Supratentorial Arteriovenous Malformations

2005 ◽  
Vol 57 (suppl_1) ◽  
pp. 164-167 ◽  
Author(s):  
Richard E. Clatterbuck ◽  
Frank P.K. Hsu ◽  
Robert F. Spetzler
Keyword(s):  
Decision Making ◽  
Central Nervous System ◽  
Nervous System ◽  
Arteriovenous Malformations ◽  
Clinical Decision Making ◽  
Neural Tissue ◽  
Venous Drainage ◽  
Clinical Decision ◽  
Vascular Lesions ◽  
Grading Scale

Abstract ARTERIOVENOUS MALFORMATIONS ARE a heterogeneous group of intra-axial central nervous system vascular lesions consisting of tangles of abnormal arteriovenous connections without intervening capillary beds. The heterogeneity of arteriovenous malformations is described by the Spetzler-Martin grading scale, a scale that also forms the basis for clinical decision making. The microsurgical treatment of appropriately selected supratentorial arteriovenous malformations is based on the tenets of circumferential isolation and transection of arterial feeders, preservation of vessels en passant and surrounding functional neural tissue, and skeletonization and transection of venous drainage.

Pulmonary Arteriovenous Malformations

2018 ◽  
pp. 315-324
Author(s):  
Jeffrey S. Pollak
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Arteriovenous Malformations ◽  
Pulmonary Arteries ◽  
Vascular Lesions ◽  
Common Symptom ◽  
Pulmonary Arteriovenous Malformations ◽  
Capillary Bed ◽  
Arteries And Veins

Pulmonary arteriovenous malformations (PAVMs) are dilated directly, connecting pulmonary arteries and veins with no capillary bed. They are generally congenital and frequently occur in patients with autosomal-dominant hereditary hemorrhagic telangiectasia (HHT), so they should be screened for PAVM. HHT causes variable-sized arteriovenous malformations (AVMs) from telangiectases to larger connections and affects mucocutaneous surfaces. Epistaxis is the most common symptom, and these vascular lesions can occur in other organs, including the lungs, central nervous system, liver, and gastrointestinal (GI) tract. PAVMs can result in hypoxemia with dyspnea, paradoxical embolization with ischemic stroke and abscess formation, and hemorrhage. Treatment consists of embolization of sufficiently sized lesions; antibiotic prophylaxis before procedures prone to produce bacteremia, such as dental processes that can cause abscesses; and avoidance of air or clots in intravenous (IV) lines. Lifelong follow-up is essential to assess for adequacy of embolization and enlargement of PAVMs that are too small to embolize.

scholarly journals EQUAL Cryptococcus Score 2018: A European Confederation of Medical Mycology Score Derived From Current Guidelines to Measure QUALity of Clinical Cryptococcosis Management

2018 ◽  
Vol 5 (11) ◽  
Author(s):  
Andrej Spec ◽  
Carlos Mejia-Chew ◽  
William G Powderly ◽  
Oliver A Cornely
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Guideline Adherence ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
World Health ◽  
Medical Mycology ◽  
High Morbidity ◽  
India Ink ◽  
Current Guidelines

Abstract Cryptococcocis is an opportunistic fungal infection with high morbidity and mortality. Guidelines to aid clinicians regarding diagnosis, management, and treatment can be extensive and challenging to comply with. There is no tool to measure guideline adherence. To create such a tool, we reviewed current guidelines from the Infectious Diseases Society of America, the World Health Organization, the American Society of Transplantation, and recent significant publications to select the strongest recommendations as vital components of our scoring tool. Items included diagnostic tests (blood, tissue, and cerebrospinal fluid cultures, Cryptococcus antigen, India ink, histopathology with special fungal stains, central nervous system imaging), pharmacological (amphotericin B, flucytosine, azoles) and nonpharmacological treatments (intracranial pressure management, immunomodulation, infectious disease consultation), and follow-up of central nervous system complications. The EQUAL Cryptococcus Score 2018 weighs and aggregates the recommendations for the optimal management of cryptococcosis. Providing a tool that could measure guideline adherence or facilitate clinical decision-making.

scholarly journals Selected Biomarkers of Tick-Borne Encephalitis: A Review

2021 ◽  
Vol 22 (19) ◽  
pp. 10615
Author(s):  
Monika Gudowska-Sawczuk ◽  
Barbara Mroczko
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Clinical Decision Making ◽  
White Blood Cells ◽  
Clinical Decision ◽  
Second Phase ◽  
Inflammatory Reactions ◽  
Tick Borne Encephalitis ◽  
Pubmed Database ◽  
The Central Nervous System

Tick-borne encephalitis (TBE) is an acute disease caused by the tick-borne encephalitis virus. Due to the viral nature of the condition, there is no effective causal treatment for full-blown disease. Current and nonspecific TBE treatments only relieve symptoms. Unfortunately, the first phase of TBE is characterized by flu-like symptoms, making diagnosis difficult during this period. The second phase is referred to as the neurological phase as it involves structures in the central nervous system—most commonly the meninges and, in more severe cases, the brain and the spinal cord. Therefore, it is important that early markers of TBE that will guide clinical decision-making and the choice of treatment are established. In this review, we performed an extensive search of literature reports relevant to biomarkers associated with TBE using the MEDLINE/PubMed database. We observed that apart from routinely determined specific immunoglobulins, free light chains may also be useful in the evaluation of intrathecal synthesis in the central nervous system (CNS) during TBEV infection. Moreover, selected metalloproteinases, chemokines, or cytokines appear to play an important role in the pathogenesis of TBE as a consequence of inflammatory reactions and recruitment of white blood cells into the CNS. Furthermore, we reported promising findings on tau protein or Toll-like receptors. It was also observed that some people may be predisposed to TBE. Therefore, to understand the role of selected tick-borne encephalitis biomarkers, we categorized these factors and discussed their potential application in the diagnosis, prognosis, monitoring, or management of TBE.

Debates in Dysphagia Management: How Do You Use Evidence-Based Practice in Your Dysphagia Patient Care?

2011 ◽  
Vol 20 (4) ◽  
pp. 121-123
Author(s):  
Jeri A. Logemann
Keyword(s):  
Decision Making ◽  
Patient Care ◽  
Clinical Outcomes ◽  
Clinical Judgment ◽  
Clinical Decision Making ◽  
Evidence Based Practice ◽  
Clinical Decision ◽  
Evidence Based ◽  
Clinical Method ◽  
Do So

Evidence-based practice requires astute clinicians to blend our best clinical judgment with the best available external evidence and the patient's own values and expectations. Sometimes, we value one more than another during clinical decision-making, though it is never wise to do so, and sometimes other factors that we are unaware of produce unanticipated clinical outcomes. Sometimes, we feel very strongly about one clinical method or another, and hopefully that belief is founded in evidence. Some beliefs, however, are not founded in evidence. The sound use of evidence is the best way to navigate the debates within our field of practice.

Sign in / Sign up

Export Citation Format

Share Document