This document discusses hemorrhagic stroke, specifically intracerebral hemorrhage. It defines intracerebral hemorrhage as bleeding within the brain tissue itself, accounting for 15% of strokes. Risk factors include hypertension and amyloid angiopathy. Clinical presentation includes sudden onset of focal neurological deficits like weakness or seizures. Diagnostics include CT scans. Prognosis is poor with 50% mortality at 1 year. Management focuses on controlling blood pressure, treating increased intracranial pressure, preventing seizures and infections. Surgical options include removing the hemorrhage via aspiration or craniotomy. Subarachnoid hemorrhage is also discussed as bleeding into the subarachnoid space, often from
Is characterized by the sudden loss of blood circulation to an area of the brain, resulting in a corresponding loss of neurologic function. Acute ischemic stroke is caused by thrombotic or embolic occlusion of a cerebral artery and is more common than hemorrhagic stroke.
It can occur
in the carotid
artery of the
neck as well as
other arteries.
When an artery is acutely occluded by thrombus or embolus, the area of the CNS supplied by it will undergo infarction if there is no adequate collateral blood supply.
Surrounding a central necrotic zone, an ‘ischemic penumbra’ remains viable for a time, i.e. it may recover function if blood flow is restored.
CNS ischemia may be accompanied by swelling for two reasons:
● cytotoxic oedema – accumulation of water in damaged glial cells and neurones,
● vasogenic oedema – extracellular fluid accumulation as a result of breakdown of the blood–brain barrier.
In the brain, this swelling may be sufficient to produce clinical deterioration in the days following a major stroke, as a result of a rise in intracranial pressure and compression of adjacent structures.
Is characterized by the sudden loss of blood circulation to an area of the brain, resulting in a corresponding loss of neurologic function. Acute ischemic stroke is caused by thrombotic or embolic occlusion of a cerebral artery and is more common than hemorrhagic stroke.
It can occur
in the carotid
artery of the
neck as well as
other arteries.
When an artery is acutely occluded by thrombus or embolus, the area of the CNS supplied by it will undergo infarction if there is no adequate collateral blood supply.
Surrounding a central necrotic zone, an ‘ischemic penumbra’ remains viable for a time, i.e. it may recover function if blood flow is restored.
CNS ischemia may be accompanied by swelling for two reasons:
● cytotoxic oedema – accumulation of water in damaged glial cells and neurones,
● vasogenic oedema – extracellular fluid accumulation as a result of breakdown of the blood–brain barrier.
In the brain, this swelling may be sufficient to produce clinical deterioration in the days following a major stroke, as a result of a rise in intracranial pressure and compression of adjacent structures.
Intracerebral hemorhage Diagnosis and managementRamesh Babu
About ICH - Diagnosis and management, Discussed the clinical presentation, evaluation, radiological features and management including recent guidelines
Craniotomy
A craniotomy involves making an incision in the scalp and creating a hole known as a bone flap in the skull. The hole and incision are made near the area of the brain being treated.
During open brain surgery, it is done to remove tumors, clip off an aneurysm, drain blood or fluid from an infection & remove abnormal brain tissue
Decompressive craniectomy
It is a neurosurgical procedure in which part of the skull is removed to allow a swelling brain room to expand without being squeezed. It is performed on victims of traumatic brain injury, stroke and other conditions associated with raised intracranial pressure.
Increased intracranial pressure is defined as cerebrospinal fluid pressure greater than 15 mm Hg.
Infections
Tumors
Stroke
Aneurysm
Epilepsy
Seizures
Hydrocephalus
Hypertensive brain injury
Hypoxemia
Meningitis
Due to etiological factors
Components of ICP is disturbed- brain tissue, CSF, blood volume
An increase in the volume of ANY ONE component must be accompanied by a reciprocal decrease in one of the other components.
When this volume-pressure relationship becomes unbalanced, ICP increases.
In medicine, a loss of blood flow to part of the brain, which damages brain tissue. CVAs are caused by blood clots and broken blood vessels in the brain. Symptoms include dizziness, numbness, weakness on one side of the body, and problems with talking, writing, or understanding language.
Intracerebral hemorhage Diagnosis and managementRamesh Babu
About ICH - Diagnosis and management, Discussed the clinical presentation, evaluation, radiological features and management including recent guidelines
Craniotomy
A craniotomy involves making an incision in the scalp and creating a hole known as a bone flap in the skull. The hole and incision are made near the area of the brain being treated.
During open brain surgery, it is done to remove tumors, clip off an aneurysm, drain blood or fluid from an infection & remove abnormal brain tissue
Decompressive craniectomy
It is a neurosurgical procedure in which part of the skull is removed to allow a swelling brain room to expand without being squeezed. It is performed on victims of traumatic brain injury, stroke and other conditions associated with raised intracranial pressure.
Increased intracranial pressure is defined as cerebrospinal fluid pressure greater than 15 mm Hg.
Infections
Tumors
Stroke
Aneurysm
Epilepsy
Seizures
Hydrocephalus
Hypertensive brain injury
Hypoxemia
Meningitis
Due to etiological factors
Components of ICP is disturbed- brain tissue, CSF, blood volume
An increase in the volume of ANY ONE component must be accompanied by a reciprocal decrease in one of the other components.
When this volume-pressure relationship becomes unbalanced, ICP increases.
In medicine, a loss of blood flow to part of the brain, which damages brain tissue. CVAs are caused by blood clots and broken blood vessels in the brain. Symptoms include dizziness, numbness, weakness on one side of the body, and problems with talking, writing, or understanding language.
A stroke is a medical condition in which poor blood flow to the brain causes cell death. There are two main types of stroke: ischemic, due to lack of blood flow, and hemorrhagic, due to bleeding. Both cause parts of the brain to stop functioning properly.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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.
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!
2. I have no conflict of interest or disclosure in
relation to this presentation.
3. Stroke is defined by the World Health
Organization as 'a clinical syndrome consisting of
rapidly developing clinical signs of focal (or global in
case of coma) disturbance of cerebral function
lasting more than 24 hours or leading to death with
no apparent cause other than a vascular origin.‘
Types:
1. Ischemic stroke : 80 %
2. Hemorrhagic Stroke : 20%
4.
5. Hemorrhagic stroke
Types:
Intracerebral Hemorrhage(15%)
- Caused by bleeding within the brain
- tissue itself
Sub Arachnoid Hemorrhage(5%)
- Caused by extravasation of blood
into the subarachnoid space
7. Intracerebral Hemorrhage
An acute and spontaneous extravasation of blood in
to the brain parenchyma that may extend into
ventricles and subarachnoid space.
- 10-15% of all cases of stroke.
- 6 month mortality is 30-50%
- Classification:
- 1. Primary ICH: Hemorrhage originate from
spontaneous rupture of small arteries or arterioles
damaged by chronic HTN or amyloid angiopathy.
- 2. Secondary ICH: Haemorrhage results from trauma,
rupture of Aneurysm, vascular malformation,
coagulopathy, haemorrhagic transformation of
cerebral infarct, intracranial neoplasm, venous
angioma, dural sinus thrombosis
8. Pathophysiology:
Early Haematoma growth:
- About 38% had an increase in haematoma
volume
of more than 33% shown by CT within 3
hours of onset.
Perihaematomal Brain Injury:
- Brain tissue injury and swelling can result in
raised ICP
or herniation.
Plasma released by clotted haematoma seeps
into
the surrounding brain tissue, is the primary
trigger
of inflammatory process.
9. Clinical Presentation
Onset of a sudden focal neurological deficit while the
patient is active, which progresses over minutes to hours
Focal neurological deficit:
- Weakness or paresis that may affect a single extremity, one
half of body or all 4 extremities.
- Facial droop
- Monocular or binocular blindness
- Dysarthria
- Ataxia
- Aphasia
- Seizure
- Headache is more common in ICH
- Vomiting
- Increased systolic BP and impaired level of consciousness
10. Brain sites and associated deficits involved in hemorrhagic
stroke include the following:
Putamen - Contralateral hemiparesis, contralateral
sensory loss, contralateral conjugate gaze paresis,
homonymous hemianopia, aphasia, neglect, or apraxia
Thalamus - Contralateral sensory loss, contralateral
hemiparesis, gaze paresis, homonymous hemianopia,
miosis, aphasia, or confusion
Lobar - Contralateral hemiparesis or sensory loss,
contralateral conjugate gaze paresis, homonymous
hemianopia, abulia, aphasia, neglect, or apraxia
Caudate nucleus - Contralateral hemiparesis, contralateral
conjugate gaze paresis, or confusion
Brainstem - Quadriparesis, facial weakness, decreased
level of consciousness, gaze paresis, ocular bobbing,
miosis, or autonomic instability
Cerebellum – Ipsilateral ataxia, facial weakness, sensory
loss; gaze paresis, skew deviation, miosis, or decreased
14. Intracranial Pressure:
-Place ICP monitor or EVD drain in patients with GCS
< 8.
-GOAL: Maintain ICP < 20mmHg ,
Minimal Cerebral Perfusion Pressure >
60mmHg
Haemostatic therapy: Eptacog alpha
Anticonvulsant therapy: Lorazepam,Phenytoin,
Fosphenytoin, valproic acid, phenobarbital
Fever control
Management of Hypergylcemia:
-Insulin if Blood sugar > 185mg/dl
Nutrition
DVT prophylaxis
15. Surgical Management
Aims:
- Decompression to reduce or prevent elevated ICP
- Removal of acute haematoma to reduce mass effect
- Minimise toxicity from blood breakdown products to
surrounding brain.
- Options:
- Ventriculostomy
- Stereotactic aspiration of haematoma
- Endoscopic haematoma evacuation
- Craniotomy
- Hemicraniectomy for decompression with or without
evacuation of haematoma
16. SUB ARACHNOID
HAEMORRHAGE
-Neurological emergency characterised by
haemorrhage into the subarachnoid space.
-One of the most important cause of sudden, acute
severe headache.
-c/c: ‘the worst headache of my life”
- 85 % of non traumatic cases are due to ruptured
cerebral aneurysm
-30 day mortality of aneurysmal SAH ~
50%
-Incidence: F > M (3:2)
-Risk higher in blacks than in whites
-Incidence increases with age and peaks at 50
19. Clinical Presentation
Prodormal events:
- Symptoms:Headache, dizziness, orbital pain, diplopia,
visual loss
- Signs: Sensory or motor disturbance, seizure, ptosis,
dysphasia
- Focal neurological findings
- Results due to: Sentinel leaks, Mass effect of
aneurysm
- expansion, Emboli
CLASSIC presentation:
- Sudden onset severe headache(Thunderclap
headache)
- Nausea/vomiting
20. Clinical Grading scales
The Hunt and Hess grading system
Grade 0 - Unruptured aneurysm
Grade I - Asymptomatic or mild headache and slight nuchal
rigidity
Grade Ia - Fixed neurological deficit without acute
meningeal/brain reaction
Grade II - Cranial nerve palsy, moderate to severe
headache, nuchal rigidity
Grade III - Mild focal deficit, lethargy, or confusion
Grade IV - Stupor, moderate to severe hemiparesis, early
decerebrate rigidity
Grade V - Deep coma, decerebrate rigidity, moribund
appearance
In the Hunt and Hess system, the lower the grade, the better the
prognosis. Grades 1-3 generally are associated with favorable
outcome; these patients are candidates for early surgery. Grades IV
and V carry a poor prognosis; these patients need stabilization and
21. WFNS Scale
Grade 1 - Glasgow Coma Score (GCS) of 15,
motor deficit absent
Grade 2 - GCS of 13-14, motor deficit absent
Grade 3 - GCS of 13-14, motor deficit present
Grade 4 - GCS of 7-12, motor deficit absent or
present
Grade 5 - GCS of 3-6, motor deficit absent or
present
23. Investigations
Serum Chemistry panel, Complete Blood count
PT, aPTT
Blood typing/screening
Cardiac enzymes, ABG, Chest Xray, ECG
CT without contrast is most sensitive imaging study in
SAH
CT angiography(Sensitivity= 77-100% ; Specificity=
79-100%)
MRI
24. Management
Medical management of SAH focuses on
- Protecting the airway
- Managing the BP
- Preventing rebleeding prior to treatment
- Managing vasospasm(Calcium channel
antagonist Nimodipine)
- Treating Hydrocephalus(EVD or permanent
ventricular shunting)
- Treating Hyponatremia
- Preventing Pulmonary embolus
25. Bed rest in quiet room and stool softner,if needed,
to prevent straining.
If headache or neck pain is severe, Mild sedation
and analgesia.
Adequate Hydration
26. Managing raised ICP
For stupurous patient, Emergency Ventriculostomy to
measure ICP.
Medical therapies: Mild hyperventilation, Mannitol
and sedation
Maintain adequate cerebral perfusion pressure(60-
70mmHg) while avoiding excessive elevation/fall of
arterial pressure