماكو_درخ
3- دقة الكتابة والصور عالية جداً جداً جداً
4- هُنالك بعض المعلومات تم توضيحها بشكل تفصيلي جداً (تُعتبر لدى الطالب أو الطالبة بإنها معلومات مُبهمة ومع ذلك تم توضيح هذهِ المعلومات المُبهمة بشكل تفصيلي جداً
5- الملزمة تشرح نفسها ب نفسها بس تكلك تعال اقراني
6- تحتوي الملزمة في اول سلايد على خارطة تتضمن جميع تفرُعات معلومات الجهاز الهيكلي المذكورة في هذهِ الملزمة
واخيراً هذهِ الملزمة حلالٌ عليكم وإتمنى منكم إن تدعولي بالخير والصحة والعافية فقط
كل التوفيق زملائي وزميلاتي ، زميلكم محمد الذهبي 💊💊
🔥🔥🔥🔥🔥🔥🔥🔥🔥
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Temple of Asclepius in Thrace. Excavation resultsKrassimira Luka
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This document provides an overview of wound healing, its functions, stages, mechanisms, factors affecting it, and complications.
A wound is a break in the integrity of the skin or tissues, which may be associated with disruption of the structure and function.
Healing is the body’s response to injury in an attempt to restore normal structure and functions.
Healing can occur in two ways: Regeneration and Repair
There are 4 phases of wound healing: hemostasis, inflammation, proliferation, and remodeling. This document also describes the mechanism of wound healing. Factors that affect healing include infection, uncontrolled diabetes, poor nutrition, age, anemia, the presence of foreign bodies, etc.
Complications of wound healing like infection, hyperpigmentation of scar, contractures, and keloid formation.
Level 3 NCEA - NZ: A Nation In the Making 1872 - 1900 SML.pptHenry Hollis
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Andreas Schleicher presents PISA 2022 Volume III - Creative Thinking - 18 Jun...EduSkills OECD
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A Visual Guide to 1 Samuel | A Tale of Two HeartsSteve Thomason
These slides walk through the story of 1 Samuel. Samuel is the last judge of Israel. The people reject God and want a king. Saul is anointed as the first king, but he is not a good king. David, the shepherd boy is anointed and Saul is envious of him. David shows honor while Saul continues to self destruct.
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Leveraging Generative AI to Drive Nonprofit Innovation
Blood Can Be Very Very Bad - CMC Neuroimaging Case Studies
1. Blood Can Be Very Very Bad
A Head CT Interpretation Primer
Faith Meyers, MD & Steven Perry, MD
Department of Emergency Medicine
Carolinas Medical Center & Levine Children’s Hospital
Andrew Perron, MD - Guest Author
Department of Emergency Medicine, Dartmouth Health
Neuroimaging Case Studies #1
Michael Gibbs, MD – Lead Editor
2. Disclosures
▪ This CMC Imaging Mastery Project is proudly sponsored by the
Emergency Medicine Residency Program at Carolinas Medical Center.
▪ The goal is to promote widespread mastery of imaging interpretation.
▪ There is no personal health information [PHI] within, and when
included, all ages have been changed to protect patient confidentiality.
3. Dr. Perron Is Currently The Associate Dean of Graduate Medical Education As Well As The
Designated Institutional Official (DIO), At Dartmouth Health.
Dr. Perron Completed The
CMC EM Residency 1995 – 1998
(Chief Resident In 1998).
We Are Fortunate That Dr. Andrew Perron, Creator Of The “Blood Can Be Very Bad”
Head CT Interpretation Framework, Is Joining Us As A Guest Author For Our Very First
Neuroimaging Case Studies Presentation Of This New Series!
4. Objectives
▪ This presentation will provide you with a structured, evidence-based
approach to head CT interpretation.
▪ Future presentations will review specific neuroimaging topics using a
case-based approach, supported by the latest, most relevant literature.
5. Meet Our Neuroimaging Editorial Team
Andrew Asimos, MD, FACEP
Medical Director, Carolinas Stroke Network
Neurosciences Institute
Clinical Professor, Department of Emergency Medicine
Jonathan Clemente, MD, FACR
Chief, Department of Radiology, Carolinas Medical Center
Charlotte Radiology, Neuroradiology Section
Adjunct Clinical Associate Professor, Department of Radiology
Scott Wait, MD, FAANS
Chief, Pediatric Neurosurgery, Levine Children’s Hospital
Carolina Neurosurgery & Spine Associates
Adjunct Clinical Associate Professor, Department of Neurosurgery
6. Annals of Emergency Medicine 1998: 32(5):554-562.
Blood Can Be Very Bad
B = Blood
C = Cisterns
B = Brain
V = Ventricles
B = Bone
Purpose: To Quantify The Baseline Ability Of Emergency Medicine Residents To Interpret Cranial CTs And
To Test A Novel Method Of Cranial CT Interpretation Designed For Emergency Physicians In Training.
7. Annals of Emergency Medicine 1998: 32(5):554-562.
Methods:
• Pretest to assess baseline knowledge
• 2-hour course based on the “Blood Can Be Very Bad” framework
• Post-test 3 months following instructional training
Results:
83 residents from 5 different institutions were enrolled.
Pretest % Correct: 60% Post-Test % Correct: 78%
Conclusion:
A novel, structured approach to head CT interpretation significantly
improved the diagnostic accuracy of emergency medicine residents.1
195% CI 71%–85%, P<0.001, paired t test.
8.
9. “V” For Vessels Was Later Added To The Mnemonic:
“Blood Can Be Very Very Bad”
10. Blood Can Be Very Very Bad
A Structured Approach To Head CT Interpretation
12. 0 +40 +80 +1000
-1000 -40
-80
H20
⫽
⫽
Brain
CT Basics: Density
Blood
The Denser The Object, The Whiter It Is On CT
Bone
Air
Hounsfield Units
13. Standard Brain Bone
CT Basics: Windowing
Focuses The Spectrum Of Gray-Scale Used On A Particular Image
14. CT Basics: Windowing
Standard Brain
In This Case The Same
Image Is Seen With Two
Different Windows:
Windowing Alters The
Appearance And Contrast
Between Different Components
Of The Image. This May Make It
Easier To Identify Hemorrhages
That Are Either Subtle And/Or
Isodense With The Adjacent
Bone Or Brain.
15. CT Basics: Windowing
In This Case Bone Windows
(Two Lower Images) Provide
Improved Anatomic
Definition To A Vertex Skull
Fracture.
16. Acute Subacute Chronic
CT Basics: The Appearance Of Blood Over Time
Category Timing Appearance Compared With Brain
Acute 1 – 3 Days Bright White Hyperdense
Subacute 3 – 14 Days Light Gray Isodense
Chronic >14 Days Dark Gray Hypodense
19. B Is For Blood
Classification:
• Epidural
• Subdural
• Intraparenchymal
• Intraventricular
• Cerebellar
• Subarachnoid
20. B Is For Blood
Decision Making:
Question #1 Is blood present (yes/no)?
Question #2 What type of hemorrhage is it?
Question #3 Where is the bleeding located?
Question #4 What effect is it having?
Question #5 Are any immediate actions required?
21. B Is For Blood
Decision Making:
Question #1 Is blood present (yes/no)?
Question #2 What type of hemorrhage is it?
Question #3 Where is the bleeding located?
Question #4 What effect is it having?
Question #5 Are any immediate actions required?
Possible Immediate Actions:
• Hemodynamic stabilization?
• Airway protection?
• Anticoagulation reversal?
• Hyperosmolar therapy?
• Urgent consultation?
• Immediate transfer?
• Preparation for an urgent
procedure?
Possible Urgent Procedures:
• Hematoma evacuation?
• External ventricular drainage?
• ICP monitor placement?
22. Epidural Hematoma
• Classically described as an injury to
the middle meningeal artery
• If treated early (prior to coma),
mortality is low, i.e.: <20%
CT Features
• Lens-shaped
• Does not cross cranial sutures
23. 23-Year-Old In A
Car Crash
50-Year-Old
Fell Off A Ladder
37-Year-Old
Pedestrian Struck
Epidural Hematoma Cases From CMC
24. 40-Year-Old Fell
With A Head Strike
17-Year-Old Fell Off
His Skateboard
66-Year-Old
Pedestrian Struck
Epidural Hematoma Cases From CMC
25. Subdural Hematoma
• Acute SDH is a marker of severe
brain injury (mortality up to 80%)
• Chronic SDH results from slow
venous bleeding and is generally well
tolerated
CT Features
• Falx or sickle-shaped
• Crosses sutures but does not cross
the midline
26. Acute 1-3 Days Hyperdense (80-100 HU) relative to brain
Subacute 3-14 Days Variable density relative to brain
Chronic >14 Days Hypodense (<40 HU) relative to brain
Hounsfield
Units
Days
Hyperdense
Isodense
Hypodense
Subdural Hematoma CT Scan Density Decreases Over Time
100
20
1 14
Neurosurgery Clinical of North America 2017; 28:247-255.
30. Tentorial SDH Parafalcine SDH
Tentorial SDHs Layers On Top
Of The Tentorium Cerebelli.
Parafalcine SDHs Are Seen
Adjacent To The Falx Cerebri.
Subdural Hematoma
33. Intraparenchymal Hemorrhage
Hemorrhage within the brain substance:
• Hypertensive
• Spontaneous
• Traumatic
• Anticoagulation-associated
CT Features
• Appearance is location-dependent
• May involve the ventricles
35. Intraventricular Hemorrhage
Results when an intraparenchymal
hemorrhage ruptures into the
ventricular cavity
CT Features
• Blood in the ventricular system
• May or may not see obstructive
hydrocephalus, depending on the
hemorrhage site and amount
36. 59-Year-Old With A History Of Hypertension Presents Minimally Responsive.
Arrow (→) Demonstrates Blood Filling The 4th Ventricle
37. 64-Year-Old With A History Of Hypertension Presents With Headache And Confusion.
39. Cerebellar Hemorrhage
A neurosurgical emergency that
often requires immediate surgical
decompression
CT Features
• Hemorrhage in the posterior fossa
• High-risk features:
• Brainstem compression
• Loss of basilar cisterns
• Acute hydrocephalus
41. 79-Year-Old Female Presents In Coma.
Acute Cerebellar Hemorrhage With Mass Effect And Obstructive Hydrocephalus.
Arrows (➛) Demonstrate Transependymal Flow Of CSF. This Occurs When Intraventricular Pressure Exceeds
The Ability of CSF To Remain Within The Ventricles, Causing It To Extrude Into The Substance Of The Brain.
43. Subarachnoid Hemorrhage
CT Features
Blood in the cisterns, sulci, and/or on
the cortical surfaces
Cerebral Aneurysms 75% - 80%
AV Malformations 5%
Vasculitis <1%
No Cause Identified 10%
52. C Is For Cisterns
• The cisterns represent potential spaces between adjacent brain
structures.
• When extra volume is added to the brain “case” (blood, edema,
tumor) these potential spaces may become compressed. This can be
a radiographic sign of ongoing or impending intracranial
hypertension.
• On CT, the cisterns at the base of the brain are typically described as
either “open” or “effaced”/ “obliterated” (closed).
57. Effaced Basilar Cisterns In A Patient With
Diffuse Subarachnoid Hemorrhage
Effaced Basilar Cisterns In A Patient
With A Cerebellar Mass
Effaced Basilar Cisterns In A Patient With
A Large Subdural Hematoma
Mid-Brain Level Cerebral Peduncle Level High Pontine Level
Normal/
Open
Normal/
Open
Normal/
Open
60. B Is For Brain
• Examination of the brain is complex, with many potential diagnoses
• Interpretation strategy:
Assess for:
• Symmetry
• Shift
• Gray-white differentiation
• Areas of hyper- or hypoattenuation
• Pneumocephalus
Step 1: What do you see?
Step 2: What could it represent?
61. CT Findings
• Irregular circular density of the left temporal area
• Loss of overlying sulci
• Moderate effacement of the left lateral ventricle
What Do You See?
• Symmetry – Discrete region of asymmetry
• Shift – None grossly
• Gray-white differentiation – Abnormal
• Areas of hyper/hypo-attenuation – Discrete
hypo-attenuated area
• Pneumocephalus – none
49-Year-Old With Headache And
Right Leg Weakness & Numbness.
What Could It Represent?
• Neoplasm, hygroma, abscess, metastasis, infarct
62. T1
T2 FLAIR
Contrast
49-Year-Old With Headache And
Right Leg Weakness And Numbness.
MRI W/ and W/O Contrast Reveals
Left Temporal Abscess With Edema
63. 32-Year-Old With Headache, Nausea,
Fever, Altered Mental Status.
What Do You See?
• Symmetry – Discrete region of asymmetry
• Shift – Focal anterior midline shift rightward
• Gray-white differentiation - Abnormal
• Areas of hyper/hypo-attenuation – Discrete
• hypo-attenuation, surrounding hyper-
attenuation
• Pneumocephalus – punctate area L frontal lobe
What Could It Represent?
• Neoplasm, hygroma, abscess, metastasis, infarct
CT Findings
• Circular density of the left frontal lobe
• Surrounding edema
• Punctate dot of air beneath the frontal bone
64. T1
32-Year-Old With Headache, Nausea,
Fever, Altered Mental Status.
MRI W/ and W/O Contrast Reveals
Left Frontal Abscess
T1
T2 FLAIR
Contrast
65. Classic MRI Findings of Intracranial Abscess and Empyema
FLAIR : Vasogenic Edema T2: Dark Hemosiderin Rim DWI : Restricted Diffusion T1+ : Ring Enhancing
Abscess
Subdural
Empyema
DWI : Restricted Diffusion
T1+ : Rim Enhancing T1+ : Rim Enhancing
Diffusion
Weighted Imaging
(DWI) is key to the
imaging diagnosis.
Abscess and
empyema will
typically show
“lightbulb bright”
restricted diffusion
centrally.
66. 34-Year-Old With A History Of
Migraines Presents With Two Weeks
Of Headache, Nausea, And Confusion.
CT Findings
• Large area of hypoattenuation of the left frontal-
parietal cortex
What Do You See?
• Symmetry – Diffuse asymmetry
• Shift – Midline shift rightward
• Gray-white differentiation - Abnormal
• Areas of hyper/hypo-attenuation – Large area of
hypo-attenuation L hemisphere
• Pneumocephalus – none
What Could It Represent?
• Neoplasm, hygroma, abscess, metastasis, infarct
67. MRI W/ and W/O Contrast Reveals
A Mass With Surrounding Edema
34-Year-Old With A History Of
Migraines Presents With Two Weeks
Of Headache, Nausea, And Confusion.
T1 Contrast T2
FLAIR
68. Gray-White Differentiation On CT Imaging
Normal Gray-White Differentiation
In The Healthy Brain The Gray And White Matter
Can Be Distinguished By Their (Adjacent) Different
Shades Of Gray.
Loss Of Gray-White Differentiation
This Is A Radiographic Sign Of Cerebral Edema.
Local: Ischemia, Inflammation, Infiltration
Global: Prolonged Hypoxia And Or Hypotension
Notice The Difference On The Next Slide…
69. 35-Year-Old Presents In Coma Following Cardiac Arrest Due To An Opioid Overdose.
CT Demonstrates Diffuse Loss Of Gray-White Differentiation And Cistern Effacement.
35-Year-Old Healthy Patient With A Normal Head CT
70. • Blood
• Cisterns
• Brain
• Ventricles
•Vessels
• Bone
Blood Can Be Very Very Bad
72. V Is For Ventricles
• Cerebral spinal fluid (CSF) is a clear, colorless fluid that bathes and
cushions the brain and spinal cord
• CSF is secreted by the choroid plexus in the lateral and 4th ventricles
• CSF secretion equals its removal, with 150-250cc present at all times
• Abnormal CSF flow may affect the size of the ventricles
75. Hydrocephalus
Non-Communicating Hydrocephalus
Occurs when the flow of CSF is blocked along one or more of the narrow passages connecting
the ventricles.
Communicating Hydrocephalus
Occurs when the flow of CSF is blocked after it exits the ventricles. The word “communicating”
refers to the fact that CSF can still flow between the ventricles, which remain open.
Congenital Hydrocephalus
Is present at birth and may be caused by either events or influences that occur during fetal
development, or genetic abnormalities.
Acquired Hydrocephalus
Develops at the time of birth or at some point afterward. This type of hydrocephalus can affect
individuals of all ages and may be caused by injury or disease.
79. 75-Year-Old Presents With One Month Of Unsteadiness And Frequent Falls. CT Imaging Demonstrates A
4.7 cm Mass Pressing On The Pons And Medulla (*) Causing Acute Obstructive Hydrocephalus.
Clear Lateral Ventricle
Enlargement Occipital Horn
Enlargement
Pronounced
Third Ventricle
Temporal Horn Becomes
Clear (“Comma Sign”)
*
81. 52-Year-Old Presents With Acute Headache And Confusion. CT Demonstrates Diffuse Subarachnoid Hemorrhage That
Fills The Basilar Cisterns. There Is Blood In The Cerebral Aqueduct (➛) Causing Acute Obstructive Hydrocephalus.
➛
93. “V” Is For Vessels
Publications On The Topic By The CMC Crew!
94. Western of Emergency Medicine 2020; 21(3):694-702.
Methods:
Case control study of the utility of the dense basilar sign (DBS) in patients with confirmed acute basilar
artery occlusion (BAO) versus a control group of suspected acute stroke patients without BAO.
Results:
60 BAO and 65 control patients were included in the analysis:
• Qualitative assessment of the DBS had poor sensitivity (54% - 72%) and specificity (55% - 89%) for BAO.
• Quantitative measurement improved the specificity of the DBS for the diagnosis of BAO. Using an ROC
curve, a threshold of 61.0 Hounsfield units had a specificity of 85% - 94%.
Conclusion:
These results demonstrate the importance of quantitatively evaluating basilary artery density, and if this
value exceeds 61 Hounsfield units, BAO should be strongly suspected.
95. American Journal Of Emergency Medicine 2021; 42:221-224.
Example Of A Normal Basilar Artery On Non-Contrast CT (50 HU).
96. Case #1
8-year-old with lethargy, disconjugate gaze, inability to speak,
difficulty following commands.
Rx: Mechanical thrombectomy within 5 hours of symptom
onset, with complete revascularization and recovery.
Case #3
14-year-old with altered mental status after collapsing. Unable
to speak, follow commands. Roving eye movements.
Rx: TPA within 1.5 hours. Thrombectomy within 2.5 hours.
Now independent, walking with a brace, otherwise recovered.
Case #2
13-year-old with fever, altered mental status and disconjugate
gaze. Moving all extremities but not following commands. A
non-contrast CT at 9 hours revealed an acute cerebellar infarct
and a CT-A later revealed BAO of the basilar apex.
American Journal Of Emergency Medicine 2021; 42:221-224.
97. • Blood
• Cisterns
• Brain
• Ventricles
• Vessels
•Bone
Blood Can Be Very Very Bad
103. Lambdoid Suture
Occipital Bone
Parietal Bone
Temporal Bone
(Squamous Part)
Superior Orbital
Fissure
Optic Canal
Anterior
Clinoid Process
Dorsum Sellae
Frontal Sinuses
104.
105. Sphenoid Sinuses
Occipitomastoid Suture
Temporal Bone
(Mastoid Part)
Temporal Bone
(Petrous Part)
Mastoid Air Cells
Occipital Bone
Internal Auditory Canal
Carotid Canal
Frontal Process
Of The Maxilla
Ethmoid Sinuses
109. Mastoid Process Of
The Temporal Bone
Mandible
Mandibular
Condyle
Nasal Septum
Pterygoid Plates
110.
111. Occipital Condyles
Styloid Process Of
The Temporal Bone
Hard Palate
Dens (C2)
Atlas - Posterior Arch (C1)
Transverse Foramen (C1)
Atlas – Anterior Arch (C1)
Maxilla
112. 27-Year-Old Falls And
Strikes His Head While
Skateboarding.
CT Demonstrates A Vertex
Subdural Hematoma (➤)
Bone Windows Provide
Superior Definition Of Skull
Fracture Fragments (→)
➤
➤
➤
→
113. 7-Year-Old Falls Off The
Playground Equipment
Landing On His Head.
A CT Scan Of The Brain
Demonstrates A
Depressed Skull Fracture
(➤)
Bone Windows Provide
Anatomic Definition Of The
Fracture Fragments (→)
114. 7-Year-Old Falls Off The
Playground Equipment
Landing On His Head.
CT Images After
Surgical Elevation of
Fracture Fragments (→)
115. 9-Month-Old Who Fell Off Of A Changing Table.
CT Demonstrates A Large Epidural Hematoma And A Linear Skull Fracture.
116. Blood Can Be Very Very Bad
A Structed Approach To Head CT Interpretation
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