A REVERSIBLE POSTERIOR ENCEPHALOPATHY SYNDROME CAUSED BY ECLAMPSIA PRES SINDROM KAO POSLJEDICA EKLAMPSIJE
|
|
- Adrian Richardson
- 5 years ago
- Views:
Transcription
1 CASE REPORT UDC A REVERSIBLE POSTERIOR ENCEPHALOPATHY SYNDROME CAUSED BY ECLAMPSIA PRES SINDROM KAO POSLJEDICA EKLAMPSIJE Daliborka Tadić1, Siniša Miljković1, Vlado Đajić1, Vojo Buzadžija2, Biljana Đukić 3 Abstract: The clinical and radiological presentation described in patients with different pathological conditions, such as hypertensive encephalopathy, eclampsia, uremia, use of immunosuppressives and porphyria, represents a syndrome called PRES, or a reversible posterior encephalopathy syndrome. We report two patients with PRES due to eclampsia, aiming to draw attention of clinicians and radiologist to the existence of this clinical and radiological entity. When early recognized and adequately treated, PRES may be reversible, otherwise permanent neurological sequelae are likely. Key words: posterior reversible encephalopathy syndrome, eclampsia, reversibility, neurological deficit Sažetak: Ista klinička slika i radiološka prezentacija opisana kod pacijenata sa više različitih patoloških stanja (hipertenzivna encefalopatija, eklampsija, uremija, primjena imunosupresivne terapije, porfirija) predstavlja sindrom nazvan PRES (reversible posterior encephalopathy syndrome). Slučajevi prikazani u ovom radu su primjer PRES sindroma nastalog kao posljedica eklampsije. Željeli smo ih prikazati zbog potrebe da podsjetimo radiologe i kliničare na postojanje ovog kliničkog i radiološkog entiteta kod pacijenata oboljelih od prethodno navedenih stanja, radi njegove potencijalne reverzibilnosti u slučaju pravovremene primjene adekvatne terapijske strategije, a u suprotnom, veoma izvjesne mogućnosti zaostajanja trajnog neurološkog deficita. Ključne riječi: PRES sindrom, eklampsija, reverzibilnost, neurološki deficit 1 Clinic for Neurology, Clinical Centre of Banja Luka, Republika Srpska, Bosnia and Herzegovina 2 Institute of Medical Rehabilitation Dr Miroslav Zotović, Banja Luka, Republika Srpska, Bosnia and Herzegovina 3 Health Care Centre of Banja Luka, Republika Srpska, Bosnia and Herzegovina Correspondence to: Daliborka Tadić, MD, MSc, Address: Lovćenska 10, Laktaši, Republika Srpska, Bosnia and Herzegovina, Tel , tadic.daliborka@gmail.com * Received December 16, 2010; accepted March 22,
2 . INTRODUCTION Since 1980, the same clinical picture and radiological findings have been described in patients with different pathological conditions, such as hypertensive encephalopathy, eclampsia, uremia, the use of immunosuppressive therapy, and porphyria (1). Hynchey and colleagues unified all the conditions resulting from the same pathophysiological mechanisms into a syndrome termed reversible posterior encephalopathy syndrome, or PRES (2). We report two patients with typical clinical and radiological presentation of eclamptic encephalopathy. CASE PRESENTATION CASE 1 A 19-year-old female patient developed high blood pressure accompanied by swelling of the legs and occasional headache during the seventh month of her first pregnancy. Until then the pregnancy had been normal, and the patient had been healthy before the pregnancy. The patient went into labor at the term and got to the gynecology ward of the local general hospital where the delivery was started, which for its long duration ended in a cesarean section. One day after the delivery the patient s blood pressure increased and she complained of severe headache, followed by a generalized tonicclonic seizure, after which the patient was somnolent. Her condition persisted. Because of the complications, the patient was referred to the university hospital clinic for gynecology and obstetric in Banja Luka. She was examined by a neurologist, and underwent brain CT, which revealed microvascular ischemic lesions in the occipital subcortex bilaterally and the left frontal area. The patient was referred to the university hospital neurology clinic in Banja Luka. On the neurological examination, all clinically significant myotatic (deep tendon) reflexes were more brisk than usual, Babinski s sign was positive bilaterally, and the patient had displacement of the right bulbus oculi due to a previous injury. The high blood pressure persisted (210/140 mmhg). Somatic findings of the body systems were normal. One day after the admission to the neurology clinic the patient was in a mild coma, responding to painful stimuli with inarticulate sounds. She was treated with antiedema drugs, sedatives, and antihypertensives. Systolic blood pressure ranged mmhg and diastolic mmhg. On day 2 after admission, the patient s level of consciousness deteriorated, she fell into a deep coma, not responding to painful stimuli. Lumbar punction was performed and the finding was a clear, cytologically and biochemically normal CSF. Magnetic resonance imaging (MRI) of the brain performed on the same day showed a pathological signal on T2W/Flair sequences in both cerebral and cerebellar hemispheres, temporal and occipital lobes, and in the brain stem (Figure 1). Magnetic resonance venography (MRV) showed a reduced blood flow signal in the left transversal sinus to the sigmoid sinus and partly in the sigmoid sinus (venous thrombus) (Figure 2). Since the findings indicated brain tissue damage characteristic of PRES and cerebral venous sinus thrombosis, the patient was treated with anticoagulants and intensive antihypertensive and antibiotic therapy. On day 3, the patient s level of consciousness improved; she was still somnolent but responded with occasional adequate responses. Within the following 10 days the patient s condition gradually improved until a complete recovery. The subsequent brain MRI-MRV examination showed almost complete regression of previously described changes in the white matter of the cerebral and cerebellar hemispheres, as well as recanalization of the thrombus in the transversal venous sinus (Figure 3). After 23-day hospitalization at the neurology clinic, the patient was discharged, and the follow-up neurological examination was completely normal. 37
3 Figure 1. Brain MRI on admission Figure 2. Brain MRV on admission Figure 3. Brain MRI and MRV performed after 10 days 38
4 CASE 2 A 35-year-old female was admitted to the intensive care unit in Banja Luka in the last trimester of her first pregnancy for occasional variations in the blood pressure and peripheral edemas. Prior to the hospitalization, the patient had had a generalized tonic-clonic seizure and suffered a head injury resulting from her having fallen onto a hard surface. The patient was transferred to the gynecology clinic where she underwent an emergency cesarean section. On the neurological evaluation after the delivery, right-sided hemiparesis with a positive Babinski response and more expressed myotatic reflexes were determined, so brain CT was performed, which revealed a hypodensity zone along the posterior horn of the left lateral ventricle (Figure 4). Subsequently, the patient had a series of generalized tonic-clonic seizures resistant to standard antiepileptic treatment and severe hypertension and was therefore hospitalized in the intensive care unit of the gynecology clinic, where she was put into a barbiturate-induced coma. After awakening from the three-day barbiturate coma the patient did not have new seizures, but her high blood pressure persisted, up to 160/100mmHg. The patient was rehospitalized at the gynecology clinic, where a follow-up neurological examination was performed. Since the neurological deficits persisted, brain MRI was performed and showed T2W/Flair hyperintense areas deep in the occipital and temporal white matter bilaterally, more pronounced on the right, corresponding to the changes characteristic of PRES and aplasia of the right transversal sinus with collateral drainage (Figure 5). On the neurological examination five days after delivery, the patient had small-amplitude horizontal nystagmus on lateral gaze, and the abnormal myotatic reflexes persisted. Her blood pressure was above normal. After her gynecological condition stabilized, the patient was transferred to the neurology clinic. With antihypertensive and antiedema drugs, antibiotics and sedatives, the patient s general condition stabilized and blood pressure normalized. After ten days of treatment at the neurology clinic, the patient was discharged, without neurological deficits. Figure 4. Brain CT performed on admission 39
5 Figure 5. Brain NMR performed after 5 days DISCUSSION A reversible posterior encephalopathy syndrome (PRES) is a term denoting several pathological conditions that have the same radiological presentation and result in the development of neurological deficit. The syndrome was first described by Hynchey et al. in 1996 (2). The pathophysiological mechanism underlying PRES is basically the same, however it may be triggered by different factors involving impaired autoregulation of the cerebral blood flow due to hypertensive encephalopathy, eclampsia, iatrogenic factors (cytostatics), toxic and metabolic disorders (uremia, porphyria) (3). The diagnosis of PRES is established on the basis of the presence of high blood pressure and neurological manifestations such as headache, nausea, vomiting, confusion, behavioral disorders, impaired level of consciousness (from somnolence to coma), visual disturbances (blurred vision, hemianopsia, cortical blindness), mental status changes (confusion, amnesia, impaired concentration, lethargy), and seizures. The radiological findings include lesions in the white matter involving posterior circulation, i.e. mostly in the parieto-occipital lobes, although cases with involvements of the anterior circulation, thalamus and brainstem have also been described (4). Despite the dramatic neurological and radiological picture, the syndrome may be reversible, as suggested by its name. However, if not adequately and timely treated, there may remain permanent neurological deficits, most frequently in the form of epilepsy (5). The therapeutic approach depends on the underlying cause and includes antihypertensives, antiedema drugs, sedatives, and antiepileptics. Furthermore, 40 the presence of the syndrome requires induction of labor in the case of eclampsia, elimination of toxic blood products in the case of uremia, or discontinuation of immunosuppressant drugs causing the syndrome (6). CONCLUSION The two patients reported represent the typical clinical and radiological presentation of eclamptic encephalopathy. It is of the utmost importance for radiologists and clinicians to be aware of the existence of this clinical and radiological entity, because the syndrome may be reversible if an adequate and timely treatment is initiated, otherwise neurological sequelae are likely to persist. REFERENCES 1. Narborne MC, Musolino R, Granata F. PRES: posterior or potentially reversible encephalopathy syndrome? Neurol Sci. 2006; 27: Hynchey I, Chaves C, Appignani B. A reversible posterior encephalopathy syndrome. N Engl J Med. 1996; 334: Servillo G, Striano P, Striano S. PRES (reversible posterior encephalopathy syndrome) in critical obstetric patients. Intensiv Care Med. 2006; 29: Bertynski WS, Boardman JE. Distinct imaging patterns and lesion distribution of PRES. AINR 2007; 28: Striano P. PRES : a dramatic but potentially reversible syndrome needing a prompt diagnosis. Neurol Sci 2006; 27: Petrović B, Kostić V, Šternić N, Kolar J, Tasić N. Posterior reversible encephalopathy syndrome. Srp Arh Celok Lek 2003; 131:
Supplementary Appendix
Supplementary Appendix This appendix has been provided by the authors to give readers additional information about their work. Supplement to: Carrera J-P, Forrester N, Wang E, et al. Eastern equine encephalitis
More informationStroke - Intracranial hemorrhage. Dr. Amitesh Aggarwal Associate Professor Department of Medicine
Stroke - Intracranial hemorrhage Dr. Amitesh Aggarwal Associate Professor Department of Medicine Etiology and pathogenesis ICH accounts for ~10% of all strokes 30 day mortality - 35 45% Incidence rates
More informationINCREASED INTRACRANIAL PRESSURE
INCREASED INTRACRANIAL PRESSURE Sheba Medical Center, Acute Medicine Department Irene Frantzis P-Year student SGUL 2013 Normal Values Normal intracranial volume: 1700 ml Volume of brain: 1200-1400 ml CSF:
More information, Correlation between Neuroimaging and Clinical Presentation in Eclampsia
Correlation between Neuroimaging and Clinical Presentation in Eclampsia Krishna Dahiya, Mahesh Rathod, Seema Rohilla, Pushpa Dahiya Department of Obstetrics and Gynecology, Pt.BDS, PGIMS, Rohtak Email:
More informationA 7 MONTH PREGNANT FEMALE PRESENTED WITH POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME WITHOUT ECLAMPSIA AND HYPERTENSION: A CASE REPORT
A 7 MONTH PREGNANT FEMALE PRESENTED WITH POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME WITHOUT ECLAMPSIA AND HYPERTENSION: A CASE REPORT Dr. S.R Meena 1, Dr. Manoj Saluja 2, Dr. Surendra Khosya 3 and Dr.
More information11/27/2017. Stroke Management in the Neurocritical Care Unit. Conflict of interest. Karel Fuentes MD Medical Director of Neurocritical Care
Stroke Management in the Neurocritical Care Unit Karel Fuentes MD Medical Director of Neurocritical Care Conflict of interest None Introduction Reperfusion therapy remains the mainstay in the treatment
More informationStroke School for Internists Part 1
Stroke School for Internists Part 1 November 4, 2017 Dr. Albert Jin Dr. Gurpreet Jaswal Disclosures I receive a stipend for my role as Medical Director of the Stroke Network of SEO I have no commercial
More informationISCHEMIC STROKE IMAGING
ISCHEMIC STROKE IMAGING ผศ.พญ พญ.จ ร ร ตน ธรรมโรจน ภาคว ชาร งส ว ทยา คณะแพทยศาสตร มหาว ทยาล ยขอนแก น A case of acute hemiplegia Which side is the abnormality, right or left? Early Right MCA infarction
More informationINTRACRANIAL PRESSURE -!!
INTRACRANIAL PRESSURE - Significance raised ICP main cause of death in severe head injury main cause of morbidity in moderate and mild head injury main target and prognostic indicator in the ITU setting
More informationDural sinus thrombosis identified by point-of-care ultrasound
https://doi.org/10.15441/ceem.17.237 Dural sinus thrombosis identified by point-of-care ultrasound Laura T. Director, David C. Mackenzie Department of Emergency Medicine, Maine Medical Center, Portland,
More informationStroke Mimics. Paul Guyler
Stroke Mimics Paul Guyler Consultant Stroke Physician at Southend University Hospital Clinical Lead for Acute Stroke Essex Cardiac and Stroke Network Aims Why worry? Stroke Recognition Tools History, Examination
More information/ / / / / / Hospital Abstraction: Stroke/TIA. Participant ID: Hospital Code: Multi-Ethnic Study of Atherosclerosis
Multi-Ethnic Study of Atherosclerosis Participant ID: Hospital Code: Hospital Abstraction: Stroke/TIA History and Hospital Record 1. Was the participant hospitalized as an immediate consequence of this
More informationSEPSIS-ASSOCIATED ENCEPHALOPATHY
Università degli Studi di Brescia Scuola di Specializzazione in Anestesia, Rianimazione e Terapia Intensiva Brescia 14 gennaio 2015 SEPSIS-ASSOCIATED ENCEPHALOPATHY Prof. N. Latronico Università degli
More informationSituaciones estresantes en el lupus
Situaciones estresantes en el lupus Munther A Khamashta MD FRCP PhD Director: Lupus Research Unit Barcelona, Noviembre 2008 What is Lupus? Lupus is a neurological disease and sometimes affects other organs
More informationNon-Traumatic Neuro Emergencies
Department of Radiology University of California San Diego Non-Traumatic Neuro Emergencies John R. Hesselink, M.D. Nontraumatic Neuroemergencies 1. Acute focal neurological deficit 2. Worst headache of
More information11/23/2015. Disclosures. Stroke Management in the Neurocritical Care Unit. Karel Fuentes MD Medical Director of Neurocritical Care.
Stroke Management in the Neurocritical Care Unit Karel Fuentes MD Medical Director of Neurocritical Care Disclosures I have no relevant commercial relationships to disclose, and my presentations will not
More informationPregnancy and Neurological Disorders
Pregnancy and Neurological Disorders Myles Connor NHS Borders and University of Edinburgh, United Kingdom Outline Why is it important? Specific conditions Eclampsia Cerebrovascular disease Epilepsy Idiopathic
More informationOBSERVATION. Postpartum Angiopathy With Reversible Posterior Leukoencephalopathy
Postpartum Angiopathy With Reversible Posterior Leukoencephalopathy Aneesh B. Singhal, MD OBSERVATION Background: Postpartum angiopathy (PPA) is a cerebral vasoconstriction syndrome of uncertain cause
More informationCase Report Late Onset Postpartum Eclampsia: It is Really Never Too Late A Case of Eclampsia 8 Weeks after Delivery
SGE-Hindawi ccess to Research Stroke Research and Treatment Volume 2010, rticle ID 798616, 4 pages doi:10.4061/2010/798616 Case Report ate Onset Postpartum Eclampsia: It is Really Never Too ate Case of
More informationIt s Always a Stroke; Except For When It s Not..
It s Always a Stroke; Except For When It s Not.. TREVOR PHINNEY, D.O. Disclosures No Relevant Disclosures 1 Objectives Discuss variables of differential diagnosis for stroke Review when to TPA and when
More informationCerebro-vascular stroke
Cerebro-vascular stroke CT Terminology Hypodense lesion = lesion of lower density than the normal brain tissue Hyperdense lesion = lesion of higher density than normal brain tissue Isodense lesion = lesion
More informationReversible Posterior Encephalopathy Syndrome as the Presentation of Late Postpartum Eclampsia: A Case Report
Case Reports 158 Reversible Posterior Encephalopathy Syndrome as the Presentation of Late Postpartum Eclampsia: A Case Report Yih-Hwa Chiou and Ping-Hong Chen Abstract- We presented a case of previous
More informationRecurrent posterior reversible encephalopathy syndrome in systemic lupus erythematosus
www.edoriumjournals.com CASE REPORT PEER REVIEWED OPEN ACCESS Recurrent posterior reversible encephalopathy syndrome in systemic lupus erythematosus Melissa Ng, Sadia Saber, Richard Stratton ABSTRACT Posterior
More informationORIGINAL ARTICLE Questionnaire-based study of cerebrovascular complications during pregnancy in Aichi Prefecture, Japan
Hypertension Research Eclampsia and stroke In Pregnancy during pregnancy 40 ORIGINAL ARTICLE Questionnaire-based study of cerebrovascular complications during pregnancy in Aichi Prefecture, Japan Yasumasa
More information41 year old female with headache. Elena G. Violari MD and Leo Wolansky MD
41 year old female with headache Elena G. Violari MD and Leo Wolansky MD ? Dural Venous Sinus Thrombosis with Hemorrhagic Venous Infarct Acute intraparenchymal hematoma measuring ~3 cm in diameter centered
More informationPathological confirmation of 4 cases with isolated cortical vein thrombosis previously misdiagnosed as brain tumor
ONCOLOGY LETTERS 11: 649-653, 2016 Pathological confirmation of 4 cases with isolated cortical vein thrombosis previously misdiagnosed as brain tumor YINGXIN YU 1*, MING REN 2*, SHENG YAO 1, XIONGFEI ZHAO
More informationTOXIC AND NUTRITIONAL DISORDER MODULE
TOXIC AND NUTRITIONAL DISORDER MODULE Objectives: For each of the following entities the student should be able to: 1. Describe the etiology/pathogenesis and/or pathophysiology, gross and microscopic morphology
More informationIn 1996, Hinchey et al
Posterior reversible encephalopathy syndrome in patients with hematologic tumor confers worse outcome Hui Li, Ying Liu, Jing Chen, Xia Tan, Xiu-Yun Ye, Ming-Sheng Ma, Jian-Ping Huang, Li-Ping Zou Beijing,
More informationCase Report Reversible Posterior Leukoencephalopathy Syndrome Developing After Restart of Sunitinib Therapy for Metastatic Renal Cell Carcinoma
Case Reports in Medicine Volume 2016, Article ID 6852951, 5 pages http://dx.doi.org/10.1155/2016/6852951 Case Report Reversible Posterior Leukoencephalopathy Syndrome Developing After Restart of Sunitinib
More informationCASE PRESENTATION. Key Words: cerebral venous thrombosis, internal jugular vein stenosis, thrombolysis, stenting (Kaohsiung J Med Sci 2005;21:527 31)
Treatment of cerebral venous thrombosis SUCCESSFUL TREATMENT OF CEREBRAL VENOUS THROMBOSIS ASSOCIATED WITH BILATERAL INTERNAL JUGULAR VEIN STENOSIS USING DIRECT THROMBOLYSIS AND STENTING: A CASE REPORT
More informationThe role of seizures in reversible posterior leukoencephalopathy
Seizure 2004; 13: 277 281 doi:10.1016/s1059-1311(03)00152-3 CASE REPORT The role of seizures in reversible posterior leukoencephalopathy T. OBEID, A. SHAMI & S. KARSOU Departments of Medicine and Diagnostic
More informationCNS pathology Third year medical students. Dr Heyam Awad 2018 Lecture 5: disturbed fluid balance and increased intracranial pressure
CNS pathology Third year medical students Dr Heyam Awad 2018 Lecture 5: disturbed fluid balance and increased intracranial pressure ILOs Understand causes and symptoms of increased intracranial pressure.
More informationPOSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME: MAGNETIC RESONANCE IMAGING AND DIFFUSION-WEIGHTED IMAGING IN 12 CASES
Posterior reversible encephalopathy syndrome POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME: MAGNETIC RESONANCE IMAGING AND DIFFUSION-WEIGHTED IMAGING IN 12 CASES Mei-Chun Chou, Ping-Hong Lai, Lee-Ren Yeh,
More informationHuman Herpes Virus-6 Limbic Encephalitis
Case Studies [1] March 19, 2013 Case history: A 32-year-old Caucasian female with newly diagnosed acute myeloid leukemia (AML) was treated with induction chemotherapy and attained complete remission. She
More informationRole of MRI in acute disseminated encephalomyelitis
Original Research Article Role of MRI in acute disseminated encephalomyelitis Shashvat Modiya 1*, Jayesh Shah 2, C. Raychaudhuri 3 1 1 st year resident, 2 Associate Professor, 3 HOD and Professor Department
More informationSinus and Cerebral Vein Thrombosis
Sinus and Cerebral Vein Thrombosis A Summary Sinus and cerebral vein clots are uncommon. They can lead to severe headaches, confusion, and stroke-like symptoms. They may lead to bleeding into the surrounding
More informationSinus Venous Thrombosis
Sinus Venous Thrombosis Joseph J Gemmete, MD FACR, FSIR, FAHA Professor Departments of Radiology and Neurosurgery University of Michigan Hospitals Ann Arbor, MI Outline Introduction Medical Treatment Options
More informationAcute stroke. Ischaemic stroke. Characteristics. Temporal classification. Clinical features. Interpretation of Emergency Head CT
Ischaemic stroke Characteristics Stroke is the third most common cause of death in the UK, and the leading cause of disability. 80% of strokes are ischaemic Large vessel occlusive atheromatous disease
More informationPrevalence of venous sinus stenosis in Pseudotumor cerebri(ptc) using digital subtraction angiography (DSA)
Prevalence of venous sinus stenosis in Pseudotumor cerebri(ptc) using digital subtraction angiography (DSA) Dr.Mohamed hamdy ibrahim MBBC,MSc,MD, PhD Neurology Degree Kings lake university (USA). Fellow
More informationHemorrhagic infarction due to transverse sinus thrombosis mimicking cerebral abscesses
ISPUB.COM The Internet Journal of Neurosurgery Volume 5 Number 2 Hemorrhagic infarction due to transverse sinus thrombosis mimicking cerebral abscesses N Barua, M Bradley, N Patel Citation N Barua, M Bradley,
More informationWhat Is an Arteriovenous malformation (AVM)?
American Society of Neuroradiology What Is an Arteriovenous malformation (AVM)? From the Cerebrovascular Imaging and Intervention Committee of the American Heart Association Cardiovascular Council Randall
More informationPathologies of postchiasmatic visual pathways and visual cortex
Pathologies of postchiasmatic visual pathways and visual cortex Optic radiation: anatomy Pathologies of the postchiamsatic visual pathways and visual cortex Characterized by homonymous hemianopsia. This
More informationImaging PRES syndrome: typical, atypical and follow up findings.
Imaging PRES syndrome: typical, atypical and follow up findings. Poster No.: C-2361 Congress: ECR 2013 Type: Educational Exhibit Authors: P. Borrego Jimenez, A. Villalba Gutiérrez, M. Á. López Pino, P.
More informationLOSS OF CONSCIOUSNESS & ASSESSMENT. Sheba Medical Center Acute Medicine Department MATTHEW WRIGHT
LOSS OF CONSCIOUSNESS & ASSESSMENT Sheba Medical Center Acute Medicine Department MATTHEW WRIGHT OUTLINE Causes Head Injury Clinical Features Complications Rapid Assessment Glasgow Coma Scale Classification
More informationTIA AND STROKE. Topics/Order of the day 1. Topics/Order of the day 2 01/08/2012
Charles Ashton Medical Director TIA AND STROKE Topics/Order of the day 1 What Works? Clinical features of TIA inc the difference between Carotid and Vertebral territories When is a TIA not a TIA TIA management
More informationEpilepsy DOJ Lecture Masud Seyal, M.D., Ph.D. Department of Neurology University of California, Davis
Epilepsy DOJ Lecture - 2005 Masud Seyal, M.D., Ph.D. Department of Neurology University of California, Davis Epilepsy SEIZURE: A temporary dysfunction of the brain resulting from a self-limited abnormal
More informationStroke in the ED. Dr. William Whiteley. Scottish Senior Clinical Fellow University of Edinburgh Consultant Neurologist NHS Lothian
Stroke in the ED Dr. William Whiteley Scottish Senior Clinical Fellow University of Edinburgh Consultant Neurologist NHS Lothian 2016 RCP Guideline for Stroke RCP guidelines for acute ischaemic stroke
More informationCT - Brain Examination
CT - Brain Examination Submitted by: Felemban 1 CT - Brain Examination The clinical indication of CT brain are: a) Chronic cases (e.g. headache - tumor - abscess) b) ER cases (e.g. trauma - RTA - child
More informationSWI including phase and magnitude images
On-line Table: MRI imaging recommendation and summary of key features Sequence Pathologies Visible Key Features T1 volumetric high-resolution whole-brain reformatted in axial, coronal, and sagittal planes
More informationCVA. Alison Atwater PA-C
CVA Alison Atwater PA-C Types of CVAs Ischemic strokes 80% of strokes 2/3 are thrombotic 1/3 are embolic emboli from the heart or arteries feeding the brain such as carotids, vertebral and basilar etc
More informationOBJECTIVES. At the end of the lecture, students should be able to: List the cerebral arteries.
DR JAMILA EL MEDANY OBJECTIVES At the end of the lecture, students should be able to: List the cerebral arteries. Describe the cerebral arterial supply regarding the origin, distribution and branches.
More informationAnton-Babinski syndrome as a rare complication of chronic bilateral subdural hematomas
DOI: 10.2478/romneu-2018-0050 Article Anton-Babinski syndrome as a rare complication of chronic bilateral subdural hematomas D. Adam, D. Iftimie, Cristiana Moisescu, Gina Burduşa ROMANIA Romanian Neurosurgery
More informationAurora Health Care South Region EMS st Quarter CE Packet
Name: Dept: Date: Aurora Health Care South Region EMS 2010 1 st Quarter CE Packet Meningitis Meningitis is an inflammatory disease of the leptomeninges. Leptomeninges refer to the pia matter and the arachnoid
More informationJMSCR Vol 05 Issue 03 Page March 2017
www.jmscr.igmpublication.org Impact Factor 5.84 Index Copernicus Value: 83.27 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: https://dx.doi.org/10.18535/jmscr/v5i3.55 Imaging of Postpartum Encephalopathy:
More informationCASO CLINICO: DELIRIUM O ENCEFALOPATIA ACUTA?
15 Congresso Nazionale Associazione Nazionale Psicogeriatria FIRENZE PALAZZO DEI CONGRESSI 16/18 APRILE 2015 CASO CLINICO: DELIRIUM O ENCEFALOPATIA ACUTA? N. Latronico Università degli Studi di Brescia
More informationTHE INNOCUOUS HEADACHE THAT TURNED SINISTER
CHAPTER 54 THE INNOCUOUS HEADACHE THAT TURNED SINISTER K. RAVISHANKAR, MD Case History A 42-year-old businessman was seen in our Headache Clinic with complaints of near-daily, continuous head pain for
More informationEEG IN FOCAL ENCEPHALOPATHIES: CEREBROVASCULAR DISEASE, NEOPLASMS, AND INFECTIONS
246 Figure 8.7: FIRDA. The patient has a history of nonspecific cognitive decline and multiple small WM changes on imaging. oligodendrocytic tumors of the cerebral hemispheres (11,12). Electroencephalogram
More informationWan-Ya Su, MD; Ling-Yuh Kao, MD; Sien-Tsong Chen 1, MD
Case Report 199 Alternate-Sided Homonymous Hemianopia as the Solitary Presentation of Mitochondrial Encephalomyopathy, Lactic Acidosis, Stroke-Like Episodes Syndrome Wan-Ya Su, MD; Ling-Yuh Kao, MD; Sien-Tsong
More informationBrain under pressure Impact of vasopressors
Brain under pressure Impact of vasopressors Brain dysfunction in sepsis Incidence: - Varying nomenclature: sepsis-associated encephalopathy, delirium, brain dysfunction - Consistently recognized as frequent:
More informationC. Douglas Phillips, MD FACR Director of Head and Neck Imaging Weill Cornell Medical College NewYork-Presbyterian Hospital
C. Douglas Phillips, MD FACR Director of Head and Neck Imaging Weill Cornell Medical College NewYork-Presbyterian Hospital I have no financial disclosures Understand range of pathology that may present
More informationWHITE PAPER: A GUIDE TO UNDERSTANDING SUBARACHNOID HEMORRHAGE
WHITE PAPER: A GUIDE TO UNDERSTANDING SUBARACHNOID HEMORRHAGE Subarachnoid Hemorrhage is a serious, life-threatening type of hemorrhagic stroke caused by bleeding into the space surrounding the brain,
More informationV. CENTRAL NERVOUS SYSTEM TRAUMA
V. CENTRAL NERVOUS SYSTEM TRAUMA I. Concussion - Is a clinical syndrome of altered consiousness secondary to head injury - Brought by a change in the momentum of the head when a moving head suddenly arrested
More informationIndex. Note: Page numbers of article titles are in boldface type.
Note: Page numbers of article titles are in boldface type. A Abdominal trauma in pregnant patients coma due to, 986 987 Absence seizures impaired consciousness effects on, 803 807 Acute adrenal failure,
More informationPRACTICE GUIDELINE. DEFINITIONS: Mild head injury: Glasgow Coma Scale* (GCS) score Moderate head injury: GCS 9-12 Severe head injury: GCS 3-8
PRACTICE GUIDELINE Effective Date: 9-1-2012 Manual Reference: Deaconess Trauma Services TITLE: TRAUMATIC BRAIN INJURY GUIDELINE OBJECTIVE: To provide practice management guidelines for traumatic brain
More informationTransverse Dural Sinus Thrombosis Joseph Junewick, MD FACR
Transverse Dural Sinus Thrombosis Joseph Junewick, MD FACR 03/19/2010 History Child with headache and otomastoiditis. Diagnosis Dural venous thrombosis secondary to mastoiditis Discussion The cerebral
More informationCASE 48. What part of the cerebellum is responsible for planning and initiation of movement?
CASE 48 A 34-year-old woman with a long-standing history of seizure disorder presents to her neurologist with difficulty walking and coordination. She has been on phenytoin for several days after having
More informationAneesh T., Hemamalini Gururaj*, Arpitha J. S., Anusha Rao, Vaishnavi Chakravarthy, Abhiman Shetty
International Journal of Research in Medical Sciences Aneesh T et al. Int J Res Med Sci. 2017 Jul;5(7):3023-3028 www.msjonline.org pissn 2320-6071 eissn 2320-6012 Original Research Article DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20172981
More informationAnalysis between clinical and MRI findings of childhood and teenages with epilepsy after hypoxic-ischemic encephalopathy in neonates periods
Analysis between clinical and MRI findings of childhood and teenages with epilepsy after hypoxic-ischemic encephalopathy in neonates periods Poster No.: C-0401 Congress: ECR 2015 Type: Scientific Exhibit
More informationThe central nervous system
Sectc.qxd 29/06/99 09:42 Page 81 Section C The central nervous system CNS haemorrhage Subarachnoid haemorrhage Cerebral infarction Brain atrophy Ring enhancing lesions MRI of the pituitary Multiple sclerosis
More informationFalse-negative and False-positive Diffusion-weighted MR Findings in Acute Ischemic Stroke and Stroke-like Episodes
JRural Med 2005 ; 1 : 27 32 Original Article False-negative and False-positive Diffusion-weighted MR Findings in Acute Ischemic Stroke and Stroke-like Episodes Shuzo Shintani 1,HiroakiYokote 1,KaoruHanabusa
More informationApproach to a Neurologic Diagnosis
Approach to a Neurologic Diagnosis Neurologic Diagnosis History Physical & Neurological Examination Ancillary Procedures 3 Questions Asked Focal neurologic deficits Increased intracranial pressure Signs
More informationNeurology on the MAU. Geraint Fuller
Neurology on the MAU Geraint Fuller Conflicts of Interest Clinical neurologist No drug company links Past President of Association of British Neurologists Co-Editor of Practical Neurology Receive Royalties
More informationFirst clinical attack of inflammatory or demyelinating disease in the CNS. Alteration in consciousness ranging from somnolence or coma
ADEM Clinical features First clinical attack of inflammatory or demyelinating disease in the CNS Acute or subacute onset Affects multifocal areas of the CNS Polysymptomatic presentation Must include encephalopathy:
More information1st interactive course in MS advanced managment
6-7 December - Toronto, Canada 1st interactive course in MS advanced managment IMPROVING THE PATIENT S LIFE THROUGH MEDICAL EDUCATION www.excemed.org Liesly Lee Sunnybrook Health Sciences Centre. Department
More informationValue of MRI in the Evaluation of Patients with Seizures: An Illustrative Case
ISPUB.COM The Internet Journal of Neurology Volume 7 Number 1 Value of MRI in the Evaluation of Patients with Seizures: An Illustrative Case Y Patel, H Pinkert, M Kaufman Citation Y Patel, H Pinkert, M
More informationThe Importance of Early Recognition of Cerebral Venous Sinus Thrombosis: A Case Report
Case Report PROVISIONAL PDF The Importance of Early Recognition of Cerebral Venous Sinus Thrombosis: A Case Report Kian Guan Goh 1, Viswanathan Shanthi 2 Submitted: 8 Sep 2014 Accepted: 2 Dec 2014 1 Faculty
More information(EEG) Faculty: M. Kabiraj, M. Fiol, D. MacDonald, M. Mikati
(EEG) Moderator: N. Biary Faculty: M. Kabiraj, M. Fiol, D. MacDonald, M. Mikati Neurosciences 2003; Vol. 8 Supplement 2 S145 S146 Neurosciences 2003; Vol. 8 Supplement 2 Mohammad Kabiraj, Nabil Biary Department
More informationCase Report Delay in Diagnosis of Cerebral Venous and Sinus Thrombosis: Successful Use of Mechanical Thrombectomy and Thrombolysis
Case Reports in Medicine Volume 2011, Article ID 815618, 4 pages doi:10.1155/2011/815618 Case Report Delay in Diagnosis of Cerebral Venous and Sinus Thrombosis: Successful Use of Mechanical Thrombectomy
More informationCesarean section for breech presentation. Jonathan H. Waters, M.D.
Cesarean section for breech presentation Jonathan H. Waters, M.D. 1 26 y.o. G1P0 presented to triage in labor at 38 weeks. Patient was a known breech with a failed version 5 days before presentation. PMH
More informationCase #1. Inter-ictal EEG. Difficult Diagnosis Pediatrics. 15 mos girl with medically refractory infantile spasms 2/13/2010
Difficult Diagnosis Pediatrics Joseph E. Sullivan M.D. Assistant Professor of Clinical Neurology & Pediatrics Director, UCSF Pediatric Epilepsy Center University of California San Francisco Case #1 15
More informationCNS pathology Third year medical students,2019. Dr Heyam Awad Lecture 2: Disturbed fluid balance and increased intracranial pressure
CNS pathology Third year medical students,2019 Dr Heyam Awad Lecture 2: Disturbed fluid balance and increased intracranial pressure ILOs Understand causes and symptoms of increased intracranial pressure.
More informationBY: Ramon Medina EMT-LP/RN
BY: Ramon Medina EMT-LP/RN Discuss types of strokes Discuss the physical and neurological assessment of stroke patients Discuss pertinent historical findings Discuss pre-hospital and emergency management
More informationA Neurologist s Approach to Altered Mental Status
A Neurologist s Approach to Altered Mental Status S. Andrew Josephson, MD Department of Neurology University of California San Francisco October 23, 2008 The speaker has no disclosures Case 1 A 71 year-old
More informationCT and MR findings of systemic lupus erythematosus involving the brain: Differential diagnosis based on lesion distribution
CT and MR findings of systemic lupus erythematosus involving the brain: Differential diagnosis based on lesion distribution Poster No.: C-2723 Congress: ECR 2010 Type: Educational Exhibit Topic: Neuro
More informationProvide specific counseling to parents and patients with neurological disorders, addressing:
Neurology Description: The Pediatric Neurology elective will give the resident the opportunity to learn how to obtain an appropriate history and perform a complete neurologic exam. Four to five half days
More informationSWISS SOCIETY OF NEONATOLOGY. Severe apnea and bradycardia in a term infant
SWISS SOCIETY OF NEONATOLOGY Severe apnea and bradycardia in a term infant October 2014 2 Walker JH, Arlettaz Mieth R, Däster C, Division of Neonatology, University Hospital Zurich, Switzerland Swiss Society
More informationIntroduction. 1 person in 20 will have an epileptic seizure at some time in their life
Introduction 1 person in 20 will have an epileptic seizure at some time in their life Epilepsy is diagnosed on the basis of two or more epileptic seizures. Around 450,000 people in the UK have epilepsy
More informationSex Differences in Stroke Risk and Quality of Life after Stroke
Sex Differences in Stroke Risk and Quality of Life after Stroke Cheryl Bushnell, MD, MHS Associate Professor of Neurology Director, WFB Stroke Center Disclosures Research funding from: World Federation
More informationReversible Posterior Leukoencephalopathy Syndrome: A Case Report and Review of the Literature
196 Reversible Posterior Leukoencephalopathy Syndrome: Case Report and Review of the Literature Ching-Sen Shih, Yu-Te Lin, Sui-Hing Yan, and Yuk-Keung Lo bstract- 23-year-old man with minimal-changed nephrotic
More informationAtypical Unilateral Posterior Reversible Encephalopathy Syndrome Mimicking a Middle Cerebral Artery Infarction
Case Report Neuroimaging and Head & Neck http://dx.doi.org/10.3348/kjr.2015.16.5.1104 pissn 1229-6929 eissn 2005-8330 Korean J Radiol 2015;16(5):1104-1108 Atypical Unilateral Posterior Reversible Encephalopathy
More informationConflict of Interest Disclosure J. Claude Hemphill III, MD,MAS. Difficult Diagnosis and Treatment: New Onset Obtundation
Difficult Diagnosis and Treatment: New Onset Obtundation J. Claude Hemphill III, MD, MAS Kenneth Rainin Chair in Neurocritical Care Professor of Neurology and Neurological Surgery University of California,
More informationEndovascular Thrombolysis in Deep Cerebral Venous Thrombosis
Endovascular Thrombolysis in Deep Cerebral Venous Thrombosis Michael P. Spearman, Charles A. Jungreis, Joseph J. Wehner, Peter C. Gerszten, and William C. Welch Summary: We present two cases of acute thrombosis
More informationCOPYRIGHT 2012 THE TRANSVERSE MYELITIS ASSOCIATION. ALL RIGHTS RESERVED
The Transverse Myelitis Association...advocating for those with acute disseminated encephalomyelitis, neuromyelitis optica, optic neuritis and transverse myelitis ACUTE DISSEMINATED ENCEPHALOMYELITIS (ADEM)
More informationDiffusion-Weighted and Conventional MR Imaging Findings of Neuroaxonal Dystrophy
AJNR Am J Neuroradiol 25:1269 1273, August 2004 Diffusion-Weighted and Conventional MR Imaging Findings of Neuroaxonal Dystrophy R. Nuri Sener BACKGROUND AND PURPOSE: Neuroaxonal dystrophy is a rare progressive
More informationAssessing the Stroke Patient. Arlene Boudreaux, MSN, RN, CCRN, CNRN
Assessing the Stroke Patient Arlene Boudreaux, MSN, RN, CCRN, CNRN Cincinnati Pre-Hospital Stroke Scale May be done by EMS o One of many o F facial droop on one side o A arm drift (hold a pizza box, close
More informationCase 2: Epilepsy A 19-year-old college student comes to student health services complaining of sporadic loss of memory. The periods of amnesia occur
Case 2: Epilepsy A 19-year-old college student comes to student health services complaining of sporadic loss of memory. The periods of amnesia occur while the student is awake and occasionally in class.
More informationEpilepsy & Behavior Case Reports
Epilepsy & Behavior Case Reports 1 (2013) 45 49 Contents lists available at ScienceDirect Epilepsy & Behavior Case Reports journal homepage: www.elsevier.com/locate/ebcr Case Report Partial disconnection
More informationl' ".'"` va" Fig. 1 Patient 1. Precontrast computed tomographic scans demonstrating areas of increased attenuation
136 -. i 'sit'' -k tz#. / e, = r + -e l' ".'"` va" "t 'hua th ;] fteqhiv.r'" ' Fig. 1 Patient 1. Precontrast computed tomographic scans demonstrating areas of increased attenuation in the region of the
More informationUpdated Ischemic Stroke Guidelines นพ.ส ชาต หาญไชยพ บ ลย ก ล นายแพทย ทรงค ณว ฒ สาขาประสาทว ทยา สถาบ นประสาทว ทยา กรมการแพทย กระทรวงสาธารณส ข
Updated Ischemic Stroke Guidelines นพ.ส ชาต หาญไชยพ บ ลย ก ล นายแพทย ทรงค ณว ฒ สาขาประสาทว ทยา สถาบ นประสาทว ทยา กรมการแพทย กระทรวงสาธารณส ข Emergency start at community level: Prehospital care Acute stroke
More informationCLINICAL PRESENTATION AND RADIOLOGY QUIZ QUESTION
Donald L. Renfrew, MD Radiology Associates of the Fox Valley, 333 N. Commercial Street, Suite 100, Neenah, WI 54956 6/30/2012 Radiology Quiz of the Week # 79 Page 1 CLINICAL PRESENTATION AND RADIOLOGY
More information