This presentation describes the common conditions, anatomy and the ideal ways to do and perform nerve conduction studies in lower limbs. It is nicely depicted with self explanatory pictures.
This presentation is an introduction to the principles of Nerve Conduction Study and is entirely sourced from the book by David C Preston and Barbara E Shapiro: Electromyography and Neuromuscular disorders, 3rd Edition
Basic MEP techniques and understanding for Intraoperative neuromonitoring of the motors tracts during Brain and Spinal surgeries to prevent postoperative complications.
This presentation is an introduction to the principles of Nerve Conduction Study and is entirely sourced from the book by David C Preston and Barbara E Shapiro: Electromyography and Neuromuscular disorders, 3rd Edition
Basic MEP techniques and understanding for Intraoperative neuromonitoring of the motors tracts during Brain and Spinal surgeries to prevent postoperative complications.
what is RNS and what the techniques to perform this test in the lab. Its significance in the evaluation and diagnosis of NMJ disorders like MG, LEMBS etc..
Late response are the most helpful findings in some of the diseases affecting the peripheral nerves, (e.g GBS, Radiculopathies, ). How to assess these responses while performing Nerve Conduction Studies, is the most technical and theoretical consideration.... Here we go with the same things in the stated slides
Nerve Conduction Studies and Electromyography for Beginners to understand basic procedure and interpretations.
It can be used as a basic guideline and advance interpretation can be easily understood after you read it.
what is RNS and what the techniques to perform this test in the lab. Its significance in the evaluation and diagnosis of NMJ disorders like MG, LEMBS etc..
Late response are the most helpful findings in some of the diseases affecting the peripheral nerves, (e.g GBS, Radiculopathies, ). How to assess these responses while performing Nerve Conduction Studies, is the most technical and theoretical consideration.... Here we go with the same things in the stated slides
Nerve Conduction Studies and Electromyography for Beginners to understand basic procedure and interpretations.
It can be used as a basic guideline and advance interpretation can be easily understood after you read it.
Case Review #1: 27 year old female presents with foot drop after 3rd lumbar s...Robert Pashman
A 27 year old female presented status post three microdiscectomies. The patient had a sudden onset of foot drop. Dr. Pashman performed a posterior spinal fusion on the patient.
Entrapment Neuropathies in Upper Limb.pptxNeurologyKota
This presentation is about the entrapment syndrome of upper limb giving an insight regarding diagnosis clinically as well as electrophysiologically and
its management.
This presentation looks at intraoperative monitoring of auditory evoked potential, somato sensory evoked potential and motor evoked potential, procedure, pitfalls and utility.
This presentation describes a few cases of stroke that presented within golden period but could not be thrombolysed. It is a case based discussion on when not to thrombolyse
Chikungunya- a short PPT.
This tells in brief about the infection.
The neurological complications is the main focus.
The management and other related issues are also discussed.
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
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
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!
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.
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.
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
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
3. LUMBAR PLEXUS
Formed by the
ANTERIOR RAMI of
L1-4.
Anterior rami join to
form OBTURATOR N.
Posterior divisions of
the rami join to form
FEMORAL N.
4. OTHER NERVES
Other nerves include-
LATERAL
CUTANEOUS NERVE
OF THIGH (pure
sensory).
ILIOHYPOGASTRIC N
ILIOINGUINAL N
GENITOFEMORAL N
5.
6. LUMBAR PLEXOPATHY
Clinical features Signs
Abrupt onset pain in
anterior aspect of thigh.
Muscle wasting and
weakness in 2-3
weeks.
Absent knee reflexes.
Tender femoral N
Positive femoral stretch
sign
7. Sensory symptoms are partial and seen in 1/3rd
patients.
NCV shows normal nerves- femoral, peroneal, sural
and saphenous N.
May show reduced amplitude.
EMG may show changes of denervation and
renervation.
Recovery may be spontaneous over months-years.
8. Normal femoral conduction velocity – 70.0 ± 5.5 m/S
FEMORAL N
From dorsal portion of anterior rami of L2-L4
Mixed Nerve
9. FEMORAL NERVE
In intraabdominal
course, supplies the
iliopsoas muscle.
Divides to anterior and
posterior division after
crossing Inguinal
ligament.
10. FEMORAL NERVE
Anterior Division Posterior Division
Medial cut N
Supplies medial thigh
Intermediate cut N
Supplies anterior thigh
Supply to Pectineus
and Sartorius
Supplies
Knee and hip joint
Quadriceps musc.
Terminates as
Saphenous N
11. FEMORAL NEUROPATHY
Causes
Weakness of Quadri.
Wasting of Quadri.
Loss of knee reflexes
Sensory loss in medial
aspect of thigh and leg
Causes
Diabetes mellitus
Intrapelvic collection
Pelvic surgery
Hip arthroplasty
Tumor of vertebra
Cannulation of Femoral
vein/artery
Inguinal lig
compression in
lithotomy
Renal transplant
12. ELECTROPHYSIOLOGY
Surface recording
electrode: belly of
vastus medialis
Reference electrode
prox to patella.
Stimulating electrode:
lateral to femoral artery.
13. NCV
Slowing of conduction velocity
Small CMAP amplitude.
Conduction block (if compressed at inguinal lig)
Saphenous vein can be used to evaluate sensory loss.
Normal femoral conduction velocity – 70.0 ± 5.5
m/S
14. Normal Saphenous conduction velocity- 49.03 ± 3.36 m/s.
SNAP Amplitude- 3.54 ± 1.52 μV
SAPHENOUS NERVE
Largest and longest pure sensory
branch of Femoral N .
Supplies skin over medial aspect of
leg and foot.
15. SAPHENOUS N
Arises from posterior
division of Femoral N
Becomes superficial
just above medial
condyle
Continues down to
head of 1st metatarsal
16. SAPHENOUS NEUROPATHY
Uncommon
Follows
Laceration injuries
Entrapment in subsartorial canal
Surgery for varicose veins
Causes sensory impairment in medial aspect of
knee, leg and foot.
17. SAPHENOUS NERVE CONDUCTION
Stimulate 1 cm above
inferior border of
patella between gracilis
and sartorius.
Recording electrode-
15 cm distal on medial
border of tibia.
18. Stimulate between
medial head of
gastrocnemius and
tibia, 12- 14 cm
proximal to med
malleolus
Recording electrode is
placed anterior to
medial malleolus
Normal Saphenous conduction velocity- 49.03 ± 3.36 m/s.
SNAP Amplitude- 3.54 ± 1.52 μV
19. Latency and Amplitude of SNAP
above Inguinal Lig- 2.8±0.4ms
and 6±1.5 μV
LATERAL FEMORAL
CUTANEOUS NERVE
OF THIGH
L2-3.
Sensory supply to
Anterolateral aspect of
thigh.
20. MERALGIA PARESTHETICA
Entrapment of the
nerve at Inguinal tunnel
Seat belts
Obesity
Unknown
Proximal lesions
Psoas abscess
Retroperitoneal tumor
Post op scarring
Pain & paresthesia over
lateral surface of thigh.
Symptoms increase on
standing and prolonged
walking.
Sensory loss is in area
smaller than supplied by
the nerve
NCV- abnormal conduction in Lat Cut N of Thigh
EMG- normal study of paraspinal, iliopsoas, quadriceps.
21. NERVE CONDUCTION-LAT
CUT N OF THIGH
Surface Electrode- 17-
20 cm distal to Ant
Supr Iliac Spine
(ASIS).
Reference electrode- 3
cm distal to surface
electrode.
Antidromic stimulation
above inguinal
ligament 1 cm medial
to ASIS
Latency and Amplitude of SNAP above Inguinal Lig- 2.8±0.4ms
and 6±1.5 μV
24. SACRAL PLEXUS
Branches
Sup Gluteal N(L4-S1)
Gluteus medius
Gluteus minimus
Tensor facsia lata
Inf Gluteal N(L5-S1)
Gluteux maximus
Sciatic N (L4-S3)
25. SACRAL PLEXOPATHY
Abrupt onset pain in
posteror aspect of the
thigh and buttocks.
Weakness of knee
flexor
Absent reflexes.
Sciatic N tenderness
Positive SLR test.
26. Normal Sciatic N Conduction
velocity- 52.75±4.66 m/s
SCIATIC NERVE
L4-S3
Comes out of sciatic notch
Supplies all hamstrings (medial
trunk) except short head of
biceps femoris
All muscles distal to knee
27. SCIATIC NEUROPATHY
Causes include-
Trauma
Fracture/disloc of hip
joint
Injection
Puncture wound
Muscle scarring
Vasculitis
Compression
Anesthesia
Coma
Lymphoma & tumours
Symptoms
Involvement of
hamstrings
Involvement of muscles
below knee
Variable sensory loss.
Needs motor
conduction studies of
Peroneal N
Post Tibial N
Sural N
Sup Peroneal N
EMG
28. SCIATIC N CONDUCTION
NCV
Difficult d/t deep location.
Surface Electrode on
distal peroneal
innervated muscle eg
abd hallucius
Stimulation-
Just below gluteal fold
Medial trunk- apex of
popliteal fossa
Lateral trunk- head of
fibula
29. EMG
Helps differentiate the condition and levels
Denervation in paraspinal muscle + normal sural snap
s/o L5/S1 radiculopathy
Involvement of gluteal muscles- involvement prior to
sciatic notch
Peroneal neuropathy v/s sciatic neuropathy-
Lat trunk- short head of biceps
Med trunk- hamstrings and other tibial supp muscles
Normal Sciatic N Conduction velocity- 52.75±4.66 m/s
31. COURSE & BRANCHES
Branches-
Lat Cut N of Calf
Supplying anterior,
lateral and posterior
surface of leg
Superficial Peroneal N
Also supplies lateral and
dorsal portion of leg and
dorsum of foot.
Deep Peroneal N
32. COMMON PERONEAL NEUROPATHY
Occurs due to
compression around
head of fibula.
In sleep/coma
Anesthesia
Plaster/tight bandage
Cross legging
Fracture of fibula
Callus/cyst/lipoma
Vasculitis
Leprosy
Weakness of
Dorsiflexion of foot and
toes
Eversion of foot
Cause foot drop and
slapping gait
Sensory loss
In distribution of
superficial peroneal N
or lat cut N of calf,
depending on level of
lesion
33. ELECTROPHYSIOLOGY
Evaluation by conduction study of
Different segments of common peroneal nerve
Superficial peroneal nerve
EMG of peroneal nerve innervated muscles.
Sural conduction and EMG of short head of biceps
differentiate from sciatic neuropathy
35. SUPERFICIAL PERONEAL
NERVE CONDUCTION
Active electrode
Just above junction of
lateral third of a line
connecting the malleoli.
Reference electrode
3cm distal to active
electrode.
Stimulation
10-15cm proximal to
upper edge of lateral
malleolus anterior to
peroneus longus
Normal peroneal nerve
conduction velocity-
49±3.4ms and amplitude
of SNAP 3.5±1.5μV
36. In peroneal neuropathy conduction block and
reduction in motor nerve conduction velocity >10ms
across head of fibula localizes the lesion at this site.
In common peroneal neuropathy muscles supplied
by the deep branch are frequently/severely
affected.
Common peroneal nerve and lateral trunk of sciatic
nerve- EMG of short head of biceps are useful
37. Sural N conduction velocity- 50.9±5.4 m/s, amplitude of SNAP 18±10.5μV
SURAL NERVE
S1 and S2
Medial derived from Tibial N
Lateral derived from Peroneal N
Pure sensory N
38. SURAL NEUROPATHY
Uncommon
Part of generalised neuropathies
Compression
Baker’s cyst
Against hard object
Tendon sheath ganglia
Scar tissue
# 5th metatarsal
Presents with
Numbness and paresthesia in supplied region
Low conduction velocity and amplitude in NCV
39. SURAL
Leg should be relaxed
and in lateral position.
Surface Electrode-between
lateral malleolus
and tendoachilles.
Stimulated 10-16 cm
proximal to recording
electrode, distal to lower
border of gastrocnemius
at the junction of middle
and lower third of leg.
Sural N conduction velocity- 50.9±5.4 m/s, amplitude of SNAP 18±10.5μV
42. TIBIAL NEUROPATHY
Damage at popliteal
fossa uncommon.
Causes-
Baker’s cyst
Nerve sheath ganglia
Popliteal A Aneurysm
Leprosy
Weakness of
plantar flexors
Invertors
Intrinsic foot muscles
Sensory loss in sole
43. TARSAL TUNNEL SYNDROME
Rare picture
Pain and paresthesia
of sole
Weakness of intrinsic
foot muscles (rare)
Causes
Ill-fitting footwear
Tight plaster cast
Post traumatic fibrosis
Tenosynovitis
RA
Hypothyroidism
Idiopathic
44. ELECTROPHYSIOLOGY
Needs tibial N
conduction, medial and
lateral plantar N
conduction, EMG.
Tibial N conduction-
Surface recording-abductor
hallucis/abductor digiti
quinti below and ant to
navicular tuberosity.
Stimulation behind and
proximal to medial
malleolus/in popliteal
fossa.
45. Motor conduction of medial and lateral plantar N
Recording electrode (M)- abductor hallucis (belly)
Recording electrode (L)-abductor digiti quinti
Nerve stimulation- behind and above medial malleolus
46. Sensory conduction of
medial and lateral
plantar nerves:
Stimulation- 1st and 5th
toes- M and L
respectively.
Recording electrode-just
below medial
malleolus.
47. In Tarsal Tunnel Syndrome
Conduction block and latency prolongation across tarsal
tunnel
Accurate localisation by inching technique (1cm)-abrupt
prolongation in latency.
Normal conduction velocity of Tibial N-48.3±4.5ms
Motor conduction
Latency for medial plantar nerve-3.8±0.5ms
Latency for lateral plantar nerve-3.9±0.5ms
Sensory conduction for
Latency for medial plantar nerve-2.4±0.2ms, 3.2±0.3ms,
4±0.2ms (10,14 and 18 cm segment).
Latency for lateral plantar nerve-3.2±0.3ms,4±0.3ms (14
and 18 cm segment).