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

Hounsfield scale

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