The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
This document discusses osteonecrosis, or bone death caused by interrupted blood flow. It focuses on osteonecrosis of the femoral head, which is the most common site. Key points include:
- The femoral head is particularly vulnerable due to its blood supply. Interruption can be caused by trauma, coagulopathies, alcohol/steroid use.
- Symptoms include hip pain and limping. Imaging like MRI can detect early changes before X-rays.
- Treatment depends on the stage and size of the lesion. Options include core decompression, bone grafting, osteotomy, or hip replacement in advanced cases.
- Porous tantalum rods are a novel minimally
This document summarizes current concepts in the management of osteonecrosis of the femoral head. Nonoperative treatments for early-stage disease include restricted weight bearing, bisphosphonates, anticoagulants, and extracorporeal shock wave therapy or pulsed electromagnetic therapy, which may prevent progression. Surgical options include core decompression or bone grafting to preserve the hip for precollapse stages, while hip replacement is used for advanced collapse. The goals are to improve hip function, relieve pain, and prevent or delay further progression and need for replacement surgery.
Dorsal root entry zone (DREZ) lesions involve thermocoagulation of the DREZ to ablate second-order neurons that transmit nociceptive pain signals. It provides relief for various refractory pain conditions, including brachial plexus avulsion, spinal cord injury, postherpetic neuralgia, and post-amputation pain. The technique precisely targets the DREZ through microscopic visualization and stimulation mapping. Outcomes studies report 50% or greater pain relief in many patients, especially for brachial plexus avulsion, with benefits lasting several years. However, risks include hypoesthesia, dysesthesia, motor weakness and sphincter dysfunction at the treated level.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The document provides guidance on how to read spine MRI scans. It discusses T1 and T2 weighted images and what tissues appear dark or bright on each. It describes how to evaluate mid-sagittal, para-sagittal, and foraminal-sagittal slices as well as axial slices. Key areas to inspect include the disc, neural foramina, thecal sac, and posterior arch. Common pathologies like disc herniations and spinal stenosis are also explained.
Ephaptic transmission of impulses between neighbouring neurons (i.e. coupling of adjacent nerve fibres due to local exchange of ions or local electric fields) leading to excessive or abnormal firing.
This document discusses measuring optic nerve sheath diameter (ONSD) in the emergency department to assess intracranial pressure. ONSD measurement uses ultrasound to non-invasively measure the diameter of the optic nerve sheath, which is distensible and connected to intracranial cerebrospinal fluid pressure. The technique involves placing a ultrasound probe over a patient's closed eyelid in both horizontal and vertical planes to image the optic nerve 3mm behind the eyeball and measure its diameter, with the average of left and right eyes used to assess intracranial pressure.
This document discusses osteonecrosis, or bone death caused by interrupted blood flow. It focuses on osteonecrosis of the femoral head, which is the most common site. Key points include:
- The femoral head is particularly vulnerable due to its blood supply. Interruption can be caused by trauma, coagulopathies, alcohol/steroid use.
- Symptoms include hip pain and limping. Imaging like MRI can detect early changes before X-rays.
- Treatment depends on the stage and size of the lesion. Options include core decompression, bone grafting, osteotomy, or hip replacement in advanced cases.
- Porous tantalum rods are a novel minimally
This document summarizes current concepts in the management of osteonecrosis of the femoral head. Nonoperative treatments for early-stage disease include restricted weight bearing, bisphosphonates, anticoagulants, and extracorporeal shock wave therapy or pulsed electromagnetic therapy, which may prevent progression. Surgical options include core decompression or bone grafting to preserve the hip for precollapse stages, while hip replacement is used for advanced collapse. The goals are to improve hip function, relieve pain, and prevent or delay further progression and need for replacement surgery.
Dorsal root entry zone (DREZ) lesions involve thermocoagulation of the DREZ to ablate second-order neurons that transmit nociceptive pain signals. It provides relief for various refractory pain conditions, including brachial plexus avulsion, spinal cord injury, postherpetic neuralgia, and post-amputation pain. The technique precisely targets the DREZ through microscopic visualization and stimulation mapping. Outcomes studies report 50% or greater pain relief in many patients, especially for brachial plexus avulsion, with benefits lasting several years. However, risks include hypoesthesia, dysesthesia, motor weakness and sphincter dysfunction at the treated level.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The document provides guidance on how to read spine MRI scans. It discusses T1 and T2 weighted images and what tissues appear dark or bright on each. It describes how to evaluate mid-sagittal, para-sagittal, and foraminal-sagittal slices as well as axial slices. Key areas to inspect include the disc, neural foramina, thecal sac, and posterior arch. Common pathologies like disc herniations and spinal stenosis are also explained.
Ephaptic transmission of impulses between neighbouring neurons (i.e. coupling of adjacent nerve fibres due to local exchange of ions or local electric fields) leading to excessive or abnormal firing.
This document discusses measuring optic nerve sheath diameter (ONSD) in the emergency department to assess intracranial pressure. ONSD measurement uses ultrasound to non-invasively measure the diameter of the optic nerve sheath, which is distensible and connected to intracranial cerebrospinal fluid pressure. The technique involves placing a ultrasound probe over a patient's closed eyelid in both horizontal and vertical planes to image the optic nerve 3mm behind the eyeball and measure its diameter, with the average of left and right eyes used to assess intracranial pressure.
This document discusses optic nerve sheath diameter (ONSD) measurement using ultrasound as a non-invasive method for monitoring intracranial pressure. It outlines the anatomy of the optic nerve sheath, how to perform the ONSD ultrasound technique, and the advantages it has over invasive monitoring methods. A cutoff of 5mm is commonly used and differentials for an increased measurement include raised ICP as well as other conditions affecting the optic nerve or surrounding structures.
278 Treatment of disk and ligamentous diseases of the cervical spineNeurosurgery Vajira
This document provides an overview of the pathophysiology, clinical presentation, diagnosis, and treatment of cervical disk and ligamentous diseases. It discusses the degenerative changes that occur with spondylosis including loss of disk height and osteophyte formation. Clinical findings are outlined for cervical radiculopathy including positive Spurling's and abduction relief signs, and for cervical myelopathy including upper and lower motor neuron signs. Diagnostic studies including plain radiographs, CT, MRI, and electrodiagnostic testing are covered. Nonoperative treatments include rest, medication, and physical therapy. Surgical indications and techniques for anterior cervical diskectomy with or without fusion and posterior cervical foraminotomy are summarized.
Newer advances in the field has made surgeons once again looking at Core decompression as an important procedure for treating avascular necrosis of the femoral head. The talk is about the newer development in the field of the Core decompression and how the newer techniques are transforming the way the surgeons take care of this important problem.
Cranioplasty is a surgical procedure to reconstruct and repair a defect in the skull. Some key points:
- The first documented cranioplasty used a piece of dog cranium to repair a defect in a Russian nobleman in the 17th century.
- Autologous bone is still considered the best graft material due to its biocompatibility and ability to integrate with native bone. Other common materials include methyl methacrylate, titanium, and hydroxyapatite.
- Indications for cranioplasty include protecting the brain, restoring cosmetic appearance, relieving headaches, and preventing brain herniation. Early repair may help alleviate symptoms of the "syndrome of the
This document discusses complications that can arise from regional anesthesia. It covers nerve injuries, infections, systemic toxicity from local anesthetics, and issues related to anticoagulation. Specific complications covered include nerve injuries from peripheral nerve blocks, infections from continuous perineural catheters, cardiac and neurological toxicity from local anesthetics, and challenges with anticoagulated patients. Prevention strategies and management approaches are provided.
A craniectomy is a neurosurgical procedure that involves removing a portion of the skull. It differs from a craniotomy in that the removed bone is not replaced, leaving a defect in the skull. A craniectomy is performed to relieve pressure on the brain, such as from swelling, bleeding, or infection. After the procedure, patients require wound care including cleaning and monitoring the incision, hair washing, and safety measures like fall prevention due to their vulnerability. Complications can include infection, bleeding, seizures, and brain injury.
Avascular necrosis of the femoral head, also known as osteonecrosis, results from interrupted blood supply to the bone and leads to bone cell death. It has traumatic causes like hip fractures or dislocations and non-traumatic causes like corticosteroid use, alcoholism, or blood disorders. MRI is the most accurate imaging test and stages the disease from pre-collapse to complete joint destruction. Early stages are treated with non-surgical options like protected weight bearing or core decompression surgery, while later stages may require joint replacement. The goal of treatment is to delay or prevent femoral head collapse through reducing pressure and promoting revascularization.
The document discusses the supraorbital craniotomy technique in neurosurgery. It provides a brief history of the approach, beginning with Krause first demonstrating it in 1900. Indications for its use include aneurysms of the anterior circulation, tumors of the anterior cranial fossa and sphenoid ridge, and pathologies of the sella and suprasellar region. The technique involves a supraorbital incision and craniotomy to access structures like the orbital roof, anterior clinoid processes, cavernous sinus, and anterior circulation vessels. Complications can include bleeding, infection, supraorbital numbness, and CSF leaks. The approach provides good exposure with minimal brain retraction and smooth postoperative recovery.
Carpal tunnel syndrome is caused by compression of the median nerve in the carpal tunnel. It is characterized by numbness and tingling in the hand and fingers, especially at night. While splinting and steroid injections provide short-term relief, surgical release of the transverse carpal ligament is often required for long-term symptom relief. Open carpal tunnel release has traditionally been used but endoscopic techniques have gained popularity due to potentially faster recovery times. Both open and endoscopic techniques have been shown to significantly improve symptoms and function, though endoscopic release may result in less postoperative pain.
Vestibular schwannoma, also known as acoustic neuroma, is a benign tumor of the vestibular nerve sheath cells. It accounts for 6% of all intracranial tumors and 80-90% of cerebellopontine angle tumors. The tumor grows medially from the Schwann cells of the vestibular nerve and presents in stages ranging from isolated otological symptoms to brainstem compression. Diagnosis involves radiological investigations like CT, MRI and MRA. Treatment options include observation, surgery, and stereotactic radiosurgery depending on tumor size and patient factors.
This document discusses using optic nerve sheath diameter (ONSD) measurements via ultrasound as a tool to assess increased intracranial pressure (ICP). It provides background on ONSD anatomy and evidence that ONSD changes mimic ICP changes. Studies show ONSD has high sensitivity and specificity for detecting elevated ICP compared to invasive monitoring. The document proposes a prospective study measuring ONSD in patients with conditions like end-stage liver disease, end-stage renal disease, and hypertensive crises to see if ONSD decreases after treatment and normalize, indicating reduced ICP. It suggests ONSD could help predict complications like dialysis disequilibrium syndrome.
This document discusses avascular necrosis (also known as osteonecrosis), which is the death of bone tissue due to a lack of blood supply. It begins by defining the condition and listing common sites of involvement. It then covers epidemiology, causes, pathogenesis, clinical features, investigations, treatment options and complications. Key points include that the femoral head is the most common site, risk factors include trauma, steroid use and sickle cell disease, and treatment ranges from non-operative options like core decompression to joint replacement surgeries depending on the stage of necrosis.
Planning for Awake Brain Surgery: In Light of Research Regarding Language Loc...Allina Health
This document discusses the evolution of surgical management of brain tumors at Abbott Northwestern Hospital over the past two decades. It describes how the integration of neuronavigation, functional MRI, and intraoperative MRI has allowed surgeons to remove more of tumors while avoiding injury to eloquent brain areas. Over 1700 patients with various brain tumors have undergone surgery using these techniques. The document also presents four case examples and discusses how awake brain mapping during surgery helps identify language areas of the brain to further aid in maximal tumor resection.
A detailed description of acoustic neuroma: the symptoms, causes, diagnosis, and treatment methods.For more information, please visit www.everydayhearing.com
Awake craniotomy allows surgeons to map eloquent brain areas and remove tumors near these areas while the patient is awake. It has advantages over surgery under general anesthesia by avoiding postoperative deficits. The technique requires careful planning and multidisciplinary coordination between the surgeon, anesthesiologist, and patient. Anesthesiologists aim to keep the patient comfortable and cooperative while limiting interference with brain mapping. Local anesthesia, sedation, and nerve blocks are used to achieve this balance. Complications can occur but are often avoided with experience and vigilance. Awake craniotomy offers benefits but demands expertise from all involved parties.
This document discusses neurological complications that can arise from regional anesthesia used in obstetrics. It outlines two case reports of patients experiencing numbness after epidurals for labor and delivery, with one case likely due to positioning during prolonged labor. It then discusses obstetric and anesthesia-related causes of neurological deficits. Obstetric causes include compression injuries from prolonged labor or forceps delivery. Proper diagnosis requires a thorough history, physical exam, and potential imaging or laboratory tests. Neurological complications from regional anesthesia are very rare but careful technique aims to minimize risk.
The document discusses various reasons for failed spinal anesthesia, including:
- Equipment failures during early experiments with spinal anesthesia that led to leakage of the cocaine solution.
- The wide variation in how cocaine solutions dispersed among patients, referred to as "capriciousness", contributed to inconsistent results.
- Factors like an inexperienced operator, patient characteristics like obesity, and acute medical conditions can increase risks of failure.
- Repeated puncture attempts, lack of adjuvant medication, and patient age over 70 were found to be independent risk factors for failure in one study.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
S1 antiarrhythmicdrugs 000 /certified fixed orthodontic courses by Indian den...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
This document discusses optic nerve sheath diameter (ONSD) measurement using ultrasound as a non-invasive method for monitoring intracranial pressure. It outlines the anatomy of the optic nerve sheath, how to perform the ONSD ultrasound technique, and the advantages it has over invasive monitoring methods. A cutoff of 5mm is commonly used and differentials for an increased measurement include raised ICP as well as other conditions affecting the optic nerve or surrounding structures.
278 Treatment of disk and ligamentous diseases of the cervical spineNeurosurgery Vajira
This document provides an overview of the pathophysiology, clinical presentation, diagnosis, and treatment of cervical disk and ligamentous diseases. It discusses the degenerative changes that occur with spondylosis including loss of disk height and osteophyte formation. Clinical findings are outlined for cervical radiculopathy including positive Spurling's and abduction relief signs, and for cervical myelopathy including upper and lower motor neuron signs. Diagnostic studies including plain radiographs, CT, MRI, and electrodiagnostic testing are covered. Nonoperative treatments include rest, medication, and physical therapy. Surgical indications and techniques for anterior cervical diskectomy with or without fusion and posterior cervical foraminotomy are summarized.
Newer advances in the field has made surgeons once again looking at Core decompression as an important procedure for treating avascular necrosis of the femoral head. The talk is about the newer development in the field of the Core decompression and how the newer techniques are transforming the way the surgeons take care of this important problem.
Cranioplasty is a surgical procedure to reconstruct and repair a defect in the skull. Some key points:
- The first documented cranioplasty used a piece of dog cranium to repair a defect in a Russian nobleman in the 17th century.
- Autologous bone is still considered the best graft material due to its biocompatibility and ability to integrate with native bone. Other common materials include methyl methacrylate, titanium, and hydroxyapatite.
- Indications for cranioplasty include protecting the brain, restoring cosmetic appearance, relieving headaches, and preventing brain herniation. Early repair may help alleviate symptoms of the "syndrome of the
This document discusses complications that can arise from regional anesthesia. It covers nerve injuries, infections, systemic toxicity from local anesthetics, and issues related to anticoagulation. Specific complications covered include nerve injuries from peripheral nerve blocks, infections from continuous perineural catheters, cardiac and neurological toxicity from local anesthetics, and challenges with anticoagulated patients. Prevention strategies and management approaches are provided.
A craniectomy is a neurosurgical procedure that involves removing a portion of the skull. It differs from a craniotomy in that the removed bone is not replaced, leaving a defect in the skull. A craniectomy is performed to relieve pressure on the brain, such as from swelling, bleeding, or infection. After the procedure, patients require wound care including cleaning and monitoring the incision, hair washing, and safety measures like fall prevention due to their vulnerability. Complications can include infection, bleeding, seizures, and brain injury.
Avascular necrosis of the femoral head, also known as osteonecrosis, results from interrupted blood supply to the bone and leads to bone cell death. It has traumatic causes like hip fractures or dislocations and non-traumatic causes like corticosteroid use, alcoholism, or blood disorders. MRI is the most accurate imaging test and stages the disease from pre-collapse to complete joint destruction. Early stages are treated with non-surgical options like protected weight bearing or core decompression surgery, while later stages may require joint replacement. The goal of treatment is to delay or prevent femoral head collapse through reducing pressure and promoting revascularization.
The document discusses the supraorbital craniotomy technique in neurosurgery. It provides a brief history of the approach, beginning with Krause first demonstrating it in 1900. Indications for its use include aneurysms of the anterior circulation, tumors of the anterior cranial fossa and sphenoid ridge, and pathologies of the sella and suprasellar region. The technique involves a supraorbital incision and craniotomy to access structures like the orbital roof, anterior clinoid processes, cavernous sinus, and anterior circulation vessels. Complications can include bleeding, infection, supraorbital numbness, and CSF leaks. The approach provides good exposure with minimal brain retraction and smooth postoperative recovery.
Carpal tunnel syndrome is caused by compression of the median nerve in the carpal tunnel. It is characterized by numbness and tingling in the hand and fingers, especially at night. While splinting and steroid injections provide short-term relief, surgical release of the transverse carpal ligament is often required for long-term symptom relief. Open carpal tunnel release has traditionally been used but endoscopic techniques have gained popularity due to potentially faster recovery times. Both open and endoscopic techniques have been shown to significantly improve symptoms and function, though endoscopic release may result in less postoperative pain.
Vestibular schwannoma, also known as acoustic neuroma, is a benign tumor of the vestibular nerve sheath cells. It accounts for 6% of all intracranial tumors and 80-90% of cerebellopontine angle tumors. The tumor grows medially from the Schwann cells of the vestibular nerve and presents in stages ranging from isolated otological symptoms to brainstem compression. Diagnosis involves radiological investigations like CT, MRI and MRA. Treatment options include observation, surgery, and stereotactic radiosurgery depending on tumor size and patient factors.
This document discusses using optic nerve sheath diameter (ONSD) measurements via ultrasound as a tool to assess increased intracranial pressure (ICP). It provides background on ONSD anatomy and evidence that ONSD changes mimic ICP changes. Studies show ONSD has high sensitivity and specificity for detecting elevated ICP compared to invasive monitoring. The document proposes a prospective study measuring ONSD in patients with conditions like end-stage liver disease, end-stage renal disease, and hypertensive crises to see if ONSD decreases after treatment and normalize, indicating reduced ICP. It suggests ONSD could help predict complications like dialysis disequilibrium syndrome.
This document discusses avascular necrosis (also known as osteonecrosis), which is the death of bone tissue due to a lack of blood supply. It begins by defining the condition and listing common sites of involvement. It then covers epidemiology, causes, pathogenesis, clinical features, investigations, treatment options and complications. Key points include that the femoral head is the most common site, risk factors include trauma, steroid use and sickle cell disease, and treatment ranges from non-operative options like core decompression to joint replacement surgeries depending on the stage of necrosis.
Planning for Awake Brain Surgery: In Light of Research Regarding Language Loc...Allina Health
This document discusses the evolution of surgical management of brain tumors at Abbott Northwestern Hospital over the past two decades. It describes how the integration of neuronavigation, functional MRI, and intraoperative MRI has allowed surgeons to remove more of tumors while avoiding injury to eloquent brain areas. Over 1700 patients with various brain tumors have undergone surgery using these techniques. The document also presents four case examples and discusses how awake brain mapping during surgery helps identify language areas of the brain to further aid in maximal tumor resection.
A detailed description of acoustic neuroma: the symptoms, causes, diagnosis, and treatment methods.For more information, please visit www.everydayhearing.com
Awake craniotomy allows surgeons to map eloquent brain areas and remove tumors near these areas while the patient is awake. It has advantages over surgery under general anesthesia by avoiding postoperative deficits. The technique requires careful planning and multidisciplinary coordination between the surgeon, anesthesiologist, and patient. Anesthesiologists aim to keep the patient comfortable and cooperative while limiting interference with brain mapping. Local anesthesia, sedation, and nerve blocks are used to achieve this balance. Complications can occur but are often avoided with experience and vigilance. Awake craniotomy offers benefits but demands expertise from all involved parties.
This document discusses neurological complications that can arise from regional anesthesia used in obstetrics. It outlines two case reports of patients experiencing numbness after epidurals for labor and delivery, with one case likely due to positioning during prolonged labor. It then discusses obstetric and anesthesia-related causes of neurological deficits. Obstetric causes include compression injuries from prolonged labor or forceps delivery. Proper diagnosis requires a thorough history, physical exam, and potential imaging or laboratory tests. Neurological complications from regional anesthesia are very rare but careful technique aims to minimize risk.
The document discusses various reasons for failed spinal anesthesia, including:
- Equipment failures during early experiments with spinal anesthesia that led to leakage of the cocaine solution.
- The wide variation in how cocaine solutions dispersed among patients, referred to as "capriciousness", contributed to inconsistent results.
- Factors like an inexperienced operator, patient characteristics like obesity, and acute medical conditions can increase risks of failure.
- Repeated puncture attempts, lack of adjuvant medication, and patient age over 70 were found to be independent risk factors for failure in one study.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
S1 antiarrhythmicdrugs 000 /certified fixed orthodontic courses by Indian den...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Radiotherapy /certified fixed orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
T m diagnosis /certified fixed orthodontic courses by Indian dental acad...Indian dental academy
The Indian Dental Academy is the Leader in
continuing dental education , training dentists
in all aspects of dentistry and offering a wide
range of dental certified courses in different
formats.
Indian dental academy provides dental crown &
Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit
www.indiandentalacademy.com ,or call
0091-9248678078
His eva of caoh&bond agnt in direct pulp capping/ rotary endodontic courses b...Indian dental academy
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Vital pulp therapy aims to preserve healthy pulp tissue and includes procedures like indirect/direct pulp capping, pulpotomy, and apexification. The goal is to stimulate reparative dentin formation and maintain the tooth as a functional unit. Success depends on factors like the patient's age, pulp chamber size, bacterial contamination, and quality of the restoration. Indirect pulp capping involves stepwise caries removal and capping the remaining dentin layer, while direct capping places a material directly over an exposed pulp. Pulpotomy and apexification procedures are used to treat immature teeth and maintain root development.
This document discusses pulp capping, which involves placing a biocompatible material over exposed dental pulp to avoid pulp tissue exposure and promote healing. It describes indirect pulp capping, which leaves decayed dentin behind to avoid pulp exposure, and direct pulp capping, which dresses small pulp exposures with calcium hydroxide or resin bonding agents. Successful pulp capping requires maintaining pulp vitality without pain or pathology and promoting dentin bridge formation. Calcium hydroxide is commonly used but can degrade over time, while resin bonding agents may provide a better seal but with less evidence of success.
Direct pulp capping involves placing a protective material directly over an exposed dental pulp to encourage healing and formation of reparative dentin. It is a conservative treatment alternative to root canal therapy to save a tooth's vitality when the exposure is small. Success rates range widely from 13-98% depending on factors like the type of exposure, quality of the restoration, and operator skill. Calcium hydroxide and mineral trioxide aggregate are commonly used capping materials that induce healing, but newer options like Biodentine show promise as well. Future trends may involve techniques like lasers, gene therapy, or stem cells to further improve pulp capping outcomes.
A radiation oncologist needs clear target identification for various cranial conditions like metastases, meningiomas, and AVMs. Imaging tools include CT, MRI, CT/MR angiography, and DSA. MRI sequences like T1, T2, FLAIR, and post-contrast are used along with specialized sequences tailored to diseases. Planning MRI aims to clearly visualize anatomy and targets while avoiding gaps or tilt. Functional MRI techniques include perfusion, diffusion, and MRS for grading tumors, distinguishing lesions, and assessing treatment response.
This document discusses stereotactic radiosurgery and radiotherapy. It begins with an introduction to stereotaxy and how it allows for highly precise radiation targeting. It then covers radiobiology concepts relevant to stereotactic radiation and lists some common indications for its use, including brain metastases and early stage prostate cancer. The document provides details on patient immobilization, planning techniques, and treatment procedures for conditions like pituitary adenomas, trigeminal neuralgia, and arteriovenous malformations.
CNS RADIOLOGY FOR RADIATION ONCOLOGISTSKanhu Charan
This document provides an overview of radiology for brain and spine imaging for radiation oncologists. It discusses various imaging modalities including CT, MRI, nuclear imaging and angiography. It describes key anatomical structures of the brain such as the meninges, ventricles, sulci and gyri, lobes, basal ganglia and cerebellum. Different MRI sequences are outlined including T1, T2, FLAIR, DWI and perfusion. Spine imaging including sequences for T1, T2, STIR and post-contrast are also reviewed. Important considerations for planning MRI such as field of view and disease-specific sequences are highlighted.
This document provides an overview of neuroimaging techniques used in psychiatry. It discusses the types and principles of structural neuroimaging like CT and MRI. CT provides visualization of brain morphology while MRI also allows evaluation of biochemical processes through techniques like fMRI. The document outlines indications for neuroimaging in psychiatric evaluation and research to study clinically defined patient groups and brain activity during tasks. It provides details on the basic principles and anatomical images of CT and MRI to interpret neuroimaging findings.
This document provides information about NCCT and CECT of the brain and orbit. It discusses anatomy, indications, protocols, and findings. Key points include:
1. It describes the anatomy of the skull, brain, meninges, ventricles, and orbit.
2. Indications for NCCT include suspected hemorrhage, masses, trauma, etc. CECT is used for evaluating tumors, aneurysms, and strokes.
3. Protocols are provided for brain and orbit NCCT and CECT, including patient preparation, positioning, scan parameters, and radiation doses.
4. Types of hemorrhages are discussed along with their appearances on CT. Common pathologies of the orbit are
Dr. Ra'ed Ahmed discusses investigations of neurological diseases. He describes how history alone makes 90% of diagnoses but investigations may include imaging like CT and MRI to assess structure, neurophysiology to assess function, CSF analysis, and other tests. He provides details on various neuroimaging techniques including their indications, advantages, disadvantages, and interpretation. Neurophysiological tests like EEG, EMG, and evoked potentials are described. Lumbar puncture for CSF analysis is also outlined.
This document provides a summary of imaging features of lesions in the anterior skull base region, including sinonasal neoplasms such as squamous cell carcinoma, adenocarcinoma, esthesioneuroblastoma, malignant melanoma, and lymphoma. Key imaging findings discussed include tumor appearance on CT and MRI, characteristics of bone and soft tissue involvement, and distinguishing features between lesion types. Imaging plays an important role in diagnosis and surgical planning for anterior skull base pathology.
This document discusses various neuroimaging techniques used in psychiatry. It begins with a brief history of neuroimaging, including early techniques like ventriculography and CT scans, as well as key developments in MRI, PET, SPECT, and other modalities. The document then explains several common neuroimaging techniques in more detail, such as CT, MRI sequences (T1WI, T2WI, FLAIR, DWI), and MRS. It provides information on the principles, applications, and appearance of structures on different sequences. In summary, neuroimaging allows measurement of brain structure, function and chemistry, and has provided useful insights into psychiatric pathophysiology that could aid diagnosis and treatment development.
This document provides information on carotid-cavernous fistulas (CCFs). It discusses the anatomy of the cavernous sinus and pathophysiology of CCFs. It notes that CCFs represent 12% of dural arteriovenous fistulas. The majority are caused by trauma, especially in young males, while spontaneous CCFs occur more in older females. Clinical presentation depends on flow rate, with high flow direct CCFs causing eye symptoms and low flow indirect CCFs having insidious onset. Treatment options include conservative management, endovascular embolization, and radiosurgery, with the approach depending on fistula type and symptoms.
Ventricular arrhythmias can originate from complex substrates involving scar tissue. New imaging techniques like intracardiac echocardiography (ICE) and contrast-enhanced cardiac magnetic resonance (ce-CMR) can help identify these substrates and guide ablation. CE-CMR can characterize scar tissue, quantify fibrosis, and identify conduction channels within scars. ICE allows visualization of catheter position and ablation lesions. Together these techniques aim to improve ablation outcomes by enabling better identification of arrhythmogenic substrates compared to conventional mapping alone.
Cardiovascular CT is a valuable tool for evaluating congenital heart disease in children. It provides high spatial and temporal resolution to depict complex anatomy. Key applications include assessing pulmonary blood flow in pulmonary atresia, vascular rings prior to surgery, coronary artery anomalies, and postoperative complications. Careful patient preparation and protocols are needed given pediatric concerns. CT enables simultaneous evaluation of vascular structures, airways, and cardiac function to comprehensively evaluate complex congenital heart disease.
This document summarizes a neurosciences academic meeting that discussed a case of a 25-year-old female who presented with sudden onset of her worst headache ever. Differential diagnoses for thunderclap headache were discussed. Imaging revealed a subarachnoid hemorrhage from an aneurysm. The meeting discussed CT and MR angiography as diagnostic tools compared to catheter angiography, and yields of CSF analysis for diagnosing aneurysmal subarachnoid hemorrhage. Causes of subarachnoid hemorrhage without an identified aneurysm were also reviewed, as well as a new clinical decision tool to exclude subarachnoid hemorrhage.
The document discusses common entrapment neuropathies including carpal tunnel syndrome, pronator syndrome, anterior interosseous nerve syndrome, cubital tunnel syndrome, and Guyon's canal syndrome. It provides details on the anatomy, etiology, symptoms, diagnostic studies including electrodiagnostic studies, ultrasound findings, and treatments for each of these conditions. The treatment typically involves initially trying conservative measures such as splinting, steroid injections, and activity modification. Surgery is considered if conservative treatments fail or if there is evidence of nerve damage on electrodiagnostic studies.
Cerebellopontine Angle Tumor can arise from various structures in the CPA. Vestibular schwannoma, also known as acoustic neuroma, is the most common type and arises from the vestibulocochlear nerve. Patients present with hearing loss, tinnitus, and imbalance. MRI is the preferred imaging method and shows a well-defined enhancing mass. Treatment options include observation, surgery to remove the tumor, and stereotactic radiosurgery.
The document summarizes brachial plexus anatomy and entrapment neuropathies of the upper limb. It describes the anatomy of the brachial plexus and its branches. It then discusses various entrapment neuropathies including carpal tunnel syndrome, anterior interosseous syndrome, pronator teres syndrome, cubital tunnel syndrome and others. For each neuropathy, it describes the anatomy, risk factors, clinical features, diagnostic tests and management approaches.
A 19-year-old female presented with a right neck mass. Imaging and biopsy identified it as a schwannoma originating from the vagus nerve in the parapharyngeal space. Schwannomas are benign nerve sheath tumors that can arise from various cranial nerves in the neck. Preoperative imaging can help determine the nerve of origin using characteristics like the relationship of the carotid artery and internal jugular vein. Complete surgical excision while preserving the involved nerve is the treatment of choice to avoid neurological deficits. Postoperative hoarseness is a potential complication for vagus nerve schwannomas.
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This document provides an overview of various neuroimaging techniques used in psychiatry, including their principles, applications, and advantages/disadvantages. It discusses structural neuroimaging methods like CT and MRI, as well as functional techniques including fMRI, PET, and SPECT. CT and MRI provide high-resolution images of brain structure. Functional methods like fMRI, PET, and SPECT allow measurement of brain activity by detecting changes in blood flow and glucose metabolism associated with neuronal activation. Together, these neuroimaging modalities have improved understanding of psychiatric pathophysiology and have diagnostic and research applications in conditions such as dementia, psychosis, and mood disorders.
This document provides an overview of neuroimaging techniques used in psychiatry, including their principles and clinical applications. It discusses several structural neuroimaging methods like CT scans and MRI, as well as functional techniques including fMRI, PET, SPECT, and MRS. CT scans provide bone detail but less contrast between brain tissues, while MRI generates high-resolution images of brain structure and pathology without radiation. Neuroimaging is increasingly being used to better understand the pathophysiology of psychiatric disorders and aid diagnosis.
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This document discusses dental occlusion concepts and philosophies for complete dentures. It introduces key terms like physiologic occlusion and defines different occlusion schemes like balanced articulation and monoplane articulation. The document discusses advantages and disadvantages of using anatomic versus non-anatomic teeth for complete dentures. It also outlines requirements for maintaining denture stability, such as balanced occlusal contacts and control of horizontal forces. The goal of occlusion for complete dentures is to re-establish the homeostasis of the masticatory system disrupted by edentulism.
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This document discusses dental casting investment materials. It describes the three main types of investments - gypsum bonded, phosphate bonded, and ethyl silicate bonded investments. For gypsum bonded investments specifically, it details their classification, composition including the roles of gypsum, silica, and modifiers, setting time, normal and hygroscopic setting expansion, and thermal expansion. It provides information on how the properties of gypsum bonded investments are affected by their composition. The document serves as a comprehensive overview of dental casting investment materials.
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Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
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Role of head and neck imaging in trigeminal neuralgia /certified fixed orthodontic courses by Indian dental academy
1. Role Of Head & Neck Imaging
Preview In Patients With Trigeminal
Neuralgia
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com
www.indiandentalacademy.com
1
2. Contents
•
•
•
•
•
•
•
Course of Trigeminal nerve
Trigeminal neuralgia
History
Clinical features
Causes
Diagn criteria
Diff modalities of investigations
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2
15. Trigeminal Neuralgia
• Also called tic douloureax
• Distributed along 5th cranial nerve
• As described by IHS:
A painful, unilateral affliction of the face ,
characterized by brief electric shock lightening-like
(lancinating) pain limited to distr. one or more div. of
trigeminal nerve
• 4 per 1,00,000 population
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15
16. Trigeminal Neuralgia
•
•
•
•
•
>50 yrs
> Women
< Right side of face
Pain is unilateral, most often in V2 & V3
Often misdiagnosed as dental pathology due to acute
bouts of severe pain in the lower face evoked by
perioral triggers,
www.indiandentalacademy.com
16
17. • Bilateral Cases-3%
• Division of involvement – Max - 66%
- Mand - 49%
- Opthal –16%
- Both Max & Mand –19%
- All 3 Divisions- 1%
(Katusic et al -1990)
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17
18. History
• Aretaeus of cappadocia – at the end of 1st century - 1st
clinical description of TN
• John Locke in 1677 (american physician &
philosopher) accurately identified clin features
• Nicolaus Andre in 1756 – tic douloureux (painful
jerking)
• John fothergill in 1773- full & accurate description
of TN
{OOO medical management update, Vol. 100, No. 5 Nov 2005}
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18
19. Etiopathogenesis
• Focal demyelination at the site of compression may also allow
electrical spread of excitation betwn. adjacent sensory axons
(‘‘ephaptic’’ transmission).
• An ephaptic short-circuit of this type within the trigeminal
nerve might explain the sudden ‘‘electric’’ jolts of pain that
characterize the disorder.
{OOO 2005}
• Central myelin replaced by - peripheral myelin.
• Continued pulsatile pressure of the trigeminal nerve at the
REZ may result in disordered conduction and “shortcircuiting” of impulses, producing trigeminal neuralgia
{Robert et al, TN: MRI Features, Radiology 1989;172:767-70}
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19
20. Sweet in 1967, diagnostic criteria for TN
1.
2.
3.
4.
5.
The pain is paroxysmal.
The pain may be provoked by light touch to the face (trigger
zones).
The pain is confined to the trigeminal distribution.
The pain is unilateral.
The clinical sensory examination is normal.
www.indiandentalacademy.com
20
21. ICHD Criteria for Classical TN
Classical Trigeminal Neuralgia:
A. Paroxysmal attacks of pain lasting from a fraction of a
second to 2 minutes, affecting one or more divisions of the
trigeminal nerve and fulfilling criteria B and C:
B. Pain has at least one of the following characteristics:
1. intense, sharp, superficial or stabbing
2. Precipitated from trigger areas or by trigger factors
C. Attacks are stereotyped in the individual patient.
D. There is no clinically evident neurological deficit.
E. Not attributed to another disorder.
www.indiandentalacademy.com
21
22. ICHD Criteria for Classical TN
Symptomatic trigeminal neuralgia:
A causative lesion, other than vascular compression, has been
demonstrated by special investigations and/or posterior fossa
exploration.
• Symptomatic TN has the same key features of TN but results
from another disease process (such as multiple sclerosis or a
cerebellopontine angle tumor).
• Symptomatic TN is defined by IHS as:
‘‘Pain indistinguishable from classic TN but caused by a
demonstrable structural lesion other than vascular
compression.’’
www.indiandentalacademy.com
22
23. Clinical evaluation
Diagnosis is of TN is based on a
• Clinical history of pain attacks that fit accepted
diagnostic criteria supplemented by
• Physical exam findings and
• Cranial imaging studies.
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23
24. Clinical examination
• Head and neck examination.
• The sensory examination: careful search for cutaneous or
intraoral trigger zones in addition to areas of focal sensory
loss.
• In majority - sensory examination will be normal,
• In some patients - mild tactile sensory deficit (hypesthesia)
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24
25. Clinical examination
• Because the facial (VII) and auditory (VIII) nerves lie adjacent
to the trigeminal nerve in the cerebellopontine angle (CPA),
they also deserve particular attention during the examination.
• A patient with symptomatic TN resulting from a CPA mass will
often also show subtle facial weakness and hearing loss on
that side.
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25
26. Physical examination
• Physical examination findings are normal;
• In fact, a normal neurologic examination is part of the
definition of idiopathic TN.
• Perform a careful examination of the cranial nerves, including
the corneal reflex.
• Abnormality suggests that the pain syndrome is secondary to
another process
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26
27. History
• In the past, clinical symptoms & signs – accurate means
• Assessment of the patient consisted of Computed tomography
(CT) and Angiography.
CT: has limited value in the evaluation of Posterior fossa &
the Trigeminal nerve
• Normal T. Nerve - not typically visualized.
• Abnormalities along the expected course of the nerve.
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27
28. History
Angiography: more successful in predicting - causative vessel
• Invasive & fails to show exact relationship bet Vess & N
{Robert et al, TN: MRI Features, Radiology:1989;172:767-70}
• Conventional biplane angiography
• Intraarterial Digital substraction angiography (DSA)
(quicker & requires smaller amounts of contrast medium
Venous abnormalities - detected more easily- better contrast
in the venous phase)
{Radiology 1986;158:721-27}
DSA
AP
www.indiandentalacademy.com
Towns
DSA
Towns
28
29. MRI
• Directly depicts the course of the cisternal portion of T. nerve.
• All portions of the nerve from the REZ to the cavernous sinus
can be more easily evaluated with MR imaging than with
traditional modalities.
• The possible impingement of neighboring vascular structures
is also readily suggested.
{Robert et al, TN: MRI Features, Radiology:1989;172:767-70}
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29
30. MRI
• Provides accurate information on
– the anatomical location &
– course of ectatic vessel in CPA &
– the caused mass effect on the brainstem
www.indiandentalacademy.com
30
31. MRA
• MRA- a more recent imaging technique, allows visualization
of the vascular anatomy of the relevant region without the use
of contrast media.
{Shahrokh C et al, JADA, Vol 135, 2004}
• Allows evaluation of:
Vessel Anatomy & Blood flow rates
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31
35. Causes
I.
Typical/ Classical/ Idiopathic and Essential TN.
Sec. to a vascular loop that compresses the
trigeminal nerve a few mm proximal to the pons.
www.indiandentalacademy.com
35
36. Causes of TN
II.
•
SECONDARY/ SYMPTOMATIC forms:
Tumor (Acoustic neurinoma, pontine glioma, epidermoid
chondroma, metastases, lymphoma)
Amyloidoma of Meckel’s Cave: A Rare Cause of Trigeminal
Neuralgia, Eugene Yu ,University of Toronto Canada, AJR:182,
June 2004
•
Vascular (pontine infarcts, Aneurysms of Arteries, Veins,
AV malform)
Vertebrobasilar ectasia rare cause of TN (MRI of vertebrobasilar
ectasia in TN, Kirsch et al, April 2005)
•
•
Inflammatory (MS, sarcoidosis)
Paraneoplastic
{Marc E. et al, trig neuralgia, march 2006}
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36
37. Vascular loops
• The main cause of trigeminal neuralgia is neurovascular
compression (NVC) in the root entry zone (REZ) of the
trigeminal nerve in the CPA cistern
{Norio Yoshino, et al, Radiology 2003}
• Sup Cereb A > Ant inf Cerebellar A > smaller pontine arteries
> petrosal veins
{Lawrence et al, 1990}
• Superior cerebellar artery (SCA)> the ant infer cerebellar A.
(AICA)> the basilar artery, or the vertebral antery.
{Robert et al, TN: MRI Features, Radiology:1989;172:767-70}
www.indiandentalacademy.com
37
39. Axial T2W MRI
SCA (arrow) Compressing PGS of
V (open arrow)
www.indiandentalacademy.com
39
40. Images of a 64-year-old man with left-sided V2 and V3 distribution of
facial pain.
a. Coronal T1W MR: Focal area of signal void (white arrow)
deforming the left fifth nerve (black arrow) at REZ.
www.indiandentalacademy.com
40
b. AP Angiogram: Ectatic distal vertebral artery.
41. Vascular loops
• Magnetic resonance angiography has been reported to be
effective in the detection of NVC in trigeminal neuralgia
• Norio Y. et al, Radiology 2003;
Three-dimensional MR imaging with constructive interference
in steady-state (3D – CISS) sequence images provided more
sufficient information than did MR angiography
• Nerve & Arteries- identified by both (MRA & 3D CISS)
• But Veins- on 3D CISS images
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41
42. •
•
•
•
•
MR angiography,
Artery - fast blood flow - high signal intensity &
Nerve - intermediate signal intensity,
Contrast between the artery & nerve good
Contrast resolution betn CSF & nerve is somewhat unclear
Depiction of the vein is impossible –cause of slow blood flow.
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42
43. `
3D CISS images –
• Provide high spatial resolution & excellent contrast resolution
betn CSF & nerve
• Clearly depict the veins
• 3D CISS imaging offers high spatial resolution & excellent
contrast resolution & depicts both artery & vein responsible
for the NVC.
www.indiandentalacademy.com
43
44. 3D CISS MR images
• Superior cerebellar artery (short arrow) has compressed the REZ
of the right trigeminal nerve (long arrow) at the medial site.
www.indiandentalacademy.com
44
45. MR angiographic images
• Superior cerebellar artery (short arrow) has compressed the
right trigeminal nerve (long arrow) at the medial site.
www.indiandentalacademy.com
45
46. • (a) Transverse 3D CISS MR image: both vein (curved arrow) &
ant inf cerebellar artery (short straight arrow) have compressed
left trigeminal nerve (long straight arrow) at the REZ.
• (b) Transverse MR angiographic image does not depict the vein,
although it shows the ant inf cerebellar artery (short arrow)- has
compressed the REZ of the left trigeminal nerve (long arrow).
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46
47. Cisternal portion of V compressed by:
1. Extra axial diseases:
•
•
•
•
•
•
Schwannomas
Meningiomas
Epidermoids
Lipoma
Metastasis
Inflam parocesses
1. Intra axial diseases:
•
•
•
•
MS
Infarct
Metastasis
Primary tumors
www.indiandentalacademy.com
47
48. Basilar Artery Aneurysm.
Postcontrast axial CT.
Angiographic confirmation
Tubular-shaped area of enhancement in left cerebellopontine angle (arrows)
typical for fusiform basilar artery aneurysm.
Left-to-right shift of fourth ventricle.
www.indiandentalacademy.com
David et al, AJR 135:93- 95 1980
48
49. Multiple sclerosis
• Prevalance: 1-8% in TN
• Common cause of symptomatic TN,
• Probably resulting from a demyelination plaque at the level of
REZ
• Frequently goes undiagnosed in patients who have relatively
mild or infrequent MS exacerbations.
• Should be considered in any person with TN symptoms,
in younger TN patients or with bilateral TN.
• A TN evaluation can be the first opportunity for the clinician
to diagnose MS.
www.indiandentalacademy.com
49
50. Multiple sclerosis
•
•
•
•
•
Neurologic symptoms seen in MS:
Unexplained episodes of monocular blindness,
Diplopia,
Vertigo,
Unusual clumsiness (ataxia),
Weakness.
• Routine brain CT scan - adequate to screen CPA tumor,
• MRI scan - better demonstrates MS plaques & anatomic
relationships of trigeminal root.
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50
51. Multiple sclerosis
•
Axial T2W MRI
• Plaques along intrapontine segments of both trig nerves
Transient enhancement – resolution of enhancement occurs in 2 months in
www.indiandentalacademy.com
51
contrast to neoplastic disease {Radiographics, Charles et al 1995}
52. Acoustic Schwannoma
•
•
•
•
•
•
•
Approx. 10 % of all intracranial tumors
80% -90% of all CPA tumors
< 21 yrs
Becomes symptomatic before 25 yrs
Mostly arises within IAC
If widening is >2mm – consider presence of tumour
Clinical findings:
– Tinnitus,
– Hearing loss
– Signs of cerebellar dysfunction
www.indiandentalacademy.com
52
54. Trigeminal schwannoma
• 0.2% of all intracranial tumors
• Majority – develop in gasserian ganglion
• Clinical findings:
– Sensory disturbance of T Nerve:
– Numbness
– Diminished/ absent corneal reflex
– Hypesthesia
– Hypalgesia
– Weakness of muscles of mastication
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54
55. Trigeminal schwannoma
• The pressure exerted by the tumor leads to erosion of the
underlying bone & enlargement of the foramen ovale, foramen
rotundum, or the superior orbital fissure.
• Small tumors are homogeneous;
• Large tumors can have heterogeneous signal intensity due to
degenerative changes, including cyst formation and fatty
degeneration
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56. Trigeminal schwannoma
CE TI W
Smoothly marginated tumors, Large, dumbbell- shaped enhancing
tumor (arrows) in the left middle cranial fossa that follows the
course of the trigeminal nerve and extends into the
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pterygopalatine and posterior fossae.
57. Trigeminal schwannoma
Most common Location: Gasserian ganglion
T2W MRI
T1W MRI
High heterogeous signal intesity
Smooth margins, low signal intesity
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59. Meningioma
•
•
•
•
2nd most freq tumors occuring in CPA,
10- 15 % of all tumors
Distinct female prediliction (2:1 to 4:1)
Middle age
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60. Meningioma
• Signal intensity similar to acoustic schwannomas
• Charac feature: Broad based attachment to adj dura matter
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61. Epidermoid Cyst
•
•
•
•
Rare - 0.2% to 1% of all intracranial tumors
Most common location: CPA
5 – 9% of all CPA masses.
4th – 5th decade of life
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62. Epidermoid Cyst
• HP: composed of int layer of squam epith. covered by an ext
fibrous capsule
• These cysts grow by desquamation of epithelial cells that
break down into keratin and cholesterol within the tumor
capsule.
• Grows slowly & is soft & very pliable
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65. Trigeminal Epidermoid
LOBULATED margins
Axial T2W
Axial T1W
Moderately high heterogeneous signal intensity
TE of Trig N & Meckel’s cave
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Low signal intensity
66. Pontine Glioma
•
•
•
•
95% of neoplasms in brainstem are Astrocytomas
In children betwn 5- 14 yrs
M>F
May be totally solid,
– Solid with cystic, necrotic or hemorrhagic component
• T1W: Isointense or hypointense
If cystic: Hypointense
• T2W: Hyperintense in both solid & cystic component
• After Gd adminstration: solid comp - enhancement
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69. Pontine Infarct
• Pontine ischemia- due to bilateral ventral pontine infarction
• Burning orofacial pain- early symptom
• ‘Locked in Syndrome’- pt. is able to understand what is being
said & happening, is imprisoned by inability to speak or move
anything apart from eyes
• Small infarcts – invisible in CT
– Evident in MRI
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70. Metastasis
• Met. lesions involving CPA:
0.2% - 2%
• Note obliteration of CSF in
right Meckels cave by mass
(large arrow)
• Note expansion of convex
dural margin by mass
• Note normal cisternal
portions of V bilaterally
(small arrow)
T2W MRI
• Neoplastic lesions most commonly involve the extracranial branches
• Spread by PNS
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71. Conclusion
• Diagnostic brain imaging should be part of the initial
screening of all patient with TN symptoms - cause a significant
% of patients have symptomatic TN
• If TN identifiable cause, such as a tumor or mass compressing
the nerve, the neurologist - elimination of the pathology or
decompression of the nerve.
• In cases of idiopathic TN, clinicians consider medical and
surgical options.
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72. •
•
•
•
MRI – useful in identification of MS or masses
Gross Vascular changes: eg. Basilar A. dolichoectasia
Magnetic resonance angiography- effective in NVC
3D CISS MR Imaging offers high spatial resolution &
excellent contrast resolution & depicts both artery & vein
responsible for the NVC.
• Coronal MRI: PGS
• Sagittal & Axial – detection of intraparenchymal lesions (MS)
• AV malformation – Angiography
{Lawrence et al, TN: MRI Assessment, Radiology1990}
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75. 2. Pre-Trigeminal Neuralgia
•
•
•
Days to years before the first attack of TN pain, some sufferers
experience odd sensations in the trigeminal distributions
destined to become affected by TN.
These odd sensations of pain, (such as a toothache) or
discomfort (like "pins and needles", parasthesia), may be
symptoms of pre-trigeminal neuralgia.
Pre-TN is most effectively treated with medical therapy used for
typical TN
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79. • Trigger zones may result from ephaptic coupling between
partially damaged trigeminal axons that allows abnormal
spread of excitation, facilitating a synchronous discharge of
hyperexcitable trigeminal afferents that produce a pain attack.
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80. • Pulsation of vessels do not visibly damage the nerve.
• Irritation from repeated pulsations may lead to changes of nerve function,
& deliver abnormal signals to the trigeminal nerve nucleus.
• Causes hyperactivity of the trigeminal nerve nucleus, resulting in the generation
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of TN pain
82. • TN ‘‘trigger zone’’ is an area of facial skin or oral mucosa
where low-intensity mechanical stimulation (such as light
touch, an air puff, or even hair-bending) can elicit a typical
pain attack.
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83. Thank you
For more details please visit
www.indiandentalacademy.com
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