Full story brain herniation imaging Dr Ahmed Esawy
include different cases for oral radiodiagnosis examination all over the world
CT /MRI Plain X ray images
I Supratentorial herniation
1-Cingulate (subfalcine/transfalcine)
2-Uncal (descending transtentorial herniation DTH)
3-Central (bilateral DTH)
4-Transcalvarial
5-Tectal (posterior)
II-Infratentorial herniation
1-Upward
(upward cerebellar or upward transtentorial)
2-Tonsillar (downward cerebellar
III-Sphenoid/alar herniation Transalar Herniation
Summary and illustrations of various traumatic brain injury including primary and secondary lesions as well as limited information on indications of brain imaging in trauma
Liliequist membrane may be understood as a projection formed by an arachnoid membrane extending from the dorsum sellae to the mammillary bodies coined after Liliequist (1956). It has surgical importance in Endoscopic third ventriculostomy and cisternostomy.
This presentation provides a comprehensive review of major sulci of brain which help in defining the different lobes of brain.Very useful for first year residents.
Anatomy of Brain by MRI
In this presentation we will discuss the cross sectional anatomy of brain. Then we will discuss the Most common diseases to be evaluated by brain imaging.
In my opinion this presentation is a road map for beginars.
Linear lung density x ray Dr Ahmed EsawyAHMED ESAWY
Linear lung density x ray dr ahmed esawy
include different cases for oral radiodiagnosis examination all over the world
Linear lung markings
CT /MRI Plain X ray images
1-Kerley’s lines
2-Plate atelectasis ( Fleischner Lines) etc
3-Pulmonary infarcts
4-Thickened fissures
5-Pulmonary / pleural scars
6-Bronchial wall thickening
7-Sentinel lines
8-Anamolous vessels
9-Artefacts
10-Curvilinear shadows (Bullae/Pneumatocoele /Bronchoceles)
“Don’t touch” lesions new version Dr Ahmed EsawyAHMED ESAWY
“Don’t touch” lesions new version dr ahmed esawy
CALCANEAL PSEUDOCYST
INTRAOSSEOUS LIPOMA
BIPARTITE PATELLA
MYOSITIS OSSIFICANS
AVULSION INJURY
CORTICAL DESMIOD
GEODES
DORSAL DEFECT OF THE PATELLA
PSEUDOCYST OF THE HUMURUS
OS ODONTOIDEUM
NON OSSIFYING FIBROMA
BONE ISLANDS
UNICAMERAL BONY CYST
EARLY BONE INFARCT
MELORHEOSTOSIS
HYPERTROPHIC PULMONARY OSTEOARTHROPATHY
ACHONDROPLASIA
AVASCULAR NECROSIS
HURLER SYNDROME
TRANSIENT OSTEOPOROSIS OF THE HIP
DIAPHYSEAL ACLASIA
MULTIPLE HEREDITARY EXOSTOSIS
OSTEOID OSTEOMA
OSTEPATHIA STRIATA
OSTEOPIKILOSIS
SARCIOD
OS STYLOIDEUM
OS TRIGONUM
Summary and illustrations of various traumatic brain injury including primary and secondary lesions as well as limited information on indications of brain imaging in trauma
Liliequist membrane may be understood as a projection formed by an arachnoid membrane extending from the dorsum sellae to the mammillary bodies coined after Liliequist (1956). It has surgical importance in Endoscopic third ventriculostomy and cisternostomy.
This presentation provides a comprehensive review of major sulci of brain which help in defining the different lobes of brain.Very useful for first year residents.
Anatomy of Brain by MRI
In this presentation we will discuss the cross sectional anatomy of brain. Then we will discuss the Most common diseases to be evaluated by brain imaging.
In my opinion this presentation is a road map for beginars.
Linear lung density x ray Dr Ahmed EsawyAHMED ESAWY
Linear lung density x ray dr ahmed esawy
include different cases for oral radiodiagnosis examination all over the world
Linear lung markings
CT /MRI Plain X ray images
1-Kerley’s lines
2-Plate atelectasis ( Fleischner Lines) etc
3-Pulmonary infarcts
4-Thickened fissures
5-Pulmonary / pleural scars
6-Bronchial wall thickening
7-Sentinel lines
8-Anamolous vessels
9-Artefacts
10-Curvilinear shadows (Bullae/Pneumatocoele /Bronchoceles)
“Don’t touch” lesions new version Dr Ahmed EsawyAHMED ESAWY
“Don’t touch” lesions new version dr ahmed esawy
CALCANEAL PSEUDOCYST
INTRAOSSEOUS LIPOMA
BIPARTITE PATELLA
MYOSITIS OSSIFICANS
AVULSION INJURY
CORTICAL DESMIOD
GEODES
DORSAL DEFECT OF THE PATELLA
PSEUDOCYST OF THE HUMURUS
OS ODONTOIDEUM
NON OSSIFYING FIBROMA
BONE ISLANDS
UNICAMERAL BONY CYST
EARLY BONE INFARCT
MELORHEOSTOSIS
HYPERTROPHIC PULMONARY OSTEOARTHROPATHY
ACHONDROPLASIA
AVASCULAR NECROSIS
HURLER SYNDROME
TRANSIENT OSTEOPOROSIS OF THE HIP
DIAPHYSEAL ACLASIA
MULTIPLE HEREDITARY EXOSTOSIS
OSTEOID OSTEOMA
OSTEPATHIA STRIATA
OSTEOPIKILOSIS
SARCIOD
OS STYLOIDEUM
OS TRIGONUM
MRI TMJ temporo mandibular jiont Dr Ahmed EsawyAHMED ESAWY
Mri tmj temporo mandibular jiont dr ahmed esawy
include different cases for oral radiodiagnosis examination all over the world
CT /MRI Plain X ray images
Temporomandibular Disk
Disk Evaluation
Retrodiskal layers
Temporomandibular Joint Disk Position Assessed at Coronal MR Imaging
According to the degree of anterior disk displacment (ADD) our series was classified into 4 categories
Category 0 (Normal disc position)
Category I (Partial anterior disc displacement with reduction (PADDWR))
Category II (Partial anterior disc displacement without reduction (PADDWOR))
Category III (Complete anterior disc displacement with reduction (CADDWR))
Category IV (Complete anterior disc displacement without reduction (CADDWOR))
Disk Displacement
May be uni- or multidirectional
Unidirectional anterior and multidirectional anterolateral and anteromedial displacements are the most common type
Unidirectional transverse and posterior displacements are rare
Partial anterior disk displacement
Unidirectional complete anterior disk displacement
Posterior disc displacement
Disk Deformity
Lateral disc displacement
Recapture of Displaced Disk
LABRUM
pseudomeniscus sign,"
Degenerative (Osteoarthritis)
34 Dr Ahmed Esawy imaging oral board of breast imaging part II (magnetic reso...AHMED ESAWY
34 dr ahmed esawy imaging oral board of breast imaging part ii (magnetic resonance mammography ,breast implants)
include different cases for oral radiodiagnosis examination all over the world
MAMMOGRAPHY
MAGNETIC RESONANCE MAMMOGRAPHY
BREAST ULTRASOUND
CT /MRI Plain X ray images
BREAST IMPLANTS RUPTURE
BREAST SILICON IMPLANT
* Case presentation: hyperosmolar hyperglycemic state (HHS)
Mortality attributed to hyperosmolar hyperglycemic state (HHS) is considerably higher than that attributed to DKA, with recent mortality rates of 5–20%.
* Agenda:
Historical perspectives and diagnosis.
Pathophysiology.
Treatment issues.
Rhabdomyolysis: an overlooked complication.
Final bottom line and take home message.
The blood supply to the central nervous system (CNS), including the brain and spinal cord, is crucial for maintaining the metabolic needs of neural tissues.
Neurosurgical interventions related to the blood supply of the CNS are often aimed at addressing vascular abnormalities, preventing strokes, and managing conditions affecting blood vessels in the brain.
Cavernous Sinus Thrombosis.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Neurosurgery involving the ventricular system requires a precise understanding of neuroanatomy, advanced imaging, and surgical techniques. Surgeons aim to address the underlying pathology while maintaining or restoring normal CSF dynamics to promote optimal brain function and minimize complications.
Comparison between ct mri in ischemic stroke AHMED ESAWY
Comparison between ct MRI in ischemic stroke .1-Definition
2-Pathology
3-Vascular territory
4-Staging
5-hemorrhagic transformation of the infarct
Difference between simple hemorrhage and hemorrhagic neoplasm
difference between Hemorrhagic infarct and primary intracerebral hemorrhage
6-Comparison between CT/MRI
7-CTA, MRA
8-Fogging
9-Pseudonormalization
10-Protocol
11-Differential diagnosis
12-home message
All thing breast ultrasound breast mammography part 3AHMED ESAWY
All thing breast ultrasound breast mammography part 3
Breast mammogram ultrasound lipoma ,oil cyst ,galactocele intramammary lymph node in UOQ hamartoma Simple cyst (typical) calcification Surgical scar Breast implants, scirrhuc carcinoma lobular carcinoma Skin calcifications vascular calcifications Sutural Dystrophic popcorn Large Rod like rim Round/punctuate Fat necrosis Milk of calcium Fibrocystic FCC fibroadenosis Fat necrosis with oil cyst mastitis with Abscess Haematoma atypical ductal hyperplasia Intracystic papilloma ductal carcinoma in situ ,invasive ductal carcinoma BIRAD
All thing breast ultrasound breast mammography part 1AHMED ESAWY
All thing breast ultrasound breast mammography part 1
Breast mammogram ultrasound lipoma ,oil cyst ,galactocele intramammary lymph node in UOQ hamartoma Simple cyst (typical) calcification Surgical scar Breast implants, scirrhuc carcinoma lobular carcinoma Skin calcifications vascular calcifications Sutural Dystrophic popcorn Large Rod like rim Round/punctuate Fat necrosis Milk of calcium Fibrocystic FCC fibroadenosis Fat necrosis with oil cyst mastitis with Abscess Haematoma atypical ductal hyperplasia Intracystic papilloma ductal carcinoma in situ ,invasive ductal carcinoma BIRAD
Update secrets in plain x ray abdomen gases ,air fluid level .AHMED ESAWY
plain x-ray abdomen gas normal air fluid level in-the-abdomen gasless abdomen small bowel obstruction large intestinal obstruction ileus gastric dilatation extraluminal abdomen gas (pneumonpperitoneum) extraluminal abdomen gas(retropneumonpperitoneum gas in specific organs (hepatobiliary ,genitourinary) gasless abdomen ‘step-ladder apperance stretch/slit sign string of pearls sign coiled spring sign small-bowel feces sign disproportionate dilatation of sb gallstone ileus intussusception caecal volvulus sigmoid volvulus colonic pseudo obstruction ogilvie syndrome acute colitis toxic megacolon ischemic colitis sentinel loops intestinal pseudo-obstruction syndromes gastric volvulus organoaxial gastric volvulus mesenterico-axial right upper quadrant gas crescent sign: air beneath the diaphragm peri hepatic sub hepatic morrison’s pouch fissure for ligament teres doges cap sign rigler’s (double wall sign) ( both the serosal and the related mucosal walls of the bowel are delineated it means free air is at that serosal surface ) ligament visualization falciform ligament sign: air delineating the falciform ligament umbilical inverted ‘v’ sign triangular air cupola sign football sign or air dome (a large air collection beneath that does not confirm to any bowel loop) continous diaphragm sign scrotal air in children decubitus abdomen sign double bubble sign lesser sac sign peritonitis postoperative pelvic and spinal fractures
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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
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.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
2. CLASSIFICATION BRAIN HERNAITION
I Supratentorial herniation
1-Cingulate (subfalcine/transfalcine)
2-Uncal (descending transtentorial herniation DTH)
3-Central (bilateral DTH)
4-Transcalvarial
5-Tectal (posterior)
II-Infratentorial herniation
1-Upward
(upward cerebellar or upward transtentorial)
2-Tonsillar (downward cerebellar
III-Sphenoid/alar herniation Transalar Herniation
Dr Ahmed Esawy
3. Brain herniation
A brain herniation is when brain tissue, cerebrospinal fluid, and blood vessels are moved or
pressed away from their usual position inside the skull.
Causes
Brain herniation occurs when something inside the skull produces pressure that moves brain
tissues. This is most often the result of brain swelling from a
•head injury, stroke
•or brain tumor.
Brain herniation can be a side effect of tumors in the brain, including:
Metastatic brain tumor
Primary brain tumour (brain tumours,meningioma,base of skull tumours,
suprasellar tumours
Herniation of the brain can also be caused by other factors that lead to increased pressure
inside the skull, including:
•Abscess
•Hemorrhage (intracerebral ,subdural ,extradual)
•Hydrocephalus
•Strokes that cause brain swelling
•Swelling after radiation therapy
Dr Ahmed Esawy
4. Pathology of Increased Intracranial Pressure
Increased intracranial pressure (ICP): - if > 40
mm Hg cerebral hypoxia, cerebral ischemia,
cerebral edema, hydrocephalus, and brain
herniation.
Cerebral edema: Edema - Disruption of the blood
brain barrier – vasodilatation – swelling.
Hydrocephalus communicating type common
inTotal Body Irradiation.
Dr Ahmed Esawy
8. Cingulate herniation
(subfalcine/transfalcine)
Subfalcine herniation on CT
In cingulate or subfalcine herniation, the most common type, the
innermost part of the frontal lobe is scraped under part of the falx cerebri,
the dura mater at the top of the head between the two hemispheres of the
brain
Cingulate herniation can be caused when one hemisphere swells and pushes
the cingulate gyrus by the falx cerebri
cingulate herniation may present with abnormal posturing and coma
Dr Ahmed Esawy
9. the cingulate gyrus lies on the medial aspect
of the cerebral hemisphere. It forms a major
part of the limbic system which has functions
in emotion and behaviour.The frontal
portion is termed the anterior cingulate gyrus
(or cortex)
Dr Ahmed Esawy
10. Subfalcine herniation
most common
•supratentorial mass in one hemicranium
•affected hemisphere pushes across the midline under the inferior "free" margin
of the falx, extending into the contralateral hemicranium
Subfalcine herniation: imaging
Axial and coronal images show that
•cingulate gyrus
•anterior cerebral artery (ACA)
•internal cerebral vein (ICV)
are pushed from one side to the other under the falx cerebri.
The ipsilateral ventricle appears compressed and displaced across the midline
Dr Ahmed Esawy
11. Subfalcine herniation
Complications
• unilateral obstructive hydrocephalus
–foramen of Monro occlusion
•Periventricular hypodensity with "blurred" margins of the lateral ventricle
–Fluid accumulates in the periventricular white matter
•When severe, the herniating ACA can be pinned against the inferior "free" margin of
the falx cerebri
• secondary infarction of the cingulate gyrus
Dr Ahmed Esawy
14. acute on chronic subdural hematoma.
Subfalcine herniation, midline shift, effacement of the ipsilateral lateral ventricle, and
enlargement of the contralateral occipital horn are present.
Dr Ahmed Esawy
15. Coronal contrast-enhancedTi-weighted image of patient with metastatic breast cancer.
Coronal MR imaging accurately shows ipsilateral cingulate gyrus (asterisk) displaced
beneath falx with depression of corpus callosum.There is compression of contralateral
cingulate gyrus (straight arrow) and corpus callosum. Pencailosal artery (curved arrow) is
displaced beneath falx. Lateral and third ventricles are also displaced.
subfaicine herniation.
Dr Ahmed Esawy
16. Degrees of subfalcine herniation.
A, Axial CT scan of right parietal posttraumatic hemorrhage and subdural hematoma
(arrowheads). some compression of right lateral ventricle is present, with shift to left asso-
ciated with mild deviation of anterior faix (arrow).
B, Axial CT scan of massive right infarct. Right lateral ventricle is compressed and markedly
displaced to opposite side. Note that posterior falx remains non displaced despite massive
shift including anterior faix (arrow) Dr Ahmed Esawy
17. Paradoxical herniation
The postoperative CT image shows evidence of
left craniectomy with a small amount of
residual subdural fluid collection and blood.
A repeat CT image upon returning after 4
months shows resolution of the subdural fluid
collection and blood
after 4 months there is interval demonstration of concave deformity of the left cerebral
hemisphere together with the overlying skin flap, with associated distortion of the left
ventricle and a new left subfalcine paradoxical herniationDr Ahmed Esawy
18. the tentorium is a structure within
the skull formed by the dura mater of the
meninges
Transtentorial herniation can occur when
the brain moves either up or down across
the tentorium, called ascending and
descending transtentorial herniation
respectively; however descending
herniation is much more common
Dr Ahmed Esawy
21. Uncal herniation
(Descending transtentorial herniations )
In uncal herniation, a common subtype of transtentorial herniation, the
innermost part of the temporal lobe, the uncus, can be squeezed so
much that it moves towards the tentorium and puts pressure on
the brainstem, most notably the midbrain
Dr Ahmed Esawy
22. The uncus is an anterior extremity of
the Parahippocampal gyrus. It is separated
from the apex of the temporal lobe by a slight
fissure called the incisura temporalis.
Dr Ahmed Esawy
25. Parietal lobe
Superior temporal gyrus
Middle temporal gyrus
Pons
Medulla oblongata
Cerebral peduncle
Centrum semiovale
3rd ventricle
Inferior temporal gyrus
Petrous ridge of temporal bone
Parahippocampal gyrus
Dr Ahmed Esawy
26. Pontine cistern
pre-pontine cistern
• Anterior to the pons.Location
• Basilar A.
• AICA.
• Ant. Pontomesencephalic V.
• Cn 5.
• Cn 6.
Contents
Dr Ahmed Esawy
32. Quadrigeminal cistern
vein of Galen cistern
• Posterior to the
quadrigeminal plate,
• Inferior to the splenium of
corpus callosum &
• Superior to the
cerebellum
Location
• Vein of Galen .
• PrecentralV.
• P3 of PCA.
Contents
Dr Ahmed Esawy
38. Uncal herniation
(Descending transtentorial herniations)
the second most common
•a hemispheric mass
•initially produces subfalcine herniation
•As the mass effect increases, the uncus of the temporal lobe is pushed medially
begins to encroach on the suprasellar cistern
hippocampus follows
hippocampus effaces the ipsilateral quadrigeminal cistern
both the uncus and hippocampus herniate inferiorly through the tentorial incisura
Dr Ahmed Esawy
39. Uncal herniation
(Descending transtentorial herniations )
The uncus can squeeze the oculomotor nerve (a.k.a.CN III), which may
affect the parasympathetic input to the eye on the side of the affected
nerve
Compression of the ipsilateral posterior cerebral artery
Duret hemorrhages (tearing of small vessels in the parenchyma) in the
median and paramedian zones of the mesencephalon and pons
The sliding uncus syndrome represents uncal herniation without
alteration in the level of consciousness and other sequelae mentioned
above.
Dr Ahmed Esawy
41. Descending transtentorial herniation
As DTH increases
hippocampus also herniates medially
quadrigeminal cistern compression
midbrain pushed toward the opposite side of the incisura
Descending transtentorial herniation
severe cases
entire suprasellar and quadrigeminal cisterns are effaced.
The temporal horn can even be displaced almost into the midline
Dr Ahmed Esawy
42. Brain herniation.
1, subfalcine; 2, herniation of the uncus and hippocampal gyrus of the temporal lobe
into the tentorial notch, causing pressure on the third nerve and mid-brain; 3,
brainstem caudally; 4, cerebellar tonsils through foramen magnum.
Dr Ahmed Esawy
43. Uncal herniation is when the medial portion of the anterior temporal lobe is shifted into the
suprasellar cistern. It is a subset of descending transtenorial herniation, which is when the
cerebral hemisphere crosses the tentorium at the level of the incisura. It can result in Infarct in
the PCA distribution
Dr Ahmed Esawy
46. A large right frontotemporal subdural hematoma is exerting mass effect on the right
frontal and temporal lobes, with resultant effacement of the suprasellar cistern and with
right-sided uncal herniation.
effaces the ipsilateral temporal horn,
causing dilatation of the contralateral
temporal horn. Subfalcine herniation
and narrowing of the contralateral
ambient and quadrigeminal plate
cisterns are present.
Dr Ahmed Esawy
47. Acute-on-chronic right temporal subdural hematoma exerts mass effect on the right
temporal lobe, causing ipsilateral temporal horn, with effacement and dilatation of the
contralateral temporal horn. Narrowing of the contralateral ambient and quadrigeminal
plate cisterns is present, with ipsilateral widening of the ambient and quadrigeminal
cisterns.
Dr Ahmed Esawy
48. Duret hemorrhage with cerebral herniation. Large left holohemispheric and parafalcine
subdural hematoma (short black arrows, a) results in midline shift (long black arrow, a) and
uncal (long white arrow, b) herniation. Downward brainstem herniation has led to classic
Duret hemorrhage (short white arrow, b) in the paramedian midbrain
Dr Ahmed Esawy
49. descending transtentorial herniation. A-C, Axial diagram (A ), axial CT scan (B), and axialT2-
weighted MR image (C) show components of left unilateral descending transtentorial
herniation (straight arrows). Brainstem is rotated and displaced to opposite side and
caudally, producing widening of ipsilateral ambient cistern (curved arrows). Compression of
neck of contralateral temporal horn results in its dilatation (asterisk
Dr Ahmed Esawy
50. Descending transtentonal herniation. A and B, Coronal diagram (A) and coronalTi-
weighted MR Image (B) show components of left unilateral descending transtentorial
herniation (curved arrows). MR image shows extent of herniation across tentorium and
deviation of brainstem.
Dr Ahmed Esawy
52. bilateral DTH
both hemispheres become swollen
the whole central brain is flattened against the skull base
All the basal cisterns are obliterated
hypothalamus and optic chiasm are crushed against the sella turcica
Dr Ahmed Esawy
53. Central herniation(bilateral DTH)
In central herniation, the diencephalon and parts of the temporal lobes of
both of the cerebral hemispheres are squeezed through a notch in
the tentorium cerebelli.
Radiographically, downward herniation is characterized by obliteration
of the suprasellar cistern from temporal lobe herniation into the
tentorial hiatus with associated compression on the cerebral peduncles.
Upwards herniation, on the other hand, can be radiographically
characterized by obliteration of the quadrigeminal cistern. Intracranial
hypotension syndrome has been known to mimic downwards
transtentorial herniation.
Dr Ahmed Esawy
54. Complete bilateral DTH
both temporal lobes herniate medially into the tentorial hiatus
midbrain and pons displaced inferiorly through the tentorial incisura
The angle between the midbrain and pons
is progressively reduced from 90° to almost 0°
Dr Ahmed Esawy
55. Complete bilateral DTH
Complications
•CN III (oculomotor) nerve compression
–CN III palsy
•PCA occlusion as it passes back up over the medial edge of the tentorium
–secondary PCA (occipital) infarct
Duret hemorrhage
diabetes insipidus due to the compression of the pituitary stalk
Dr Ahmed Esawy
57. BILateral descending transtentorlal herniation. Axial CT scan reveals bilateral
descending transtentorial herniation with obliteration of perimesencephalic
cisterns. Dorsal midbrain is compressed and dongated anteroposteriorly, causing
pear-shaped deformity (asterisk) Dr Ahmed Esawy
58. Nine-year-old boy with diffuse cerebral edema and central herniation secondary to
treatment of DKA Juvenile Diabetic Ketoacidosis
.
A, Axial noncontrast CT scan shows diffuse cerebral edema with effacement of sulci and
basal cisterns.
B, Axial noncontrast CT scan obtained 2 days after A shows marked low-density infarcts in
the gyrus recti and medial orbital gyri (arrows), globus pallidi,
hippocampi/parahippocampal gyri, hypothalamus, midbrain, and posterior right temporal
lobe.
Dr Ahmed Esawy
59. C–D, Axial noncontrastT2-weighted (4000/105/1) (C) and coronal postcontrastT1-weighted
SPGR (14.4/3.7/1) (D) MR images obtained 24 days after A show cavitary infarcts in the gyrus
recti and medial orbital gyri (arrows), medial temporal lobes, midbrain and thalami.
Enhancement is present within the thalamic and midbrain lesions.There is diffuse cerebral
atrophy.
Dr Ahmed Esawy
60. Kernohan notch
•Kernohan notch phenomenon is an imaging finding
resulting from extensive midline shift due to mass effect,
resulting in indentation in the contralateral cerebral crus by
the tentorium cerebelli.This has also been referred to
as Kernohan-Woltman notch phenomenon and false
localising sign.
As the herniating temporal lobe pushes the midbrain
toward the opposite side of the incisura
contralateral cerebral peduncle is forced against the hard
edge of the tentorium
Pressure ischemia ipsilateral hemiplegia
the "false localizing" sign
Dr Ahmed Esawy
72. complications of transtentorial herniation. Midbrain (Duret’s) hemorrhage.
Axial CT scan of patient with head trauma reveals left transtentorial herniation
with deformity of brainstem. Midline hemorrhage is seen within upper pons
(arrow) caused by herniation
Dr Ahmed Esawy
74. Tentorial incisure(also known as the tentorial notch or incisura tentorii) to
the anterior opening between the free edge of the tentorium cerebelli and theclivus for
the passage of the brainstem.
It's located between the tentorial edges and communicates
the supratentorial and infratentorial spaces
Tentorial incisure seen from above
The propensity of tonsillar herniation to
follow descending tentorial herniation is
related to the size and shape of the incisura.
If the incisura is small, the patient will be
less likely to have tonsillar herniation
Dr Ahmed Esawy
75. DownwardTonsillar herniation
In tonsillar herniation, also called downward cerebellar herniation] transforaminal
herniation, or "coning", the cerebellar tonsils move downward through
the foramen magnum possibly causing compression of the lower brainstem and
upper cervical spinal cord
Tonsillar herniation of the cerebellum is also known as a Chiari
malformation (CM),
Cerebellar tonsillar ectopia (CTE) is a term used by radiologists to describe
cerebellar tonsils that are "low lying"
Dr Ahmed Esawy
76. DescendingTonsillar herniation
•The cerebellar tonsils are displaced inferiorly and become impacted into the foramen
magnum.
•congenital (e.g.,Chiari 1 malformation)
– mismatch between size and content of the posterior fossa
•Acquired
–an expanding posterior fossa mass (tumour, haemorrhage,stroke, abscess) pushing
the tonsils downward—more common
–intracranial hypotension: abnormally low intraspinal CSF pressure
tonsils are pulled downward
Diagnosing
tonsillar herniation on NECT scans may be problematic.
Cisterna magna obliteration
Dr Ahmed Esawy
77. life threatening tonsillar herniation exerting mass effect on
the brain parenchyma can displace the posterior cranial
fossa structures inferiorly. In doing so the brainstem is
compressed against the clivus thereby altering the vital life-
sustaining functions of the pons and medulla, such as the
respiratory and cardiac centres.
Non-life threatening tonsillar descent can bee seen in
conditions such as Chiari malformations
Dr Ahmed Esawy
78. SagittalT1-weighted magnetic resonance
image of the brain. Anatomic landmarks
identified include
the fourth ventricle (A),
basion (B),
medulla oblongata (C),
cerebellar tonsil (D),
opisthion (E),
cerebellar hemisphere (F).
Dr Ahmed Esawy
79. he distance is measured by drawing a line from the inner margins foramen magnum
(basion to opisthion), and measuring the inferior most part of the tonsils
As is to be expected, values used vary somewhat from author to author
above foramen magnum: normal
<5 mm: also normal but the term benign
tonsillar ectopia can be used
>5 mm: Chiari 1 malformation
Dr Ahmed Esawy
80. -A, Drawing showing basion (B), opisthion (0), and cerebellar tonsil (T) in a
normal patient. B, Midline sagittal section, SE 500/40, showing line from basion
to opisthion in a nomal patient. Measurements were from this
Dr Ahmed Esawy
81. reference line. Bottoms of tonsils have a normal, rounded appearance and CSF is seen in a
normal cisterna magna.
Dr Ahmed Esawy
82. Coronal SE 700/40 through medulla and tonsils.The lower limits of foramen
magnum are difficult to identify. Coronal scans were not used for this reason.
Dr Ahmed Esawy
83. DescendingTonsillar herniation
MR: much more easily diagnosed
•In the sagittal plane
–the tonsillar folia become vertically oriented
–the inferior aspect of the tonsils becomes pointed
–Tonsils > 5 mm (or 7 mm in children) below the foramen magnum are generally abnormal
especially if they are peg-like or pointed (rather than rounded)
In the axial plane,T2 scans show that the tonsils are impacted into the foramen magnum
–obliterating CSF in the cisterna magna
–displacing the medulla anteriorly
Complications
•obstructive hydrocephalus
•tonsillar necrosis
Dr Ahmed Esawy
85. Normal anatomy of the cerebellum (left). Chiari I malformation (right). With the size of
the posterior fossa too small, the cerebellar tonsils may herniate through the skull into
the spinal canal.The tonsils block the flow of CSF (blue) and may cause fluid buildup
inside the spinal cord, called a syrinx.
Dr Ahmed Esawy
86. A, Midline sagittal SE 500/40 scan in a
symptomatic patient.Tonsils extend 1.1
cm below foramen magnum.Tonsils are
"pointed" and cisterna magna is
obliterated.The latter two findings were
seen in both asymptomatic
symptomatic patients with low tonsils. B,
Midline sagittal SE 500/40 scan after
decompression via suboccipital craniectomy.
Tonsils now have a normal rounded
appearance.
Dr Ahmed Esawy
87. Typical MRI manifestation of brain sagging.MidsagittalT1-weighted MRI shows downward
displacement of the cerebellar tonsil by 5 mm (arrow).
brain sagging, which was
defined as either cerebral
aqueduct displacement ≥1.8
mm or cerebellar tonsil
displacement ≥4.3 mm
subdural haematoma in
patients with spontaneous
intracranial hypotension.
Dr Ahmed Esawy
88. Typical MRI manifestation of the venous distension sign.T1-weighted MRI through the
midportion of the dominant transverse sinus shows the venous distension sign (box)
subdural haematoma in patients
with spontaneous intracranial
hypotension.
Dr Ahmed Esawy
89. An MRI of the brain shows the cerebellar
tonsils (arrow) herniating through the
foramen magnum (yellow line).
Dr Ahmed Esawy
92. With a loss in CSF volume, there is a greater increase in blood volume.This
results in dural venous hyperemia and pachymeningeal venous engorgement
and edema, which can be identified on MR imaging as diffuse
pachymeningeal enhancement.
Furthermore, the decrease in volume of the suspending CSF results in
downward descent of the brain and can cause descending central
transtentorial herniation and tonsillar herniation.
A blood patch or surgical repair of the dural defect is usually required.
Dr Ahmed Esawy
93. Intracranial hypotension. (A) Coronal enhancedT1-weighted MR image demonstrates
diffuse pachymeningeal enhancement (arrows) in a patient with severe postural headaches.
(B) Sagittal enhancedT1-weighted NM image reveals tonsillar herniation (arrow),
descending transtentorial herniation (note downward descent of the brainstem, loss of
surrounding CSF spaces and flattening of the pons against the clivus) and pachymeningeal
enhancement (arrowheads). (C) Postmyelogram CT scan of the thoracic spine shows an
extradural accumulation of contrast (arrow) within die spinal canal consistent with a CSF
leak.The extradural and intradural confluent medium outlines the dura (arrowhead) at the
T10 level. A blood patch performed at this level resulted in resolution of the patient's
symptoms. Dr Ahmed Esawy
94. Tonsillar herniation. Sagittal enhancedT I -weighted MR image demonstrates a large
enhancing cerebellar mass causing both tonsillar herniation and ascending
transtentorial herniation. Note the inferior displacement of the tonsils (arrow) below
the foramen magnum and the effacement of the surrounding CSF spaces.The
brainstem is compressed and displaced against the clivus and there is upward
displacement of the superior cerebellar vermis (arrowhead) through the incisura.Dr Ahmed Esawy
96. Foramen magnum/tonsillar herniation
child with a history of an Arnold-Chiari I
malformation. Image shows tonsillar
herniation with compression of the central
canal at the craniocervical junction and
resultant syringohydromyelia in the visualized
portion of the cervical spinal cord.
T2-. through the cervical spine was obtained in the
same patient as in the previous image.The cerebellar
tonsils are projecting inferiorly below the level of the
opisthion, with compression of the central canal at
the craniocervical junction. Hyperintense
syringohydromyelia in the visualized portion of the
cervical spinal cord is demonstrated.Dr Ahmed Esawy
97. tonsiliar herniation and ascending transtentorial herniation. A, SagittalTi -weighted MR image
of patient with cerebellar astrocytoma. Cerebeliar tonsils are displaced through foramen
magnum, compressing medulla and upper cervical cord. Note that there is also ascending
transtentorial herniation with tentorium bowed superiorly (curved arrow). B,Axial contrast-
enhancedTi-weighted MR image shows cerebeliar tonsils (asterisks) displaced into foramen
magnum Dr Ahmed Esawy
99. Upward herniation
Increased pressure in the posterior fossa can
cause the cerebellum to move up through the
tentorial opening in upward, or cerebellar
herniation.The midbrain is pushed through the
tentorial notch
Dr Ahmed Esawy
101. MR and CT findings of ascending transtentorial herniation include
Effacement of the superior cerebellar cistern
superior displacement of the superior vermis through the incisura
compression of the midbrain
forward displacement of the pons against the clivus
. can compress the posterior cerebral artery or superior cerebellar arteries
against the tentorium, resulting in infarctions
can compress the aqueduct of Sylvius, resulting in hydrocephalus.
Obstruction of venous outflow by compression of the vein of Galen and
basal vein of Rosenthal may occur and further
increase intracranial pressure.
Dr Ahmed Esawy
103. Ascending transtentorial herniation. (A) AxialT I - weighted MR image and (B) sagittal
enhancedT I -weighted MR image demonstrate ascending transtentorial herniation in a
patient with a cerebellar lung metastases. Note the upward displacement of the superior
cerebellar vermis (black arrows) through the incisura, compression of the fourth
ventricle, and anterior displacement of the pons (arrowhead) against the clivus.
Dr Ahmed Esawy
104. Ascending transtentorial herniation
Right parasagittal gadolinium-enhancedT1-weighted
magnetic resonance image in a 9-year-old girl with a history
of right cerebellar astrocytoma who presented with
headaches and vomiting. Heterogeneously enhancing mass
is demonstrated in the right cerebellum, with compression
of the adjacent brainstem and fourth ventricle. Ascending
transtentorial herniation of the cerebellum is demonstrated
through the incisura. Descending tonsillar herniation also is
present.
Axial gadolinium-enhancedT1-weighted magnetic
resonance image obtained at the level of the midbrain in
the same patient as in the previous image. A
heterogeneously enhancing mass is seen in the right medial
anterior cerebellum, with mass effect on the right posterior
lateral midbrain and fourth ventricle.The image shows
enlargement of the temporal horns of both lateral
ventricles as a result of obstruction by the cerebellar mass
at the level of the fourth ventricle.
Dr Ahmed Esawy
108. ascending transtentorial herniation. Axial CT scan obtained after posterior fossa surgery
with subsequent cerebellar hemorrhage and edema. Perimesencephalic cistern is effaced.
Trapped temporal horns are caused by aqueductal compression and hydrocephalus
Dr Ahmed Esawy
109. unilateral ascending transtentorial herniation. A, Axial CT scan of patient with right cere-
bellar astrocytoma shows distortion of right quadrlgeminal cistern (arrow) and brainstem
compression caused by upward herniation. B, AxialTi-weighted MR image shows leftsided
cerebellar cystic medulloblastoma with marked compression and rotation of midbrain.
Frequently, midbrain is elevated and pons, following midbrain, is forced against clivus
Dr Ahmed Esawy
111. descending transalar herniation
Descending transphenoidal herniation occurs when anterior cranial
fossa mass effect causes displacement of the posterior frontal lobe
over the sphenoid wing into the middle cranial fossa.
Ascending transalar herniation
Ascending transphenoidal herniation is produced by middle cranial
fossa mass effect, which causes displacement of the anterior
temporal lobe over the sphenoid ridge into the anterior cranial
fossa.
Dr Ahmed Esawy
112. transalar herniation
Temporal lobe + sylvian fissure + MCA
up and over the greater sphenoid wing
The middle cerebral artery can become compressed
between the displaced brain and the sphenoid ridge,
resulting in middle cerebral artery infarction
Although vascular compromise may occur with
transphenoidal herniation, it is rare. Moreover, the
clinical features of this type of herniation are poorly
defined.
Dr Ahmed Esawy
113. ascending transalar herniation. Axial contrast-enhanced CT scan of patient with right
temporal lobe gliobiastoma shows contrast filled right middle cerebral artery (arrow)
displaced anteriorly.Also present is asymmetry and effacement of ipsilateral sylvian
fissure.These changes indicate ascending transalar herniation.
Dr Ahmed Esawy
117. Transphenoidal herniation. Sagittal enhanced Tl- weighted MR image
demonstrates a large ring enhancing mass (arrowhead) in the right frontal lobe
causing descending transphenoidal herniation (arrow)
Dr Ahmed Esawy
118. Descending transalar herniation. A, Coronal enhancedTi-weighted MR image shows left
frontal lobe glioblastoma.When compared with normal right side, medial orbital gyrus of
left frontal lobe Is displaced over sphenold ridge into middle cranial fossa (arrow). B, Sagittal
enhancedTi-weighted MR image shows tumor and resultant transalar herniation (arrow).
Left syivian fissure is effaced. Compare this image with normal right side. C, Sagittal
enhancedTi-weighted MR image shows normal position of right frontal lobe (asterisk)
above sylvian fissure (arrow
Dr Ahmed Esawy
121. Extracranial herniation /Transcalvarial
/transdural/Transcranial herniation
the brain squeezes through a fracture or a surgical site in the skull. Also called
"external herniation
•Traumatic
–infants or young children with a comminuted inward skull fracture
•Iatrogenic
–a burr hole, craniotomy, or craniectomy
MR best depicts these unusual herniations.
•The disrupted dura
–discontinuous black line onT2WI
–Brain tissue, blood vessels, and CSF, are extruded through the defects into the
subgaleal space Dr Ahmed Esawy
122. Nonenhanced computed tomography (CT) scan of the brain at the level of the body of
the lateral ventricles was obtained in a 37-year-old man who underwent a right
frontotemporal decompression craniectomy for a large right frontal hematoma after a
skiing accident. A focal hypoattenuating infarct is seen in the right frontal lobe, with an
adjacent edematous brain parenchyma herniating through the right frontotemporal
craniectomy defect.The patient had communicating hydrocephalus with dilatation of
the lateral ventricles.
Dr Ahmed Esawy
124. fungus cerebri. A, Axial CT scan of patient with chronic head injury shows left hemispheric
encephalomaiacia and dilated lateral ventricle. Brain tis- sue is identified herniating through
calvarlal defect. B, AxialTi-weighted MR image of patient with severe head trauma. Swollen
brain is seen herniating through calvarial defect (arrows outline margins of defect ). Hemorrhage
is seen adjacent to defect’s anterior rim, which may be result of herniatlon or initial injur
Dr Ahmed Esawy
125. focal herniation Into surgical defect. Coronal contrast- enhancedTi-weighted MR
image of patient following radical mastoidectomy for cholesteatoma that extended
into epitympanum and mastoid antrum. Postoperatively, there Is dehiscence of
tegmen tympani with focal herniatlon of temporal lobe into middle ear cavity (arrow)
sur- rounded by enhancing granulation tissue.This finding can easily be misinterpreted
as middle ear mass Dr Ahmed Esawy
131. Pathogenesis:
Supratentorial herniation common. 3 sub types
Subfalcine herniation:The cingulate gyrus of the frontal
lobe (commonest) :The brain can shift across falx cerebri
Central transtentorial herniation: displacement of the basal
nuclei and cerebral hemispheres downward
Uncal herniation: Medial edge of the uncus and the
hippocampal gyrus
infratentorial herniation : Cerebellar (tonsillar)
herniation: - tonsil of the cerebellum is pushed
through the foramen magnum and compresses the
medulla, leading to bradycardia and respiratory
arrest.
Dr Ahmed Esawy
132. Subfalcine Herniation: in brain
trauma.Contusion of the inferior
temporal lobe (blue arrow) has
resulted in diffuse edema.
(compressed and flattened gyri
on the right).
This has resulted in subfalcine
herniation of the cingulate gyrus
(red arrow), with a secondary
hemorrhagic infarction above
that (black arrow). A midline shift
from right to left is also present,
as is uncal herniation (yellow
arrow).
Dr Ahmed Esawy
133. Uncal Herniation:
Inferior view,The
herniated uncus is
bulging over the
position of the
tentorium (black
arrows) and
compressing the
midbrain.The two
mammillary bodies
(blue arrows) have been
shifted to the patients
right due to the
pressure.
Dr Ahmed Esawy
135. acute brain swelling + Uncal
Herniation Swelling of the left
cerebral hemisphere
has produced a shift
with herniation of
the uncus of the
hippocampus
through the
tentorium, leading
to the groove seen
at the white arrow.
Dr Ahmed Esawy
136. Cerebellar Tonsil -
Herniation Note the cone shape of the
herniated tonsils around the
medulla in this cerebellum
specimen.
Results in compression and
Duret hemorrhages in the
pons.
Dr Ahmed Esawy
137. Transtentorial herniation:
Transtentorial herniation
at the base of the brain. A
prominent groove
surrounds the displaced
parahippocampal gyrus
(arrow).The adjacent 3rd
nerve (N) is compressed
and distorted and the
ipsilateral cerebral
peduncle (P) is distorted
with small areas of
haemorrhage.
Dr Ahmed Esawy