A womb with a view Brain-oriented fetal care
|
|
- Christian Fletcher
- 7 years ago
- Views:
Transcription
1 A womb with a view Brain-oriented fetal care Adre du Plessis, MBChB Fetal and Transitional Medicine Children s National Medical Center Speaker Disclosures I have no financial relationships to disclose I will not discuss off Label use and/or investigational uses in my presentation Barker hypothesis Impaired fetal growth is strongly associated with a number of chronic conditions in later life, including coronary heart disease, stroke, hypertension, and diabetes These result from adaptations made by the fetus to an unfavorable environment Thrifty phenotype to thrifty epigenotype hypothesis The effects may cross generations 1
2 The Mission of Fetal and Transitional Medicine at Children s National Medical Center To advance understanding of normal and abnormal fetal development To translate of such knowledge toward identification of the at-risk fetus To inform safe and rational surgical and medical management of the at-risk fetus throughout gestation and the often complex transition to newborn life To address the entire spectrum of conditions that may affect the fetus from primary genetic conditions to those mediated by environment influences Fetal Neurology Background Fetal and neonatal brain development is a continuum which genetic and environmental factors may influence Many neuropsychiatric conditions may originate from acquired and potentially preventable brain insults during the fetal period Current expertise and its application toward preserving fetal brain integrity is not well integrated Diagnostic techniques are rapidly advancing and must be exploited for development of brain-oriented fetal care Decades of experience in the management of premature infants ( exteriorized fetus ) 2
3 Fetal neurology in 2011 Still largely confined to consultation for malformations of the developing brain Opinions are largely based on lesion pattern recognition Counseling prior to viability to inform decisions about the future of the pregnancy Counseling prior to delivery to inform decisions regarding the level of medical intervention at delivery Counseling regarding future risks to the brain from other non-neurologic conditions Neurodevelopmental integrity is fundamental to future quality of life Boston Children s Hospital Advanced Fetal Care Center Neurology Consultations Cases/yr Normal structural development of the fetal brain 3
4 If the brain was simple enough for us to understand it, we would be too simple to understand it Ken Hil Critical periods of brain development Months Primary neurulation Prosencephalic development Myelination Neuronal proliferation Neuronal migration Organization Astroglial reactivity First Trimester (Embryonic Period) Primary Neurulation (3-4 weeks) Posterior neuropore Anterior neuropore Prosencephalic Development (2-3 months) Forebrain Midbrain Hindbrain Cervical flexure Pontine flexure Spinal cord 4
5 Second Trimester Neuronal migration along radial glia Cortical development - Neuronal migration Tangential migration Laminin Marginal zone Reelin Cortical plate Subplate zone Tangential migration Intermediate zone MGE LGE MZ SV IZ Striatum Subventricular zone Ventricular zone Ventricle Radial migration 32 Normal Third Trimester Brain Development 34 Brain growth in premature infants Surface Area (cm 2 ) GA (weeks) Huppi et al.,
6 Cerebral energy demands in the third trimester The explosive phase of axonal and neurite outgrowth, and synaptic development during the third trimester is highly dependent on adequate energy supply A major part of this energy consumption goes toward the function of enzymes (e.g., Na/K-ATP-ase) ase) responsible for maintenance of changing ionic gradients across neural membranes Nerve impulses activate neuronal activity stimulating release of growth factors and activating immediate early genes in remote brain regions, establishing and consolidating brain connectivity Neuronal action potentials and Na/K-ATPase Depolarization Repolarization Nerve action potentials are the fundamental elements of neurologic function and are highly energy dependent K Na Na/K-ATPase ATP Human Cerebral Cortex Rapid Golgi Stain 6
7 Normal functional development of the fetal brain Development of Fetal Motor Patterns Erbkam (1837) human fetal motility after spontaneous miscarriage since the 1970s 2D-US and more recently 4D-US have allowed direct intrauterine study of fetal movements and behavior a spontaneous expression of the developing nervous system reactivity to stimuli is an indication of sensorimotor reflex development simple movements generated by spinal-brainstem circuitries ~ 7 weeks evoked motor response to tactile stimulation from co-twin ~ 11 weeks progressive organization into complex and distinct behavioral patterns, reactivity and habituation to stimuli, denote supraspinal modulation of spinal-brainstem activity Fetal Motor Activity 7
8 Early spinal-brainstem reflex pathways Extremity modeling of cerebral pathways Cerebral modulation of fetal behaviors 8
9 EEG in Premature Infant Trace discontinue pattern Fetal magnetobiometric techniques (MEG and MCG) Spontaneous activity Evoked reactivity VER AER HRV Evaluation of Fetal Brain Function Spontaneous motor behaviors Sensorimotor reflexes (reactivity) Autonomic nervous system (e.g., heart rate) Behavioral state development Cerebral activation studies (fetal MEG; functional MRI) 9
10 Substrate support for the developing fetal brain Fetal Circulatory Support of Substrate Supply to the Developing Brain Compensatory mechanisms maintain cerebral substrate supply during transient fetal hypoxemia Systemic mechanisms Circulatory centralization Cerebrovascular autoregulation Pressure and oxygen reactivity Cerebral metabolism powers down Endogenous synaptic inhibition 10
11 Fetal hypoxemia triggers adaptive circulatory responses Cortex Cerebral autoregulation Basal Ganglia Brainstem Centralization of systemic perfusion Heart Adrenals Liver Kidneys Doppler US Cerebral-placental ratio Fetal hypoxemia triggers cerebral vasodilation Cerebral vasodilation first increases diastolic flow Doppler resistive index (RI) = SV-DV / SV Cerebral-Placental Ratio (CPR) = MCA-RI / UA-RI Normal CPR > 1.0 CPR < 1.0 suggests brain sparing effect Neuronal responses to hypoxia and energy failure Adenosine Synaptic inhibition ATP PCr Na/K-ATPase Na Anoxic depolarization K Duration of Hypoxia-ischemia 11
12 Disturbances in Fetal Brain Development Pi Primary genetic causes Environmental-acquired disturbances (disruptions) Environmental or acquired causes of abnormal brain development (disruptions) Cerebral substrate restriction Hemorrhage Toxins (exogenous-endogenous) Infection-inflammation Trauma Other Neuronal Migration Defects Band heterotopias Primary genetic causes of cerebral dysgenesis Lissencephaly and cerebellar hypoplasia LIS1 mutation (17p13) Band heteroptopia ( double cortex ) DCX mutation (Xq22-23) 12
13 Neuronal Migration Defects Fetal cerebral substrate deprivation Global insult Focal insult Polymicrogyria in ex-24 week infant with severe IUGR Schizencephaly and polymicrogyria following fetal MCA stroke Effects of substrate deprivation on the developing brain Destructive (encephaloclastic) lesions Disruption of normal development Programming-epigenetic mechanisms Developmental disruption following fetal cerebellar hemorrhage * Fetal MRI Right cerebellar hemorrhage 18-month MRI Marked unilateral cerebellar disruption 13
14 Cerebral dysgenesis associated with fetal viral encephalitis Congenital CMV encephalitis Early gestation onset Late gestation onset Cerebral dysgenesis associated with inherited metabolic disease Zellweger syndrome with cortical dysgenesis and severe hypomyelination Glutaric aciduria 1 with failure of opercular closure and basal ganglia lesions Tuberous sclerosis (26 wk GA) 14
15 Neurodiagnostic techniques in fetal medicine Current and future Evaluation of Fetal Brain Structure Fetal Ultrasound 2D-US is the principal screening technique 4D-US three-dimensional US imaging in real time Fetal Magnetic Resonance Imaging Conventional MRI Major advances in resolution of brain anatomy Diagnostic technique of choice Quantitative MRI Volumetric 3D-MRI Diffusion-based MRI 1 H-MR Spectroscopy Functional MRI Dynamic MRI 2D Fetal Ultrasound Primary prenatal imaging modality Difficult to visualize entire brain Limited evaluation of the cortical anatomy 15
16 Conventional Fetal MRI Advent of ultrafast T2-weighted imaging sequences Improved diagnostic capability Provides superior tissue contrast Multiplanar imaging Development Timetable for Sulcation Sylvian fissure 16-18w Parietooccipital sulcus 20-23w Calcarine sulcus 22-25w Callosal sulcus 22-23w23w Hippocampal sulcus 22-23w Cingulate sulcus 22-25w Central sulcus 24-27w Superior temporal sulcus 26-28w Pre and post central sulci 26-28w 21 wk GA Orit Glenn, UCSF 16
17 28 wk GA Orit Glenn, UCSF 21 wk The developing brain has a multilayered pattern between weeks Ventricular zone Periventricular zone Subventricular & Intermediate zones Subplate Cortical plate & Marginal layer Quantitative MRI studies Brain growth (3-D MRI) Brain microstructure (DTI) Brain metabolism ( 1 H-MRS) Cho Cr Naa 17
18 3D Volumetric Fetal MRI Volum ume (cc) (cc) Volum me (cc) Term Gestational Age (weeks) Gestational Age (weeks) MR diffusion tractography of the fetal brain Kasprian et al., 2008 Fetal Cerebral Proton MRS ( 1 H MRS) TE: 135 ms N-acetyl aspartate (NAA) a neuro-axonal marker reflects mitochondrial metabolism Girard et al.,2006a, 2006b 18
19 Third trimester Total Brain Volumes in CHD and Control Fetuses Control CHD p<0.001 Third trimester NAA/Cho in CHD vs Control Fetuses p<0.001 Controls CHD Fetal cortical surface development 19
20 Fetal cerebral cortical folding pattern Quantification of fetal cortical folding pattern between 25 to 35 weeks GA Clouchoux et al., submitted Cedric Clouchoux 2011 Fetal Neurology The Road Ahead 20
21 Future Role of Fetal Neurologist Beyond counseling and prognostication Provide continuity of brain-oriented care of the fetus and newborn Bring neuroscience expertise into a wellintegrated multidisciplinary team Role of Fetal Neurologist in 20..? Pregnant mothers in neurologist s waiting room Comprehensive neurologic evaluations performed Advanced fetal neurodiagnostic testing Close collaboration with primary OB/MFM s for the planning of truly brain-oriented fetal care Fetal neurointensive care Currently we focus on events from weeks on Future Challenges for the Fetal Neurologist Is this fetal brain adequately supplied by this placenta and for how long will this continue? Will the extrauterine environment become more supportive of the developing brain than the intrauterine environment? Is this baby adequately equipped to go through labor and the transitional period unscathed? What complications might we anticipate at birth and how do we minimize those? What interventions need to be planned to deliver truly neuroprotective care during periods of potential risk? 21
22 22
Brain Injury during Fetal-Neonatal Transition
Brain Injury during Fetal-Neonatal Transition Adre du Plessis, MBChB Fetal and Transitional Medicine Children s National Medical Center Washington, DC Brain injury during fetal-neonatal transition Injury
More informationChapter 7: The Nervous System
Chapter 7: The Nervous System I. Organization of the Nervous System Objectives: List the general functions of the nervous system Explain the structural and functional classifications of the nervous system
More informationChapter 7: The Nervous System
Chapter 7: The Nervous System Objectives Discuss the general organization of the nervous system Describe the structure & function of a nerve Draw and label the pathways involved in a withdraw reflex Define
More informationDoppler Ultrasound in the Management of Fetal Growth Restriction Chukwuma I. Onyeije, M.D. Atlanta Perinatal Associates
Doppler Ultrasound in the Management of Fetal Growth Restriction Chukwuma I. Onyeije, M.D. Atlanta Perinatal Associates 1 For your convenience a copy of this lecture is available for review and download
More informationCHILDREN S NEUROSCIENCE CENTER
CHILDREN S NEUROSCIENCE CENTER W hen families come to Children s Memorial Hermann Hospital, they expect to find the technological advances and healing expertise of a university-affiliated, academic hospital.
More information3. The neuron has many branch-like extensions called that receive input from other neurons. a. glia b. dendrites c. axons d.
Chapter Test 1. A cell that receives information and transmits it to other cells via an electrochemical process is called a(n) a. neuron b. hormone c. glia d. endorphin Answer: A difficulty: 1 factual
More informationNeural Tube Defects - NTDs
Neural Tube Defects - NTDs Introduction Neural tube defects are also known as NTDs. They happen when the spine and brain do not fully develop while the fetus is forming in the uterus. Worldwide, there
More informationStudent Academic Learning Services Page 1 of 8 Nervous System Quiz
Student Academic Learning Services Page 1 of 8 Nervous System Quiz 1. The term central nervous system refers to the: A) autonomic and peripheral nervous systems B) brain, spinal cord, and cranial nerves
More informationChapter 10. Summary & Future perspectives
Summary & Future perspectives 123 Multiple sclerosis is a chronic disorder of the central nervous system, characterized by inflammation and axonal degeneration. All current therapies modulate the peripheral
More informationCerebral palsy, neonatal death and stillbirth rates Victoria, 1973-1999
Cerebral Palsy: Aetiology, Associated Problems and Management Lecture for FRACP candidates July 2010 Definitions and prevalence Risk factors and aetiology Associated problems Management options Cerebral
More informationNerves and Nerve Impulse
Nerves and Nerve Impulse Terms Absolute refractory period: Period following stimulation during which no additional action potential can be evoked. Acetylcholine: Chemical transmitter substance released
More informationNeonatal Hypotonia. Clinical Approach to Floppy Baby
Neonatal Hypotonia Clinical Approach to Floppy Baby Hypotonia in the newborn is a common presenting feature of systemic illness or neurologic dysfunction at any level of the central or peripheral nervous
More informationCord Blood Erythropoietin and Markers of Fetal Hypoxia
July 21, 2011 By NeedsFixing [1] To investigating the relationship between cord blood erythropoietin and clinical markers of fetal hypoxia. Abstract Objective: To investigating the relationship between
More informationName Date Hour. Nerve Histology Microscope Lab
Name Date Hour Nerve Histology Microscope Lab PRE-LAB: Answer the following questions using your reading and class notes before starting the microscope lab. 1. What is the difference between the functions
More informationTrauma Insurance Claims Seminar Invitation
Trauma Insurance Claims Seminar Invitation Introduction Since the development of Trauma Insurance in Australia in the 1980s, the product has evolved at a great pace. Some of the challenges faced by claims
More informationCerebral Palsy Information
Cerebral Palsy Information The following information was extracted from the Mayo Clinic s website Definition: "Cerebral palsy" is a general term for a group of disorders that appear during the first few
More informationUniversal Fetal Cardiac Ultrasound At the Heart of Newborn Well-being
Universal Fetal Cardiac Ultrasound At the Heart of Newborn Well-being Optimizes detection of congenital heart disease (chd) in the general low risk obstetrical population Daniel J. Cohen, M.D. danjcohen@optonline.net
More informationSheep Brain Dissection
Sheep Brain Dissection http://www.carolina.com/product/preserved+organisms/preserved+animals+%28mammal s%29/sheep+organs/preserved+sheep+dissection.do Michigan State University Neuroscience Program Brain
More informationSheep Brain Dissection Picture Guide
Sheep Brain Dissection Picture Guide Figure 1: Right Hemisphere of Sheep s Brain Figure 2: Underside of Sheep s Brain Figure 3: Saggital cut of Sheep s Brain to reveal subcortical structures Figure 4:
More informationWhat do we mean by birth asphyxia
Neonatal Medicine and brain injury in the Infant at term Andrew Whitelaw Professor of Neonatal Medicine University of Bristol What do we mean by birth asphyxia Interruption in oxygen delivery to the fetus
More informationCSE511 Brain & Memory Modeling. Lect04: Brain & Spine Neuroanatomy
CSE511 Brain & Memory Modeling CSE511 Brain & Memory Modeling Lect02: BOSS Discrete Event Simulator Lect04: Brain & Spine Neuroanatomy Appendix of Purves et al., 4e Larry Wittie Computer Science, StonyBrook
More informationWhy is prematurity a concern?
Prematurity What is prematurity? A baby born before 37 weeks of pregnancy is considered premature. Approximately 12% of all babies are born prematurely. Terms that refer to premature babies are preterm
More informationHuman Neuroanatomy. Grades 9-12. Driving Question: How did the evolution of the human brain impact the structure and function it has today?
Human Neuroanatomy Grades 9-12 Driving Question: How did the evolution of the human brain impact the structure and function it has today? Objectives: Students will be able to Describe the basic parts and
More informationPrenatal Testing Special tests for your baby during pregnancy
English April 2006 [OTH-7750] There are a number of different prenatal (before birth) tests to check the development of your baby. Each test has advantages and disadvantages. This information is for people
More informationCerebral Palsy. In order to function, the brain needs a continuous supply of oxygen.
Cerebral Palsy Introduction Cerebral palsy, or CP, can cause serious neurological symptoms in children. Up to 5000 children in the United States are diagnosed with cerebral palsy every year. This reference
More informationCareful collection, organization and review of medical information
Preparing Birth Injury Case Prior To Expert Review of Causation Careful collection, organization and review of medical information essential to documentation of injury By RICHARD A. SILVER When analyzing
More informationDeveloping Human Fetus
Period Date LAB. DEVELOPMENT OF A HUMAN FETUS After a human egg is fertilized with human sperm, the most amazing changes happen that allow a baby to develop. This amazing process, called development, normally
More informationCognitive Neuroscience. Questions. Multiple Methods. Electrophysiology. Multiple Methods. Approaches to Thinking about the Mind
Cognitive Neuroscience Approaches to Thinking about the Mind Cognitive Neuroscience Evolutionary Approach Sept 20-22, 2004 Interdisciplinary approach Rapidly changing How does the brain enable cognition?
More informationEpilepsy 101: Getting Started
American Epilepsy Society 1 Epilepsy 101 for nurses has been developed by the American Epilepsy Society to prepare professional nurses to understand the general issues, concerns and needs of people with
More information1. What is Cerebral Palsy?
1. What is Cerebral Palsy? Introduction Cerebral palsy refers to a group of disorders that affect movement. It is a permanent, but not unchanging, physical disability caused by an injury to the developing
More informationApplications of Doppler Ultrasound in Fetal Growth Assessment. David Cole
Applications of Doppler Ultrasound in Fetal Growth Assessment David Cole Aims The aim of this presentation is to consider the use of Doppler ultrasound to investigate and monitor those pregnancies at risk
More informationWhat is the basic component of the brain and spinal cord communication system?
EXPLORING PSYCHOLOGY David Myers The Biology of Mind Chapter 2 Neural Communication Neurons How Neurons Communicate How Neurotransmitters Influence Us The Nervous System The Peripheral Nervous System The
More informationDevelopmental delay and Cerebral palsy. Present the differential diagnosis of developmental delay.
Developmental delay and Cerebral palsy objectives 1. developmental delay Define developmental delay Etiologies of developmental delay Present the differential diagnosis of developmental delay. 2. cerebral
More informationChapter 9 Nervous System
Chapter 9 Nervous System Nervous System function: The nervous system is composed of neurons and neuroglia. at the ends of peripheral nerves gather information and convert it into nerve impulses. When sensory
More information23. TERATOGENS AND THEIR EFFECTS
23. TERATOGENS AND THEIR EFFECTS Wendy Chung, M.D. Ph.D. Telephone: 851-5313 e-mail: wkc15@columbia.edu SUMMARY A congenital malformation is an anatomical or structural abnormality present at birth. Congenital
More informationSTROKE CARE NOW NETWORK CONFERENCE MAY 22, 2014
STROKE CARE NOW NETWORK CONFERENCE MAY 22, 2014 Rehabilitation Innovations in Post- Stroke Recovery Madhav Bhat, MD Fort Wayne Neurological Center DISCLOSURE Paid speaker for TEVA Neuroscience Program.
More informationNeural tube defects: open spina bifida (also called spina bifida cystica)
Screening Programmes Fetal Anomaly Neural tube defects: open spina bifida (also called spina bifida cystica) Information for health professionals Publication date: April 2012 Review date: April 2013 Version
More informationTHE SPINAL CORD AND THE INFLUENCE OF ITS DAMAGE ON THE HUMAN BODY
THE SPINAL CORD AND THE INFLUENCE OF ITS DAMAGE ON THE HUMAN BODY THE SPINAL CORD. A part of the Central Nervous System The nervous system is a vast network of cells, which carry information in the form
More informationChapter Fourteen. Emotion, Reward, Aggression, and Stress
Chapter Fourteen Emotion, Reward, Aggression, and Stress EMOTIONS! Emotions generally include a Physical component, and a Subjective component or quality, and a Valence Emotions a product of Evolution?
More informationCerebral Palsy. 1995-2014, The Patient Education Institute, Inc. www.x-plain.com nr200105 Last reviewed: 06/17/2014 1
Cerebral Palsy Introduction Cerebral palsy, or CP, can cause serious neurological symptoms in children. Thousands of children are diagnosed with cerebral palsy every year. This reference summary explains
More information3) Cerebral Cortex & Functions of the 4 LOBES. 5) Cranial Nerves (Nerves In the Cranium, i.e., Head)
Lecture 5 (Oct 8 th ): ANATOMY and FUNCTION OF THE NERVOUS SYSTEM Lecture Outline 1) Basic Divisions (CNS vs. PNS, Somatic vs. Autonomic) and Directional Terms 2) The Brain (Hindbrain/ Midbrain/ Forebrain)
More informationCerebral palsy can be classified according to the type of abnormal muscle tone or movement, and the distribution of these motor impairments.
The Face of Cerebral Palsy Segment I Discovering Patterns What is Cerebral Palsy? Cerebral palsy (CP) is an umbrella term for a group of non-progressive but often changing motor impairment syndromes, which
More informationCavernous Angioma. Cerebral Cavernous Malformation ...
Cavernous Angioma... Cerebral Cavernous Malformation Information For Patients And Loved Ones 107 Quaker Meeting House Road Williamsburg, Virginia 23188 USA 1-866-HEAL-CCM 1-757-258-3355 www.angiomaalliance.org
More informationConcussion/MTBI Certification Series. Featuring: Frederick R Carrick, DC, PhD Distinguished Professor of Neurology, Life University
Concussion/MTBI Certification Series Featuring: Frederick R Carrick, DC, PhD Distinguished Professor of Neurology, Life University Please note that spaces are limited for this specialty certification program.
More informationNEUROIMAGING in Parkinsonian Syndromes
NEUROIMAGING in Parkinsonian Syndromes (Focus on Structural Techniques: CT and MRI) Dr. Roberto Cilia Parkinson Institute, ICP, Milan, Italy OUTLINE Primary Parkinsonism Idiopathic Parkinson s Disease
More informationAndrew Rosen - Chapter 3: The Brain and Nervous System Intro:
Intro: Brain is made up of numerous, complex parts Frontal lobes by forehead are the brain s executive center Parietal lobes wave sensory information together (maps feeling on body) Temporal lobes interpret
More informationAUTONOMIC NERVOUS SYSTEM
AUTONOMIC NERVOUS SYSTEM Somatic efferent and ANS Somatic Efferent Control is over skeletal muscles. External environment This division of the PNS responds to some change in the external environment. single
More informationDiagnosis Codes for Pregnancy and Complications of Pregnancy
This list is for informational purposes only and is not a binding or definitive list of covered conditions. It is not a guarantee of coverage; coverage depends on the available benefits and eligibility
More informationAI CPT Codes. x x. 70336 MRI Magnetic resonance (eg, proton) imaging, temporomandibular joint(s)
Code Category Description Auth Required Medicaid Medicare 0126T IMT Testing Common carotid intima-media thickness (IMT) study for evaluation of atherosclerotic burden or coronary heart disease risk factor
More informationCerebral Palsy An Expensive Enigma
Cerebral Palsy An Expensive Enigma Rhona Mahony National Maternity Hospital A group of permanent disorders of the development of movement and posture, causing activity limitation that are not attributed
More informationM2 Pathology Course Phone: 312-996-1772 Lecture # 72 e-mail: tiborv@uic.edu Tuesday, February 11, 2003 9:30 10:20
Tibor Valyi-Nagy, M.D., Ph.D. UIC College of Medicine Assistant Professor of Pathology, UIC M2 Pathology Course Phone: 312-996-1772 Lecture # 72 e-mail: tiborv@uic.edu Tuesday, February 11, 2003 9:30 10:20
More informationAnoxic Brain Injury and Neural Damage: Three Case Reports
Anoxic Brain Injury and Neural Damage: Three Case Reports Abstract Anoxic brain injury (ABI) is common and can occur in a wide variety of disorders. This neural injury is associated with significant and
More informationCAMBRIDGE UNIVERSITY CENTRE FOR BRAIN REPAIR A layman's account of our scientific objectives What is Brain Damage? Many forms of trauma and disease affect the nervous system to produce permanent neurological
More informationA test your patients can trust.
A test your patients can trust. A simple, safe, and accurate non-invasive prenatal test for early risk assessment of Down syndrome and other conditions. informaseq Prenatal Test Simple, safe, and accurate
More informationHuman Growth and Reproduction
Human Growth and Reproduction Sperm reach ovum and cluster around it Only one sperm is allowed to penetrate egg When the sperm penetrates the egg, the egg immediately releases a chemical creating a hard
More informationFUNCTIONAL EEG ANALYZE IN AUTISM. Dr. Plamen Dimitrov
FUNCTIONAL EEG ANALYZE IN AUTISM Dr. Plamen Dimitrov Preamble Autism or Autistic Spectrum Disorders (ASD) is a mental developmental disorder, manifested in the early childhood and is characterized by qualitative
More informationEXCITABILITY & ACTION POTENTIALS page 1
page 1 INTRODUCTION A. Excitable Tissue: able to generate Action Potentials (APs) (e.g. neurons, muscle cells) B. Neurons (nerve cells) a. components 1) soma (cell body): metabolic center (vital, always
More informationMyelinization. THOMAS P. NAIDICH, MD FACR Mt. Sinai Medical Center New York, NY USA
Myelinization THOMAS P. NAIDICH, MD FACR Mt. Sinai Medical Center New York, NY USA ALTERS BRAIN WATER LOCALLY MYELIN CONTAINS: GLYCOLIPIDS PHOSPHOLIPIDS & CHOLESTEROL Maturation of the White Matter Maturation
More informationBiology Slide 1 of 38
Biology 1 of 38 2 of 38 35-2 The Nervous System What are the functions of the nervous system? 3 of 38 35-2 The Nervous System 1. Nervous system: a. controls and coordinates functions throughout the body
More informationCerebral Palsy: Intervention Methods for Young Children. Emma Zercher. San Francisco State University
RUNNING HEAD: Cerebral Palsy & Intervention Methods Cerebral Palsy & Intervention Methods, 1 Cerebral Palsy: Intervention Methods for Young Children Emma Zercher San Francisco State University May 21,
More informationCORTICAL VISUAL IMPAIRMENT
Idaho Project for Children and Youth with Deaf-Blindness Fact Sheet CORTICAL VISUAL IMPAIRMENT Definition: Cortical Visual Impairment (CVI) is a temporary or permanent visual impairment caused by the disturbance
More informationU N IT 10 NE RVOUS SYS TE M REVIEW 1. Which of the following is controlled by the somatic nervous system? A. rate of heartbeat B.
U N IT 10 NE RVOUS SYS TE M REVIEW 1. Which of the following is controlled by the somatic nervous system? A. rate of heartbeat B. contraction of skeletal muscles C. increased blood flow to muscle tissue
More informationEmbryology. From Conception through Birth. From Conception through Death
Embryology From Conception through Birth From Conception through Death - Immune system 18 months after birth - Lungs 3-8 years after birth - Nervous 12 years after birth - Reproductive Puberty - Skeletal
More informationMotor dysfunction 2: Spinal cord injury and subcortical motor disorders ANATOMY REVIEW: Basal Ganglia
Motor dysfunction 2: Spinal cord injury and subcortical motor disorders ANATOMY REVIEW: Basal Ganglia A group of subcortical nuclei caudate, putamen, globus pallidus Caudate & Putamen = Neostriatum caudate
More informationGuide to Pregnancy and Birth Injury Claims
Being pregnant, especially for the first time can be a very daunting experience where you often have to put all of your faith in your midwife or doctor. The majority of pregnancies and births occur without
More informationThe Developing Person Through the Life Span 8e by Kathleen Stassen Berger
The Developing Person Through the Life Span 8e by Kathleen Stassen Berger Chapter 4 Prenatal Development and Birth PowerPoint Slides developed by Martin Wolfger and Michael James Ivy Tech Community College-Bloomington
More informationPregnancy and Substance Abuse
Pregnancy and Substance Abuse Introduction When you are pregnant, you are not just "eating for two." You also breathe and drink for two, so it is important to carefully consider what you put into your
More informationUBC Pain Medicine Residency Program: CanMEDS Goals and Objectives of the Neurology Rotation
UBC Pain Medicine Residency Program: CanMEDS Goals and Objectives of the Neurology Rotation Goals of the Program To acquire the knowledge and skills necessary to assess and provide a management plan for
More informationFAMILY PLANNING AND PREGNANCY
FAMILY PLANNING AND PREGNANCY Decisions about family planning can be difficult and very emotional when one of the prospective parents has a genetic disorder, such as Marfan syndrome. Before making any
More informationManagement in the pre-hospital setting
Management in the pre-hospital setting Inflammation of the joints Two main types: Osteoarthritis - cartilage loss from wear and tear Rheumatoid arthritis - autoimmune disorder Affects all age groups,
More informationThe Detection of Neural Fatigue during intensive conditioning for football: The Potential of Transcranial Magnetic Stimulation
The Detection of Neural Fatigue during intensive conditioning for football: The Potential of Transcranial Magnetic Stimulation Carl Wells PhD Sport Science Lead, Perform, National Football Centre, St.
More informationReproductive System & Development: Practice Questions #1
Reproductive System & Development: Practice Questions #1 1. Which two glands in the diagram produce gametes? A. glands A and B B. glands B and E C. glands C and F D. glands E and F 2. Base your answer
More informationMultiple Sclerosis: An imaging review and update on new treatments.
Multiple Sclerosis: An imaging review and update on new treatments. Dr Marcus Likeman Consultant Neuroradiologist North Bristol NHS Trust Bristol Royal Hospital for Children MRI appearances - White Matter
More informationCEREBRAL PALSY AND MENTAL RETARDATION DEFINITION
CEREBRAL PALSY AND MENTAL RETARDATION DEFINITION It is a disorder of posture movement and tone due to a static encephalopathy acquired during brain growth in fetal life infancy or early childhood. Though
More informationWendy Martinez, MPH, CPH County of San Diego, Maternal, Child & Adolescent Health
Wendy Martinez, MPH, CPH County of San Diego, Maternal, Child & Adolescent Health Describe local trends in birth Identify 3 perinatal health problems Identify 3 leading causes of infant death Age Class
More information3nd Biennial Contemporary Clinical Neurophysiological Symposium October 12, 2013 Fundamentals of NCS and NMJ Testing
3nd Biennial Contemporary Clinical Neurophysiological Symposium October 12, 2013 Fundamentals of NCS and NMJ Testing Peter D. Donofrio, M.D. Professor of Neurology Vanderbilt University Medical Center
More informationOverview of Fetal Alcohol Spectrum Disorders (FASD) Natalie Novick Brown, PhD. University of Washington natnb@u.washington.edu
Overview of Fetal Alcohol Spectrum Disorders (FASD) Natalie Novick Brown, PhD University of Washington natnb@u.washington.edu Fetal Alcohol Spectrum Disorders (FASD) Fetal Alcohol Spectrum Disorders (FASD)
More informationFetal Responses to Reduced Oxygen Delivery
Fetal Responses to Reduced Oxygen Delivery Abraham M Rudolph Fetal Cardiology Symposium May 2016, Phoenix Faculty Disclosure Information I have no financial relationship with any manufacturer of any commercial
More informationSlide 4: Forebrain Structures. Slide 5: 4 Lobes of the Cerebral Cortex. Slide 6: The Cerebral Hemispheres (L & R)
Slide 1: [Film Clip: The Brain #2- Phineas Gage] Integrated Bodily Communications Within Brain (Hemispheres and structures) The remaining Nervous System Endocrine System (Hormonal communication) Our bodies-
More informationNEURO M203 & BIOMED M263 WINTER 2014
NEURO M203 & BIOMED M263 WINTER 2014 MRI Lab 1: Structural and Functional Anatomy During today s lab, you will work with and view the structural and functional imaging data collected from the scanning
More informationCommon types of congenital heart defects
Common types of congenital heart defects Congenital heart defects are abnormalities that develop before birth. They can occur in the heart's chambers, valves or blood vessels. A baby may be born with only
More informationGenetic Aspects of Mental Retardation and Developmental Disabilities
Prepared by: Chahira Kozma, MD Associate Professor of Pediatrics Medical Director/DCHRP Kozmac@georgetown.edu cck2@gunet.georgetown.edu Genetic Aspects of Mental Retardation and Developmental Disabilities
More informationLyme Disease in Pregnancy. Dr Sarah Chissell Consultant Obstetrician William Harvey Hospital, Kent
Lyme Disease in Pregnancy Dr Sarah Chissell Consultant Obstetrician William Harvey Hospital, Kent Conflict of interest My son has chronic Lyme disease Infections in pregnancy Transplacental infection Perinatal
More informationPromising Treatments for SCI: What s on The Horizon. SCI: A Devastating Injury. Case: Mr. MC 9/21/2015. Epidemiology: Costs:
Promising Treatments for SCI: What s on The Horizon Shawn Song, MD SCI Fellow University of Washington/VA Puget Sound Healthcare System SCI: A Devastating Injury Epidemiology: Incidence of ~12,000 patients/year.
More informationEMG and the Electrodiagnostic Consultation for the Family Physician
EMG and the Electrodiagnostic Consultation for the Family Physician Stephanie Kopey, D.O., P.T. 9/27/15 The American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) Marketing Committee
More information2401 : Anatomy/Physiology
Dr. Chris Doumen Week 7 2401 : Anatomy/Physiology The Brain Central Nervous System TextBook Readings Pages 431 through 435 and 463-467 Make use of the figures in your textbook ; a picture is worth a thousand
More informationCerebral Palsy The ABC s of CP
Cerebral Palsy The ABC s of CP Toni Benton, M.D. Continuum of Care Project UNM HSC School of Medicine April 20, 2006 Cerebral Palsy Outline I. Definition II. Incidence, Epidemiology and Distribution III.
More informationThe Influence of Infant Health on Adult Chronic Disease
The Influence of Infant Health on Adult Chronic Disease Womb to Tomb Dr Clare MacVicar Introduction Many diseases in adulthood are related to growth patterns during early life Maternal nutrition important
More informationAutonomic Nervous System Dr. Ali Ebneshahidi
Autonomic Nervous System Dr. Ali Ebneshahidi Nervous System Divisions of the nervous system The human nervous system consists of the central nervous System (CNS) and the Peripheral Nervous System (PNS).
More informationComputed Tomography, Head Or Brain; Without Contrast Material, Followed By Contrast Material(S) And Further Sections
1199SEIU BENEFIT AND PENSION FUNDS High Tech Diagnostic Radiology and s # 1 70336 Magnetic Resonance (Eg, Proton) Imaging, Temporomandibular Joint(S) 2 70450 Computed Tomography, Head Or Brain; Without
More informationWhat Is an Arteriovenous Malformation (AVM)?
What Is an Arteriovenous Malformation (AVM)? From the Cerebrovascular Imaging and Intervention Committee of the American Heart Association Cardiovascular Council Randall T. Higashida, M.D., Chair 1 What
More informationAnatomi & Fysiologi 060301. The cardiovascular system (chapter 20) The circulation system transports; What the heart can do;
The cardiovascular system consists of; The cardiovascular system (chapter 20) Principles of Anatomy & Physiology 2009 Blood 2 separate pumps (heart) Many blood vessels with varying diameter and elasticity
More informationBirth defects. Report by the Secretariat
EXECUTIVE BOARD EB126/10 126th Session 3 December 2009 Provisional agenda item 4.7 Birth defects Report by the Secretariat 1. In May 2009 the Executive Board at its 125th session considered an agenda item
More informationIntegration and Coordination of the Human Body. Nervous System
I. General Info Integration and Coordination of the Human Body A. Both the and system are responsible for maintaining 1. Homeostasis is the process by which organisms keep internal conditions despite changes
More informationI.O. Phd International Research Program
Founders A.W.D. Gavilanes, MD, PhD (Maastricht, The Netherlands) D.S.M. Gazzolo, MD, PhD (Alessandria, Italy) F. van Bel, MD, PhD (Utrecht, The Netherlands) G.H.A. Visser, MD, PhD (Utrecht, The Netherlands)
More information2 Neurons. 4 The Brain: Cortex
1 Neuroscience 2 Neurons output integration axon cell body, membrane potential Frontal planning control auditory episodes soma motor Temporal Parietal action language objects space vision Occipital inputs
More informationSTAGES OF PRENATAL DEVELOPMENT
STAGES OF PRENATAL DEVELOPMENT College of William and Mary Students for Life 2013 Germinal Period From conception to implantation Terms to Know Conception: the first stage in human development in which
More informationNorth Bergen School District Benchmarks
Grade: 10,11, and 12 Subject: Anatomy and Physiology First Marking Period Define anatomy and physiology, and describe various subspecialties of each discipline. Describe the five basic functions of living
More informationMeeting Report: XX WFN World Congress on Parkinson s Disease and Related Disorders
Meeting Report: XX WFN World Congress on Parkinson s Disease and Related Disorders Karen Frei, Erik Ch. Wolters Abstract: The twentieth World Congress on Parkinson s Disease and Related Disorders was held
More informationAUBMC Multiple Sclerosis Center
AUBMC Multiple Sclerosis Center 1 AUBMC Multiple Sclerosis Center The vision of the American University of Beirut Medical Center (AUBMC) is to be the leading academic medical center in Lebanon and the
More information