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Cerebral Spinal Fluid

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161. CEREBRAL ATROPHY — Clinical Manifestations in Adults (PubMed)

personality deviations were observed in 31 per cent. Although the electroencephalogram was abnormal in many patients, it appeared to be of little aid in the diagnosis of the cerebral atrophy. The spinal fluid did not seem to be consistently altered in any significant or diagnostic manner. Most of the patients in the 35 to 50 year age group did not have the symptoms characteristic of Alzheimer's disease, and in only a few cases did the symptoms resemble those of other recognized disease entities. (...) CEREBRAL ATROPHY — Clinical Manifestations in Adults A study was made of the cases of 200 patients with demonstrated cerebral atrophy. In patients under 70 years of age cerebral atrophy was twice as common in men as women. Over 70 years the ratio was reversed. The incidence of cerebral atrophy was relatively high in the age group 35 to 50. Convulsions were present in more than a third of the 200 patients. Neurological abnormalities were present in 51 per cent of the entire series. Significant

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1954 California Medicine

162. Cerebral Syndromes of Diabetes Mellitus (PubMed)

were found unexpectedly in one patient, a rare occurrence in this country although recently reported from Europe. The other patient had large vessel atherosclerosis only. The clinical expression of the vascular disease was modified by concurrent abnormalities and reflected the sum total of the complexities which coexisted. The pathophysiology of the unconscious state necessarily depends on the inciting factors. Ketoacidotic coma is associated with depressed cerebral oxygen consumption. Spinal fluid (...) Cerebral Syndromes of Diabetes Mellitus Three labile diabetic patients had recurring episodes of altered sensorium. Each had severe cerebrovascular disease with superimposed metabolic derangements, including ketoacidosis, hyperglycemia without ketosis, mild uremia, and possibly cerebral edema. Two of the patients were examined postmortem. Severe leptomeningeal scarring, basal ganglial calcification and destruction of small intracerebral vessels without evidence of large vessel atherosclerosis

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1969 California Medicine

163. Spinal Cord Tumors

the parenchyma. They may extend over multiple spinal cord segments and obstruct the flow of cerebrospinal fluid within the cord, resulting in a . Extramedullary tumors Extramedullary tumors may be Intradural: Located within the dura but on the surface of the spinal cord, rather than within its parenchyma Extradural: Located outside the dura Most intradural tumors are benign and are usually meningiomas or neurofibromas, which are the two most common primary spinal tumors. Most extradural tumors are metastatic (...) Spinal Cord Tumors Spinal Cord Tumors - Neurologic Disorders - MSD Manual Professional Edition Brought to you by The trusted provider of medical information since 1899 SEARCH SEARCH MEDICAL TOPICS Common Health Topics Resources QUIZZES & CASES Quizzes Cases The trusted provider of medical information since 1899 SEARCH SEARCH MEDICAL TOPICS Common Health Topics Resources QUIZZES & CASES Quizzes Cases / / / / IN THIS TOPIC OTHER TOPICS IN THIS CHAPTER Test your knowledge Other Neurologic Imaging

2013 Merck Manual (19th Edition)

164. Syrinx of the Spinal Cord or Brain Stem

presented at the... 3D Model Herniated Nucleus Pulposus Video How to do the Cranial Nerve Examination SOCIAL MEDIA Add to Any Platform Loading , MDCM, Weill Cornell Medical College Click here for Patient Education NOTE: This is the Professional Version. CONSUMERS: Topic Resources A syrinx is a fluid-filled cavity within the spinal cord (syringomyelia) or brain stem (syringobulbia). Predisposing factors include craniocervical junction abnormalities, previous spinal cord trauma, and spinal cord tumors (...) Syrinx of the Spinal Cord or Brain Stem Syrinx of the Spinal Cord or Brain Stem - Neurologic Disorders - MSD Manual Professional Edition Brought to you by The trusted provider of medical information since 1899 SEARCH SEARCH MEDICAL TOPICS Common Health Topics Resources QUIZZES & CASES Quizzes Cases The trusted provider of medical information since 1899 SEARCH SEARCH MEDICAL TOPICS Common Health Topics Resources QUIZZES & CASES Quizzes Cases / / / / IN THIS TOPIC OTHER TOPICS IN THIS CHAPTER

2013 Merck Manual (19th Edition)

165. Effect of fibrin glue on the prevention of persistent cerebral spinal fluid leakage after incidental durotomy during lumbar spinal surgery. (PubMed)

Effect of fibrin glue on the prevention of persistent cerebral spinal fluid leakage after incidental durotomy during lumbar spinal surgery. Approximately one million spinal surgeries are performed in the United States each year. The risk of an incidental durotomy (ID) and resultant persistent cerebrospinal fluid (CSF) leakage is a significant concern for surgeons, as this complication has been associated with increased length of hospitalization, worse neurological outcome, and the development (...) glue revealed that prior lumbar spinal surgery was the only univariate predictor of persistent CSF leak, conferring a 2.8-fold increase in risk. A persistent CSF leak, defined as continued drainage of CSF from the operative incision within 90 days of the surgery that required an intervention greater than simple bed rest or over-sewing of the wound, was noted in a total of 64 patients (11.7%). This persistent CSF leak rate was significantly higher (P < 0.001) in patients with prior lumbar surgery

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2009 European Spine Journal

166. Variability analysis of human plasma and cerebral spinal fluid reveals statistical significance of changes in mass spectrometry-based metabolomics data (PubMed)

Variability analysis of human plasma and cerebral spinal fluid reveals statistical significance of changes in mass spectrometry-based metabolomics data Analytical and biological variability are issues of central importance to human metabolomics studies. Here both types of variation are examined in human plasma and cerebrospinal fluid (CSF) using a global liquid chromatography/mass spectrometry (LC/MS) metabolomics strategy. The platform shows small analytical variation with a median coefficient

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2009 Analytical chemistry

167. Delivering novel therapies in the 21st century

months of dosing. Modelling indicates that a 60% reduction in mHTT in the cerebrospinal fluid represents a 70 – 85% reduction in brain mHTT in the cerebral cortex, and a 35 – 50% reduction in the caudate tissue. This mHTT reduction in cerebrospinal fluid is greater than that required to reverse symptoms in animal models, making RG6042 a promising therapeutic for treatment of Huntington’s disease. This is the first demonstration of ASO-mediated protein suppression in the CNS of patients (...) organ or organ function via the relevant peripheral nerve. • Personalise treatment by modifying the electrical signals introduced. • Use the well-evidenced therapeutic approach of neuromodulation in new therapeutic areas (eg spinal cord stimulation has been used to treat pain, and deep brain stimulation for tremor for decades). • Treat without risk of side effects from systemic drug exposure. Therapeutic potential Bioelectronic medicine has broad applications, from rapidly reversing

2019 Academy of Medical Sciences

168. Diagnosis and Management of Acute Pulmonary Embolism

Treatment of pulmonary embolism in pregnancy 39 9.3.1 Role of a multidisciplinary pregnancy heart team 40 9.4 Amniotic fluid embolism 40 10 Long-term sequelae of pulmonary embolism 41 10.1 Persisting symptoms and functional limitation after pulmonary embolism 41 10.2 Chronic thromboembolic pulmonary hypertension 41 10.2.1 Epidemiology, pathophysiology, and natural history 41 10.2.2 Clinical presentation and diagnosis 42 10.2.3 Surgical treatment 42 10.2.4 Balloon pulmonary angioplasty 43 10.2.5 (...) weeks post-partum 38 Figure 8 Follow-up strategy and diagnostic workup for long-term sequelae of pulmonary embolism 44 Abbreviations and acronyms AcT Right ventricular outflow Doppler acceleration time AFE Amniotic fluid embolism ALT Alanine aminotransferase AMPLIFY Apixaban for the Initial Management of Pulmonary Embolism and Deep-Vein Thrombosis as First-line Therapy ASPIRE Aspirin to Prevent Recurrent Venous Thromboembolism trial AV Arteriovenous b.i.d Bis in die (twice a day) BNP B-type

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2019 European Society of Cardiology

169. Cerebral shunt

Cerebral shunt Cerebral shunt - Wikipedia Cerebral shunt From Wikipedia, the free encyclopedia Cerebral shunt A diagram of a typical brain shunt [ ] Cerebral shunts are commonly used to treat , the swelling of the brain due to excess buildup of . If left unchecked, the cerebrospinal fluid can build up leading to an increase in which can lead to , , crushed brain tissue or . The cerebral shunt can be used to alleviate or prevent these problems in patients who suffer from hydrocephalus or other (...) with enough epithelial cells to absorb the incoming CSF. Below are some common routing plans for cerebral shunts. Shunt routing [ ] Route Location of Fluid Drain Ventriculo-peritoneal shunt (VP shunt) Ventriculo-atrial shunt (VA shunt) of the heart Ventriculo-pleural shunt (VPL shunt) Ventriculo-cisternal shunt (VC shunt) Ventriculo-subgaleal shunt (SG shunt) Lumbar-peritoneal shunt (LP shunt) A subgaleal shunt is usually a temporary measure used in infants who are too small or premature to tolerate other

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2012 Wikipedia

170. Cerebral edema

has allowed for some differentiation between the two mechanisms and suggests that in the case of trauma, the cytotoxic response dominates Osmotic [ ] Normally, the of cerebral-spinal fluid (CSF) and extracellular fluid (ECF) in the brain is slightly lower than that of plasma. Plasma can be diluted by several mechanisms, including excessive water intake (or ), secretion (SIADH), , or rapid reduction of blood in hyper state (HHS), formerly known as hyperosmolar non-ketotic acidosis (HONK). Plasma (...) Cerebral edema Cerebral edema - Wikipedia Cerebral edema From Wikipedia, the free encyclopedia Cerebral edema Other names Cerebral oedema Edema (darker areas) surrounding a brain tumor. Cerebral edema is excess accumulation of fluid ( ) in the or spaces of the . Contents Signs and symptoms [ ] Most changes in are associated with cerebral edema: the brain becomes soft and smooth and overfills the , become flattened, become narrowed, and become compressed. Symptoms include , , , , and in severe

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2012 Wikipedia

171. Cerebral arteriovenous malformation

, are and , backaches, neckaches and eventual nausea, as the coagulated blood makes its way down to be dissolved in the individual's spinal fluid. It is supposed that 15% of the population, at detection, have no symptoms at all. Other common symptoms are a pulsing noise in the head, progressive and and vision changes as well as debilitating, excruciating pain. In serious cases, the blood vessels rupture and there is bleeding within the brain ( ). Nevertheless, in more than half of patients with AVM, hemorrhage (...) Cerebral arteriovenous malformation Cerebral arteriovenous malformation - Wikipedia Cerebral arteriovenous malformation From Wikipedia, the free encyclopedia Cerebral arteriovenous malformation Large arteriovenous malformation of the parietal lobe A cerebral arteriovenous malformation ( cerebral AVM , CAVM , cAVM ) is an abnormal connection between the and in the —specifically, an in the . Contents Signs and symptoms [ ] The most frequently observed problems, related to an AVM

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2012 Wikipedia

172. Proton beam therapy in adults

or sacral, skull base chondrosarcoma/sarcoma Meningioma, for which no other medical treatment (surgery, chemotherapy, photon therapy etc.) is possible Non-resectable or insufficiently resected adenoid cystic carcinoma Cerebral arteriovenous malformations (AVM), for which surgery, Non-resectable or insufficiently resected salivary gland carcinoma (except for squamous cell embolisation and (stereotactic) photon radiotherapy are all impossible or have already been delivered without success. carcinoma (...) and residual uncertainty around the effects of proton beam therapy is highly problematic. We rated the net health benefit of proton beam therapy relative to alternative treatments to be … “Incremental” (small net health benefit) in adult brain/spinal cancers …. We judged the net health benefit to be “Comparable” (equivalent net health benefit) in several other cancers, including liver, lung, and prostate cancer, …. It should be noted, however, that we made judgments of comparability based on a limited

2019 Belgian Health Care Knowledge Centre

173. Optimisation of RIZIV – INAMI lump sums for incontinence

of neurological conditions such as different forms of paralysis, spina bifida, stroke, multiple sclerosis, motor neurone disease, but also diabetes. Patients can have UUI or dysfunction of sphincter(s) with or without FI. Neurological disorders affecting the brain, spinal cord, or the peripheral nervous system have FI due to impaired anal sphincter control, reduced or absent anorectal sensibility, or abnormal anorectal reflexes. Diabetic patients can have neuropathy of the anal canal or chronic diarrhoea (...) . Table 5 – Neurological causes of incontinence Cause of faecal and urinary incontinence Underlying pathology Neurological disorders • Spinal cord injuries • Stroke • Multiple sclerosis • Spina bifida • Diabetic neuropathy • Obstetric N. pudendus damage 2.3.2 Non-Neurological causes The non-neurological incontinence group can be divided into three main categories: a large group with stress urinary incontinence (SUI), UUI and mixed UI (MUI). A second patient group with FI, and lastly, incontinence

2019 Belgian Health Care Knowledge Centre

174. Major trauma: assessment and initial management

to maintain central circulation until control is achieved. 1.5.21 For patients who have haemorrhagic shock and a traumatic brain injury: if haemorrhagic shock is the dominant condition, continue restrictive volume resuscitation or or if traumatic brain injury is the dominant condition, use a less restrictive volume resuscitation approach to maintain cerebral perfusion. Fluid replacement in pre-hospital and hospital settings Fluid replacement in pre-hospital and hospital settings 1.5.22 In pre-hospital (...) This guideline covers the rapid identification and early management of major trauma in pre-hospital and hospital settings, including ambulance services, emergency departments, major trauma centres and trauma units. It aims to reduce deaths and disabilities in people with serious injuries by improving the quality of their immediate care. It does not cover care for people with burns. The guideline should be read alongside the NICE guidelines on major trauma: service delivery, spinal injury, complex fractures

2016 National Institute for Health and Clinical Excellence - Clinical Guidelines

175. CRACKCast E198 – Brain Resuscitation

to avoid coughing (propofol decreases cerebral metabolic activity and CBF) Initiate osmolar therapy (mannitol or HTS) Use mannitol in cases of fluid overload (is a diuretic) Use HTS in other settings (can be used as a resuscitative fluid) Consider barbiturate coma if refractory to other therapies. (further decreases CBF and lowers ICP) Hypothermia can be considered in highly refractory cases. Surgical management – craniectomy can be considered in refractory ICP or if herniation present. [4] What (...) ICP that is not responding to hyperosmolar therapies. [3] What is the Monro-Kellie hypothesis? The Monro-Kellie hypothesis states that the skull is a rigid container with three non-compressible elements: brain, blood, and cerebrospinal fluid. Increases in one substance will cause displacement of others from the box or increases in ICP. The first vault content to be displaced is CSF. CSF is shunted from the intracranial compartment to the spinal subarachnoid space. Next to be displaced is blood

2019 CandiEM

176. Guidelines on Diagnosis and Management of Syncope

= electrocardiogram; ED = emergency department; ICD = implantable cardioverter defibrillator; SCD = sudden cardiac death. 3. Definitions, classification, and pathophysiology 3.1 Definitions Syncope is defined as TLOC due to cerebral hypoperfusion, characterized by a rapid onset, short duration, and spontaneous complete recovery. Syncope shares many clinical features with other disorders; it therefore presents in many differential diagnoses. This group of disorders is labelled TLOC. TLOC is defined as a state (...) attack; TLOC = transient loss of consciousness. The clinical features characterizing TLOC are usually derived from history taking from patients and eyewitnesses. Specific characteristics that aid diagnosis are outlined in section 3 of the . TLOC groups are defined using pathophysiology: the qualifying criterion for syncope is cerebral hypoperfusion; for epileptic seizures, it is abnormal excessive brain activity; and for psychogenic TLOC it is the psychological process of conversion. The syncope

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2018 European Society of Cardiology

177. New and emerging technologies in neurophysiology and operating theatres

, gases and fluids are administered during surgery. Advances in intraoperative neurophysiological monitoring will enable monitoring of neural structures within the brain, spinal cord and peripheral nerves during a procedure to minimise risk of damaging them. This technology is currently used in other countries, such as the United States, and is becoming emerging practice in Australia. The use of decision support technologies — which, for example, can facilitate clinical decision-making by providing (...) , such as anaesthetic devices for automated control of gas concentrations, haemodynamic monitoring technology to guide fluid management, NIRS monitoring of cerebral oxygenation, image- guidance techniques and ‘decision support’ tools which facilitate decision-making (for example, by enhanced display of patient information). Discussion The findings of this report have important implications for technicians, including their skills, responsibilities, education and training. These factors will need to evolve and expand

2018 Sax Institute Evidence Check

178. Sirens to Scrubs: Subarachnoid Hemorrhage

to look for blood, or the products of hemoglobin breakdown (“xanthochromia”) in the cerebral spinal fluid. In a patient that doesn’t have such obvious symptoms, the Ottawa SAH Rule can help guide decision-making. You’ll notice that many of the components of the rule are also on the list of red-flag symptoms for headache, which you can read about in this great . However, the rule should be used with caution as it has not yet been fully validated across a broad enough range of populations yet (...) for Jennifer now With Jennifer having such clear-cut symptoms of SAH, the team will do some bloodwork and order a CT head to check for obvious bleeding. The resident is confident that the CT will find a bleed, as CT will find a subarachnoid hemorrhage nearly 100% of the time within 6h of the onset of symptoms. However, when suspicion is high for SAH and the CT is normal, when symptoms developed >6h prior to presentation, or in other specific circumstances, a lumbar puncture (“spinal tap”) is performed

2019 CandiEM

179. Practice Advisory for Perioperative Visual Loss Associated with Spine Surgery 2019

artery occlusion, cerebral visual loss, and posterior reversible encephalopathy syndrome. Anterior ischemic optic neuropathy damages the front of the optic nerve (the optic nerve head or optic disc), whereas posterior ischemic optic neuropathy injures the portion of the optic nerve behind the eye. “High-risk patients” are defined for this Advisory as those who undergo spine procedures while positioned prone and who have prolonged procedures, experience substantial blood loss, or both. Purpose (...) ” for visual loss. Intraoperative Management Intraoperative management topics consist of (1) blood pressure management, (2) management of blood loss and administration of fluids, (3) use of vasopressors, (4) patient and head positioning, and (5) staging of surgical procedures. Blood Pressure Management Literature Findings. One retrospective descriptive and two retrospective observational studies reported equivocal findings regarding the association of hypotension and perioperative ischemic optic neuropathy

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2019 American Society of Anesthesiologists

180. Management of Stroke in Neonates and Children

in a delayed manner, that are presumed to have occurred in the perinatal period. These infants typically present with pathological early handedness or seizures, leading to brain imaging and the diagnosis of a remote infarction. As in adults, pediatric stroke can also be classified according to whether the underlying cause is ischemic or hemorrhagic, as detailed in the NIH Common Data Elements. Ischemic stroke includes arterial ischemic stroke (AIS) and venous infarction caused by cerebral sinovenous (...) focal motor seizures involving only 1 extremity. , In 1 study, seizures at the time of AIS occurred in 94% of neonates versus only 17% of older children. Occasionally, perinatal AIS presents with encephalopathy, leading to suspicion for hypoxic-ischemic injury rather than AIS; neuroimaging distinguishes the 2 diagnoses. The left cerebral hemisphere is affected in 80% of neonates with unilateral infarctions. Individuals with presumed perinatal stroke may seem normal after birth but later present

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2019 American Heart Association

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