This document provides an overview of common spinal cord diseases characterized by high signal within the cord on T2-weighted MRI. It discusses the differential diagnosis and key features of demyelinating diseases like multiple sclerosis and neuromyelitis optica, acute disseminated encephalomyelitis, transverse myelitis, spinal cord tumors, vascular conditions like infarction and vasculitis. Multiple sclerosis is the most common demyelinating disease and can present with short segment focal lesions in the posterior spinal cord with associated periventricular brain lesions. Neuromyelitis optica preferentially involves the optic nerve and spinal cord.
Imaging of spinal cord acute myelopathiesNavni Garg
This presentation provides a comprehensive review of imaging of causes of acute myelopathies and a systemic approach for narrowing down the differentials
Imaging of spinal cord acute myelopathiesNavni Garg
This presentation provides a comprehensive review of imaging of causes of acute myelopathies and a systemic approach for narrowing down the differentials
Myelitis is a spinal disorder. Myelitis is the infection of the white matter of spinal cord. White matter of spinal cord is a part of the central nervous system that functions as a bridge between the brain and the rest of the body.
Myelitis can result in muscle weakness or paralyzing legs and then arms.
MRI in evaluation of white matter diseases like multiple sclerosis, leukodystrophies, demyelination, dysmyelination, ADEM, leukoencephalopathies, van der knaap disease, ALD, MLD, Krabbes disease, Leighs disease, Vanishing white matter disease, Canavan disease, Alexander disease
Myelitis is a spinal disorder. Myelitis is the infection of the white matter of spinal cord. White matter of spinal cord is a part of the central nervous system that functions as a bridge between the brain and the rest of the body.
Myelitis can result in muscle weakness or paralyzing legs and then arms.
MRI in evaluation of white matter diseases like multiple sclerosis, leukodystrophies, demyelination, dysmyelination, ADEM, leukoencephalopathies, van der knaap disease, ALD, MLD, Krabbes disease, Leighs disease, Vanishing white matter disease, Canavan disease, Alexander disease
Multiple sclerosis: Introduction, Risk Factors, Diagnosis and TreatmentEnriqueAlvarez93
Introduction about Multiple Sclerosis.
Risk factors affect to Multiple Sclerosis.
When to Suspect Multiple Sclerosis.
Evaluation and Diagnosis of Multiple Sclerosis.
How to treatment of Multiple Sclerosis.
Treatment of Multiple Sclerosis with Monoclonal Antibody.
Multiple sclerosis (MS) is a potentially disabling disease of the brain and spinal cord (central nervous system). In MS , the immune system attacks the protective sheath (myelin) that covers nerve fibers and causes communication problems between your brain and the rest of your body.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
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To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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
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.
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.
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
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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.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
9. In this presentation we will focus on spinal cord
diseases that are characterised by high signal within
the cord on T2WI.
The most common causes are inflammatory and
demyelinating disorders.
11. If we exclude myelopathy due to cord compression as seen in
trauma, degeneration and metastatic disease, which is usually
not a diagnostic dilemma, then the most common diseases of
the spinal cord are Demyelinating diseases.
AND
Multiple Sclerosis is by far the most common demyelinating
disease.
12. Whenever there is an abnormality in the spinal cord, we need a
systematic approach to analyse the findings
14. MULTIPLE SCLEROSIS:
MS is an immune-mediated inflammatory demyelinating disease of
the brain and the spinal cord.
Multiple lesions disseminated over time and space.
Pathologic studies have shown that 95% of MS patients have spinal
cord lesions, whether they have spinal symptoms or not.
Brain lesions are typically in periventricular, subcortical and
cerebellar white matter and also in brainstem and corpus callosum.
CSF: monoclonal bands.
15. MS: short segment focal wedge-shaped involvement of the posterior
column of the spinal cord with typical periventricular WM-lesions.
16.
17. On transverse images MS lesions typically have a round or triangular shape and are located
posteriorly or laterally
18. So can we exclude MS if a lesion is located anteriorly?
Unfortunately not.
MS is the great mimicker and can also be located anteriorly like in this patient who has
a lesion in the typical location (blue arrow) but also a lesion ventrally in the cord (red
arrow).
This is uncommon, but we can not exclude MS.
19. When MS lesions are active, they can enhance, but enhancement is not as common as
in the brain.
The enhancement patterns are non-specific.
We can see ring enhancement, intense and less-intense enhancement.
The less intense enhancement is the most common pattern.
20. Diffuse abnormalities that can look like transverse myelitis
or extensive astrocytoma are sometimes seen.
This pattern is more common in primary progressive and
secondary progressive MS.
22. Neuromyelitis Optica (NMO)
is an autoimmune demyelinating disease induced by a specific auto-
antibody, the NMO-IgG, which is a specific biomarker for NMO
NMO preferentially affects the optic nerve and spinal cord.
Brain lesions do occur and often are distinct from those seen in MS.
Demyelination of the spinal cord looks like transverse myelitis, i.e. often
extensive over 4 -7 vertebral segments and the full transverse diameter.
Female:male = 9:1
Also called Devic disease
25. One month later this child presented with acute transverse myelopathy, i.e. bilateral symptoms.
The images show abnormal signal in the spinal cord with swelling and some enhancement.
An astrocytoma could very well present with these images, but given the history of an optic
neuritis and the acute myelopathy, we do not think of a tumor.
This proved to be NMO and the Ig-test for NMO was positive.
26. Previously it was thought that in NMO the brain was spared, but now we know, that brain
lesions do occur.
They are often distinct from those seen in MS.
The location of the brain lesions in NMO is only around the ventricles.
27. It is also possible to have large lesions in the corpus callosum of patients with NMO as was
described by Nakamura.
So in any CNS disease with optic nerve and spinal cord involvement it is good to do the test for
NMO-IgG.
28. ADEM
Acute disseminated encephalomyelitis (ADEM) is an inflammatory
demyelinating disease of the CNS after viral infection or vaccination.
In 75% of patients there is a clear infectious event or vaccination (1-4
weeks)
Mostly seen in young children.
In 50% of ADEM patients the anti-MOG IgG test is positive and supports
the diagnosis. This is antibody-reactivity against Myelin Oligodendrocyte
Glycoprotein (MOG).
Usually the brain is also involved. 30% of cases has spinal involvement.
29. These are images of a teenage child with a typical history of respiratory tract infection
There is swelling and cord involvement and no enhancement
The imaging findings and clinical history is typical of ADEM
30. What is typical for ADEM and uncommon for MS is:
• Massive involvement of the pons.
• Involvement of the basal ganglia.
31. The follow up MR shows that the
cord has returned to normal again
32. Another case of ADEM.
Notice the typical involvement of the pons and basal ganglia.
33. On follow up scan almost complete
normalisation.
34. Transverse Myelitis (TM)
Focal inflammatory disorder of the spinal cord resulting in motor, sensory
and autonomic dysfunction.
Imaging findings:
• More than 2/3 of the cross sectional area is involved.
• Focal enlargement.
• T2WI hyperintensity
• Enhancement + / -.
Two forms of TM:
Acute partial transverse myelitis - APTM
Lesions extending less than two Segments.
These patients are at risk of developing MS.
Acute complete transverse myelitis - ACTM
Lesions extending more than two Segments
35. The sagittal image shows a large segment of hyperintensity on T2WI.
The transverse image shows that most of the cord is involved.
36. These images are of a 31 year old male
The images show a long segment myelopathy with full transverse involvement.
There is no swelling and no enhancement.
It does not look like MS or tumor, so we should think of ATM - acute transverse
myelitis.
37. Transverse myelitis may occur in isolation or in the
setting of another illness.
When it occurs without apparent underlying cause,
it is referred to as idiopathic.
Idiopathic transverse myelitis is assumed to be the
result of abnormal activation of the immune
system against the spinal cord.
Patients with an acute short segment TM (or
APTM) are at risk of developing MS if there is one
of the following:
• partial TM, i.e. short segment TM.
• Family history of MS. Brain lesions on MR.
• Oligoclonoal bands in CSF.
38.
39. Here images of a typical case of TM.
There is multisegment high signal on STIR and T2WI with some swelling.
There is no enhancement, which is usually the case in TM. When there is enhancement, it
can be difficult to differentiate TM from an astrocytoma.
40. Spinal cord tumor
Astrocytoma
The major differential of the spinal cord
diseases that we have discussed so far is an
astrocytoma.
Astrocytoma is a diffusely infiltrating tumor,
that is not mass-like.
Usually there is some patchy enhancement.
41. This ia a case of astrocytoma.T2 hyperintense expansion of the thoracic
cord is demonstrated. Postcontrast images demonstrate patchy irregular
peripheral enhancement of this lesion, and central low intensity
42. The other two common spinal cord tumors are
ependymoma and hemangioblastoma and they
just look like a tumor.
They present as enhancing masses and will not
cause a differential problem.
43. The images are of a patient with neurofibromatosis who has multiple
ependymomas.
They present as multiple enhancing masses.
44. Vascular
Arterial infarction
Spinal cord ischemia is typically seen as a complication
of aortic aneurysm surgery or stenting
Aortic aneurysm stenting is the most common
cause of spinal chord infarction
45. The images are of a patient who developed a paraparesis after stenting of an aortic aneurysm.
Notice the high signal ventrally in the chord, which is typical for arterial infarction.
On transverse images a typical snake-eye appearance can be seen.
47. Vasculitis
Vasculitis can be idiopathic, but is also seen in SLE,
Sjogren and Behcet.
Normally we think of vasculitis as a disease of the
vessels in the brain, but all vasculitis can be seen in
the spine as well.
It produces MS-like images
48. The images are of a child . The images are non-specific with multiple focal lesions and probably
the first choise would be MS.
The differential diagnosis would include inflammation, infection and metastases.
In such cases always perform a transverse image of the spine to look for the exact location and
perform a MRI of the brain.
49. The lesions are located dorsally and one of the lesions is enhancing.
Now if this was infection or metastases it would be strange that not all lesions enhance.
MS is still on our list.
We continue with brain images in next slide
50. On the CE-T1WI only one lesion shows enhancement.
The location of the lesions and the enhancement could very well fit to the diagnosis of MS, but
this proved to be vasculitis.