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