The vestibuloocular reflex of the adult flatfish. I. Oculomotor organization

1985 ◽  
Vol 54 (4) ◽  
pp. 887-899 ◽  
Author(s):  
W. Graf ◽  
R. Baker
Keyword(s):  
Eye Movements ◽  
Motor Neuron ◽  
Motor Neurons ◽  
Vertical Plane ◽  
Extraocular Muscles ◽  
The Body ◽  
Medial Rectus ◽  
Inferior Rectus ◽  
Abducens Nucleus ◽  
Eye Muscles

The flatfish species constitute a natural paradigm for investigating adaptive changes in the vertebrate central nervous system. During metamorphosis all species of flatfish experience a 90 degree change in orientation between their vestibular and extraocular coordinate axes. As a result, the optic axes of both eyes maintain their orientation with respect to earth horizontal, but the horizontal semicircular canals become oriented vertically. Since the flatfish propels its body with the same swimming movements when referenced to the body as a normal fish, the horizontal canals are exposed to identical accelerations, but in the flatfish these accelerations occur in a vertical plane. The appropriate compensatory eye movements are simultaneous rotations of both eyes forward or backward (i.e., parallel), in contrast to the symmetric eye movements in upright fish (i.e., one eye moves forward, the other backward). Therefore, changes in the extraocular muscle arrangement and/or the neuronal connectivity are required. This study describes the peripheral and central oculomotor organization in the adult winter flounder, Pseudopleuronectes americanus. At the level of the peripheral oculomotor apparatus, the sizes of the horizontal extraocular muscles (lateral and medial rectus) were considerably smaller than those of the vertical eye muscles, as quantified by fiber counts and area measurements of cross sections of individual muscles. However, the spatial orientations and the kinematic characteristics of all six extraocular muscles were not different from those described in comparable lateral-eyed animals. There were no detectable asymmetries between the left and the right eye. Central oculomotor organization was investigated by extracellular horseradish peroxidase injections into individual eye muscles. Commonly described distributions of extraocular motor neurons in the oculomotor, trochlear, and abducens nuclei were found. These motor neuron pools consisted of two contralateral (superior rectus and superior oblique) and four ipsilateral populations (inferior oblique, inferior rectus, medial rectus, and lateral rectus). The labeled cells formed distinct motor neuron populations, which overlapped little. As expected, the numbers of labeled motoneurons differed in horizontal and vertical eye movers. The numerical difference was especially prominent in comparing the abducens nucleus with one of the vertical recti subdivisions. Nevertheless, there was bilateral symmetry between the motoneurons projecting to the left and right eyes.(ABSTRACT TRUNCATED AT 400 WORDS)

scholarly journals Skeletal Muscle Metabolism: Origin or Prognostic Factor for Amyotrophic Lateral Sclerosis (ALS) Development?

Cells ◽  
2021 ◽  
Vol 10 (6) ◽  
pp. 1449
Author(s):  
Cyril Quessada ◽  
Alexandra Bouscary ◽  
Frédérique René ◽  
Cristiana Valle ◽  
Alberto Ferri ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Amyotrophic Lateral Sclerosis ◽  
Motor Neuron ◽  
Motor Neurons ◽  
Muscle Metabolism ◽  
The Body ◽  
Energy Deficit ◽  
Acid Oxidation ◽  
Progression Of Disease ◽  
Lateral Sclerosis

Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease characterized by progressive and selective loss of motor neurons, amyotrophy and skeletal muscle paralysis usually leading to death due to respiratory failure. While generally considered an intrinsic motor neuron disease, data obtained in recent years, including our own, suggest that motor neuron protection is not sufficient to counter the disease. The dismantling of the neuromuscular junction is closely linked to chronic energy deficit found throughout the body. Metabolic (hypermetabolism and dyslipidemia) and mitochondrial alterations described in patients and murine models of ALS are associated with the development and progression of disease pathology and they appear long before motor neurons die. It is clear that these metabolic changes participate in the pathology of the disease. In this review, we summarize these changes seen throughout the course of the disease, and the subsequent impact of glucose–fatty acid oxidation imbalance on disease progression. We also highlight studies that show that correcting this loss of metabolic flexibility should now be considered a major goal for the treatment of ALS.

Characteristics of antidromically identified oculomotor internuclear neurons during vergence and versional eye movements

1994 ◽  
Vol 71 (3) ◽  
pp. 1111-1127 ◽  
Author(s):  
R. A. Clendaniel ◽  
L. E. Mays
Keyword(s):  
Eye Movements ◽  
Medial Rectus ◽  
Oculomotor Nucleus ◽  
Abducens Nucleus ◽  
Unit Recording ◽  
Antidromic Activation ◽  
Reversible Inactivation ◽  
Lidocaine Injection ◽  
Lidocaine Hcl ◽  
Tonic Pattern

1. Previous studies have shown that midbrain near response cells that increase their activity during convergent eye movements project to medial rectus motoneurons, which also increase their activity during convergence. Most neurons in the abducens nucleus decrease their firing rate during convergence, and the source of this vergence signal is unknown. Oculomotor internuclear neurons (OINs) in monkeys project primarily from the medial rectus subdivisions of the oculomotor nucleus to the contralateral abducens nucleus, although there is a smaller ipsilateral projection as well. Because of these anatomic connections, it has been suggested that the OIN input may be responsible for the vergence signal seen on abducens neurons. The behavior of the OINs during eye movements and their synaptic drive are not known. Thus the goal of this study is to determine the behavior of these neurons during conjugate and disjunctive eye movements and to determine if these neurons have an excitatory or inhibitory drive on the abducens neurons. 2. Single-unit recording studies in alert rhesus monkeys were used to characterize the behavior of OINs. Eighteen OINs were identified by antidromic activation and collision testing. The recorded OINs displayed a burst-tonic pattern of activity during adducting saccades, and the majority of these cells displayed an increase in tonic activity with convergent eye movements. 3. Identified OINs were compared with a large sample of non-activated and untested horizontal burst-tonic cells in the medial rectus subdivisions of the oculomotor nucleus. The results indicate that the OINs behave similarly to medial rectus motoneurons during vergence and versional eye movements. None of the OINs displayed vertical eye position sensitivity. 4. Microstimulation of the oculomotor nucleus where both the OINs and medial rectus motoneurons were located resulted in a large adducting twitch of the ipsilateral eye and a smaller abducting twitch of the contralateral eye. The latter effect was presumed to be the result of OIN innervation of the contralateral abducens nucleus. This result suggests that the crossed OIN pathway is predominately, if not entirely, excitatory. 5. Injection of 10% lidocaine HCl into the medial rectus subdivision of the oculomotor nucleus caused a reversible inactivation of the medial rectus motoneurons and OINs. As expected, the inactivation of medial rectus motoneurons resulted in an exophoria and weakness of adduction for the eye ipsilateral to the lidocaine injection. In addition, the lidocaine injection resulted in hypometric and slowed abducting saccades in the eye contralateral to the injection site. This result also suggest that the crossed OIN pathway is excitatory.(ABSTRACT TRUNCATED AT 400 WORDS)

scholarly journals Intermediate filaments in the medial rectus muscles in patients with concomitant exotropia

2019 ◽  
Vol 40 (2) ◽  
pp. 403-410
Author(s):  
Tao Shen ◽  
Jing Lin ◽  
Xiuling Li ◽  
Daming Deng
Keyword(s):  
Intermediate Filaments ◽  
Intermediate Filament ◽  
Extraocular Muscles ◽  
The Body ◽  
The Other ◽  
High Expression ◽  
Medial Rectus ◽  
Pathological Changes ◽  
Specific Antibodies

Abstract Purpose Distribution of intermediate filament (IF) proteins in normal extraocular muscles (EOMs) showed that the EOMs differ significantly from the other muscles in the body with respect to their IFs composition, including desmin and nestin. The aim of the present study was to investigate the pathological changes in the medial rectus (MR) in patients with concomitant exotropia (XT). Methods Forty-six MR muscle samples from 46 patients with XT were analyzed pathologically and processed for immunohistochemistry with specific antibodies against desmin and nestin. Results Although most of MR muscles remained normal structures relatively, they presented high expression of desmin, and in contrast, nestin was absent in a large proportion of the MR muscles. Conclusion Desmin, which is downregulated in normal EOMs, had high expression in MR muscles of patients with XT. Nestin, which is present in a high proportion of normal EOMs, was downregulated in MR muscles of patients with XT.

scholarly journals The functions of the proprioceptors of the eye muscles

2000 ◽  
Vol 355 (1404) ◽  
pp. 1685-1754 ◽  
Author(s):  
I.M.L. Donaldson
Keyword(s):  
Eye Movement ◽  
Visual Analysis ◽  
Extraocular Muscles ◽  
The Body ◽  
General Question ◽  
Eye Muscle ◽  
Eye Muscles ◽  
Visuomotor Behaviour ◽  
Extrapersonal Space ◽  
The Brain

This article sets out to present a fairly comprehensive review of our knowledge about the functions of the receptors that have been found in the extraocular muscles – the six muscles that move each eye of vertebrates in its orbit – of all the animals in which they have been sought, including Man. Since their discovery at the beginning of the 20th century these receptors have, at various times, been credited with important roles in the control of eye movement and the construction of extrapersonal space and have also been denied any function whatsoever. Experiments intended to study the actions of eye muscle receptors and, even more so, opinions (and indeed polemic) derived from these observations have been influenced by the changing fashions and beliefs about the more general question of how limb position and movement is detected by the brain and which signals contribute to those aspects of this that are p erceived (kinaesthesis). But the conclusions drawn from studies on the eye have also influenced beliefs about the mechanisms of kinaesthesis and, arguably, this influence has been even larger than that in the converse direction. Experimental evidence accumulated over rather more than a century is set out and discussed. It supports the view that, at the beginning of the 21st century, there are excellent grounds for believing that the receptors in the extraocular muscles are indeed proprioceptors, that is to say that the signals that they send into the brain are used to provide information about the position and movement of the eye in the orbit. It seems that this information is important in the control of eye movements of at least some types, and in the determination by the brain of the direction of gaze and the relationship of the organism to its environment. In addition, signals from these receptors in the eye muscles are seen to be necessary for the development of normal mechanisms of visual analysis in the mammalian visual cortex and for both the development and maintenance of normal visuomotor behaviour. Man is among those vertebrates to whose brains eye muscle proprioceptive signals provide information apparently used in normal sensorimotor functions; these include various aspects of perception, and of the control of eye movement. It is possible that abnormalities of the eye muscle proprioceptors and their signals may play a part in the genesis of some types of human squint (strabismus); conversely studies of patients with squint in the course of their surgical or pharmacological treatment have yielded much interesting evidence about the central actions of the proprioceptive signals from the extraocular muscles. The results of experiments on the eye have played a large part in the historical controversy, now in at least its third century, about the origin of signals that inform the brain about movement of parts of the body. Some of these results, and more of the interpretations of them, now need to be critically re–examined. The re–examination in the light of recent experiments that is presented here does not support many of the conclusions confidently drawn in the past and leads to both new insights and fresh questions about the roles of information from motor signals flowing out of the brain and that from signals from the peripheral receptors flowing into it. There remain many lacunae in our knowledge and filling some of these will, it is contended, be essential to advance our understanding further. It is argued that such understanding of eye muscle proprioception is a necessary part of the understanding of the physiology and pathophysiology of eye movement control and that it is also essential to an account of how organisms, including Man, build and maintain knowledge of their relationship to the external visual world. The eye would seem to provide a uniquely favourable system in which to study the way in which information derived within the brain about motor actions may interact with signals flowing in from peripheral receptors. The review is constructed in relatively independent sections that deal with particular topics. It ends with a fairly brief piece in which the author sets out some personal views about what has been achieved recently and what most immediately needs to be done. It also suggests some lines of study that appear to the author to be important for the future.

Three forms of the scratch reflex in the spinal turtle: central generation of motor patterns

1985 ◽  
Vol 53 (6) ◽  
pp. 1517-1534 ◽  
Author(s):  
G. A. Robertson ◽  
L. I. Mortin ◽  
J. Keifer ◽  
P. S. Stein
Keyword(s):  
Spinal Cord ◽  
Motor Neuron ◽  
Neuromuscular Blockade ◽  
Motor Neurons ◽  
Muscle Activity ◽  
Activity Patterns ◽  
Knee Extensor ◽  
The Body ◽  
Retractor Muscle ◽  
Neuron Activity

A turtle with a complete transection of the spinal cord, termed a spinal turtle, exhibits three types or “forms” of the scratch reflex: the rostral scratch, pocket scratch, and caudal scratch (21). Each scratch form is elicited by tactile stimulation of a site on the body surface innervated by afferents entering the spinal cord caudal to the transection. We recorded electromyographic (EMG) potentials from the hindlimb during each of the three forms of the scratch in the spinal turtle (see Fig. 1). Common to all scratch forms is the rhythmic alternation of the activity of the hip protractor muscle (VP-HP) and hip retractor muscle (HR-KF). Each form of the scratch displays a characteristic timing of the activity of the knee extensor muscle (FT-KE) with respect to the cycle of activity of the hip muscles VP-HP and HR-KF. In a rostral scratch, activation of FT-KE occurs during the latter portion of VP-HP activation. In a pocket scratch, activation of FT-KE occurs during HR-KF activation. In a caudal scratch, activation of FT-KE occurs after the cessation of HR-KF activation. The timing characteristics of these muscle activity patterns correspond to the timing characteristics of changes in the angles of the knee joint and the hip joint obtained with movement analyses (21). We recorded electroneurographic (ENG) potentials from peripheral nerves of the hindlimb during each of the three forms of the “fictive” scratch in the spinal turtle immobilized with neuromuscular blockade (see Fig. 4). Common to all forms of the fictive scratch is the rhythmic alternation of the activity of hip protractor motor neurons (VP-HP) and hip retractor motor neurons (HR-KF). Each form displays a characteristic timing of the activity of knee extensor motor neurons (FT-KE) with respect to the cycle of VP-HP and HR-KF motor neuron activity. The timing characteristics of these motor neuron activity patterns are similar to the timing characteristics of the muscle activity patterns obtained in the preparation with movement (cf. Figs. 1 and 4). The motor pattern for each scratch form is generated centrally within the spinal cord. In the spinal immobilized preparation, neuromuscular blockade prevents both limb movement and phasic sensory input, and complete spinal transection isolates the cord from supraspinal input.(ABSTRACT TRUNCATED AT 400 WORDS)

Learning and Maintaining Saccadic Accuracy: A Model of Brainstem–Cerebellar Interactions

1994 ◽  
Vol 6 (2) ◽  
pp. 117-138 ◽  
Author(s):  
Paul Dean ◽  
John E. W. Mayhew ◽  
Pat Langdon
Keyword(s):  
Eye Movements ◽  
Superior Colliculus ◽  
Motor Neurons ◽  
Feedback Controller ◽  
Functional Explanation ◽  
Eye Position ◽  
Error Signal ◽  
Internal Feedback ◽  
Eye Muscles ◽  
Oculomotor Vermis

Saccadic accuracy requires that the control signal sent to the motor neurons must be the right size to bring the fovea to the target, whatever the initial position of the eyes (and corresponding state of the eye muscles). Clinical and experimental evidence indicates that the basic machinery for generating saccadic eye movements, located in the brainstem, is not accurate: learning to make accurate saccades requires cerebellar circuitry located in the posterior vermis and fastigial nucleus. How do these two circuits interact to achieve adaptive control of saccades? A model of this interaction is described, based on Kawato's principle of feedback-error-learning. Its three components were (1) a simple controller with no knowledge of initial eye position, corresponding to the superior colliculus; (2) Robinson's internal feedback model of the saccadic burst generator, corresponding to preoculomotor areas in the brain-stem; and (3) Albus's Cerebellar Model Arithmetic Computer (CMK), a neural net model of the cerebellum. The connections between these components were (I) the simple feedback controller passed a (usually inaccurate) command to the pulse generator, and (2) a copy of this command to the CMAC; (3) the CMAC combined the copy with information about initial eye position to (4) alter the gain on the pulse generator's internal feedback loop, thereby adjusting the size of burst sent to the motor neurons. (5) If the saccade were inaccurate, an error signal from the feedback controller adjusted the weights in the CMAC. It was proposed that connection (2) corresponds to the mossy fiber projection from superior colliculus to oculomotor vermis via the nucleus reticularis tegmenti pontis, and connection (5) to the climbing fiber projection from superior colliculus to the oculomotor vermis via the inferior olive. Plausible initialization values were chosen so that the system produced hypometric saccades (as do human infants) at the start of learning, and position-dependent hypermetric saccades when the cerebellum was removed. Simulations for horizontal eye movements showed that accurate saccades from any starting position could be learned rapidly, even if the error signal conveyed only whether the initial saccade were too large or too small. In subsequent tests the model adapted realistically both to simulated weakening of the eye muscles, and to intrasaccadic displacement of the target, thereby mimicking saccadic plasticity in adults. The architecture of the model may therefore offer a functional explanation of hitherto mysterious tectocerebellar projections, and a framework for investigating in greater detail how the cerebellum adaptively controls saccadic accuracy.

scholarly journals Single-cell transcriptomic analysis of the adult mouse spinal cord

2020 ◽  
Author(s):  
Jacob A. Blum ◽  
Sandy Klemm ◽  
Lisa Nakayama ◽  
Arwa Kathiria ◽  
Kevin A. Guttenplan ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Motor Neuron ◽  
Single Cell ◽  
Motor Neurons ◽  
The Body ◽  
Molecular Heterogeneity ◽  
Spinal Motor Neuron ◽  
Spinal Motor ◽  
Full Complement ◽  
Adult Spinal Cord

AbstractThe spinal cord is a fascinating structure responsible for coordinating all movement in vertebrates. Spinal motor neurons control the activity of virtually every organ and muscle throughout the body by transmitting signals that originate in the spinal cord. These neurons are remarkably heterogeneous in their activity and innervation targets. However, because motor neurons represent only a small fraction of cells within the spinal cord and are difficult to isolate, the full complement of motor neuron subtypes remains unknown. Here we comprehensively describe the molecular heterogeneity of motor neurons within the adult spinal cord. We profiled 43,890 single-nucleus transcriptomes using fluorescence-activated nuclei sorting to enrich for spinal motor neuron nuclei. These data reveal a transcriptional map of the adult mammalian spinal cord and the first unbiased characterization of all transcriptionally distinct autonomic and somatic spinal motor neuron subpopulations. We identify 16 sympathetic motor neuron subtypes that segregate spatially along the spinal cord. Many of these subtypes selectively express specific hormones and receptors, suggesting neuromodulatory signaling within the autonomic nervous system. We describe skeletal motor neuron heterogeneity in the adult spinal cord, revealing numerous novel markers that distinguish alpha and gamma motor neurons—cell populations that are specifically affected in neurodegenerative disease. We also provide evidence for a novel transcriptional subpopulation of skeletal motor neurons. Collectively, these data provide a single-cell transcriptional atlas for investigating motor neuron diversity as well as the cellular and molecular basis of motor neuron function in health and disease.

scholarly journals A descending pathway facilitates undulatory wave propagation in Caenorhabditis elegans through gap junctions

2017 ◽  
Author(s):  
Tianqi Xu ◽  
Jing Huo ◽  
Shuai Shao ◽  
Michelle Po ◽  
Taizo Kawano ◽  
...  
Keyword(s):  
Caenorhabditis Elegans ◽  
Gap Junctions ◽  
Motor Neuron ◽  
Motor Neurons ◽  
Central Pattern Generators ◽  
The Body ◽  
C Elegans ◽  
Bending Waves ◽  
Forward Locomotion ◽  
Type Motor

Descending signals from the brain play critical roles in controlling and modulating locomotion kinematics. In the Caenorhabditis elegans nervous system, descending AVB premotor interneurons exclusively form gap junctions with B-type motor neurons that drive forward locomotion. We combined genetic analysis, optogenetic manipulation, and computational modeling to elucidate the function of AVB-B gap junctions during forward locomotion. First, we found that some B-type motor neurons generated intrinsic rhythmic activity, constituting distributed central pattern generators. Second, AVB premotor interneurons drove bifurcation of B-type motor neuron dynamics, triggering their transition from stationary to oscillatory activity. Third, proprioceptive couplings between neighboring B-type motor neurons entrained the frequency of body oscillators, forcing coherent propagation of bending waves. Despite substantial anatomical differences between the worm motor circuit and those in higher model organisms, we uncovered converging principles that govern coordinated locomotion.Significance StatementA deep understanding of the neural basis of motor behavior must integrate neuromuscular dynamics, mechanosensory feedback, as well as global command signals, to predict behavioral dynamics. Here, we report on an integrative approach to defining the circuit logic underlying coordinated locomotion in C. elegans. Our combined experimental and computational analysis revealed that (1) motor neurons in C. elegans could function as intrinsic oscillators; (2) Descending inputs and proprioceptive couplings work synergistically to facilitate the sequential activation of motor neuron activities, allowing bending waves to propagate efficiently along the body. Our work thus represents a key step towards an integrative view of animal locomotion.

scholarly journals Task-dependent modification of leg motor neuron synaptic input underlying changes in walking direction and walking speed

2015 ◽  
Vol 114 (2) ◽  
pp. 1090-1101 ◽  
Author(s):  
Philipp Rosenbaum ◽  
Josef Schmitz ◽  
Joachim Schmidt ◽  
Ansgar Büschges
Keyword(s):  
Motor Neuron ◽  
Motor Neurons ◽  
Synaptic Input ◽  
Walking Speed ◽  
Vertical Plane ◽  
Stick Insect ◽  
Neuron Activity ◽  
Step Cycle ◽  
Synaptic Inputs ◽  
Dependent Modification

Animals modify their behavior constantly to perform adequately in their environment. In terrestrial locomotion many forms of adaptation exist. Two tasks are changes of walking direction and walking speed. We investigated these two changes in motor output in the stick insect Cuniculina impigra to see how they are brought about at the level of leg motor neurons. We used a semi-intact preparation in which we can record intracellularly from leg motor neurons during walking. In this single-leg preparation the middle leg of the animal steps in a vertical plane on a treadwheel. Stimulation of either abdomen or head reliably elicits fictive forward or backward motor activity, respectively, in the fixed and otherwise deafferented thorax-coxa joint. With a change of walking direction only thorax-coxa-joint motor neurons protractor and retractor changed their activity. The protractor switched from swing activity during forward to stance activity during backward walking, and the retractor from stance to swing. This phase switch was due to corresponding change of phasic synaptic inputs from inhibitory to excitatory and vice versa at specific phases of the step cycle. In addition to phasic synaptic input a tonic depolarization of the motor neurons was present. Analysis of changes in stepping velocity during stance showed only a significant correlation to flexor motor neuron activity, but not to that of retractor and depressor motor neurons during forward walking. These results show that different tasks in the stick insect walking system are generated by altering synaptic inputs to specific leg joint motor neurons only.

scholarly journals Acute Nontraumatic Muscle Weakness

2019 ◽  
Vol 06 (03) ◽  
pp. 236-256
Author(s):  
Kiran Jangra ◽  
Hemant Bhagat ◽  
Aastha Takkar
Keyword(s):  
Motor Neuron ◽  
Clinical Features ◽  
Motor Neurons ◽  
Motor Nerve ◽  
Respiratory Muscles ◽  
Acute Onset ◽  
The Body ◽  
Systematic Evaluation ◽  
Definitive Treatment ◽  
Motor Pathway

AbstractAcute nontraumatic weakness (ANTW) is defined as acute onset of weakness in any part of the body. The weakness occurs due to interruption at any point along the motor pathway. The motor pathway originates from upper motor neuron cells in the cerebral cortex and traverses through the brainstem till lower motor neurons in the spinal cord. The axon of a lower motor neuron is known as the peripheral motor nerve that synapses with muscle. ANTW is of varied etiology and presentation that may be immediately life-threatening if respiratory muscles or autonomic nervous system is involved. Involvement of respiratory muscles may be associated with respiratory failure that may require mechanical ventilation. The weakness may be localized to one limb or generalized involving several muscle groups. When bulbar muscles are involved, weakness leads to problem in swallowing and coughing that endangers the patient's airway. Similarly, the course of the disease also varies, and these patients may worsen rapidly. Hence, a comprehensive history, systematic evaluation, and a detailed neurological examination are performed to localize the disorder. There are specific clinical features peculiar to the particular location of the lesion in the body. Hence, it is possible to anatomically localize these lesions based on the clinical features. Initial laboratory tests and appropriate neuroimaging should be obtained as indicated by history and examination. The time-sensitive emergencies should be addressed immediately, as the delay in management may lead to either permanent neurological damage or may worsen the overall outcome in such conditions. The initial management should always include care of airway, breathing, and circulation (ABC). The imaging should be obtained only after initial stabilization of ABC. The definitive treatment should be done as per the etiology.

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