This document discusses seizure in the context of head injury or traumatic brain injury (TBI). It covers several topics:
- TBI accounts for 10-20% of symptomatic epilepsy and increases the risk of developing post-traumatic epilepsy (PTE).
- Risk factors for PTE include severity of brain injury, presence of early seizures, and certain genetic factors like ApoE4 allele.
- Prevention of epileptogenesis after TBI is challenging. Some treatments that may help include anti-inflammatory drugs, hypothermia, and ketogenic diet, but evidence is limited.
- For treatment of established PTE, anti-seizure drugs are used as for other partial seizures, though
Diagnosis and management of status epilepticusSheela Aglecha
Status epilepticus is defined as continuous seizure activity or recurrent seizures without regaining consciousness lasting more than 5 minutes. It is most common in children under 5 years old, with an incidence over 100 per 100,000 children in this age group. The document outlines various etiologies and risk factors for status epilepticus as well as treatments including anesthetic doses of midazolam, phenobarbital, ketamine or propofol administered via bolus or infusion. There is no clear evidence to guide therapy after initial treatment failure, but additional options discussed include inhaled anesthetics, the ketogenic diet, epilepsy surgery, hypothermia, immunotherapy, and electroconvulsive therapy.
Prophylactic antiepileptics are used after traumatic brain injury to prevent post-traumatic seizures. While prophylaxis with phenytoin decreases early seizures, it does not reduce the risk of late post-traumatic epilepsy. Levetiracetam may be superior to phenytoin as it has antiepileptogenic properties in animal models. However, evidence is still lacking and more research is needed to determine the ideal drug, duration of treatment, and whether prophylaxis reduces long-term disability from post-traumatic epilepsy. Genetic factors may also influence an individual's risk, and warrant further investigation.
1. Septic encephalopathy is an acute brain dysfunction that can occur in patients with sepsis and is characterized by impaired consciousness including coma.
2. The pathophysiology is multifactorial but is thought to involve the action of inflammatory mediators and free radicals on the brain resulting from systemic inflammation.
3. Septic encephalopathy is associated with worse prognosis and higher mortality in sepsis patients. The severity of encephalopathy correlates with mortality.
The document discusses predicting the risk of post-traumatic epilepsy (PTE) following a head injury. It provides context on grading head injury severity and the relationship between intracranial bleeding seen on CT scan and risk of PTE. The risk of PTE is highest with severe injuries showing intracranial bleeding and contusions, and this risk declines over time but may remain elevated for many years depending on the severity of the initial injury. Predicting the initial and residual risk of PTE is important for occupations like piloting that have consequences from seizure.
Presentation given by Dr Catherine Poots from Craigavon Area Hospital at the 2014 Northern Ireland Intensive Care Society annual Coppel Prize on Wednesday November 26th
This document discusses seizure in the context of head injury or traumatic brain injury (TBI). It covers several topics:
- TBI accounts for 10-20% of symptomatic epilepsy and increases the risk of developing post-traumatic epilepsy (PTE).
- Risk factors for PTE include severity of brain injury, presence of early seizures, and certain genetic factors like ApoE4 allele.
- Prevention of epileptogenesis after TBI is challenging. Some treatments that may help include anti-inflammatory drugs, hypothermia, and ketogenic diet, but evidence is limited.
- For treatment of established PTE, anti-seizure drugs are used as for other partial seizures, though
Diagnosis and management of status epilepticusSheela Aglecha
Status epilepticus is defined as continuous seizure activity or recurrent seizures without regaining consciousness lasting more than 5 minutes. It is most common in children under 5 years old, with an incidence over 100 per 100,000 children in this age group. The document outlines various etiologies and risk factors for status epilepticus as well as treatments including anesthetic doses of midazolam, phenobarbital, ketamine or propofol administered via bolus or infusion. There is no clear evidence to guide therapy after initial treatment failure, but additional options discussed include inhaled anesthetics, the ketogenic diet, epilepsy surgery, hypothermia, immunotherapy, and electroconvulsive therapy.
Prophylactic antiepileptics are used after traumatic brain injury to prevent post-traumatic seizures. While prophylaxis with phenytoin decreases early seizures, it does not reduce the risk of late post-traumatic epilepsy. Levetiracetam may be superior to phenytoin as it has antiepileptogenic properties in animal models. However, evidence is still lacking and more research is needed to determine the ideal drug, duration of treatment, and whether prophylaxis reduces long-term disability from post-traumatic epilepsy. Genetic factors may also influence an individual's risk, and warrant further investigation.
1. Septic encephalopathy is an acute brain dysfunction that can occur in patients with sepsis and is characterized by impaired consciousness including coma.
2. The pathophysiology is multifactorial but is thought to involve the action of inflammatory mediators and free radicals on the brain resulting from systemic inflammation.
3. Septic encephalopathy is associated with worse prognosis and higher mortality in sepsis patients. The severity of encephalopathy correlates with mortality.
The document discusses predicting the risk of post-traumatic epilepsy (PTE) following a head injury. It provides context on grading head injury severity and the relationship between intracranial bleeding seen on CT scan and risk of PTE. The risk of PTE is highest with severe injuries showing intracranial bleeding and contusions, and this risk declines over time but may remain elevated for many years depending on the severity of the initial injury. Predicting the initial and residual risk of PTE is important for occupations like piloting that have consequences from seizure.
Presentation given by Dr Catherine Poots from Craigavon Area Hospital at the 2014 Northern Ireland Intensive Care Society annual Coppel Prize on Wednesday November 26th
Post-traumatic epilepsy (PTE) is defined as recurrent seizures occurring after traumatic brain injury (TBI). TBI accounts for 10-20% of epilepsy cases. Risk factors for early PTE include GCS <10, intracranial hematoma, and seizures within 24 hours of injury. Risk factors for late PTE include penetrating injury, intracranial hematoma, early PTE, and age over 35. Temporal lobes are the most common localization. Standard anticonvulsants are used to treat established PTE but prophylaxis is ineffective at preventing late PTE. Surgery may be considered for refractory late PTE if the seizure focus is well-localized.
Septic encephalopathy is characterized by diffuse brain dysfunction that occurs in patients with sepsis without direct evidence of intracranial infection or metabolic causes unrelated to the infectious process. It is a common complication among critically ill patients, occurring in 9-71% of cases. Diagnosis involves assessing for altered mental status in the setting of sepsis through EEG, biomarkers of brain injury, and neuroimaging while excluding other potential causes. Management focuses on early treatment of the underlying sepsis through organ support and intensive care, with adjunctive therapies like EEG monitoring and antipsychotics potentially helping to guide care and symptoms.
1) Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a rare acquired neuropathy accounting for 1-2 cases per 100,000 people, most commonly affecting males in the 5th-6th decades of life.
2) It is characterized by progressive weakness and sensory loss in both the proximal and distal portions of the limbs and can involve the cranial nerves. Diagnosis requires supportive electrophysiology and cerebrospinal fluid analysis.
3) Treatment involves immunotherapies like intravenous immunoglobulin, plasma exchange, or corticosteroids to reduce inflammation and prevent disability. Most patients respond well but some may require additional immunosuppressive agents and long-
Status epilepticus is a medical emergency defined as a seizure lasting more than 5 minutes or recurrent seizures without regaining consciousness. It can be convulsive, involving motor symptoms, or non-convulsive without obvious symptoms but still involving abnormal brain activity. Causes include prior epilepsy, trauma, infection, drugs or metabolic imbalances. Treatment aims to stop seizures quickly with benzodiazepines or anti-seizure drugs to prevent complications like cardiac or respiratory issues, metabolic disturbances and neuronal damage. Prolonged status epilepticus can lead to a refractory state requiring intensive care management to prevent disability or death.
This document discusses the definition, diagnosis, and treatment of refractory epilepsy. It defines refractory epilepsy as the absence of seizure control despite two or more antiepileptic drugs. Treatment options discussed include dietary therapies like the ketogenic diet, herbal medicines, surgical procedures, vagus nerve stimulation, deep brain stimulation, and responsive neurostimulation. Surgical options aim to remove or disable the epileptic focus and can reduce seizures in many patients. Vagus nerve stimulation and other devices provide seizure reduction for some patients but do not cure epilepsy. Dietary therapies and surgery offer the highest chances of improved seizure control or possible cure in refractory epilepsy cases.
1) A 58-year old male developed central pontine myelinolysis (CPM) and extrapontine myelinolysis (EPM) four days after being discharged from the ICU following treatment for hyponatremia.
2) CPM was first described in 1959 as a demyelinating condition affecting the pons seen in alcoholic and malnourished patients. Subsequent studies found it can result from rapid correction of hyponatremia.
3) The pathogenesis of CPM/EPM involves rapid correction of hyponatremia causing an osmotic gradient that opens the blood-brain barrier, allowing blood factors to enter and cause demyelination. The specific
This document presents a case report of organophosphate poisoning in a 2-year-old child who ingested malathion. It outlines the patient's presentation, management, progress, investigations and discharge. It also provides background information on organophosphate poisoning including pathophysiology, effects on different organ systems, grading of severity, management principles and potential complications.
José L. Ruiz-Sandoval, Erwin Chiquete,
Lucía E. Álvarez-Palazuelos, Miguel
A. Andrade-Ramos & Luis R. Rodríguez-
Rubio
Osmotic demyelination syndrome (ODS) is the
damage over the central nervous system caused by several
electrolytes, metabolic and toxic disorders. We aimed to
describe cases of unusual forms of ODS. In a 9-year period,
25 consecutive patients with ODS (15 men; mean age
42 years) were registered in our referral institution, among
them, four (16 %) with atypical neuroimaging findings
were abstracted for this communication. None of them
presented cardiorespiratory arrest, head trauma, seizures,
neuromyelitis optica spectrum or contact with toxic
chemicals. Case 1 was a 33-year-old alcoholic man without
hypertension or electrolyte imbalance, who presented a
classic central pontine myelinolysis (CPM) and a hemorrhage
within the pons. Case 2 was a 34-year-old alcoholic
man with hypoglycemia and hyponatremia who presented
CPM and diffuse bihemispheric extrapontine myelinolysis
(EPM) after correction of serum sodium. Case 3 was a
52-year-old woman with mild hypokalemia and hyponatremia
(inadequately corrected), who presented a peduncular
and cerebellar EPM. Case 4 was a 67-year-old
woman who had a suicidal attempt with antidepressants
and carbamazepine without impaired consciousness, who
complicated with mild hyponatremia associated with a
classical CPM and a spinal cord EPM. Case 2 died and the
rest remained with variable neurological impairments at
last follow-up visit. With modern neuroimaging, the
so-called atypical forms of ODS may not be as rare as
previously thought; however, they could have a more
adverse outcome than the classical ODS.
Osmotic demyelination syndrome (ODS), also known as central pontine myelinolysis, is a demyelinating condition that affects the pons region of the brain stem. It occurs when hyponatremia (low sodium levels) are corrected too rapidly, such as when sodium levels increase more than 12 mmol/L in a 24 hour period. Symptoms include paralysis, dysarthria, and dysphagia. Risk factors include chronic alcoholism and hyponatremia. While prognosis was once poor, improved imaging techniques now allow for earlier diagnosis and treatment with rehabilitation. Prevention through controlled correction of hyponatremia is key to avoiding ODS.
Case presentation on seizure and status epilepticusnigatendalamaw2
The document outlines a presentation on seizures and status epilepticus. It covers definitions, pathophysiology, classification, etiology, epidemiology, prognosis, and management of seizures. The case presentation describes a 28-year-old female who presented with status epilepticus and was treated with anti-seizure medications but later died of possible respiratory arrest. Key points discussed include different seizure types, phases of seizures, causes of seizures, prognosis, and appropriate treatment approaches.
Reversible cerebral vasoconstriction syndrome. Anne DucrosStefii Gómez Cedrón
Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by severe headaches and diffuse narrowing of cerebral arteries that resolves within 3 months. Thunderclap headaches are usually the first symptom, and patients often experience recurrent headaches for 1-4 weeks. Associated symptoms can include seizures, focal neurological deficits, and various types of strokes including subarachnoid hemorrhage and cerebral infarction. Diagnosis is based on clinical features and imaging evidence of cerebral artery constriction that resolves over time. Management focuses on treating headaches and preventing further complications, though prognosis is generally good with full recovery in most cases.
This document provides an overview of recent advances in the pathogenesis and management of Guillain-Barré syndrome (GBS). It discusses the variants of GBS (AIDP and AMAN), their pathogenesis involving molecular mimicry and antibody responses, clinical manifestations, diagnostic criteria and tests, treatment including immunotherapy options, prognostic indicators, and novel immunomodulatory approaches being studied.
Electrical status beyond convulsive status epilepticusTeik Beng Khoo
Non-convulsive status epilepticus (NCSE) refers to ongoing seizures without convulsions lasting more than 30 minutes. Studies have found NCSE occurs in 11-21% of pediatric intensive care unit patients based on EEG findings. Risk factors for NCSE include prior seizures, acute brain injury, and abnormal brain imaging. Left untreated, NCSE can lead to worse outcomes including increased mortality and neurological impairment. Prompt treatment of NCSE is important to mitigate negative effects.
1. CT scans early after a hypoxic/ischemic event may show signs of cerebral edema but have limited sensitivity to structural brain damage. MRI, particularly DWI, can detect damage like laminar necrosis in the cortex within hours.
2. Severe hypoxia can cause selective vulnerability of cortical layers, seen as laminar necrosis on DWI, T1, and FLAIR sequences. The necrosis appears as hyperintensity and restricted diffusion. Extensive laminar necrosis and brainstem/white matter changes predict poor recovery.
3. Basal ganglia are commonly involved, seen as hyperintensity on DWI, T1, and FLAIR. Involvement of different deep gray nuclei varies between patients
Encephalopathy is a generalized alteration in brain function caused by an underlying systemic condition that is usually reversible. It is acute or subacute in onset and resolves when the underlying cause is treated. Common causes include infection, organ failure, drugs/toxins. Specific types include toxic, metabolic, septic encephalopathies. Accurately diagnosing encephalopathy is important for documenting severity of illness and determining principal diagnosis. While altered mental status is non-specific, encephalopathy identifies toxic/metabolic brain dysfunction. Distinguishing encephalopathy from dementia or delirium relies on determining if mental status changes are due to acute/reversible toxic or metabolic factors.
This document discusses diabetic neuropathy. It defines diabetic neuropathy as nerve dysfunction in people with diabetes after excluding other causes. Diabetic neuropathy can involve both sensory and autonomic nerves and manifest as distal symmetrical polyneuropathy, focal or asymmetrical neuropathies, or combinations. Risk factors include poor glycemic control, hypertension, smoking, and genetics. Diagnosis involves clinical exam and electrodiagnostic testing. Management focuses on glycemic control and treating symptoms.
This document discusses autoimmune encephalitis, which is caused by antibodies targeting neuronal cell surface or synaptic antigens. It can present with various neuropsychiatric symptoms and be misdiagnosed as viral encephalitis. Diagnosis is confirmed by detecting antibodies in CSF and serum, often against NMDA receptors. Treatment involves immunotherapy like steroids, IVIg, or plasma exchange. Outcomes are generally good if treated promptly, though some disorders relapse. Tumor removal may also be needed if one is present.
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.
A 35-year-old diabetic woman presented with altered consciousness for 12 days. She had a history of vomiting and abdominal pain. Examinations revealed she was disoriented with hypertonia and exaggerated reflexes. Investigations showed hyponatremia that had since corrected. MRI brain showed changes consistent with osmotic demyelination syndrome. She was diagnosed with diabetes, osmotic demyelination from hyponatremia, and erosive gastritis. She was treated with insulin, omeprazole, rehabilitation and discharged with advice to follow up in neurology.
Neonatal encephalopathy is a clinical syndrome in newborns associated with hypoxic-ischemic injury to the brain near the time of birth. It is characterized by difficulties with maintaining respiration, hypotonia, altered consciousness, depressed reflexes, and sometimes seizures. Risk factors include complications of pregnancy, issues during labor and delivery, and problems with the placenta or umbilical cord. An evaluation includes the baby's history and exam findings as well as imaging studies, EEG, and laboratory tests to assess organ function and rule out other conditions. Management focuses on treatment of seizures and supportive care, with cooling therapy in moderate to severe cases aiming to reduce brain injury.
This patient, a 65-year-old male, presented with 6 months of gradually worsening gait difficulties and incoordination. Over the past 4 months, he developed forgetfulness, hallucinations, and sensorium changes. Exams found rigidity, myoclonic jerks, and a non-reactive semi-conscious state. Imaging and tests were suggestive of Creutzfeldt-Jakob disease (CJD), a prion disease characterized by spongiform changes in the brain. A definitive diagnosis requires brain biopsy or autopsy.
Post-traumatic epilepsy (PTE) is defined as recurrent seizures occurring after traumatic brain injury (TBI). TBI accounts for 10-20% of epilepsy cases. Risk factors for early PTE include GCS <10, intracranial hematoma, and seizures within 24 hours of injury. Risk factors for late PTE include penetrating injury, intracranial hematoma, early PTE, and age over 35. Temporal lobes are the most common localization. Standard anticonvulsants are used to treat established PTE but prophylaxis is ineffective at preventing late PTE. Surgery may be considered for refractory late PTE if the seizure focus is well-localized.
Septic encephalopathy is characterized by diffuse brain dysfunction that occurs in patients with sepsis without direct evidence of intracranial infection or metabolic causes unrelated to the infectious process. It is a common complication among critically ill patients, occurring in 9-71% of cases. Diagnosis involves assessing for altered mental status in the setting of sepsis through EEG, biomarkers of brain injury, and neuroimaging while excluding other potential causes. Management focuses on early treatment of the underlying sepsis through organ support and intensive care, with adjunctive therapies like EEG monitoring and antipsychotics potentially helping to guide care and symptoms.
1) Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a rare acquired neuropathy accounting for 1-2 cases per 100,000 people, most commonly affecting males in the 5th-6th decades of life.
2) It is characterized by progressive weakness and sensory loss in both the proximal and distal portions of the limbs and can involve the cranial nerves. Diagnosis requires supportive electrophysiology and cerebrospinal fluid analysis.
3) Treatment involves immunotherapies like intravenous immunoglobulin, plasma exchange, or corticosteroids to reduce inflammation and prevent disability. Most patients respond well but some may require additional immunosuppressive agents and long-
Status epilepticus is a medical emergency defined as a seizure lasting more than 5 minutes or recurrent seizures without regaining consciousness. It can be convulsive, involving motor symptoms, or non-convulsive without obvious symptoms but still involving abnormal brain activity. Causes include prior epilepsy, trauma, infection, drugs or metabolic imbalances. Treatment aims to stop seizures quickly with benzodiazepines or anti-seizure drugs to prevent complications like cardiac or respiratory issues, metabolic disturbances and neuronal damage. Prolonged status epilepticus can lead to a refractory state requiring intensive care management to prevent disability or death.
This document discusses the definition, diagnosis, and treatment of refractory epilepsy. It defines refractory epilepsy as the absence of seizure control despite two or more antiepileptic drugs. Treatment options discussed include dietary therapies like the ketogenic diet, herbal medicines, surgical procedures, vagus nerve stimulation, deep brain stimulation, and responsive neurostimulation. Surgical options aim to remove or disable the epileptic focus and can reduce seizures in many patients. Vagus nerve stimulation and other devices provide seizure reduction for some patients but do not cure epilepsy. Dietary therapies and surgery offer the highest chances of improved seizure control or possible cure in refractory epilepsy cases.
1) A 58-year old male developed central pontine myelinolysis (CPM) and extrapontine myelinolysis (EPM) four days after being discharged from the ICU following treatment for hyponatremia.
2) CPM was first described in 1959 as a demyelinating condition affecting the pons seen in alcoholic and malnourished patients. Subsequent studies found it can result from rapid correction of hyponatremia.
3) The pathogenesis of CPM/EPM involves rapid correction of hyponatremia causing an osmotic gradient that opens the blood-brain barrier, allowing blood factors to enter and cause demyelination. The specific
This document presents a case report of organophosphate poisoning in a 2-year-old child who ingested malathion. It outlines the patient's presentation, management, progress, investigations and discharge. It also provides background information on organophosphate poisoning including pathophysiology, effects on different organ systems, grading of severity, management principles and potential complications.
José L. Ruiz-Sandoval, Erwin Chiquete,
Lucía E. Álvarez-Palazuelos, Miguel
A. Andrade-Ramos & Luis R. Rodríguez-
Rubio
Osmotic demyelination syndrome (ODS) is the
damage over the central nervous system caused by several
electrolytes, metabolic and toxic disorders. We aimed to
describe cases of unusual forms of ODS. In a 9-year period,
25 consecutive patients with ODS (15 men; mean age
42 years) were registered in our referral institution, among
them, four (16 %) with atypical neuroimaging findings
were abstracted for this communication. None of them
presented cardiorespiratory arrest, head trauma, seizures,
neuromyelitis optica spectrum or contact with toxic
chemicals. Case 1 was a 33-year-old alcoholic man without
hypertension or electrolyte imbalance, who presented a
classic central pontine myelinolysis (CPM) and a hemorrhage
within the pons. Case 2 was a 34-year-old alcoholic
man with hypoglycemia and hyponatremia who presented
CPM and diffuse bihemispheric extrapontine myelinolysis
(EPM) after correction of serum sodium. Case 3 was a
52-year-old woman with mild hypokalemia and hyponatremia
(inadequately corrected), who presented a peduncular
and cerebellar EPM. Case 4 was a 67-year-old
woman who had a suicidal attempt with antidepressants
and carbamazepine without impaired consciousness, who
complicated with mild hyponatremia associated with a
classical CPM and a spinal cord EPM. Case 2 died and the
rest remained with variable neurological impairments at
last follow-up visit. With modern neuroimaging, the
so-called atypical forms of ODS may not be as rare as
previously thought; however, they could have a more
adverse outcome than the classical ODS.
Osmotic demyelination syndrome (ODS), also known as central pontine myelinolysis, is a demyelinating condition that affects the pons region of the brain stem. It occurs when hyponatremia (low sodium levels) are corrected too rapidly, such as when sodium levels increase more than 12 mmol/L in a 24 hour period. Symptoms include paralysis, dysarthria, and dysphagia. Risk factors include chronic alcoholism and hyponatremia. While prognosis was once poor, improved imaging techniques now allow for earlier diagnosis and treatment with rehabilitation. Prevention through controlled correction of hyponatremia is key to avoiding ODS.
Case presentation on seizure and status epilepticusnigatendalamaw2
The document outlines a presentation on seizures and status epilepticus. It covers definitions, pathophysiology, classification, etiology, epidemiology, prognosis, and management of seizures. The case presentation describes a 28-year-old female who presented with status epilepticus and was treated with anti-seizure medications but later died of possible respiratory arrest. Key points discussed include different seizure types, phases of seizures, causes of seizures, prognosis, and appropriate treatment approaches.
Reversible cerebral vasoconstriction syndrome. Anne DucrosStefii Gómez Cedrón
Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by severe headaches and diffuse narrowing of cerebral arteries that resolves within 3 months. Thunderclap headaches are usually the first symptom, and patients often experience recurrent headaches for 1-4 weeks. Associated symptoms can include seizures, focal neurological deficits, and various types of strokes including subarachnoid hemorrhage and cerebral infarction. Diagnosis is based on clinical features and imaging evidence of cerebral artery constriction that resolves over time. Management focuses on treating headaches and preventing further complications, though prognosis is generally good with full recovery in most cases.
This document provides an overview of recent advances in the pathogenesis and management of Guillain-Barré syndrome (GBS). It discusses the variants of GBS (AIDP and AMAN), their pathogenesis involving molecular mimicry and antibody responses, clinical manifestations, diagnostic criteria and tests, treatment including immunotherapy options, prognostic indicators, and novel immunomodulatory approaches being studied.
Electrical status beyond convulsive status epilepticusTeik Beng Khoo
Non-convulsive status epilepticus (NCSE) refers to ongoing seizures without convulsions lasting more than 30 minutes. Studies have found NCSE occurs in 11-21% of pediatric intensive care unit patients based on EEG findings. Risk factors for NCSE include prior seizures, acute brain injury, and abnormal brain imaging. Left untreated, NCSE can lead to worse outcomes including increased mortality and neurological impairment. Prompt treatment of NCSE is important to mitigate negative effects.
1. CT scans early after a hypoxic/ischemic event may show signs of cerebral edema but have limited sensitivity to structural brain damage. MRI, particularly DWI, can detect damage like laminar necrosis in the cortex within hours.
2. Severe hypoxia can cause selective vulnerability of cortical layers, seen as laminar necrosis on DWI, T1, and FLAIR sequences. The necrosis appears as hyperintensity and restricted diffusion. Extensive laminar necrosis and brainstem/white matter changes predict poor recovery.
3. Basal ganglia are commonly involved, seen as hyperintensity on DWI, T1, and FLAIR. Involvement of different deep gray nuclei varies between patients
Encephalopathy is a generalized alteration in brain function caused by an underlying systemic condition that is usually reversible. It is acute or subacute in onset and resolves when the underlying cause is treated. Common causes include infection, organ failure, drugs/toxins. Specific types include toxic, metabolic, septic encephalopathies. Accurately diagnosing encephalopathy is important for documenting severity of illness and determining principal diagnosis. While altered mental status is non-specific, encephalopathy identifies toxic/metabolic brain dysfunction. Distinguishing encephalopathy from dementia or delirium relies on determining if mental status changes are due to acute/reversible toxic or metabolic factors.
This document discusses diabetic neuropathy. It defines diabetic neuropathy as nerve dysfunction in people with diabetes after excluding other causes. Diabetic neuropathy can involve both sensory and autonomic nerves and manifest as distal symmetrical polyneuropathy, focal or asymmetrical neuropathies, or combinations. Risk factors include poor glycemic control, hypertension, smoking, and genetics. Diagnosis involves clinical exam and electrodiagnostic testing. Management focuses on glycemic control and treating symptoms.
This document discusses autoimmune encephalitis, which is caused by antibodies targeting neuronal cell surface or synaptic antigens. It can present with various neuropsychiatric symptoms and be misdiagnosed as viral encephalitis. Diagnosis is confirmed by detecting antibodies in CSF and serum, often against NMDA receptors. Treatment involves immunotherapy like steroids, IVIg, or plasma exchange. Outcomes are generally good if treated promptly, though some disorders relapse. Tumor removal may also be needed if one is present.
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.
A 35-year-old diabetic woman presented with altered consciousness for 12 days. She had a history of vomiting and abdominal pain. Examinations revealed she was disoriented with hypertonia and exaggerated reflexes. Investigations showed hyponatremia that had since corrected. MRI brain showed changes consistent with osmotic demyelination syndrome. She was diagnosed with diabetes, osmotic demyelination from hyponatremia, and erosive gastritis. She was treated with insulin, omeprazole, rehabilitation and discharged with advice to follow up in neurology.
Neonatal encephalopathy is a clinical syndrome in newborns associated with hypoxic-ischemic injury to the brain near the time of birth. It is characterized by difficulties with maintaining respiration, hypotonia, altered consciousness, depressed reflexes, and sometimes seizures. Risk factors include complications of pregnancy, issues during labor and delivery, and problems with the placenta or umbilical cord. An evaluation includes the baby's history and exam findings as well as imaging studies, EEG, and laboratory tests to assess organ function and rule out other conditions. Management focuses on treatment of seizures and supportive care, with cooling therapy in moderate to severe cases aiming to reduce brain injury.
This patient, a 65-year-old male, presented with 6 months of gradually worsening gait difficulties and incoordination. Over the past 4 months, he developed forgetfulness, hallucinations, and sensorium changes. Exams found rigidity, myoclonic jerks, and a non-reactive semi-conscious state. Imaging and tests were suggestive of Creutzfeldt-Jakob disease (CJD), a prion disease characterized by spongiform changes in the brain. A definitive diagnosis requires brain biopsy or autopsy.
Movement disorders: A complication of chronic hyperglycemia? A case reportApollo Hospitals
A 77-year-old man presented with bilateral choreic movements that had developed over the past month. He had a history of poorly controlled type 2 diabetes. At admission, he was found to have severe hyperglycemia without ketosis. A CT scan showed hyperdensity in the putamen and lenticular nucleus. Treatment with insulin, haloperidol, and glycemic control led to regression of the choreic movements within 4 days. Chorea secondary to nonketotic hyperglycemia is a rare complication of uncontrolled diabetes that is usually reversible with normalization of blood glucose levels and neuroleptic treatment. The pathophysiology is thought to involve metabolic disturbances from hyperglycemia impairing neurotransmission in basal ganglia structures and
Herpes Simplex Encephalitis in Medulloblastoma Patients: Case Report and Revi...clinicsoncology
Encephalitis caused by Herpes Simplex Virus (HSV) and medulloblastoma are both fairly rare disorders with relatively poor prognoses. We experienced a case of HSV encephalitis (HSE) in which the patient presented 1 year after surgical resection and radiation therapy and 1 month after chemotherapy....
Herpes Simplex Encephalitis in Medulloblastoma Patients: Case Report and Revi...SarkarRenon
Encephalitis caused by Herpes Simplex Virus (HSV) and medulloblastoma are both fairly rare disorders with relatively poor prognoses. We experienced a case of HSV encephalitis (HSE) in which the patient presented 1 year after surgical resection and radiation therapy and 1 month after chemotherapy....
Herpes Simplex Encephalitis in Medulloblastoma Patients: Case Report and Revi...pateldrona
Encephalitis caused by Herpes Simplex Virus (HSV) and medulloblastoma are both fairly rare disorders with relatively poor prognoses. We experienced a case of HSV encephalitis (HSE) in which the patient presented 1 year after surgical resection and radiation therapy and 1 month after chemotherapy..
Herpes Simplex Encephalitis in Medulloblastoma Patients: Case Report and Revi...komalicarol
Medulloblastoma is the most common malignant solid tumor
in childhood, with the highest frequency among other brain tumors accounting for 30% of pediatric brain tumors and 7% to 8%
of all brain tumors. According to the World Health Organization
(WHO), medulloblastoma is classified as a grade IV tumor and
defined as “a malignant, invasive embryonal tumor of the cerebellum with preferential manifestation in children, predominantly
neuronal differentiation and an inherent tendency to metastasize
via cerebrospinal (CSF) pathways
Herpes Simplex Encephalitis in Medulloblastoma Patients: Case Report and Revi...georgemarini
Encephalitis caused by Herpes Simplex Virus (HSV) and medulloblastoma are both fairly rare disorders with relatively poor prognoses. We experienced a case of HSV encephalitis (HSE) in which the patient presented 1 year after surgical resection and radiation therapy and 1 month after chemotherapy....
Herpes Simplex Encephalitis in Medulloblastoma Patients: Case Report and Revi...AnonIshanvi
Encephalitis caused by Herpes Simplex Virus (HSV) and medulloblastoma are both fairly rare disorders with relatively poor prognoses. We experienced a case of HSV encephalitis (HSE) in which the patient presented 1 year after surgical resection and radiation therapy and 1 month after chemotherapy....
Sepsis-associated encephalopathy (SE) is a brain dysfunction caused by sepsis and systemic inflammatory response syndrome. It is characterized by acute impairment of consciousness and confusion. Between 9-71% of sepsis patients develop SE. The pathophysiology involves oxidative stress, elevated pro-inflammatory cytokines, complement activation, and aromatic amino acid imbalance. Diagnosis is based on clinical assessment and EEG, while treatment focuses on managing the underlying sepsis along with supportive care. SE can cause long-term cognitive and psychiatric impairments in sepsis survivors.
PRIONS. Plegable kelly johanna agudelo gilKelly Gil
1. Prion diseases like Creutzfeldt-Jacob disease can spread between animals and humans through consumption of infected meat and milk. 2. A new study finds prion diseases may also spread through airborne transmission. 3. Mother-to-child transmission of prion diseases in sheep was also observed.
1. Prion diseases such as Creutzfeldt-Jacob disease can be transmitted from mother sheep to offspring and may be spread through airborne transmission.
2. Fatal familial insomnia is a prion disease characterized by progressively worsening insomnia and autonomic dysfunction that ultimately leads to death.
3. Definitive diagnosis of prion diseases requires brain biopsy or autopsy, though neuroimaging and cerebrospinal fluid analysis can provide supportive evidence for suspected cases.
a presentation on autoimmune encephalitis, paraneoplastic syndrome. their types and various imaging and lab finding
their differential diagnosis
acute and long term management plans
A case of Neuromyelitis optica as a presenting manifestation of Systemic Lupu...Apollo Hospitals
Neuromyelitis optica (NMO) is a well characterised, autoimmune, clinicopathological syndrome, which is uncommon and occurs as an isolated entity. Unlike multiple sclerosis, in NMO, the autoimmunity is humorally mediated and the recent availability of Antiaquaporin antibody testing has increased the positive diagnosis of this condition. NMO can also occur in patients with established Systemic Lupus Erythematosis (SLE) who have multiple autoantibodies. The presence of Antiaquaporin antibody is specific for NMO and is seen in patients with SLE who develop inflammatory CNS disease. However, Neuromyelitis optica occurring as a presenting manifestation of SLE is extremely rare and we report one such case.
Movement disorders: A complication of chronic Hyperglycemia? A case reportApollo Hospitals
This case report describes a 77-year-old man who presented with bilateral choreic movements that were predominantly on the right side, along with some dystonic movements. He had long-standing type 2 diabetes that was poorly controlled, with an HbA1c of 17.3%. Brain imaging showed hyperdensity in the putamen and lenticular nucleus. His symptoms improved with insulin treatment and a neuroleptic medication. The report discusses that uncontrolled diabetes can rarely cause movement disorders like chorea due to metabolic disturbances in the basal ganglia from hyperglycemia. Prompt treatment of the hyperglycemia typically leads to resolution of the neurological symptoms.
Hypoxic Ischemic Encephalopathy (HIE) occurs when a term infant experiences intrapartum asphyxia and lack of oxygen. It can lead to death or disabilities like cerebral palsy. Diagnosis involves assessing the infant at birth using the APGAR score and neurological staging. Imaging tools like MRI are useful for showing patterns of brain injury. HIE management aims to prevent further brain damage through measures like temperature control and treating seizures, while newer treatments target excitotoxicity and oxidative stress.
Hypoxic Ischemic Encephalopathy (HIE) occurs when a term infant experiences intrapartum asphyxia and lack of oxygen. It can cause death or disabilities like cerebral palsy. Diagnosis involves assessing the infant at birth using the APGAR score and neurological staging. Imaging tools like MRI are useful to detect brain injury patterns. HIE management aims to prevent further brain damage through temperature control, seizure treatment, and potentially neuroprotective drugs. The condition remains a major cause of newborn mortality and morbidity.
Similar to Fatal Bilateral Strokes in a Child With Hemolytic Uremic Syndrome- A Potential Therapeutic Role of Eculizumab (20)
Carbon monoxide (CO) poisoning is a major public health issue in the United States that accounts for approximately 50% of poisoning cases in the nation each year and around 50,000 emergency room visits. In most instances of CO poisoning, the culprit is a malfunctioning or poorly tended heating system within the home or, occasionally, commercial building, which causes the system to leak this hazardous gas. One of the more insidious aspects of CO poisoning is that the gas is odorless and colorless, and victims of CO poisoning often do not realize that there is a problem until they begin to experience the effects of poisoning and have no choice but to seek medical attention. Unfortunately, many victims of CO poisoning die before they are able to seek treatment. This paper makes use of a qualitative, systematic literature review to examine the four major parts of the brain that are most severely affected by CO poisoning. Overall, the literature review showed that the white matter, globus pallidus, basal ganglia, and cortex are the parts of the brain most severely impacted by CO poisoning. While many CO poisoning victims do make it to the hospital on time and are treated, they may nonetheless suffer long-term neurological consequences as a result of their exposure. As such, CO poisoning is a major public health issue.
Drug abuse has now become a major public health problem in Nigeria requiring urgent attention. Although drug abuse cut across all age groups, the youths are however the most affected. This study aimed at assessing Community Pharmacists involvement in the rehabilitation of drug abuse victims. The study was carried out in Abuja Municipal Area Council, questionnaires were administered to Community Pharmacists practicing within the Area Council. A total of 176 Community Pharmacists participated in the study, and slightly above a quarter (27.43%) of them had post-graduate degrees. More than three-quarters (79.5%) of the study participants had received training on drug abuse. A total of 89.2% of the study participants had come across persons suspected to be abusing prescription medicines. Almost all (96.6%) of the study participants indicated that they are willing to advise persons suspected to be abusing drugs on the dangers of drug abuse, and 88.1% of the study participants had spoken to clients concerning abuse of prescription medicines. Also, more than three-quarters (80.1%) of the study participants indicated that pharmacists’ role in the prevention of drug abuse is very important. The study has revealed that Community Pharmacists can play an invaluable role in the rehabilitation of drug abuse victims in Nigeria.
Background; Social Class has shown relation with admissions at Emergency Departments. To assess whether there is a relationship between the level of triage and the social class of patients who attend the emergency department and whether there are other variables that can modulate this association. Methods Observational study with 1000 patients was carried out between May and July 2018 in the Emergency Department of the University Hospital Arnau de Vilanova in Lleida. Sociodemographic variables such as age, gender, country of origin and marital status were analyzed. The triage level and the main explanatory variable was social class. Social class was calculated based on the CSO-SEE 2012 scale. Results 49.4% were male and the average age was 51.7 years. Most of the patients (66.6%) attended the emergency department under their own volition and the most common triage levels were level III or Emergency (45%). There is a significant relationship between age and triage level. The younger patients had a lower triage level (p <0.001). The percentage of patients with lower social class who attended the emergency department for minor reasons was 42% higher compared to the rest of the patients (RR = 1.42; 1.21-1.67 95% CI, p <0.001). Conclusions; Patients with a lower socioeconomic class go to the Emergency Department for less serious pathologies.
This document summarizes a study exploring child healthcare and treatment-seeking behavior in a village located in a haor region of Bangladesh. The study utilized interviews and focus groups to understand the various factors influencing healthcare choices, including the interrelationship between local ecology and health. Key findings were that the haor ecosystem is declining due to overuse of resources, and villagers utilize multiple healthcare sectors - including popular/family-based care, folk healers, and biomedical professionals - with choices influenced by cultural and socioeconomic factors. Government and NGOs could help improve child health by increasing access to services and promoting awareness of nutrition and sanitation practices.
Objective: The purpose of this paper is to review literature on music and biomarkers of stress in order to (1) Identify music interventions and (2) Detail the biomarkers of stress associated with music. Methods: PRISMA guidelines were followed in performing this systematic review. Studies published from January 1995 to January 2020 that pertain to biomarkers of stress and music were identified through the use of the PubMed database, using the keywords: ‘music’ AND ‘biomarker’ OR ‘marker’ OR ‘hormone’. Two authors independently conducted a focused analysis and reached a final consensus on 16 studies that met the specific selection criteria and passed the study quality checks. Results: The reviewed studies were all randomized controlled trials. Reviewed music interventions included Music Listening (ML), Meditational Music (MM), ‘Guided Imagery and Music’ (GIM), and Singing. The studies showed that music is associated with a decreasing trend in cortisol, salivary α-amylase, heart rate, and blood pressure, as well as an increasing trend in Immunoglobulin A (IgA), oxytocin, and EEG theta wave, while testosterone was associated with sex-related differences. Conclusion: Music is associated with significant changes in biomarkers of stress, suggesting that it could be utilized for the development of stress reduction tools.
Background: Nurse practitioners play a vital role in wound care and management because of the prevalence of wounds in the community and hospital setting. Aims and objectives: The purpose was to identify current knowledge and practices of nurses with respect to wound management. Method: A qualitative descriptive research was designed, nineteen nurses in wound care wards in Bingham University teaching hospital were recruited into this study. This was achieved with the aid of a self-administered questionnaire for a two-week period. Results: Three groups of nurses responded to this survey (73.7% males; 31.6% aged 31-40 years). Registered nurses dominated (68.4%), majority of them worked in male ward (36.8%) and private ward (36.8%). Almost on full-time (94.7%), more than half were diploma holders (57.9%) with 1 to 5 years of experience (47.4%). Majority (84.2%) were involved in wound treatment and management, there were significant association between years of experience and wound classification, wound treatment, treatment failure and treatment failure factors. Conclusion: Wound care practices require accurate knowledge and assessment skills, a better understanding of wound management provides comprehensible, rapid patient wound care and minimizes patient mortality as well as reduces health services financial costs.
Background: Job satisfaction is a significant indicator of the way nurses feel about their profession, the efforts to perform their professional duties, or otherwise abandons it willingly. Method: cross-sectional research design approach was used to assess the job satisfaction and the associated factors among 300 hundred nurses. Data was analyzed using descriptive statistics and kruskal wallis test for association between the socio-demographic variables and job satisfaction at significance level of 0.05 Result: About 1/3 of the respondents (31%) reported gross dissatisfaction with their job, 0% reported being well satisfaction while (68.7%) respondents reported moderate satisfaction with their job. Across items on the scale, gross dissatisfaction was noted on key managerial factors and the salary of the workers. Job satisfaction was associated with specialty (p<0.018), gender (P<0.002) and age (P<0.000) of Nurses. Conclusion: majority of the respondents were moderately satisfied with their job but grossly dissatisfied with salary and administrative roles like communication flow.
Viral infections have always been of major concern in communities, health care settings and medical fields including radiotherapy and Radiology. Recently corona virus infection has attained global attention in the wake of covid-19 outbreak and consequently highlighted importance of viral prevention, diagnostic and therapeutic strategies to control and treat viral disease. In view of the recent events, the author reviewed the current and past literature to discuss contagious versus infectious viral transmission, as well as simple and effective ways of preventing the spread of viral diseases in community and health care setting so that this information can be used for preventing viral transmission at all levels. The article is written for a wide variety of audiences i.e. scientific and medical communities policy makers and general public.
The Coronavirus Disease – 2019 (COVID-19) is officially now a pandemic and not just a public health emergency of international concern as previously labelled. Worldwide, the new coronavirus has infected more than 4.9 million people and leaving more than 300,000 people dead in 188 countries. As countries of the world get locked down in an effort to contain the widespread of the virus, experts are concern about the global impacts of the pandemic on individuals, countries and the world at large. Millions of people are currently under quarantine across the globe. Many countries have responded by proclaiming a public health emergency, closed their borders and restrict incoming flights from high risk countries. This has grossly affected the travel plan of many. Several international programs, conferences, workshops and sporting activities are either postponed or cancelled. As the number of confirmed cases continues to escalate across the globe, hospitals seems to be running out of medical supplies, hospital spaces and personnel. Health workers are being overwhelmed by the numbers of people requesting for testing and treatment. Many of such health workers have been infected with the coronavirus and even lost their lives since the fight against COVID-19 started. Public health experts are also concerned about the huge medical wastes coming from the hospitals at this time and the adverse effects associated with improper management of such medical wastes, both at the hospital and community levels. The pandemic has also impacted negatively on the global economy. There have been serious crises in the stock market, with gross fall in the price of crude oil resulting in inflation and economic hardship among the populace. Many are currently out of job and as a result, the level of crime, protest and violence have continued to escalate in different parts of the world. The deaths of loved ones due to the coronavirus has left many emotionally traumatized. Nigeria, like other African countries is not spared of the ravaging effects of the pandemic, even as the government take strict measures to contain the virus. No doubt, this is very challenging, but the country is capable of surmounting the virus with the needed help from her international partners and cooperation from the citizenry. But if we as a people, remain complacent and continue with business as usual, without taking measures to flatten the curve, the disease will escalate too quickly beyond our capacity to handle and our health system will be overwhelmed and may collapse eventually. We cannot therefore afford to be complacent in our response to containing the pandemic.
Purpose: To investigate the effect of sulfur dioxide on the lung microbiota of healthy rats. Methods Fifteen male rats were randomly divided into high dose and low dose exposure group and control group. After 7 days of SO2 exposure, the lung tissues were obtained and the lung microbiota was identified by Illumina high-throughput sequencing. Results The microbial community of lung microbiota was significantly alternated in the exposure group and the dominant phylum changed from Firmicutes to Proteobacteria. In addition, the SO2 exposure caused the bronchial wall thickening and a large number of inflammatory cell infiltration in the lungs of rats in exposure groups. Conclusions The results suggest that SO2 can significantly alter the lung microbiota and pathological structure of the lungs.
Malaria is still considered globally as a leading cause of morbidity with Nigeria carrying the highest burden of 19%. Coinfection of malaria and Human Immunodeficiency Virus (HIV) accelerate disease progression of HIV/AIDS subjects. This study investigated the prevalence and predictors of malaria among HIV infected subjects attending the antiretroviral therapy Clinic at Federal the Medical Centre, Keffi, Nigeria. After ethical clearance, 200 whole blood specimens were collected from patients who gave informed consent and completed a self-structured questionnaire. The specimens were examined for malarial parasite using rapid kits and microscopy. The overall prevalence of the infection was 78/200 (39.0%). The prevalence was higher in male (44.7%) than female (34.0%) subjects. Those subjects aged < 20 years (54.5), male gender (44.7%), non-formal education holders (61.5%), farmers (62.5%), stream water users (48.1%), those that lives in rural setting (43.6%), those that do not use Insecticides Treated Nets (ITNs) (39.4%) and swampy environment dwellers (41.7%) were identified predictors for malaria infection in the area. All the predictors studied did not show any statistically significant difference with the infection but some arithmetic difference exists (P > 0.05). The 39.0% prevalence of malaria in HIV infected subjects is a public health concern. Therefore, Public health surveillance and health education among HIV population should be advocated to help eradicate malaria comes 2030. Further study that will characterize the genes of the parasite should be carried out.
This document presents a mathematical model to eliminate malaria transmission by breaking the life cycle of Anopheles mosquitoes. The model introduces two natural enemies - copepods to prey on mosquito larvae and tadpoles to prey on pupae. Differential equations were derived to model the growth of each mosquito life stage from egg to adult when under attack by these predators. Stability analysis of the disease-free equilibrium was conducted using equilibrium points, Beltrami's conditions, and Diekmann's conditions. The results indicate that introducing copepods and tadpoles makes the disease-free equilibrium stable, meaning the mosquito life cycle would be broken and no adult mosquitoes emerge to transmit malaria.
Spindle cell neoplasms usually occur in head, neck, orbit, soft tissues of scalp and along the upper aerodigestive tract. They are relatively uncommon in lower gastrointestinal tract and represent a distinct clinical entity. Increased awareness is required among colorectal surgeons and pathologists due to their benign nature & uncertain etiology, to avoid misdiagnosis of rectal cancer. Definitive diagnosis necessitates immunohistochemical analysis. We present an unusual case of spindle cell neoplasm of rectum in an asymptomatic elderly gentleman, detected on screening colonoscopy. Following thorough evaluation with MRI pelvis, CT scan thorax, abdomen, pelvis with contrast and multidisciplinary meeting discussion (MDT) at our institution, he was successfully treated with a specialized minimally invasive approach (TAMIS). Histopathology with immunohistochemistry confirmed the diagnosis of spindle cell neoplasm. As they are uncommon in colorectum & non-invasive, management and long-term follow-up is still under study. These lesions should be differentiated from other stromal tumours in GIT.
This document summarizes a study on the relationship between socio-demographic characteristics and the prevalence of brucellosis among community members in Mandera East Sub-County, Kenya. Blood samples from 420 respondents were tested for brucellosis using the Rose Bengal Plate Test (RBPT) and Serum Slow Agglutination Test (SSAT). The RBPT indicated a prevalence of 24.8% while the SSAT, a confirmatory test, indicated a prevalence of 14.3%. The study found the seroprevalence was higher among males (98% by RBPT and 98% by SSAT) and there was a significant relationship between gender and seroprevalence. Socio-demographic data
The Matrix metalloproteinase-9 is involved in several pathologies. Its strong presence in ocular pathologies explains our interest for its genetic variation in cataract, glaucoma and retinoblastoma in Senegal. MMP9 is highly polymorphic with cataract and glaucoma. 77 mutations were noted with 21 haplotypes for the entire population. The haplotype diversity Hd is 0.831 and the nucleotide diversity Pi is 0.016; k = 17.395. The polymorphism of the Matrix metalloproteinase-9 gene is associated with all three diseases and SNP 3918249 is found in both cataract and glaucoma.
This paper proposes the development of a software that performs the pre-diagnosis of malignant melanoma, spincellular carcinoma and basal-cell carcinoma. The software is divided into five modules, these being: digital imaging, analysis and processing, storage, feature extraction and classification by means of an Artificial Neural Network (ANN). The results shown the performance of the software for two different combination of activation functions in the network. With the use of spectroscopic techniques for the acquisition of images and the combination of non-linear and linear activation functions in the ANN, the software shows an effectiveness greater than 80%, concluding that it can be an effective tool as an aid in the diagnosis of cancer of skin.
Background: Tuberculous meningitis is defined as an inflammatory response to mycobacterial bacterial infection of the pia, arachnoid and CSF of the subarachnoid space. It is a dangerous form of extrapulmonary tuberculosis because it can cause permanent neurological disabilities and even death. Stroke is a devastating complication which further increase the morbidity and mortality in the disease. Matrix metalloproteinases are endopeptidases which degrade all the components of the extracellular matrix and thus have potential to disrupt blood brain barrier and cause CNS damage. Matrix metalloproteinases have been associated with pathophysiology of ischemic stroke. MMP levels in serum and CSF have also been seen to rise with advancing stage of TBM. So it is postulated that MMP may have role in the pathophysiology of stroke in TBM and may serve as a biomarker to predict stroke in TBM. Aims: To compare Serum Matrix metalloproteinase-9 in patients with Tuberculous Meningitis with and without Stroke and correlate it with various clinical, biochemical and radiological features of TBM. Methods: 40 Patients of probable or definite TBM and 40 age and sex matched patients of TBM with clinical stroke were enrolled in the study and formed two groups i.e. cases and controls. The two groups were compared for various clinical parameters, biochemical parameters (CSF cytology, glucose and protein), neuroimaging parameters and serum MMP-9 levels. Serum MMP-9 was estimated by ELISA method. Results: Serum MMP-9 levels were (224 ± 261.627 ng/ml) in cases and (157.23 ± 197.155 ng/ml) controls, which though higher in cases but no difference was statistically significant (p value 0.157) between two groups. Also there was no correlation between the serum MMP-9 levels and various clinical features (duration of illness, fever, headache, vomiting, weight loss, seizure, hemiparesis), CSF characteristics (protein, sugar and cytology) and radiological findings (tuberculoma, and hydrocephalus). Conclusion: we conclude that MMP-9 levels is not correlated with occurrence of stroke in TBM. MMP-9 levels were not increased with severity of disease, complications and outcomes.
This study aimed to determine factors influencing postnatal monitoring in the Bafang Health District of Cameroon. The study found that women who were informed of postnatal appointment dates by midwives, those who believed the appropriate period for follow-up was 6 weeks postpartum, and those who massaged their abdomen after childbirth were more likely to have knowledge of postnatal follow-up. In contrast, women with no knowledge of the appropriate periods for postnatal consultations were less likely to have knowledge. The study concluded that lack of knowledge about postnatal consultations and traditional practices are factors influencing postnatal follow-up in the district, and increased awareness campaigns are needed.
Aim: To highlight the challenge in the management of Arginosuccinic acidemia as well as demonstrate the importance of newborn screening for inborn errors of metabolism. Method: Report of two cases of neonatal onset ASA with encephalopathy and review of relevant literature. Conclusion: Early diagnosis and institution of appropriate intervention can significantly improve outcome. Routine newborn metabolic screening should not only be implemented universally, the result should be available promptly.
To form the basis of a respiratory disease model in rats by investigating the microbial distribution and composition in the lower respiratory tracts of normal rats. Methods: DNA was extracted from the intestine, trachea, bronchus and lung samples collected from healthy rats under sterile conditions. The 16S rDNA V4-V5 region was sequenced using Illumina high-throughput technology. Results: The sequencing results showed that there was no significant difference in abundance and species diversity of microbiota between the lower respiratory and the intestine. The microbiota structure analysis showed samples from lungs and intestinal shared similarity. However, the dominant species at the levels of phylum, family, and genus diverged. The similarity analysis showed that the lung microbiota were different from the intestines. The linear discriminant analysis showed significantly different species in different tissues; function prediction also showed different microbiota function in different tissues. Conclusions: These results suggest that bacterial colonization depends on the sample’s anatomical location. The human pathogen Acinetobacter lwoffii was also detected in the rat lower respiratory tract samples.
“Psychiatry and the Humanities”: An Innovative Course at the University of Mo...Université de Montréal
“Psychiatry and the Humanities”: An Innovative Course at the University of Montreal Expanding the medical model to embrace the humanities. Link: https://www.psychiatrictimes.com/view/-psychiatry-and-the-humanities-an-innovative-course-at-the-university-of-montreal
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
DECLARATION OF HELSINKI - History and principlesanaghabharat01
This SlideShare presentation provides a comprehensive overview of the Declaration of Helsinki, a foundational document outlining ethical guidelines for conducting medical research involving human subjects.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Summer is a time for fun in the sun, but the heat and humidity can also wreak havoc on your skin. From itchy rashes to unwanted pigmentation, several skin conditions become more prevalent during these warmer months.
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
How to Control Your Asthma Tips by gokuldas hospital.Gokuldas Hospital
Respiratory issues like asthma are the most sensitive issue that is affecting millions worldwide. It hampers the daily activities leaving the body tired and breathless.
The key to a good grip on asthma is proper knowledge and management strategies. Understanding the patient-specific symptoms and carving out an effective treatment likewise is the best way to keep asthma under control.
NAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdfRahul Sen
Time-lapse embryo monitoring is an advanced imaging technique used in IVF to continuously observe embryo development. It captures high-resolution images at regular intervals, allowing embryologists to select the most viable embryos for transfer based on detailed growth patterns. This technology enhances embryo selection, potentially increasing pregnancy success rates.
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
Are you looking for a long-lasting solution to your missing tooth?
Dental implants are the most common type of method for replacing the missing tooth. Unlike dentures or bridges, implants are surgically placed in the jawbone. In layman’s terms, a dental implant is similar to the natural root of the tooth. It offers a stable foundation for the artificial tooth giving it the look, feel, and function similar to the natural tooth.
Co-Chairs, Val J. Lowe, MD, and Cyrus A. Raji, MD, PhD, prepared useful Practice Aids pertaining to Alzheimer’s disease for this CME/AAPA activity titled “Alzheimer’s Disease Case Conference: Gearing Up for the Expanding Role of Neuroradiology in Diagnosis and Treatment.” For the full presentation, downloadable Practice Aids, and complete CME/AAPA information, and to apply for credit, please visit us at https://bit.ly/3PvVY25. CME/AAPA credit will be available until June 28, 2025.
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
Nano-gold for Cancer Therapy chemistry investigatory project
Fatal Bilateral Strokes in a Child With Hemolytic Uremic Syndrome- A Potential Therapeutic Role of Eculizumab
1. International Journal of Healthcare and Medical Sciences
ISSN(e): 2414-2999, ISSN(p): 2415-5233
Vol. 4, Issue. 4, pp: 49-53, 2018
URL: http://arpgweb.com/?ic=journal&journal=13&info=aims
Academic Research Publishing
Group
*Corresponding Author
49
Original Research Open Access
Fatal Bilateral Strokes in a Child With Hemolytic Uremic Syndrome- A Potential
Therapeutic Role of Eculizumab
Geetanjali S. Rathore M. D.*
Assistant Professor, University of Nebraska Medical Center Department of Pediatrics, Neurology 982163 Nebraska Medical Center Omaha,
Nebraska
Paul D. Larsen M. D.
Professor and Section Chief University of Nebraska Medical Center Department of Pediatrics, Neurology 982163 Nebraska Medical Center
Omaha, Nebraska
Abstract
Background: HUS is a life-threatening multisystem disease caused by uncontrolled complement activation. About 25
% of patients have CNS (Central nervous system) involvement, often leading to serious long-term disabilities in
young children. Eculizumab, a humanized monoclonal antibody that targets the complement protein C5, has shown
to improve the disease course in children with better neurological outcomes. Early use in disease course showed
much better results and its potential use as a prophylactic therapy has been indicated. Scoring systems have been
developed for prediction of CNS complications, which may help identify potential candidates for prophylactic
Eculizumab therapy. Presentation: We present a 3 year old child who presented with Shiga-Toxin Producing E coli
Hemolytic-Uremic Syndrome (STEC-HUS) and seizures. One week into hospitalization he suddenly became
unresponsive besides withdrawal to pain. Brain MRI revealed multifocal infarcts involving bilateral basal ganglia,
thalami, dorsal brainstem, and cerebellar white matter with microhemorrhages. He was started on Eculizumab in an
attempt to halt neurological decline. In spite of starting Eculizumab therapy, our patient succumbed to a fatal cardiac
arrest. Based on the SCWP ( sodium, CSR, white count and protein) scoring system our patient was at very high risk
for developing neurological sequelae even at initial presentation. His therapy was not started until very late in the
course of the disease which may have led to the unfavorable outcome Conclusion: Ecluzimab therapy should be
initiated early in HUS patients with CNS involvement. Scoring systems may help identify at risk patients and
potentially start prophylactic Eculizumab therapy to achieve improved neurological outcomes in children.
Keywords: Thalamic stroke; Eculizumab; HUS; Microangiopathy; E.coli 0157:H7.
CC BY: Creative Commons Attribution License 4.0
1. Introduction
Hemolytic uremic syndrome (HUS) is a multisystem disease mostly affecting children less than 5 years [1].
HUS primarily manifests as a clinical triad of renal failure, thrombocytopenia and hemolytic anemia [2]. It is caused
by Escherichia coli serotype O157:H7 in majority of cases [3]. Shiga toxin, produced by this bacteria, leads to
endothelial damage followed by activation of complement cascade which causes thrombotic microangiopathy mostly
in the kidney [3]. Neurological involvement is the most common extra-renal manifestation with almost 50% of the
patients with HUS [2]. It may manifest as altered mental status, seizures, cortical blindness, hemiparesis or other
focal neurological deficit. Neurological symptoms may be multifactorial secondary to hyponatremia, hypertension or
cerebral microangiopathy [1]. CNS (central nervous system) involvement is associated with high morbidity and
mortality [2]. Brain magnetic resonance imaging (MRI) typically show acute involvement of basal ganglia and
thalamus or the supratentorial white matter [1]. Early initiation of eculizumab therapy in patients with HUS and CNS
involvement, has shown to improve neurological outcomes [2, 3]. We present a 3 year old patient who had a severe
presentation of typical HUS with bilateral thalamic infarcts. He received one dose of eculizumab, later in the course
of disease, but succumbed to a fatal cardiac arrest.
2. Case Presentation
A three year old unimmunized boy presented to his local ED with two day history of fever and bloody diarrhea.
On initial evaluation he appeared lethargic and was hypoxemic, so got transferred to our pediatric ICU for further
management. On admission his sodium was 126, BUN 65, creatinine 2.6, protein 5.3, albumin 1.9, WBC 31,
platelets 74, CRP 19. As he lived on a cattle ranch and family did consumed unprocessed food his stool was tested
for E.Coli. His stool tested positive for Shiga toxin producing E.coli (STEC). ADAMTS 13 activity (ADAM
metallopeptidase with thrombospondin type 1 motif 13) was normal, C3 and C4 levels were normal. He was
diagnosed with Diarrhea + Hemolytic uremic syndrome (HUS) and started on hemodialysis with transition to
continuous renal replacement therapy (CRRT). Within the next 24 hours he had a generalized tonic clonic seizure.
CT head was normal, EEG just showed diffuse slowing with no epileptiform discharges but sodium had dropped
further to 123. He was started on 3% saline with gradual increase in serum sodium. He was also started on
levetiracetam following 2 more brief seizures. He continued to remain febrile and his WBC rose from 31 on
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50
admission to 66. He was started on prophylactic antibiotics for possible sepsis. Over the next few days he had no
more seizures but was agitated. On 7th
day of admission he had acute change in mental status where he became
unresponsive to painful stimuli, tachypneic and tachycardic. Brainstem reflexes were intact and no focal deficits
were noted. A STAT brain MRI showed multifocal infarcts involving bilateral basal ganglia, thalami, dorsal
brainstem, and cerebellar white matter with microhemorrhage (Figure 1,2). With these findings he was started on
Eculizumab therapy to try to slow down disease progression and improve neurological status. His respiratory and
cardiac status continued to decline over the next 48 hours. His echocardiogram did not show any significant cardiac
dysfunction. On day 9 he had a cardiac arrest and could not be resuscitated.
3. Discussion
Hemolytic uremic syndrome (HUS) is defined by the presence of microangiopathic hemolytic anemia,
thrombocytopenia, and acute renal failure. Shiga toxin-producing Escherichia coli O -157 is a major cause of HUS
and most commonly affects young children less than 5 years old [1]. Neurological complications affect 20 –50% of
patients and often imply a poor prognosis with increased mortality and morbidity [4]. Shiga toxin starts a pathogenic
cascade leading to thrombotic microangiopathy (TMA) in the kidney. The pathophysiology of neurological
involvement in HUS is thought to be multi-factorial. Cerebral TMA which was thought to play a key role, was found
only in a minority of HUS patients on autopsy [5]. A multi-faceted pathology was also supported by animal studies,
where cerebral TMA was absent in animals with HUS and neurological complications [6]. Shiga toxin acting
directly on the endothelial and neuronal cells, in combination with electrolyte imbalance, uremia and hypertension,
have been proposed as integral mechanisms for neurological involvement during HUS. [2].
CNS involvement mostly manifests as stupor/coma, seizures, hemiparesis, visual disturbances or other focal
neurological deficits [2]. Our patient initially had some decreased alertness, this could have been the first sign of
neurological involvement, however was attributed to dehydration and electrolyte abnormality. His seizure was also
thought to be provoked from hyponatremia as his CT head showed no signs of abnormality and EEG was not
epileptiform. EEG recordings in patients with HUS have mostly shown non-specific diffuse slowing of background,
only rarely showing epileptiform abnormalities. Majority of patients have normalization of EEG by 6 months with
about 20% still showing nonspecific slowing even in absence of any clinical symptoms. Status epilepticus including
non-convulsive status was not detected in any patient [2]. Patients with neurological involvement may show
variable MRI pattern, T2 and DWI hyperintensities in the basal ganglia, thalamus and extending into the white
matter [1]. Parieto occipital white matter T2 hyperintensities, extending into the white matter and cortical watershed
cerebral area is seen in reversible posterior leukoencephalopathy (PRES). T1 hyperintense lesions may represent
regions of hemorrhagic conversion or coagulative necrosis secondary to microthrombi [7]. Our patient showed a
similar radiological picture with bilateral thalamic and basal ganglia diffusion restriction and micro-hemorrhagic
changes. He did not have evidence of PRES on initial CT or the later MRI.
Yamamoto, et al. [8] looked at risk factors to predict neurological involvement in patients with typical HUS.
They found that high WBC and CRP at presentation in addition to lower sodium and serum protein, indicated higher
risk for neurological involvement [4]. A scoring system – SCWP (sodium CRP, WBC and protein) score has also
been developed to predict CNS involvement in a patient presenting with HUS. Typical HUS patients with
neurological complications were noted to have higher SCWP scores as compared to those without. [4] The scoring
system is not widely used in clinical practice yet and was not implemented in our patient. However, in retrospect, our
patient presented with a very low sodium, high CRP, very high WBC and low protein level. If the scoring had been
used it would correctly identify our patient at high risk for neurological involvement.
Treatment of HUS is mostly supportive with no proven treatment for neurological complications. Correcting
electrolytes, dialysis, preventing hypertension and early correction of fluid deficit are the mainstay of therapy [9]. A
large double blind randomized control study of 120 patients with HUS showed no significant benefit of
corticosteroids vs placebo in preventing renal, neurological, or hematological complications [10]. One prospective
study of 12 patients showed good outcomes with intravenous IgG in patients with neurological involvement. All 12
patients survived, with all but two, having complete neurological and renal recovery. [11]. Most studies have failed
to demonstrate improvement in outcomes with plasmapheresis in typical HUS [12]. A small study with 5 patients did
show benefits of early plasma exchange in five adults with HUS and neurological involvement. [13]. The difference
in response can also be due to timing of initiation of therapy (early in the latter study) and severity of illness (sicker
patients in the prior studies). The failure to demonstrate presence of autoantibodies in HUS, make plasmapheresis
and immunoadsorptive therapy experimental/hypothetical. [11].
Eculizumab is a humanized monoclonal antibody that binds to the terminal compliment C5 and inhibits
activation of complement cascade. Its use is well established to benefit in atypical HUS, which differs from typical
diarrheal associated HUS, due to abnormalities in the complement regulating system as the underlying
pathophysiology [3]. The pathophysiology of neurological involvement in HUS is multifactorial and the literature
supporting its use was limited to isolated case reports [14]. Pape et. al in their recent case series [3] demonstrated
the early use of Eculizumab to be associated with good neurological outcome in patients with typical HUS.
Eculizumab is proposed to prevent the hyperactivation of compliment system seen in typical HUS and henceforth
prevent complement mediated cerebral thrombotic microangiopathy [3, 15]. This study also proposed a potential role
of prophylactic use of eculizimab in patients with rapidly progressive HUS to prevent long term neurological
sequelae.
Our patient’s clinical status worsened in spite of getting started on supportive therapy early in course of disease.
Eculizumab use was discussed when patient had his first seizure. As there is no clear consensus for its use in typical
3. International Journal of Healthcare and Medical Sciences
51
HUS and there was concern for sepsis in our unimmunized patient with escalating white count, Eculizumab was not
given early on. With worsening of his neurological condition and MRI changes, Eculizumab and plasma exchange
were discussed as potential interventions again. Plasma exchange does not have strong evidence to improve outcome
in typical HUS patients and would have added risk of bleeding and cardiac decompensation. Looking at his overall
picture we decided to immunize patient against encapsulated organisms and start Eculizumab therapy.
Unfortunately, our patient did not have a good outcome. This may have been due to severity of disease, delay in
starting immunomodulating therapy or cardiac involvement, even though Echocardiogram did not show significant
cardiac changes.
In conclusion, HUS is a serious condition with potential life-threatening CNS involvement. Changes in the basal
ganglia and thalamus are commonly seen on imaging. In addition to supportive measures, early use of Eculizumab
can play a potential therapeutic role in preventing cerebral thrombotic microangiopathy, leading to better
neurological outcomes. Use of predictive risk factors or scores may even help select patients who would benefit from
prophylactic Eculizumab therapy. Randomized controlled studies in the future are needed to help establish this.
4. Abbreviations
HUS- hemolytic uremic syndrome
CNS- central nervous system
STEC- HUS- Shiga-Toxin Producing E coli Hemolytic-Uremic Syndrome
MRI- magnetic resonance imaging
ICU- intensive care unit
BUN- blood urea nitrogen
CRP- C-reactive protein
WBC- white blood cell
CRRT- continuous renal replacement therapy
TMA- thromobotic microangiopathy
CT- computerized tomography
EEG- electroencephalogram
DWI- diffusion weighted imaging
PRES- posterior reversible encephalopathy syndrome
Illustrations
Figure-1. axial DWI image showing diffusion restriction from bilateral acute basal ganglia strokes
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Figure-2. axial FLAIR images showing bilateral basal ganglia hyperintensity representing ischemic injury
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