Color-Coded Duplex in Neuromonitoring of Critical Care Patients
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This document summarizes the use of transcranial color-coded duplex (TCCD) ultrasound to evaluate cerebral arteries and pathology in 21 patients. TCCD utilizes B-mode, color Doppler, and spectral analysis to visualize arteries and assess blood flow parameters. The study identified 5 patterns in the patients - normal, vasospasm, high resistance, hyperemia, and cerebral circulatory arrest. The authors conclude that TCCD is a useful monitoring tool that allows real-time imaging and evaluation of unstable patients, though more training is needed as its use is not yet widespread.
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Medicina nuclear juega un papel importante en el diagnóstico de amiloidosis cardiaca. Los radiofármacos como difosfonatos marcados con Tc99m tienen alta sensibilidad y especificidad. La medicina nuclear permite detección temprana, evaluar extensión de la enfermedad, y pronóstico. Exámenes como PET con trazadores de amiloide y MIBG-131 para evaluar denervación cardiaca proveen información adicional. La medicina nuclear no invasiva es útil para el diagnóstico y seguimiento de pac
Cardiac CT Angiography to detect Myocardial Bridging
CTCA is a reliable non-invasive tool for detecting myocardial bridging in coronary artery disease. [The study] found an 8.2% frequency of myocardial bridging in 219 patients with coronary artery disease who underwent CTCA. CTCA allows for visualization of the length and depth of the bridging artery and measurement of stenosis. While myocardial bridging can be clinically significant when associated with hemodynamic changes, in most cases it remains asymptomatic. CTCA is an emerging alternative to other invasive tests for diagnosing myocardial bridging.
Nardilisina marcador de morbi mortalidad en infarto maligno
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Austin Biomarkers & Diagnosis
Austin Biomarkers & Diagnosis is a peer-reviewed, open access journal published by Austin Publishers. It provides easy access to high quality Manuscripts covering aspects of measure and evaluation to examine normal biological processes, pathogenic processes, or pharmacologic responses to a therapeutic intervention. It also focus upon aspects of dynamic and powerful approaches in understanding the spectrum of disease with applications in observational and analytic epidemiology, randomized clinical trials, screening and diagnosis.
Austin Publishing Group is a successful host of more than hundred peer reviewed, open access journals in various fields of science and technology with intent to bridge the gap between academia and research access.
Austin Biomarkers & Diagnosis accepts original research articles, review articles, case reports, mini reviews, rapid communication, opinions and editorials on all the related aspects of biomarkers involved in normal biological processes, pathological process, and pharmacological responses as well as in diagnosing diseases.
CEREBRAL VENOUS THROMBOSIS
Cerebral venous thrombosis (CVT) is an uncommon type of stroke caused by a blood clot in the brain's venous sinuses or veins. It has a significant morbidity. Common presentations include headache, seizures, and long-lasting neurological deficits. Diagnosis is made through imaging studies like MRI and MRV. Treatment involves management of increased intracranial pressure, seizures, and anticoagulation with heparin or thrombolytics to prevent extension of clots. Prognosis depends on factors like impaired consciousness, underlying cause and location of clots. Most patients recover without sequelae, but mortality can be high if left untreated.
simultaneous anterolateral medullary infarct
This case report describes an unusual case of a 31-year-old male who presented with symptoms of Wallenberg syndrome due to simultaneous bilateral infarction of the anterolateral medulla. Extensive evaluation did not reveal a clear cause of the stroke. MRI showed subacute infarcts in the anterolateral aspect of the medulla bilaterally. CT angiogram showed a hypoplastic left vertebral artery but no significant stenosis. Investigations ruled out conditions like vasculitis, vascular malformations, and cardiac abnormalities. The patient was diagnosed with cryptogenic stroke and made a near complete recovery with treatment. This case highlights the importance of thorough evaluation for young patients presenting with stroke to identify potentially treatable causes.
Unruptured intracranial aneurysms in children with SCD
Five out of 179 children with sickle cell disease who underwent brain imaging were found to have unruptured intracranial aneurysms, for a prevalence of 2.8%. A total of 18 aneurysms were detected in these 5 patients, with most patients having multiple aneurysms and bilateral involvement. The majority of aneurysms were located in the cavernous and clinoid segments of the carotid circulation. This study suggests that children with sickle cell disease may be at increased risk of developing multiple intracranial aneurysms.
Ventricular Arrhythmias in Cardiac Amyloidosis.pdf
This document provides an overview of ventricular arrhythmias in cardiac amyloidosis. It discusses that arrhythmias in cardiac amyloidosis can include atrial arrhythmias, AV block, or ventricular arrhythmias. The clinical significance of ventricular arrhythmias is variable, with some studies finding they predict prognosis and others not. Predictors of ventricular tachycardia in cardiac amyloidosis include a history of congestive heart failure, presyncope or syncope, and structural heart abnormalities seen on echocardiogram or cardiac MRI like reduced ejection fraction or increased fibrosis. Electrophysiology studies can help determine conduction disease risk and guide therapies.
Dilating the Dogma of Vasospasm
R. Loch Macdonald, M.D., Ph.D.
Community Neurosciences Institute
Fresno, California, USA
Angiographic vasospasm and more accurately, delayed cerebral ischemia, continue to contribute to morbidity and mortality in patients with aneurysmal subarachnoid hemorrhage (SAH). It is known that angiographic vasospasm is common after SAH, occurring in two-thirds of patients. Cerebral infarctions that developed days after the SAH have been attributed to angiographic vasospasm, occuring in about a third of patients, although this has always been controversial. Angiographic vasospasm theoretically can only damage the brain by restricting blood flow but there is no easy, accurate, widely available method to measure cerebral blood flow and this is not the measurement we need. Blood flow depends on metabolic demand so what we need to know to determine if angiographic vasospasm is causing ischemia is oxygen extraction fraction in the brain tissue supplied the the spastic artery. Without this measurement, the attribution of ischemia to vasospasm is subjective. Since angiographic vasospasm is essentially the only detectable delayed phenomenon after SAH, we focus on it and apply tremendous resources to preventing or reversing the vasospasm. Undoubtedly angiographic vasospasm can cause cerebral infarctions, but it has to be severe and flow limiting. But SAH is a complex disease. There are many other causes for cerebral infarctions after SAH, the most common being due to the aneurysm repair procedure. And a given degree of vasospasm may cause infarction in a volume-depleted patient with poor collateral blood supply but not in a patient without these things. There also are hypodense brain lesions after SAH that are due to intracerebral hemorrhages. There can be hypodensities in the brain directly under usually thick SAH where the brain dies. This observation in particular supports a role for cortical spreading depolarizations/ischemia as a cause of infarction after SAH. Other macromolecular processes that are hypothesized to cause brain damage after SAH include microthromboembolism, changes in the microcirculation, delayed brain cell apoptosis and capillary transit time heterogeneity. Determining the importance of these things is hindered by the lack of an easy way to detect them in patients. It is also known that poor grade patients, who presumably have more early brain injury and ischemia than good grade patients, are more prone to delayed cerebral ischemia, suggesting increased sensitivity to secondary insults of the already injured brain. We also assume delayed neurological deterioration when attributed to vasospasm or delayed cerebral ischemia, is purely due to ischemia. While knowledge about what happens pathophysiologically after SAH is increasing, management of delayed cerebral ischemia still focuses on detecting angiographic vasospasm and then augmenting the blood pressure to improve cerebral blood flow or dilating the spastic arteries with balloons or drugs.
CADASIL
CADASIL is caused by mutations in the NOTCH3 gene and is the most common monogenic form of cerebral small vessel disease. It is characterized clinically by recurrent strokes, cognitive decline, and mood disorders. Diagnosis involves identifying white matter changes, cerebral microbleeds, and NOTCH3 gene mutations on imaging and genetic testing. While there are currently no disease-modifying treatments, understanding the pathogenic mechanisms of CADASIL may help develop new therapeutic strategies.
Stroke
perfusion imaging of stroke for early detection and selectiong appropriate patients for thrombolytic therapy
Clinical imaging and molecular biomarkers of drug resistant epilepsy.pptx
Clinical, imaging and molecular biomarkers in drug resistant epilepsy
1. Several clinical factors predict drug resistant epilepsy including early age of onset, frequent seizures, neurological deficits, and failure to respond to initial treatment.
2. Imaging biomarkers such as abnormalities on MRI, focal hypometabolism on PET, and changes in diffusion can help identify potential epileptogenic lesions.
3. Molecular biomarkers reflect underlying pathological processes like abnormal excitatory/inhibitory neurotransmission, neuroinflammation, and changes in gene and protein expression that may contribute to drug resistance. Combining biomarkers provides a more precise approach to managing drug resistant epilepsy.
Pocus in acute ischemic stroke.docx
This study evaluated the use of hand-held echocardiography (HHE) as point-of-care ultrasound scanning (POCUS) to detect potential sources of embolism in 130 patients with non-lacunar ischemic stroke within 24 hours of onset. Main sources of embolism (MSEs) detected by HHE included embolic valvulopathies and severe ventricular dysfunction, and were confirmed in 19.23% of patients by comparison with transthoracic echocardiography (TTE). Large vessel occlusion and chronic heart failure independently predicted the detection of MSEs. HHE also identified an enlarged left atrium as an independent predictor of later detection of atrial fibrillation in patients
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Genetic Cardiomyopathy & Sarcoidosis Clinic: Is There Room to Subspecialize?
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Comunicaciones españolas en Heart Failure Congress 2021 (1)
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Color-Coded Duplex in Neuromonitoring of Critical Care Patients
- 1. Authors: Gauna DN, Macchiavello L, Feldman A Mail to: gaunamd@gmail.com P014
- 2. Introduction Transcranial color-coded Dupplex (DXT) identifies cerebral arteries as well as anatomy and pathology. DXT has 3 components: mode B, color Doppler and spectral analysis.
- 3. OBJECTIVE To describe DXT technique, patient´s diseases and the patterns found in them. Pictures were taken between December 2018 and June 2019. 21 patients were included, and a low frequency transducer was used. Method
- 4. 57% male 43% female Age 55,6 (20-79) 6 SAH, 5 TBI, 4 AVM, 2 stroke , 2 ICH, 2 BT.
- 5. Cella Media Mesencephalic brain stem Gauna DN 2019Gauna DN 2019
- 6. Lateral ventricles Gauna DN 2019 Gauna DN 2019 Abcsess
- 7. Gauna DN 2019 LIMITATIONS: Presence of air
- 8. post Gauna DN 2019 Circle of Willis
- 9. Posterior cerebral circulation Gauna DN 2019
- 10. Data parameters: Flow direction, mean velocity (MV), peak systolic velocity (PV), end-diastolic velocity (EDV), Pulsatility and Resistence Index (PI) (RI), Lindergaard Ratio (LR) MV: PV+(EDV*2)/3 PI: (PV-EDV)/MV RI: (PV-EDV)/PV PATTERN INTERPRETATION
- 11. Gauna DN 2019 Spectral Analysis: MCA M1
- 12. Carotid Artery Gauna DN 2019
- 13. Transorbital Window (TOW) Gauna DN 2019 Ophtalmic Artery Carotid Syphon
- 14. TT vs TOW Gauna DN 2019 Gauna DN 2019
- 15. M1 mild VS M2 severe VS ICA
- 16. High Resistense Pattern Gauna DN 2019 Gauna DN 2019
- 17. Hyperemia Pattern Gauna DN 2019
- 18. Results • Normal Pattern: 10 patients (rel. freq 0,47) • Vasospasm: 5 patients (rel. freq 0,23) • High resistance: 4 patients (rel. freq 0,19) • Hyperemia: 1 patient (rel. freq 0,04) • Cerebral circulatory arrest: 1 patient (rel. freq 0,04) 5 Patterns were set out:
- 19. MCA MV (cm/seg) in the sample
- 20. Conclusion DXT should be part of patient monitoring routine. Even with normal patterns it allows to obtain images in real time. The evaluation of different clinical situations bed-side becomes even more relevant when patients are unstable. In Argentina (and globally) only few centers use DXT and less professionals are skilled in this technique, it requires time and practice however our experience with DXT was encouraging.