Treatment Of Malignant Middle Cerebral Artery Infarction

DECOMPRESSIVE CRANIECTOMY FOR MALIGNANT MIDDLE CEREBRAL ARTERY INFARCTION INTRODUCTION Stroke represents a public health issue that is affecting both developed and developing countries. A lot money and time have been invested in attempts to improve outcome in these patients. The majority of patients are treated with medical management. There are however few patients in which an occlusion of the middle cerebral artery (MCA) can lead to progressive edema, mass effect and herniation of the brain. As a consequence of this progressive rise in intracranial pressure surgical decompression of the cranium is often considered creating a role for the neurosurgeon in the management of stroke patients. I will present a case of a young boy with an underlying predisposing factor who presented with malignant progression of an MCA infarct, that required surgical intervention. CASE A 14 year old boy presented to the Accident and Emergency department of the Kingston Public Hospital with a history of acute left sided weakness. He was known to have sickle cell disease with the HbSS genotype. He had previously presented with a stroke and had residual right sided weakness. There was no history of headaches fever, vomiting, chest or joint pain. He was admitted to the medical ward where treatment was instituted. On admission he had a Glasgow Coma Score (GCS) of 15 with grade 2 power (MRC) in the upper limbs and grade 3 (MRC) in the lower limbs. Radiological investigations wereShow MoreRelatedComplications Of Brain Surgery860 Words   |  4 Pagesstudies have drawn conclusions between certain patients’ characteristics and their prognosis. â€Æ' References Arac, A., Blanchard, V., Lee, M., Steinberg, G. K. (2009). Assessment of outcome following decompressive craniectomy for malignant middle cerebral artery infarction in patients older than 60 years of age. Neurosurgical Focus, 26(6). doi:10.3171/2009.3.focus0958 Ban, S. P., Son, Y., Yang, H., Chung, Y. S., Lee, S. H., Han, D. H. (2010). Analysis of complications following decompressive craniectomyRead MoreInternational Classification of Diseases Coding Ii10064 Words   |  41 Pagesparents carried the sickle-cell gene. O. The code for sickle-cell disease should be assigned. P. The patient received the sickle-cell gene from only one parent and is a carrier of the trait. 5. How should hemorrhagic disorder due to treatment with anticoagulants like Coumadin or heparin be coded? Q. D68.318 R. D68.32 and T45.515A S. D68.318 and T45.515A T. D68.32 6. A patient was admitted for lower gastrointestinal bleeding that is secondary to recurrentRead MoreUnit 2 study guide8637 Words   |  35 Pagesand posture? Emotions and behavior are controlled by the hypothalamus (p.455) The cerebellum is responsible for maintaining balance and posture (p.455) The reticular formation is essential for maintaining wakefulness and in conjunction with the cerebral cortex is referred to as the reticular activating system (p.450) The Broca speech area is rostral to the inferior edge of the premotor area on the inferior frontal gyrus. It is usually on the left hemisphere and is responsible for the motor aspectsRead MoreCase Study Essay33967 Words   |  136 Pagesdischarged from the hospital for exacerbated HF. Comprehensive patient education starting at admission is considered a standard of care and is mandated by The Joint Commission when providing care to hospitalized patients. The goal of the discharge treatment plan is to facilitate successful patient selfmanagement, minimize symptoms, and prevent readmission. CASE STUDY PROGRESS During the admission interview, the nurse makes a list of the medications M.G. took at home. ââ€"   Chart View Nursing Assessment:Read MoreHesi Practice31088 Words   |  125 Pagesthe knees are flexed. C. Atrophy of the lower leg muscles. D. Positive Homans sign. 7. A client has approached the nurse asking for advice on how to deal with his alcohol addiction. The nurse should tell the client that the only effective treatment for alcoholism is A. psychotherapy. B. total abstinence. C. Alcoholics Anonymous (AA). D. aversion therapy. 8. A 23-month-old child is brought to the emergency department with suspected croup. Which assessment finding reflects increasing respiratoryRead More_x000C_Introduction to Statistics and Data Analysis355457 Words   |  1422 PagesParagraph 575 Graphing Calculator Explorations 580 11 Comparing Two Populations or Treatments 583 11.1 Inferences Concerning the Difference Between Two Population or Treatment Means Using Independent Samples 583 11.2 Inferences Concerning the Difference Between Two Population or Treatment Means Using Paired Samples 606 11.3 Large Sample Inferences Concerning a Difference Between Two Population or Treatment Proportions 619 11.4 Interpreting and Communicating the Results of Statistical Analyses

Epic Poems By Homer Tell The Tails Of Mighty Greeks

Epic poems by Homer tell the tails of mighty Greeks. The Odyssey tells the great adventure of the Greek hero Odysseus trying to get back home to Ithaca after the Trojan War. In the Iliad it tells the tale about Achilles during the seize of Troy in the Trojan War. Several different Greek kingdoms where mentioned in the Iliad Athens, Sparta, and Pylos. The Greek kingdom of Pylos was an actual kingdom within the Mycenaean civilization in Bronze Age Greece. The kingdom of Pylos in South Greece was centered in the town of Pylos and from there controlled its territory within the Messenia region of Greece. Peloponnesus is a peninsula connected to main land Greece by the Isthmus of Corinth in south Greece (fig. 1) (â€Å"Peloponnesus.†). Messenia is a region on the area of Peloponnesus in the south West (â€Å"Messenia.†). Within the ancient region of Messenia, the Mycenaean center of Pylos can be found (â€Å"Messenia.†). Pylos is a great Mycenaean palace that dated in the 13th century B.C. (â€Å"Pylos†). Carl Blegen discovered this great palace at Pylos in 1939; it was seated near Navarino Bay on the Adriatic coast (Castleden 9). Fig. 1. Map of Mycenaean Greece (â€Å"The Bronze Age Aegean.) At first, the palace at Pylos was no greater than the neighboring sites, such as the site of Iklaina (Vermeule 162). In the fourteenth-century, the town was burned and new princes took over the hilltop Pylos site (Vermeule 163). The settlement was quickly rebuilt ushering a new era and new leadership atShow MoreRelatedThe Myth Of The Epic Stories Of Hero s And Heroines2167 Words   |  9 Pageslost in the epic stories of Hero’s and Heroines as you go on an adventure with them through real places and time, facing their trials and tribulations like Agamemnon and the sack of Troy, or following Zeus on one of his many adventures. Whilst cultures don’t seem to question the authenticity, modern scholars try and make sense of them, by readin g ancient hymns and scripts and theorising why the myth was created in the first place. In modern times, scholars try to decipher these epics into logic orRead MoreEssay on The Odyssey21353 Words   |  86 Pagesincludes other far-flung places, such as the island of the Cyclops. The main action of the poem takes place in Ithaca, after a disguised Odysseus reaches there in Book 13. In Books 13 to 24, Odysseus is slowly reunited with his family and takes revenge on the suitors that have been wooing his wife and wasting his property. CHARACTERS Major Odysseus - the protagonist and hero of the poem. Odysseus is the King of Ithaca, a small, rugged island on the western coast of Greece. He

Irony in the Matrix Essay Example For Students

Irony in the Matrix Essay Imagine realizing that all of what we know, knew or experienced was an artificially created belief. This is the idea that the movie Matrix, with its main character Neo, and Plato’s Allegory of the Cave, with the slaves, try to present as they question our perception of reality. In both publications, human beings live their lives experiencing what for them is reality until some of them are able to see reality and realize that all their lives were based on illusions. The Matrix and Plato’s Allegory of the Cave are very similar for both involve men who live unreal lives that are controlled by other beings and who, upon perceiving this, initially reject the truth yet finally manage to accept it and try to present it to other persons. At first, Neo and the slaves lived ordinary lives. For them, what they saw was the reality and anything that contradicted this reality was false. In the case of Neo, he lived a normal life in Capital City, USA; he had a job as a programmer, a car and an apartment. Likewise, the slave in Plato’s Allegory lived an ordinary life that did not differ in any way from that which he had lived all his life; he was always chained, lived in a gloomy cave and could only stare at a wall. In their perspective, that was their reality for it was the only one they knew and the one that they had experienced throughout their whole lives. Initially, Neo lives within the Matrix; a machine produced world that creates every aspect of Neo’s life and causes him to believe that he is actually living it. Similarly, the slave lives in a cave where all that occurs is artificially created and controlled by a passerby who projects figures on the cave wall in the form of shadows and makes incomprehensible sounds. In both cases, the men believe that what they perceive is true for their senses and their interactions which other beings allow them to make such a hypothesis. Suddenly, both men are presented with the truth that they are living an illusion. One day, Neo meets Morpheus and when asked if he wants to know the truth about his life, decides to accompany him and hence leave the Matrix. Neo wakes up in a place full of mechanical pods where human beings are connected to cables. He is then released from the pod and transferred through pipes until he is rescued by Morpheus’ vessel. This senses are disrupted when he leaves the Matrix and this is why Neo has trouble seeing at first. In the same manner, the slave is released from the chains by his captor and exposed to the real world. While being taken away from his chains and towards the exit of the cave, the slave sees that apparatus that had formed his reality for such a long time; he sees the chains that had held him, he sees the origins of the shadows and the sounds. He has trouble accepting this, for it is much easier for him to continue believing what he has always believed. Regardless of this he is taken outside and sees the sunlight. At first he is dazzled; the light blinds him and distorts his senses. The slave has trouble adapting to a world so different to the one that he had become accustomed to. In essence, both men are removed from their fake realities and forced to digest the truth about their lives and to experience the real world. Now that Neo and the slave have realized the truth regarding their lives, they decide in trying to save those who are still living in an illusion. .u247a70aaf480e8d5c5f8218569dfa22e , .u247a70aaf480e8d5c5f8218569dfa22e .postImageUrl , .u247a70aaf480e8d5c5f8218569dfa22e .centered-text-area { min-height: 80px; position: relative; } .u247a70aaf480e8d5c5f8218569dfa22e , .u247a70aaf480e8d5c5f8218569dfa22e:hover , .u247a70aaf480e8d5c5f8218569dfa22e:visited , .u247a70aaf480e8d5c5f8218569dfa22e:active { border:0!important; } .u247a70aaf480e8d5c5f8218569dfa22e .clearfix:after { content: ""; display: table; clear: both; } .u247a70aaf480e8d5c5f8218569dfa22e { display: block; transition: background-color 250ms; webkit-transition: background-color 250ms; width: 100%; opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #95A5A6; } .u247a70aaf480e8d5c5f8218569dfa22e:active , .u247a70aaf480e8d5c5f8218569dfa22e:hover { opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #2C3E50; } .u247a70aaf480e8d5c5f8218569dfa22e .centered-text-area { width: 100%; position: relative ; } .u247a70aaf480e8d5c5f8218569dfa22e .ctaText { border-bottom: 0 solid #fff; color: #2980B9; font-size: 16px; font-weight: bold; margin: 0; padding: 0; text-decoration: underline; } .u247a70aaf480e8d5c5f8218569dfa22e .postTitle { color: #FFFFFF; font-size: 16px; font-weight: 600; margin: 0; padding: 0; width: 100%; } .u247a70aaf480e8d5c5f8218569dfa22e .ctaButton { background-color: #7F8C8D!important; color: #2980B9; border: none; border-radius: 3px; box-shadow: none; font-size: 14px; font-weight: bold; line-height: 26px; moz-border-radius: 3px; text-align: center; text-decoration: none; text-shadow: none; width: 80px; min-height: 80px; background: url(https://artscolumbia.org/wp-content/plugins/intelly-related-posts/assets/images/simple-arrow.png)no-repeat; position: absolute; right: 0; top: 0; } .u247a70aaf480e8d5c5f8218569dfa22e:hover .ctaButton { background-color: #34495E!important; } .u247a70aaf480e8d5c5f8218569dfa22e .centered-text { display: table; height: 80px; padding-left : 18px; top: 0; } .u247a70aaf480e8d5c5f8218569dfa22e .u247a70aaf480e8d5c5f8218569dfa22e-content { display: table-cell; margin: 0; padding: 0; padding-right: 108px; position: relative; vertical-align: middle; width: 100%; } .u247a70aaf480e8d5c5f8218569dfa22e:after { content: ""; display: block; clear: both; } READ: Mary Queen of scots- biography EssayThis is the task that Neo and the rest of Morpheus’ crew are set to do as they venture across the dangerous real world in an attempt to defeat the Matrix. They even go to the extent of returning to the Matrix in order to defeat the machines and hence save the people. Regardless of this, some persons do not want to accept the truth and want to return to their illusion; where they did not have to endure the pain of knowing the truth regarding humanity. Such is the case with Cypher; in order to return to the Matrix and live an unreal yet comfortable life, he betrays his peers and even kills other persons. In the case of Platos Allegory, the slave who has seen the real world decides to go back in and help the other slaves see it. Upon hearing what they friend has to say, they reject the truth and even fight to stay. The slaves do not want their illusion to change; for them it is their reality and they fear that it might be disrupted by what their peer wants to show them. As you may see, in both cases, the freed men try to save those who have not been freed, yet the fear of leaving their â€Å"comfort zone† within their fake lives causes them to fight in order to not see the truth.

Alexander the Great and the Battle of Gaugamela Essay Example

Alexander the Great and the Battle of Gaugamela Paper King Alexander at only 25 years old, his reputation already one of greatness had led his men into Asia. To his soldiers, their invasion of Persia was to fight back after half a century of devastation brought onto Greece during the Persian wars between 499 and 448 BC. Alexander’s private desire, however, was to cast a shadow on the large Persian empire by winning all its lands and bringing it under his rule. Gaugamela, named after the village it was fought by, was the decisive battle in the struggle between Alexander III and Darius II for the Persian Empire. The battle occurred in 331 BC, this battle was one of importance as it shows a significant amount of Alexander’s tactical and military genius while including examples of his great leadership skills with his men. Mesopotamia was an abundant region between the rivers, Euphrates and Tigris, dominated by Darius more than a century earlier. The major city in this region was Babylon and was located south where Darius anticipated Alexander would lead his troops. Instead Alexander headed north in the direction of the Tigris River basically there was more food for the horses, the heat was less intense and it would also tempt Darius away from the widespread plains surrounding Babylon. Darius needed vast, flat, obstacle free areas for his chariots and cavalry to be allowed to fight effectively. Alexander knew this, hence the reason he wanted to force Darius northward where the ground would be less favourable to him. This was just one instance that shows a factor that contributed to Alexander’s triumph in the battle. We will write a custom essay sample on Alexander the Great and the Battle of Gaugamela specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Alexander the Great and the Battle of Gaugamela specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Alexander the Great and the Battle of Gaugamela specifically for you FOR ONLY $16.38 $13.9/page Hire Writer Therefore Darius moved north and encamped near the village of Gaugamela while Alexander camped a few kilometers away. Alexander managed to capture some Persian soldiers and discovered where Darius’ location was so he could observe the activities of his rival. Unlike previous battles, Darius had found a suitable battlefield and was unwilling to give this one up. The ground here was flat, perfect for chariots. Darius made it even flatter by ordering the terrain plowed, leveled, removed stones, shrubs and filled in potholes so the area would be ideal for chariots and cavalry. Alexander in turn had also prepared himself for the battle. From his captured and interrogated Persian soldiers he had gathered information that helped him reconstruct the Persian army allowing him to work his movements against Darius’. After seeing that Alexander’s Army was outnumbered five Persians to every one Macedonian Parmenio advised against an instant attack. Alexander approved this suggestion as he was anxious about the superior Persian cavalry and wanted more time to think of how to outmaneuver Darius and the Persians. Alexander permitted his men a decent meal and sleep, while only a few kilometers away Darius kept his men on standby all night long. This, Arrian believed to be a major mistake, ultimately causing Darius’ defeat since the next day Alexander’s men were well rested whereas Darius’ were exhausted. Giving his men rest and food also shows how Alexander was a responsible leader and furthermore he would have respect from his men for doing so. Not rushing into a battle unprepared also shows this excellent leadership and by planning carefully would have allowed more men be spared from death. Alexander knew that the only way to triumph over the gigantic Persian army was through clever strategies so he thought about the difficult conditions over night while his men rested, he came up with a series of orders for his men. He ordered the Agrianians near his cavalry and specifically told them to bring the chariots and elephants to a halt, the chariots may be made of tough material but the drivers were only human just like the elephants were only animals, they could still be injured and stopped. In the centre were the phalanx and the Greek cavalry. A second line of infantry was following them, Alexander ordered them all to turn around and fight the enemy if they became surrounded as there was a high chance of this considering the size of the Persian army. The infantry were all told to break ranks and create corridors for the chariots and elephants to pass directly through hoping that no infantry would be injured, this meant that then the infantry could then quickly press forward before the elephants and chariots would have a chance to turn around and come back. The arrangements ended up being parallel to that of the battle of Issus. However, realizing that the Persian cavalry was moderately powerful, Alexander reinforced his wings and ordered them to lengthen if there was any risk of being out-flanked. These well designed decisions would have made a huge impact on the final outcome of the battle, this shows Alexander’s ability to adapt his tactics to suit different situations and develop ways to overcome problems that may occur. The battle turned out better than it possibly could have for Alexander, as we can see his well thought out plan coincided with the actual events of the battle and all went as he had pre-determined. Alexander initially ordered his right wing cavalry to advance on an angle, as always, to the right. Consequently forcing the Persian cavalry further left to pursue them, thus moving away from the specially cleared area Darius had so carefully arranged for them. To counteract these actions Darius ordered his men to stop moving to the left and head directly forward to attack Alexander’s right wing as intended. This arrangement worked well for Alexander as he postponed a rather dominant attack to his right wing and would have confused Darius’ cavalry who needed to aim to break through Alexander’s right wing and get behind his troops as to fight them from the back. Darius then launched the elephants and chariots against the phalanx but Alexander had foreseen this problem and all his men followed their detailed instructions. The Agrianians stopped the majority of the chariots and elephants before they even reached the phalanx. The rest caused many of the infantry to panic but because of their training and discipline they followed Alexander’s orders and broke ranks at precisely the right moment allowing the elephants and chariots to pass through corridors made for them so the attack failed miserably as it caused very minimal damage. If Alexander had not thought of this intelligent tactic then the elephants and chariots would certainly have caused great destruction to the phalanx. But his simple yet ingenious plan worked brilliantly, saving them from possible defeat. Darius, after seeing this failure, saw that he was not on the winning side and desperately ordered a general offence where his whole line advanced. Darius also quickly ordered his very strong right wing cavalry, led by Mazaeus, to attack Alexander’s left wing cavalry, under the command of Parmenio. The Persian cavalry was significantly superior to that of Alexander’s; hence Parmenio was under a great deal of pressure. Alexander put a lot of trust in to Parmenio and he obviously believed he could deal with the pressure or he would not have placed him in the situation. Darius was still intent on using his cavalry on his left wing to attempt to get through Alexander’s right wing to encircle him, so he sent his Indian cavalry to help attack the right wing. However, this created a gap in the Persian line, to the left of the centre. This was the moment Alexander had been waiting for, he and his companions advanced for Darius. They were held up by the Persian horse guard and the Greek mercenaries, preventing them from reaching Darius who was standing in his chariot. Darius decided the battle was lost and fled with his entire left wing following close behind. Darius’ left wing and center were still intact, and both parties would have had most likely equal chances if he could secure the gap in the left of the center, and pull together his right wing again. The result of the battle might have been entirely different if the Persians had a more firm, determined and brave king. But Alexander knew that a gap would eventually appear and in his brave charge he managed to frighten Darius into backing down, although Alexander would have wanted to catch his rival instead of allowing him to escape. Parmenio on the left wing was being brutally beaten by Mazaeus and the Persians, who at this point had no idea that Darius had gone. Some of the Persian right wing had even gotten through the Macedonian line and reached the baggage animals and Macedonian camp where Arrian states there was fierce fighting ‘for the Persians boldly attacked men who were mainly unarmed and had not expected that anyone would cut their way through the double phalanx and force their way up to them’. Yet, as instructed the second line of infantry turned around and caught them in the camp, attacking from the rear they forced the Persians to retreat back the way they came. Alexander anticipated the problem of the Persians getting in behind, unusually as it is he provided a solution not to prevent the problem but solve it if it occurred. He knew it would be difficult to stop them getting in behind but coming up with such a plan was really very resourceful and tactful, thus insuring his victory in the battle. In the meantime, although Alexander wanted to pursue his rival Darius, Parmenio was in great peril and sent a message to Alexander requesting help. As Arrian states ‘When the king received this information, he refrained from further pursuit’ and Alexander alongside his companions quickly headed to help his left wing. But, on the way, they bumped into the Persian right wing, who in turn were trying to escape from the Macedonian camp. Here there was a terrible fight and many companions’ lives were lost but nevertheless Alexander prevailed and rushed to the aid of Parmenio. Though, by this time, Parmenio and the left wing did not need his help any more. Mazaeus, after hearing of Darius’ flight, hastily led his men away from the battle and was pursued by the Thessalians. Alexander showed remarkable leadership skills in this stage of the battle as he put aside his own wants for the needs of his men. Alexander considered the victory at Gaugamela to be one of significance in the fight over the Persian Empire, as Darius’ army was crushed, Alexander now had control of the heart of Asia and so he proclaimed himself ‘king of Asia’. This statement, before the whole Macedonian army, would have had huge propaganda worth to Alexander making him appear very impressive to his people. Throughout the battle Alexander proved himself to be worthy of his title; Alexander the Great. This particular battle illuminated Alexander’s tactical brilliance, strength and genius because he won purely through intellectual strategies. Considering the size of Darius’ army and the outcome of the battle Alexander shows that there is some truth to the saying that brains beat brawn.