Author: Renu Maurya

Brown Sequard Syndrome


Brown Sequard Syndrome


Introduction:

→ Etiology: HEMISECTION of spinal cord

Features: Ipsilateral (Same side) & Contralateral (Opposite side) to Dorsal & Antero-Lateral Column.

→ NOTE: Dorsal column IPSILATERAL ONLY in SPINAL CORD; Crosses to OPPOSITE SIDE @MEDULLA

→ 2 pathways – Tractus Cuneatus (From Upper Limb) & Tractus Gracilis (From Lower Limb)
Clinical Presentation – Ex. Lesion on left side of spinal cord

IPSILATERAL to Dorsal Column-Left side loss of Proprioception, Touch & Vibration.

CONTRALATERAL to Antero-Lateral Column-Right side loss of Pain & Temperature

Blood brain barrier


Blood brain barrier


BBB Locations:

→ Formed by TIGHT JUNCTIONS & FOOT PROCESSES OF ASTROCYTES.

→ ABSENT BBB = CIRCUMVENTRICULAR ORGANS (mnemonic – SOAP)

S= Subfornical organ; O – Organum Vasculosum of Lamina Terminalis; A – Area Postrema; P – Posterior Pituitary

BBB Permeability:

PERMEABLE Substance:

Glucose (GLUT-1),

Water (Aquaporin-4),

Gases (CO2, O2, N2),

Lipid soluble hormones (Steroids)

NON-PERMEABLE Substance:

Protein Hormones,

• Dopamine (L-dopa in Parkinsonism),

H+ ions

Best methods of doing medical termination of pregnancy


Best methods of doing medical termination of pregnancy


Period of pregnancy Methods
≤ 7 weeks Medical method
7-15 weeks Suction evacuation
≥ 15 weeks Prostaglandins

 

Heading-Auditory pathway


Heading-Auditory pathway


Mnemonic – E C O L I M A
E – EIGHTH Cranial Nerve

C- COCHLEAR Nerve

O – Superior OLIVARY Nucleus

L – Lateral LEMNISCUS

I – INFERIOR Colliculi

M – MEDIAL Geniculate Body

A-Auditory Cortex (Brodmann Area – 41)

Antiphospholipid antibody syndrome-Management


Antiphospholipid antibody syndrome-Management


If APLA is diagnosed based on H/O Abortion then aspirin along with low molecular weight heparin has to be given
Aspirin:
• Aspirin low doses= 50-100mg (80mg)

• Started-Urine Pregnancy Test (UPT) +ve

• Continued throughout Pregnancy

• Stopped 4-6 days before labor

Heparin:

Started- Only after confirmation of IU pregnancy

Continued throughout Pregnancy

Stopped at onset of labor

If APLA is diagnosed based on the criteria of Preterm Labor give only Aspirin @ the end of first trimester ;dose- 50-100mg (80mg).

Antiphospholipid antibody syndrome-Diagnosis


Antiphospholipid antibody syndrome-Diagnosis


Clinical diagnosis:
1. Arterial/ Venous Thrombosis (Superficial/Deep)

  1. ≥3 losses in <10 weeks 3. ≥1 loss in >10 weeks of morphologically normal fetus.

  2. At least 1 Preterm delivery secondary to severe PIH/Uteroplacental insufficiency

Lab Findings:

  1. Presence of Lupus Anticoagulant (LAC)

  2. Presence of IgM / IgG Cardiolipin Antibody Any of these should beresent@2occasions12wksapart

  3. Presence of β2 Micro globulin

Note: In APLA – APTT is prolonged; PT is normal; Russel viper venom time is prolonged.

Antiphospholipid antibody syndrome


Antiphospholipid antibody syndrome


• APLA syndrome can lead to thrombosis in vessels. Depending upon which vessels get thrombosed we will get the manifestation like if cerebral vessel get thrombosed manifestation of stroke can be seen. It can even lead to thrombosis in placental blood vessels.

  •  Based on this size of placenta will decrease and there will be placental insufficiency.
  • Abortion can happen in first trimester due to APLA but it generally causes abortion in second trimester (M/C).
  •  Even if there is 1 abortion due to APLA but for first trimester we need 3 abortion to say it is caused due to APLA.

Antihypertensives for chronic hypertension in pregnancy


Antihypertensives for chronic hypertension in pregnancy


For PIH/PE-1st choice- Labetalol

Chronic HT in Pregnancy-Labetalol or α-Methyl Dopa

HT Crisis-I/V Labetalol, I/V Hydralazine

Safe Antihypertensive:

  • Labetalol
  • Alpha-methyldopa (safest)
  • Nitroglycerine
  • Calcium channel blockers – nifedipine
  • Hydralazine
  • Sodium nitroprusside (last resort)
  • Beta Blockers

Contraindicated during pregnancy:

  • ACE inhibitors – like enalapril, captopril
  • Angiotensin receptor blockers-Losartan
  • Diuretics
  • Atenolol
  • Diazoxide

Amniotic fluid index


Amniotic fluid index


• Imagine the uterus in 4 parts and in these 4 parts measure the single largest vertical pocket.

• Here in this image the uterus is divided into 4 quadrants and the single largest vertical pocket namely A, B, C & D are measured.

• AFI= A+B+C+D= 5-24 (NORMAL)

• >25 cm is polyhydramnios & <5 cm oligohydramnios.

• AFI is not appropriate to use in twin pregnancy. Therefore, the best sensitive method is to measure single Deepest vertical pocket (SDP).

Amniotic fluid index explained with images

Absolute & Relative refractory period


Absolute & Relative refractory period


ABSOLUTE Refractory Period – Any stimulus (Any strength) – NO RESPONSE (NO AP).

RELATIVE Refractory Period – From 1/3rd Repolarization till End of AP.

ONLY STUIMULUS OF MAXIMUM STRENGTH CAN PRODUCE RESPONSE.

During Depolarization  Na+ influx happens due to Voltage gated Na+ channels - With this in MIND GATE CONCEPT EVOLVED

Absolute & relative refractory period explained in the form of a graphical illustration

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