thyroid ppt
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ARTERIO-VENOUS MALFORMATION
Definition
Arteriovenous malformations (AVM) of the brain and spinal cord are tangles of abnormal blood vessels. They can form wherever arteries and veins exist.
Causes
The exact cause of arteriovenous malformations is unknown.
Risks
Family history—some types of arteriovenous malformations are from genetic defects that can be passed on from one generation to the next.
History of bleeding—some types of arteriovenous malformations are linked to an increased risk of bleeding. People with unexplained recurrent bleeding may be at higher risk of having arteriovenous malformations.
Smoking
Symptoms
Seizures Headache, especially on one side of the head Muscle weakness Lightheadedness Loss of coordination, especially when walking Difficulty speaking or understanding language Loss of senses / Visual problems Memory loss Difficulty thinking or mental confusion Hallucinations
Diagnosis
Angiography or arteriography Computed axial tomography (CT
scan) Magnetic resonance imaging (MRI) Magnetic resonance angiogram
(MRA)
Treatment
Microsurgery Radiosurgery Endovascular (embolization)
Radiosurgery
very successful at treating small to medium-sized AVMs.
Obliteration (destruction) rates for AVMs less than 3 cm in diameter are about 80 to 85%.
Microsurgery
Endovascular Treatment
Associated symptoms
Examination
Vital signs Physical examination Neurologic Examination
Glasgow Coma Scale
ER Management
ABCs of resuscitation IVF Blood glucose level Medical or structural cause?
Medical Cause
Additional laboratory and radiologic tests Infectious Metabolic Toxicologic
Structural Cause
Cranial CT scan Refer to neurosurgeon
Case Scenario
Chief Complaint: vomiting and loose stools. History: fever, vomiting, irritable , (-)
fall/trauma Physical Examination:
drowsy, irritable, (+) seizure BP80/60 PR 130 RR 38 Temp 39oC CBG
40mg/dL soft-tissue contusion over the left scalp and
ecchymosis Chest: clear breath sounds Abdomen: globular, hyperactive BS, soft, non
tender, (+)multiple 1- peso-like marks on the anterior abdomen
Extremities are cool and mottled.
Additional Information
History Bleeding tendencies Associated medical problems
Neurologic Exam Pupils Funduscopic findings Motors: preferential movement
Social History Caregiver Socio-economic status Educational attainment of parents/caregiver
DIAGNOSIS?
Differentials
Medical Structural
Electrolyte abnormality
Encephalopathy Infection (sepsis) Intussusception Meningitis and
encephalitis Uremia (hemolytic-
uremic syndrome)
Cerebral vascular accident
Cerebral vein thrombosis
Hydrocephalus Intracerebral tumor Subdural empyema Trauma (intracranial
hemorrhage, diffuse cerebral swelling, shaken baby syndrome)
Management
Blood work-up Imaging
Cranial CT scan Xrays
CHILD ABUSE
Shaken Baby Syndrome
Definition: SBS is the vigorous manual shaking of an infant who is being held by the extremities or shoulders
Whiplash-induced intracranial and intraocular hemorrhage
No external signs of head injury
Presenting Symptoms
Frequently non-specific May be seen first in the outpatient
setting URTI, vomiting, irritability (23%) Respiratory distress Diarrhea, poor feeding Lethargy/decreased level of
consciousness Apnea, seizure, history of minor trauma
Symptoms
History must match physical findings High index of suspicion when non-
specific symptoms and history are at odds
Signs on Physical Exam
Retinal hemorrhage Bulging fontanel Pupillary changes Other physical injuries:
Fractures, soft tissue injuries, bruises Mechanism of injury/history does not
coincide with presenting signs
Diagnosis
CT scan – method of choice
Diagnosis
Ophthalmologic consult Retinal hemorrhage (75-90%)
Minimal external signs (one of the hallmarks of SBS)
Bulging fontanelle in 55% of infants with subdural hematoma
Findings
The Brain Subdural hemorrhage Subarachnoid hemorrhage Diffuse axonal injury Edema/infarction Parenchymal contusion Parenchymal hemorrhage
The Eye Retinal hemorrhage Vitreous hemorrhage Papilledema Retinal detachment Disruption of eye contents
The Bones Rib fractures Skull fractures Long bone injuries:
Periosteal stripping Metaphyseal fractures Shaft fractures
Prognosis
Significant morbidity (50%) and mortality
(15%)
SBS Complications
Developmental delays Behavioral problems Mental retardation Post-traumatic hydrocephalus, cerebral
atrophy Permanent brain damage Seizures Paralysis Blindness Deafness
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