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Clinical Workflows Supported by Patient Care Device Data
Published in John R. Zaleski, Clinical Surveillance, 2020
Changes or alterations in levels of alertness and responsiveness are typical in the case of stroke. But, in addition, and particularly in the case of hemorrhagic strokes, increases in blood pressure can and do result in increased intracranial pressure (ICP). As the pressure within the braincase (skull) increases due to bleeding within the skull, the brain can be forced down into the foramen magnum at the base of the skull (the entry point of the spinal cord). This not only causes changes in the patient level of consciousness, but the increasing pressure also results in changes in vital signs, including heart rate, respiration rate, and blood pressure. The increasing pressure at the base of the brain, where the medulla oblongata and the pons are centered, results in effects and changes in vital signs, in addition to the fact that the increasing pressure inside of the skull results in the need to counter that increasing pressure by raising the blood pressure in the arteries. This causes the heart to beat more forcefully and with greater volume, which causes the blood pressure in the body to rise concomitantly to counteract the increasing pressure within the skull. Needless to say, these are all emergent events and if not addressed directly, death can and often does result.
The nervous system
Published in Laurie K. McCorry, Martin M. Zdanowicz, Cynthia Y. Gonnella, Essentials of Human Physiology and Pathophysiology for Pharmacy and Allied Health, 2019
Laurie K. McCorry, Martin M. Zdanowicz, Cynthia Y. Gonnella
Various injuries to the head such as blunt force trauma, skull fractures, whiplash and penetrating wounds can result in traumatic brain injury. Because the brain floats freely within the skull, blunt force trauma to the head can cause the brain to bang against the skull as it accelerates and decelerates within the brain case. Contusions or bruises of brain tissue can occur in regions of the brain that impact the skull. Small contusions may cause limited clinical symptoms, whereas large contusions may produce significant neurologic defects. Traumatic brain injury may also be associated with damaged cerebral blood vessels and bleeding around or into the brain, leading to the formation of intracranial hematomas.
Muscles, Soft Tissues, and Craniofacial Growth
Published in D. Dixon Andrew, A.N. Hoyte David, Ronning Olli, Fundamentals of Craniofacial Growth, 2017
Washburn was careful to point out that, although the origin of the process “probably involves intrinsic factors,” his study could not throw light on the relative importance of self-differentiation and function prenatally. He concluded that ablation of the muscle demonstrated the extreme dependence of form on function. In those animals with surgically separated nuchal musculature, in addition to ablation of the temporalis, the nuchal crest failed to form and the neurocranium showed less vertical growth on the operated side. This finding conflicted somewhat with his third category of skull components, “... those which are largely independent of the muscles which happen to be associated with them (brain case).”
Different results of vestibular examinations and blood flow in cases with transient vascular vertigo/dizziness with or without central nervous system symptoms
Published in Acta Oto-Laryngologica, 2022
Takaki Inui, Tatsuro Kuriyama, Shin-ichi Haginomori, Kou Moriyama, Takeo Shirai, Yusuke Ayani, Yuko Inaka, Michitoshi Araki, Ryo Kawata
Other than the one case of TVVw (case 10) and two cases of TVVo (case 16 and 19) revealed abnormal VA signs on MRA. Regarding the MRI findings of TVVw cases, four showed diffusely scattered, age-related ischemic changes throughout the brain (case 2, 5, 7, and 10), whereas 6 showed normal MRI findings (case 1, 3, 4, 6, 8 and 9). Regarding MRI findings of TVVo cases, 6 showed diffusely scattered, age-related ischemic changes (case 15, 16, 17, 18, 19, and 22), two showed old cerebral infarction (case 14 in the cerebrum, thalamus, brainstem and cerebellum, and case 20 in the cerebellum), whereas four had normal MRI findings (case 11, 12, 13, and 21). On the basis of these MRI findings, 12 cases with some ischemic signs should be diagnosed as having ‘transient vascular vertigo/dizziness,’ and other 10 cases with MRI findings within normal range as having ‘probable transient vascular vertigo/dizziness.’
The impact of training and professional collaboration on the interobserver variation of lung cancer delineations: a multi-institutional study
Published in Acta Oncologica, 2019
Susan Mercieca, José S. A. Belderbos, Angela van Baardwijk, Stefan Delorme, Marcel van Herk
The participants were divided into 7 to 10 groups, depending on the total number of participants and the number of rooms available at the course venues. The mean number of participants per group was 10 and ranged from 7 to 30. The group consisted of 70% radiation oncologists (and trainees), 20% radiologists and 10% radiographers and physicist. Each group appointed two participants; one to operate the computer and one to moderate the discussion. All members reviewed the delineations in progress on a big screen and proposed amendments to the contour until a consensus was reached. The final consensus delineation is now described in the manuscript as interprofessional. The participants were allowed 3.5 h to discuss four cases (this lung case, a head-and-neck case, prostate case and a brain case). Here only the lung case is reported. Due to time constraints, during this session the participants were asked to delineate only the four CT images, selected by the experts.
Neurosurgical intraoperative ultrasonography using contrast enhanced superb microvascular imaging -vessel density and appearance time of the contrast agent-
Published in British Journal of Neurosurgery, 2023
Mami Ishikawa, Kazuto Masamoto, Ryota Hachiya, Hiroshi Kagami, Makoto Inaba, Heiji Naritaka, Shojiro Katoh
Ultrasonography images before and after injection of contrast agent, fusion MR images, superimposed vessel images and preoperative representative MRI. (A) Meandering and dilating vessels are observed in a schwannoma (Case 1, Video 1). Green arrowhead: schwannoma. Yellow dotted line: normal cerebellar vessel showing a tree-like structure. Red arrowhead: hemangioblastoma. Tumor sparkles in grayscale mode immediately after injection of contrast agent in a hemangioblastoma (Case 2, Video 2). The lymphoma is hypoechoic and shows low vascular density, compared to surrounding normal brain (Case 4). Blue dotted circle: avascular area in lymphoma before and after injection of contrast agent. Yellow arrowhead: brain abscess. Each color of arrow shows tumor in the fusion MRI and preoperative MRI. (B) SMI of rounded, dilated, and bent vessels is enhanced by injection of contrast agent in the glioblastoma (Cases 6–10, Video 3). Yellow arrowhead: glioblastoma. Red circles: enhanced, dense vessels in glioblastoma after injection of contrast agent. Yellow arrows show tumor in the fusion MRI and preoperative MRI. Necrotic or cystic areas in the tumor are hypoechoic and show no vessels. (C,D) Following injection of contrast agent, SMI of thick and branching vessels is enhanced in the meningioma. Contrast-enhanced vessel images vary, depending on intravascular or presurgical treatment before US monitoring; Case 11, no treatment; Case 12, preoperative embolization, deep vessels are visualized (red circle); Cases 13 and 14, no treatment, tumor vessels are fed by tentorial attachments (red asterisk); Case 15, intraoperative coagulation of the attachment and dura mater. Deep vessels are visualized in the tumor without coagulation (red circle); Case 16, intraoperative coagulation of feeders; Case 17, intraoperative complete coagulation of the attachment and dura mater, with few vessels observed in the meningioma; Case 18, no treatment, typical sunburst flow in the tumor; Case 19, no treatment, vessel density and flow are increased in the tumor; Case 20, intraoperative coagulation of the attachment and dura mater. Deep vessels are visualized in the tumor without coagulation (red circle). Green arrows show tumor in US images, fusion MRI and preoperative MRI. MRI: magnetic resonance imaging; SMI: superb microvascular imaging; US: ultrasonography; HB: hemangioblastoma.