Cervicocephalic arterial dissections are an important cause of stroke in younger patients. They involve dissections of the carotid and vertebral arteries, which can be extracranial or intracranial. The document outlines the epidemiology, classification, etiology, clinical manifestations, diagnosis, treatment and prognosis of these dissections. Dissections are typically diagnosed using imaging modalities like ultrasound, MRI/MRA, CTA or DSA. Treatment involves medical management with anticoagulation or antithrombotics, while surgical or endovascular treatment may be used in cases of aneurysm or failed medical therapy.
Intracerebral hemorhage Diagnosis and managementRamesh Babu
About ICH - Diagnosis and management, Discussed the clinical presentation, evaluation, radiological features and management including recent guidelines
Intracerebral hemorhage Diagnosis and managementRamesh Babu
About ICH - Diagnosis and management, Discussed the clinical presentation, evaluation, radiological features and management including recent guidelines
Brain arteriovenous malformations (bAVM) are abnormal connections of arteries and veins in the brain, forming a tangled web of vessels instead of a normal capillary network treated with multimodalities including, SRS, embolisation and Microneurosurgery.
This slides updates the management of AVM highlighting the importance of SM grading, Pollock radiation grading etc.
Pituitary tumor accounts for ~10% ICT. They are common in 3-4 decade and shows association with MEN I.
About 5% of PT are invasive usually with giant tumor (>4cm). Tumor can be classified as functional (hormone secreting) or non functional. This slides details the algorithmic approach in management of pituitary tumors.
Brain arteriovenous malformations (bAVM) are abnormal connections of arteries and veins in the brain, forming a tangled web of vessels instead of a normal capillary network treated with multimodalities including, SRS, embolisation and Microneurosurgery.
This slides updates the management of AVM highlighting the importance of SM grading, Pollock radiation grading etc.
Pituitary tumor accounts for ~10% ICT. They are common in 3-4 decade and shows association with MEN I.
About 5% of PT are invasive usually with giant tumor (>4cm). Tumor can be classified as functional (hormone secreting) or non functional. This slides details the algorithmic approach in management of pituitary tumors.
Neuroradiology in multiple sclerosis
MRI in diagnosis of MS
MRI in D.D. of MS
MRI in monitoring disease progression and response to DMT
New imaging techniques
Brain metastasis is an advance diseases with poor overall prognosis management of which is full of controversies. This slide aims to make metastasis simplified.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
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MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
3. INTRODUCTION
Important cause of stroke in younger patients
Carotid and vertebral artery dissections
Thanvi, B., Munshi, S. K., Dawson, S. L., & Robinson, T. G. (2005). Carotid and vertebral artery dissection syndromes. Postgraduate medical journal, 81(956), 383-388.
4. EPIDEMIOLOGY
35-50 y.o (peak 50)
20 % of strokes in age < 45
Incidence: 2,6 per 100.000 per year
Maybe asymtomatic
Schievink WI, Mokri B, O’Fallon WM. Recurrent spontaneous cervical-artery dissection. N Engl J Med1994;330:393–7.
Bogousslavsky J, Pierre P. Ischaemic stroke in patients under age 45. Neurol Clin1992;10:113–24.
Schievink WI, Mokri B, Whisnant JP. Internal carotid artery dissection in a community: Rochester, Minnesota, 1987–1992. Stroke1993;24:1678–80.
5. CLASSIFICATION
Internal carotid artery dissection
– extracranial dissections
– intracranial dissections
Vertebral artery dissections
– extracranial dissections
– intracranial dissections
Thanvi, B., Munshi, S. K., Dawson, S. L., & Robinson, T. G. (2005). Carotid and vertebral artery dissection syndromes. Postgraduate medical journal, 81(956), 383-388.
6. CLASSIFICATION
Carotid dissections 3 times more common than vertebral
dissections.
Extracranial segment dissection more common than
intracranial segment because more mobile and is also
prone to damage by bony structures such as the
vertebrae and styloid processes.
The site predilection for dissection is quite different from
that of atherosclerosis affecting the cervical arteries.
Dissection involves the pharyngeal and distal parts of
the internal carotid artery, whereas atherosclerosis
usually affects the origin and the carotid bulb.
Similarly, dissections affect distal parts of the
extracranial vertebral artery, whereas atherosclerosis
tends to involve the proximal segments
Thanvi, B., Munshi, S. K., Dawson, S. L., & Robinson, T. G. (2005). Carotid and vertebral artery dissection syndromes. Postgraduate medical journal, 81(956), 383-388.
Caplan LR, Tettenborn B. Vertebraobasilar occlusive disease: review of selected aspects: I. Spontaneous dissection of extracranial and intracranial posterior
circulation arteries. Cerebrovasc Dis1992;2:256–65.
8. PATHOPHYSIOLOGY
Local thrombus formation promotes by luminal
stenosis and the release of thrombogenic factors by
the intimal damage.
Cerebral ischaemia:
(1) a narrowed lumen with the consequent
haemadynamic failure (borderzone infract) or,
(2) embolisation from local thrombus (more common),
or both
Thanvi, B., Munshi, S. K., Dawson, S. L., & Robinson, T. G. (2005). Carotid and vertebral artery dissection syndromes. Postgraduate medical journal, 81(956), 383-388.
9. CLINICAL MANIFESTATION OF CAROTID
DISSECTIONS
Constant and non-throbbing
head and neck pain
ipsilateral in frontal /
frontoparietal area
Partial Horner’s syndrome
without anhidrosis (fibers of
sweat function travel along
ECA)
Pulsatile tinnitus
Ipsilateral cranial nerve
palsies especially lower
ones
TIA
Amaurosis fugax,
Hemiplegia,
Dysphasia, etc.
LOCAL EFFECTS
CEREBRAL & RETINAL
ISCHAEMIA
Bogousslavsky J, Despland PA, Regli F. Spontaneous carotid dissection with acute stroke. Arch Neurol1987;44:137.
Silbert PL, Mokri B, Schievink WI. Headache and neck pain in spontaneous internal carotid and vertebral artery dissections. Neurology1995;45:1517–22.
Biousse VD, Anglejan-Chatillon J, Massion H, et al. Head pain in non-traumatic carotid artery dissection: a series of 65 patients. Cephalagia1994;14:33–6.
Hess DC, Sethi KD, Nichols FT. Carotid dissection: a new false localizing sign. J Neurol Neurosurg Psychiatry1990;53:804–5
Biousse V, Schaison M, Touboul P-J, et al. Ischaemic optic neuropathy associated with internal carotid artery dissection. Arch Neurol1998;55:715–19.
10. INTRACRANIAL CAROTID SYSTEM DISSECTIONS
Lack of spesific angiographic features
Younger age ( 2nd – 3rd decade)
Associated with large stroke (75% mortality rate)
Subarachnoid haemorrhage (SAH) can result from
intracranial dissections, because of the extension of
an intramural haematoma through the adventitia.
Can cause aneurysmal dilatations of the arteries
that may behave as space occupying lesions
compressing adjacent cranial nerves or the brain
Surgical interventions are more often needed.
Thanvi, B., Munshi, S. K., Dawson, S. L., & Robinson, T. G. (2005). Carotid and vertebral artery dissection syndromes. Postgraduate medical journal, 81(956), 383-388.
11. VERTEBRAL DISSECTIONS
Neck trauma may clearly precede an extracranial
vertebral dissection.
The vertebral artery is most mobile and thus most
vulnerable to mechanical injury at C1 to C2 as it
leaves the transverse foramen of the axis vertebra
and suddenly turns to enter the intracranial cavity.
F is 2,5 times than M (extracranial);
M>F (intracranial)
Hinse P, Thie A, Lachenmayer L. dissection of the extracranial vertebral artery: report of four cases and review of the literature. J Neurol Neurosurg Psychiatry1991;54:863.
13. DIAGNOSIS
Doppler ultrasound
CTA
MRI/MRA
DSA
Thanvi, B., Munshi, S. K., Dawson, S. L., & Robinson, T. G. (2005). Carotid and vertebral artery dissection syndromes. Postgraduate medical journal, 81(956), 383-388.
14. DOPPLER ULTRASOUND
Non-invasive, inexpensive, readily available
90 % sensitivity
High resistance flow pattern in the distal arteries
Intramural haematoma or double lumen and intimal
flap are rarely found
TCD for intracranial dissections
Limitation: Technical difficulties
- Scanning in distal ICA.
- Detecting emboli.
- A lower sensitivity with dissections that cause low
grade stenoses.
Steinke W, Rautenberg W, Schwartz A. Non invasive monitoring of internal carotid artery dissections. Stroke1994;25:998–1005.
15. MRI/MRA & CTA
Intramural haematomas can be shown as
hyperdense signals on T1 weighted imaging and
characteristically have a crescent shape adjacent to
the lumen.
MR scans can also show a luminal stenosis or an
occlusion.
Sensitivity of MRI/MRA is highest two days after
dissections.
MR imaging can also be used for follow up
monitoring of the dissections.
CTA: high sensitivity
Thanvi, B., Munshi, S. K., Dawson, S. L., & Robinson, T. G. (2005). Carotid and vertebral artery dissection syndromes. Postgraduate medical journal, 81(956), 383-388.
16. DSA
Invasive
Risk of stroke: 0,5 – 1 %
“string sign”—a long segment of narrowed lumen
The pathognomonic features of dissection, such as
an intimal flap or a double lumen, are found in less
than 10% of cases.
The artery may show sudden tapering because of
occlusion of the lumen.
Aneurysmal dilatation are also found in some
cases.
Djouhri H, Guillon B, Brunereau L, et al. MR angiography for the long-term follow-up of dissecting aneurysms of the extracranial internal carotid artery. AJR Am J
Roentgenol2000;174:1137–40.
17. TREATMENT
Medical: anticoagulation (heparin followed by
warfarin) continued with antiplatelet
Surgical / endovascular treatment:
- SAH
- Aneurysmal dilatation
- Failed after 6 months medical therapy
- persistence of high grade stenosis
Thanvi, B., Munshi, S. K., Dawson, S. L., & Robinson, T. G. (2005). Carotid and vertebral artery dissection syndromes. Postgraduate medical journal, 81(956), 383-388.
18. PROGNOSIS
Extracranial CADs generally carry a good prognosis.
A literature review reports 50% of cases having no
neurological deficit, 21% mild deficits only, and 25% moderate
to severe deficits, the remaining 4% having died.
The neurological outcome was dependent on the lesion
localisation and the presence of good collaterals.
Intracranial dissections are usually associated with severe
neurological deficits or subarachnoid bleed and carry a poor
prognosis.
The recurrence rate for CAD is usually low. Higher recurrence
rates have been noted in the immediate post-dissection period
and CAD associated with familial disorders of connective
tissue.
There is no evidence to suggest that anticoagulation or
antiplatelet therapy prevents recurrence of CAD.
Thanvi, B., Munshi, S. K., Dawson, S. L., & Robinson, T. G. (2005). Carotid and vertebral artery dissection syndromes. Postgraduate medical journal, 81(956), 383-388.
Caso V, Paciaroni M, Corea F, et al. Recanalization of cervical artery dissection: nfluencing factors and rate in neurological outcome. Cerebrovasc Dis2004;17:93–7.
Saver JL, Easton JD. Dissection of cervicocerebral arteries. In: Barnett HJM, Mohr JP, Stein BM, et al, eds. Stroke: pathophysiology, diagnosis and management. New York:
Churchill Livingstone, 1998:769–86, 1459.
19. SUMMARY
Important stroke causes in younger patients
Carotid vs vertebral
Extracranial vs Intracranial
Classic triad: pain, headache, ipsilateral Horner’s
syndrome
Diagnosis using ultrasound, MRI/MRA, CTA, or
DSA
Medical vs surgical treatment
Editor's Notes
Schema of interaction of genetic and environmental factors in the pathogenesis of cervicocerebral dissections.