Tuesday, September 25, 2012

Central nervous system cavernous hemangioma

Central neverous system cavernous hemangioma is a cavernous hemangioma that arises in the central nervous system. It can be considered to be a variant of hemangioma, and is characterized by grossly large dilated blood vessels and large vascular channels, less well circumscribed, and more involved with deep structures, with a single layer of endothelium and an absence of neuronal tissue within the lesions. These thinly walled vessels resemble sinusoidal cavities filled with stagnant blood. Blood vessels in patients with CCM can range from a few millimeters to several centimeters in diameter. Most lesions occur in the brain, but any organ may be involved.[1]

The incidence in the general population is roughly 0.5%, and clinical symptoms typically appear between 20 to 30 years of age.[2] Once thought to be strictly congenital, these vascular lesions have been found to occur de novo. It may appear either sporadically or exhibit autosomal dominant inheritance.


Clinical symptoms of CNS origin include recurrent headaches, focal neurological deficits, hemorrhagic stroke, and seizures, but CCM can also be asymptomatic. The nature and severity of the symptoms depend on the lesion’s location.
Diagnosis is generally made by magnetic resonance imaging (MRI), particularly using a specific imaging technique known as a gradient-echo sequence MRI, which can unmask small or punctate lesions that may otherwise remain undetected. These lesions are also more conspicuous on FLAIR imaging compared to standard T2 weighing. FLAIR imaging is different from Gradient sequences, rather, it is similar to T2 weighing but suppresses free-flowing fluid signal. Sometimes quiescent CCMs can be revealed as incidental findings during MRI exams ordered for other reasons. Many cavernous hemangiomas are detected “accidentally” during MRIs searching for other pathologies. These “incidentalomas” are generally asymptomatic. In the case of hemorrhage, however, a CT scan is more efficient at showing new blood than an MRI, and when brain hemorrhage is suspected, a CT scan may be ordered first, followed by an MRI to confirm the type of lesion that has bled.

Sometimes the lesion appearance imaged by MRI remains inconclusive. Consequently neurosurgeons will order a cerebral angiogram or magnetic resonance angiogram (MRA). Since CCMs are low flow lesions (they are hooked into the venous side of the circulatory system), they will be angiographically occult (invisible). If a lesion is discernible via angiogram in the same location as in the MRI, then an arteriovenous malformation (AVM) becomes the primary concern.

CCMs & venous angiomas

DVA in MRI (T1 axial contrast enhanced)

In up to 30% there is a coincidence of CCM with a venous angioma, also known as a developmental venous anomaly (DVA). These lesions appear either as enhancing linear blood vessels or caput medusae, a radial orientation of small vessels that resemble the hair of Medusa from Greek mythology. These lesions are thought to represent developmental anomalies of normal venous drainage. These lesions should not be removed, as venous infarcts have been reported. When found in association with a CCM that needs resection, great care should be taken not to disrupt the angioma.

Intracerebral bleeds are the second most common cause of stroke, accounting for 30–60% of hospital admissions for stroke. High blood pressure raises the risks of spontaneous intracerebral hemorrhage by two to six times. More common in adults than in children, intraparenchymal bleeds are usually due to penetrating head trauma, but can also be due to depressed skull fractures. Acceleration-deceleration trauma, rupture of an aneurysm or arteriovenous malformation (AVM), and bleeding within a tumor are additional causes. Amyloid angiopathy is a not uncommon cause of intracerebral hemorrhage in patients over the age of 55. A very small proportion is due to cerebral venous sinus thrombosis. Infection with the k serotype of Streptococcus mutans may also be a risk factor, due to its prevalence in stroke patients and production of collagen-binding protein.

The risk of death from an intraparenchymal bleed in traumatic brain injury is especially high when the injury occurs in the brain stem. Intraparenchymal bleeds within the medulla oblongata are almost always fatal, because they cause damage to cranial nerve X, the vagus nerve, which plays an important role in blood circulation and breathing. This kind of hemorrhage can also occur in the cortex or subcortical areas, usually in the frontal or temporal lobes when due to head injury, and sometimes in the cerebellum.
For spontaneous ICH seen on CT scan, the death rate (mortality) is 34–50% by 30 days after the insult, and half of the deaths occur in the first 2 days.

Saturday, September 15, 2012

Death Row

Just a couple weeks ago, as I Laid in bed, unable to sleep, I started to foolishly self pity myself over some of my life’ struggles. My loving husband laying next to me, his hands around me, pulling me towards him in his sleep… I realized that I was not alone despite what I am facing. I reminded myself of all the people suffering, alone, hopeless, helpless, and felt guilty for this short self pity trip I took. I may be facing some scary hardships, but I am mostly understood, cared for and protected.

The next day, I was surfing the Netflix and found a documentary on Solitary Confinement. I never once put any thoughts into it. Never. Not knowing anyone in prison, only knowing what I know from movies and Tv shows, I never heard or researched such predicament. I was shockingly surprised and my heart sank. I cried. Not only that, I sobbed… and I don’t cry easy. I don’t remember last time I did sob. This has completely changed me, and I hope, for the better. Why is there no awareness over this matter, I don’t know…. Like millions of people in this country, I was ignorant, totally ignorant, and now I am ashamed. This could happen to your son, your husband, your brother… Dont get me wrong, I believe in prison. I believe in keeping murderers off the street, but this is more than that. This is simply unnecessary for the vast majority of them. Most of the prisoners in solitary confinement never killed anyone.

I have always believed in people. Everybody has a heart and in my opinion, very few people on this earth can be characterized as “Evil”, and I seriously thought that this type of predicament was only reserved for the rare individual on earth that do not have a conscience , simply to keep them from killing others, not as a living condition, but as a measure of security. I was so wrong. To me, people are who they are first. What they do is not who they are. We all make mistakes, some more terrible than others, but our mistakes do not define who we are. Of course I believe that murderers should go to prison! But please be sure you have the right guys!! Did you know that there are at least 150 innocent men released from prisons every year, and that isonly the ones that are cleared thru DNA? How about the ones that dont have any DNA in their cases??

After watching the documentary, I spent the day researching Solitary confinement, prisoners in general, and one thing leading to another, I tumbled across http://www.writeaprisoner.com and decided to find someone to write to. I would like to at least try to bring someone the sightless humanity sense they have left.

I have always been a very positive person. I am told over and over that I am full of empathy and compassion. I don’t know how this seems to be a weakness to some people. I don’t think about it. I just love people. I always had the ability to understand every side of a story, without judging anyone and still be able to encourage both sides. Some people have called me a hypocrite, because I refused to take sides, and managed to be able to be kind to both and encourage both, without putting the other down. They don’t understand…. But I just see clearly… that is how I can explain it. I think that most conflicts in life are simply due to misunderstanding and quick judgment. Of course, If I find a cause that I believe in, I will stand strong on what I believe in, and I do see how important it can be to “pick a side” on certain issues.

People long to be understood, and the only way to do that, is to look at someone’s intentions, and not their actions. However, society has to judge its citizen according thru their actions, because they cant be personal or close enough to judge one’s intentions. I wouldn’t be surprised to find out a overwhelming high number of the prison population being innocent, simply because some facts were left out, circumstances were deplorable and no other proof than the failing human instincts were used to accused someone. I also didnt know that it was proven that if counting on identification of a perpetrator thru photo only, the person identifying is 82% of the time wrong. 82% !!
I was so so ignorant… I thought the death penalty was only used to execute the ones that are, without any doubts at all, guilty of gruesome crimes that are inexplicable to the human race, And you know what… very few human beings fall into that category anyway! I didnt know so many men have been executed on death row simply because the court refused to give them a new trial after DNA testing became available. A lot of innocent men were put to death by a very faulty system!

I have always judge people according to their intentions. And when in doubts, I give them the benefit of the doubts, always. I truly believe that its very rare to know someone that is truly evil… and you know what… I think most of the ones that are so, do so in a way that they are not figured out. When people are judged by their actions only and their mistakes, at some point, their humanity scream “look at me, im suffering, im good, cant you see, im good!!” But no, one terrible mistakes and we are doomed.

Friends letting go of friends after one falls hard into a pit of self destruction, depression and guilt. Why not be there anyway, in the worse of the worse, instead of trashing away like sour milk. Friends and family members walking away from one another over desperate human weaknesses and failures….
Nobody is a good, kind, nice guy one day, and overnight changed into a heartless monstrous murderer. I would think its very rare anyway. True people recognize who their loved one is as a person, they know his/her heart and that is what they see, no matter the mistakes. Everybody with a conscience, which is most of us, suffer enough guilt. Most people I have seen (on tv) that committed a crime and admitted to it, wanted prison, they want to pay, they understand why they are there. The ones with no conscience are the ones we may want to send forever, but kill them? I don’t know anymore?!! Isnt being in solitary confinement, completely alone, with no physical contacts, no body to talk to and nobody to hug, for the rest of your life, a punishment worse than death itself? Of course I believe in putting the guilty in prison, but I dont believe in the horror they are submitted to. You are not going to fix a broken human being by isolating them like this. There are over 80 000 prisoners in solitary confinement in the USA, and more 75% of them have never killed anyone.

I am a Christian, but I don’t preach. It’s a never ending inner learning journey and I believe we all have to do it at our own pace. Once we know Him, He takes care of the rest. I cant stand extremists… either its religious, politics and other. Jesus himself dined with prostitute and saved a heartless criminal on execution “table”. But that’s just me. I have gone thru phases of rejection and madness at God, but somehow always found my way back.

I don’t believe much in pity. I usually don’t stay there long anyway. We all have our moments , and I do however pay a great deal of attention and understand when others need that moment. Weither it is one hour or one year, some situation in life need special attention.

It takes a lot to insult me and I am a strong woman so never worry about what you are about to, or need to say. Say it like it is. Authentic people are my favorite people. Its not important to me how a person is personality wise. Goofy, serious, crazy, quiet etc.. as long as you are authentic, you’ve got me.
I have always been realistic and like things for what they truly are. That is probably why I don’t like romance, because its seem “pushy” to me. However, if my husband wants to kiss my hand and tell me how much he loves me, he can, but between you and me, I’d rather hear him say “you’r the bomb hun” in between farts, because, well, that’s who he is. Hahahaha

Looks is something else so irrelevant to me. Something else people can use to judge others. If you are not good looking enough, you are not worth people’s attention. If you are too pretty, you are stupid or slutty… people are never happy, really. So many times, I have been judged by it, and 9 times out of 10, people were so so wrong… I am the type of person that sit next to the maddest person on the bus, and you know what? They are the nicest ones.
Why? because people needing Grace know it. The crave it. Give it to them, without any judgement, without anything in return, and you will not only help them tremendously, you will help yourself, too.