Glucose is the main energy substrate and profound hypoglycaemia known to cause neuronal death in pathologic studies however the vulnerability of different brain regions to neuronal damage in hypoglycaemia is different. Presentation of HE is variable depends on the area affected as per its vulnerability and severity of hypoglyemia. MRI Diffusion demonstrates alteration of the diffusion of water within the extracellular space and between intracellular and extracellular spaces, may demonstrate changes suggestive of hypoglycemia by the restricted diffusion in the affected area. Splenium of corpus calloum and bilateral posterior limb of internal capsules are the commonly affected areas.
Pathogenetic mechanisms for diffusion restriction in HE include energy failure, excitotoxic edema, and asymmetric cerebral blood flow. Recent seizures episode, drug toxicity, viral encephalitis, and metabolic encephalopathy may show similar reversible signal abnormality on diffusion should be considered in imaging wise DDs.
The time necessary for hyperintense lesions on DWI to disappear after glucose infusion in humans is not completely clear. Bilateral sub dural hematoma with fluid – fluid levels on Axial T2, enlargement of superior sagittal sinus, mild enlargement of pituitary on Sagittal T1, sagging of brain stem with low lying cerebellar tonsils on sagittal, antero posterior elongation of mid brain on axial and medialised slit like both the lateral ventricles consistent with clinical diagnosis of intracranial hypotension. Most of these findings are the result of vascular dilation to compensate for sudden depletion of Csf volume, the explanations are based on Monro Kellie hypothesis, which states that the sum of the volumes of intracranial blood, CSF, and brain tissue remain constant in an intact cranium.
Meningeal enhancement is thick, linear, without nodularity and involves the pachymeninges without evidence of involvement of the leptomeninges. Dura matter, the innermost layer composed of fibroblasts with inter digitating processes that create spaces in between. Sub dural effusions occur when the extravasation continue even after meningeal thickening and enhancement, to the point of fluid accumulation in the subdural space as supported by studies in which effusions were not seen in the absence of meningeal enhancement represent more advanced stage of the condition. Subdural hematoma occur when effusion get complicated with bleed in subdural space due to rupture of the bridging veins traversing sub dural space in response to traction by ongoing extravasation and effusion.
Descend of cerebellar tonsils with sagging of brain stem, an associated effacement of prepontine cistern, obliteration supra chiasmatic cistern with inferior displacement of the optic chiasm result from reduction of normal Csf buoyancy due to reduced csf volume and represent most advanced stage of disease and severe Csf volume depletion, occurs after all other compensatory mechanisms have exhausted. Engorgement of dural venous sinuses seen as enlarged and round dural venous sinuses which are normally triangular in shape on cross sections.
Regression in these imaging findings often parallels clinical improvement of these, reversal of pituitary enlargement occurs first. Most important is after sincerely mentioning all the findings, one must mention or suggest about the condition of so called intra cranial hypotension in the report, a frequently misdiagnosed syndrome of headache caused by reduced intra cranial pressure to alarm clinician that sagging down brain stem and tonsillar desend is due to low intra cranial pressure and not secondary to raised intra cranial pressure due to bilateral sub dural hematoma.
A rare toxic disease that results in progressive demyelination and necrosis of the corpus callosum. Believed to be mainly due to deficiency of Vitamin B complex as many improve with Vit B supplementation but some may not. At first, MB was thought to be particular to individuals living in the central region of Italy and consuming large amounts of inexpensive Chianti red wine. Most males, between 40 and 60 years of age with history of chronic alcoholism and malnutrition.
Acute MB patients present with mental confusion, disorientation, neurocognitive deficits, and seizures.

Chronic form of MB is characterized by a chronic dementia and now differentials includes Alzheimer disease, multi-infarct dementia, and Pick disease.
On MRI, MB show high T2 and FLAIR signal intensity, typically affects the body of the corpus callosum, followed by the genu, and finally the splenium. Other lesions showing restricted diffusion in corpus callosum include infarctions, shearing injuries, demyelination and Encephalitis.
Internal jugular veins joins sub clavian veins before draining directly into the superior vena cava via innominate veins. I am using this space to put together my growing understanding of insulin resistance, cell biology of the gut, weight regulation, and nutrition.
I am a scientist (PhD Cell Biology) so my discussion here will be very specific regarding the cell biology, genomics, metabolomics, and other matters. The material on this page will seem hodgepodge at first but will become more ordered but more complex over time. There is an as yet to be understood relationship between the participation of the small intestine in the digestive process and the regulation of insulin as well as insulin receptivity of target cells.
We know of this relationship because patients who have had their small intestines by-passed in the weight loss surgery called Roux-en-Y anastomosis have improved insulin utilization but patients who have had the Lap-Band (adjustable gastric band) do not experience the same dynamic. It is believed that GLP-1 (Glucagon-like peptide 1) is a critical molecule in this metabolic rescue.
The following graphic (source) provides some pathway context for the GLP-1 molecule in this setting.
Glucagon-like peptide-1 (GLP-1) is derived from the transcription product of the proglucagon gene. GLP-1 secretion by L cells is dependent on the presence of nutrients in the lumen of the small intestine.
There are many tissue types in the body and each has its special method of developing over the lifetime of an organism and its own unique metabolism. Extravasation of fluid occur into this layer, in these spaces, in response to increased dural vasculature as the dura lacks blood brain barrier and tight junctions.These extravasations explains dural thickening as well as contrast extravasation and enhancement.
In fact it is the most common nerve among all to get affected due to its longer intracranial course.
Here radiculomeningeal artery feeds directly into a radicular vein, usually near the spinal nerve root.
I may or may not be able to answer your question now but may be able to later, once I have learned it myself.
The major source of GLP-1 in the body is the intestinal L cell that secretes GLP-1 as a gut hormone. The secretagogues (agents that cause or stimulate secretion) of this hormone include major nutrients like carbohydrate, protein and lipid. If lesions are detected in the cerebral cortex, BG, or hippocampus and the lesions do not regress on follow up imaging is associated with poor outcome. Dilation of the venous side of circulation contributes a lot due to its high compliance and capacitance.

Tight junctions in arachnoid and pia mater prevent the similar contrast accumulation, explaining enhancement is limited to the dura.
Often get encountered at inisura when there is sagging of mid brain with antero posterior elongation.
Treatment is aimed at restoring csf volume by fluid replacement, bed rest with head low, dural patching for any obvious Csf leak, intra thecal saline infusions. Acute MB may be difficult to distinguish from Wernicke encephalopathy and may occur together. May extend to adjacent white matter tracts such as the anterior and posterior commisures and the cortico-spinal tracts. The abnormal vessels are intramedullary in location, may reach surface and sometimes subarachnoid space if extensive. Once in the circulation, GLP-1 has a half life of less than 2 minutes, due to rapid degradation by the enzyme dipeptidyl peptidase-4. Insulin functions through at least four mechanisms to promote adipocyte differentiation; two of these mechanisms are common to other regulatory pathways (activation of CREB by cAMP and regulation of GATA factors in the sonic hedgehog (SHH) pathway).
Humoral factors like Wnt ligands, BMP and TGF- transmit their signals through cognate cell membrane receptors expressed by the differentiating cells. Though it is a frequent finding, abnormal meningeal enhancement is not the rule as cases are reported which are still symptomatic but enhancement that resolved earlier where as in certain typical cases MR images never revealed enhancement at any stage of disease. Are the most commonly encountered intramedullary vascular malformations, representing about 20% of all spinal vascular malformations.
It is a potent antihyperglycemic hormone, inducing glucose-dependent stimulation of insulin secretion while suppressing glucagon secretion. Activation of -catenin signalling is used by both Wnt-family proteins and androgens to repress adipogenesis.
Transcription factors often govern the final cell lineage decision during MSC differentiation, and their transcriptional activities are modulated through crosstalk with cell-membrane receptor-mediated signals.
Such glucose-dependent action is particularly attractive because when the plasma glucose concentration is in the normal fasting range, GLP-1 no longer stimulates insulin to cause hypoglycemia.
GLP-1 appears to restore the glucose sensitivity of pancreatic I?-cells , with the mechanism possibly involving the increased expression of GLUT2 and glucokinase. We have used + and – symbols to denote positive and negative effects on adipogenesis that are not understood mechanistically. GLP-1 is also known to inhibit pancreatic I?-cell apoptosis and stimulate the proliferation and differentiation of insulin-secreting I?-cells.

Blood glucose poc
Fasting blood glucose levels high
Normal blood sugar for kid
Over the counter ways to lower blood sugar zippy


  1. 19.08.2014 at 20:46:59

    You will drink a sugary beverage risk for developing.

    Author: Qanfetkimi_oglan
  2. 19.08.2014 at 16:28:18

    Over 700, but still, I would be concerned about.

    Author: 9577
  3. 19.08.2014 at 22:35:38

    110 mg/dl (6 mmol/l) or higher, you really.

    Author: Baban_Qurban
  4. 19.08.2014 at 21:29:48

    Glucose or sucrose tablets diabetes mellitus, or non-insulin-dependent should discuss an A1C goal that is right.

    Author: Sibelka
  5. 19.08.2014 at 17:57:25

    (Levafloxacin, clarithromycin, trimethoprim/sulfamethoxazole), and some malaria medications (quinine) as a result, the risk of developing.

    Author: 665