Hyponatremia and Central Pontine Myelinolysis
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This document discusses hyponatremia and central pontine myelinolysis (CPM). It notes that CPM is an acute non-inflammatory demyelinating disease precipitated by the rapid correction of severe chronic hyponatremia. The document outlines the clinical approach and treatment considerations for acute versus chronic hyponatremia. It also describes the clinical manifestations and supportive treatment approach for CPM, noting that CPM has a poor prognosis.
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This document describes a case of a 43-year-old male diagnosed with chronic myelomonocytic leukemia (CMML). His symptoms included abdominal distension, weight loss, fever, and bleeding tendencies. Investigations found elevated white blood cell and monocyte counts, hepatosplenomegaly, and bone marrow findings consistent with CMML. He received supportive care including transfusions and hydroxyurea. Prognosis in CMML can vary depending on risk factors like ASXL1 mutations. Treatment options include hypomethylating agents like decitabine and azacitidine, as well as targeted therapies for mutations like low-dose imatinib for PDGFRB mutations.
benign and malginant conditions of the adrenal gland-2.pptx
The adrenal gland is one of the most important endocrine glands in the body and any lesion in it could result into serious complications
Oncological emergencies
The document discusses several oncological emergencies including tumor lysis syndrome, leucoestasis, hypercalcemia, superior vena cava syndrome, spinal cord compression, and hyperviscosity syndrome. It provides details on the pathogenesis, risk factors, signs and symptoms, diagnostic evaluation and treatment recommendations for each condition. The treatment sections emphasize hydration, uric acid lowering agents, corticosteroids, radiation therapy, surgery, chemotherapy and other supportive measures depending on the specific emergency.
ACS:STEMI
1. The document presents a case of a 56-year-old male smoker with hypertension and diabetes presenting with acute chest pain.
2. On examination, the patient is pale, diaphoretic with a heart rate of 108 and normal blood pressure. His ECG shows ST elevation.
3. The diagnosis is an acute ST elevation myocardial infarction (STEMI) requiring timely reperfusion therapy such as thrombolytics or percutaneous coronary intervention to restore blood flow and limit damage from the heart attack.
Sarcoidosis PK (2) (1).pptx
Radiology (/ˌreɪdɪˈɒlədʒi/ rey-dee-ol-uh-jee) is the medical discipline that uses medical imaging to diagnose diseases and guide their treatment, within the bodies of humans and other animals. It began with radiography (which is why its name has a root referring to radiation), but today it includes all imaging modalities, including those that use no electromagnetic radiation (such as ultrasonography and magnetic resonance imaging), as well as others that do, such as computed tomography (CT), fluoroscopy, and nuclear medicine including positron emission tomography (PET). Interventional radiology is the performance of usually minimally invasive medical procedures with the guidance of imaging technologies such as those mentioned above.
Radiology (/ˌreɪdɪˈɒlədʒi/ rey-dee-ol-uh-jee) is the medical discipline that uses medical imaging to diagnose diseases and guide their treatment, within the bodies of humans and other animals. It began with radiography (which is why its name has a root referring to radiation), but today it includes all imaging modalities, including those that use no electromagnetic radiation (such as ultrasonography and magnetic resonance imaging), as well as others that do, such as computed tomography (CT), fluoroscopy, and nuclear medicine including positron emission tomography (PET). Interventional radiology is the performance of usually minimally invasive medical procedures with the guidance of imaging technologies such as those mentioned above.
Radiology (/ˌreɪdɪˈɒlədʒi/ rey-dee-ol-uh-jee) is the medical discipline that uses medical imaging to diagnose diseases and guide their treatment, within the bodies of humans and other animals. It began with radiography (which is why its name has a root referring to radiation), but today it includes all imaging modalities, including those that use no electromagnetic radiation (such as ultrasonography and magnetic resonance imaging), as well as others that do, such as computed tomography (CT), fluoroscopy, and nuclear medicine including positron emission tomography (PET). Interventional radiology is the performance of usually minimally invasive medical procedures with the guidance of imaging technologies such as those mentioned above.
Radiology (/ˌreɪdɪˈɒlədʒi/ rey-dee-ol-uh-jee) is the medical discipline that uses medical imaging to diagnose diseases and guide their treatment, within the bodies of humans and other animals. It began with radiography (which is why its name has a root referring to radiation), but today it includes all imaging modalities, including those that use no electromagnetic radiation (such as ultrasonography and magnetic resonance imaging), as well as others that do, such as computed tomography (CT), fluoroscopy, and nuclear medicine including positron emission tomography (PET). Interventional radiology is the performance of usually minimally invasive medical procedures with the guidance of imaging technologies such as those mentioned above.
Radiology kosam amaksk mama
Management of MYOCARDIAL INFARCTION_081637.pptx
This document provides an overview of the management of acute myocardial infarction (AMI or heart attack). It discusses the epidemiology, causes, symptoms, diagnostic criteria, risk factors, treatments, and complications of AMI. The main points are: AMI occurs when blood flow to the heart is blocked, causing death of heart muscle cells. It is a medical emergency treated with oxygen, nitrates for pain relief, aspirin, and reperfusion therapies like fibrinolytics or angioplasty. Goals of treatment are to prolong life, minimize heart damage, and prevent complications like heart failure, arrhythmias, and heart block. Lifestyle changes and long term medications are also important for recovery and prevention of future heart attacks.
Oncologic emergencies
This document discusses various oncologic emergencies and their management. It covers 10 common complications seen in cancer patients including: upper airway obstruction, malignant pericardial tamponade, superior vena cava syndrome, acute spinal cord compression, hypercalcemia, hyperviscosity syndrome, hyperleukocytic syndrome, acute tumor lysis syndrome, SIADH, and adrenal insufficiency/crisis. For each complication, it describes causative tumors, symptoms, diagnosis, and treatment options. The goal is rapid diagnosis and management to prevent life-threatening consequences of these time-sensitive oncologic complications.
deep vein thrombosis ANTICOAGULANTS.pptx
1. Deep vein thrombosis (DVT) and pulmonary embolism (PE) are manifestations of venous thromboembolism (VTE) which occurs due to Virchow's triad of stasis, hypercoagulability, and endothelial injury.
2. The document presents several case studies demonstrating the diagnosis and management of DVT and PE. Clinical features, diagnostic testing including Doppler ultrasound, CT pulmonary angiogram, and echocardiogram are discussed.
3. Treatment involves anticoagulation with heparin, low molecular weight heparin, or novel oral anticoagulants initially followed by vitamin K antagonists. Thrombolytic therapy may be used in massive PE
Perioperative care of phaeochromocytoma
This document discusses the perioperative care of patients with phaeochromocytoma. It covers the classification, aetiology, incidence, symptoms, diagnosis, localization and preoperative preparation of phaeochromocytoma. For preoperative preparation, the key goals are controlling blood pressure through adrenergic blockade, optimizing volume status and cardiac function, and correcting metabolic disturbances. Intraoperatively, the anaesthetic technique aims to prevent catecholamine release while managing surges in blood pressure from tumour handling and treating hypotension after tumour removal.
Cardio 4
Cardiovascular Emergencies discusses coronary artery disease, which is the leading cause of death in US adults. The document covers risk factors for CAD like smoking, diabetes, and family history. It also discusses signs and symptoms of a heart attack, including chest pain and assessments like an ECG. Treatment for a suspected heart attack includes oxygen, aspirin, nitroglycerin, and morphine. Fibrinolysis and percutaneous coronary intervention are discussed as alternatives to treat a heart attack. Congestive heart failure and associated pathophysiology, signs, and prehospital treatment are also summarized.
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Allergic Acute Coronary Syndrome - KOUNIS SYNDROME
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Flail Arm Syndrome (FAS) is an atypical form of Motor Neuron Disease characterized by predominantly proximal, progressive and symmetric wasting and paresis of the upper limb muscles, while lower limbs and bulbar muscles are spared. Diagnosis is made clinically and supported by electrodiagnostic studies and genetic testing. There is no cure, so treatment is supportive and symptomatic. Prognosis is generally better than ALS, with prolonged survival.
Dentatorubral Pallidoluysian Atrophy.pptx
Dentatorubral pallidoluysian atrophy (DRPLA) is a progressive, autosomal dominant disorder caused by an abnormal CAG repeat, characterized by symptoms such as ataxia, myoclonus, epilepsy, and progressive cognitive and motor deterioration. It typically has an adult onset and poor prognosis, with death often occurring within 15 years of symptom onset. Diagnostic evaluation includes genetic testing, EEG, and brain MRI showing nonspecific atrophy. Treatment is supportive and multidisciplinary to address symptoms.
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This document summarizes myelin-associated glycoprotein (MAG) neuropathy. It presents as a chronic, slowly progressive large-fiber sensory-motor polyneuropathy, usually affecting the lower extremities initially. Diagnosis involves detecting anti-MAG antibodies and demonstrating demyelination on electrophysiology. While the condition progresses slowly over decades, it can ultimately cause significant muscle weakness, wasting, and ataxia. Current treatments focus on B cell depleting therapies like rituximab, while future therapies may involve antigen-specific immunotherapy.
Trigeminal Trophic Syndrome.pptx
Trigeminal trophic syndrome (TTS) is a rare condition characterized by cutaneous ulceration in the distribution of the trigeminal nerve, most commonly the infraorbital nerve, due to self-inflicted trauma from facial dysesthesia. It results from damage to the trigeminal nerve pathway from various etiologies like iatrogenic nerve injury, cerebrovascular disease, or malignancy. Clinically, patients present with trigeminal anesthesia, facial paresthesia, and crescent-shaped nasal ulcers. Treatment is multidisciplinary and includes behavioral modification, neurologic evaluation, pain management, and various medical therapies.
Acute Exacerbation of Trigeminal Neuralgia.pptx
Trigeminal neuralgia is a painful condition of the trigeminal nerve that causes sudden, severe facial pain. It can be primary due to blood vessel compression or secondary from tumors or multiple sclerosis. While treatments aim to reduce long-term symptoms, there is limited evidence on interventions for acute exacerbations that provide pain relief within 24 hours. Most rescue options provide less than 24 hours of relief, so a more comprehensive care plan is needed. Future studies on potential acute rescue analgesics like lidocaine, sumatriptan, and magnesium sulfate are still needed.
Management of Motor Fluctuations in Parkinson Disease.pptx
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Role of Clopidogrel in Minor Stroke and Transient Ischaemic Attack.pptx
This document discusses the role of clopidogrel in treating transient ischemic attack (TIA) and minor stroke. It defines TIA and stroke, and explains that clopidogrel works by inhibiting platelet activation and aggregation. It reviews several clinical trials that evaluated the efficacy of clopidogrel combined with aspirin in secondary stroke prevention. The recommendations from health organizations like AHA/ASA and ESO are that clopidogrel can be used for secondary stroke prevention in ischemic stroke. For high-risk TIA or minor stroke patients who are not at high bleeding risk, the recommendation is dual antiplatelet therapy with clopidogrel and aspirin for 21 days, followed by single antiplatelet therapy thereafter.
Transient Epileptic Amnesia.pptx
Transient epileptic amnesia (TEA) is a form of focal epilepsy characterized by recurrent episodes of retrograde or anterograde amnesia. During episodes, patients exhibit repetitive questioning and confusion but otherwise intact neurological function. Diagnosis requires witnessed amnesic episodes, intact cognition otherwise during episodes, and evidence of epilepsy from EEG, seizures, or response to anti-seizure medication. TEA can be differentiated from conditions like transient global amnesia and is frequently underdiagnosed in older adults.
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The document discusses the management of benzodiazepine misuse and dependence. It notes that long-term benzodiazepine use has been associated with increased risks, harms, and mortality. The management of benzodiazepine dependence involves preventing misuse through short prescriptions, substituting to longer-acting benzodiazepines or other drugs, gradually tapering doses to avoid withdrawal symptoms, and using psychotherapy or other pharmacological interventions during tapering. Abrupt discontinuation can cause seizures, so slow tapering is generally recommended.
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Cerebral superficial siderosis is characterized by linear hemosiderin deposits in the leptomeninges and superficial layers of the cerebral and cerebellar cortices, brainstem, and spinal cord. It can present as either classical infratentorial or cortical superficial siderosis. Potential etiologies include cerebral amyloid angiopathy, vascular malformations, head trauma, and other conditions. Diagnosis is made through MRI brain imaging. Treatment depends on the underlying cause and may involve surgery to repair vascular abnormalities.
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This document discusses frontotemporal brain sagging syndrome, a potentially treatable disorder characterized by apathy, behavioral changes, cognitive dysfunction, and orthostatic headache. Imaging shows sagging of the brain similar to spontaneous intracranial hypotension. Symptoms can mimic frontotemporal dementia. The syndrome is caused by mechanical forces on the frontal and temporal lobes from spontaneous intracranial hypotension. Early diagnosis and treatment are important as it is a reversible condition.
Epidural Blood Patch.pptx
An epidural blood patch involves injecting the patient's own blood into the epidural space to treat a post-dural puncture headache that has not responded to conservative treatments like bed rest. It has an 85% success rate initially and up to 90% with repeated patches. The procedure involves identifying the epidural space and slowly injecting 5-25mL of blood drawn from the patient over 30-60 seconds. Complications can include worsening headaches from additional dural rents, back pain, or infection at the injection site.
Spontaneous Intracranial Hypotension.pptx
Spontaneous intracranial hypotension is a medical condition caused by loss of cerebrospinal fluid from the spinal canal, resulting in headaches and neurological symptoms. It most commonly presents with orthostatic headaches that are less apparent over time. Brain MRI and spine MRI are used to diagnose and locate CSF leaks. Treatment involves conservative measures, percutaneous patching of leaks, or surgical closure. Spontaneous intracranial hypotension can lead to complications like subdural hematomas if not properly diagnosed and treated.
Clinical Evaluation and Management of Facial Nerve Trauma
This document summarizes the clinical evaluation and management of facial nerve trauma. It discusses that facial palsy occurs in 20 per 100,000 people, with 16% being traumatic from temporal bone fractures. The duration, mechanism, and location of the injury provide important clues for evaluation and prognosis. Diagnostic tests include CT, MRI, and electrodiagnostic testing. Management options include conservative treatment with steroids and physical therapy or surgical decompression of the facial nerve, with earlier surgical intervention found to have better outcomes.
Argyrophilic Grain Disease.pptx
Argyrophilic grain disease (AGD) is a progressive neurodegenerative condition characterized by argyrophilic grains in neuronal processes. It is the second most common neurodegenerative disease after Alzheimer's disease. AGD prevalence increases with age to over 30% in centenarians. Clinically, AGD typically presents as a slowly progressive mild cognitive impairment, often with early emotional or personality changes. Diagnosis of AGD can only be made post-mortem by brain biopsy.
Anti-IgLON5 Disease.pptx
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Globular Glial Tauopathies.pptx
The document discusses globular glial tauopathies (GGTs), a group of neurodegenerative diseases characterized by cytoplasmic tau protein inclusions. GGTs include progressive supranuclear palsy, corticobasal degeneration, and argyrophilic grain disease. They are defined by inclusions predominantly composed of tau isoforms with four microtubule-binding domains. GGTs are characterized neuropathologically by tau-positive globular oligodendroglial inclusions and granular astrocytic inclusions, which are mostly Gallyas-negative. These features help distinguish GGTs from other four-repeat tauopathies, particularly progressive supranuclear palsy.
The Tauopathies.pptx
This document discusses tauopathies, which are neurodegenerative diseases characterized by abnormal tau aggregates in neurons and glial cells. Tau is a microtubule-associated protein that promotes cytoskeleton structure and axonal transport in the nervous system. In tauopathies, tau becomes pathological and forms inclusions like paired helical filaments. Tauopathies show heterogeneity in clinical presentations depending on the type and location of tau aggregates. Classification is based on the tau isoforms involved, with 4-repeat tauopathies including progressive supranuclear palsy and corticobasal degeneration. Understanding tau aggregation mechanisms and their role in toxicity is important for developing targeted therapies for these diseases.
Primary Progressive Aphasia.pptx
Primary progressive aphasia (PPA) is a neurodegenerative syndrome characterized by a gradual deterioration of language abilities over time due to left-hemisphere brain atrophy. It is classified into three main variants - logopenic, nonfluent agrammatic, and semantic - based on distinct language profiles and brain regions affected. Diagnosing PPA and differentiating between variants can be challenging due to overlapping language impairments, clinical variability, and disease progression over time. Management involves a multidisciplinary approach, though treatment options are limited as there is no cure currently.
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Gene therapy can be broadly defined as the transfer of genetic material to cure a disease or at least to improve the clinical status of a patient.
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Safe methods have been devised to do this, using several viral and non-viral vectors.
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- 4. SEVERE Acute or Chronic ? MILD ASYMPTOMATIC
- 9. CHRONIC HYPONATREMIA > 48 hours Mild symptoms Search for etiology Avoid overcorrection CPM !!
- 12. CPM • First described by Adams et al in 1958 • Acute non-inflammatory demyelinating disease • Precipitated by the rapid correction of severe chronic hyponatremia • MRI is the imaging modality of choice • 10 % extrapontine
- 13. Clinical Manifestation • Tremor • Ataxia • Mutism • Spastic quadriparesis • Locked-in syndrome • Coma • Death is common • Ventilator dependency • Aspiration pneumonia • Venous thrombosis • Pulmonary embolism • Contractures • Muscle wasting • Decubitus ulcers • Urinary tract infections • Depression
- 15. CSF Analysis • Not really necessary • Only to rule out other conditions Increased opening pressure Mononuclear pleocytosis Elevated protein
- 17. Take Home Messages: • In treating hyponatremia we should be able to recognize whether it’s acute or chronic hyponatremia • Acute severe hyponatremia (with seizure & coma) is an emergency condition that need correction with hypertonic saline • In chronic hyponatremia, we need to decide the etiology first and then treat the hyponatremia based on the etiology • CPM is a devastating complication of too rapid correction of hyponatremia especially in chronic hyponatremia • The treatment of CPM is supportive only with poor prognosis