Diagnostics and Stroke Improvement launched this publication on “Why treat stroke and transient ischaemic attacks (TIAs) as emergencies”. This publication highlights the benefits and provides examples of how radiology departments have managed to meet these demands
(Jun 2010)
Saint Louis University Hospital has a variety of advanced neuroscience technologies to aid in diagnosis and treatment, including MEG, intraoperative MRI, angiography suites, PET/CT scans, and CyberKnife. The document discusses several specific technologies and their applications in mapping brain activity, allowing surgeons to scan patients' brains during surgery, performing minimally invasive vascular procedures, combining CT and PET scans, and precisely targeting tumors. It also summarizes services for stroke treatment, skull base surgery, epilepsy treatment, and neurocritical care.
Decompressive craniectomy is a surgical procedure where part of the skull is removed to relieve pressure on the brain from swelling after severe traumatic brain injury. There are various techniques for decompressive craniectomy including size and location of bone flap removed and methods for opening and repairing the dura mater. Key goals are to provide space for brain swelling, improve blood flow, and reduce pressure while preventing complications like brain herniation. The author discusses their experience with standard large frontotemporoparietal decompressive craniectomy and considerations for optimal decompression balancing risks.
This document discusses decompressive craniectomy for refractory intracranial hypertension. It provides rationale and indications for decompressive craniectomy, which aims to reduce intracranial pressure by removing part of the skull. Common complications are also mentioned. Guidelines from the American Association of Neurological Surgeons are presented regarding criteria for performing decompressive craniectomy in patients with traumatic brain injury or refractory increased intracranial pressure. Outcomes of decompressive craniectomy are discussed for different patient groups.
This clinical study examined whether decompressive craniectomy (DC) reduces cumulative ischemic burden and therapeutic intensity levels in severe traumatic brain injury (TBI) patients with elevated intracranial pressure (ICP). The study found that performing DC on 10 severe TBI patients with elevated ICP reduced ICP immediately and lowered therapeutic intensity levels within 12 hours after surgery. DC also significantly reduced the duration and severity of cumulative ischemic burden in these patients. Overall mortality was lower than predicted, suggesting DC may help reduce secondary brain injury from elevated ICP in severe TBI.
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.
Kevin M. Pantalone DO ECNU CCD, Stephen E. Jones PhD, Robert J. Weil, Amir ...JesusCajigas3
MRI is the preferred imaging modality for evaluating pituitary disorders. It provides detailed images of pituitary gland anatomy and surrounding structures. Interpreting pituitary MRI images involves:
1. Distinguishing between T1-weighted images which show fat bright and water dark, and T2-weighted images which are opposite.
2. Identifying pre-contrast images where nasal conchae appear similar to brain gray matter, versus post-contrast images where conchae appear brighter due to enhancement.
3. Evaluating the normal pituitary gland which appears hypointense on T1-weighted images and hyperintense on T2-weighted images, and noting the pituitary stalk should be less than 4mm wide.
The document discusses perioperative neurosurgical critical care. It describes a clinical case of a patient returning to the ICU after decompressive craniectomy for malignant MCA infarction who faces challenges from medical comorbidities and surgery. It then discusses goals of postoperative neurosurgical care including emergence from anesthesia, hemodynamic and respiratory status optimization, and complication management. Specific complications are reviewed for various neurosurgeries like craniotomies, pituitary surgery, and carotid endarterectomy.
Saint Louis University Hospital has a variety of advanced neuroscience technologies to aid in diagnosis and treatment, including MEG, intraoperative MRI, angiography suites, PET/CT scans, and CyberKnife. The document discusses several specific technologies and their applications in mapping brain activity, allowing surgeons to scan patients' brains during surgery, performing minimally invasive vascular procedures, combining CT and PET scans, and precisely targeting tumors. It also summarizes services for stroke treatment, skull base surgery, epilepsy treatment, and neurocritical care.
Decompressive craniectomy is a surgical procedure where part of the skull is removed to relieve pressure on the brain from swelling after severe traumatic brain injury. There are various techniques for decompressive craniectomy including size and location of bone flap removed and methods for opening and repairing the dura mater. Key goals are to provide space for brain swelling, improve blood flow, and reduce pressure while preventing complications like brain herniation. The author discusses their experience with standard large frontotemporoparietal decompressive craniectomy and considerations for optimal decompression balancing risks.
This document discusses decompressive craniectomy for refractory intracranial hypertension. It provides rationale and indications for decompressive craniectomy, which aims to reduce intracranial pressure by removing part of the skull. Common complications are also mentioned. Guidelines from the American Association of Neurological Surgeons are presented regarding criteria for performing decompressive craniectomy in patients with traumatic brain injury or refractory increased intracranial pressure. Outcomes of decompressive craniectomy are discussed for different patient groups.
This clinical study examined whether decompressive craniectomy (DC) reduces cumulative ischemic burden and therapeutic intensity levels in severe traumatic brain injury (TBI) patients with elevated intracranial pressure (ICP). The study found that performing DC on 10 severe TBI patients with elevated ICP reduced ICP immediately and lowered therapeutic intensity levels within 12 hours after surgery. DC also significantly reduced the duration and severity of cumulative ischemic burden in these patients. Overall mortality was lower than predicted, suggesting DC may help reduce secondary brain injury from elevated ICP in severe TBI.
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.
Kevin M. Pantalone DO ECNU CCD, Stephen E. Jones PhD, Robert J. Weil, Amir ...JesusCajigas3
MRI is the preferred imaging modality for evaluating pituitary disorders. It provides detailed images of pituitary gland anatomy and surrounding structures. Interpreting pituitary MRI images involves:
1. Distinguishing between T1-weighted images which show fat bright and water dark, and T2-weighted images which are opposite.
2. Identifying pre-contrast images where nasal conchae appear similar to brain gray matter, versus post-contrast images where conchae appear brighter due to enhancement.
3. Evaluating the normal pituitary gland which appears hypointense on T1-weighted images and hyperintense on T2-weighted images, and noting the pituitary stalk should be less than 4mm wide.
The document discusses perioperative neurosurgical critical care. It describes a clinical case of a patient returning to the ICU after decompressive craniectomy for malignant MCA infarction who faces challenges from medical comorbidities and surgery. It then discusses goals of postoperative neurosurgical care including emergence from anesthesia, hemodynamic and respiratory status optimization, and complication management. Specific complications are reviewed for various neurosurgeries like craniotomies, pituitary surgery, and carotid endarterectomy.
This document discusses encephalo-duro-arterio-myo-synangiosis (EDAMS) surgery for moyamoya disease. It notes that EDAMS is a simpler and safer procedure than other bypass options. The document presents results from a study of 75 patients who underwent EDAMS, showing that 83.33% returned to work or school within 6 months with few complications. While both children and adults saw benefits, children tended to have better outcomes from EDAMS while adults fared better with direct bypass. The document provides background on moyamoya disease and reviews literature on evaluation, classification systems, treatment approaches and outcomes.
The document discusses spasticity and its treatments. It defines spasticity as increased resistance to passive movement caused by hyperactive stretch reflexes. Treatments mentioned include oral medications, intrathecal baclofen therapy using an implanted pump, selective dorsal rhizotomy neurosurgery, and orthopedic procedures. Intrathecal baclofen therapy involves testing patients by injecting baclofen and monitoring response, then implanting a pump if symptoms improve. Programming the pump involves setting dosage and mode of delivery. Complications are also summarized.
This document outlines the study objectives for understanding the basics of emergency radiology. It will cover the basic physics of imaging modalities like plain radiography, ultrasound and CT scans. It will discuss the advantages and limitations of each modality as well as basic rules for requesting radiology exams. It will also cover principles of picture archiving systems and current and future trends in radiology. The document then begins discussing the basics of plain film radiography, explaining how it uses x-rays to create 2D images projected on a screen from a 3D object.
CT scans of the head provide detailed images of the brain, skull, and soft tissues. They are useful for evaluating head injuries, tumors, strokes, and other neurological conditions. The procedure involves lying still in a scanner while an X-ray tube rotates around the head to create cross-sectional images, which are reconstructed and analyzed by radiologists. Contrast dye may be used to enhance visualization of certain structures. CT scans are generally safe but involve radiation exposure, so they are only performed when clinically indicated.
FTP Decompressive Craniotomy: How I do it?Amit Agrawal
Decompressive craniectomy is described as a surgical technique to treat malignant cerebral edema and refractory intracranial hypertension. It involves removing part of the skull bone and dura to allow the brain room to swell externally rather than being compressed. The key steps include identifying anatomical landmarks, making burr holes connected by bone removal to create a bone flap, opening and closing the dura, and standard scalp closure. Post-operative care focuses on managing complications like hydrocephalus or seizures. While early decompressive craniectomy can improve outcomes for conditions like severe traumatic brain injury, further research is still needed to fully understand its long-term costs and benefits.
Experience of Vascular Interventional Procedures of Adana Numune Research and...ijtsrd
Objective The aim of this study was to analyze our experiences of interventional procedures for diagnosis and treatment. Methods This study was performed retrospective between January 2016 and June 2016. 38 patients were included in this study in Neurology clinic of Adana Numune Research and Training Hospital. Results The mean age of the patients was 58.6. A number of males were 19. A number of females were 19. 21 55.3 of the patients underwent diagnostic angiography, 6 15.8 underwent stenting and 11 28.9 underwent thrombectomy or endovascular coiling operation. Conclusions The use of interventional neurological procedures is increasing. Interventional neurological procedures are very risky. But diagnosis and treatment options are very beneficial for well-selected patient groups. Experienced experts are needed. Investments should be made for the progression of neuro endovascular therapies in our country. Abdurrahman Sönmezler | Semih Giray "Experience of Vascular Interventional Procedures of Adana Numune Research and Training Hospital" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-3 | Issue-2 , February 2019, URL: https://www.ijtsrd.com/papers/ijtsrd21597.pdf
Paper URL: https://www.ijtsrd.com/medicine/other/21597/experience-of-vascular-interventional-procedures-of-adana-numune-research-and-training-hospital/abdurrahman-s%C3%B6nmezler
1. The document outlines the workflow and procedures for performing an emergent CT brain perfusion scan for a potential stroke patient. Key steps include alerting necessary personnel, transporting the patient directly to the CT department, performing a non-contrast head CT to check for hemorrhage, and if no hemorrhage is found, performing a CT brain perfusion scan according to the specified protocol.
2. The protocol utilizes a dual-phase CTA technique with 80kV, 50mA scans and intravenous injection of contrast to generate perfusion maps of cerebral blood flow, volume, mean transit time and time to peak to identify areas of reduced flow indicative of a stroke and its severity.
3. If a stroke
Peripheral Nerve Catheters - an introductionAmit Pawa
In November 2019 Dr Pawa Delivered a Lecture to the South Thames Acute Pain Group, in Cobham, Just outside London, on Peripheral Nerve Catheters. This was meant to serve as an introduction to the subject and to outline some of the challenges and difficulties he had instituting these at his own trust.
Cardiac PET perfusion imaging provides superior diagnostic accuracy compared to SPECT imaging due to higher image quality and detection efficiency. While PET was previously underutilized due to limited availability, recent increases in PET camera systems and improved acquisition/processing have led to greater use of cardiac PET. PET allows for more accurate detection of coronary artery disease and assessment of individual coronary arteries compared to SPECT. PET protocols can also be completed much faster than SPECT, in around 25 minutes.
Method of history taking in clinical neurosurgeryAmit Ghosh
This document provides guidance on taking a thorough history from patients in clinical neurosurgery. It outlines 10 steps to follow, including introducing yourself, collecting the patient's profile and chief complaints, taking a detailed history of the present illness and past medical history, reviewing systems, making a provisional diagnosis, and analyzing specific symptoms like headaches. For headaches, it describes how to characterize features like location, onset, character, radiation, associated symptoms, time course, exacerbating/relieving factors and severity. It identifies red flag presentations that may indicate serious underlying conditions needing urgent attention.
1) The DECRA trial investigated whether early decompressive craniectomy improved outcomes for patients with severe traumatic brain injury and refractory intracranial hypertension compared to standard care.
2) Patients who underwent early craniectomy had decreased intracranial pressure and shorter time on ventilators and in the ICU compared to standard care.
3) However, patients who received early craniectomy were more likely to have an unfavorable outcome, with 70% having functional disability or death, compared to 51% of patients receiving standard care.
This presentation summarizes a nuclear cardiology case study of a 43-year old male patient who presented with shortness of breath. Nuclear imaging tests found ischemia in the patient's heart. After an angiogram revealed blockages, the patient received an angioplasty and stenting to improve blood flow. A follow-up nuclear test 5 months later showed the previously ischemic area had become normal tissue after the treatment.
This document provides guidance on assessing patients presenting with neurological emergencies. It outlines the key components of a neurological examination, including testing of mental status, cranial nerves II-VIII, motor function, reflexes, sensation, and coordination/balance. A thorough history and physical exam can help identify acute, life-threatening conditions and guide further diagnostic evaluation and treatment. Specialized neurocritical care units are well-equipped to manage critically ill neurological patients through a multidisciplinary approach and focused treatment of conditions like brain injuries, strokes, and seizures.
TRAUMATIC BRAIN INJURY - DR DEVAWRAT BUCHERenuka Buche
1. The document discusses guidelines and management of traumatic brain injury (TBI). It outlines different levels of evidence and recommendations for treatment.
2. It describes the etiology, demographics, patterns of injury, and pathophysiology of primary and secondary brain injury following TBI. Secondary injuries like hypotension and hypoxia can worsen outcomes.
3. The document provides guidance on the initial management of TBI, including the primary and secondary surveys, with a focus on airway, breathing, circulation, and neurological assessment. It also discusses brain-specific resuscitation approaches.
CT perfusion of the head uses x-rays to show which areas of the brain are adequately supplied with blood. It provides detailed information about blood flow and is useful for evaluating conditions like stroke, brain vessel diseases, and tumors. The procedure involves injecting contrast dye and taking multiple scans as it circulates through the brain. It is fast, painless, and can help diagnose conditions and guide treatment.
The document discusses anesthesia and resuscitation, covering topics like the ABCs of airway management, breathing, and circulation. It describes techniques for securing the airway like intubation, different types of anesthesia like general and regional, and considerations for special patient populations. Tracheal intubation is discussed in detail, outlining indications, equipment, positioning, techniques like rapid sequence induction, and ways to confirm proper tube placement.
The document discusses the approach to a patient experiencing ongoing bleeding. It outlines the following key steps:
1. First consider the possibility of a technical cause like an unligated vessel and examine for injuries.
2. If no technical cause is found, check the patient's temperature and perform laboratory tests. Hypothermia can cause coagulopathy.
3. Evaluate test results along with the patient's history for clues to underlying causes like platelet dysfunction, coagulation factor deficiencies, or inherited bleeding disorders. Treat the specific condition while continuing evaluation.
Nuclear cardiology uses radiolabeled tracers and imaging techniques to provide functional data on cardiac physiology. Common studies include myocardial perfusion imaging using thallium-201 or technetium-99m to evaluate blood flow and ischemia. Gated blood pool imaging with technetium-99m allows assessment of ejection fraction and wall motion. Myocardial infarction can be identified using radiolabeled antibodies that localize to injured heart muscle. Positron emission tomography provides metabolic data to evaluate hibernating myocardium. Overall, nuclear cardiology noninvasively evaluates cardiac function and identifies ischemia, scar, and viability.
This document provides an overview of ultrasound-guided peripheral nerve blocks. It lists the benefits of ultrasound guidance such as visualizing surrounding structures and avoiding injury. It discusses machine controls and optimizing ultrasound imaging. The objectives are to list benefits of ultrasound guidance, discuss machine controls, and identify images of peripheral nerves. It then covers techniques for various upper and lower extremity nerve blocks and provides ultrasound images of relevant anatomy.
This document discusses brain death and organ donation. It begins by outlining the history of defining brain death from 1959 to present. It then explains how brain death is determined, including establishing the cause of coma, performing a clinical examination to demonstrate signs of brain death like coma, brainstem areflexia and apnea, and confirming with ancillary tests if needed. The document provides details on specific tests like the apnea test and discusses special considerations for determining brain death in children. It also outlines conditions that must be excluded before declaring brain death. Finally, it discusses the importance of organ donation and the types of donations possible.
The document discusses the role of radiographers in stroke management and acute stroke care. It outlines how diagnostic brain imaging such as CT and MRI scans are vital for determining the type and severity of stroke in order to guide appropriate treatment. Al Ain Hospital's acute stroke pathway is described which emphasizes rapid access to imaging and interpretation within time windows to facilitate early interventions like thrombolysis. The radiographer's role in performing scans and potentially interpreting images is highlighted as critical for expediting stroke care and treatment.
What is a Brain CT Imaging Perfusion Study?Carestream
Computed tomography perfusion (aka CTP) imaging shows which areas of the brain are supplied or perfused adequately with blood and provides detailed information on delivery of blood or blood flow to the brain. Here are 10 things you need to know about the procedure.
This document discusses encephalo-duro-arterio-myo-synangiosis (EDAMS) surgery for moyamoya disease. It notes that EDAMS is a simpler and safer procedure than other bypass options. The document presents results from a study of 75 patients who underwent EDAMS, showing that 83.33% returned to work or school within 6 months with few complications. While both children and adults saw benefits, children tended to have better outcomes from EDAMS while adults fared better with direct bypass. The document provides background on moyamoya disease and reviews literature on evaluation, classification systems, treatment approaches and outcomes.
The document discusses spasticity and its treatments. It defines spasticity as increased resistance to passive movement caused by hyperactive stretch reflexes. Treatments mentioned include oral medications, intrathecal baclofen therapy using an implanted pump, selective dorsal rhizotomy neurosurgery, and orthopedic procedures. Intrathecal baclofen therapy involves testing patients by injecting baclofen and monitoring response, then implanting a pump if symptoms improve. Programming the pump involves setting dosage and mode of delivery. Complications are also summarized.
This document outlines the study objectives for understanding the basics of emergency radiology. It will cover the basic physics of imaging modalities like plain radiography, ultrasound and CT scans. It will discuss the advantages and limitations of each modality as well as basic rules for requesting radiology exams. It will also cover principles of picture archiving systems and current and future trends in radiology. The document then begins discussing the basics of plain film radiography, explaining how it uses x-rays to create 2D images projected on a screen from a 3D object.
CT scans of the head provide detailed images of the brain, skull, and soft tissues. They are useful for evaluating head injuries, tumors, strokes, and other neurological conditions. The procedure involves lying still in a scanner while an X-ray tube rotates around the head to create cross-sectional images, which are reconstructed and analyzed by radiologists. Contrast dye may be used to enhance visualization of certain structures. CT scans are generally safe but involve radiation exposure, so they are only performed when clinically indicated.
FTP Decompressive Craniotomy: How I do it?Amit Agrawal
Decompressive craniectomy is described as a surgical technique to treat malignant cerebral edema and refractory intracranial hypertension. It involves removing part of the skull bone and dura to allow the brain room to swell externally rather than being compressed. The key steps include identifying anatomical landmarks, making burr holes connected by bone removal to create a bone flap, opening and closing the dura, and standard scalp closure. Post-operative care focuses on managing complications like hydrocephalus or seizures. While early decompressive craniectomy can improve outcomes for conditions like severe traumatic brain injury, further research is still needed to fully understand its long-term costs and benefits.
Experience of Vascular Interventional Procedures of Adana Numune Research and...ijtsrd
Objective The aim of this study was to analyze our experiences of interventional procedures for diagnosis and treatment. Methods This study was performed retrospective between January 2016 and June 2016. 38 patients were included in this study in Neurology clinic of Adana Numune Research and Training Hospital. Results The mean age of the patients was 58.6. A number of males were 19. A number of females were 19. 21 55.3 of the patients underwent diagnostic angiography, 6 15.8 underwent stenting and 11 28.9 underwent thrombectomy or endovascular coiling operation. Conclusions The use of interventional neurological procedures is increasing. Interventional neurological procedures are very risky. But diagnosis and treatment options are very beneficial for well-selected patient groups. Experienced experts are needed. Investments should be made for the progression of neuro endovascular therapies in our country. Abdurrahman Sönmezler | Semih Giray "Experience of Vascular Interventional Procedures of Adana Numune Research and Training Hospital" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-3 | Issue-2 , February 2019, URL: https://www.ijtsrd.com/papers/ijtsrd21597.pdf
Paper URL: https://www.ijtsrd.com/medicine/other/21597/experience-of-vascular-interventional-procedures-of-adana-numune-research-and-training-hospital/abdurrahman-s%C3%B6nmezler
1. The document outlines the workflow and procedures for performing an emergent CT brain perfusion scan for a potential stroke patient. Key steps include alerting necessary personnel, transporting the patient directly to the CT department, performing a non-contrast head CT to check for hemorrhage, and if no hemorrhage is found, performing a CT brain perfusion scan according to the specified protocol.
2. The protocol utilizes a dual-phase CTA technique with 80kV, 50mA scans and intravenous injection of contrast to generate perfusion maps of cerebral blood flow, volume, mean transit time and time to peak to identify areas of reduced flow indicative of a stroke and its severity.
3. If a stroke
Peripheral Nerve Catheters - an introductionAmit Pawa
In November 2019 Dr Pawa Delivered a Lecture to the South Thames Acute Pain Group, in Cobham, Just outside London, on Peripheral Nerve Catheters. This was meant to serve as an introduction to the subject and to outline some of the challenges and difficulties he had instituting these at his own trust.
Cardiac PET perfusion imaging provides superior diagnostic accuracy compared to SPECT imaging due to higher image quality and detection efficiency. While PET was previously underutilized due to limited availability, recent increases in PET camera systems and improved acquisition/processing have led to greater use of cardiac PET. PET allows for more accurate detection of coronary artery disease and assessment of individual coronary arteries compared to SPECT. PET protocols can also be completed much faster than SPECT, in around 25 minutes.
Method of history taking in clinical neurosurgeryAmit Ghosh
This document provides guidance on taking a thorough history from patients in clinical neurosurgery. It outlines 10 steps to follow, including introducing yourself, collecting the patient's profile and chief complaints, taking a detailed history of the present illness and past medical history, reviewing systems, making a provisional diagnosis, and analyzing specific symptoms like headaches. For headaches, it describes how to characterize features like location, onset, character, radiation, associated symptoms, time course, exacerbating/relieving factors and severity. It identifies red flag presentations that may indicate serious underlying conditions needing urgent attention.
1) The DECRA trial investigated whether early decompressive craniectomy improved outcomes for patients with severe traumatic brain injury and refractory intracranial hypertension compared to standard care.
2) Patients who underwent early craniectomy had decreased intracranial pressure and shorter time on ventilators and in the ICU compared to standard care.
3) However, patients who received early craniectomy were more likely to have an unfavorable outcome, with 70% having functional disability or death, compared to 51% of patients receiving standard care.
This presentation summarizes a nuclear cardiology case study of a 43-year old male patient who presented with shortness of breath. Nuclear imaging tests found ischemia in the patient's heart. After an angiogram revealed blockages, the patient received an angioplasty and stenting to improve blood flow. A follow-up nuclear test 5 months later showed the previously ischemic area had become normal tissue after the treatment.
This document provides guidance on assessing patients presenting with neurological emergencies. It outlines the key components of a neurological examination, including testing of mental status, cranial nerves II-VIII, motor function, reflexes, sensation, and coordination/balance. A thorough history and physical exam can help identify acute, life-threatening conditions and guide further diagnostic evaluation and treatment. Specialized neurocritical care units are well-equipped to manage critically ill neurological patients through a multidisciplinary approach and focused treatment of conditions like brain injuries, strokes, and seizures.
TRAUMATIC BRAIN INJURY - DR DEVAWRAT BUCHERenuka Buche
1. The document discusses guidelines and management of traumatic brain injury (TBI). It outlines different levels of evidence and recommendations for treatment.
2. It describes the etiology, demographics, patterns of injury, and pathophysiology of primary and secondary brain injury following TBI. Secondary injuries like hypotension and hypoxia can worsen outcomes.
3. The document provides guidance on the initial management of TBI, including the primary and secondary surveys, with a focus on airway, breathing, circulation, and neurological assessment. It also discusses brain-specific resuscitation approaches.
CT perfusion of the head uses x-rays to show which areas of the brain are adequately supplied with blood. It provides detailed information about blood flow and is useful for evaluating conditions like stroke, brain vessel diseases, and tumors. The procedure involves injecting contrast dye and taking multiple scans as it circulates through the brain. It is fast, painless, and can help diagnose conditions and guide treatment.
The document discusses anesthesia and resuscitation, covering topics like the ABCs of airway management, breathing, and circulation. It describes techniques for securing the airway like intubation, different types of anesthesia like general and regional, and considerations for special patient populations. Tracheal intubation is discussed in detail, outlining indications, equipment, positioning, techniques like rapid sequence induction, and ways to confirm proper tube placement.
The document discusses the approach to a patient experiencing ongoing bleeding. It outlines the following key steps:
1. First consider the possibility of a technical cause like an unligated vessel and examine for injuries.
2. If no technical cause is found, check the patient's temperature and perform laboratory tests. Hypothermia can cause coagulopathy.
3. Evaluate test results along with the patient's history for clues to underlying causes like platelet dysfunction, coagulation factor deficiencies, or inherited bleeding disorders. Treat the specific condition while continuing evaluation.
Nuclear cardiology uses radiolabeled tracers and imaging techniques to provide functional data on cardiac physiology. Common studies include myocardial perfusion imaging using thallium-201 or technetium-99m to evaluate blood flow and ischemia. Gated blood pool imaging with technetium-99m allows assessment of ejection fraction and wall motion. Myocardial infarction can be identified using radiolabeled antibodies that localize to injured heart muscle. Positron emission tomography provides metabolic data to evaluate hibernating myocardium. Overall, nuclear cardiology noninvasively evaluates cardiac function and identifies ischemia, scar, and viability.
This document provides an overview of ultrasound-guided peripheral nerve blocks. It lists the benefits of ultrasound guidance such as visualizing surrounding structures and avoiding injury. It discusses machine controls and optimizing ultrasound imaging. The objectives are to list benefits of ultrasound guidance, discuss machine controls, and identify images of peripheral nerves. It then covers techniques for various upper and lower extremity nerve blocks and provides ultrasound images of relevant anatomy.
This document discusses brain death and organ donation. It begins by outlining the history of defining brain death from 1959 to present. It then explains how brain death is determined, including establishing the cause of coma, performing a clinical examination to demonstrate signs of brain death like coma, brainstem areflexia and apnea, and confirming with ancillary tests if needed. The document provides details on specific tests like the apnea test and discusses special considerations for determining brain death in children. It also outlines conditions that must be excluded before declaring brain death. Finally, it discusses the importance of organ donation and the types of donations possible.
The document discusses the role of radiographers in stroke management and acute stroke care. It outlines how diagnostic brain imaging such as CT and MRI scans are vital for determining the type and severity of stroke in order to guide appropriate treatment. Al Ain Hospital's acute stroke pathway is described which emphasizes rapid access to imaging and interpretation within time windows to facilitate early interventions like thrombolysis. The radiographer's role in performing scans and potentially interpreting images is highlighted as critical for expediting stroke care and treatment.
What is a Brain CT Imaging Perfusion Study?Carestream
Computed tomography perfusion (aka CTP) imaging shows which areas of the brain are supplied or perfused adequately with blood and provides detailed information on delivery of blood or blood flow to the brain. Here are 10 things you need to know about the procedure.
This document provides an overview of stroke neuroimaging essentials. It begins with an introduction to stroke basics, including definitions of ischemic and hemorrhagic strokes. It then covers typical stroke presentations based on the affected territory. The document outlines the imaging approach to acute stroke, including the role of non-contrast CT, CTA, and MRA. It reviews common early signs on non-contrast CT such as the hyperdense vessel sign. Later signs like hypoattenuation and mass effect are also discussed. The document concludes with an example case walking through the imaging and management of an acute stroke patient.
This document discusses anaesthesia considerations for craniotomy to remove a mass lesion in the brain. It covers preoperative evaluation focusing on signs of increased intracranial pressure. Strict control of blood pressure, intubation technique to avoid pressure increases, and maintenance with balanced anaesthesia to control ICP and CPP are emphasized. Monitoring of ICP, CPP and other parameters is important. Positioning must be done carefully to avoid pressure on nerves or veins.
Journal Club on Decompressive Craniotomy in Acute Ischemic Stroke.pptxSan Mal
Decompressive craniectomy is a surgical procedure to relieve pressure in the skull from brain swelling after large ischemic strokes. Several randomized controlled trials found that decompressive craniectomy reduces mortality in patients under 60 with large hemispheric strokes affecting the middle cerebral artery territory, but does not significantly improve functional outcomes. Guidelines recommend considering decompressive craniectomy for selected younger patients with deteriorating neurological function from malignant cerebral edema within 48 hours of stroke onset.
1. The document discusses traumatic brain injuries and CNS infections, outlining their assessment, management, and surgical treatment.
2. Key points include evaluating patients using the Glasgow Coma Scale, identifying different types of intracranial hemorrhages on imaging and their presentations, and treating brain abscesses medically with antibiotics and surgically via burr hole aspiration or craniotomy for excision.
3. Surgical management of conditions like epidural hematomas and brain abscesses aims to decrease intracranial pressure and obtain samples for culture.
PRACTICALITY OF CRANIOSPINALIRRADIATIONKanhu Charan
This document discusses cranio-spinal irradiation (CSI) for the treatment of medulloblastoma and other central nervous system tumors. CSI involves delivering radiation to the entire brain, spinal cord, and cerebrospinal fluid (CSF) spaces to prevent CSF spread of the tumor. Key aspects of CSI planning and delivery discussed include target volume delineation, dose and fractionation schedules, patient positioning, junction shifts, and management of side effects.
The document discusses the determination of brain death through clinical examination or ancillary testing. It provides details on the preconditions that must be met before determining brain death clinically, including a minimum observation period of 4 hours. It also lists the cranial nerves tested in various brainstem reflexes and acceptable imaging techniques to demonstrate brain death according to ANZICS guidelines. Contraindications to the apnea test include high cervical cord injury, severe hypoxemia, and hemodynamic instability.
1) The document discusses the recent management of acute ischemic stroke, outlining evaluation, diagnosis using imaging like CT and MRI, and treatment options including intravenous thrombolysis, intra-arterial thrombolysis, and mechanical thrombectomy.
2) Revascularization through restoration of blood flow is the main target in acute ischemic stroke management in order to minimize brain injury within the time window.
3) Prevention of future ischemic strokes involves optimal medical management as well as interventional procedures like carotid angioplasty and stenting for selected patients with carotid artery stenosis.
The Emerson Hospital Stroke Awareness 2020 program aims to educate staff about recognizing the signs and symptoms of acute stroke, the importance of early intervention, and stroke prevention. As a designated Primary Stroke Center, the hospital is required to have stroke protocols and collect data to maintain this status. Stroke is a leading cause of death in the US, with someone having a stroke every 40 seconds. Recognizing symptoms quickly and getting treatment, such as clot-busting drugs within 3-4.5 hours or clot removal within 24 hours, is critical to limiting brain damage from stroke.
This document discusses considerations for anesthesia management of supratentorial brain tumors. It begins by describing the anatomy of the supratentorial and infratentorial compartments. Common tumor types in the supratentorial compartment include gliomas, meningiomas, pituitary adenomas and metastases. Key goals for anesthesia include maintaining adequate brain perfusion and oxygenation, facilitating tumor resection, and allowing for rapid emergence. Monitoring includes standard ASA monitors plus ICP monitoring if elevated preoperatively. Positioning can affect ventilation and ICP, so padding pressure points is important. Induction aims to avoid ICP elevations while maintaining cerebral perfusion pressure. Maintenance involves propofol, opioids and muscle relaxation to prevent movements
The document discusses recent developments in stroke management. It summarizes that (1) endovascular therapy plus usual care is more effective than usual care alone for acute ischemic stroke patients with proximal arterial occlusion within 6 hours of onset, (2) early intensive blood pressure lowering is safe and may improve outcomes for intracerebral hemorrhage patients presenting within 6 hours with systolic BP 150-220 mmHg, and (3) stroke rehabilitation involving early mobilization, drug therapy to enhance motor recovery, and robotic training can improve functional recovery.
This document discusses acute ischemic stroke interventions. It provides details on:
- The typical size and duration of untreated ischemic strokes
- How many neurons and synapses are lost each hour and minute of untreated stroke
- Guidelines for emergency evaluation, diagnosis, and imaging of acute ischemic strokes
- Details on different imaging techniques like CT, MRI, CTA, and perfusion imaging
- Guidelines and recommendations for intravenous thrombolysis with rtPA within 3-4.5 hours of stroke onset.
Decompressive craniectomy in Traumatic Brain Injuryjoemdas
Decompressive craniectomy is a surgical technique used to relieve increased intracranial pressure by removing a portion of the skull bone and opening the dura mater. It allows swollen brain tissue room to expand and reduces pressure. The document discusses the history of the procedure, indications such as severe traumatic brain injury and malignant stroke, types including decompressive hemicraniectomy and bifrontal craniectomy, potential complications like subdural fluid collections, and the role of later cranioplasty. While controversies remain, decompressive craniectomy can be life-saving for carefully selected patients with medically refractory elevated intracranial pressure.
This document provides information about traumatic brain injury (TBI) for patients and families. It defines TBI as an injury to the brain caused by trauma to the skull. Common types of TBI are contusions, hemorrhages, and brain swelling. Management involves monitoring pressure and oxygen levels in the brain and using treatments like sedation, hypothermia, medications, and surgery to prevent further brain injury from swelling. The prognosis varies for each patient, but most experience worsening before improvement as the brain heals.
This document provides an overview of cerebrovascular accidents or strokes. It defines a stroke as the sudden death of brain cells due to lack of oxygen from a blocked or ruptured artery in the brain. Risk factors include hypertension, heart disease, smoking, obesity, and age. Strokes are classified as ischemic or hemorrhagic and treatment involves medications to break up clots, surgery, and rehabilitation to regain functions. Nursing care focuses on airway maintenance, communication, mobilization, and psychological support during recovery.
This document provides an overview of head and neck trauma management. Key points include:
- Prevent secondary brain injury in head trauma by avoiding hypotension and hypoxia. Expedite surgery for epidural and subdural hematomas.
- Prevent secondary spinal cord injury by immediately immobilizing the cervical spine in patients with suspected spinal cord injury.
- Liberal use of CT for head injury evaluation. Immobilize the entire spine and image the full spine if spinal fracture is found.
- Timely neurosurgical consultation is crucial for managing certain brain injuries.
This document provides information about stroke, including what it is, what causes it, symptoms, and treatment options. Stroke occurs when a blood vessel to the brain is blocked by a clot or bursts, cutting off blood and oxygen to part of the brain. It is a medical emergency, as time lost can mean brain tissue death. Early treatment, such as clot-busting drugs within 4.5 hours, can reverse strokes. Modern neurointerventional techniques can remove clots and open blocked vessels to restore blood flow to the brain.
This document discusses the anesthetic management of patients with traumatic brain injury (TBI). It covers the pathophysiology of primary and secondary brain injuries following TBI. Evaluation involves a neurological exam including Glasgow Coma Scale. The goals of airway management and ventilation are to prevent hypoxia and hypercarbia which can worsen outcomes. Intraoperative monitoring such as ICP monitoring aims to maintain cerebral perfusion pressure and reduce intracranial pressure. Blood pressure and ventilation are carefully managed to optimize oxygen delivery and avoid elevating ICP.
Similar to Why treat stroke and transient ischaemic attacks as emergencies? (20)
This document outlines a webinar series from the Patient Experience Network (PEN) discussing initiatives that have improved patient experience. The webinars will feature presentations on a homeless hospital discharge program in the UK that improved outcomes for homeless patients, and a digital platform called Patient Connect and Staff Connect that provides personalized health information and engagement tools. The webinar series runs from September to November 2015 and invites attendees to learn about successful approaches to enhancing patient experience.
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2. **Dermis**: Located beneath the epidermis, the dermis contains connective tissue, blood vessels, hair follicles, and sweat glands. It plays a vital role in supporting and nourishing the epidermis, regulating body temperature, and housing sensory receptors for touch, pressure, temperature, and pain.
3. **Hypodermis**: Also known as the subcutaneous layer, it consists of fat and connective tissue that anchors the skin to underlying structures like muscles and bones. It provides insulation, cushioning, and energy storage.
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2. **Clogged Pores:** When dead skin cells and oil block hair follicles, bacteria (usually Propionibacterium acnes) can thrive, causing inflammation and acne lesions.
3. **Hormonal Factors:** Fluctuations in hormone levels, such as during puberty, menstrual cycles, pregnancy, or certain medical conditions, can contribute to acne.
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- **Blackheads:** Open plugged pores with a dark surface.
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- **Pustules:** Pimples with pus at their tips.
- **Nodules:** Large, solid, painful lumps beneath the surface.
- **Cysts:** Painful, pus-filled lumps beneath the surface that can cause scarring.
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Treatment depends on the severity and type of acne but may include:
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- **Oral Medications:** Antibiotics or oral contraceptives for hormonal acne.
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- **Sun Protection:** Use sunscreen to prevent exacerbation of acne scars and inflammation.
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Why treat stroke and transient ischaemic attacks as emergencies?
1. NHS
CANCER NHS Improvement
DIAGNOSTICS
Diagnostics and Stroke Improvement
HEART Why treat stroke and transient
ischaemic attacks (TIAs) as
LUNG emergencies?
STROKE
2. 1 Why treat stroke and transient ischaemic attacks (TIAs) as emergencies?
Stroke
During a stroke 1.9 million neurons
die every minute. In that same
minute, the brain loses 14 billion
synapses and 7.5 miles of
myelinated fibres. Surrounding the
dead cells is a penumbra of
salvageable but at-risk neurons.
In the past, stroke was diagnosed on
clinical grounds and we only
scanned the occasional suspected
haemorrhage. Recent improvements
in clinical management have
demonstrated that stroke outcome
can be significantly improved by
early active interventions such as
thrombolysis, specialist nursing care,
physiotherapy and speech therapy. There is abundant guidance telling Saving penumbra saves functioning
This has led to the development of us what we need to do and why - neural tissue, but also saves neurons
stroke units akin to coronary care Intercollegiate guidelines, National for improved plasticity response in
units – a good stroke unit improves Stroke Strategy, NICE Stroke regaining function – quality of life,
outcome for the patient by: Guidance.1 2 3 4 5 5 independence etc.
• Reducing mortality; There is also plenty of evidence that Further - there is a large body of
• Reducing length of stay; active stroke management does research and analysis that shows
• Improving functional recovery make a difference, and increasingly that immediate brain imaging for
and minimising residual disability; our own speciality is leading the way stroke has high clinical utility and is
• Increasing the chance of a return in demonstrating ways in which the very cost-effective.9 10 Who can
to independent existence. brain adapts and recovers argue against reducing bed days,
(functional MRI, functional improving clinical outcome and
To achieve this, physicians need to PET, etc).7 8 saving money – particularly at a time
confirm the diagnosis, exclude of financial stringency?
haemorrhage, eliminate stroke The recovery potential of the brain is
mimics, and have some idea of the amazing. We can help to maximise
vascular territory affected and the salvage of the penumbra so
size of the infarct. Most or all of this minimising the amount of dead
can be gained from an early CT brain, and the ‘plasticity’ of the
scan. Currently most of us don’t do brain then enables it to recover
too well on this: 6 function even further.
3. 2 Why treat stroke and transient ischaemic attacks (TIAs) as emergencies?
So the old response ‘we can’t cope
with all the urgent head trauma and Real recent data from a UK radiology department
abdominal CTs - why should we
rush to scan stroke patients when it 500
doesn’t make any difference?’ is no 450
longer appropriate. It does make a 400
Number of Patients
difference, particularly where patient 350
management is based on proper 300
processes and a dedicated stroke 250
unit, and radiology should be 200
pleased to be part of improving
150
stroke patient outcome.
100
For example - can you devise a
50
process where stroke patients go
0
from the point of admission (A&E 0 4 8 12 16 20 24 28 32 36 40 44 48
etc) via CT directly to the stroke Time from stroke to first brain scan (hours)
unit? Others have. We are going to
scan all stroke patients sooner or
later, lets try to make it sooner, and
be useful.
To review the current guidance: The RCP Sentinel Audit for Stroke 2008
• Patients with stroke who are
candidates for thrombolysis or
100
for some other urgent categories
should take the next available CT Optimal
Recovery
Neurological score
slot in-hours and be scanned
within an hour out-of-hours.
• No stroke patient should wait Plasticity
longer than 24 hours before they No
Recovery
have a CT scan of the brain. 30
..… and a new target: 0
3 months 6 months
• 50% of stroke patients to be Time after stroke
scanned within one hour of
hospital arrival (by April 2011).
4. 3 Why treat stroke and transient ischaemic attacks (TIAs) as emergencies?
Transient ischaemic attacks (TIA) • High risk TIAs should have • Patients are assessed and have
Transient ischaemic attacks (TIA) carotid imaging and treatment their acute stroke diagnosed by
have traditionally been diagnosed within 48 hours. trained ambulance paramedics.
on clinical grounds, with relatively • Low risk TIAs should have carotid When the patient is a suitable
few patients being imaged in the imaging within seven days, and candidate for thrombolysis the
acute phase. Evidence has emerged definitive treatment within two ambulance crew pre-warns CT
recently that there is a higher risk of weeks. staff. The patient is delivered
a stroke in the period immediately • All these investigations need to straight to CT. Where this is done
after a TIA than previously thought. be reported within this time the median door-to-needle time
This risk is around 20% in the first frame. for thrombolysis is as short as 10
four weeks. The ABCD2 scoring minutes.
system allows patients to be How to do it • Extended working day and/or
stratified into high and low risk For most departments in the UK weekend working in CT and MR
groups according to age, blood these are challenging (but increases capacity and allows
pressure, clinical features, duration achievable) ambitions. more timely stroke and TIA
of symptoms and co-existent imaging.
diabetes. So why should we bother? Because • Shift working of radiographers
It is important therefore that this is a setting in which our input and training of additional
patients who have suffered a TIA can make a huge difference to radiographers to perform head
undergo prompt assessment and individual patients and to the CT allows scans to be performed
treatment, particularly if they fall population as a whole. In contrast to promptly by staff already working
into the high risk group. Around many of the things that we willingly in the department at night and
80% of patients with TIAs require offer, the potential benefit is actually during the weekend.
carotid imaging and around half will based on very good evidence. Yes, it • Outsourcing of out-of-hours CT
require bain imaging. will be difficult, but it will be worth reporting to other trusts or private
the effort. providers reduces the additional
The current guidance for imaging in demand on radiologists.
TIAs is: Some examples of how radiology • Instead of performing a full head
departments have managed to meet MR protocol for TIA patients
• MRI with diffusion-weighted these demands:11 several weeks after the event
imaging should be available for (which is of no benefit), some
patients with suspected TIA if • The patient pathway is redesigned units have adopted a one-stop
there is doubt about the diagnosis so that stroke patients always service by using an abbreviated
or the vascular territory (ie carotid have a CT on their way from but still effective scan protocol (eg
or vertebrobasilar). In high risk A&E/Medical Assessment Unit to axial T2W and DWI only).
cases this should be done within the stroke unit. Where this is
24 hours, otherwise within a routine practice there is no
week. difficulty in scanning all stroke
patients within 24 hours.
5. 4 Why treat stroke and transient ischaemic attacks (TIAs) as emergencies?
References
1. Stroke management guidelines. Intercollegiate working party, 2004
www.rcplondon.ac.uk/pubs/books/stroke/stroke_guidelines_2ed.pdf
2. National Stroke Strategy. Department of Health, 2007
www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_081062
3. National clinical guideline for diagnosis and initial management of acute stroke and transient ischaemic
attack (TIA) - NICE guidance (published by RCP 21st July 2008)
http://guidance.nice.org.uk/CG68/Guidance/pdf/English
4. Guidelines for Management of Ischaemic Stroke and Transient Ischaemic Attack 2008
The European Stroke Organization (ESO) Executive Committee and the ESO Writing Committee
www.eso-stroke.org/pdf/ESO08_Guidelines_English.pdf
Presentation based on - Guidelines for Management of Ischaemic Stroke 2008
www.eso-stroke.org/ppt/ESO08_Slides_25thApril.PPT
5. Guidelines for the Early Management of Adults With Ischemic Stroke
Stroke. 2007;38:1655
Guideline From the American Heart Association/ American Stroke Association Stroke Council, Clinical Cardiology
Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and
Quality of Care Outcomes in Research Interdisciplinary Working Groups.
6. Dr Foster Case Notes
BMJ Volume 328 14 February 2004
7. Functional Recovery After Stroke
Reviews on Recent Clinical Trials, 2006, Vol. 1, No. 1 77
8. Functional Neuroimaging Studies of Motor Recovery After Stroke in Adults: A Review
Stroke 2003;34;1553-1566; originally published online May 8, 2003;
Cinzia Calautti and Jean-Claude Baron
9. Immediate Computed Tomography Scanning of Acute Stroke Is Cost-Effective and Improves Quality of Life
Stroke 2004;35;2477-2483; originally published online Sep 30, 2004;
Joanna M. Wardlaw, Janelle Seymour, John Cairns, Sarah Keir, Steff Lewis and Peter Sandercock
10. What is the best imaging strategy for acute stroke?
Health Technology Assessment 2004; Vol. 8: No. 1
JM Wardlaw, SL Keir, J Seymour, S Lewis, PAG Sandercock, MS Dennis and J Cairns
11. Case Studies - NHS Improvement
A selection of case studies demonstrating how clinical teams have implemented changes in CT, MR
and Doppler Ultrasound to support the National Stroke Strategy
www.improvement.nhs.uk/diagnostics
6. NHS
CANCER
NHS Improvement
DIAGNOSTICS
HEART
NHS Improvement
With over ten years practical service improvement experience in cancer, diagnostics
LUNG and heart, NHS Improvement aims to achieve sustainable effective pathways and
systems, share improvement resources and learning, increase impact and ensure
value for money to improve the efficiency and quality of NHS services.
Working with clinical networks and NHS organisations across England, NHS
Improvement helps to transform, deliver and build sustainable improvements across
STROKE the entire pathway of care in cancer, diagnostics, heart, lung and stroke services.
NHS Improvement
3rd Floor | St John’s House | East Street | Leicester | LE1 6NB
Telephone: 0116 222 5184 | Fax: 0116 222 5101
www.improvement.nhs.uk
Delivering tomorrow’s
improvement agenda
for the NHS