Professional Documents
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_____________________
. HEMORRHAGE -> HYPER-dense areas on CT. (WHITE).
. INFARCTIONS -> HYPO-dense areas on CT. (BLACK).
. GAITS IN NEUROLOGY:
_____________________
1. FESTINATING ----> PARKINSONISM:
___________________________________
(Mask face - bradykinesia - resting tremor - rigidity).
. N.B. PARKINSONISM's gait -> FESTINATING = HYPOKINETIC = SHUFFLING.
2. HIGH STEPPAGE --> TABES DORSALIS:
_____________________________________
(Neuro$ - Loss of proprioception - +ve Romberg sign).
3. SEMI-CIRCLE ----> STROKE HEMIPLEGIA:
_______________________________________
(Adducted affected arm & Extended affected leg).
4. WADDLING -------> MUSCULAR DYSTROPHY:
_________________________________________
(Weakness of gluteal muscles).
5. WIDE BASED & SHUFFLING -> NORMAL PRSSURE HYDROCEPHALUS:
___________________________________________________________
(Urine incontinence & dementia).
6. IPSILATERAL ATAXIA -> CEREBELLAR ATAXIA:
____________________________________________
The pt tends to fall towards the side of the lesion,
(Nystagmus-Hypotonia-Dysarthria-Loss of coordination-Dysdiadokokinesia).
7. SPASTIC ----> UMNL UPPER MOTOR NEURON LESION:
_________________________________________________
(Spinal cord injury or cerebral palsy).
8. STAGGERING -> VESTIBULAR ATAXIA:
____________________________________
(Ass. with nausea & vomiting).
. TREMORS IN NEUROLOGY:
_______________________
1. RESTING TREMORS (PARKINSON):
________________________________
*
*
*
*
*
2. ESSENTIAL TREMORS:
______________________
* Familial in up to 50 % of cases.
* Starts with fine movement in the upper extremity.
* Worst at the end of the goal directed activity (e.g. reaching a pen).
* Involving the entire head.
3. CEREBELLAR TREMORS:
_______________________
* Intension tremors.
* low fequency 3-4 Hz.
* Affect the extremity & the Whole head.
* Nystagmus & ataxia are present.
. TRIGEMINAL NEURALGIA:
_______________________
. Paroxysmal, LIGHTENING PAIN on the face.
. Severe intense burning or electric shock like.
. Tx: CARBAMAZEPINE.
. CEREBELLAR TUMORS:
____________________
. Ipsi-lateral ataxia (The pt. falls towards the side of the lesion).
. Ipsi-lateral muscular hypotonia.
. Titubation (Forward & backward movement of the trunk).
. Nystagmus.
. Intention tremors.
. Dysdiadokokinesia (Difficulty in performing rapid & alternating movements).
. INTRA-CRANIAL HEMORRHAGE:
___________________________
. HYPERTENSION is the most imp. risk factor.
. Focal neurological signs develop suddenly & gradually worsen over mins to hours.
. The degree of symptoms is not maximal at onset (# SAH or embolic stroke).
. Symptoms start during normal activity (may be ppt by sex).
. Site of INTRA-CRANIAL HEMORRHAGE ------> NEUROLOGICAL FINDINGS:
_________________________________________________________________
1- BASAL GANGLIA (PUTAMEN):
___________________________
* Hemi-plegia, hemi-sensory loss.
* Homonymous hemianopsia, gaze palsy.
* Stupor & coma.
2- "T"HALAMUS:
______________
* Hemi-paresis, hemi-sensory loss.
* Eyes deviate "T"owards hemiparesis.
* UP-GAZE palsy.
* (Non-reactive) miotic pupils.
3- CEREBELLUM:
______________
* NO hemiparesis.
* GAIT ATAXIA.
* OCCIPITAL HEADACHE (+nausea & vomiting).
* Gaze palsy (6th CN. paralysis)
* Facial weakness.
4- "P"ONS:
__________
* COMPLETE PARAPLEGIA.
* Followed by deep coma in a few mins.
* (REACTIVE) "P"IN POINT PUPILS.
5- CEREBRAL:
____________
* May be associated with seizures.
* Eyes deviate AWAY from the hemi-paresis.
. GUILLAIN BARRE' $YNDROME:
___________________________
. Acute idiopathic polyneuropathy.
. Ascending paralysis (i.e. affects LL 1st then involve the rest of the ms upwards!).
. Preceided by infection or vaccination.
. weakness in both legs then ascends to involve the arms, respiratory ms & face.
. Reflexes are diminished or symptoms.
. Distal paresthesia may occur.
. Dx: CSF ANALYSIS -> HIGH PROTEIN CONCENTRATION with NORMAL CELL COUNT.
. ++ PROTEIN & NORMAL (WBCs - RBCs - GLUCOSE) !
. i.e. CYTO-ALBUMINOUS DISSOCIATION.
. Tx: Supportive care, IVIG (Intravenous immunoglobulins) & plasmapharesis.
. GB$ may lead to respiratory failure.
. LUNG VITAL CAPACITY is the best way to monitor the respiratory function.
. N.B. TICK BORNE PARALYSIS:
____________________________
. Progressive ascending paralysis.
. Over hours - days.
. NO fever.
. Normal sensations.
. Normal CSF analysis.
. Meticulous search & removal of the tick results in improvement & complete
recovery.
# PARA-NEOPLASTIC $YNDROMES !
_____________________________
.1. MYASTHENIA GRAVIS:
______________________
. Female 18 - 25 ys.
. NEURO-MUSCULAR JUNCTION DISEASE.
. Muscle weakness after a period of muscle use.
. Dysarthria - Dysphagia.
. Drooping eyelids (Ptosis) - Diplopia (Double vision). {Extraocular ms
involvement}.
. Generalized weakness may develop (trunks - arms - legs). {Bulbar ms
involvement}.
. RESOLUTION OF MUSCULAR WEAKNESS with REST is the HALLMARK of Myasthenia
gravis.
. Dx: CT SCAN CHEST is MANDATORY to exclude THYMOMA.
. Tx: Oral ANTI-CHOLINESTERASES e.g. PYRIDOSTIGMINE & NEOSTIGMINE.
. Immunosuppressive agents & thymectomy may induce remission.
. MYASTHENIC CRISIS may occur resulting in severe weakness of the respiratory
muscles.
. Tx with ENDOTRACHEAL INTUBATION & withdrawal of anti-cholinesterases.
.2. LAMBERT EATON $YNDROME:
___________________________
. H/O of cancer mostly LUNG CANCER (Heavy smoking - weight loss - malaise - lung
mass).
. Small cell carcinoma.
. Proximal ms weakness.
. Auto-antibodies directed against the voltage gated calcium channels,
. leading to -- Acetylcholine release with proximal ms weakness.
. Dx: Electro-physiological studies.
. Tx: Plasmapharesis & immunosuppressive therapy.
. N.B. MYASTHENIA GRAVIS:
_________________________
. Auto-antibodies against the (post)-synaptic receptors.
. INTACT deep tendon reflexes.
. N.B. LAMBERT-EATON $:
________________________
. Auto-antibodies against the (pre) - synaptic receptors.
. LOSS of deep tendon reflexes.
.3. DERMATOMYOSITIS/POLYMYOSITIS:
___________________________________
. MUSCLE FIBER INJURY.
. Symmetric & more proximal ms weakness.
___________________
. ACTION tremor.
. Absence of other neurological signs.
. Suppressed at rest (# parkinsonism).
. Noticed when the pt. attempts a task that requires fine motor movement !
. Tx: BB (Propranolol) is the 1st line of ttt.
. Primidone may be used (Anti-convulsant which may ppt acute intermittent
Porphyria,
. manifested as abdominal pain, neurologic & psychiatric abnormalities.
. MULTIPLE SCLEROSIS:
_____________________
. Affects women in child bearing peiod (15-50 ys).
. Multiple neurological deficits that can't be explained by single lesion.
. "PATCHY" neurological manifestations.
. Optic neuritis (painful loss of vision) & diplopia.
. Sensory symptoms -> Numbness & paresthesia.
. Motor symptoms -> Paraparesis & spasticity.
. Bowel/bladder dysfunction.
. "UHTHOFF phenomenon" Exacerbated by hot weather or exercise !
. "LHERMITTE's sign" Electric shock-like sensation down the spine on flexion of the
neck.
. INTER-NUCLEAR OPHTHALMOPLEGIA (INO) is characteristic:
_______________________________________________________
* On attempted left gaze, the left eye abducts & exhibits horizontal jerk nystagmus,
* but the right eye remains stationary.
* On attempted right gaze, the right eye abducts & exhibits horizontal jerk
nystagmus,
* but the left eye remains stationary.
* caused by demyelination of the MEDIAL LONGITUDINAL FASCICULUS.
. Dx: BRAIN MRI with & without GADOLINIUM.
. MRI:Multiple bilatreal asymmetric hyperintense lesions in periventricular white
matter.
. CSF analysis: OLIGOCLONAL IgG bands - Normal pressure.
. Tx of acute exacerbation -----> HIGH DOSE IV GLUCOCORTICOIDS.
. Tx to prevent future attacks -> B-interferon or Glatiramer acetate.
. N.B. YOUNG FEMALE with BILATERAL TRIGEMINAL NEURALGIA = MS.
. AMYOTROPHIC LATERAL SCLEROSIS:
________________________________
. UPPER + LOWER motor neuron lesions.
. UMNL (Spasticity - bulbar symptoms - exagerrated deep tendon reflexes).
. LMNL (Fasciculations, wasting).
. Tx: RILUZOLE (Glutamate inhibitor) - Steroids are WRONGGGGGGGGGGGGGGG !
. CARPAL TUNNEL $YNDROME = MEDIAN NERVE ENTRAPPMENT $YNDROME:
_____________________________________________________________
. At WRIST !
. Numbness & pain in the palm.
. Thenar eminence atrophy.
.
.
.
.
.
Contralateral hemianesthesia.
Conjugate eye deviation toward the side of stroke.
Homonymous hemianopia.
Aphasia (dominant hemisphere).
Hemi-neglect (Non dominant hemisphere).
_____________________________________________________________________________________
_____
. HEMI-NEGLECT $YNDROME = LESION in the (RIGHT PARIETAL LOBE CORTEX):
_____________________________________________________________________
. Lesion of the RIGHT (NON)-dominant hemi-sphere.
. which is responsible for spatial organization.
. So, In this disease, The pt ignores the left side of a space.
. Responds only to the stimuli coming from the RIGHT side.
. Pt may shave only the Right side of their face.
. Comb the Right side of his hair.
. Ignore the subject located in the left side of a space.
. Dx: Ask the pt to fill in the numbers o a clock !
. EXERTIONAL HEAT STROKE:
_________________________
. Severe exertion under direct sun light.
. Acute confusion, hyperthermia, tachycardia & persistent epistaxis.
. Due to FAILURE OF THERMO-REGULATORY CENTER to maintain a euthermic state.
. Core temperature > 40 with altered mental status.
. Factory workers, Military recruits exposed to hot humid environment.
. Complications: Rhabdomyolysis - RF - ARDS - Coagulopathic bleeding.
. Tx -> EVAPORATION COOLING (NOT immersion in cold water xxx).
. MALIGNANT HYPERTHERMIA:
_________________________
. Genetically susceptible pt during anesthesia.
. Ass. with halothane & succinyl choline.
. Uncotrolled efflux of calcium from the sarcoplasmic reticulum.
. CAVERNOUS SINUS THROMBOSIS:
_____________________________
. Un-controlled infection of the skin, sinuses & orbit may spread to he cavernous
sinus.
. Bec. the facial / ophthalmic venous system is valveless !
. Cav. sinus inflammation may lead to cav. sinus thrombosis & intracranial
hypertension.
. HEADACHE (INTOLERABLE) is the most common symptom.
. Vomiting is common due to ++ ICT.
. Fundoscopy will reveal papilledema.
. Binocular palsies, periorbital edema with hypo/hperesthesia.
. Dx: MRI.
. Tx: Broad spectrum Antibiotics.
. RESTLESS LEG $YNDROME:
________________________
. Uncomfortable "Crawling" sensation or urge to move the legs.
. Discomfort which worsens in the evening or during sleep.
. Discomfort which worsens at rest.
. Discomfort alleviated by movement of the affected limb.
______________________
. Progressive dementia.
. Age, female gender, +ve family H/O, head trauma are common risk factors.
. Subtle memory loss, language difficulties & apraxia.
. Impaired judgement & personality changes.
. N.B. HYPOTHYROIDISM is an imp. cause of reversible changes in memory &
mentation:
___________________________________________________________________________________
. Accompanied by systemic changes e.g. weight gain, fatigue, hoarseness &
constipation.
.4. HUNTINGTON's DISEASE:
_________________________
. Triad of mood disturbances + Choreiform movements + Dementia.
. Due to ATROPHY of the CAUDATE NUCLEUS.
. Autosomal dominant (Gene defect on chromosome 4).
. Affects both sexes equally.
. Family H/O of the disease is present.
. Age 30 - 50 ys.
. Mood disturbances (Depression & apathy).
. Choreiform movements (facial grimacing, ataxia, dystonia, tongue protrusion).
. Writhing movements of the extremeties.
.5. CREUTZFELDT - JAKOB DISEASE:
______________________________
. Age 50 - 70 ys.
. It is a spongiform encephalopathy caused by a prion.
. Rapidly progressive dementia & myoclonus.
. EEG -> SHARP TRI-PHASIC SYNCHRONOUS DISCHARGES.
. Pts die within one year of onset.
.6. NORMAL PRESSURE HYDROCEPHALUS:
________________________________
. Triad of Urine incontinence + Abnormal gait + Dementia.
. Gait -> Broad based & shuffling
. ++ in ventricular size without persistent ++ in ICT.
. Symptoms due to distortion of the periventricular brain matter.
. The cause is -- CSF ABSORPTION.
. Dx: CT or MRI -> ENLARGED VENTRICLES.
. Dx: LP -> NORMAL OPENING PRESSURE.
. Tx: VENTRICULO-PERITONEAL SHUNT.
.7. PSEUDO-DEMENTIA:
____________________
. Major depressive episode may present as pseudo-dementia.
. Elderly pts who r severely depressed may present with memory loss.
. H/O of emotional situation with the pt. (e.g. Pt's son moving out !).
. Symptoms coincides with the emotional situation.
. Tx -> Anti-depressants e.g. SSRIs (SLECTIVE SEROTONIN RE-UPTAK INHIBITORS).
. Diminished tearing.
. Hyperacusis.
. Loss of taste sensation over the anterior 2/3s of the tongue.
. If the lesion in the CNS occuring above the facial nucleus,
. it will typically CONTRALATERAL LOWER FACIAL WEAKNESS SPARING THE
FOREHEAD.
. AMAUROSIS FUGAX:
__________________
. Painless loss of vision.
. Cholesterol particles may be seen in the eye.
. It is a warning sign of impending stroke.
. An underlying embolic disease is most always present.
. Emboli occur at the carotid bifurcation.
. Dx: NECK DUPLEX ULTRA$OUND.
. SUB-DURAL HEMATOMA:
_____________________
. Due to BLUNT or shearing trauma tearing the BRIDGING VEINS.
. causing them to slowly bleed into the subdural space.
. Headache & gradual loss of consciousness occur gradually.
. More common in older pts & alcoholics due to brain atrophy & vessel fragility.
. NON contrast head CT -> WHITE CRESCENT..
. Mass effect with mid line shift may be seen.
. Emergent neurosurgical consultation for hematoma evacuation is necessary.
. EPI-DURAL HEMATOMA:
_____________________
. Trauma to the TEPORAL bone.
. Injury to the MIDDLE MENINGEAL ARTERY.
. Non contrast head CT -> BICONVEX HEMATOMA.
. SYRINGOMYELIA = CORD CAVITATION:
__________________________________
. Idiopathic Cavitary expansion of the spinal cord.
. Affets the upper limbs in a CAPE like distribution.
. Areflexic weakness in the upper extremeties.
. Dissociated anesthesia (Loss of pain & temperature with intact position &
vibration).
. A cord cavity is present !
. Lower cervical or upper thoracic are the most common affected sites.
. DIABETIC NEUROPATHY:
______________________
. Symmetric peripheral polyneuropathy, mononeuropathy or autonomic neuropathy.
. Mononeuropathies either cranial or somatic.
. CN 3 (Oculomotor) is the most common affected.
. The cause of neuropathy is ISCHEMIC.
. Somatic & parasympathetic fibers in CN 3 have separate blood supplies.
. So .. Only somatic fibers are affected while the parasympathetic fibers are intact.
.
.
.
.
.
.
.
.
.
.
.
.5. ABSCESS:
____________
. Solitary.
. {Ring enhancing}.
. Isolated, round with smooth borders.
. H/O of known extra-cranial infections.
. Fluid collection in the maxillary sinus.
. The most common causative organisms are AEROBIC & ANAEROBIC
STREPTOCOCCI & BACTEROIDES.
# CAROTID ARTERY STENOSIS:
__________________________
. May progress to embolic stroke or TIAs.
. May be silent with no symptoms.
. Symptomatic -> sudden onset of focal neuro. syms ipsilateral to the blocked
artery.
. Dx: NECK DUPLEX U/$.
. Tx: CEA or CAS.
. CAROTID END ARTERECTOMY (CEA) is recommended if:
_________________________________________________
. * Symptomatic pts with carotid stenosis 70 - 99 %.
. * Low surgical risk.
. * Good 5 year predicted survival.
. * Surgically accessible carotid lesion.
. CAROTID ANGIOPLASTY WITH STENTING (CAS) is recommended if:
___________________________________________________________
. * High surgical risk.
. * Poor 5 year predicted survival.
. * Lesion not amenable to surgery.
# IMPORTANT CRANIAL NERVES & THEIR FUNCTIONS:
_____________________________________________
* OPTIC NERVE (CN 2):
_____________________
. VISION.
* OCULOMOTOR (CN 3):
____________________
. Eye movement (Most).
. Adduction with medial rectus.
. Elevation with superior rectus.
. Depression with inferior rectus.
. Eye lid opening.
. Pupil constriction.
* TRIGEMINAL (CN 5):
____________________
. Three branches with both motor & sensory fibers.
.3 * BRADYKINESIA:
__________________
. Difficulty initiating movements as when starting to walk or rising from a chair.
. Narrow based, shuffling gait with short strides without arm swing (FESTINATING).
. Micrographia (Small hand writing).
. Hypomimia (-- facial expression).
. Hypophonia (soft speech).
.4 * POSTURAL INSTABILITY:
__________________________
. Flexed axial posture.
. Loss of balance during turning or stopping.
. Loss of balance when pushed slightly.
. Frequent falls.
. NO SPECIAL TEST FOR EXACT DIAGNOSIS.
. ONLY PHYSICAL EXAMINATION CAN LEAD TO THE Dx.
. STATUS EPILEPTICUS:
_____________________
. Single seizure lasting > 30 mins.
. H/O of seizure disorder with no compliance to anti-convulsant therapy.
. A brain seizing > 5 mins is at ++ risk of permanent injury : CORTICAL LAMINAR
NECROSIS.
. Tx -> BENZODIAZEPINE -> IV DIAZEPAM.
. Failed -> ADD FOSPHENOTOIN.
. Failed -> ADD PHENOBARBITAL.
. Failed -> ADD SUCCINYL CHOLINE.
. DELIRIUM:
___________
. Acute confusion state.
. Reduced oe fluctuating level of consciousness.
. Inability to sustain attention.
. Anxiety, agitation & hallucinations.
. Common ppt factors (infections: UTI).
. Polypharmacy, medication side effects, volume depletion & electrolyte imbalance.
. SERUM ELECTROLYTES & URINALYSIS sh'd be done to detect the cause.
. Tx-> Typical & atypical anti-psychotics (HALOPERIDOL).
. Benzodiazepines (Lorazepam) are not recommended in old age.
. ONCE MORE: DIFFERENT CEREBRAL ARTERY OCCLUSIONS & THEIR EFFECTS:
__________________________________________________________________
* MIDDLE cerebral artery occlusion:
____________________________________
. Contralateral motor & sensory deficits.
. More pronounced in the {upper limb} than the lower limb.
. Homonymous hemianopia.
. If the dominant lobe (LEFT) is involved ------> APHASIA.
_________________________________________
. NORMAL PRESSURE HYDROCEPHALUS = Triad of Urine incontinence + Abnormal
gait + Dementia.
_____________________________________________________________________________________
____
. BENIGN IDIOPATHIC INTACRANIAL HYPERTENSION = PSEUDOTUMOR CEREBRI:
___________________________________________________________________
. Over-weight female in the child bearing period.
. H/O of OCPs intake or hypervitaminosis A.
. Headache - transient loss of vision - pulastaile tinnitus - diplopia.
. Dx: MRI & LP (CSF opening pressure > 250 mmHg with NORMAL analysis).
=========================
. KEY-WORDS to RE-MEMBER:
=========================
. OLIGO-CLONAL BANDS -> MS.
. CYTO-ALBUMINOUS DISSOCIATION -> GB$.
. HEMORRHAGE -> HYPER-dense areas on CT. (WHITE).
. INFARCTIONS -> HYPO-dense areas on CT. (BLACK).
.
.
.
.
.
.
.
.
.
GAITS
FESTINATING = HYPOKINETIC = SHUFFLING -> PARKINSONISM.
HIGH STEPPAGE -------------------------> TABES DORSALIS or L5 Radiculopathy.
SEMI-CIRCLE ---------------------------> STROKE HEMIPLEGIA.
WADDLING ------------------------------> MUSCULAR DYSTROPHY.
WIDE BASED & SHUFFLING ----------------> NORMAL PRSSURE HYDROCEPHALUS.
IPSILATERAL ATAXIA --------------------> CEREBELLAR ATAXIA.
SPASTIC -------------------------------> UMNL UPPER MOTOR NEURON LESION:
STAGGERING ----------------------------> VESTIBULAR ATAXIA.
. TREMORS
. RESTING TREMORS (PARKINSON)-> At rest,imp. e' activity,High frequency tremors
5-7 Hz.
. ESSENTIAL TREMORS-> Worst at the end of the goal directed activity (reaching a
pen).
. CEREBELLAR TREMORS -> Intension tremors - low fequency 3-4 Hz - Nystagmus &
ataxia.
. TRIGEMINAL NEURALGIA: LIGHTENING PAIN on the face - electric shock - Tx:
CARBAMAZEPINE.
. GUILLAIN BARRE'$: Ascending paralysis - Pre.by infection - CYTOALBUMINOUS
DISSOCIATION.
. TICK BORNE PARALYSIS: Ascending paralysi - NO fever - Normal CSF - Tx: Tick
removal.
. MYASTHENIA GRAVIS: Ptosis,Diplopia RESOLUTION OF MUSCULAR WEAKNESS
WITH REST.
. LAMBERT EATON $YNDROME: LUNG CANCER H/O, Auto-Abs against voltage gated
Ca channels.
. N.B. MYASTHENIA GRAVIS: AutoAbs against (post)synaptic recs - INTACT DTRs.
. N.B. LAMBERT-EATON $: AutoAbs against (pre)synaptic receptors - LOST DTRs.
. DERMATOMYOSITIS: Sym. prox. ms weakness - SKIN (Gottron's papules &
Heliotrope rash).
. STEROID INDUCED MYOPATHY: Prox. ms weakness (LL before UL) - No pain.
. SUB-ARACHNOID HEMORRHAGE: Rupture of "Berry" aneyrysm - WORST
HEADACHE EVER.
. NEURO-FIBROMATOSIS "2": S.C. neurofibromas + Cafe' au lait spots + acoustic
neuromas.
. PRONATOR DRIFT = UMNL.
. ESSENTIAL TREMOR: Tx: BB "Propranolol".
. MULTIPLE SCLEROSIS
. MULTIPLE SCLEROSIS
. MULTIPLE SCLEROSIS
. MULTIPLE SCLEROSIS
. MULTIPLE SCLEROSIS
GLUCOCORTICOIDS.
. MULTIPLE SCLEROSIS
acetate.
. MULTIPLE SCLEROSIS
=
=
=
=
=
. UN-PROVOKED FIRST SEIZURE -> HEAD CT WITHOUT CONTRAST is the 1st initial
step done.
. LIMB ISCHEMIA: 5 Ps (Pain - Pallor - Paresthesia - Pulselessness & Paralysis).
. METOCLOPRAMIDE: Side effect Dystonia - Manifested by stiff painful neck.
. HEMI-NEGLECT $YNDROME: RIGHT PARIETAL LOBE CORTEX lesion - (NON)dominant hemi-sphere.
. EXERTIONAL HEAT STROKE: Tx -> EVAPORATION COOLING (NOT immersion in cold
water xxx).
. CAVERNOUS SINUS THROMBOSIS: Dx: MRI - Tx: Broad spectrum Antibiotics.
. RESTLESS LEG $YNDROME: "Crawling" sensation - Tx : Dopaminergic agonists e.g.
L-dopa.
. WERNICKE's ENCEPHALOPATHY: ecephalopathy,oculomotor dysf. & gait ataxia.(-Vit B1).
. DECUBITUS ULCER: Preveted by repositioning of the pt every 2-4 hours.
. LEVO-DOPA / CARBI-DOPA Side effects: Most common side effect is
HALLUCINATIONS.
. TRI-HEXY-PHENIDYL:
Red as beet, dry as bone, hot as hare, blind as bat, mad as hatter & full as a flask.
. DEMENTIAS
. FRONTO-TEMPORAL : Personality changes (euphoria - disinhibition - apathy).
. LEWY BODIES DEMENTIA: Bizarre visual hallucinations.
. ALZHEIMER's DISEASE: Progressive dementia - Impaired judgement & personality
changes.
. HUNTINGTON's DISEASE: Triad of mood disturbances + Choreiform movements +
Dementia.
. CREUTZFELDT - JAKOB DISEASE: EEG -> SHARP TRI-PHASIC SYNCHRONOUS
DISCHARGES.
. NORMAL PRESSURE HYDROCEPHALUS: Triad of Urine incontinence + Abnormal
gait + Dementia.
. PSEUDO-DEMENTIA: Tx -> SSRIs.
. NORMAL AGING: Absence of functional impairments.
. BRAIN DEATH: DTRs may be STILL PRESENT - MUST BE CONFIRMED BY TWO
PHYSICIANS.
. SHY DRAGER $YNDROME: MULTIPLE SYSTEM ATROPHY - PARKINSON pt. + bladder
loss of control.
. Chronic alcohol abuse -> Cerebellar damage.