This document discusses the evaluation of stroke. It begins by classifying the pathophysiologic processes that can cause stroke into four categories: those intrinsic to the vessel, those originating remotely as an embolism, those resulting from inadequate cerebral blood flow, and those from rupture of vessels in the brain. It then describes transient ischemic attacks, intracerebral hemorrhage, subarachnoid hemorrhage, and the three main subtypes of brain ischemia. The document outlines the initial assessment, history, physical exam, tests to confirm diagnosis including vascular studies, cardiac evaluation, and blood tests. It provides details on the appropriate cardiac and hypercoagulable testing based on a patient's history and symptoms.
Buerger's disease (thromboangiitis obliterans) is a rare disease of the arteries and veins in the arms and legs. In Buerger's disease, your blood vessels become inflamed, swell and can become blocked with blood clots (thrombi)
Buerger's disease (thromboangiitis obliterans) is a rare disease of the arteries and veins in the arms and legs. In Buerger's disease, your blood vessels become inflamed, swell and can become blocked with blood clots (thrombi)
Hemiparesis is unilateral paresis, that is, weakness of the entire left or right side of the body (hemi- means "half"). Hemiplegia is, in its most severe form, complete paralysis of half of the body. Hemiparesis and hemiplegia can be caused by different medical conditions, including congenital causes, trauma, tumors, or stroke
Hypenension: Commonest cause of intracerebral haemorrhage.
Rupture of an intracranial aneurysm, angioma or A-V malformation: commonest cause of subarachnoid haemorrhage.
Haemorrhagic blood diseases: purpura, haemophilia.
Anticoagulants.
Trauma to the head: commonest of subdural haematoma.
II. Infective: ;
Encephalitis
Meningitis – Brain abscess.
III. Neoplastic: e.g. Meningioma.
IV. Demyelination: multiple sclerosis may present with hemiplegia.
V. Traumatic: e.g. Cerebral laceration and subdural haematoma.
VI. Hysterical: patient suffering from paralysis in the absence of organic lesion.
This work was done by 2nd year student in faculty of medicine,Menoufia University,Egypt and under supervision of staff of anatomy and embryology department
Hemiparesis is unilateral paresis, that is, weakness of the entire left or right side of the body (hemi- means "half"). Hemiplegia is, in its most severe form, complete paralysis of half of the body. Hemiparesis and hemiplegia can be caused by different medical conditions, including congenital causes, trauma, tumors, or stroke
Hypenension: Commonest cause of intracerebral haemorrhage.
Rupture of an intracranial aneurysm, angioma or A-V malformation: commonest cause of subarachnoid haemorrhage.
Haemorrhagic blood diseases: purpura, haemophilia.
Anticoagulants.
Trauma to the head: commonest of subdural haematoma.
II. Infective: ;
Encephalitis
Meningitis – Brain abscess.
III. Neoplastic: e.g. Meningioma.
IV. Demyelination: multiple sclerosis may present with hemiplegia.
V. Traumatic: e.g. Cerebral laceration and subdural haematoma.
VI. Hysterical: patient suffering from paralysis in the absence of organic lesion.
This work was done by 2nd year student in faculty of medicine,Menoufia University,Egypt and under supervision of staff of anatomy and embryology department
Medicinal Cannabis in the Treatment of Parkinson'sJames Van Geelen
An overview of the MMJ program in CT, cannabis' benefits in the treatment of parkinson's disease and an introduction to the world of medicinal cannabis.
Relative Contraindications for Thrombolysis in Acute Ischemic StrokeSudhir Kumar
Thrombolysis with rt-PA (Actilyse) is approved for the treatment of acute ischemic stroke since 1996. However, only 10-15% people receive this very effective treatment. One of the factors for low rates of thrombolysis is a large number of relative contraindications. This talk discusses, how we can include several of the patients with relative contraindications for thrombolytic treatment.
NEURODEGENERATION & NEUROPROTECTION-AN AYURVEDIC PERSPECTIVE.
WHAT AYURVEDA CAN OFFER BOTH IN PREVENTION & TREATMENT.FAMOUS PEOPLE SUFFERING FROM NEURODEGENERATION.MANDUKPARNI,SHANKHAPUSPI,POMGRENATE,ASWAGANDHA.BUDDHIBHRANSHA.NILANJAN DATTA.ROGNIDAN.PARKINSON,MULTIPLE SCLEROSIS,HUNTINGTONS CHOREA,ALZHEIMERS IN AYURVEDA TREATMENT.THANK YOU.ACKNOWLEDGEMENTS.DR.B.C.JANA.BHU.IPGAER AT SVSP,KOLKATA.BHU.
Definition of stroke and cerebrovascular disorders and pathophysiology of cerebral infarct and CT imaging overview of acute-subacute and chronic infarcts and penumbra.
causes of cerebral edema , Radiological signs of acute infarct and hemorrhagic infarct and comparison of MRI and CT in the diagnosis of acute infarct
Role of diffusion weighted imaging (DWI) and diffusion perfusion mismatch
The Neuroprotective Effects of Ketones in TBIBryan Barksdale
Traumatic Brain Injury (TBI) is the number one cause of death and chronic disability for those under the age of 45. Unfortunately there are few current treatments available and there has been a large failure to translate neuroprotective treatments from animal models. One potential reason is that metabolic dysfunction, a key part of TBI pathophysiology is not addressed. Ketogenic diets and exogenous ketones have been shown to have neuroprotective effects through multiple mechanisms in animal models of TBI, including the reversal of metabolic dysfunction. I will discuss the current evidence for the KD in the treatment of TBI. I will also briefly discuss other nutritional and lifestyle factors in the treatment of TBI.
Is characterized by the sudden loss of blood circulation to an area of the brain, resulting in a corresponding loss of neurologic function. Acute ischemic stroke is caused by thrombotic or embolic occlusion of a cerebral artery and is more common than hemorrhagic stroke.
It can occur
in the carotid
artery of the
neck as well as
other arteries.
When an artery is acutely occluded by thrombus or embolus, the area of the CNS supplied by it will undergo infarction if there is no adequate collateral blood supply.
Surrounding a central necrotic zone, an ‘ischemic penumbra’ remains viable for a time, i.e. it may recover function if blood flow is restored.
CNS ischemia may be accompanied by swelling for two reasons:
● cytotoxic oedema – accumulation of water in damaged glial cells and neurones,
● vasogenic oedema – extracellular fluid accumulation as a result of breakdown of the blood–brain barrier.
In the brain, this swelling may be sufficient to produce clinical deterioration in the days following a major stroke, as a result of a rise in intracranial pressure and compression of adjacent structures.
Cerebrovascular Diseases - Strokes and Their Etiology with Cerebral Blood SupplySudheera Semasinghe
Cerebrovascular accidents/strokes and their etiology (cerebral blood supply) by O. D. Roshan Indika. REFERENCES :
HARRISON’S Principles of Internal Medicine
20th edition
a quick review of the articles issued by WHO, CDC and other medical experts...
>>>
on its epidemiology, etiology, clinical manifestations, diagnosis, management and prevention.
Amyotrophic lateral sclerosis (ALS), AKA "Lou Gehrig's Disease," is a progressive neurodegenerative disease that affects nerve cells in the brain and the spinal cord. Motor neurons reach from the brain to the spinal cord and from the spinal cord to the muscles throughout the body. The progressive degeneration of the motor neurons in ALS eventually leads to their death. When the motor neurons die, the ability of the brain to initiate and control muscle movement is lost. With voluntary muscle action progressively affected, patients in the later stages of the disease may become totally paralyzed.
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
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
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
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
2. Stroke
• Result from ischemic infarction or bleeding
into part of the brain manifest by rapid onset
(seconds to mnutes) of CNS focal neurologic
deficits
3. Classification of pathophysiologic
processes:
A. Intrinsic to the vessel:
1) Atherosclerosis
2) Lipohyalinosis
3) Inflammation
4) Amyloid deposition
5) Arterial dissection
6) Developmental malformation
7) Aneurysmal dilatation
8) Venous thrombosis
4. Classification of pathophysiologic
processes:
B. Originate remotely - Embolus from
heart/extracrainal circulation
C. Inadequate cerebral blood flow – decreased
perfusion pressure/ increased blood viscosity
The first three cause: TIA/ ischemic stroke
D. Rupture of vessel in subarachnoid space or
intracerebral tissue
- SAH/ ICH
5. TIA
• Transient episode of neurologic dysfunction
caused by focal brain, spinal cord, or retinal
ischemia WITHOUT acute infarction
• Relies on the absence of end organ injury
based on imaging or other tests
• Temporary occlusion of part of cerebral
circulation by emboli
• Sx <24hours
6. Intracerebral hemorrhage
• Bleeding from small arteries/arterioles
• Bleeding directly into the brain localized
hematoma hematoma gradually enlarges
• Cause: HTN, trauma, bleeding
diathesis, amyloid angiopathy, illicit drug use
and vascular malformations
• less common: bleeding tumors, aneurysmal
rupture & vasculitis
7. SAH
• Spontaneous bleeding into subarachnoid space
• Aneurysmal rupture (saccular) blood in
subarachnoid space CSF rapidly increasing ICP
• Other causes: vascular malformation, bleeding
diathesis, trauma, amyloid angiopathy & illicit
drug use
• Sx: severe headache, pain lateralised to the side
of the aneurysm +/- brief LOC, seizure, N/V, focal
neuro deficit, stiffneck, kernig’s sign, retinal or
subhyaloid hemorrhages
8. Subtypes of Brain Ischemia
1) Thrombotic stroke:
- Thrombus formation in an artery produces a
stroke by reduced bld flow distally (low flow) or
embolic fragment that breaks off and travels to a
more distant vessel (artery to artery embolism)
a) Large vessel disease – atherothrombosis
- extra/intracranial arterial system
a) Small vessel disease – penetrating arteries
arising from the distal vertebral artery, basilar
artery, MCA stem & arteries of COW
9. Subtypes of Brain Ischemia
2) Embolic stroke- particle of debris originating
elsewhere that block particular access to the
brain regon
Causes: a) known sourcem- cardiac
b) ? Cardiac/ aortic – based on
Echocardiographic findings
c) arterial source
d) unknown source
10. Subtypes of Brain Ischemia
3) Systemic Hypoperfusion – reduced perfusion
due to cardiac pump failure by cardiac
arrest, arrythmia or reduced cardiac output
AMI, Pericardial effusion or bleeding
11. Initial General Assesment
• A, B, C
• BP: usually elevated in stroke
• Breathing: pt with ICP decreased respi drive
or muscular airway obstruction
• Fever: can worsen brain ischemia
• Hx & PE: DDX: seizures, syncope, migraine &
hypoglycemia
12. Initial General Assesment
• Non-contrast CT brain
– widespread acces and speed of acquisition
- highly sensitive for the diagnosis of bleeding in
acute cases
- focal white hyperdense lesionwithin the brain
parenchyma
13. Initial General Assesment
• MRI brain:
- Can show old hemorrhages since sensitive to
hemosiderin
- More sensitive than CT inearly detection of
infarction
• LP:
- Needed to make diagnosis for SAH
14. Initial General Assesment
• ? Thrombolytic Therapy – rt-PA
- Extracranial & intracranial US, CTA, MRA-show
occlusive thromboembolus
- Most severe complication: intracranial
hemorrhage (6%)
15. history
• Clinical course:
- Embolic stroke: occurs suddenly, focal loss of
brain function that is usually maximal, rapid
recovery
- Thrombosis – normal or abnormal or
progressing in a stepwise fashion with some
periods of improvements
- Penetrating artery occlusion- sx develop in
hours or a few days
16. history
- Intracerebral hemorrhage: does not improve
during the early period, progresses gradually
during minutes or few hours
- Aneurysmal SAH: develops instantly, focal brain
dysfunction is less common
17. history
• Ecology – age, sex and race
- Thrombotic and embolic strokes related to
atherosclerosis – occur in older patients
- Rare in <40yo, unless:
DM, HTN, HLD, smoker, strong Family Hx
- Cardiac origin embolism – common in young
pt with heart disease
18. history
- HTN ICH – common: blacks, in asians
• Previous TIA: strongly favors the presence of a
local vascular lesion (thrombosis)
• Activity at the onset or just before the stroke: a)
hemorrhages can be precipitated by physical
activities
b) trauma before stroke: traumatic dissection/
occlusion of arteries/traumatic brain hemorrhages
19. history
• Associated symptoms:
- Fever – endocarditis embolic stroke
- Infections activate acute phase reactants
predisposing to thrombosis
- Headache: fx of hmg stroke, prodromal period
before thrombotic strokes
- Seizures: seen in lobar ICH or brain embolism
- Reduced alertness: indicates hemorrhage and:
(+) neurologic signs ICH
(-) neurologic signs SAH
20. PE:
• Absent of pulses: atherosclerosis with
thrombosis
• Unpalpable ICA (neck): occlusion of CCA
• Cardiac findings: AF, mumur, cardiac
enlargement cardiac origin embolism
21. Neurologic exam
• Weakness of face, arm, leg on one side
without sensory/visual/cognitive
abnormalities (pure motor stroke)
thrombotic stroke in penetrating arteries /
small ICH
• Large focal neurlo deficits that begin abruptly/
progresses quicklyembolism / ICH
• Language abno, motor and sensory signs same
side of body anterior circulation disease
22. Confirm the diagnosis
• Vascular Studies:
1) Anterior circulation – exracranial and intracranial
carotid arteries , middle and anterior cerebral
artery branches should be the focus
- Duplex US of neck & transcranial Doppler of
intracranial arteries
2) Posterior circulation – vertebrobasilar system –
extracranial & intracranial vertebral arteries, basilar
arteries & posterior cerebral arteries should be the
focus
23. Confirm the diagnosis
3) CT angiography or MR angiography of neck
and head arteries – done when the screening
test do not fully define the lesion and more
characterization is warranted and when surgery
or interventional treatment by an arterial
catheter may be indicated
24. Confirm the diagnosis
• Cardiac Evaluation:
1) ECG & 24 Holter - ? AF as source of emboli
2) Echocardiography- for all patient suspected for
embolic stroke
a) TEE- examines the atria, atrial region and the
aorta
- to exclude ascending aortic atheromatous
disease, look for patent foramen ovale or atrial
septal aneurysm
b) TTE-
26. Blood tests:
Hypercoagulable Studies:
1) Protein C, Protein S, antithrombin III
2) Lupus Anticoagulant
3) Anticardiolipin antibodies
4) Activated protein C resistance/ factor Leiden
mutation
5) Prothrombin Mutation
27. Antiphospholipid antibody testing is
recommended in:
1. Hx of Lupus or sx compatible with Lupus
2. Fx suggestive of Antiphopholipid Syndrome:
a) Miscarriages
b) Venous thrombosis
c) Migraine headaches
3. Cryptogenic stroke / TIA at young age