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
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.
Full story brain herniation imaging Dr Ahmed EsawyAHMED ESAWY
Full story brain herniation imaging Dr Ahmed Esawy
include different cases for oral radiodiagnosis examination all over the world
CT /MRI Plain X ray images
I Supratentorial herniation
1-Cingulate (subfalcine/transfalcine)
2-Uncal (descending transtentorial herniation DTH)
3-Central (bilateral DTH)
4-Transcalvarial
5-Tectal (posterior)
II-Infratentorial herniation
1-Upward
(upward cerebellar or upward transtentorial)
2-Tonsillar (downward cerebellar
III-Sphenoid/alar herniation Transalar Herniation
Gliomas are the commonest tumor of brain arising from the supportive cells of the brain with diverse form and presentation the treatment of which is surgical and demands adjuvant therapy for most of circumstances.
In this presentation we will dscuss the imp imaging features of Posterior fossa tumors in pediatric age group.
Medulloblastoma
Pilocytic Astrocytoma
Ependymoma
Brainstem Glioma
Schwanoma
Meningioma
Epidermoid Cyst
Arachnoid Cyst
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.
Full story brain herniation imaging Dr Ahmed EsawyAHMED ESAWY
Full story brain herniation imaging Dr Ahmed Esawy
include different cases for oral radiodiagnosis examination all over the world
CT /MRI Plain X ray images
I Supratentorial herniation
1-Cingulate (subfalcine/transfalcine)
2-Uncal (descending transtentorial herniation DTH)
3-Central (bilateral DTH)
4-Transcalvarial
5-Tectal (posterior)
II-Infratentorial herniation
1-Upward
(upward cerebellar or upward transtentorial)
2-Tonsillar (downward cerebellar
III-Sphenoid/alar herniation Transalar Herniation
Gliomas are the commonest tumor of brain arising from the supportive cells of the brain with diverse form and presentation the treatment of which is surgical and demands adjuvant therapy for most of circumstances.
In this presentation we will dscuss the imp imaging features of Posterior fossa tumors in pediatric age group.
Medulloblastoma
Pilocytic Astrocytoma
Ependymoma
Brainstem Glioma
Schwanoma
Meningioma
Epidermoid Cyst
Arachnoid Cyst
Splenic trauma - Causes, Complications, ManagementVikas V
Splenic Trauma - A detailed Presentation about Splenic Trauma, anatomy of the spleen, Causes of Trauma, Mechanism of Injury, Diagnosis, Management, Surgical management, Steps of Splenectomy, and Complications
chiari or arnold chiari malformations, various types and pathophysiology, radiological and clinical presentation of the types, signs symptoms, investigations and treatment of these malformations both conservative and surgical. considerations and controversiies in management of chiari malformation associated with various conditions.
Hydrocephalous is a serious disease of the central nervous system which has both congenital and aquired subtypes. the congenital variety affects the children and is a considerable burden especially is the developing countries. I tleads to long term morbidity and high rates of mortality
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
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.
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!
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
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdf
Empty sella syndrome
1. Dr. Shahnawaz Alam
Guided by: Dr. Vikas Chandra Jha
HOD, Dept. of Neurosurgery
Moderated by: Dr. Saraj kumar Singh
Faculty, Dept. of Neurosurgery
EMPTY SELLA SYNDROME
2. Normal dimension of sella
Dimension (mm) Min Max Avg
Depth 4 12 4.1
Length 5 16 10.6
* Rhoton Microanatomy
3. Definition
• An empty sella is defined as a
sella, which, regardless of its size,
is completely or partially filled
with CSF.
• The pituitary gland is compressed
and lies posteriorly and inferiorly
in the sella.
• Empty sella syndrome can be
primary or secondary.
• PES syndrome- absence of pituitary surgery or irradiation for pituitary disease and
SES is that which occurs following these procedures.
• ESS resulted from herniation of the subarachnoid space through the diaphragm
sella displacing the normal pituitary gland.
• First coined by Bush in 1951.
4. * Guinto et al. 2019; www.journals.elsevier.com/world-neurosurgery
5. PATHOGENESIS
• An incomplete sellar diaphragm is an essential pre-requisite.
• Inherent weakness of the diaphragm sella and/or Increase in the intracranial
pressure.
1. Congenital Factors: Deficiency of the diaphragma sellae.
2. Suprasellar Factors
3. Intrasellar Factors
• Physiological involution
• Pathological involution: Pituitary apoplexy/ Rupture of an intrasellar or parasellar cyst
4. Systemic Factors
6.
7. CLASSIFICATION
Empty sella is defined as partial or total.
• Partial: less than 50% of the sella is filled with CSF with the gland thickness being >
2 mm.
• Total: More than 50% of sella filled with CSF with the gland thickness being < 2
mm.
8. Primary empty sella syndrome
• Range from the occasional discovery of a clinically asymptomatic arachnoid pouch
within the sella turcica to severe intracranial hypertension and rhinorrhoea.
• PES may be seen anatomically and radiologically without producing any symptoms or
signs.
• Herniation of the arachnoid membrane into the sella turcica which can act as a mass,
probably as a result of repeated CSF pulsation.
• The sella can become enlarged and the pituitary gland may become compressed against
the floor.
• Occurs in the absence of prior treatment of a pituitary tumor (medical, surgical or
XRT).
9. Association
• Female sex ( female:male ratio = 5:1)
• Obesity and HTN
• 8-35 % in general population
• 30-40 years of age
• Present in 70-80 % patients with IIH
10. Clinical presentation
• Severity depends on the extent to which the hypothalamus, hypophysis and optic
structure are involved.
• Systemic, neurological and endocrine Symptoms.
• About 30% hypertensive.
• Headache, which occurs in 50−70%- MC neurological symptoms.
• Visual disturbances up to 34%.
• Memory disturbances, imbalance, dizziness, convulsions and CSF rhinorrhoea.
11. Endocrine abnormalities
Endocrine symptoms reported in 10−15% of patients.
30% = abnormal pituitary function tests.
Isolated GH deficiency is being the commonest; reduced response of GH to
insulin induced hypoglycaemia.
Mild elevation of prolactin (PRL) and reductionof ADH : stalk effect
These patients show a normal PRL rise with TRH stimulation (whereas
patients with prolactinomas do not)
Hyperprolactinaemia is not as high as in a prolactin secreting adenoma, unless
the partially empty sella is associated with a prolactinoma. The prolactin level
is usually below 100−125 ng/ml.
12.
13.
14.
15. Secondary Empty Sella Syndrome
• Occurs after surgical and/or radiation therapy of a pituitary tumour.
• May be caused by pituitary adenomas undergoing spontaneous necrosis (ischemia or
hemorrhage).
• Other causes: infective/ autoimmune/ traumatic/ drugs.
• Regression of an inflammatory lesions of a pituitary gland such as lymphocytic and
granulomatous hypophysitis.
• The predominant clinical finding in these patients is visual abnormality, occurring
due to arachnoidal adhesions and traction on the optic apparatus.
• The Endocrine symptoms due to hypersecretion or hyposecretion are more common
in secondary empty sella than in the primary variety.
• This is mainly due to the tumour itself and not due to the empty sella. CSF
rhinorrhoea can occur due to shrinkage of the tumour.
16. MRI sagittal of a patient with secondary empty sella showing
evidence of transsphenoidal surgery with empty sella
MRI of a patient having a pineal
tumour (white arrow) and empty sella
17. Other sellar pathology in comparision
SN Pathology Sella
enlargement
Clinoid
Erosion
1 Pituitary adenoma + -
2 Craniopharyngioma +/- +
3 ESS + -
4 Tuberculum
meningioma
- +
20. Treatment
• Empty sella syndrome is usually a benign condition. The majority of cases do not require
treatment, except symptomatic for headache.
• Hypertension must be treated and weight reduction advised in obese patients.
• Hyperprolactinemia may be treated e.g. with bromocriptine, if it interferes with gonadal
function.
• Indications for surgery:
Visual disturbances
CSF rhinorrhoea
• When surgery is indicated, the type of surgery depends on clinical presentation and
radiologicalfindings.
21. • CSF rhinorrhoea requires prompt surgical treatment, as the fistula rarely closes
spontaneously.
• When associated with hydrocephalus or BIH, an initial CSF diversion procedure, like
VP- shunt or lumboperitoneal shunt should be done and, if the leak persists, definitive
surgery must be undertaken.
• Simple shunting for hydrocephalus runs the risk of producing tension pneumocephalus
from air drawn in through the former leak site.
• When the fistula is from the sella into the sphenoid, the transsphenoidal route is ideal.
The sellar dura should be opened and the sella packed with fat covered over by fascia.
22. Different surgical procedures according to the mode of presentation and the radiological
findings:
• Extradural transsphenoidal packing of the sella using fat and fascia with fibrin glue.
(transsellar fistulous tract after intrathecal contrast)
• Subfrontal craniotomy with intradural repair of the anterior cranial fossa with fascia.
• Thecoperitoneal/ VP- shunt.
• Reconstruction of the sellar floor using either a fragment of the bone from the anterior
sphenoid wall or the bony septum.
• In cases with previous transsphenoidal surgery (secondary empty sella), the reconstruction
of the sellar floor using a bone graft from iliac crest or acrylic material.
23. * Guinto et al. 2019; www.journals.elsevier.com/world-neurosurgery
24. • When visual symptoms are present in SES the cause should clearly be identified.
• On MR, if there is a clear demonstration of descent of the optic apparatus into the sella and
there is kinking of the optic nerves or chiasm, chiasmapexy is indicated.
• Chiasmapexy (propping up the chiasm) usually by transsphenoidal approach and packing
the sella with fat, muscle or cartilage.
25. Surgical benefit
• Patients with preoperative complaint of headache respond well to surgery,
with complete resolution in 85.3% of cases (12 cases out of 14).
• Only 60% of the patients with preoperative visual field defect improved (6 cases
out of 10).
• No patients with preoperative poor visual acuity (4 cases) have improved after
surgery.
Wael Fouad: 2011
26. • Patients diagnosed to have an empty sella should be followed up regularly and any
progression of symptoms should appropriately be treated.
• Sudden and rapid deterioration, especially in vision, may occur and the patient should
be warned of this.
• Patients with no abnormalities at baseline are unlikely to develop neurological/
ophthalmological symptoms or endocrine abnormalities in the follow-up.
• Moreover, the radiological degree of PES also tends to remain constant over time.
• However, because of the theoretical risk of progression, a re-evaluation after 24−36
months (if there are no clinical indications before) of the endocrine/ neurological/
ophthalmological/ radiological picture is reasonable.
Follow-up
27. References:
• Youmans and Winn neurological surgery 7th edition
• Ramamurthi & Tandon's textbook of neurosurgery 3rdediton edition
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