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12.10.17 Notes


Radiology Notes
  • World War 2
    • T2 => Water White
  • FLAIR suppresses FREE water
    • But oedema is still white
  • Colours are the right way round on T1
    • Grey matter is grey
    • White matter is white
  • Try to avoid the eyes when doing a CT
    • Knackers the lens => Cataracts
    • => CTs are in an oblique plane compared to MRI


Viral encephalitis

  • HSV
    • => Cerebral oedema in 10%
      • => 50% mortality
    • NB One of the TORCH illnesses
  • Enteroviruses
    • Coxsackievirus
    • Mumps
  • Varicella zoster


Cranial nerve notes

  • Bitemporal hemianopia
    • Lose the top first in pituitary adenoma
      • Pituitary hangs down below the chiasm
    • Lose the bottom first in craniopharyngioma
  • Scotoma = An island of failure
  • Fixed, dilated pupil?
    • Probably an efferent failure
    • Because the response is bilateral
  • MS - PAIN precedes loss of vision
    • Usually by about a week 
  • Anisochoria = Unequal pupils
  • Holmes-Addey pupil
    • Large and irregular pupil
    • Pupillary constriction:
      • to light is slow and incomplete
      • to accomodation is relatively normal
      • once the pupil has constricted it remains small for an abnormally long time (tonic pupil)
  • Carotid dissection
    • Causes PAINFUL Horner's
    • Have they been on the teacup ride??


Visual fields

  • Commonest presentation for exams is a homonymous hemianopia
  • Test inattention first, so you pick up hemianopias early
  • Use SMALL, 1-finger movements
    • Move HORIZONTALLY inwards
  • Don't start too far out for inattention
    • Nose gets in the way and you'll confuse with bitemporal hemianopia


Presentations of neurological deficit

  • Immediate
    • Electrical stuff
      • Epilepsy etc
  • Seconds
    • Vascular
  • Minutes
    • Vascular
  • Hours
    • Inflammation
  • Weeks
    • SOL
    • Subdural
    • TB meningitis
  • Months
    • Degenerative
      • MND
      • Alzheimers
      • Parkinsons


Motor tracts

  • Pyramidal
    • Corticospinal 
      • Lateral - Crossed-over fibres
      • Anterior - Un-crossed-over fibres
        • Cross further down in the cord
    • Corticobulbar
      • Carries information to motor neurons of the cranial nerve nuclei, rather than the spinal cord
  • Extra-pyramidal
    • Generally DON'T directly innervate motor neurons
    • Coordinate reflexes, locomotion, complex movements, postural control
    • Tracts:
      • Rubrospinal tract
      • Pontine reticulospinal tract
      • Medullary reticulospinal tract
      • Lateral vestibulospinal tract
      • Tectospinal tract


Rehab notes

  • Wechsler Adult Intelligence Scale (WAIS-IV) for cognitive assessment
  • Homunculus man is UPSIDE DOWN
  • Rehab is:
    • Active + participatory
    • Mixture of restorative + compensatory
    • If you can LEARN you can CHANGE
  • Domains of cognition
    • Attention
      • Sustained
      • Focused
      • Divided
    • Memory
      • Encoding
      • Storage
      • Retrieval
    • Language
    • Visual
    • Executive
    • Intellect
  • GAS goals
  • Disability => Activity limitations => Restrictions on participation
  • "Body schema"


WAIS-IV Test


Verbal Comprehension Core Description
Similarities X Abstract verbal reasoning (e.g., "In what way are an apple and a pear alike?")
Vocabulary X The degree to which one has learned, been able to comprehend and verbally express vocabulary (e.g., "What is a guitar?")
Information X Degree of general information acquired from culture (e.g., "Who is the president of Russia?")
(Comprehension)
Ability to deal with abstract social conventions, rules and expressions (e.g., "What does 'Kill two birds with one stone' metaphorically mean?")
Perceptual Reasoning Core Description
Block Design X Spatial perception, visual abstract processing, and problem solving
Matrix Reasoning X Nonverbal abstract problem solving, inductive reasoning, spatial reasoning
Visual Puzzles X Spatial reasoning
(Picture Completion)
Ability to quickly perceive visual details
(Figure Weights)
Quantitative and analogical reasoning
Working Memory Core Description
Digit span X Attention, concentration, mental control (e.g., Repeat the numbers 1-2-3 in reverse sequence)
Arithmetic X Concentration while manipulating mental mathematical problems (e.g., "How many 45-cent stamps can you buy for a dollar?")
(Letter-Number Sequencing)
Attention, concentration, mental control (e.g., Repeat the sequence Q-1-B-3-J-2 in numerical and alphabetical order)
Processing Speed Core Description
Symbol Search X Visual perception/analysis, scanning speed
Coding X Visual-motor coordination, motor and mental speed, visual working memory
(Cancellation)
Visual-perceptual speed


Hounsfield scale

Substance HU
Air −1000
Lung −700
Soft Tissue −300 to -100
Fat −84
Water 0
CSF +15
White matter
+20 to +30
Blood +30 to +45
Grey matter
+35 to +45
Muscle +40
Bone +700 (cancellous bone) to +3000 (dense bone)


Notes
  • Acute inflammatory demyelinating polyneuropathy (AIDP)
    • Most common form of GBS / ~Synonymous with GBS
  • Migraine aura - Cardinal features
    • Lasts 10-30 mins
    • Moves around in the visual field
    • Always +ve
      • Never any visual loss
  • ABC
    • Antecedents => Behaviour => Consequences
  • Steroids DON'T help much in oedema due to stroke
    • Neither does mannitol => Big rebound effect
    • Do craniectomy instead
  • Botox for spasticity
  • 5-10% of the corticospinal pathway is IPSILATERAL
    • => Some function remains after loss of half the brain

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