Paraneoplastic syndrome (PNS) is the term used to refer to the disorders that accompany the benign or the malignant tumors and are not caused by mass effect or invasion / metastasis.
These disorders are triggered by an immune system response to neuronal proteins expressed by the tumor(onconeural proteins).
These PNS also occur due to substances secreted by the neoplasm itself.
MYOPATHIES A SPECIAL AND SEPERATE ENTITY WITH SPECIFIC FEATURES IN EACH DISORDER MAKING US EASY FOR DIAGNOSIS,CONFIRMATION BY MUSCLE BIOPSY.THE SEMINAR WAS PRSENTED ON 06/07/2011...AT 09.00AM
HAVE A LOOK ..AND COMMENT..WITHOUT BIAS..
MYOPATHIES A SPECIAL AND SEPERATE ENTITY WITH SPECIFIC FEATURES IN EACH DISORDER MAKING US EASY FOR DIAGNOSIS,CONFIRMATION BY MUSCLE BIOPSY.THE SEMINAR WAS PRSENTED ON 06/07/2011...AT 09.00AM
HAVE A LOOK ..AND COMMENT..WITHOUT BIAS..
Ataxia denotes a syndrome of imbalance and Incoordination involving gait, limbs, and speech and usually results from the disorder of the cerebellum or its
connections
It is characterized by dyssynergia, dysmetria, dysdiadochokinesia (Joseph Babinski).
It is a disorder of rate, range, direction and force of movements (Gordon Holmes).
Consciousness consists of awareness of one’s surrounding and responsiveness to external stimulation and inner need.
A normal level of consciousness (wakefulness) depends upon activation of the cerebral hemispheres and by neurons located in the brainstem reticular activating system (RAS).
Both components and the connections between them must be preserved for consciousness to be maintained
Sudden onset Neurological deficit (Focal/ Global) of vascular etiology motor weakness, sensory disturbance,visual disturbance, speech disturbance and Imbalance.
Every year 15 million people worldwide suffer a stroke
Stroke is second leading cause of death over the age of 60
Stroke is the second leading cause of disability, after dementia
15% - 30% of stroke survivors are permanently disabled.
Ataxia (Gk. A Taxis = Order; means lack of order)
Ataxia denotes a syndrome of imbalance and incoordination involving gait, limbs, and speech and usually results from the disorder of the cerebellum or its connections
It is characterized by dyssynergia, dysmetria,mdysdiadochokinesia (Joseph Babinski).
It is a disorder of rate, range, direction and force of movements (Gordon Holmes).
Neuroimaging is the use of various techniques to either directly or indirectly image the structure, function of the nervous system.
Neuroimaging plays a pivotal role in the diagnosis of central nervous system (CNS) disorders.
Main modalities of neuroimaging techniques are CT scan and MRI.
T1-weighted images optimally show normal soft-tissue anatomy and fat (e.g. to confirm a fat-containing mass).
T2-weighted images optimally show fluid and abnormalities (e.g. tumors, inflammation, trauma).
In practice, T1- and T2-weighted images provide complementary information, so both are important for characterizing abnormalities.
Magnetic resonance imaging (MRI) is an imaging technique used primarily in medical settings to produce high quality images of the soft tissues of the human body.
More from Sir Salimullah Medical College, Mitford, Dhaka, Bangladesh (8)
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
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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.
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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
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.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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
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.
1. Paraneoplastic syndromes
- CNS manifestations
Dr. Aminur Rahman
FCPS(Med), MD(Neuro) ,FINR (Switzerland),
MACP (USA) , Member AAN (USA)
Fellow Interventional Neuroradiology (Thailand)
Assistant Professor
Department of Neurology
Sir Salimullah Medical College
2. Learning objectives
Definition
Introduction
Pathogenesis
Classification
Paraneoplastic cerebellar degeneration (PCD)
Paraneoplastic encephalomyelitis / sensory neuronopathy (PEM/PSN)
Paraneoplastic opsoclonus myoclonus (POM)
Lambert-Eaton myasthenic syndrome (LEMS)
To know the antineural antibodies associated with the syndromes
Differentiations of different syndromes
3. Definition
Paraneoplastic syndrome (PNS) is the term used to
refer to the disorders that accompany the benign or
the malignant tumors and are not caused by mass
effect or invasion / metastasis.
These disorders are triggered by an immune system
response to neuronal proteins expressed by the
tumor(onconeural proteins).
These PNS also occur due to substances secreted
by the neoplasm itself.
4. Introduction
PNS may be the first presentation of the underlying
neoplasm (often tumor is unknown). – Neurological
involvement in PNS often produces rapid and severe
deficits in short period of time. – Prompt tumor control
improves neurological outcome.
Complications of cancer and cancer therapy are not
considered as PNS (e.g. coagulopathy, stroke, metabolic
and nutritional conditions, infections and side effects of
cancer
5. Introduction- Continued
Heterogeneous group of disorders
Associated with systemic cancers
Mechanisms other than…
Metastases
Metabolic and nutritional deficits
Infections
Coagulopathy
Side effects of treatment
6. Introduction- Continued
Occur in < 1% of pts with systemic cancer
Heralds diagnosis of cancer in up to 60%
Highly specific antineuronal antibodies
Most common (presence overlaps)
Paraneoplastic cerebellar degeneration (PCD)
Paraneoplastic encephalomyelitis / sensory neuronopathy
(PEM/PSN)
Paraneoplastic opsoclonus myoclonus (POM)
Lambert-Eaton myasthenic syndrome (LEMS)
7. Pathogenesis
Most PNS are mediated by immune responses triggered by
neuronal proteins (onconeural antigens) expressed by
tumors.
Both humoral (antibodies) and cell mediated immunity
(CD4 & CD8)are activated. Subsequently microglial
activation leads to gliosis and neuronal loss.
These Immune responses have complex mechanism hence
these PNS are resistant to therapy .
8. Pathogenesis- Continued
Cell mediated immunity acts against intracellular antigens
and is less responsive to therapy than antibody mediated.
Antibody mediated acts primarily at the neuronal surface
antigens and neuromuscular junctions.
Classic PNS occur with cancer association.
Non classical PNS may or may not occur with cancer
association and they are commonly seen in children.
11. Examples of non classical PNS
Brain stem encephalitis
Stiff person syndrome
Necrotizing myelopathy
Motor neuron disease
Guillian Barre syndrome
Subacute or chronic mixed neuropathies
Neuropathy associated with plasma cell dycrasias
Vasculitis of nerve or muscle
Pure autonomic neuropathy
Acute necrotizing myopathy
Optic neuropathy
12. Paraneoplastic cerebellar degeneration (PCD)
This is characterized by symptoms such as dizziness,
oscillopsia, blurry or double vision, nausea, and vomiting.
Most commonly develops in women
Pathology – extensive degeneration of Purkinje cells in
cerebellum occasionally in cortex.
13. PCD- continued
After few weeks diseases progresses patient usually
severely disabled
Gait and limb ataxia
Severe dysarthria
Patients usually have downbeating nystagmus and
opsoclonus
14. PCD- continued
50% have nonspecific CSF analysis
Lymphocytic pleocytosis
Elevated protein levels
MRI reveals cerebellar atrophy.
These tumors are involved in SCLC(anti VGCC), ca
breast, ca ovary(anti Yo ), Hodgkin's lymphoma(anti Tr ).
15. Paraneoplastic encephalomyelitis /
sensory neuronopathy (PEM/PSN)
Most commonly associated with lung cancer
Onset of symptoms precedes diagnosis of cancer
PEM symptoms (limbic involvement)
Rapidly progressive dementia
Seizures
PSN symptoms
Progressive paresthesias
Profound sensory ataxia
Multimodality sensory loss
16. PEM/PSN (continued)
Neuroimaging is normal
CSF findings reveal nonspecific inflammation
Lymphocytic pleocytosis
Elevated protein level
Nerve conduction studies in PSN reveal markedly reduced
or absent sensory nerve potentials
17. PEM/PSN (continued)
Careful malignancy evaluation indicated
CT chest/abdomen/pelvis
Testicular U/S and mammography
Natural history
Progresses rapidly over weeks
Causes severe disability
Stabilizes
18. Paraneoplastic opsoclonus myoclonus
(POM)
Opsoclonus is a disorder of eye movement
characterized by involuntary, chaotic
saccades that occur in all directions of gaze;
it is frequently associated with myoclonus and
ataxia. Rarely they present with laryngeal
spasms and autonomic dysfunctions.
In adults, most commonly associated with…
Small cell lung cancer
Breast cancer
Develops prior to diagnosis of cancer
19. POM - continued
Pathology – disinhibition of fastigial nucleus in cerebellum.
Associated antibodies – anti Ri antibodies
Manifestations
Rapidly progressive cerebellar ataxia
Opsoclonus
Myoclonus
Treatment
– control of tumour and
– immunotherapy(glucocorticoids , plasma exchange and
IVIG)
20. Lambert-Eaton myasthenic syndrome (LEMS)
Incidence
Uncommon, true incidence unknown
Occurs much less frequently than myasthenia gravis
Middle-aged adults
50% of LEMS associated with a malignancy (small cell lung
cancer (SCLC)
3% of SCLC have LEMS
Other tumors are lymphoproliferative disorders (Hodgkin
lymphoma), "atypical" carcinoid and malignant thymoma
27% have other autoimmune disorders (DM Type 1 or Thyroid)
+FHx - Families of pts with non-paraneoplastic LEMS have an
increased frequency of autoimmune diseases, while families of
patients with paraneoplastic LEMS do not.
21. Pathophysiology LEMS
Antibodies directed against the voltage-gated calcium
channel (VGCC) interfering with the normal pre-
synaptic calcium influx required for Ach release
Among these, the L-type, N-type, and P/Q-type
VGCC are the most important.
P/Q-type VGCCs make up more than 95 percent of
the functioning receptors at the neuromuscular
junction (NMJ) and probably represent the main
immunologic target in LEMS
The expression of functional VGCCs in the surface
membrane of small cell lung cancer (SCLC) cells is
probably responsible for most if not all cases of
paraneoplastic LEMS
22. Clinical features of LEMS
Usual manifestations
Proximal upper and lower extremity weakness
Symptoms of autonomic dysfunction
Dry eyes and mouth
Orthostatic hypotension
Bowel and bladder dysfunction
23. Clinical features of LEMS
Signs
Deep Tendon Reflexes (DTRs )are almost always
depressed or absent.
Postsynaptic /post exercise facilitation
10sec Maximal isometric contraction may lead to
temporary reappearance of previously depressed or
absent DTRs/temporary improvement of muscle
weakness.
24. LEMS (continued)
Voltage gated calcium channel (VGCC)
Helps release acetylcholine at NMJ
Antagonized by anti-VGCC antibodies
Produce clinical disease
Blockade muscle weakness facilitation
Blockade at other sites autonomic dysfunction
90% of affected patients are seropositive
25. LEMS (continued)
Nerve conduction studies
Low-amplitude motor potentials
Increased amplitude with…
Exercise
Rapid repetitive stimulation
Most closely associated with SCLC
50-60% of patients have underlying cancer
Careful evaluation indicated
26. LEMS- Treatment
Aggressive search for a primary underlying malignancy
(SCLC) is central
Guanidine - inhibits voltage-gated K channels and enhances
the release of ACh. Significant toxicity limits use. SE
include bone marrow suppression and renal toxicity.
Aminopyridines (Dalfampridine) - significant prolongation
of the nerve terminal membrane depolarization enhancing Ca
entry and improving Ach release.
AChEI (Pyridostigmine) - Reduce the metabolism of ACh.
Intravenous immune globulin (IVIG) - Useful with MG and
LEMS reducing the mass of voltage-gated Ca channel
antibodies