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تفريغات
#radiology

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محاضرة myopathies تابعة لهذة السلسلة .

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Diabetes mellitus: Ramadan
Type one
It is not recommended to fast..
If a patient with type 2 diabetes mellitus does decide to fast:
 they should try and and eat
a meal containing long-acting
carbohydrates prior to sunrise
(Suhoor)
 patients should be given
a blood glucose monitor to
allow them to check their
glucose levels,
particularly if they feel unwell
 for patients taking metformin
the expert consensus is that
the dose should be split
one￾third before sunrise (Suhoor) and two-thirds after
sunset (Iftar)
 expert consensus also
recommends switching once-daily sulfonylureas to after sunset.
For patients taking twice-daily
preparations such as gliclazide
it is recommended that a larger proportion of the dose is taken
after sunset
 no adjustment is needed for
patients taking pioglitazone.
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May 2017 exam: H/O type 2
diabetes on metformin500 mg tds,
asks for advice regard his medication
because he is due to start fasting for Ramadan soon.
What is the most appropriate advice?
500 mg at the predawn meal +
1000 mg at the sunset meal .
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ESSENTIALS OF DIAGNOSIS
(epilepsy).
▶ Paroxysmal spells with sudden
onset; generally brief
(lasting <5 minutes)
▶ Presentation varies across
populations and age groups,
ranging from subtle staring to
generalized shaking and
falling down
▶ Episodes are stereotyped
▶ Diagnosis often depends on
eyewitness account
▶ Epilepsy—defined by recurrent,
unprovoked seizures
▶ Status epilepticus—defined by
prolonged seizures
(lasting >5 minutes)

MIGRAINE
Migraine Without Aura
(80% of patients)
▶ At least five attacks
▶ Headache attacks lasting 4–72
hours (unless successfully treated)
▶ At least two of the following pain
characteristics:
● Unilateral location
● Pulsating quality
● Moderate to severe intensity
● Aggravated by or causes
avoidance of routine physical activity
▶ During headache at least
one of the following:
● Nausea or vomiting
● Photophobia and phonophobia
Migraine With Aura
(15–20% of patients)
▶ Same features as migraine
without aura
▶ Visual symptoms, including
positive features
(eg, flicker￾ing lights, spots, or lines)
or negative features (eg, blind spots,
loss of vision), or both
▶ Sensory symptoms, including
positive features
(eg, pins and needles) or negative
features (eg, numbness), or both
▶ Dysphasic speech disturbance
▶ Symptoms of aura that develop
over at least 5 minutes
and last less than 1 hour and
headache, if present, that
follows within the hour

TENSION-TYPE HEADACHE
At least 10 episodes occurring
on less than 1 day per month,
on average
▶ Headache lasting from
30 minutes to 7 days
▶ At least two of the following pain characteristics:
● Bilateral location
● Pressing or tightening
(nonpulsating) quality
● Mild to moderate intensity
● Not aggravated by routine
physical activity
▶ Absence of nausea or vomiting
▶ Photophobia or phonophobia,
but not both

Cluster Headache
Multiple attacks of severe
unilateral orbital, supraorbital,
or temporal pain lasting 15–180
minutes if untreated
▶ During headache at least
one of the following:
● Unilateral conjunctival injection,
lacrimation, or both
● Ipsilateral nasal congestion,
rhinorrhea, or both
● Ipsilateral eyelid edema
● Ipsilateral forehead and
facial sweating
● Ipsilateral miosis, ptosis, or both
● A sense of restlessness or agitation
▶ Attack frequency ranging from
one every other day to eight per day


MEDICATION OVERUSE HEADACHE
Headaches occurring at least
15 days per month in a patient with
a preexisting headache disorder
▶ Regular overuse for more
than 3 months of one or more
drugs that can be taken for
acute and/or symptomatic
treatment of headache
▶ Not better accounted for by
another International Clas￾sification
of Headache Disorders, 3rd edition
(ICHD-3) diagnosis

TRIGEMINAL NEURALGIA
Paroxysmal attacks of severe
facial pain, lasting seconds
▶ Sudden, sharp, superficial,
stabbing, or burning in quality
▶ Distribution along one of more
trigeminal distributions
▶ Precipitated by touching or
moving trigger regions (eg,
while eating, speaking, or
brushing teeth)
▶ Absence of symptoms
between attacks

Stroke (ischemic)
Sudden onset of focal neurologic
deficits
▶ Initial computed tomography
(CT) scan of the head to exclude
intracranial hemorrhage or
mass lesion
▶ Follow-up brain imaging showing
evidence of acute infarction
▶ Rapid diagnosis is required to
initiate thrombolytic
therapy within 3 hours of onset
and thrombectomy within 24 hours

Stroke (hemorrhgic)
Sudden-onset focal deficit, with
worsening over
seconds to minutes; headache,
nausea, vomiting, and
coma are common
▶ Etiologies include hypertension,
vascular malforma￾tions,
vasculopathies, coagulopathies
, and others
▶ Computed tomography (CT)
and magnetic resonance

imaging (MRI) are exquisitely
sensitive to acute IPH
▶ Treatment and prevention of
recurrence are based on
etiology; there are no treatments
for IPH that are known
to improve outcome
SUBARACHNOID Hge
Sudden onset of excruciating
headache, sometimes accompanied
by focal neurologic symptoms and
signs or sudden coma
▶ May cause sudden death due to
massive brain injury, raised
intracranial pressure, or
malignant cardiac arrhythmia
▶ Diagnosis requires emergent
brain imaging with CT or
MRI; lumbar puncture (LP)
if imaging is negative

MS
Episodic or progressive multifocal
symptoms and signs
▶ Onset most often in otherwise
healthy young adults
▶ Abnormal findings on magnetic
resonance imaging
(MRI) of the brain (>95% of patients)

MYOPATHY
Weakness,generally greater
proximally than distally
▶ Normal sensation
(absent another cause for
sensory loss)
▶ Normal sphincter function
▶ Relative preservation of deep
tendon reflexes
▶ Laboratory testing supportive of
diagnosis and etiology
▶ Electromyography testing is
a key component of diagnosis
▶ Muscle biopsy and genetic testing
often definitive
..