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12.11.01 Stuff

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
      • 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

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
    • Try to open their eyes
  • Temporal lobe => Fiddling, mouthing
  • SUDEP
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Kieran Gillick,
2 Nov 2012, 06:39
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