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4 results

  • Section 6 - Gastrointestinal emergencies

  • Edited by Kaushal Shah, Jarone Lee, Kamal Medlej, American University of Beirut, Scott D. Weingart
  • Book:
    Practical Emergency Resuscitation and Critical Care
    Published online:
    05 November 2013
    Print publication:
    24 October 2013, pp 229-288

  • Summary

    This chapter discusses the diagnosis, evaluation and management of bradyarrhythmias. Sinus bradycardia occurs in 15-20% of patients with acute myocardial infarction secondary to ischemia of the sinoatrial (SA) node. Syncope may result from primary dysrhythmia or from reduced cardiac output. A 12-lead electrocardiogram (ECG) is essential for the diagnosis of bradycardia and to differentiate between the different types of bradyarrhythmias. History should focus particularly on symptoms of ischemic heart disease, and on medications such as nodal blockers. As the bradycardia worsens, cardiac output decreases as well. This results in hypotension and hypoperfusion that need to be corrected using medications or a pacemaker. In addition, a decrease in cardiac output can result in pulmonary edema. Even with the development of pulmonary edema, the bradycardia is the first thing that needs to be addressed. Treatment of the cardiogenic pulmonary edema can be instituted afterward.

  • Chapter 42 - Neuroimaging and posttraumatic stress disorder

  • from Section 5 - Neuroimaging of sleep disorders
  • Edited by Eric Nofzinger, University of Pittsburgh, Pierre Maquet, Université de Liège, Belgium, Michael J. Thorpy
  • Book:
    Neuroimaging of Sleep and Sleep Disorders
    Published online:
    05 March 2013
    Print publication:
    07 March 2013, pp 340-346

  • Summary

    This chapter reviews the spectrum of neuroimaging in Kleine-Levin syndrome (KLS). Although structural neuroimaging in KLS is within the normal range in most cases, the vast majority of studies report hypoperfusion in several brain regions. Cognitive impairment and altered perception occur in all KLS patients during sleep episodes according to the review by Arnulf. It is thus pertinent to investigate the neural concomitants to cognitive function in KLS by functional neuroimaging. N-Acetylasparate (NAA) is a biomarker for neuronal health, associated with either neuronal loss or neuronal dysfunction. Hypothalamic pathology constitutes a main hypothesis for KLS etiology. This hypothesis is based on the important function of the hypothalmus in sleep and appetite regulation as well as regarding sexual activity. The sparsity of neuroimaging findings in the hypothalamus might be a result of the detection limit for functional imaging in this region of the brain.

  • Vascular Burden of the White Matter

  • Arne Brun
  • Journal:
    International Psychogeriatrics / Volume 15 / Issue S1 / July 2003
    Published online by Cambridge University Press:
    10 January 2005, pp. 53-58

  • In cerebrovascular disease of all kinds, the white matter bears a heavy burden – particularly in the early and late periods of life. The infarcts are of the complete and incomplete type, the latter accompanying and extending the white-matter damage of the former. Complete infarcts are mainly caused by vascular occlusions. Incomplete infarcts are mainly due to hypoperfusion, wherein pathogenic factors are, above all, different types of angiopathies leading to an inadequate autoregulatory response in the event of an episodic or more longstanding hypotension, acting as an etiological factor through hypoperfusion. There is growing consensus that white-matter lesions affect brain function. Correlation with symptoms and understanding of mechanisms behind the lesions would gain from more precise diagnostics as to tracts involved.