KAPITA SELEKTA

NEUROLOGI
Dept. Neurologi
FKUAJ/RSA

Human Nervous System

Neurological Levels
Brain
Brainstem
Spinal cord
Motor neuron
Peripheral nerve
Neuromuscular junction
Muscle

Neurological Levels

Brain

Brainstem
Spinal cord
Motor neuron
Peripheral nerve
Neuromuscular junction
Muscle

Often unilateral
Motor and/or sensory
Language
Consciousness
Memory
Behavior
Vision
Seizures
Movement d/o

Neurological Levels

Brain

Brainstem

Spinal cord
Motor neuron
Peripheral nerve
Neuromuscular junction
Muscle

Often unilateral
Motor and/or sensory
Consciousness
Cerebellar
Movement d/o
Cranial nerves

Diplopia
Vertigo
Face
Swallow
Tongue

Neurological Levels

Brain
Brainstem

Spinal cord

Motor neuron
Peripheral nerve
Neuromuscular junction
Muscle

Often bilateral
Motor and/or sensory
Head OK
Bowel and bladder

Neurological Levels

Brain
Brainstem
Spinal cord

Motor neuron

Peripheral nerve
Neuromuscular junction
Muscle

Asymmetric bilateral
Motor only
Proximal and distal
Insidious onset
Fasciculations

Neurological Levels

Brain
Brainstem
Spinal cord
Motor neuron

Peripheral nerve
Neuromuscular junction
Muscle

Symmetric or focal
Sensory > motor
Often distal
Stocking-glove

If proximal think
Demyelinating (UE + LE)
Cauda equina (LE)

Neurological Levels

Brain
Brainstem
Spinal cord
Motor neuron
Peripheral nerve

Neuromuscular
junction
Muscle

Asymmetric bilateral
Motor only
Proximal and distal
Eyes involved in
myasthenia gravis

Fatigable weakness
Myasthenia gravis

Progressive weakness
Lambert-Eaton
myasthenic syndrome

Neurological Levels

Brain
Brainstem
Spinal cord
Motor neuron
Peripheral nerve
Neuromuscular junction

Muscle

Symmetric bilateral
Motor only
Usually proximal

Case 1
History of Present Illness (HPI)
This is a 42 yo woman with progressive leg weakness
and numbness over the last 6 months. The left is a little
worse than the right. The sensory loss involves most of
the left leg, and below the knee on the right. Urinary
frequency and urgency are present.
Review of System: (+) mild back pain, constipation, and
poor balance walking with one fall.
(-) fever, speech, cognition, swallow, hearing, dizziness,
vision, diplopia, or headache.

Case 1
Past Medical History (PMH)
HTN, hypothyroid, psoriasis, hysterectomy
MEDICATIONS: enalapril, synthroid, MVI
Family History (FH)
Mother with lupus, father is healthy, sister with type 2 DM
Social History (SH): Stay at home mom. One EtOH
per week. Smoked in college. No illicet drugs.

LOCALIZE
A.
B.
C.
D.
E.
F.
G.

Brain
Brainstem
Spinal cord
Motor neuron
Peripheral nerve
Neuromuscular
junction
Muscle

Case 1
Physical Examination (PE):
Vitals: 128/64, 72, 14
Mental Status: Alert
Cranial Nerves: Normal
Motor: Mild 4/5 weakness in left hip flexion, knee flexion and foot
dorsiflexion. Spastic tone L > R. No atrophy.
Sensory: Mild diffuse decrease in light touch in the L > R leg
compared to the arm. Vibration reduced in the left toe. The
abdomen also had mild reduced sensation to pinprick.
Reflexes: UE 2/4. 3/4 knees, 3/4 R ankle, 4/4 (clonus) L ankle.
L (+) Babinski sign.
Cerebellar: FNF normal. HKS impaired by spasticity.
Gait: Gait unstable with left circumduction.
Movements: None

LOCALIZE
A.
B.

Spinal cord
Peripheral nerve

Differential: VINDICATE-O

Vascular
Infection
Neoplastic
Drugs/Toxins
Inflammatory/Autoimmine
Congenital/Inherited
Allergic
Trauma
Endocrine
Other

Vascular
malformation

Differential: VINDICATE-O

Vascular
Infection
Neoplastic
Drugs/Toxins
Inflammatory/Autoimmine
Congenital/Inherited
Allergic
Trauma
Endocrine
Other

HTLV-I, II
Abscess

Differential: VINDICATE-O

Vascular
Infection
Neoplastic
Drugs/Toxins
Inflammatory/Autoimmine
Congenital/Inherited
Allergic
Trauma
Endocrine
Other

Primary spinal cord

tumor
Metastatic cancer
with cord
compression

Differential: VINDICATE-O

Vascular
Infection
Neoplastic
Drugs/Toxins
Inflammatory/Autoimmine
Congenital/Inherited
Allergic
Trauma
Endocrine
Other

Multiple sclerosis
Lupus myelitis

Differential: VINDICATE-O

Vascular
Infection
Neoplastic
Drugs/Toxins
Inflammatory/Autoimmine
Congenital/Inherited
Allergic
Trauma
Endocrine
Other

Hereditary spastic
paraparesis

Differential: VINDICATE-O

Vascular
Infection
Neoplastic
Drugs/Toxins
Inflammatory/Autoimmine
Congenital/Inherited
Allergic
Trauma
Endocrine
Other

Spinal stenosis from

osteophyte or disc

Differential: VINDICATE-O

Vascular
Infection
Neoplastic
Drugs/Toxins
Inflammatory/Autoimmine
Congenital/Inherited
Allergic
Trauma
Endocrine
Other

B12 deficiency
Copper deficiency

Differential: Summary

Vascular
Infection
Neoplastic
Inflammatory/Autoimmine
Congenital/Inherited
Trauma
Endocrine

Prioritize the
possible causes and
start your work-up.
Experience.

Testing
Labs: B12 and copper normal
MRI: Thoracic parenchymal mass

MRI

Axial T2

Saggital T1 + gadolinium

Diagnosis

Ependymoma