By N. Grok. University of Charleston. 2017.
Using computed tomography and enhanced magnetic resonance imaging to distinguish between scar b tissue and recurrent lumbar disc herniation buy 5 mg ditropan mastercard. Spine 1994;19:2826 Kirkaldy-Willis WH, Wedge JH, Yong-Hing K, Reilly J. Spine Osti OL, Vernon-Roberts B, Moore R, Fraser RD. Annular 1978;3:319 tears and disc degeneration in the lumbar spine. J Bone Joint Surg 1992;74-B:678 Modic MT, Steinberg PM, Ross JS, Masaryk TJ, Carter JR. Degenerative disk disease: assessment of changes in verte- Selby DK, Paris SV. Anatomy of facet joints and its clini- bral body marrow with MR imaging. Contemp Orthop 1988;166:193 1981;3:1097 ©2002 CRC Press LLC 4 Acute trauma Acute trauma, either in the form of a direct blow to stretched beyond their elastic capacity and tear. If the spine or the application of excessive rotational or these tears are oriented in a radial fashion, the compressive force applied to the spine, can result in nucleus pulposus may migrate through the tear, injury to virtually any structure. The structures most causing a protrusion of the disc beyond its natural vulnerable to acute trauma are the annulus fibrosus borders. This can occur as an acute process in a of the intervertebral discs, the endplates of the inter- healthy disc given sufficient force. Degenerated vertebral discs and the vertebral bodies. If there is a disruption of the posterior When compressive or rotational forces are applied to longitudinal ligament, nuclear material can extrude the spine, the fibers of the annulus fibrosus can be through the annulus, narrowing the diameter of the Figure 4. Courtesy Churchill-Livingstone (Saunders) Press ©2002 CRC Press LLC Figure 4. The disc protrusion effaces the dorsal root ganglion (arrow); (b) non- enhanced computed tomography of the same patient reveals increased signal density of the lateral disc herniation; (c) post- discography computed tomography of the same patient demonstrates contrast enhancement of the lateral disc hernia- b tion (arrow) Figure 4.
Hyponatremia should be corrected at a rate not exceeding 12 mEq/L/day because rapid correction of hyponatremia leads to central pontine myelinolysis purchase ditropan 5 mg otc. Central pontine myelinolysis may obscure or follow improvement in hyponatremic encephalopathy. The pathologic hall- mark of the disorder is breakdown and loss of myelin in the anterior pons and other brain stem regions, which may be visualized by magnetic resonance imaging. The disorder is associated with alcoholism, electrolyte disturbances, malignant disease, and malnutrition, and it relates particularly to the rapid correction of hyponatremia. A 78-year-old woman is transported to the emergency department after being “found down” by a fami- ly member. Upon arrival at the emergency department, the patient is pulseless and apneic. A “code 10” is called, and advanced cardiac life support is initiated. Chest compressions are performed, and the patient is intubated and oxygenated with 100% fraction of inspired oxygen (FIO2). Pharmacologic therapy with epinephrine and atropine is administered. After the second round of epinephrine and atropine, the patient regains a pulse. She is transferred to the medical inten- sive care unit for further care. You are concerned about the possibility of anoxic-ischemic encephalopa- thy secondary to circulatory arrest. Which of the following statements regarding anoxic-ischemic encephalopathy is accurate? In the mature nervous system, white matter is generally more vulnera- ble to ischemia than gray matter 20 BOARD REVIEW B.