seizure or Adam-Stokes attack due to hypoxia

3258352 06C 09 01 7o male laryngeal cancer transfer to 4FI 06
Stokes-Adams attackWikipedia, the free encyclopedia - Cite This SourceThe term Stokes-Adams Attack refers to a sudden, transient episode of syncope, occasionally featuring seizures. It is named after two Irish physicians, Robert Adams (1791–1875) and William Stokes (1804–1877).
Signs and symptomsThe patient goes pale just before the attack, the pulse stops, and they collapse. Normal periods of unconsciousness are around 30 seconds; if seizures are present, they will consist of twitching after 15–20 seconds. Breathing continues normally throughout the attack, and so on recovery the patient becomes flushed as the heart rapidly pumps the oxygenated blood from the pulmonary beds into a systemic circulation which has become dilated due to hypoxia.
As with any syncopal episode that results from a cardiac dysrhythmia, the faints do not depend on the patient's position. If they occur during sleep, the presenting symptom may simply be feeling hot and flushed on waking.
DiagnosisStokes-Adams attacks may be diagnosed from the history, with paleness prior to the attack and flushing after it particularly characteristic. The ECG will show asystole or ventricular fibrillation during the attacks.
CausesThe attacks are caused by loss of cardiac output due to cardiac asystole, heart block, or ventricular fibrillation. The resulting lack of blood flow to the brain is responsible for the faint.
TreatmentTreatment is normally surgical, involving the insertion of a pacemaker.
PrognosisIf undiagnosed (or untreated), Stokes-Adams attacks have a 50% mortality within a year of the first episode. The prognosis following treatment is very good.
Wikipedia, the free encyclopedia © 2001-2006 Wikipedia contributors (Disclaimer)This article is licensed under the GNU Free Documentation License.Last updated on Sunday May 06, 2007 at 04:33:34 PDT (GMT -0700)View this article at Wikipedia.org - Edit this article at Wikipedia.org - Donate to the Wikimedia Foundation

心因性腦中風在診斷及處置上之新進展

心因性腦中風在診斷及處置上之新進展

林美淑1 張念中2 李聰明3

台北市 台灣大學公共衛生學院 流行病學研究所暨台灣大學附設醫院藥劑部1台北市 台北醫學大學附設醫院 內科部 心臟內科2台北醫學大學醫學系暨奇美醫學中心 內科部 心臟內科3缺血性中風有1/5 是源自心臟的栓塞所造成。心因性腦中風通常病況嚴重且易早期復發。核磁共振、穿顱都卜勒、心臟超音波、24 小時心電圖及電氣生理學檢查可協助辨認心因性栓塞之來源。非瓣膜性心房顫動是心因性中風最常見的原因，而持續口服抗凝血劑已證實可預防中風之發生。然而臨床統計卻顯示：有心房顫動伴隨有發生心因性栓塞的危險因子且無使用抗凝血劑之禁忌者，有一半以上並沒有持續使用口服抗凝血劑。新一世代抗凝血劑似乎具有較高的安全性及使用之方便性，但是仍待大規模的臨床試驗來證實。發生急性心因性中風時，目前並不建議立即常規使用抗凝血劑治療。冠狀動脈介入治療後之中風雖然罕見，但ㄧ旦併發中風時死亡率卻很高。導管操作中完全沖刷導管、最小限度的操作導管、及使用最少量的顯影劑可減少冠狀動脈介入治療後中風之發生。關鍵詞：中風、心臟、栓塞、冠狀動脈介入術。12

PCA anatomy

2007/6/25 Monday morning 6am

P1 segment— precommunal PCA
Paramedian mesencephalic arteries (PMA)
Thalamoperfortating arteries (TPA)—supply diencephalon and midbrain
Medial posterior choroidal arteries [may be braches of P2 segment]

P2 segment—postcommunal PCA; ambient cistern
Medial posterior choroidal arteries (MPChAs)
Origin: proximal P2 segment
Course: run medially around midbrain and forward along roof of third ventricle
Supply colliculi, posterior thalamus, pineal gland, and part of midbrain
Angiography: 3 configuration on lateral view
Lateral posterior choroidal arteries (LPChAs)
Origin: from either PCA or its cortical branches
Course: pass into choroids plexus of lateral ventricle, run over pulvinar of thalamus
Supply: MPChAs and LPChAs anastomose with each other and anterior choroids arteries (with which they have reciprocal relationship); variable areas of supply
Angiography: on lateral view, LPChAs behind and above MPChAs.

3. Peduncular perfortating arteries (PPA)
4. Thalamogeniculate arteries (TGA)
5. Medial posterior choroidal arteries

P3 segment—along the dorsal part of midbrain; quadrigeminal cistern
Lateral posterior choroidal arteries
Temporal branches: Anterior and posterior temporal arteries
parietooccipital arteries with calcarine artery

Ref. handbook of neuroradiology; 當代神經學 p162-163

tPA was used for a acute ischemic stroke, rght MCA territory

i was called around 9:19 pm on 2007/6/19 to visit a 63-year-old male patient with suspected acute ischemic stroke. i noticed the patient is a brother Chen's father. His NIHSS was 14. Head CT showed no ICH, there was dense MCA sign at the right MCA, and there was no contraindication for tPA. CTA and CT perfusion were tried but failed because the patient was irritable on exam, and so Dormicum was given. On arrival at the 4D1 stroke ICU, stroke attending VS Dr. Tsai just arrived at NTUH. So the time is not delayed. But the patient's neurological status was about 4 points worsen due to drug effect of Dormicum. It is under the control of God, and i believe there should be something wonderful happened in the family of Br. Chen. May the Lord of gace stengthen our brother and bless alll his family to believe into Christ and gain eternal life soon.
Lukas at the 5D classroom 5:9 am 2007/6/20

2007 The Massachusetts General Hospital Handbook of Neurology. 2/e

The Massachusetts General Hospital Handbook of Neurology. 2/e　作者：Flaherty　書號：LR1133　年份：2007　isbn：9780781751377　定價： 1598 元　

內容介紹
Book DescriptionNow in its revised, updated Second Edition, this pocket-sized handbook is a practical quick-reference guide to the diagnosis and management of neurologic diseases. It presents specific management recommendations in a succinct outline format and includes protocols, step-by-step tests and procedures, and treatment algorithms.This handbook is unique in its inclusion of material from related disciplines such as general medicine, cardiology, psychiatry, neurosurgery, neuroanatomy, and radiology. The authors offer guidance in using contemporary neuroimaging techniques in diagnosis.Product DescriptionNow in its revised, updated Second Edition, this pocket-sized handbook is a practical quick-reference guide to the diagnosis and management of neurologic diseases. It presents specific management recommendations in a succinct outline format and includes protocols, step-by-step tests and procedures, and treatment algorithms.
訂購

台北市新生南路三段88號5樓 電話: 23652183, 23657917 傳真 : 02-23649654, 23649642　劃撥帳號 : 01660429

2005年諾貝爾醫學獎得主 talk Barry J. Marshall

臺大醫院 112 週年院慶國際學術研討會
2005年諾貝爾醫學獎得主 PROFESSOR BARRY MARSHALL專題演講
PROFESSOR BARRY MARSHALL, NOBEL LAUREATE IN MEDICINE SPECIAL LECTURE 日期：96年06月26日(星期二) 時間：10:00 am ~ 4:10 pm 地點：臺大醫院國際會議中心 201 演講廳
http://ntuh.mc.ntu.edu.tw/cmrd/symposium.htm
Plenary Speakers
Barry J. Marshall Personal Doc 1/2
Jaw-Town LinPersonal Doc 1
Ann-Li Cheng
Personal Doc 1
Ching-Chow ChenPersonal Doc 1
Ping-Ning HsuPersonal Doc 1/2
Time
Subjects/Speakers
Moderators
09:30-10:00
Registration

10:00-10:15
Opening Remarks
侯勝茂署長Mr. Steve Waters 陳定信院長 林芳郁院長
行政院衛生署 澳洲駐台代表臺大醫學院臺大醫院
10:15-11:15
Keynote Speech by Prof. Barry Marshall MB BS FRACP : Essential Helicobacter Facts and why it won the Nobel Prize Nobel Laureate in Medicine 2005Clinical Professor of Medicine, Clinical Professor of Microbiology, University of Western Australia
林芳郁院長 臺大醫院
11:15-11:45
Discussion
林芳郁院長 臺大醫院
11:45-12:00
Press Conference
Dr. Barry Marshall MB BS FRACP
林芳郁院長陳定信院長Mr. Steve Waters
臺大醫院臺大醫學院澳洲駐台代表
12:00-13:00
Lunch

13:00-13:25
Overview of Helicobacter Pylori Research in NTUH & NTUCM Prof. Jaw-Town Lin 林肇堂主任Director, Dept. of Internal Medicine, National Taiwan University Hospital
楊泮池副院長 臺大醫院
13:25-13:50
H. Pylori and gastric mucosa-associated lymphoid tissue (MALT) lymphoma Prof. Ann-Li Cheng 鄭安理教授Deputy Director, Dept. of Oncology, National Taiwan University Hospital
楊泮池副院長 臺大醫院
13:50-14:10
Coffee Break

14:10-14:35
Signal transduction of Helicobacter pylori-induced COX-2and cyclin D1 expressionsProf. Ching-Chow Chen 陳青周教授Dept. of Pharmacology, National Taiwan University College of Medicine
陳培哲主任 臺大醫院醫研部
14:35-15:00
Modulation of TRAIL-mediated apoptosis by Helicobacter pyloriProf. Ping-Ning Hsu 許秉寧教授Dept. of Immunology, National Taiwan University College of Medicine
陳培哲主任 臺大醫院醫研部
15:00-15:10
Closing Remarks
陳定信院長 臺大醫學院
15:10-16:10
Visit NTUCM Faculty Club and Meet the Students
陳定信院長 臺大醫學院

test 力大圖書電子報

- 您 可 以 信 任 的 醫 學 圖 書 智 庫 新書介紹 www.leaderbook.com.tw Histology and Cell Biology: An Introduction to Pathology, 2nd Edition - With STUDENT CONSULT Online Access -病理科 - 編號： 0-000000323045278 - 作者：Abraham Kierszenbaum, MD - 原價-1900 - (熱賣價)1350 - 節省 ↓29% - 加入購物車 推薦指數： - 內容介紹 Histology and Cell Biology: An Introduction to Pathology, 2nd Edition - With STUDENT CONSULT Online Access By Abraham Kierszenbaum, MD, PhD 688 pages 995 ills Trim size 8 1/2 X 10 7/8 in Copyright 2007 Description A vivid, visual tour of a complex and fascinating subject! This book uses a wealth of vivid, full-color images?rather than dense text?to help you master all the histology and cell biology information you need to prepare for your course exams as well as the USMLE? Step 1. Clinical correlations drive home the relevance of the material to clinical practice, and new Essential Concepts sections at the end of every chapter facilitate review. And now, online access via STUDENT CONSULT makes this an even more effective learning resource! Reviews "Dr Kierszenbaum and the publishers must be heartily congratulated as this is indeed a wonderful and really a quite beautiful book. It brings together cell biology, histology and pathophysiology with some clinical correlations. The diagrams are vivid, colourful and complement the informative and comprehensive text. All clinicians need to have a basic understanding of cell biology as this is where the future of medicine lies. This is a wonderful book for students of medicine at any level." Declan O'Kane MD FRCP(UK), www.medexam.net "The book is good all round. It seems very comprehensive in its coverage of normal histology, but it certainly goes much further: it has some simple explanations of physiology and some pathology...For the student interested in histology and in reading a little bit extra physiology, this is a useful textbook." 1st Year Medical Student, Dundee University REVIEW OF THE LAST EDITION "Virtually every key concept in the field of histology has been thoughtfully illustrated with a staggering level of detail...The visual presentation is simply outstanding...Dr. Kierszenbaum has not only succeeded in providing a valuable educational resource but has also raised the standard with regard to the use of graphics and photomicrographs within medical texts." ? Archives of Pathology & Laboratory Medicine Key Features Uses a unique pictorial approach, involving approximately 1,000 full-color illustrations, to make complex principles exceptionally easy to understand and remember. Correlates normal histology with cellular and molecular biology, pathology, and clinical medicine, continually demonstrating the clinical relevance of the material. New to this Edition Offers new Essential Concepts sections at the end of every chapter to make studying easier than ever. Includes STUDENT CONSULT access at no additional charge, enabling you to consult the book online, anywhere you go · perform quick searches · add your own notes and bookmarks · follow Integration Links to related bonus content from other STUDENT CONSULT titles?to help you see the connections between diverse disciplines · and more! Table of Contents Part 1 ? Basic Tissues and Integrated Cell Biology 1. Epithelium 2. Epithelial Glands 3. Cell Signaling 4. Connective Tissue 5. Osteogenesis 6. Blood and Hematopoiesis 7. Muscle Tissue 8. Nervous Tissue 9. Sensory Organs: Vision and Hearing Part 2 ? Organ Systems: Protection of the Body 10. Immune-Lymphatic System 11. Integumentary System Part 3 ? Organ Systems; Blood Circulatory Systems 12. Cardiovascular System 13. Respiratory System 14. Urinary System Part 4 ? Organ Systems: Alimentary System 15. Upper Digestive System 16. Lower Digestive System 17. Digestive Glands Part 5 ? Organ Systems: Endocrine System 18. Neuroendocrine system 19. Endocrine system Part 6 ? Organ Systems: Reproductive System 20. Spermatogenesis 21. Sperm Transport and Maturation 22. Follicle Development and Menstrual Cycle 23. Fertilization, Placentation, and Lactation

sharing on stroke plus heart failure in an elderly woman with poor consciousness

Stroke is an abrupt or acute onset of neurological deficiet which has a presice neurological localization based on history and neurological exam.

Case 18-1 at 5D ward
a 78y/o female, right-handed, had old infarction at the right PCA territory with proxima PCA occlusion based on the neuroimage finding of midbrain damage and the whole right PCA territory infarction.
D/D
Recurrent stroke in the left hemisphere: consider brain MRI or head CT + CT perfusion study
infection, aspiration: f/u CXR and infection profiles
new myocardial infarction ? check cardiac enzymes