const pptxgen = require("pptxgenjs");
const { execSync } = require("child_process");

// ── Fetch images ──────────────────────────────────────────────────────────────
const imageUrls = [
  "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_c78b9cd19cbc7e420263c18c8f59720630d97db30bf13101d609a5ea18bb768a.jpg",  // bilateral wrist drop
  "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_7d726bf16a56d7045e167114a510136003849a948f87f56745635b5af1666495.jpg",  // spiral groove surgical
  "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_a28ff6596a25663ccb2bfd2250efbac88de069e575d85ea4a7154ead0c2ebc92.jpg",  // leash of Henry / radial tunnel
  "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_7fe11ef23c87afac267d6dd555fd56844f09f3305a917a618a8667eed5b88474.jpg",  // PIN ultrasound
  "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_a004352e7abdf7c03973d774cf98041af0ac55624aa742fff4e28e8cc542ec57.jpg",  // distal supinator surgical
  "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_354dce7ca479b86a1a3329a39952f2e673374dbe7ae8c3f471f83e5673956ea2.jpg",  // radiograph humeral nerve course
  "https://cdn.orris.care/cdss_images/d78d1b83ae7c118cfd762fa686fb3785b4120f17adce49e86c0a97a166e9fac7.png",            // Gray's radial nerve arm diagram
];

console.log("Fetching images...");
const imgs = JSON.parse(
  execSync(
    `node /home/daytona/skills/shared/scripts/fetch_images.js ${imageUrls.map(u => `"${u}"`).join(" ")}`
  ).toString()
);
console.log("Images fetched:", imgs.map(i => i.error ? "ERROR: " + i.error : "OK").join(", "));

// ── Helpers ───────────────────────────────────────────────────────────────────
const DARK_BG   = "0D1B2A";   // deep navy
const MID_BG    = "1B2E40";   // mid navy for cards
const ACCENT    = "E07B39";   // warm amber/orange
const ACCENT2   = "4BA3C3";   // teal
const WHITE     = "FFFFFF";
const LIGHT_TXT = "D4E4F0";
const SUBTITLE  = "A8C4D8";
const FONT      = "Calibri";

function titleSlide(pres) {
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function twoColumnSlide(pres, title, leftTitle, leftBullets, rightTitle, rightBullets) {
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}

// ── Build Presentation ────────────────────────────────────────────────────────
const pres = new pptxgen();
pres.layout = "LAYOUT_WIDE";
pres.title = "Radial Nerve – Anatomical Sites of Compression and Injury";
pres.author = "Orris Medical";

// Slide 1: Title
titleSlide(pres);

// Slide 2: Overview – anatomy
contentSlide(pres,
  "Overview: Radial Nerve Anatomy",
  [
    "## Origin & Course",
    "Largest nerve in upper extremity; arises from posterior cord of brachial plexus (C5–C8, T1)",
    "Enters arm by crossing inferior margin of teres major, posterior to brachial artery",
    "Passes through triangular interval with profunda brachii artery into posterior compartment",
    "Runs diagonally medial → lateral in the radial groove (spiral groove) directly on bone",
    "Pierces lateral intermuscular septum → enters anterior compartment at lateral epicondyle",
    "## Key Branches",
    "Posterior cutaneous nerve of arm & forearm (cutaneous)",
    "Muscular branches: triceps brachii, brachioradialis, ECRL, ECRB",
    "At lateral epicondyle divides: Superficial Radial Nerve (sensory) & Posterior Interosseous Nerve (PIN – motor)",
    "PIN enters supinator canal under the Arcade of Frohse",
    "## Radial Tunnel",
    "Not a true anatomical tunnel; space from humeroradial joint past supinator",
    "Contains 5 potential compression points (LEAFS)"
  ],
  6,   // Gray's radial nerve arm diagram
  "Fig. Radial nerve course in the arm\n(Gray's Anatomy for Students)"
);

// Slide 3: Section header – compression sites
sectionHeader(pres, "01", "Compression Sites: Proximal", "Axilla • Spiral Groove • Lateral Intermuscular Septum");

// Slide 4: Axilla
contentSlide(pres,
  "Site 1 – Axilla",
  [
    "## Anatomy",
    "Radial nerve enters arm crossing inferior margin of teres major; most proximal site of compression",
    "## Causes",
    "Crutch palsy: prolonged pressure from ill-fitting crutches ('crutch neuropathy')",
    "Honeymoon palsy: sleeping partner's head resting on arm for extended period",
    "Shoulder joint dislocation or post shoulder arthroplasty",
    "Iatrogenic: forceful retraction during surgery",
    "## Clinical Features",
    "MOST PROXIMAL lesion → affects ALL radial-innervated muscles including TRICEPS",
    "Wrist drop + inability to extend elbow against resistance",
    "Sensory loss on lateral arm, posterior forearm, and dorsum of hand",
    "Loss of triceps reflex",
    "## Prognosis",
    "Dependent on cause; neuropraxic lesions from positional compression usually recover in weeks"
  ],
  null, null
);

// Slide 5: Spiral Groove
contentSlide(pres,
  "Site 2 – Spiral Groove (Radial Groove) of the Humerus",
  [
    "## Anatomy",
    "Shallow groove formed deep to the lateral head of the triceps; nerve lies directly on bone",
    "Most common and clinically significant site of radial nerve compression",
    "## Causes",
    "Humeral shaft fractures (mid-shaft): 11.8% prevalence of nerve injury (Rockwood & Green)",
    "Saturday-night palsy: arm draped over chair/park bench ('park bench palsy') during sleep",
    "Honeymoon palsy (pressure from partner's head)",
    "General anaesthesia positioning injury",
    "Exuberant callus formation post-fracture; lipoma or fibroma",
    "## Clinical Features",
    "Classic WRIST DROP (finger & wrist extensors paralysed)",
    "Triceps typically SPARED – branches to triceps leave before the spiral groove",
    "Sensory loss: dorsum of hand, thumb, index & middle finger (dorsal 1st web space)",
    "## Prognosis",
    "Demyelinating (neuropraxia): resolves 6–8 weeks | Axon-loss lesions: longer recovery",
    "Ultrasound: CSA >5.75 mm² highly specific for neuropathy at spiral groove"
  ],
  1,  // spiral groove surgical anatomy
  "Intraoperative: radial nerve & plate at spiral groove"
);

// Slide 6: wrist drop image slide
contentSlide(pres,
  "Clinical Sign – Wrist Drop",
  [
    "## Hallmark of High/Mid Radial Nerve Lesion",
    "Inability to actively extend wrist at wrist joint → 'drop hand'",
    "Metacarpophalangeal extension also lost; fingers hang in passive flexion",
    "## Associated Findings",
    "Sensory loss confined to dorsal web space between thumb and index finger (exclusive territory)",
    "Extension of sensory loss to dorsum of hand, thumb, index & middle fingers (proximal interphalangeal level)",
    "## Distinguishing Levels",
    "AXILLARY lesion: triceps weakness + wrist drop + full sensory loss up the arm",
    "SPIRAL GROOVE: wrist drop, triceps SPARED, sensory loss on dorsum of hand",
    "RADIAL TUNNEL / PIN: finger extension weakness only, NO wrist drop, NO sensory loss",
    "## EMG Findings",
    "Absent SNAP: common in axon-loss lesions",
    "Conduction block across spiral groove in demyelinating lesions",
    "Needle EMG: denervation of wrist/finger extensors; triceps involvement only in axillary lesions"
  ],
  0,  // bilateral wrist drop image
  "Classic bilateral wrist drop – peripheral radial nerve palsy"
);

// Slide 7: lateral intermuscular septum
contentSlide(pres,
  "Site 3 – Lateral Intermuscular Septum",
  [
    "## Anatomy",
    "As the radial nerve passes anteriorly from the posterior compartment, it pierces the lateral intermuscular septum (mid-arm level)",
    "Transition from posterior to anterior compartment creates a potential entrapment point",
    "## Causes",
    "Chronic compression from bridging vessels and connective-tissue septa",
    "Fibrous bands and adhesions in the region",
    "Iatrogenic injury during humeral fracture fixation (penetrating screws)",
    "## Clinical Features",
    "Mid-level radial nerve lesion: wrist drop with sensory disturbances",
    "Triceps typically preserved",
    "## Radiograph Reference",
    "Radial nerve courses medially then posteriorly along humeral shaft before crossing laterally",
    "Point A: nerve crosses from dorsal to lateral",
    "Point B: bend from lateral to anterior",
    "Point C: bifurcation at lateral epicondyle"
  ],
  5,  // radiograph showing nerve course
  "Radiograph with radio-opaque wire marking radial nerve course"
);

// Slide 8: Section header – distal
sectionHeader(pres, "02", "Compression Sites: Distal", "Radial Tunnel • Arcade of Frohse • Wartenberg Syndrome");

// Slide 9: Radial Tunnel Syndrome
contentSlide(pres,
  "Site 4 – Radial Tunnel / Posterior Interosseous Nerve Entrapment",
  [
    "## The 5 Compression Points (LEAFS)",
    "L – Leash of Henry (recurrent radial vessels crossing over PIN)",
    "E – proximal Edge of ECRB tendon (medial edge of extensor carpi radialis brevis)",
    "A – Arcade of Frohse (proximal fibrous edge of supinator – most common)",
    "F – Fibrous band at the radial head",
    "S – distal edge of Supinator",
    "## Radial Tunnel Syndrome",
    "Primarily a PAIN syndrome: lateral proximal forearm pain 3–4 cm distal to lateral epicondyle",
    "Often confused with lateral epicondylitis (tennis elbow)",
    "Minimal or absent motor weakness",
    "## PIN Compression Syndrome",
    "Motor-predominant: weakness of finger extensors, ECU (NO wrist drop – ECRL spared)",
    "No sensory disturbance",
    "## Surgical Decompression",
    "Anterior (Henry) or posterior (Thompson) approach",
    "Release of Arcade of Frohse is the key step; outcome more predictable for PIN vs. radial tunnel"
  ],
  2,  // leash of Henry / radial tunnel surgical view
  "Intraoperative: Leash of Henry & PIN in radial tunnel"
);

// Slide 10: Arcade of Frohse ultrasound
contentSlide(pres,
  "Arcade of Frohse – Imaging & Diagnosis",
  [
    "## Arcade of Frohse",
    "Proximal fibrous arch of the superficial head of the supinator muscle",
    "Most clinically important compression point for the PIN",
    "PIN passes beneath this arch into the supinator canal",
    "## Ultrasound Features of Entrapment",
    "Focal thickening and hypoechoic change of PIN proximal to arcade",
    "Loss of normal 'honeycomb' fascicular pattern",
    "Pre-stenotic nerve swelling with downstream narrowing (hourglass sign)",
    "## MRI Features",
    "Intraneural edema: T2 hyperintensity and focal nerve swelling",
    "Denervation changes: T2 hyperintensity in extensor digitorum, ECU (downstream muscles)",
    "Can reveal compressive masses: lipoma, fibroma, ganglion at arcade",
    "## Key Point",
    "Lipoma at arcade of Frohse is a classic cause of PIN palsy",
    "Surgical release: divide arcade (fibrous edge), decompress supinator canal"
  ],
  3,  // PIN ultrasound
  "Ultrasound: PIN compression at Arcade of Frohse (Panel B shows constriction)"
);

// Slide 11: Distal supinator / Wartenberg
contentSlide(pres,
  "Site 5 – Distal Supinator Canal & Site 6 – Wartenberg Syndrome",
  [
    "## Distal Supinator Canal (Supinator Syndrome)",
    "Deep branch (PIN) compressed at exit from supinator by distal fibrous edge",
    "Clinically: pure motor weakness of extensors – no wrist drop, no sensory loss",
    "Intraoperatively: whitish-yellow fibrous band at distal supinator edge",
    "## Wartenberg Syndrome (Cheiralgia Paresthetica)",
    "Compression of Superficial Branch of Radial Nerve (SBRN) at the wrist",
    "SBRN emerges between brachioradialis and ECRL tendons in distal forearm",
    "Compressed by: tight wristwatch, handcuffs, cast, tight bracelet",
    "## Clinical Features of Wartenberg Syndrome",
    "Pain and paresthesias over dorsoradial hand and thumb (first web space)",
    "No motor weakness",
    "Positive Tinel's sign over radial border of distal forearm",
    "Finkelstein test may be positive (confusing with De Quervain's)",
    "## Treatment",
    "Conservative first: remove offending compressive item, splinting",
    "Surgical decompression if refractory"
  ],
  4,  // distal supinator surgical
  "Intraoperative: distal supinator edge & exiting PIN"
);

// Slide 12: Two-column – comparison table
twoColumnSlide(pres,
  "Summary: Lesion Level vs. Clinical Features",
  "Axilla / Proximal Arm",
  [
    "## Muscles Affected",
    "Triceps (elbow extension lost)",
    "Brachioradialis, ECRL, ECRB",
    "All wrist and finger extensors",
    "## Signs",
    "Wrist drop + absent triceps reflex",
    "## Sensory Loss",
    "Posterior arm, posterior forearm, dorsum of hand",
    "## Causes",
    "Crutch palsy, shoulder dislocation, honeymoon palsy"
  ],
  "Spiral Groove (Most Common)",
  [
    "## Muscles Affected",
    "Brachioradialis, ECRL, ECRB",
    "All finger and wrist extensors",
    "Triceps SPARED",
    "## Signs",
    "Wrist drop; triceps reflex intact",
    "## Sensory Loss",
    "Dorsum of hand, thumb, index & middle fingers",
    "## Causes",
    "Humeral fracture, Saturday-night palsy, park bench palsy"
  ]
);

twoColumnSlide(pres,
  "Summary: Distal Lesions",
  "Radial Tunnel / PIN Syndrome",
  [
    "## Muscles Affected",
    "Finger extensors, ECU",
    "ECRL and wrist extension PRESERVED",
    "Triceps SPARED",
    "## Signs",
    "Finger drop, no wrist drop",
    "Radial tunnel: mainly pain (3–4 cm distal to epicondyle)",
    "## Sensory",
    "Normal (PIN is pure motor)",
    "## Compression Points (LEAFS)",
    "Leash of Henry, ECRB edge, Arcade of Frohse, Fibrous band at radial head, Distal supinator"
  ],
  "Wartenberg Syndrome (Wrist)",
  [
    "## Structure",
    "Superficial Branch of Radial Nerve (SBRN)",
    "Pure sensory compression",
    "## Site",
    "Between brachioradialis and ECRL tendons, distal forearm",
    "## Causes",
    "Wristwatch, handcuffs, cast, tight bracelet",
    "## Signs",
    "Pain & paresthesias: dorsoradial hand",
    "No motor weakness",
    "Positive Tinel's over distal radial border",
    "## Rx",
    "Remove compression; surgery if refractory"
  ]
);

// Slide 14: Management
contentSlide(pres,
  "Diagnosis & Management Principles",
  [
    "## Electrodiagnostic Studies (EDX) – Essential",
    "Confirm site and extent of lesion; exclude other causes of wrist drop",
    "Demyelinating (neuropraxia): conduction block across spiral groove",
    "Axon-loss: reduced SNAP amplitude; denervation on needle EMG",
    "Estimate severity and guide prognosis",
    "## Ultrasound",
    "Cross-sectional area (CSA) >5.75 mm² at spiral groove: highly specific",
    "Identifies focal nerve enlargement, hourglass deformity, compressive masses",
    "## Conservative Treatment",
    "Most Saturday-night palsies (neuropraxia): spontaneous recovery in 6–8 weeks",
    "Wrist extension splint to prevent contracture; physiotherapy",
    "## Surgical Indications",
    "Failure to recover after 3–6 months of conservative management",
    "Open injuries, complete nerve transaction, confirmed mass lesion on imaging",
    "## Nerve Repair",
    "Primary repair if tension-free; performed within 14 days if possible",
    "Nerve gaps: conduit, decellularized allograft or autograft"
  ],
  null, null
);

// Slide 15: Key points
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  ["3", "LEAFS mnemonic", "5 PIN compression points: Leash of Henry, ECRB edge, Arcade of Frohse, Fibrous band at radial head, Supinator distal edge"],
  ["4", "Arcade of Frohse", "Most common PIN entrapment site; fibrous arch of supinator; no wrist drop, no sensory loss"],
  ["5", "Wartenberg syndrome", "SBRN compression at wrist; pure sensory; common cause = wristwatch"],
  ["6", "Wrist drop absentPin", "PIN lesion does NOT cause wrist drop (ECRL preserved); important distinction from spiral groove palsy"],
];

const colX = [0.35, 0.9, 2.9];
const rowH = 0.82;
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});

// ── Write file ────────────────────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/radial-nerve-pptx/Radial_Nerve_Compression_Sites.pptx" })
  .then(() => console.log("✅ Presentation written successfully"))
  .catch(e => { console.error("ERROR:", e); process.exit(1); });

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/radial-nerve-pptx/build.js'

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/radial-nerve-pptx/build.js'