He contralateral, right temporal horn and a residual ipsilateral ambient cistern (left) still remaining. viagra online The uncus is also filling the left aspect of the suprasellar cistern. lyrics to 2 chainz viagra Complications of descending transtentorial herniations include occipital infarction. buy viagra online canada no prescription The posterior cerebral artery becomes compressed as the ipsilateral uncus and parahippocampal gyrus compresses the artery against the ipsilateral cerebral peduncle. cheap generic viagra The gross specimen associated with the ct of occipital infarcts demonstrates the excellent correlation. viagra pill 100 This can occur unilaterally or bilaterally depending on the extent of injury and amount of mass effect. buy viagra online legally Generally, an ipsilateral occipital infarct will appear first followed by contralateral infarction. Another complication of descending transtentorial herniation includes durette hemorrhage. buy viagra online This is due to pontine perforators which are displaced downward by mass effect. buy cheap viagra The basilar artery sends these perforators posteriorly into the pons. cheapest generic super viagra As the pons shifts inferiorly, these perforators are stretch and can cause hemorrhage within the brain stem or pons. viagra oral jelly side effects Sagittal and axial mri demonstrates the hemorrhage in the dorsal lateral pons. cheap generic viagra Kernohan’s notch is another type of hemorrhagic damage caused by transtentorial herniation. can u buy viagra over the counter in spain This is due to compression of the contralateral cerebral peduncle against the incisura. viagra oral jelly side effects If this occurs, it leads to ipsilateral hemiparesis since the cortical spinal tracts become damaged. Irwin goldstein viagra The gross specimen demonstrates hemorrhage in the left central midbrain from durette hemorrhage and cortical damage with some hemorrhage at the right cerebral peduncle consistent with kernohan’s notch. cheap viagra There is also a left uncal herniation.     ascending transtentorial herniation is less common then descending transtentorial herniation. Cheap viagra in canada Perhaps this is due to the much larger area of the supratentorial brain leading to complications with the transtentorial herniation. viagra for sale This type of herniation is usually caused by a slowly growing cerebellar or brainstem process, such as a diffusely infiltrating astrocytoma. generic viagra online   due to the symmetric cistern findings and the different appearances of the quadrigeminal plate cistern depending on the angle of the ct scan, ascending transtentorial herniation can often be more difficult to evaluate on imaging studies. viagra oral jelly side effects The clinical presentation includes nausea and vomiting followed by obtundation (table 2). With these few clinical signs, this can at times be considered emergency since patients can progress from nausea and vomiting to obtundation and coma rapidly depending on the length of time the mass effect has been present in the po. super viagra reviews viagra pills for men side effects


IMG 0419

Why this picture? 

Well, the Statue of Liberty hanging out on a dock in the Pacific Ocean seemed like an apt metaphor for my life these days.

After spending close to 30 years at top ad agencies in NYC, I moved to California where I'm now running my own small direct marketing creative shop. 

I'm using all the skills I honed working as a writer and Creative Director at agencies such as G2/Grey Direct and DMB&B Direct. 

With one huge difference. 

Where agencies take months to complete projects, I can now turn projects around within days, and, in some cases, hours. 

And, since I don't have a large staff or big office to pay for, I can charge less.
A lot less.

If you need help with a direct marketing project, let's chat. My work includes: direct mail • e-mail • print • DRTV • radio • websites • banners • collateral brochures • billboards •  point of sale •  Tweets • Facebook updates

For a sample of my work, please browse through the rest of this site.  My contact information is at the top right of each page.

Thanks for visiting.

- Karen

Karen has the rare ability to combine left and right brain thinking into award winning, results-driven creative solutions. I would recommend her for any creative job, especially those which are complicated messages that need to be delivered through multiple channels with conflicting audiences." 

-David Magrini, Aetna and Prudential

© Karen Heller creative 2012                karen heller creative aka lauren heller consulting, Inc.
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