This document discusses ultrasonography of the canine brain. It begins by describing ultrasonography as a low-cost, non-invasive alternative to other imaging techniques. It then covers the technique, including use of linear and microconvex probes on various acoustic windows to obtain sagittal, transverse, and dorsal plane images. The document details normal brain anatomy visible on ultrasound and vascular anatomy. It also discusses several congenital and acquired diseases that can be evaluated with transcranial ultrasonography, including hydrocephalus, lissencephaly, cysts, Chiari-like malformations, neoplasms, encephalitis, trauma, neurodegeneration, and strokes. Throughout, it provides examples of ultrasound images depicting various anatomical structures and
1-definition of SPECT :Single Photon Emission Computed Tomography.
2-differs from BET scan and SPECT.
3-divaice of SPECT.
4-SPECT scan for brain.
5-clinical application
6-patient preparation
7-ADVANTAGE & DISADVANTAGE
1-definition of SPECT :Single Photon Emission Computed Tomography.
2-differs from BET scan and SPECT.
3-divaice of SPECT.
4-SPECT scan for brain.
5-clinical application
6-patient preparation
7-ADVANTAGE & DISADVANTAGE
Application of dect in emergency radiology including the application in diagnosis of renal calculi, bone marrow edema, gout , abdominopelvic imaging,detection of pulmonary embolism and in cardiac imaging.
Magnetic Resonance Elastography is an advanced imaging technique in MRI. This method is a method of "virtual palpation" of internal organs with the help of MRI.
Tomography as a medical imaging technique that allows for the visualization of cross-sectional images of the human body. Emphasize that tomography provides detailed, three-dimensional views of anatomical structures, which can be invaluable for diagnosis and treatment planning in radiology.
Application of dect in emergency radiology including the application in diagnosis of renal calculi, bone marrow edema, gout , abdominopelvic imaging,detection of pulmonary embolism and in cardiac imaging.
Magnetic Resonance Elastography is an advanced imaging technique in MRI. This method is a method of "virtual palpation" of internal organs with the help of MRI.
Tomography as a medical imaging technique that allows for the visualization of cross-sectional images of the human body. Emphasize that tomography provides detailed, three-dimensional views of anatomical structures, which can be invaluable for diagnosis and treatment planning in radiology.
Ultrassonografia do fígado com desvio portossistêmicoCibele Carvalho
Aula proferida no Congresso de Especialidades da Sociendade Paulista de Medicina Veterinária - 2016
Descrição dos aspectos clínicos e sonográficos do desvio portossistêmico, assim como dos diagnósticos diferenciais.
Aula explica os tipos de aparelhos e metodo utilizados para a US FAST, além disso, faz um resumo das principais aplicações da ultrassonografia em diversas situações emergenciais em pequenos animais.
Outlines of the presentation
- How to read a brain CT
- Gross CT brain anatomy
- Traumatic brain injury
- Ischemic and hemorrhagic strokes
- Type of intracranial hemorrhages
-what is hydrocephalus
-introduction of hydrocephalus
-embryonic development
-normal CSF circulation
-flow of CSF
-congenital hydrocephalus
-acquired hydrocephalus
-types of hydrocephalus
-communicating hydrocephalus
-non communicating hydrocephalus
-symptoms
-Crack pot sign
-Macewen Sunset sign
-testing and diagnosis of hydrocephalus
-medical management of hydrocephalus
-surgical management of hydrocephalus
-physiotherapy management of hydrocephalus
-recent advance in hydrocephalus
-hydrocephalus
physiotherapy
Los días 20 y 21 de octubre de 2016, la Fundacion Ramón Areces organizó un simposio internacional para analizar las 'Enfermedades raras de la piel: de la clínica al gen y viceversa'. El doctor Fernando Larcher Laguzzi, del CIEMAT-Universidad Carlos III de Madrid-IIS Fundación Jiménez Díaz, ejerció de coordinador.
Hydrocephalous is a serious disease of the central nervous system which has both congenital and aquired subtypes. the congenital variety affects the children and is a considerable burden especially is the developing countries. I tleads to long term morbidity and high rates of mortality
Dr Ahmad Taha - Fetal Medicine Unit, Orient Hospital. Presented in Syrian Society of Obstetricians and Gynaecologists Annual Meeting 2015 - Dama Rose Hotel.
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.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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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.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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.
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This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
1. Ultrasonography of brain
Cibele Figueira Carvalho
DMV, MSc, PhD
Imaging Diagnostic Department - PROVET
Researcher INRAD - HCFMUSP
2. Introduction
• Alternative method
• Low cost, non-invasive and safe
• No anesthesia or contrasts
• Allows repeated measurements and monitoring
• Small breed dogs (<10kg): good image
resolution
4. Equipment
Technique
•Patient
•Equipment
•Acoustic windows
•Planes of images
Real time equipment with:
•linear probes (5 - 10MHz)
-neonates and/ or opened rostral fontanelle
•high resolution microconvex probes (2 - 6MHz)
- adults (small breed dogs) with closed fontanelle
5. Acoustic windows
Technique
•Patient
•Equipment
•Acoustic windows
•Planes of images
• opened fontanelle (neonates, toy breeds until
3months of age or abnormal)
• closed rostral fontanelle (small dogs, thin frontal
bone)
• Temporal (above zygomatic arch)
• Suboccipital
CARVALHO, 2004
6. • Saggital
• Transversal
• Dorsal
Planes of images
Technique
•Patient
•Equipment
•Acoustic windows
•Planes of images
7. ROSTRAL WINDOW
Transversal Planes
CARVALHO, 2014
Saggital Planes
Technique
•Patient
•Equipment
•Acoustic windows
•Planes of images
8. Dorsal Planes
CARVALHO, 2014
TEMPORAL WINDOW
Technique
•Patient
•Equipment
•Acoustic windows
•Planes of images
11. Anatomy
What can we see?
• Sulci
• Interhemispheric fissure
• ventricular system (LV, III, IV, mesencephalic aqueduct)
• Cerebellum
• Brainstem
• Medulla
18. Vascular anatomy
• RI brain arteries = 0,55±0,04
(SEO et al.,2005)
• RI basilar artery = 0,5 - 0,78
(SAITO et al.,2003)
Arterious circle
Vertebrobasilar system
35. Physiology – main considerations
• Supply of O2
• Glucose supply
• Blood flow supply
36. Hemodynamic changing diseases
Intracranial pressure (ICP) can be increased:
•Hydrocephaly
•Neoplasia
•Encephalitis
•Traumas
•Neurodegeneration
•Strokes
37. Hydrocephaly
• Hydrocephaly
• Neoplasia
• Encephalitis
• Traumas
• Neurodegeneration
• Strokes
• Sonographic images may demonstrate ventriculomegaly
but the parameters obtained in B-mode are not suitable
for monitoring the treatment and clinical evolution of the
disease (Spaulding and Sharp, 1990; Tucker and Gavin,
1996)
Researches show that induced acute hydrocephaly in
cats leads to a reduction of 22% in the blood flow of the
brain, cerebellum, and encephalic trunk (Hochwald et al.,
1975).
44. Color Doppler image demonstrated conspicuous
vessels in the arterial circle that appeared tortuous and
more obvious than usual with minimum adjustments on
color gain settings
• Hydrocephaly
• Neoplasia
• Encephalitis
• Traumas
• Neurodegeneration
• Strokes
45. - Some ventriculomegaly degrees
- Focal hyperechoic lesion
(granuloma)
- the diffuse brain congestion and
inflammation can lead to a
compensatory vasodilatation
• Hydrocephaly
• Neoplasia
• Encephalitis
• Traumas
• Neurodegeneration
• Strokes
46. • Hydrocephaly
• Neoplasia
• Encephalitis
• Traumas
• Neurodegeneration
• Strokes
- Doppler spectral mapping can demonstrate low or high resistive index depending on
mechanical compression (e.g., stenosis or occlusion) caused by the perivascular cuffs
observed in pathologic evaluation, or space-occupying mass
47. • Hydrocephaly
• Neoplasia
• Encephalitis
• Traumas
• Neurodegeneration
• Strokes
Granulomatous meningoencephalitis in a dog – increased blood vessels caliber;
inflammatory process with mononuclear cells around subpial surface and ocluded
blood vessels (hematoxilin eosin stain; scale 100 μm). Photo: Paulo C. Maiorka.
49. Trauma
• Focal lesion detection varies with location,
extension and collateral damages;
• Vessels change can be present or not
• Focal lesion can cause “mass effect” and
intracranial pressure (ICP) increase
• Hydrocephaly
• Neoplasia
• Encephalitis
• Traumas
• Neurodegeneration
• Strokes
50. • Hydrocephaly
• Neoplasia
• Encephalitis
• Traumas
• Neurodegeneration
• Strokes
ICP x RI
•RI is correlated to intracranial pressure (ICP) in patients
with severe brain damage and in hydrocephalic infants;
•and detecting brain death (after head injury)
Rainov, 2000; Fukushima et al., 2000
51. • Hydrocephaly
• Neoplasia
• Encephalitis
• Traumas
• Neurodegeneration
Neurodegeneration • Strokes
Neurodegeneration process displays some
common morphological characteristics:
•cortical cerebral atrophy,
•ventricles enlargement,
•diffuse deposits of β-amyloid (A) peptides,
•senile plaques formation,
•lipofuscin and intraneuronal “aging pigment”
accumulations changing the cytoskeleton,
•vascular changes in the cerebrum.
53. • Hydrocephaly
• Neoplasia
• Encephalitis
• Traumas
• Neurodegeneration
• Strokes
Brain strokes or cerebrovascular
accidents
• Stroke is the most common clinical
manifestation of cerebrovascular disease, and
can be broadly divided into ischemic and
hemorrhagic stroke (Braund, 1994).
61. In conclusion...
- Useful tool that can trial small breed dogs
with neurologic signs
62. References
CARVALHO CF, ANDRADE NETO JP. Encéfalo In: Ultrassonografia em pequenos
animais. 2ed. Editora Roca, São Paulo. 2014.
CARVALHO CF, ANDRADE NETO JP, JIMENEZ CD, DINIZ SA, CHAMMAS MC.
Ultrassonografia transcraniana em cães com distúrbios de origem central. Arq.
Bras. Med. Vet. Zootec., v.59, n.6, p.1412-1416, 2007.
CARVALHO CF, CINTRA TCF, ANDRADE NETO JP. Ultrassonografia Doppler
transcraniana. In: Carvalho, CF Ultrassonografia Doppler em pequenos animais.
Editora Roca, 2009.
CARVALHO CF, PEREZ RB, CHAMMAS MC, MAIORKA PC. Transcranial Doppler
sonographic findings in granulomatous meningoencephalitis in small breed dogs.
Canadian Veterinary Journal v.53, p.855–859, 2012.
CARVALHO CF, ANDRADE NETO JP, DINIZ SA. Small breed dogs with confirmed
stroke: concurrent diseases and sonographic findings. Arq. Bras. Med. Vet.
Zootec., v.64, n.5, p.1177-1183, 2012.
CINTRA TCF, CARVALHO CF, CANOLA JC, NEPOMUCENO AC. Ultrassonografia
transcraniana em cães hígidos: padronização da técnica e descrição anatômica.
Arq. Bras. Med. Vet. Zootec., v.66, n.1, p.61-68, 2014.
63. BERG, D.; GODAU, J.; WALTER, U. Transcranial sonography in movement
disorders. Lancet Neurology. v.7, p.1044-1055, 2008.
HUDSON, J. A. et al. Ultrasonographic anatomy of the canine brain.
Veterinary Radiology, v. 30, n. 1, p. 13-21, 1989.
HUDSON, J. A.; SIMPSON, S. T.; COX, N. R. Ultrasonographic examination of
the normal canine neonatal brain. Veterinary Radiology, v. 32, p. 50-59,
1991.
SAITO, M.; OLBY, J. N.; SPAULDING, K. Identification of arachnoid cysts in
the quadrigeminal cistern using ultrasonography. Veterinary Radiology &
Ultrasound, v. 42, n.5, p.435-439, 2001.
GAROSI, L. S. Cerebrovascular disease in dogs and cats. Veterinary Clinics
of North America: Small Animal Practice, v. 40, p. 65-79, 2010.
HILLOCK, S. M. et al. Vascular encephalopathies in dogs: incidence, risk
factors, pathophysiology, and clinical signs. Compendium on Continuing
Education for the Practicing Veterinarian, v. 2, n. 3, p. 196-207, 2006.
LILLEHEI, K. O.; CHANDLER, W. F.; KNAKE, J. E. Real time ultrasound
characteristics of the acute intracerebral hemorrhage as studied in the canine
model. Neurosurgery, v.14, n.1, p. 48-51, 1984.
64. PLATT, S. R.; GAROSI, L. Canine cerebrovascular disease: Do dogs have
strokes? Journal of the American Animal Hospital Association, v. 39, n.
4, p. 337-342, 2003.
DE LAHUNTA, A.; GLASS, E. Veterinary neuroanatomy and clinical
neurology. 3rd ed. Philadelphia: Saunders, 2009.
HOSKINS, J. D.; SHELTON, G. D. The nervous and neuromuscular systems.
In: HOSKINS, J. D. Veterinary pediatrics. 3rd. ed. Philadelphia: W.B.
Saunders Co., 2001. Cap. 19, p. 425.
FUKUSHIMA, U. et al. Evaluation of intracranial pressure by transcranial
Doppler ultrasonography in dogs with intracranial hypertension. Journal
Veterinary Medical Science, v. 62, n. 3, p. 353-355, 2000.
SPAULDING, K. A.; NICHOLAS, J. H.; SHARP, B. Ultrasonographic imaging of
the lateral cerebral ventricles in the dog. Veterinary Radiology, v. 31, n. 2,
p. 59-64, 1990.
BRAUND, K. G. Neurological syndromes. In: __ Clinical neurology in small
animals: localization, diagnosis and treatment. New York: International
Veterinary Information Service, 2003.
SAITO, M. et al. Magnetic resonance imaging features of lissencephaly in 2
lhasa apsos. Veterinary Radiology & Ultrasound, v. 43, n. 4, p. 331-337,
2002.
Good morning dear colleagues! Thank you very much for coming along here today. I hope my presentation isn’t gonna take too long and that you’ll find it interesting. The purpose of today presentation is to discuss about brain’s sonography. In the next hour I gonna talk about: how to do, what we can see and finally the main application in veterinary medicine.
I’d be very happy to invite you to ask questions at the end of the session and I’m sure there’ll be plenty of time for us to discuss some of the points that have been raised.
Now, let me begin by explaining that brain’s ultrasonography is an alternative method because it is a low cóst, non-invasive and safe technique. Other advantages are that no anesthesia or contrasts are needed, and this method allows repeated measurements and monitoring.
But in our experience, we can obtain good image only in small breed dogs.
If you have a look at this clip, you can see that is a small breed dog. It’s beeing restrained by its owner with no stress. Patient can be sitting, or placed into lateral or sternal recumbency without sedation. In this case we’re using acoustic gel over the dog’s head and scanning the brain with a microconvex probe.
Talking about the technique, we use ...
Three acoustic windows are used to scan all the brain: rostral, temporal and suboccipital windows...
Each window has to be scanned on all planes of images. Let’s see what I mean...
At rostral window, driving the probe rostral to caudal direction, we obtain transversal planes.
And driving the probe in lateral direction we obtain saggital planes.
At temporal window, above the zygomatic arch and driving the probe from dorsal to ventral direction we obtain dorsal planes.
And finally, at suboccipital window we obtain transversal and saggital planes
There are several publications about transcranial ultrasonography. My science degree student wrote this article. This work correlates transcranial images with healty dog’s encephalic anatomy.
So let’s check... what can we see? We can see some anatomic landmarks as...
As we can see here, in a saggital plane, obtained through rostral window, these thin hyperechoic lines that are brain’s sulci.
Also here, in a dorsal plane obtained through temporal window, we see interhemispheric fissure.
Moreover, in a transversal plane obtained through rostral window, we can see part of ventricular system: lateral ventricles and third ventricle
Through temporal window we can obtain some oblique dorsal planes in order to scan:
Here at suboccipital window we can see in transversal and saggital planes of cerebellum and medulla
And finally, still at suboccipital window driving caudally the probe, we can see medulla and subaracnoid space.
Vascular anatomy can be assessed by transcranial Doppler ultrasound.
A few reports have described vascular anatomy and reference values.
To conclude, we have to remember that main arterial brain’ supply is made of vertebrobasilar system and cerebral arterial circle.
Temporal window is the best acoustic window to assess arterious circle. Besides other arteries’ flow are assessed by Doppler from rostral window.
And suboccipital window is the best to assess vertebrobasilar system, here in transversal and saggital planes.
This movie is a good illustration of that. Initially, B-mode are made. In a temporal approach, driving caudally the probe, we obtain dorsal planes.
Color Doppler image is performed to identify the cerebral arterial circle.
Once the vessels are identified, pulsed Doppler is initiated.
Take a look at this movie: color Doppler is used as a guide to identify vessel. Then, pulsed Doppler is initiated. We have to pay attention to the correct insonation angle to maximize signal.
You can freeze when you get 3 similar sequencial waveforms. Then, measurements are made on a representative spectral waveform to determine peak systolic velocity, end diastolic velocity and resistive index.
Now that we saw how to do and what we can see, let’s talk about main applications in veterinary medicine.
In our experience hydrocephaly is the most commom central neurological disorder.
As I told before, ultrasonography is a valuable alternative to be used to detect all these congenital and adquired diseases in small breed dogs.
Probably, US brain is the most commom method to determine ventricles size in suspected hydrocephalus toy breed dogs.
Here hydrocephalus with and without ventricle communication.
Lissencephaly is a formation disorder resulting in a brain folds and grooves lack of development.
For example in this case, the sulci absence can be seen in the near field of the image. At necropsy we see the abnormal appearance of the surface of the brain.
Furthermore, congenital cysts are seen as an anechoic, well defined focal lesion.
It often causes liquoric system obstruction as we can see in this figure in saggital and transversal planes.
Chiari – like is a bony malformation in the back part of the skull. Patients use to have a crowded cerebellum (pushed against the foramen magnum) resulting in a kicking medulla and obstruction of varying degrees.
Dandy walker syndrome is a condition that affects brain development: patients have abnormal cerebellum (as hypoplasia for example) and cysts in the forth ventricle.
Now, move on to see adquired diseases...
Trauma appearance varies.
This first figure (in dorsal plane obtained at temporal window), we can see a hypo to anechoic focal lesion that suggests edema.
This another patient, a saggital plane obtained at subocciptal window, we can see a hyperechoic lesion surrounded by edema causing obstrution.
Most of neoplasias are seen as focal hyperechoic lesions as we see here...
These lesions often cause mass effect and liquoric system obstrution (depending on location).
Move on to encephalitis...
Some of them, as necrotizing encephalitis can cause ‘ex vaccum’ hydrocephalus as we can see here at sonogram and necropsy
Other encephalitis as granulomatous meningomyeloencephalitis can cause focal lesions that usually occur within the white matter of the cerebrum, cerebellum, caudal brainstem and cervical spine cord.
Additionally, some diseases can lead to hemodynamic changes. Mainly occured because decrease in oxygen supply, glucose or blood flowing
In these cases (hydrocephaly, neoplasia, encephalitis, traumas, degeneration and strokes), transcranial Doppler ultrasonography can provide additional information.
Let’s see what and why...
We drove a research that compared Doppler parameters of main cerebral arteries in dogs with hydrocephalus before and after clinical treatment.
The results presented that there’s no significant influence of the variables in the B-mode. And the resistive index was the best parameter to monitor the treatment.
Besides, patients with hydrocephalus may alter cerebral arteries’ resistive index in each brain part, as we’re seeing in this example
Furthermore, a good example of “mass effect”.
Rostral and caudal arteries are presenting elevated resistive index.
Move on to encephalitis... In the case of granulomatous meningoencephalitis, hemodynamic changes are variable and progressive with the disease
This retrospective study describes transcranial Doppler ultrasonography findings in dogs with confirmed histopathology of granulomatous meningoencephalitis (GME) in several degrees
In early stages
Other findings are:
As progression the disease...
In addition, in this case we can see
Another patient: histhology after treatment presented
In the case of trauma,
There are some articles showing that
Move on to neurodegeneration, we know that this process displays some commom morphological characteristics as:
All these features may lead to hemodynamic changes, disturbances and eventually to brain chronic hypoxia seen at Transcranial Doppler ultrasonography
Finally, cerebrovascular accidents...
This retrospective study in 512 examinations selected only 42 dogs with cerebrovascular disease confirmed at necropsy.
This table shows concurrent diseases found in our study:
33% with cerebral amyloid angiopathy
31% with endocrinopathies
And 24% with coagulopathy
This table shows concurrent diseases found in our study:
33% with cerebral amyloid angiopathy
31% with endocrinopathies
And 24% with coagulopathy
This table shows concurrent diseases found in our study:
33% with cerebral amyloid angiopathy
31% with endocrinopathies
And 24% with coagulopathy
This table shows concurrent diseases found in our study:
33% with cerebral amyloid angiopathy
31% with endocrinopathies
And 24% with coagulopathy
In brief, we saw the coexisting diseases occurrence with cerebrovascular accidents like these:
In general,
Focal lesion was the most commom finding with high sensitivity at necropsy as we can see here;
Decrease in echogenicity was related to edema with 62% of sensitivity in our study,
Diffuse increase in echogenicity was related to aging changes and also cerebral stenosis and resistive index increasing
In conclusion, in our experience, brain ultrasonography is an useful tool that can trial small breed dogs with neurologic signs.