Radiology Notes
- World War 2
- 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%
- NB One of the TORCH illnesses
- Enteroviruses
- 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
- 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
- Seconds
- Minutes
- Hours
- 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
- Memory
- 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
- 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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