Neurology pdf_240802_121354.pdf

MEDICINE NEUROLOGY By Dr.Priyansh Jain ABOUT AUTHOR MBBS (Gold Medalist) MD (General Medicine) — JLN Medical college Consultant Physician & Assistant Professor USMLE/MRCP qualiﬁed 7 International Publications National Level Faculty - NEET-PG, FMGE/NExT President's Award (Scouts) Selected for Research and Training at NIH, USA (sponsored by USA Government) Delivered lectures in International and National Medical Colleges Dr. Priyansh Jain In dex INDEX OF NEUROLOGY WORKBOOK CHAPTER 1: STROKE/CEREBRO-VASCULAR ACCIDENT…………3.3 CHAPTER 2: MENINGITIS………………………………………………………13 CHAPTER 3: DEMENTIA………………………………………………………….17 CHAPTER 3B: PARKINSONISM……………………………………………….25 CHAPTER 4: HEADACHE………………………………………………………….31 CHAPTER 5: APHASIA……………………………………………………………37 CHAPTER 6: EPILEPSY…………………………………………………………..40 CHAPTER 7: NEURO-MUSCULAR JUNCTION DISORDER………47 CHAPTER 8: DYSTROPHINOPATHIES……………………………………..52 CHAPTER 8B: MULTIPLE SCLEROSIS & GBS…………………………53 CHAPTER 9: MOTOR NEURON DISEASE……………………………….59 CHAPTER 10: SPINAL CORD DISORDER………………………………61 CHAPTER 11: BRAIN STEM DISORDER………………………………..65 CHAPTER 12: FACIAL PALSY………………………………………………..71 DR. PRIYANSH JAIN MEDICINE NEUROLOGY:STROKE/CVA NEUROLOGY:STROKE/CVA CHAPTER 1 STROKE/CEREBRO-VASCULAR ACCIDENT BLOOD SUPPLY OF BRAIN Subarchnoid Hemorrhage — Rupture of C /C/FNFe c— —k stiffness — Defect of tunica............ +................. N eMcCk sstitieff n—e ss — If — Post. Commu. Art. — M SCc soirte — Risk of Rupture, if size — I f — PCoSsFt. C o m m u. A r t. — ECG — Complication — S A H le a d s to release of...........--> DOC — 3 DR. PRIYANSH JAIN MEDICINE DR. PRIYANSH JAIN MEDICINE 3 NEUROLOGY:STROKE/CVA Score — Risk of Rupture, if size — CSF ECG — Complication — S A H l e ads to release of …………………… DOC — DR. PRIYANSH JAIN MEDICINE DR. PRIYANSH JAIN MEDICINE 4 NEUROLOGY:STROKE/CVA EDH— — CT - — Lucid Interval SDH— — CT - — Lucid Interval ICP — Sign - — MC CN involved - — Complication - — Rx— Most effective — — Other - 45 DR. PRIYANSH JAIN MEDICINE NEUROLOGY:STROKE/CVA LESION OF— ACALoss - of motor & sensory innervation in- Urine & stool - Anal area sensation - — Paracentral lobule — MCA - Loss of motor & sensory innervation in - Speech - Superior division - suppy -............... area Inferior division - suppy -............... area — PCA DR. PRIYANSH JAIN MEDICINE 65 NEUROLOGY:STROKE/CVA Lesion of — Frontal Lobe [ACA]— Gait - — ??. Gaganhalton — Temporal Lobe — Occipital Lobe — Parietal Lobe [MCA] Dominant Non-Dominant Patient A Patient B CEREBELLAR LESION Neo-cerebellum — Archi-Cerebellum — Nystagmus also seen in — 67 DR. PRIYANSH JAIN MEDICINE NEUROLOGY:STROKE/CVA TREMOR Contraction of agonist and antagonist muscle Intentional tremor Goal Startin g Po i nt Resting tremor Goal Startin g Po i nt ESS: Tremor — MC — Rx - Goal Startin g Po i Lesion of Basal Ganglia — Caudate Nucleus nt — Putamen — Subthalamic Nucleus Thalamus — Ventro-Posterolateral Nucleus — Lesion of — Amygdala-Appetite - -Sexuality - -Hyper-orality — Mamillary Body DR. PRIYANSH JAIN MEDICINE 87 NEUROLOGY:STROKE/CVA CEREBRO-VASCULAR ACCIDENT [CVA] Types of CVA a- b- c- MMAANNAAGGEMEMENENT TO OF FH TEHRMeEmOMoROrRrR 55 year / male / uncontrolled HTN C/F- Inv- 1st- Rx- C/I — C/I - 89 DR. PRIYANSH JAIN MEDICINE NEUROLOGY:STROKE/CVA MANAGEMENT OF ISCHEMIC STROKE 70 year / male / DM/ Smoker C/f - Inv - 1st- - radiological investigation - Rx- If patient present within........hours Indication for Thrombolysis — — Time — Age Contra-indication — BP for Thrombolysis — Infarction Size - TRANSIENT ISCHEMIC ATTACK [TIA] If patient present after..... hours To be given to every pt. Of Ischemic stroke DR. PRIYANSH JAIN MEDICINE 190 NEUROLOGY:STROKE/CVA TRAN S IT E r Na Tn s I iSe Cn tH E I Ms cI C h eA m T Ti cA C TIA is TIA is indicator a indicator of future risk risk of future of stroke of stroke and for risk assessment ---- >............................ and for risk assessment score is used. ………………… score is used. ABCD2 SCORE 11 DR. PRIYANSH JAIN MEDICINE !! NEUROLOGY:HEADACHE NEUROLOGY:STROKE/CVA SUMMARY # match the following 1 - frontal A) worst headache oflobe life B) homonymous hemianopia 2- occipital lobe C) gaganholtan 3- non dominant parietal lobe D) prospognosia 4- putamen E) hemineglect 5- cerebellum F) intentional tremor 6 -SAH G)atheotosis 7 - temporal lobe H) kluver bucy syn 8- mAammygildlarlay body A...... B...... C..... D....... E...... F....... G...... H.... #MC type of stroke - ischemic/ hemorrahagic #1st investigation in ischemic stroke - NCCT / CECT./ MRI / RBS #C/f of stroke + NCCT - grossly normal - probable diagnosis Hemorragic stroke / ischemic stroke # Thrombolysis is done if patient comes within........ hours DR. PRIYANSH JAIN MEDICINE 132 NEUROLOGY:MENINGITIS CHAPTER 2 MENINGITIS ETIOLOGY a) Bacterial meningitis MCC- Other - b) Viral meningitis MCC - Other - HSV- 1 HSV-2 HSV -2 13 0 DR. PRIYANSH JAIN MEDICINE NEUROLOGY:MENINGITIS NEUROLOGY:MENINGITIS c) Fungal Meningitis Seen in - MC- C/F OF MENINGITIS O/E— — Investigation CSF - production by - - absorbtion by - - color - - cell - - protein - - glucose - DR. PRIYANSH JAIN MEDICINE 134 NEUROLOGY:MENINGITIS CSF ANALYSIS OPENING CELL NUMBER CSF PROTEIN PRESSURE & TYPE. SUGAR NORMAL BACTERIAL MENINGITIS VIRAL TUBERCULAR Poly-morphia nuclear cell (PMN) TB meningitis — IDIOPATHIC INTRACRANIAL HTN Seen in - Risk Factor - C/f — Fundus - Rx - 15 DR. PRIYANSH JAIN MEDICINE !NEUROLOGY:HEADACHE NEUROLOGY:MENINGITIS SUMMARY # prophylaxis for nesseria meningitis - azithromycin penicillin Ceftriaxone # mollorate meningitis - HSV-1/ HSV 2 # meningitis symptom + complex hallucination - # match the following A) normal glucose in CSF 1 - bacterial meningitis B) increase PMN in CSF 2- viral meningitis C) increase lymphocyte + decrease suagr 3- SAH D) xanthocromia4 - tubercular meningits A.... B..... C..... D DR. PRIYANSH JAIN MEDICINE 136 NEUROLOGY:DEMENTIA CHAPTER 3 DEMENTIA Deﬁnition Decrease in....................... Causes of Dementia NORMAL PRESSURE HYDROCEPHALUS [NPH] Strech of periventricular limbic system 17 DR. PRIYANSH JAIN MEDICINE DR. PRIYANSH JAIN MEDICINE 3 NEUROLOGY:DEMENTIA DR. PRIYANSH JAIN MEDICINE 18 NEUROLOGY:DEMENTIA ALZHEIMER’S DISEASE Patho-physiology Intracellular accumulation of - Extracellular accumulation of - Severity of alz. Dis - 19 DR. PRIYANSH JAIN MEDICINE DR. PRIYANSH JAIN MEDICINE 3 NEUROLOGY:DEMENTIA NEUROLOGY:DEMENTIA Alz. Disease Sporadic Familial Chromosome -... -................................ gene Chromosome -... -.................................... gen Chromosome -... -.......................... gene Chromosome -... -........................ Structure involved in Alz. Disease Temporal..... parietal........ frontal......... occipital lobe C/F Unable to recall name of objects - Unable to domlearned motor acitivity - Lack of insight of disease - Investigation: Treatment: DR. PRIYANSH JAIN MEDICINE 230 NEUROLOGY:DEMENTIA MULTI-INFARCT DEMENTIA C/f C/f C/f C/F Time FRONTO-TEMPORAL DEMENTIA Patho-physiology : Involvement of ______________ lobe ____________ is spared S_o_________________ Due_ t_o_ _ac_c_u_m_u_l_at_i_on_ _o_f tau _______ LEWY BODY DEMENTIA D/t accumulation of _________Protein | LEWY ____ | Damage to ___________ | 21 DR. PRIYANSH JAIN MEDICINE DR. PRIYANSH JAIN MEDICINE 3 N E UROLOGY:DEMENTIA NEUROLOGY:DEMENTIA HUNTINGTON CHOREA = Autosomal ________ Patho-physiology : Ch — __________ gene | | | number - _____ codon | Damage to ___________ | C/F — | Severity of disease in successive generations Investigation : MRI — Damage to Rx -Mc Rx Parkinson’s related dementia — DDRR.. PPRRIIYYAANNSSHH JJAAIIN NEUROLOGY:DEMENTIA CRETZFELD-JAKOB DISEASE Patho-physiology CH Prp (prion related Protien) Found in cytoplasm Types Of CJD1.Mc — 2. 3.Contaminated meats — 4. C/F EEG - CSF - MRI - (Brain) Rx 23 DR. PRIYANSH JAIN MEDICINE DR. PRIYANSH JAIN MEDICINE 3 "!! N eurology - demantiaNEUROLOGY:DEMENTIA S uSmUmMarMy AofR Yde mantia Normal pressure hypdrocephalus - C/F - Triad - - rx - Alzheimer’s disease - patho - intra- neuronal accumulation of …………protein C/a- - extra neuronal - C/a - Severity of alz. Disease depends on - MC lobe involved in alz disease - fronto temporal demantia - ………………….Is spared. Huntington’s chorea - ch ……-> increase in ………. Codon repeats leads to damage at ……………. Nucleus. - autosomal …………. - MRI Brain - CJD - ch …. —> ……………protein accumulation leads to ………………… encephalopathy —>MRI —> ………………………………. CSF —> Reversible dementia — Cortical dementia — Subcortical dementia — DR. PRIYANSH JAIN MEDICINE 24 NEUROLOGY:PARKINONISM Chapter - 3B CHAPTER 3b PARKINSONISM PARKINSONISM 25 DR. PRIYANSH JAIN MEDICINE N E U R OLOGY:DEMENTIA NEUROLOGY:PARKINSONISM PARKINSON DISEASE Patho-physiology Bodies Protien Substantia Nig ra Degenerate n PD Limb s>axis C/F ____ hypothesis is related to Parkinson’s d/s C/f - Motor — T — R— A— P— Treatment Non motor DR. PRIYANSH JAIN MEDICINE 2 36 SNUEBUJREOCLTO:TGOYP:PIACRKINSONISM Treatment: Last Rx — Electrode is placed in Best initial Rx for PD in old age — — Rx — S/E of — L-DOPA — ROPINIROLE 27 DR. PRIYANSH JAIN MEDICINE NEUROLOGY:DEMENTIA NEUROLOGY:PARKINSONISM ATYPICAL PARKINSONISM a) Multisystem Atrophy (MSA) | Atypical Parkinsonism | Bradykinesia & Rigidity (neck&spine) + In axis Q) MRI brain b) Progressive Supranuclear Palsy(PSP) Atypical Parkinsonism + C/f — MRI — c) Cortico-Basal Degeneration Atypical Parkinsonism + DR. PRIYANSH JAIN MEDICINE 2 38 NEUROLOGY:DPAEMRKEINNTSIOAN ISM Protein Accumulation Parkinson Disease Alz. Disease Lewy Body Dementia F-T dementia MSACortico Basal Degeneration Progressive Supranuclear Palsy DEMENTIA PUGLISTICA — seen in — C/F — — — a/c/a — Syn dro m e 29 DR. PRIYANSH JAIN MEDICINE DR. PRIYANSH JAIN MEDICINE 3 NEUROLOGY:HEADACHE NEUROLOGY:PARKINSONISM SUMMARY Parkinsonism - ……………………+ ……………………… Typical - C/F are more in ………… Atypical -C/F are more in ………… Parkinson’s disease - protein ………………………. Accumulation at ……………………. …………… leads to decrease In ……………… C/F - motor - - non motor - - Gait - match the following feature of atypical Parkinsonism A) orthostatic hypotension 1) cortico basal degeneration B) vertical gaze palsy 2) multi system atrophy C) demantia 3) PSP D) hot bun cross sign E) hummingbird sign A……. B…. C….. D…… E…… DR. PRIYANSH JAIN MEDICINE 3 30 NEUROLOGY:HEADACHE CHAPTER 4 HEADACH TYPES OF HEADACHEE 1 (idiopathic) 2 MIGRAINE FF> M M B/w. YR Last for Hr Type headache Disabling in character Mostly Hint MCQ — asso. c Patho-physiology Vasodilation Vascular theory Meninges Stretch in Rx Vasoconstriction meninges Cortical wave Of depolarisation 31 DR. PRIYANSH JAIN MEDICINE DR. PRIYANSH JAIN MEDICINE 3 NEUROLOGY:HEADACHE NEUROLOGY:HEADACHE Types of Migraine — _________ migraine — migraine c — _________ migraine — migraine c — _________ migraine Variant Migraine — Retinal Migraine —Migraine headache + monocular blindness — Focal Migraine —Migraine headache + dysphagia — Opthalmoplegic Migraine —3/4/6 CN palsy — Migraine sine Migraine —No Headache + only visual complaints — Basilar Migraine —Migraine headache + vertigo + dizziness + ataxia Disability of Migraine calculated by TREATMENT OF MIGRAINE a) For acute attack 1st line DOC Other Dx b) For Prevention of migraine Verapamil — SSRI — DR. PRIYANSH JAIN MEDICINE 332 NEUROLOGY:HEADACHE c) Other Modalities STATUS MIGRANOSUS If migraine last for >72 hours TENSION TYPE MC cause HEADACHE of headache F M _________ headache (B/L) Not disability in character _______ 4 hr to (7-11) Rx — — cluster headache - TRIGEMINAL — paroxysmalAUTONOMIC CEPHALGIAS hemicranial headache — SUNCT/SUNA 33 DR. PRIYANSH JAIN MEDICINE DR. PRIYANSH JAIN MEDICINE 3 N E U ROLOGY:HEADACHE NEUROLOGY:HEADACHE a) Cluster HeadacheMCQ Hint — C/F M F Trigger — Pain (___________ in nature) + + Last for 30 mins to 2 hour — Ist Line — Rx — For acute attack — DOC — For Prevention b) Paroxysmal c) SUNCT/SUNA - S Hemicranial Headache - U N C T MF MF 10-20 20-100 IInnddoommeetthhaalcinine In do m ethacin Rx Rx DR. PRIYANSH JAIN MEDICINE 334 NEUROLOGY:HEADACHE Analgesic abuse Headache — Metabolic Headache — PCO2 — — PO2 — — S. Na — Trigeminal Neuralgia — Trigger — — Character — — Lasting — — Rx — No autonomic symptoms 35 DR. PRIYANSH JAIN MEDICINE DR. PRIYANSH JAIN MEDICINE 3 ! NEUROLOGY:HEADACHE NEUROLOGY:HEADACHE SUMMARY match the following A) retro orbital headache + tearing + alcohol 1) focal migraine B) headache + nausea + pulsating type 2) basilar migraine C) headache in Trigeminal area + runny nose 3) sunct D) headache in Trigeminal area + without runny nose 4) migraine E) headache + dysphagia 5) cluster headache F) headache + 3 /4/6 CN palsy - 6) Trigeminal neuralgia G) headache + vertigo + ataxia 7) opthalmoplegic migraine A….B……C……D…….E……..F………G…. migraine treatment - acute attack - Prophylaxis - cluster headache - Rx - acute - - prophylaxis - status migranosus - if migraine attack last for > ……… hours. DOC for Trigeminal neuralgia - DR. PRIYANSH JAIN MEDICINE 336 NEUROLOGY:APHASIA CHAPTER 5 APHASIA Unable to SPEEC Or Apha sia CUIT AHph-aCsIiaR Unable to Area Area Cortex Cortex Blood supply — BROCA area— _________ division (MCA) — WERNICKE area— _________ division (MCA) So, for Repitation - 37 DR. PRIYANSH JAIN MEDICINE DR. PRIYANSH JAIN MEDICINE 3 NEUROLOGY:APHASIA NEUROLOGY:APHASIA TYPES OF APHASIA APHASIA COMPREHENSION REPITATION FLUENCY (Sensory aphasia) WERNICKE’S Non - ﬂuent Motor AphasiaBROCA’S CONDUCTION TRANSCORTICAL SENSORY TRANSCORTICAL MOTOR ISOLATION (Echolalia) GLOBAL MC Aphasia — Comp — Rep — Fluency — Naming — Pure word deafness - Pure word deafness Pure word blindness - DR. PRIYANSH JAIN MEDICINE 338 NEUROLOGY:APHASIA SUMMARY 39 DR. PRIYANSH JAIN MEDICINE DR. PRIYANSH JAIN MEDICINE 3 NEUROLOGY:APHASIA NEUROLOGY:EPILEPSY CHAPTER 6 EPILEPSY SEIZURE EPILEPSY — Tendency to develop recurrent seizures 1) An identiﬁable epilepsy syndrome (typically the genetic or idiopathic epilepsies). 2) Atleast 2 unprovoked (or reﬂex) seizures or clusters of seizures occurring atleast 24 hours apart. 3) A single unprovoked (or reﬂex) seizure that has atleast a 60% chance of recurrence in the next 10 years. CLASSIFICATION OF SEIZURE Generalised Focal Both Hemispheres involved One Hemisphere involved DR. PRIYANSH JAIN MEDICINE 430 NEUROLOGY:AEPIHLAESPISAY GENERALIZED a) GTCS(Gen. Tonic clonic seizures) A) Stages — Ist IInd IIIrd IVth DOC — MC electrolyte abnormality leading to GTCS — b) Myoclonic — Occurs — Yr — Pt. in morning — — EEG — Rx — DOC — JME — Trigger — MC presentation of JME Myoclonic epilepsy + Laﬁta body in — sweat gland Bx JME associated with — 41 DR. PRIYANSH JAIN MEDICINE DR. PRIYANSH JAIN MEDICINE 3 NEUROLOGY:APHASIA NEUROLOGY:EPILEPSY c) Tonic Seizure d) Atonic Seizure e) Absence Seizure _____ yr EEG — Trigger of Absence Seizure — Rx — DR. PRIYANSH JAIN MEDICINE 432 NEUROLOGY:AEPIHLAESPISAY FOCAL SEIZURE a) Focal aware (Marching/progression) Of C/F d/t involvement Rx - of nearby neuron b) Focal impaired awareness MC site — C/F — Rx — Focal impaired awareness with — cognition — — Behaviour change — Rx 43 DR. PRIYANSH JAIN MEDICINE DR. PRIYANSH JAIN MEDICINE 3 NEUROLOGY:APHASIA N E U ROLOGY:EPILEPSY EPILEPSY SYNDROME a)a L) ELNENONXO-XG-AGSETSATUATU TS YSNynDdRrOomMeE H/o EEG — Rx — b) Infantile Spasm [1 year] Salam seizure Infantile spasm — DOC — Infantile spasm + tuberous sclerosis — S/E of Vigabatrin — D RUG RESISTANT EPILEPSY Epilepsy not C o n t rolled despite — __________ anti-epileptic medication c max dose DR. PRIYANSH JAIN MEDICINE 434 NEUROLOGY:AEPIHLAESPISAY STATUS EPILEPTICUSIf seizure episodes lasting ____ mins Or Rx —If 2 seizure episode c out ___________________ — PRerxi o-dic sharp ——————— EEG— Triphasic — Hypsarrythmia — 3Hz spike & wave — 2.5Hz spike & wave — 4-6Hz SPECIAL POINTS — Rx of GTCS if NO I/V access — — Anti-epileptic drug can only be stopped after — — Seizure to brain tumor — DOC — — GTCS in pregnancy — Ist time - — old case - — Photosensitive seizure — Rx — — Rolandic epilepsy — Age - — C/F - — EEG - — Rx - — Sudden/Rapid/Multidirectional eye movement 45 DR. PRIYANSH JAIN MEDICINE DR. PRIYANSH JAIN MEDICINE 3 ! NEUROLOGY:EPILEPSY NEUROLOGY:APHASIA SUMMARY GTCS - stages -………………/………………../…………………/……………. - DOC - juvenile myoclonic epilepsy - myoclonic …………. F/b …………../…………… - EEG - ……………HZ polispike pattern absence seizure - hallmark -………………. …………. - EEG …………hz spike and wave patter. - Rx - focal seizures- aware - ……………………… march F/b ……………. Palsy - impaired awareness - hallmark - A………….…… Lennox gestaut syn - >……. Types of seizure status epilepticus - seizure episode lasting > ……. Min. DR. PRIYANSH JAIN MEDICINE 436 NEUROLOGY:ANPMHJA DSISAORDER CHAPTER 7 NEURO-MUSCULAR JUNCTION DISORDER NEURO-MUSCULAR JUNCTION A) MYASTHENIA GRAVIS Patho-physiology Type ___ HSR M.gravis is associated with — — Thyroid Pathology 47 DR. PRIYANSH JAIN MEDICINE DR. PRIYANSH JAIN MEDICINE 3 NEUROLOGY:APHASIA NEUROLOGY:NMJ DISORDER C/F — Cogan lid twitch Types of M.G. — Ocular M.G. — Generalised M.G. — M. Crisis Investigation — Most sensitive — Most speciﬁc Nerve conduction test — Repeated Nerve stimulation — DR. PRIYANSH JAIN MEDICINE 4 38 NEUROLOGY:ANPMHJA DSIASORDER Treatment 1) Only ocular M.G. — 2) Generalise M.G. — 3) M. Crisis — B) LAMBORT-EATON SYNDROME Patho-Physiology L.E. Syn — Associated c C/F — 49 DR. PRIYANSH JAIN MEDICINE DR. PRIYANSH JAIN MEDICINE 3 NEUROLOGY:APHASIA NEUROLOGY:NMJ DISORDER Investigation — Treatment — MYASTHENIA GRAVIS LAMBORT-EATON SYNDROME ____ synaptic disorder ____ synaptic disorder Associated with Associated with Antibody — Antibody — Repeated Nerve Repeated Nerve stimulation stimulation /F —Morning Evening C C/F —Morning Evening DR. PRIYANSH JAIN MEDICINE 530 NEUROLOGY:ANPMHJA DSISAORDER SUMMARY 51 DR. PRIYANSH JAIN MEDICINE DR. PRIYANSH JAIN MEDICINE 3 NEUROLOGY:APHASIA NEURO L O G Y :NMJ DYSTROPHINOPATHIE CHAPTER 8 DYSTROPHINOPATHIES Dystrophin Patho-Physiology | Quality | Quantity Other causes of Proximal Myopathy — Distal myopathy - TYPES OF DYSTROPHINOPATHY DUCHENE’S BACKER’S Inheritance - Pathogenesis - C/F - GOWER sign - Age group - Cardiomyopathy - IQ - Rx - Cause of Death - DR. PRIYANSH JAIN MEDICINE 532 NNEUEURROOLOLOGGY:YM:ASP &HA GSBISA Chapter 8b CHAPTER Multiple MULTIPLE SCLEROSIS 8b & GBS sclerosis MULTIPLE SCLEROSIS & GBS Saltatory conduction Patho-Physiology F>M — Cold/Ch. Smoker/| sunlight/EBV C/F — MC — — optic neuritis — — cerebellum involvement — — spinal cord — — involvement of MLF — (medial longitudinal fasiculus) 53 DR. PRIYANSH JAIN MEDICINE DR. PRIYANSH JAIN MEDICINE 3 NEUROLOGY:APHASIA NEUROLOGY:MS & GBS Types of MS Time U th Off Phenomenon Useless Hand of Oppenheimer - If M.S — involves hand — paralysis Lhermitte sign Can also be seen in — Investigation - CSF — For Optic neuritis — DR. PRIYANSH JAIN MEDICINE 5 34 NEUROLOGY:MAPSH &A SGIBAS IOC — Rx — Acute — — Prophylaxis — MOST EFFECTIVE — DEVIC DISEASE / NEUROMYELITIS OPTICA Patho-Physiology Rx — Rx — 55 DR. PRIYANSH JAIN MEDICINE DR. PRIYANSH JAIN MEDICINE 3 NEUROLOGY:APHASIA NEUROLOGY:MS & GBS GULLIAN BARRE SYNDROME Patho-Physiology Urine & stool incontinence O/E DTR — DR. PRIYANSH JAIN MEDICINE 536 NEUROLOGY::AMPSH &ASGIABS Investigation — Diagnosis criteria - — CSF - — Nerve conduction test - — Antibody - Rx - Steroid MILLER FISHER VARIANT 57 DR. PRIYANSH JAIN MEDICINE DR.PRIYANSH JAIN MEDICINE 3 ! NEUROLOGY:MS & GBS NEUROLOGY:APHASIA SUMMARY Antibody against — MC c/f — 2nd MC MLF Synd. — lead to — MC type of M.S. — Symptom worse on exposure to heat c/a — IOC — Finding — Criteria Rx — acute — prophylaxis — — | Risk of — INF - Demyelination M. Sclerosis — CNS — NMO/Devic disease — CNS — GBS — PNS — Miller Fischer Syndrome — PNS — DR. PRIYANSH JAIN MEDICINE 538 NEUROLOGY:MAPOHTAOSRI ANEURON DISEASE CHAPTER 9 MOTOR NEURON DISEASE CORTICO-SPINAL TRACT Motor cortex Corona radiata Internal capsule Post limp — Blood supply — UPPER MOTOR LESION LOWER MOTOR LESION [UMN LESION] [LMN LESION] 59 DR. PRIYANSH JAIN MEDICINE DR. PRIYAN S H JAIN MEDICINE 3 NEUROLOGY:APHASIA NEUROLOGY:MOTOR NEURON DISEASE TYPES OF MND a) UMN type b) LMN type c) Mixed type AMYOTROPHIC LATERAL SCLEROSIS Patho-Physiology Tounge — C/F— UL — HMF — — LL — Eye Ball — Investigation — Rx — DR. PRIYANSH JAIN MEDICINE 630 NEUROLOGY:ASPIHNAASLI ACORD DISOREDER CHAPTER 10 SPINAL CORD DISORDER SPINAL CORD DISORDER TABESDORSALIS Patho-Physiology Gait - Joint sense Position sense Vibration sense P upil - ROMBERG TEST Eye Open Eye close Subacute combined degeneration of spinal cord - Similar C/F — seen with — Reﬂex —Finger ﬂexion Hint — CBC — 61 DR. PRIYANSH JAIN MEDICINE DR.PRIYANSH JAIN MEDICINE 3 NEUROLOGY:APHASIA NEUROLOGY:SPINAL CORD DISOREDER SYRINGOMYELIA Patho-physiology Joint sense Temprature Temprature Joint sense Position sense Position sense Pain Pain Vibration sense Vibration sense C/F — Investigation —IOC — Rx — DR. PRIYANSH JAIN MEDICINE 632 NEUROLOGY:SAPIHNAASLI ACORD DISOREDER CAUDA EQUINA vs CONUS MEDULLARIS CAUDA EQUINA CONUS MEDULLARIS Ankle reﬂex [S1/S2] Knee reﬂex [L2/L3/L4] Saddle sensation [S2/S3/S4] Bowel & Bladder Symmetry BROWN SEQUARD SYNDROME 63 DR. PRIYANSH JAIN MEDICINE DR. PRIYANSH JAIN MEDICINE 3 NEUROLOGY:SPINAL CORD DISOREDER SUMMARY OF SPINAL CORD DISORDERS DR. PRIYANSH JAIN MEDICINE 64 NEUROLOGY:BRAIN STEM DISORDER CHAPTER 11 BRAIN STEM DISORDER BRAIN STEM Mid Brain— 3 CN — 4CN PONS— 5 CN — 6 CN — 7 CN — 8 CN 65 DR. PRIYANSH JAIN MEDICINE NEUROLOGY:BRAIN STEM DISORDER 11 CN 12 CN DR. PRIYANSH JAIN MEDICINE 66 NEUROLOGY:BRAIN STEM DISORDER 67 DR. PRIYANSH JAIN MEDICINE NEUROLOGY:BRAIN STEM DISORDER MEDIAL MEDULLARY SYNDROME Etiology C/F 12 CN M.L. CST CST LATERAL MEDULLARY SYNDROME Etiology 8 CN Sympathetic tract Spinothalamic tract Sensory nuclei of CN 5 N. ambiguous – CN 9 — – CN 10 — – CN 11 — Fine touch & proprioception — Hemiparesis can be seen in — _______ — But not in — ______ DR. PRIYANSH JAIN MEDICINE 638 NEUROLOGY:ABRPHAAINS ISATEM DISORDER PONTINE SYNDROME Millard Gubler Syndrome Foville Syndrome Locked in Syndrome Fever + pinpoint pupil — Mid Brain Weber Syndrome — Artery involved Nothnagel syndrome — 69 DR. PRIYANSH JAIN MEDICINE DR. PRIYANSH JAIN MEDICINE 3 NEUROLOGY:BRAIN STEM DISORDER SUMMARY Medial Medullary Syndrome — Lateral Medullary Syndrome — Millard Gubler — Foville Syndrome — Weber Syndrome — Nothnagel’s syndrome — DDRR..P PRRIYIYAANNSSHH J AJAIN NEUROLOGY:AFAPCHIAASLI APALSY CHAPTER 12 FACIAL PALSY Facial palsy — if idiopathic — c/a — taste sensation 71 DR. PRIYANSH JAIN MEDICINE DR.PRIYANSH JAIN MEDICINE 3

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