1. An ischemic stroke occurs when a blood clot or fat deposit blocks an artery in the brain, cutting off blood flow and oxygen to brain cells.
2. There are two main types - arterial thrombosis where a clot forms in the brain artery, and cerebral embolism where a clot forms elsewhere and travels to the brain.
3. Risk factors include age, gender, medical conditions like high blood pressure, smoking, high cholesterol, prior transient ischemic attacks, and family history.
Intracerebral hemorhage Diagnosis and managementRamesh Babu
About ICH - Diagnosis and management, Discussed the clinical presentation, evaluation, radiological features and management including recent guidelines
Intracerebral hemorhage Diagnosis and managementRamesh Babu
About ICH - Diagnosis and management, Discussed the clinical presentation, evaluation, radiological features and management including recent guidelines
Dr Avinash.KM is a Neurosurgeon with advanced training in Interventional vascular Neurosurgery(FINR) from Zurich, Switzerland, and FMINS-Fellowship in minimally invasive and Endoscopic Neurosurgery from Germany.
He is presently working in Columbia asia hospitals, Bangalore.
His main areas of interest are Vascular Neurosurgery, Stroke specialist, interventional neuroradiology, Endovascular Neurosurgery, Endoscopic and minimally invasive Neurosurgery, Endoscopic spine surgery.He has advanced training in both Brain Aneurysm coiling and clipping, Brain AVM embolizations and its surgical removal, carotid artery stenting and carotid endarterectomy. Since he is trained both in open microvascular Neurosurgery and in Interventional Neurosurgery he helps patients in choosing the right treatment options for brain vascular diseases with out any bias of one treatment over the other.
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.
Dr Avinash.KM is a Neurosurgeon with advanced training in Interventional vascular Neurosurgery(FINR) from Zurich, Switzerland, and FMINS-Fellowship in minimally invasive and Endoscopic Neurosurgery from Germany.
He is presently working in Columbia asia hospitals, Bangalore.
His main areas of interest are Vascular Neurosurgery, Stroke specialist, interventional neuroradiology, Endovascular Neurosurgery, Endoscopic and minimally invasive Neurosurgery, Endoscopic spine surgery.He has advanced training in both Brain Aneurysm coiling and clipping, Brain AVM embolizations and its surgical removal, carotid artery stenting and carotid endarterectomy. Since he is trained both in open microvascular Neurosurgery and in Interventional Neurosurgery he helps patients in choosing the right treatment options for brain vascular diseases with out any bias of one treatment over the other.
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.
localization of stroke, CVS, stroke, for post graduates Kurian Joseph
New localization of stroke syndromes
1.Clinical localization of the site of the lesion.
2.Identifying the vascular territory and the vessel involved.
3.Correlating with the imaging findings.
Ischemic Stroke Subclassification, An Asian ViewpointErsifa Fatimah
Pada awalnya, sistem klasifikasi stroke diderivasi dari temuan autopsi yang dikaitkan dengan klinis pasien. Seiring dengan berkembangnya modalitas imaging & investigasi vaskular, klasifikasi stroke yang pada awalnya menitikberatkan pada sindroma klinis beralih menjadi suatu proses decision-making berdasarkan data klinis-radiologis-laboratoris.
Menariknya lagi, proporsi subtipe stroke ini pun berubah, sesuai sistem & kriteria yang digunakan...
Hmmm, bagaimana dengan klasifikasi dan proporsi tipe stroke di Asia?
Definition of stroke and cerebrovascular disorders and pathophysiology of cerebral infarct and CT imaging overview of acute-subacute and chronic infarcts and penumbra.
causes of cerebral edema , Radiological signs of acute infarct and hemorrhagic infarct and comparison of MRI and CT in the diagnosis of acute infarct
Role of diffusion weighted imaging (DWI) and diffusion perfusion mismatch
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Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
2. INTRODUCTION
• The blood supply is
blocked by a blood clot or
clump of fat. This
damages your brain cells
and they begin to die.
• Ischaemic stroke affects
about 9 out of every 10
people who have a stroke.
It’s most common in
people over the age of 65,
although can happen at
any age.
3. TWO TYPES
ARTERIAL THROMBOSIS
• Also called thrombotic
stroke or cerebral
thrombosis.
• This is when a blood clot
forms in an artery that
supplies your brain and
blocks the blood supply.
4. TWO TYPES (cont’d)
CEREBRAL EMBOLISM
• Also known as embolic
stroke.
• This is when a blood clot
forms somewhere else in
your body and travels to
your brain and blocks the
blood supply. The clot
usually forms in your heart
or one of the large arteries
that supplies your brain.
8. SIGNS & SYMPTOMS
• Symptoms usually come
on suddenly, within
seconds or minutes.
• You may also have a
Transient Ischaemic
Attack (TIA) before a
full blown stroke.
9. SIGNS & SYMPTOMS (cont’d)
• A good way to
recognise if you or
someone you’re with
has had a stroke is to
use the ‘FAST’ test.
10. SIGNS & SYMPTOMS (cont’d)
• The exact symptoms
depend on where in
your brain the blood
supply has been
blocked.
• This is because different
areas of your brain
control different
functions and they all
receive blood through
different arteries.
11. SIGNS & SYMPTOMS (cont’d)
TRANSIENT ISCHAEMIC ATTACK
(TIA)
• A transient neurologic
attack that lasts <24 hours
(most last <1 hour) and is
determined to be of
ischaemic etiology.
12. SIGNS & SYMPTOMS (cont’d)
ANTERIOR CEREBRAL ARTERY
• Contralateral paresis and
sensory loss in the leg.
• Cognitive or personality
changes.
13. SIGNS & SYMPTOMS (cont’d)
MIDDLE CEREBRAL ARTERY
• Pneumonic: “CHANGes”
– Contralateral paresis and
sensory loss in the face and
the arm.
– Homonymous Hemianopsia.
– Aphasia.
– Neglect.
– Gaze preference toward the
side of the lesion.
15. SIGNS & SYMPTOMS (cont’d)
BASAL GANGLIA LACUNAR
• Pure motor or sensory
stroke.
• Dysarthria-clumsy hand
syndrome, ataxic
hemiparesis.
16. SIGNS & SYMPTOMS (cont’d)
BASILAR ARTERY
• Coma
• “Locked-In” Syndrome
• Cranial Nerve Palsies
• Apnea
• Visual Symptoms
• Drop Attacks
• Dysphagia
• Dysarthria
• Vertigo
• “Crossed” weakness and sensory
loss affecting the ipsilateral face
and contralateral body.
17. DIAGNOSIS
• You will have your blood
pressure measured and an
electrocardiogram (ECG) to
record the rhythm and
electrical activity of your
heart.
• Echocardiogram (ECHO) of
your heart if embolic stroke
is suspected.
• You may then have tests to
measure the levels of
cholesterol and sugar in
your blood.
18. DIAGNOSIS (cont’d)
• As soon as possible you’ll
also have a brain scan, such
as a CT or MRI. This will
determine whether you
have had an ischaemic
stroke or a haemorrhagic
stroke. A haemorrhagic
stroke is when an artery or
vein bursts and bleeds into
your brain.
• Strokes <6 hours old are
usually NOT visible on CT
scan.
19. DIAGNOSIS (cont’d)
• White signals on left side
are suggestive of
blockage of blood flow in
Left side blood vessel
(MCA) suggestive of acute
brain attack (infarction).
• Diffusion-weighted MRI is
sensitive for acute stroke
with changes as early as
20 minutes after an
ischaemic event.
20. DIAGNOSIS (cont’d)
• MRI of acute middle carotid
artery (MCA) stroke on MRI at 12
hours post-ictus. T2-weighted
image shows mild hyper-intensity
of the middle carotid artery
territory (arrows). Non-contrast
T1-weighted image demonstrates
early stroke changes with
effacement of cortical sulci in the
MCA territory associated with
swelling and mild hypo-intensity
of the cortical ribbon (arrows).
After contrast (gadolinium)
administration, intravascular
enhancement is present,
indicating sluggish flow in the
ischemic zone (arrows).
21. DIAGNOSIS (cont’d)
• MRI axial FLAIR images
of Brain show an infarct
involving left frontal
lobe anterior to sylvian
fissure. Area of
involvement
corresponds to left MCA
Superior Division
territory.
22. DIAGNOSIS (cont’d)
• Left: CT scan slice of the
brain showing a right-
hemispheric ischemic
stroke.
• Right: MRI showing
damaged brain cells due
to a left-hemispheric
ischaemic stroke.
24. DIAGNOSIS (cont’d)
LABORATORY STUDIES
• Complete blood count (CBC)
• Basic chemistry panel
• Coagulation studies
• Toxicology screening: May assist
in identifying intoxicated patients
with symptoms/behaviour
mimicking stroke syndromes.
• Arterial blood gas analysis: In
selected patients with suspected
hypoxemia. It defines the severity
of hypoxemia and may be used to
detect acid-base disturbances.
26. TREATMENT (cont’d)
• If you can't swallow, you’ll be
given fluid through a drip in
your arm to stop you
becoming dehydrated.
• You will have a nasogastric
tube inserted to give you all
the nutrients and medicines
that you need.
• You may also be given oxygen
through a face mask or by
means of endotracheal
intubation to help maintain
optimum blood oxygen
saturation levels.
27. TREATMENT (cont’d)
• You’ll be helped to sit up and
encouraged to move around as
soon as you’re able.
• If you can’t move, your
healthcare team will regularly
help you to turn in your bed. This
will reduce your risk of getting
bed sores and deep vein
thrombosis (DVT).
• You may also be given a
mechanical pump to use on your
feet and legs. This is called an
intermittent compression device.
The pump automatically squeezes
your feet and lower legs to help
your blood circulate.
28. TREATMENT (cont’d)
MEDICINES
• Alteplase is a medicine (IV
tPA-Tissue Plasminogen
Activator) used to break up
blood clots, and will help
restore the blood flow to
your brain. You need to
have it within four and a
half hours of your
symptoms starting for it to
be effective.
• Intra-arterial thrombolysis
can be used within 6 hours
of a major stroke from
Middle Cerebral Artery
occlusion if such patients
are not suitable candidates
for Alteplase.
29. CONTRAINDICATIONS TO ALTEPLASE
THERAPY
Pneumonic: SAMPLE STAGES
– Stroke or head trauma within
the last 3 months.
– Anticoagulation with INR>1.7
or prolonged PTT.
– MI (recent).
– Prior Intracranial
Haemorrhage.
– Low Platelet Count
(<100,000/mm3 )
– Elevated BP: Systolic>185 or
Diastolic >110mmHg
– Surgery in the past 14 days.
– TIA (mild symptoms or rapid
improvement of symptoms).
– Age<18
– GI or urinary bleeding in the
past 21 days
– Elevated (>400mg/dl) or
Decreased (<50mg/dl) Blood
glucose.
– Seizures present at the onset
of stroke.
30. TREATMENT (cont’d)
MEDICINES
• Aspirin and Clopidogrel are
used to reduce your risk of
blood clots forming after a
stroke.
• Aspirin is associated with
reduced morbidity and
mortality in acute ischaemic
stroke presenting <48 hours
from onset.
• Warfarin, non-vitamin K
antagonist oral anticoagulant
medicines (NOACs) or Heparin
can also prevent blood clots
forming. You may have these
medicines if your doctor thinks
the clot came from your heart.
Again, these aren’t suitable for
everybody.
• You may also be given some
other medicines to control
your blood pressure, blood
sugar and lower your
cholesterol.
31. TREATMENT (cont’d)
SURGERY
• This may involve an
operation called Carotid
Endarterectomy to remove
blood clots and fatty
deposits from one of the
carotid arteries in your
neck. The surgery may help
to reduce your risk of
having another stroke but
isn’t suitable for everyone.
33. TREATMENT (cont’d)
• Monitor for signs and
symptoms of brain
swelling, ↑ICP and
herniation.
• Serial CTs are helpful in
the evaluation of
deteriorating patients.
• As a temporizing
measure, treat with
Mannitol and
hyperventilation.
34. TREATMENT (cont’d)
SEVERE HYPERTENSION (SYSTOLIC
BP>220 OR DIASTOLIC BP>120mmHg)
• Treat with IV Labetalol or
Nicardipine infusion.
• For the administration of
Alteplase, the patient’s
systolic BP must be <185
and diastolic BP<110mmHg.
35. TREATMENT (cont’d)
• Treat: Fever and
Hyperglycaemia, as
both are associated
with worse prognoses
in the setting of acute
stroke.
• Prevent and treat post-
stroke complications:
Aspiration Pneumonia,
UTI and DVT.
37. REHABILITATION
• A multidisciplinary team of
health professionals will work
out a rehabilitation
programme for you that’s
designed around your
particular needs.
• Rehabilitation aims to help you
stay as independent as
possible and get back to your
usual activities, or adapt to
new ways of doing things.
• You may make most of your
recovery in the early weeks
and months afterwards but
you may continue to improve
for years.
39. PROGNOSIS
• In the acute phase of stroke, the strongest
predictors of outcome are : Stroke Severity
and Patient Age.
• Stroke severity can be judged clinically, based
upon the degree of neurologic impairment
and the size and location of the infarction on
neuroimaging with MRI or CT.
• Other important influences on stroke
outcome include infarct location, ischemic
stroke mechanism, comorbid conditions,
epidemiologic factors, and complications of
stroke.
• In the period from 12 hours to 7 days after
ischemic stroke onset, many patients who
are without complications experience
moderate but steady improvement in
neurologic impairments. The greatest
proportion of recovery occurs in the first 3 to
6 months after stroke, with lesser
improvements thereafter.
40. PROGNOSIS (cont’d)
• The return of arm and hand
function after stroke is
particularly important to a
good functional recovery.
Early active finger
extension, grasp release,
shoulder shrug, shoulder
abduction, and active range
of motion are associated
with a favourable prognosis
for arm and hand recovery
at 6 months.