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