Name the most common intraorbital tumors in children.
Tuesday, January 24th 2012
Orbital Tumors
Monday, January 23rd 2012
Senator Suffers Large Stroke
Senator Mark Kirk is the junior Senator from Illinois. He currently holds President Obama’s old seat which he won in a special election in 2010 to replace Roland Burris.
He has apparently suffered a large right sided, non-dominant hemisphere middle cerebral artery stroke, potentially after a carotid artery dissection on that side. And he’s now undergone a decompressive craniectomy on the right from the late edema suffered with such a large stroke.
Dr. Fessler said the stroke “will affect his ability to move his left arm, possibly his left leg and possibly will involve some facial paralysis. Fortunately, the stroke was not on the left side of his brain, in which case it would affect his ability to speak, understand and think.”
Chances for a full mental recovery were “good” but chances for a full physical recovery were “not great,” Fessler said.
The doctor said he was hopeful that, after rehabilitation at an acute care facility, Kirk would regain the use of his left leg, but said prospects for regaining the full use of his left arm were “very difficult.”
He said recovery is a matter of weeks or months — “it’s not going to be days.” Kirk’s relative youth and good physical shape are positives, Fessler said, and he expects Kirk could return to “a very vibrant life.”
I’m sure they’ve been aggressive considering his age and functional status, not to mention his stature. But to feel the need to go ahead with a craniectomy following a stroke implies a large area of ischemia. Decompressive craniectomy for large middle cerebral artery strokes is not terribly uncommon and the popularity for it has probably grown over the decades. As one, admittedly international paper, describes it.
Decompressive craniotomy in the setting of acute brain swelling from massive MCA infarct is a life saving procedure. It should be considered in patients with initial good GCS, who are deteriorating in neurological status. With the team effort of neurologist and neurosurgeons these cases have good outcome contrary to the natural history of disease…Thus an ideal candidate for decompressive craniotomy is the victim who is young, with no risk factors, who presents early and has nondominant, middle cerebral artery territory infarct, with a reasonable Glasgow Coma Scale with no (or) early signs of herniation. The key for success of these cases of large MCA infarcts is early detection. Clinicians should concentrate on formulating newer clinical, radiological and technical protocols to detect the suitable patients at an early stage.
Certainly from what we know Senator Kirk appears to be an ideal candidate. From the description of his possible long term deficits he appears to have had a large non-dominant hemisphere middle cerebral artery stroke. He is relatively young and fit. And, as The Chicago Tribune describes it, he presented with a relatively good exam and deteriorated quickly.
My thoughts and prayers are with him and his family. He has a long road ahead of him.
Monday, January 23rd 2012
Atlas Fractures
How are C1 vertebrae fractures classified?
Thursday, January 19th 2012
Dentate Gyrus Cell Layers
Name the layer labeled #2 in this cross section of the dentate gyrus of the hippocampus.
Tuesday, January 17th 2012
Unusual Risk Factors For Thrombotic Stroke
What risk factors should be considered in unusual cases of thrombotic stroke?
Tuesday, January 17th 2012
It Is Cheating But Should It Be?
This has been up and around. I’m sure within the radiology community the CNN “exclusive” was hardly news at all.
The gist of the accusation is that,
For years, doctors around the country taking an exam to become board certified in radiology have cheated by memorizing test questions, creating sophisticated banks of what are known as “recalls,” a CNN investigation has found.
No doubt what was going on constituted cheating. There were specific prohibitions against reproducing questions that test takers agreed to before the privilege of being able to take the written portions of the radiology boards.
But, I guess controversially, should it be that way?
True, it would be hardly a point of confidence if the board self published the questions on their tests and then told the resident candidates to memorize all the answers before they showed up. But the recalls are hardly that. I imagine them more as a study tool. I also imagine that studying them and getting the questions right on the board exam means the radiology residents have learned the material. And that seems the whole point of standardized testing as a method for certifying physicians for various specialties; to make sure they have a baseline, basic set of knowledge. In once sense, how does it matter how that knowledge is memorized?
Saturday, January 14th 2012
Arachnoid Cysts
What are the most common presentations of arachnoid cysts?
Friday, January 13th 2012
Pseudotumor Cerebri
Name some secondary causes of pseudotumor cerebri.
Thursday, January 12th 2012
A Penny For Your Sugar Water
A group of public health researchers out of UCSF and Columbia have a piece in the pending edition of Health Affairs. In it they argue that 1c per ounce tax on sugar sweetened drinks would,
prevent 2.4 million diabetes person-years, 95,000 coronary heart events, 8,000 strokes, and 26,000 premature deaths, while avoiding more than $17 billion in medical costs
over the next ten years. If you can’t access the full study on Health Affairs behind the firewall then here’s a write up on a Los Angeles Times blog.
First and foremost I have a major problem with taxation to influence behavior. I don’t even like the federal tax on cigarettes. I understand the public health issues involved in second hand smoke. Even factoring those I think something like the tobacco tax, which is beyond discredit in terms of its success, is beyond the purview of the government.
And the junk food tax is likely to be something less effective than the tax on cigarettes and targets a behavior with far few social costs; even admitting that the bill for diseases associated with obesity is footed in part by society in general it is a far cry from say the public health effects of second hand smoke.
Plenty of previous data finds the conclusions of the Health Affairs paper optimistic.
[A] trio of economists analyzed 16 years of U.S. household health data to study the feasibility of using a soft-drink tax to help Americans lose weight. In a 2008 paper, the researchers calculated that a 1-percentage-point increase in the tax would reduce the average body mass index by just 0.003 units.
In other words, an overweight person with a BMI of 27 would end up with a BMI of 26.997 — still well short of the 20-25 range considered healthy.
Even a soft-drink tax increase of 20 percentage points wouldn’t help much, because soda accounts for only 7% of calories in the American diet.
I am highly dubious rising the cost of a can of soda 12c or a six pack by less than a dollar is liable to significantly discourage use.
Tobacco taxes are also much higher than anything likely to be adopted for food and beverages. Slapping a 10% tax on a $1.50-bottle of Coke would raise the price a mere 15 cents — not enough to persuade most shoppers to drink Diet Coke instead. Many calorie-laden foods are simply too cheap to be priced out of the market by any but the most draconian of taxes.
As well, such a tax would be highly regressive since sweetened drink use is inversely proportional to socioeconomic status (myself excluded of course; I go through 4-5 sodas a day).
In the end though, like I said, I just don’t like the idea of government dictating what we should and shouldn’t be eating and drinking. Their role in such, with agricultural subsidies and regulations of commercial foodstuff is already too big. The idea of a tax to specifically influence or diet is too much to take.
Thursday, January 12th 2012
Hemifacial Spasm
This may be an obvious one, even if you’re not familiar with these pathologies, but what major thing distinguishes hemifacial spasm from blepharospasm?
