Spurling test
- Used to assess nerve root pain (aka radicular pain)
- Involves turning the patient's head to the affected side and applying downward pressure to the top of the patient's head#
- Positive if radicular pain is elicited
Medial longitudinal fasciculus (MLF)
- Pair of crossed fiber tracts, one on each side of the brainstem
- Situated near the midline of the brainstem
- Composed of both ascending and descending fibers that arise from a number of sources and terminate in different areas
- Carries information about the direction that the eyes should move
- Connects CN III, IV, VI
- Integrates movements directed by the gaze centers (frontal eye field) and information about head movement (from cranial nerve VIII)
- Integral component of saccadic eye movements as well as vestibulo-ocular and optokinetic reflexes
- Tectal plate expansion can impinge
- => Classically gives UPGAZE PALSY
SLE
- Common initial and chronic complaints include fever, malaise, joint pains, myalgias, fatigue, and temporary loss of cognitive abilities
- Sequalae
- 1/3 get epilepsy
- 1/3 get psychological problems
- 1/3 get vascular problems
- American College of Rheumatology criteria: A person has SLE if any 4 out
of 11 symptoms are present simultaneously or serially on two separate
occasions:
- Malar rash
- Discoid rash
- Serositis
- Oral ulcers
- Arthritis
- Photosensitivity
- Hematologic disorder
- Hemolytic anemia
- Leukopenia
- Lymphopenia
- Thrombocytopenia
- Renal disorder
- Antinuclear antibody
- Immunologic disorder
- Anti-Smith
- Anti-ds DNA
- Antiphospholipid antibody
- False positive serological test for syphilis
- Neurologic disorder
Meningiomas
- Most common primary brain tumour (1/3)
- Usually benign (92%) + asymptomatic
- Mechanism:
- Arise from arachnoidal cells
- Most of which are near the vicinity of the venous sinuses
- Tumor is usually gray, well-circumscribed, and takes on the form of space it occupies
- Usually dome-shaped, with the base lying on the dura
- Location:
- Parasagittal/falcine (25%)
- Convexity (surface of the brain) (19%)
- Sphenoid ridge (17%)
- Suprasellar (9%)
- Posterior fossa (8%)
- Olfactory groove (8%)
- Middle fossa/Meckel's cave (4%)
- Tentorial (3%)
- Peri-torcular (3%)
Dermatomyositis - Features:
- Connective-tissue disease related to polymyositis
- Characterized by inflammation
of the muscles and the skin
- Also has systemic features: may affect the joints,
the esophagus, the lungs, and, less commonly, the heart
- Aetiology:
- Viral infection?
- Autoimmune?
- Presentation:
- Gottron lesions
- Scaly erythematous eruptions or red patches overlying the knuckles, elbows, and knees
- X-ray findings sometimes include dystrophic calcifications in the muscles
- Small calcium deposits under the skin
- Priapism
- Interstitial lung disease
- Treatment:
- Prednisone, intravenous immunoglobulin, plasmapheresis, chemotherapies
- Prognosis:
- 90% achieve remission with optimal therapy
Romberg's test - Stand erect with feet together and eyes closed
- A positive sign is noted when a swaying, sometimes irregular swaying and even toppling over occurs
- Balance comes from the combination of proprioception, vestibular input, and vision
- Any two should be sufficient
- Closing eyes leaves only two:
- If there is a vestibular disorder (labyrinthine) or a sensory disorder (proprioceptive dysfunction) the patient will become much more imbalanced
Serum prolactin levels in epilepsy - If a serum prolactin concentration is greater than three times the baseline when taken within one hour of syncope, then in the absence of test "modifiers":
- the patient is nine times more likely to have suffered a GTCS as compared with a pseudoseizure positive
- five times more likely to have suffered a GTCS as compared with non-convulsive syncope positive
- The serum prolactin level is less sensitive for detecting partial seizures
Epilepsy
- Eyes rolling vs eyes closed
- Temporal lobe => Fiddling, mouthing
- SUDEP
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 Updating...
Ċ Kieran Gillick, 2 Nov 2012, 06:39
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