Format First, as indicated by the series title, Board Review Series, one of the . 1 2 BRS Pathology FIGURE Marked atrophy of frontal cortex of the brain. BRS Pathology. FIGURE Marked atrophy of frontal cortex of brain. Note the thinning of the gyri and the widen ing of the sulci. IFrom Rubin R, Strayer 0, et aI. BRS Pathology Medical_Medium_Life-Changing_Foods_-_Anthony_William. pdf Medical Medium BRS Biochemistry, Molecular Biology, and Genetics.
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Arthur S. Schneider, Philip A. Szanto - BRS Pathology, 5th Edition ISBN: , | | PDF | pages | 34 MB This revised fifth edition is. This article contains all BRS books PDF for free download. BRS Pathology 5th Edition PDF; BRS Microbiology and Immunology 6th Edition. This revised fifth edition is an excellent pathology review for students preparing for the USMLE Step 1 and course examinations. Written in the popular Board.
He explains everything from a basic mechanistic approach which is critical because that is how the questions are tested, but more importantly it develops true understanding which is never forgotten.
I am truly convinced that this is the strongest review product for pathology out there. I have to say I am absolutely convinced that this is how medicine and board reviews should be taught. I ended up with a on Step 1 largely due to your amazing lecture series and textbook. All I have to say is thank you for doing what you do. I will always appreciate the effort you put into making material interesting and simple enough to fully grasp.
I can honestly say after having taken the test , this was by far the best resource I used. Everyone at my school is loving this! Integration of key concepts from associated disciplines. Over often-tested, full-color images. Completely written and taught by Dr. This category includes intraparenchymal hemorrhage , or bleeding within the brain tissue, and intraventricular hemorrhage , bleeding within the brain's ventricles particularly of premature infants.
Intra-axial hemorrhages are more dangerous and harder to treat than extra-axial bleeds. Extra-axial hemorrhage, bleeding that occurs within the skull but outside of the brain tissue, falls into three subtypes:.
Cerebral contusion is bruising of the brain tissue. The majority of contusions occur in the frontal and temporal lobes. Complications may include cerebral edema and transtentorial herniation. The goal of treatment should be to treat the increased intracranial pressure.
The prognosis is guarded. Diffuse axonal injury , or DAI, usually occurs as the result of an acceleration or deceleration motion, not necessarily an impact. Axons are stretched and damaged when parts of the brain of differing density slide over one another.
Prognoses vary widely depending on the extent of damage. Three categories used for classifying the severity of brain injuries are mild, moderate or severe. Symptoms of a mild brain injury include headaches, confusions, ringing ears, fatigue, changes in sleep patterns, mood or behavior. Other symptoms include trouble with memory, concentration, attention or thinking. Mental fatigue is a common debilitating experience and may not be linked by the patient to the original minor incident. Narcolepsy and sleep disorders are common misdiagnoses.
Cognitive symptoms include confusion, aggressive, abnormal behavior, slurred speech, and coma or other disorders of consciousness. Physical symptoms include headaches that do not go away or worsen, vomiting or nausea, convulsions or seizures, abnormal dilation of the eyes, inability to awaken from sleep, weakness in the extremities and loss of coordination. In cases of severe brain injuries, the likelihood of areas with permanent disability is great, including neurocognitive deficits , delusions often, to be specific, monothematic delusions , speech or movement problems, and intellectual disability.
There may also be personality changes. The most severe cases result in coma or even persistent vegetative state.
Symptoms observed in children include changes in eating habits, persistent irritability or sadness, changes in attention, disrupted sleeping habits, or loss of interest in toys. Presentation varies according to the injury. Some patients with head trauma stabilize and other patients deteriorate. A patient may present with or without neurological deficit. Patients with concussion may have a history of seconds to minutes unconsciousness, then normal arousal.
Disturbance of vision and equilibrium may also occur. Common symptoms of head injury include coma , confusion, drowsiness, personality change, seizures , nausea and vomiting , headache and a lucid interval , during which a patient appears conscious only to deteriorate later.
Because brain injuries can be life-threatening, even people with apparently slight injuries, with no noticeable signs or complaints, require close observation; They have a chance for severe symptoms later on.
The caretakers of those patients with mild trauma who are released from the hospital are frequently advised to rouse the patient several times during the next 12 to 24 hours to assess for worsening symptoms.
The Glasgow Coma Scale GCS is a tool for measuring degree of unconsciousness and is thus a useful tool for determining severity of injury.
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The Pediatric Glasgow Coma Scale is used in young children. Symptoms of brain injuries can also be influenced by the location of the injury and as a result impairments are specific to the part of the brain affected.
Lesion size is correlated with severity, recovery, and comprehension. Studies show there is a correlation between brain lesion and language, speech, and category-specific disorders. Wernicke's aphasia is associated with anomia , unknowingly making up words neologisms , and problems with comprehension.
An impairment following damage to a region of the brain does not necessarily imply that the damaged area is wholly responsible for the cognitive process which is impaired, however. For example, in pure alexia , the ability to read is destroyed by a lesion damaging both the left visual field and the connection between the right visual field and the language areas Broca's area and Wernicke's area. However, this does not mean one suffering from pure alexia is incapable of comprehending speech—merely that there is no connection between their working visual cortex and language areas—as is demonstrated by the fact that pure alexics can still write, speak, and even transcribe letters without understanding their meaning.
Lesions to the fusiform gyrus often result in prosopagnosia , the inability to distinguish faces and other complex objects from each other. Amygdala lesions change the functional pattern of activation to emotional stimuli in regions that are distant from the amygdala. Other lesions to the visual cortex have different effects depending on the location of the damage.
Lesions to V1 , for example, can cause blindsight in different areas of the brain depending on the size of the lesion and location relative to the calcarine fissure.
Head injuries can be caused by a large variety of reasons. All of these causes can be put into two categories used to classify head injuries; those that occur from impact blows and those that occur from shaking. Head injuries from shaking are most common amongst infants and children. In addition, the highest rate of injury is among children ages 0—14 and adults age 65 and older. Brain tumors can increase intracranial pressure, causing brain damage. There are a few methods used to diagnose a head injury.
A healthcare professional will ask the patient questions revolving around the injury as well as questions to help determine in what ways the injury is affecting function.
In addition to this hearing, vision, balance, and reflexes may also be assessed as an indicator of the severity of the injury. A CT is an imaging technique that allows physicians to see inside the head without surgery in order to determine if there is internal bleeding or swelling in the brain.
The changes in microcirculation, impaired auto-regulation, cerebral edema, and axonal injury start as soon as head injury occurs and manifest as clinical, biochemical, and radiological changes. Glasgow Coma Scale GCS is the most widely used scoring system used to assess the level of severity of a brain injury. This method is based on the objective observations of specific traits to determine the severity of a brain injury.
It is based on three traits eye opening, verbal response, and motor response, gauged as described below. Based on the Glasgow Coma Scale severity is classified as follows, severe brain injuries score , moderate brain injuries score and mild score CT scans and MRI are the two techniques widely used and are most effective.
CT scans can show brain bleeds, fractures of the skull, fluid build up in the brain that will lead to increased cranial pressure. MRI is able to better to detect smaller injuries, detect damage within the brain, diffuse axonal injury, injuries to the brainstem, posterior fossa, and subtemporal and subfrontal regions.
However patients with pacemakers, metallic implants, or other metal within their bodies are unable to have an MRI done. Typically the other imaging techniques are not used in a clinical setting because of the cost, lack of availability. Most head injuries are of a benign nature and require no treatment beyond analgesics such as acetaminophen.
Non-steroidal painkillers such as ibuprofen are avoided since they could make any potential bleeding worse. Due to the high risk of even minor brain injuries, close monitoring for potential complications such as intracranial bleeding. If the brain has been severely damaged by trauma, neurosurgical evaluation may be useful.
Treatments may involve controlling elevated intracranial pressure. This can include sedation, paralytics, cerebrospinal fluid diversion. Second line alternatives include decompressive craniectomy Jagannathan et al. Although all of these methods have potential benefits, there has been no randomized study that has shown unequivocal benefit. Rules like these are usually studied in depth by multiple research groups with large patient cohorts to ensure accuracy given the risk of adverse events in this area.
Prognosis, or the likely progress of a disorder, depends on the nature, location, and cause of the brain damage see Traumatic brain injury , Focal and diffuse brain injury , Primary and secondary brain injury. In children with uncomplicated minor head injuries the risk of intra cranial bleeding over the next year is rare at 2 cases per 1 million. Malignant post traumatic cerebral swelling can develop unexpectedly in stable patients after an injury, as can post traumatic seizures.
Recovery in children with neurologic deficits will vary. Children with neurologic deficits who improve daily are more likely to recover, while those who are vegetative for months are less likely to improve.
Most patients without deficits have full recovery. However, persons who sustain head trauma resulting in unconsciousness for an hour or more have twice the risk of developing Alzheimer's disease later in life.
Head injury may be associated with a neck injury. Bruises on the back or neck, neck pain, or pain radiating to the arms are signs of cervical spine injury and merit spinal immobilization via application of a cervical collar and possibly a long board. If the neurological exam is normal this is reassuring.
Reassessment is needed if there is a worsening headache , seizure , one sided weakness, or has persistent vomiting. To combat overuse of Head CT Scans yielding negative intracranial hemorrhage, which unnecessarily expose patients to radiation and increase time in the hospital and cost of the visit, multiple clinical decision support rules have been developed to help clinicians weigh the option to scan a patient with a head injury. Brain injuries are very hard to predict in outcome. Many tests and specialists are needed to determine the likelihood of the prognosis.
People with minor brain damage can have debilitating side effects; not just severe brain damage has debilitating effects. Even a mild concussion can have long term effects that may not resolve.
The foundation for understanding human behavior and brain injury can be attributed to the case of Phineas Gage and the famous case studies by Paul Broca. In , Phineas Gage was paving way for a new railroad line when he encountered an accidental explosion of a tamping iron straight through his frontal lobe.
Gage observed to be intellectually unaffected but exemplified post injury behavioral deficits. These deficits include: Gage started having seizures in February, dying only four months later on May 21, Ten years later, Paul Broca examined two patients exhibiting impaired speech due to frontal lobe injuries.
He saw this as an opportunity to address language localization. It wasn't until Leborgne, formally known as "tan", died when Broca confirmed the frontal lobe lesion from an autopsy. The second patient had similar speech impairments, supporting his findings on language localization.
The results of both cases became a vital verification of the relationship between speech and the left cerebral hemisphere. A few years later, a German neuroscientist, Carl Wernicke , consulted on a stroke patient. The patient experienced neither speech nor hearing impairments, but suffered from a few brain deficits. These deficits included: After his death, Wernicke examined his autopsy that found a lesion located in the left temporal region.
This area became known as Wernicke's area. Wernicke later hypothesized the relationship between Wernicke's area and Broca's area, which was proven fact. Head injury is the leading cause of death in many countries. From Wikipedia, the free encyclopedia. See also: Traumatic brain injury. This article needs additional citations for verification. Please help improve this article by adding citations to reliable sources.
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Find sources: Skull fracture Lacerations to the scalp and resulting hemorrhage of the skin Traumatic subdural hematoma, a bleeding below the dura mater which may develop slowly Traumatic extradural, or epidural hematoma, bleeding between the dura mater and the skull Traumatic subarachnoid hemorrhage Cerebral contusion , a bruise of the brain Concussion , a loss of function due to trauma Dementia pugilistica , or "punch-drunk syndrome", caused by repetitive head injuries, for example in boxing or other contact sports A severe injury may lead to a coma or death Shaken baby syndrome — a form of child abuse.
Main article:Cognitive symptoms include confusion, aggressive, abnormal behavior, slurred speech, and coma or other disorders of consciousness. If the neurological exam is normal this is reassuring.
The changes in microcirculation, impaired auto-regulation, cerebral edema, and axonal injury start as soon as head injury occurs and manifest as clinical, biochemical, and radiological changes. Difficult concepts are explained stepwise, concisely, and clearly, with appropriate illustrative examples and sample problems. A Practical Guide 2nd ed.