Medicine 5th year, 3rd lecture (Dr. Mohammed Tahir)
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This document discusses intracranial hemorrhage (ICH), including its epidemiology, etiologies, diagnosis, and treatment strategies. The most common causes of ICH are hypertension and cerebral amyloid angiopathy. Diagnosis is made using CT scan. Treatment focuses on controlling blood pressure, intracranial pressure, and cerebral perfusion pressure. Surgical intervention may be indicated for large hemorrhages or those causing brain compression. New therapies are being tested to improve outcomes for this condition.
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Intracerebral hemorhage Diagnosis and management
Intracerebral hemorrhage (ICH) is bleeding within the brain tissue. The document discusses the causes, risk factors, clinical features, diagnosis and management of ICH. The major causes are hypertension and vascular abnormalities like aneurysms. Clinical features depend on the location of bleeding and may include altered consciousness, headache, vomiting and focal neurological deficits. CT scan is the primary imaging method to detect ICH. Prognosis depends on factors like hematoma size, location and growth. Management involves controlling blood pressure, treating the underlying cause and complications.
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literature summary of different types of intracranial haemorrhage and their management highlighting relevent or controversial papers
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The document summarizes the investigations and management of stroke. Key points include:
1. Imaging such as CT or MRI is used to distinguish between hemorrhagic and ischemic stroke and identify underlying causes. CT is more widely available while MRI is more sensitive.
2. Risk factors, cardiac investigations, and vascular imaging are also conducted to determine the cause of ischemic stroke.
3. Management of ischemic stroke involves supportive care, thrombolysis within 3 hours, aspirin to prevent recurrence, and carotid surgery for severe stenosis to reduce risk of further stroke.
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This document provides information on intracerebral haemorrhage (ICH), including:
1) ICH is the second most common type of stroke and onset is usually smooth and progressive unlike ischemic stroke.
2) Unenhanced CT is the first investigation and volume correlates to mortality and morbidity.
3) Risk factors include hypertension, liver dysfunction, smoking, and alcohol abuse.
4) Treatment options include factor VIIa within 4 hours to limit volume and surgery may play a role.
Ischaemic stroke
Stroke occurs when blood flow to the brain is interrupted, causing brain cells to die. It is a leading cause of death and disability worldwide. In Bangladesh, around 10% of emergency medical admissions are due to stroke. Presenting symptoms can include weakness, speech problems, visual issues, ataxia, headache, and seizures. Risk factors include hypertension, diabetes, smoking, obesity, and high cholesterol. Rapid diagnosis and treatment is important to reduce long-term effects through thrombolysis, aspirin, carotid surgery, and rehabilitation.
Ischemic stroke
Dr. Syed Muhammad Ali Shah provides an overview of ischemic stroke. Key points include:
- Stroke is defined as rapid onset of neurological deficit lasting over 24 hours caused by a vascular issue.
- Risk factors include atrial fibrillation, hypertension, smoking, obesity, and high cholesterol.
- Diagnosis involves investigations like CT scans and MRI. Treatment depends on the cause but may include thrombolysis within 4.5 hours, aspirin, rehabilitation, and preventing future strokes through controlling risk factors.
- Future advances include endovascular therapies to remove clots and research on neuroprotection strategies. Prevention through lifestyle changes and medications can reduce stroke risk.
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This document provides an overview of ischaemic stroke, including its definition, risk factors, pathophysiology, clinical presentation, diagnosis and management. Key points include:
- Ischaemic stroke accounts for 80% of strokes and results from focal brain infarction due to obstruction of cerebral blood flow.
- Major risk factors include hypertension, atrial fibrillation, diabetes, hyperlipidemia and previous stroke or TIA.
- Clinical syndromes depend on the location of brain infarction and can include motor/sensory deficits, aphasia and visual field cuts.
- Diagnosis involves neuroimaging such as CT, MRI and vascular imaging to identify the cause.
- Acute
Intracranial hemorrhage
This document discusses intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH). ICH can be caused by hypertension, cerebral amyloid angiopathy, aneurysms, or bleeding disorders. Common symptoms include sudden headache, weakness on one side of the body, and altered mental status. Treatment focuses on controlling blood pressure, reducing pressure in the brain, and potentially surgically evacuating large bleeds. SAH most often results from aneurysms and presents with a sudden, severe headache. Angiography is used to locate the source of bleeding, and aneurysms are often clipped surgically to prevent rebleeding.
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1. Imaging such as CT or MRI is used to distinguish between hemorrhagic and ischemic stroke and identify underlying causes. CT is more widely available while MRI is more sensitive.
2. Risk factors, cardiac investigations, and vascular imaging are also conducted to determine the cause of ischemic stroke.
3. Management of ischemic stroke involves supportive care, thrombolysis within 3 hours, aspirin to prevent recurrence, and carotid surgery for severe stenosis to reduce risk of further stroke.
4. For hemorrhagic stroke, reversal of coagulopathy and surgical evacuation may be considered to control bleeding and intracranial pressure
Intracerebral Haemorrhage.Dr NG NeuroEdu
This document provides information on intracerebral haemorrhage (ICH), including:
1) ICH is the second most common type of stroke and onset is usually smooth and progressive unlike ischemic stroke.
2) Unenhanced CT is the first investigation and volume correlates to mortality and morbidity.
3) Risk factors include hypertension, liver dysfunction, smoking, and alcohol abuse.
4) Treatment options include factor VIIa within 4 hours to limit volume and surgery may play a role.
Ischaemic stroke
Stroke occurs when blood flow to the brain is interrupted, causing brain cells to die. It is a leading cause of death and disability worldwide. In Bangladesh, around 10% of emergency medical admissions are due to stroke. Presenting symptoms can include weakness, speech problems, visual issues, ataxia, headache, and seizures. Risk factors include hypertension, diabetes, smoking, obesity, and high cholesterol. Rapid diagnosis and treatment is important to reduce long-term effects through thrombolysis, aspirin, carotid surgery, and rehabilitation.
Ischemic stroke
Dr. Syed Muhammad Ali Shah provides an overview of ischemic stroke. Key points include:
- Stroke is defined as rapid onset of neurological deficit lasting over 24 hours caused by a vascular issue.
- Risk factors include atrial fibrillation, hypertension, smoking, obesity, and high cholesterol.
- Diagnosis involves investigations like CT scans and MRI. Treatment depends on the cause but may include thrombolysis within 4.5 hours, aspirin, rehabilitation, and preventing future strokes through controlling risk factors.
- Future advances include endovascular therapies to remove clots and research on neuroprotection strategies. Prevention through lifestyle changes and medications can reduce stroke risk.
Ischaemic stroke
This document provides an overview of ischaemic stroke, including its definition, risk factors, pathophysiology, clinical presentation, diagnosis and management. Key points include:
- Ischaemic stroke accounts for 80% of strokes and results from focal brain infarction due to obstruction of cerebral blood flow.
- Major risk factors include hypertension, atrial fibrillation, diabetes, hyperlipidemia and previous stroke or TIA.
- Clinical syndromes depend on the location of brain infarction and can include motor/sensory deficits, aphasia and visual field cuts.
- Diagnosis involves neuroimaging such as CT, MRI and vascular imaging to identify the cause.
- Acute
Intracranial hemorrhage
This document discusses intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH). ICH can be caused by hypertension, cerebral amyloid angiopathy, aneurysms, or bleeding disorders. Common symptoms include sudden headache, weakness on one side of the body, and altered mental status. Treatment focuses on controlling blood pressure, reducing pressure in the brain, and potentially surgically evacuating large bleeds. SAH most often results from aneurysms and presents with a sudden, severe headache. Angiography is used to locate the source of bleeding, and aneurysms are often clipped surgically to prevent rebleeding.
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Medical Radiological and Surgical Management of Stroke
This document provides an overview of radiological imaging in the management of stroke. It discusses:
1) Various imaging modalities used including unenhanced CT, CT angiography, MRI, and their benefits. Diffusion weighted MRI can detect acute ischemia within 30 minutes.
2) Examples of imaging findings for different stroke types like ischemic and hemorrhagic strokes. Ischemic strokes appear as bright lesions on DWI MRI.
3) Surgical interventions for acute stroke management include decompressive hemicraniectomy to reduce intracranial pressure for large hemispheric infarcts, and external ventricular drainage for intraventricular hemorrhage and hydrocephalus.
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Intracerebral hemorrhage (ICH) has a high mortality rate, with only 25% of survivors being independent after 6 months. The majority of ICH cases occur spontaneously due to ruptured blood vessels damaged by hypertension and amyloid angiopathy. Management focuses on preventing hematoma expansion and minimizing cerebral ischemia. Blood pressure control is important for reducing hematoma growth and improving outcomes, with guidelines recommending keeping systolic BP below 160 and mean arterial pressure below 110 while monitoring closely.
Subarachnoid hemorrhage
The document summarizes subarachnoid hemorrhage (SAH). The most common cause is a ruptured cerebral aneurysm. Clinical presentation includes sudden, severe headache and loss of consciousness. Diagnosis is made using non-contrast CT or lumbar puncture. Treatment involves securing the aneurysm with coiling or clipping, managing rebleeding risk with blood pressure control, and treating complications like hydrocephalus. Outcomes depend on factors like disease severity, treatment at high-volume centers, and management of neurological complications including rebleeding, hydrocephalus, and seizures.
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This document discusses diagnostic imaging for acute ischemic stroke. It provides details on the use of non-contrast CT, MRI, CT angiography and MR angiography to evaluate patients with suspected stroke. CT is widely available but MRI, especially diffusion-weighted imaging, can detect small or recent strokes better. Ultrasound is used to screen for carotid artery stenosis and can classify severity based on blood flow velocities. Digital subtraction angiography remains the gold standard but is more invasive. The pathophysiology of cerebral infarction over time correlates to changing imaging appearances on CT and MRI.
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The document provides information on subarachnoid haemorrhage (SAH), including:
- SAH is a neurological emergency caused by bleeding in the subarachnoid space, usually due to a ruptured saccular aneurysm.
- Clinical manifestations include the sudden onset of the worst headache of one's life, neck stiffness, vomiting, focal neurological deficits, and loss of consciousness.
- Investigations include non-contrast CT scan, which identifies the location and extent of subarachnoid blood in 95% of cases within 72 hours, and cerebral angiography to locate the aneurysm.
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Subarachnoid haemorrhage
Subarachnoid hemorrhage (SAH) is bleeding into the subarachnoid space between the brain's outermost layers. It is often caused by the rupture of an aneurysm, which is a bulge or weakening in the wall of a brain artery. Symptoms include a sudden and severe headache, decreased consciousness, vomiting, and neck stiffness. Diagnosis involves CT scan and lumbar puncture to detect blood. Treatment focuses on preventing rebleeding through aneurysm coiling or clipping, and managing complications like hydrocephalus, vasospasm, seizures, and hyponatremia. Prognosis depends on the severity of the initial bleed and development of complications.
Subarachnoid haemorrhage assessment and investigation
1) The document summarizes a presentation on the assessment and investigation of subarachnoid haemorrhage (SAH).
2) It finds that modern CT scans have high accuracy in detecting SAH within 6 hours, but lumbar puncture remains important for cases presenting later.
3) The risk of serious side effects from lumbar puncture often outweigh its benefits, except for patients with pre-test probabilities of SAH between 2-7% based on their history and exam findings.
Stroke
Stroke is the third leading cause of death in Malaysia. The document defines stroke, classifies its types, and outlines its diagnosis and management. Key points include that stroke is caused by blocked blood flow to the brain, and risk factors include age, gender, family history, hypertension, diabetes, atrial fibrillation, smoking, and high cholesterol. Diagnostic tests include CT/MRI scans and angiograms to determine the cause. Treatment focuses on rehabilitation, managing risk factors, and preventing future strokes.
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This document discusses the diagnosis and management of intracranial hemorrhage (ICH). ICH is bleeding within the skull and can occur in different locations, including within brain tissue, around the brain, or in the fluid-filled spaces. Diagnosis involves history, exam, and non-contrast CT scan of the brain. Initial management focuses on airway protection if decreased consciousness, monitoring vital signs, and controlling blood pressure to reduce risk of hemorrhage expansion. Treatment depends on ICH type but generally involves stabilization in the ICU followed by specialized management depending on location and cause of bleeding.
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Please find the power point on Management of Sub arachnoid hemorrhage. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
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Ischemic and hemorrhagic stroke
This document presents a case report of a 75-year-old female patient who presented with right-sided body weakness and inability to speak for 1 hour. Her medical history includes hypertension for 25 years and ischemic heart disease for 10 years. On examination, she had right-sided facial weakness and numbness as well as aphasia. Diagnostic tests revealed an ischemic stroke likely due to an embolism. Her treatment plan included medications, oxygen therapy, and further tests such as echocardiography and carotid Doppler. The document then provides definitions and details on stroke types, risk factors, pathogenesis, management of ischemic and hemorrhagic strokes.
Pharmacotherapy of Stroke
This document discusses the pharmacotherapy of stroke. It begins by defining stroke and classifying it as either ischemic or hemorrhagic. Risk factors and pathophysiology are described. Clinical presentations include weakness, speech problems, or vision loss. Diagnosis involves imaging like CT or MRI to distinguish ischemic from hemorrhagic stroke. Treatment goals are to reduce injury, prevent complications and recurrence. For ischemic stroke, IV tissue plasminogen activator within 3 hours or aspirin within 48 hours are recommended. Secondary prevention includes managing conditions like atrial fibrillation, hypertension, and diabetes to prevent future strokes.
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This document describes the case of a 56-year-old male who presented with drowsiness and vomiting after a fall and head injury. On examination, he had a Glasgow Coma Scale of 13/15. Imaging showed a subdural hematoma. He underwent surgical evacuation of the subdural hematoma. The document then provides background information on subdural hematomas including causes, risk factors, classification, signs and symptoms, diagnosis using CT scans, and treatment options including conservative management or craniotomy. Guidelines for management of mild, moderate and severe traumatic brain injuries are also summarized.
Ischaemic stroke cme
Ischaemic stroke is caused by blockage of arteries in the brain and accounts for 87% of all strokes. The main types are thrombosis, embolism, and hypoperfusion. Risk factors include atherosclerosis, small vessel disease, and cardiogenic embolism from conditions like atrial fibrillation. Symptoms depend on the affected brain region and may include weakness, sensory loss, speech problems, and visual issues. Treatment involves stabilizing vital functions, managing blood pressure and glucose, and administering thrombolysis within 4.5 hours or revascularization procedures for selected patients to restore blood flow. Secondary prevention focuses on controlling risk factors and long-term anticoagulation or antiplatelet therapy.
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Endovascular treatment of cerebral aneurysms
1) Endovascular treatment of cerebral aneurysms has evolved from early techniques using balloons and detachable coils to modern techniques using bioactive coils, flow diverters, and liquid embolic agents.
2) Placement of coils aims to occlude the aneurysm but often results in incomplete occlusion, with recanalization rates of over 30%. Newer bioactive coils and flow diverters better induce thrombosis.
3) Flow diverters like the Pipeline device promote parent vessel reconstruction and improved aneurysm occlusion compared to traditional coiling or stenting. One-year follow up shows successful aneurysm treatment with this emerging technology.
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Medical Radiological and Surgical Management of Stroke
This document provides an overview of radiological imaging in the management of stroke. It discusses:
1) Various imaging modalities used including unenhanced CT, CT angiography, MRI, and their benefits. Diffusion weighted MRI can detect acute ischemia within 30 minutes.
2) Examples of imaging findings for different stroke types like ischemic and hemorrhagic strokes. Ischemic strokes appear as bright lesions on DWI MRI.
3) Surgical interventions for acute stroke management include decompressive hemicraniectomy to reduce intracranial pressure for large hemispheric infarcts, and external ventricular drainage for intraventricular hemorrhage and hydrocephalus.
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Intracerebral hemorrhage (ICH) has a high mortality rate, with only 25% of survivors being independent after 6 months. The majority of ICH cases occur spontaneously due to ruptured blood vessels damaged by hypertension and amyloid angiopathy. Management focuses on preventing hematoma expansion and minimizing cerebral ischemia. Blood pressure control is important for reducing hematoma growth and improving outcomes, with guidelines recommending keeping systolic BP below 160 and mean arterial pressure below 110 while monitoring closely.
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The document summarizes subarachnoid hemorrhage (SAH). The most common cause is a ruptured cerebral aneurysm. Clinical presentation includes sudden, severe headache and loss of consciousness. Diagnosis is made using non-contrast CT or lumbar puncture. Treatment involves securing the aneurysm with coiling or clipping, managing rebleeding risk with blood pressure control, and treating complications like hydrocephalus. Outcomes depend on factors like disease severity, treatment at high-volume centers, and management of neurological complications including rebleeding, hydrocephalus, and seizures.
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This document discusses cerebral venous thrombosis (CVT). It begins by defining CVT as a condition where thrombosis occurs in cerebral veins or dural sinuses, obstructing drainage from the brain. It has various nonspecific clinical manifestations. The document then covers epidemiology, pathogenesis, risk factors, clinical aspects, investigations including imaging findings, treatment including anticoagulation, and guidelines for managing CVT.
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This document discusses diagnostic imaging for acute ischemic stroke. It provides details on the use of non-contrast CT, MRI, CT angiography and MR angiography to evaluate patients with suspected stroke. CT is widely available but MRI, especially diffusion-weighted imaging, can detect small or recent strokes better. Ultrasound is used to screen for carotid artery stenosis and can classify severity based on blood flow velocities. Digital subtraction angiography remains the gold standard but is more invasive. The pathophysiology of cerebral infarction over time correlates to changing imaging appearances on CT and MRI.
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The document provides information on subarachnoid haemorrhage (SAH), including:
- SAH is a neurological emergency caused by bleeding in the subarachnoid space, usually due to a ruptured saccular aneurysm.
- Clinical manifestations include the sudden onset of the worst headache of one's life, neck stiffness, vomiting, focal neurological deficits, and loss of consciousness.
- Investigations include non-contrast CT scan, which identifies the location and extent of subarachnoid blood in 95% of cases within 72 hours, and cerebral angiography to locate the aneurysm.
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2) It finds that modern CT scans have high accuracy in detecting SAH within 6 hours, but lumbar puncture remains important for cases presenting later.
3) The risk of serious side effects from lumbar puncture often outweigh its benefits, except for patients with pre-test probabilities of SAH between 2-7% based on their history and exam findings.
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Sub Arachnoid Hemorrhage (SAH)
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Ischemic and hemorrhagic stroke
This document presents a case report of a 75-year-old female patient who presented with right-sided body weakness and inability to speak for 1 hour. Her medical history includes hypertension for 25 years and ischemic heart disease for 10 years. On examination, she had right-sided facial weakness and numbness as well as aphasia. Diagnostic tests revealed an ischemic stroke likely due to an embolism. Her treatment plan included medications, oxygen therapy, and further tests such as echocardiography and carotid Doppler. The document then provides definitions and details on stroke types, risk factors, pathogenesis, management of ischemic and hemorrhagic strokes.
Pharmacotherapy of Stroke
This document discusses the pharmacotherapy of stroke. It begins by defining stroke and classifying it as either ischemic or hemorrhagic. Risk factors and pathophysiology are described. Clinical presentations include weakness, speech problems, or vision loss. Diagnosis involves imaging like CT or MRI to distinguish ischemic from hemorrhagic stroke. Treatment goals are to reduce injury, prevent complications and recurrence. For ischemic stroke, IV tissue plasminogen activator within 3 hours or aspirin within 48 hours are recommended. Secondary prevention includes managing conditions like atrial fibrillation, hypertension, and diabetes to prevent future strokes.
Subdural Hematoma
This document describes the case of a 56-year-old male who presented with drowsiness and vomiting after a fall and head injury. On examination, he had a Glasgow Coma Scale of 13/15. Imaging showed a subdural hematoma. He underwent surgical evacuation of the subdural hematoma. The document then provides background information on subdural hematomas including causes, risk factors, classification, signs and symptoms, diagnosis using CT scans, and treatment options including conservative management or craniotomy. Guidelines for management of mild, moderate and severe traumatic brain injuries are also summarized.
Ischaemic stroke cme
Ischaemic stroke is caused by blockage of arteries in the brain and accounts for 87% of all strokes. The main types are thrombosis, embolism, and hypoperfusion. Risk factors include atherosclerosis, small vessel disease, and cardiogenic embolism from conditions like atrial fibrillation. Symptoms depend on the affected brain region and may include weakness, sensory loss, speech problems, and visual issues. Treatment involves stabilizing vital functions, managing blood pressure and glucose, and administering thrombolysis within 4.5 hours or revascularization procedures for selected patients to restore blood flow. Secondary prevention focuses on controlling risk factors and long-term anticoagulation or antiplatelet therapy.
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2) Saccular aneurysms are the most common type and can cause subarachnoid hemorrhage from rupture. They are often detected on CT/CTA or catheter angiography.
3) Other aneurysm types discussed include fusiform, dissecting, mycotic, oncotic, and traumatic pseudoaneurysms. These have different etiologies and features on imaging.
Anatomy and intervention in cerebral vasculature
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2. The Circle of Willis is a major vascular structure that connects the arteries of the brain. It includes components like the anterior and posterior cerebral arteries.
3. Imaging techniques used to evaluate the cerebral vasculature include conventional angiography, CT angiography, MR angiography, ultrasound and digital subtraction angiography. Each has advantages and disadvantages for assessing the anatomy and identifying abnormalities.
Aneurysm by dr.majid nawaz
An aneurysm is an abnormal dilation of a blood vessel wall due to weakening. It can cause thrombosis, alterations in blood flow, rupture, and compression of nearby structures. Aneurysms are classified based on wall composition, shape, and cause. The most common sites for aneurysms are the abdominal aorta and thoracic aorta. Symptoms depend on the specific type of aneurysm but can include rupture, obstruction, embolism, and masses. Diagnosis and treatment involve identifying the type and managing risks like rupture.
Arteriovenous Malformation (AVM) of Brain
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Intracranial hemorrhage- shruthi s jayaraj, calicut medical college
This document summarizes different types of intracranial hemorrhages. It classifies hemorrhages based on location as either intra-axial within the brain parenchyma, or extra-axial outside the brain. Common intra-axial hemorrhages include those in the basal ganglia, thalamus, cerebellum, and pons caused by hypertension. Extra-axial hemorrhages include epidural, subdural, and subarachnoid hemorrhages. Clinical features, management, and prognosis are described for different hemorrhage types. Surgical evacuation or medical management are used depending on location and size of the bleed.
Interventional radiology & angiography
Interventional radiology uses minimally invasive techniques guided by imaging to diagnose and treat medical conditions. Procedures use small incisions or catheters inserted through blood vessels to access internal organs. The Seldinger technique is commonly used, involving insertion of a guidewire and catheter through a needle into the femoral artery. A variety of catheters and guidewires are used depending on the target vessel. Angiography involves injecting contrast dye to visualize vessels. Interventional radiology suites contain specialized equipment like large X-ray tubes and digital image receptors to facilitate complex image-guided procedures.
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Intracranial hemorrhage- shruthi s jayaraj, calicut medical college
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Management of cerebral hemorrhage...A quick guide
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Stroke hyperacute treatment
1. Hyperacute management of stroke focuses on reperfusion through thrombolysis or mechanical disruption of clots, reducing infarct size, and treating complications like raised intracranial pressure.
2. For intracerebral hemorrhage, the goals are to stop or slow the initial bleeding, control blood pressure, and reduce edema through hematoma evacuation, osmotherapy, or neuroprotective measures.
3. Specific treatments discussed include thrombolysis within 4.5 hours, aspirin, anticoagulants, blood pressure control, osmotherapy with mannitol or hypertonic saline, hematoma evacuation, seizure control with antiepileptics only for clinical seizures, and avoiding
The Pathophysiology And Management Of Hemorrhagic Stroke
1. The document discusses the pathophysiology and management of hemorrhagic stroke, specifically intracerebral hemorrhage (ICH). ICH is more common and more lethal than subarachnoid hemorrhage.
2. Risk factors for ICH include increasing age, hypertension, male gender, and alcohol use. CT scan is used to diagnose ICH. Management involves airway protection, blood pressure control, intracranial pressure monitoring, and seizure prophylaxis.
3. Treatment goals are to maintain blood pressure below 130 mmHg, intracranial pressure below 20 mmHg, and cerebral perfusion pressure above 70 mmHg. Surgical evacuation may be considered depending on hemor
Management Of Intracranial Hemorrhages
Intracranial hemorrhages account for 8-11% of all acute strokes and have a high mortality rate. The main causes are hypertension, amyloid angiopathy, AVMs, anticoagulation, and tumors. Management involves stabilizing the patient, controlling blood pressure, preventing clot growth, managing cerebral edema and seizures. Surgery is generally not beneficial except for cerebellar hemorrhages. Clinical trials have found no clear benefit to aggressive blood pressure control or clot evacuation surgery over medical management alone.
Management Of Intracranial Hemorrhages
Intracranial hemorrhages account for 8-11% of all acute strokes and have a high mortality rate. The main causes are hypertension, amyloid angiopathy, AVMs, anticoagulation, and tumors. Management involves stabilizing the patient, controlling blood pressure, stabilizing the clot, managing cerebral edema and seizures. Surgery is generally not beneficial except for cerebellar hemorrhages. Clinical trials have found no clear benefit of aggressive blood pressure control or clot evacuation surgery over medical management alone.
Icu care after acute head injury
This document discusses the management of intensive care for patients with acute head injuries. It outlines factors that influence patient outcomes, such as the severity of the primary and secondary injuries. It emphasizes the importance of monitoring patients to avoid physiological insults that can exacerbate secondary brain injury, including intracranial hypertension, hypoxia, hypotension, and fever. A variety of monitoring modalities are described to optimize cerebral perfusion pressure and oxygenation in order to minimize ischemia. Both general and specific medical management strategies are covered, such as surgical intervention, ventilation, fluid management, and use of pharmacological agents to reduce intracranial pressure.
pengelolaan hipertensi intrakranial
pengelolaan hipertensi intrakranialDepartment of Anesthesiology, Faculty of Medicine Hasanuddin University
Raised ICP: What are our option?
- Pathophysiology intracranial hypertension.
- Use Brain Trauma Foundation Guideline (first-tier and second-tier therapy).
- On going research is the effect of TH to decrease ICP.Cognitive-Aids-for-Neuroanesthetic-Emergencies.pdf
The document provides 11 cognitive aids developed by the Society for Neuroscience in Anesthesia and Critical Care to assist anesthesia teams facing neuroanesthetic emergencies. Each cognitive aid outlines the differential diagnosis, treatment steps to stabilize the patient, and treatment guidance for common neurosurgical emergencies including acute stroke, aneurysm rupture, intraoperative aneurysm rupture, autonomic hyperreflexia, bleeding during spine surgery, and delayed emergence after craniotomy. The cognitive aids are not protocols but are meant to provide resources during emergent situations.
Anaesthetic Management of Supratentorial Tumours
This document discusses the anaesthetic management considerations for supratentorial brain tumours. It begins with an overview of common brain tumour types and surgeries. Key factors include maintaining cerebral homeostasis, minimizing brain retraction, reducing intracranial pressure, and early postoperative awakening. Specific techniques covered are osmotic agents, steroids, hyperventilation, fluid management, positioning, and hemodynamic control. Close monitoring of vital signs, gases, glucose and electrolytes is emphasized due to the risks of pressure effects, seizures, and other complications.
HTN & CVA.pptx
This document discusses hypertension and its relationship to stroke. It covers several key points:
1. Hypertension is a major risk factor for stroke, responsible for 10% of deaths in India, with 51% of stroke deaths due to hypertension. Both systolic and diastolic blood pressure are strongly correlated with stroke risk.
2. Acute blood pressure management in ischemic stroke is complex, as both extreme hypertension and induced hypotension can be detrimental by disrupting cerebral blood flow. Moderate control to less than 220/120 mmHg is recommended when possible.
3. In intracerebral hemorrhage, elevated blood pressure increases hematoma expansion risk in the first hours, so aggressive control to less
Hypertension
This document discusses hypertension and hypertensive crisis. It covers:
- Causes of hypertension including increased systemic vascular resistance and cardiac output.
- Target organs affected by hypertensive crisis like the kidneys, brain, eyes, and heart.
- Types of hypertensive emergencies and their treatments. Short term treatments focus on gentle blood pressure reduction to avoid end organ damage.
- Guidelines for treating hypertension in specific conditions like stroke, aortic dissection, pheochromocytoma, and cocaine or alcohol use. Goals and agents vary depending on the underlying cause and organs involved.
Hypertension
Hypertension has many potential causes and treatments depending on the clinical situation. Secondary hypertension should be considered when initial control is difficult or the onset of hypertension is rapid. Treatment of hypertensive emergencies involves gradual reduction of blood pressure while avoiding hypotension, using agents like sodium nitroprusside or labetalol. Long-term regimens after crisis typically include vasodilators, beta-blockers, and diuretics. Management is tailored based on any underlying conditions and target organ effects.
Salon 2 14 kasim 13.30 14.30 susan yeager
This document provides an overview of the initial evaluation and management of common neurologic emergencies such as traumatic brain injury and stroke. It discusses performing a full neurologic exam including evaluation of the cranial nerves. For traumatic brain injury, it recommends maintaining airway, circulation, and intracranial pressure while preventing seizures. For stroke, it emphasizes rapid diagnosis and treatment to restore perfusion through medications like tPA if indicated. It also reviews hemorrhagic stroke diagnosis and focusing on limiting hematoma expansion and rebleeding risk.
Hypertension and stroke
This was lecture given at College of General Practitioner Hyderabad on 16th June 2013 as refresher course on Hypertension
Cerebral protection
1) Cerebral protection aims to improve neurological outcomes in patients at risk of cerebral ischemia through preemptive therapeutic interventions to prevent further brain damage and reverse existing damage.
2) Various pharmacological and non-pharmacological interventions can be used for cerebral protection, including hypothermia, hypertension, osmotherapy, barbiturate coma, and inhaled anesthetics. These interventions work to maintain cerebral perfusion and oxygenation while minimizing intracranial pressure and secondary brain injury.
3) Careful monitoring of patients is important for cerebral protection, including intracranial pressure, oxygenation, metabolism, hemodynamics, and electrical activity. Targeted interventions are aimed at preventing increases in intracran
HTN E & U(1) (1).pptx
Hypertension emergency is characterized by severely elevated blood pressure (>180/120 mm Hg) and evidence of impending organ damage. Hypertension urgency also involves severely elevated blood pressure but without organ damage. The goal of treatment is to gradually lower blood pressure over minutes to hours in emergencies and over 24 hours in urgencies to prevent organ damage. Intravenous drugs are used for emergencies while oral drugs are preferred for urgencies with close monitoring. Specific treatment depends on the underlying cause and affected organs.
Htn urgency and emg
(1) The document discusses the evaluation, classification, and treatment of hypertensive emergencies and urgencies. It defines the differences between the two conditions and outlines the goals and approaches for treating each.
(2) For hypertensive urgencies, the goal is to lower blood pressure within several hours to prevent further increases without causing too rapid of a drop. For emergencies, the goal is to reduce blood pressure more quickly to prevent end-organ damage, while maintaining adequate perfusion.
(3) Several intravenous antihypertensive drugs are discussed as options for treatment in hypertensive emergencies, including nitroprusside, nicardipine, labetalol, and
complications of thrombolysis (alteplase) in stroke
This document summarizes key information about the use of recombinant tissue plasminogen activator (r-tPA, also known as alteplase) for the treatment of acute ischemic stroke (AIS). It discusses FDA approval of r-tPA for AIS, dosing and administration, mechanisms of action, risks and rates of symptomatic intracerebral hemorrhage, eligibility criteria, monitoring parameters, contraindications, and management of hemorrhagic complications.
Hp Crisis
Hypertensive crisis refers to severely elevated blood pressure that can lead to organ damage and is categorized as hypertensive urgency or emergency depending on the presence of end-organ damage; treatment of urgency involves gradual oral medication while emergency requires immediate intravenous drugs to reduce blood pressure to prevent further damage; careful diagnosis and monitoring of blood pressure and organs is needed along with selecting appropriate drugs based on the situation.
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Growth and development milestones from birth through age 5 are outlined. Growth refers to increases in cell mass and number, while development is the differentiation of functions. Key milestones are provided for gross and fine motor skills, communication/language, and cognitive/social development according to average ages. Growth is also defined for weight, height/length, and head circumference based on age.
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I examined this patient's peripheral vascular system. On inspection from the end of the bed, the patient appeared comfortable at rest with no signs of vascular disease. Both limbs were pink and well perfused with normal capillary refill times. All pulses were present and equal bilaterally. Buerger's test was negative. To complete my examination, I would assess the cardiovascular system and test the relevant muscles and nerves of the affected limb, and perform duplex scans and ankle-brachial pressure indexes.
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The origins of surgery can be traced back many centuries, with practitioners using various materials and techniques for closing wounds. Ancient methods included using ants or thorns to close wounds. In more modern times, catgut made from sheep intestine was used. Post-World War II, sutures were developed with needles attached to reduce tissue trauma. Sutures are classified based on material and absorbability, and appropriate suture selection depends on factors like the tissue and wound characteristics.
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