Localization of Neurologic Pathologies 2014-2015 PDF

Localization of Neurologic Pathologies 2014 -2015 Dr. Dela Cruz...

Localization of Neurologic Pathologies 2014 -2015 Dr. Dela Cruz [ Neurology ] Questions asked in the Diagnosis of Neurological Problems 2. Inductive Reasoning - Just by history taking you now form an initial hypothesis - Where is the lesion located? then from there you try to rule in and rule out to prove your - Is the CNS primarily involved? hypothesis. - If the Nervous System is involved is it focal or diffuse? - At the end of the history you are left with 2 or 3 differential o Left side, Right side or the Middle Part diagnosis which will be further analysed by the result of PE - What part of the nervous system is being affected by the - Needs a very good history taking disease process Usually, Neurologic diseases presents with inhibitory manifestations Localization or as a stimulatory manifestation: Longitudinal Ex. - Anatomic and Physiologic I. Motor System - Neuroaxis - Inhibition Type of Pathology Horizontal o Paralysis - Stimulation Type of Pathology Motor Sensory Conscio CSF Vascular Internal o Involuntary Movements  usness Regulati  Chorea ( Jerky ) Table 1 on System  Athetoid ( Snake-like ) ( Sympa  Ballistic Movement / Para ) II. Memory  Poor Memory Supratentor + + + + + ial Sometimes, the inhibition inhibits the inhibitory neurons  so the Posterior + + + + + Non previously inhibited functions will be released from inhibition and will Fossa Localizin be activated Spinal + + - + + g Peripheral + + - - + N - Babinski Reflex - Snout Reflex - Grasp Reflex Motor System - Sucking Reflex - Rooting Reflex From the Supratentorial the motor system starts in the primary motor o These reflex are normally absent in the adult cortex of the frontal lobe because as we age, they are being supressed by - Neurons here are part of the UMN the frontal lobe. - Axons of these UMN will go down as fiber of the motor o When they reappear during a disease process, tracts called corticospinal tract then it means that the part of frontal lobe that inhibits them is released from the said inhibition Fibers that go to the face will end up in the brainstem making them active again o Midbrain - From these it is apparent that the neurologic manifestation o Pons of the disease process is highly dependent on the part being o Medulla affected - These tracts are called corticobulbar tracts o So that whatever the pathologic process is whether it is secondary to stroke, a neoplastic The Primary UMN whose axon that will go down will synapse with disorder or whatever. The manifestations will be LMN the same as long as it affects the same area of the - These LMN are located at: brain. o At spinal level they are located in the Anterior Horn  so these anterior horn cells are made up Some Pathologies Involving Perception of Touch of LMN Hypoesthesia / Analgesia o Axons of Anterior Horn cells will go out as - Loss of touch sensation Peripheral Motor Nerves Paresthesia Motor Tract - Abnormal sensation Cortex  Internal Capsule  Brainstem  Lower Medulla then - Pins and needle sensation decussate to the other side Hyperesthesia - So that a lesion affecting the motor cortex on the right will - Hypersensitive manifest on the contralateral extremity o Remember that the Sx will only be apparent on Approach in Diagnosing Neurologic Disease the extremities not on the trunk because trunk has dual innervation coming from both cortices - Lesion affecting frontal lobe will manifest on the 1. Syndrome Approach contralateral side - Wherein you know the signs and symptoms of a particular disease beforehand, Then adding it up to come up with a diagnosis o Entails a lot of memory usage LOL  Magno Opere Somnia Dura Page 1 of 3  Kidok   Localization of Neurologic Pathologies 2014 -2015 Dr. Dela Cruz [ Neurology ] - Sx UMN Lesion VS LMN Lesion o CST Lesion will give you  Spastic Paralysis on the same side of the UMN LMN body below the lesion. [ UMN ] Hyper-reflexia Hypo-reflexia  At the level of the lesion, there will be a Spastic Paralysis Flaccid Paralysis flaccid paralysis. [ LMN ] ( - ) Fasciculation + Fasciculation o Lesion on the Dorsal Column Atrophy Disuse / Less marked / Marked Atrophy  Ipsilateral Loss of Vibration, Sometimes absent Proprioception and Fine Touch + Babinski ( - ) Babinski o Loss of Spinothalamic Tract  Loss of pain and temperature sensation Pathology affecting: from the contralateral side beginning - The nucleus of the Cranial Nerves will manifest as LMN type one or two segments below the lesion of lesion - The Spinal Cord UMN - Hi Guys, medyo ang gulo sa part na to pls paki double check na lang  Okay galing na ulit to kay doc. o UMN  Corticospinal and Corticobulbar o LMN  Spinal and Brainstem Lesions Brainstem Lesion o Mixed  Spinal Manifestation: - Cranial Nerve Pathology will manifest on the ipsilateral side Sensory System - Motor Dysfunction will be on the contralateral side Sensory will start from the peripheral nerves, where you have the Generalities receptors found on the skin, muscle and joints. Upper Medullary lesion, Pontine lesion, Midbrain lesion, - These receptors transform different type of stimuli into Supratentorial lesion  motor manifestation will be on the electrical Potential which can further develop into an action contralateral side. potential if sufficient enough  - While CN will be on ipsilateral side Types of Receptors - Chemical Long Tract Signs - Mechanical - These give the laterality of the lesion whether Right or Left o Reacts to:  Pressure Segmental Signs  Pain - Are manifestations inherent at a certain levels  Stretch Examples:  Action potential as we all know back sa physio ay ALL - Supratentorial level OR NONE  o Dysfunction in: Intelligence, Memory, Behavior, - Light touch  Pacinian Corpuscle Emotions, Language, Aphasias, Visual and - More Pressured touch  Pressure / Stretch / Pain receptors Olfaction pathways - Brainstem Pathway of Sensory Perception o Dysfunctions involving the Cranial Nerves Peripheral  will enter SC by way of DRG which goes up 2 or 3 nd  Bell’s Palsy segments higher  Synapse with 2 order neuron  go up as lateral  Peripheral N and Posterior Spino-thalamic tract  Thalamus [ Nucleus: Ventroposterolateral VPL rd Fosa ] where we have our 3 order neuron Parietal Cortex  Primary rd  3 Nerve Palsy Sensory Cortex  Peripheral Nerve and Brain ( wahaa pa double check di ko First Order Neuron  Paraspinal Ganglia masyado marinig lintik naulan Lateral Geniculate for vision is also located in the thalamus ) - Spinal Decussation: happens at the spinal level 2-3 levels higher o Brown Sequard  UMN and LMN affectation Examples Hi, eto hindi galing sa lecture I googled it HAHA tinuturo lang kasi ni Consciousness [ RAS ] doc yung lesion kanina sa board so hindi ko mahulaan kung saan  so - For attention control kahit wag nyo na basahin kung di nyo type  - See table 1 o Changes in sensorium may be due to: + Hemisection of the Spinal Cord ( Brown Sequard Syndrome )  Diffuse affectation of supratentorial - Affects level or lesion in the brainstem o UMN CST o Dorsal Column o Spinothalamic Tract Magno Opere Somnia Dura Page 2 of 3  Kidok   Localization of Neurologic Pathologies 2014 -2015 Dr. Dela Cruz [ Neurology ] o Coma  Brainstem  either focal or small Temporal Profile lesion - How the S/Sx behold? VS Time  Supratentorial  dapat Diffuse and o Acute < 2 days both Left or Right hemispheres are o Subacute < 2 weeks affected o Chronic > 2 weeks o In stroke, comatose sila kase  secondary to remote effects  Increased ICP  Brainstem Example Herniation - 7 y/o Boy - 2 weeks PTA had on and off fever Characteristics of Lesions - 1 week PTA + headache - Focal / Diffuse - a day before consult  left sided weakness o Focal - On PE, boy is febrile and with weakness sa left side  One level is affected Diagnosis - Focal or Diffuse?  Pwede ding magka multiple o Focal because there is weakness on one side focal lesion - What Level?  Examples: Stroke, Abscess, Tumors, o Supratentorial kasi may headache Demyelinating Diseases - Mass / Non Mass? o Diffuse o Mass  Continous lesions - Temporal Profile  Examples: Meningitis, Encephalitis and o Subacute Encephalopaties - Check the tableeeee   So ang na fufullfll daw nya sa table ay - Mass / Non-Mass o Vascular o Mass o Neoplastic  Space occupying lesions o Inflammatory  Produce symptoms by exerting pressure o Immunologic on the surrounding structures or an o Traumatic increase in ICP producing distant  Among these 4 alin daw ang may fever LOL remote effects On further PE  grade 3 Systolic Murmur, what is your final DX? o Non-mass - Ako feeling ko subacute bacterial endocarditis HAHA CHAROT LANG!  Secondary to injured neurons - Corny di rin sinabi yung pinaka sagot. Anyways aralin na lang natin  Maybe due to: Encephalopathies,  Metabolic problems, Infarctions and PA DOUBLE CHECK NA LANG YUN TABLE SA NOTES NYO THEN PA CORRECT IF Toxin exposure MAY MALI  Magno Opere Somnia Dura Page 3 of 3  Kidok 