• 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

• 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
• Seizures
• Psychosis

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

• 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
• Try to open their eyes
• Temporal lobe => Fiddling, mouthing
• SUDEP