TCM theory and practice
Raymond Cooper, Chun-Tao Che, Daniel Kam-Wah Mok, Charmaine Wing-Yee Tsang in Chinese and Botanical Medicines, 2017
Two cases of abnormalities are the deviated tongue and the shortened tongue. A deviated tongueIn this case, the characteristic observation is that the tongue deviates to one side when extended. The clinical significance is seen in stroke patients or prodrome of apoplexy (see glossary).A shortened tongueCharacteristics of this tongue are that the tongue cannot fully extend from the mouth and appears to be contracted. In this scenario, the clinical significance is a condition of cold retained in the vessels or deficiency of qi and blood.Coating of the tongueUsually on the tongue there is a light coating seen as a layer of moss-like spreading on the surface of the tongue produced by the upward steaming of stomach qi and upward flow of stomach fluid. In the case of a healthy tongue, the coating is seen as thin, even, white, and exhibits a moderately moist layer. The terms thin or thick reflect the condition of pathogenic factors and healthy qi and the site of the disease.
Neurosurgery: Neuroendocrine lesions
Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor in Essentials of Geriatric Neuroanesthesia, 2019
Most of the pituitary adenomas in the elderly age group are nonfunctioning (80%), while functional adenomas are approximately 20% of all pituitary tumors. In a series of 39 elderly patients, NFPTs represented 80%, acromegaly 13%, and prolactinomas 7% of the cases (7). Similarly, other studies also reported the dominancy of NFPTs and preponderance of growth hormone−secreting tumors among the functional tumors (1,4,5,8,9). A few studies also suggest that gonadotroph adenomas and prolactinomas tend to increase with age, especially in men, and are usually included erroneously in the NFPT category (10,11). With aging, the rate of cellular proliferation decreases, which accounts for the slow growth of pituitary tumors in elderly patients (11,12). Functional tumors tend to remain intrasellar, except for prolactinomas (1,4,7,8). Cushing disease is rare in the elderly and presents by rule as microadenomas (1,8). The microprolactinomas are generally diagnosed only on autopsy (13). The presence of comorbidities such as hypertension or anticoagulation might favor spontaneous apoplexy (1).
Endocrine emergencies
Philip E. Harris, Pierre-Marc G. Bouloux in Endocrinology in Clinical Practice, 2014
The diagnosis should be considered in patients who present with a severe headache, with or without neuro-ophthalmological signs. Apoplexy can mimic subarachnoid hemorrhage, meningitis, and stroke. Computed tomography (CT) scan is often the initial imaging modality used, and this scan will identify abnormalities in 80% of cases but is diagnostic in only about 20%–30% of cases.2 Magnetic resonance imaging (MRI) pituitary scan will therefore be required in most cases. Cerebrospinal fluid (CSF) analysis, if performed, may show polymorphs or lymphocytes but is sterile on culture.6
Apoplexy in Richard Bright’s (1789–1858) reports of medical cases
Published in Journal of the History of the Neurosciences, 2021
Théophile Bonet (1620–1689) and his contemporaries thought of apoplexy as a disease with a “sudden abolition of all the activities of the mind, with the preservation, for a time, of the pulse and respiration” (Bonet 1700, 5). However, abrupt paralysis without the loss or impairment of consciousness or with a gradual rather than an abrupt onset was also widely regarded as a form of apoplexy by the scholars quoted by Bonet. Morgagni stated, “In apoplectic cadavers extravasated and coagulated blood and extravasated serum is present, hence apoplexy is sanguineous or serous.” Morgagni concluded that the causes for apoplexy were either the “extravasation or congestion of blood, or deposition of serum; hence the celebrated distinction of apoplexy into sanguineous and serous: but it will appear in the sequel, that apoplectic symptoms may arise from other lesions of the brain” (Morgagni 1769, Vol. I, 22). He added a third category of apoplexy in which neither hemorrhage nor an effusion of serum were found at autopsy (Morgagni 1769, Vol. I, 20).
RVG29-modified microRNA-loaded nanoparticles improve ischemic brain injury by nasal delivery
Published in Drug Delivery, 2020
Rubin Hao, Bixi Sun, Lihua Yang, Chun Ma, Shuling Li
The treatment of cerebral apoplexy has always been clinically difficult, and the effects of conventional oral and intravenous treatments are unsatisfactory. The focus of cerebral apoplexy treatment is to protect normal brain tissue and promote the recovery of the ischemic penumbra near the infarcted area (Leigh et al., 2018). After cerebral infarction, the morphological structure of nerve cells changes, leading to a loss of function, but functional recovery can occur after a short period (Muzzi et al., 2019). Currently, the commonly used treatment method in clinical practice is chemical drug thrombolysis, but the effect is insufficient. Nucleic acid drugs have good pharmacodynamic effects, low toxicity, and few side effects. At present, treatment with nucleic acids has received increasing attention (Davide et al., 2019). MicroRNAs (miR) are short single-stranded RNAs with specific regulatory functions that can control signal pathways through a related network (Adlakha & Saini, 2014). MiR-124 is one of the most abundantly expressed miRNAs in the mature central nervous system (CNS) and is closely related to neuronal differentiation, maturation, and survival (Kozuka et al., 2019). In preclinical studies of neurological diseases, miR-124 is often used to assess neuroprotection and functional recovery after cerebral apoplexy (Hamzei Taj et al., 2016), and this molecule plays an important role in the plasticity of synaptic homeostasis (Hou et al., 2015).
Spontaneous preoperative pituitary adenoma resolution following apoplexy: a case presentation and literature review
Published in British Journal of Neurosurgery, 2020
Daniel G. Eichberg, Long Di, Ashish H. Shah, William A. Kaye, Ricardo J. Komotar
Pituitary adenomas are 5.4 times more likely to hemorrhage than any other brain tumor.32 The mechanism underlying apoplexy is not fully understood. The pituitary gland itself has a rich vascular supply and is fed by major vessels, such as the superior and inferior hypophyseal arteries.33 Several theories have been proposed regarding the pathophysiology of PA. Either primary hemorrhage or hemorrhagic infarction of a tumor can result in PA. Epstein et al. proposed that rapid tumor growth may outstrip arterial blood supply resulting in ischemia.34 While apoplexy does seem to occur more frequently in macroadenomas, even microadenomas can hemorrhage as was described in one of the cases by Yoshino et al.24 Alternatively, Rovit et al. posits that the mass effect of the growing tumor may compress the pituitary stalk against the diaphragma sella, thus compromising blood flow in the stalk’s fragile vascular network, thus leading to ischemia and hemorrhagic infarction.35
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