Professional Documents
Culture Documents
DDX feature of subarachnoid hemorrhage: pain does not go away. This is a headache telling you that there is bleeding
somewhere: it is trying to tell you something.
INTRACEREBRAL HEMATOMA
• Result of severe head trauma that destroys part of the brain. Not usually something you need to DDX: trauma will be
obvious.
• Symptoms will depend on the part of the brain that is affected. Can be fatal, or full recovery is possible.
• On CT: the hemorrhage is white in colour. Looks like bone.
• In case of overextension of neck, chin, will always injure the part that is being stretched. Injuries that will cause this:
whiplash (improperly positioned head rest in car accident). If head goes back, anterior part of cord will be stretched,
and posterior will be compressed.
• Flexion injury (example given was hanging!): stretch posterior aspect, compression of anterior. Cause of death in
hanging is shearing force applied to C1-C0.
• Transection: motor vehicle accident, surgical mistakes, space-occupying lesions. If you survive this, there is
permanent disability. Loss of autonomic functions.
CORD SYNDROMES
• Presentation of pathologies that are clinically relevant.
• The history is about 80% of the case: helps you find out where damage is.
• Upper motor neurons: injury to these causes spastic paralysis. “Upper” is above decussation (where the neuron
crosses the spinal cord.) This happens in an area, around mid-brain (above and below this too). Reflexes still work.
• Injury to lower motor neuron: no reflexes, flaccid paralysis.
• Look at injury and see if it is unilateral or bilateral.
BROWN-SEQUARD’S SYNDROME
• Severed half of spinal cord.
• Can trace the areas of sensory deficit on their skin.
• Clean-cut vs. slanted cut: pattern to loss of sensation.
• See functions of tracts in notes.
• Cut to the “middle” of the spinal cord, but a partial cut may have the same effect as a cut to the absolute centre of
cord.
• Patient can still feel crude touch, but not pain. Can tell that they are being touched, but can’t determine what it is,
quality.
• Re: dermatome chart: there is always overlap between these areas. When you identify an area as “L3”, this is the
nerve that dominates it, but L2 and L4 probably have some function here. Muscles don’t have this kind of overlap (not
as much).
• Peripheral nerves are made of more than one root. Cut these nerves, you lose all of their function. Complete loss.
• Read the rest of this page, but chart and “myelopathy due to mass lesions” not covered in class. We are still
responsible for it, but he is highlighting the most important sections.
HEADACHES
• What is a “serious” headache? ALARM SIGNS: One that won’t go away. One that is recurrent that is now happening
more frequently, with more intensity, longer duration. Loss of vision, flashes of light. Crescendo: headache that
keeps getting worse, worse worse, then gives you a break. (Like an obstruction colic in the head). Meds have
stopped working that used to work. Headaches that wake someone up at night (sleep usually relieves headaches),
signs of meningial inflammation.
• (A “worst _______ ever!” should always get your attention)
• If you get a headache every day at the same time, for the same length of time, it is probably something in your
environment that you are reacting to.
• Most headaches are benign. If you get the flags above, there is a much more serious underlying cause: no
watching/waiting.
SEIZURES
• Rigor: children that have seizures. Not related to epilepsy
• Seizures in children are NOT a sign that the body isn’t doing well. Children may just have a slightly higher incidence
of epilepsy.
• Doesn’t mean that you don’t need to address it. Is there an underlying cause? Dehydration, electrolyte imbalance…
ETIOLOGY OF EPILEPSY
• Can measure electrical activity during seizure. Electro-chemical, magnetic event.
• Hypoxia: can get seizures from this. Pass out and have seizures while regaining consciousness.
• Storage diseases: make you more susceptible to seizures.
• Epilepsy is a diagnosis of exclusion