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