Neurology | Master Of Medicine

Category Archives: Neurology

Basal ganglia and their classification

This diagram shows the pathways between the nu...

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The basal ganglia is an important part of the brain which program impulses from cerebral cortex and initiates motor activities through cerebellum and corticospinal tracts. Parkinsonism is a disorder in which there is decrease in the dopaminergic neurons in the striatum which results in motor impairment.

The components of the basal ganglia are:

Corpus Striatum- Caudate+Lentiform nucleus.

Lentiform nucleus- Putamen+Globus pallidus.

Striatum - Caudate nucleus+Putamen.

 

 

Lateral medullary syndrome

Also known as Wallenberg syndrome.

Vertebral artery is the most commonly involved artery (V4 segment) or Posterior Inferior cerebellar artery(PICA)

Right sided lateral medullary lesion

  1. Loss of pain and temperature in right side of face and left side of body.
  2. Ipsilateral palatal palsy and loss of gag reflex due to involvement of IXth and Xth cranial nerves.
  3. Ipsilateral ataxia nad horners syndrome(because sympathetic chain runs along this course)
  4. Dysphagia,nystagmus.
  5. Loss of taste sensation on ipsilateral part of tongue.
  6. No hemiplegia/Hemiparesis.

Midbrain and pontine syndromes

This is a section in the transverse plane thro...

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Midbrain Syndromes

Weber’s syndrome

Ipsilateral 3rd Nerve palsy with contralateral hemiplegia

Nothnagels Syndrome

  1. Due to superior cerebellar peduncle injury.
  2. Ipsilateral 3rd nerve palsy with Contralateral cerebellar ataxia

Benedicts Syndrome

  1. Due to involvement of red nucleus
  2. Ipsilateral 3rd nerve palsy with contralateral chorea,tremors, athetosis.

Claudes Syndrome

  1. Combination of features of benedicts and Nothnagel’s syndromes.
  2. 3rd N palsy with contralateral tremor and ataxia, no hemiparesis.

Perinaud’s syndrome

  1. Dorsal Midbrain sydrome
  2. Paralysis of upgaze
  3. Pseudo Argyll Robertson’s pupils:Light near dissociation
  4. Skew deviation
  5. Lid retraction(Colliers sign)
  6. Setting sun sign:Downward ocular deviation
  7. Seen in pinealomas,Obstructive hydrocephalus

Pontine Syndromes

Raymond Cestan Syndrome

  1. Upper dorsal pontine syndrome
  2. Ipsilateral ataxia,tremor,INO,contalateral hemiparesis

Millard Gubler Syndrome

  1. Ventral paramedian pontine lesion involving 6th and 7th fascicles and the pyramidal tract
  2. Lateral rectus palsy

Fovilles syndrome

  1. Lower pontine tegmental lesion involving PPRF,6th N,7th N,pyramidal tract.
  2. Lateral gaze palsy present

Locked In syndrome

  1. Bilateral pontine infarction/bleed
  2. Quardiplegia, consiousness preserved
  3. Only vertical eye movements present.

Gait disturbances with their causes.

Festinant gait – Parkinsonism

Reeling/ Ataxic gait – Cerebellar vermis involvement.

Stamping/Tabetic gait – Sensory ataxia.

Steppage/ Equine gait – Foot drop.

Waddling gait/ Trendelenberg gait – Gluteal muscle weakness.

Toppling gait – Vestibular neuronitis, Brainstem strokes.

Apraxic gait, paratonia(Gegenhalten), Bruns ataxia – Frontal lobe involvement.

Circumductive gait – Hemiplegia.

Astasia- Abasia - Hysterical.

Guillain Barre syndrome and variants

Guillain Barre Syndrome

  1. Ascending Areflexic paralysis
  2. Minimal or no sensory loss
  3. Preceded by infection with Campylobacter Jejuni(MC),CMV,Mycoplasma
  4. Autoantibodies against gangliosides usually anti GM1.
  5. IVIg is the treatment of choice,plasmapheresis also done.

GBS variants

AIDP

  1. Seen in adults
  2. Demyelinating disorder
  3. Anti GM1 antibodies
  4. Rapid recovery

AMAN

  1. Mainly affects children
  2. Axonal disease
  3. Anti GD1A antibodies
  4. Rapid recovery

AMSAN

  1. Adults
  2. Axonal disease
  3. Slow recovery
  4. Similar to AMAN

Miller Fisher

  1. Characterised by Opthalmoplegia,ataxia,Areflexia
  2. Anti GQ1b antibodies
  3. Demyelinating disorder.

Causes of Reversible Dementia

  • Wernickes Encephalopathy
  • Hypothyroidism
  • Cushings syndrome
  • Organ failure
  • Neurosyphilis
  • Whipples disease
  • Chronic Subdural hematoma
  • Normal pressure hydrocephalus
  • Drugs,medications,Narcotics
  • Depression(pseudo dementia)
  • Schizophrenia
  • Vasculitis
  • Acute intermittent porphyria
  • Recurrent non convulsive seizures

Channelopathies

Sodium Channel

  1. Hyperkalemic Periodic paralysis
  2. Paramyotonia congenita
  3. Congenital Long QT syndrome
  4. Brugada syndrome
  5. Myoclonic epilepsy

Pottassium Channel

  1. Jervell Lange Nielsen Syndrome
  2. Acquired neuromyotonia- Isaac’s syndrome
  3. Episodic Ataxia 1
  4. Andersens syndrome

Calcium Channel

  1. Hypokalemic Periodic Paralysis
  2. Malignant Hyperthermia
  3. ARDVC
  4. Familial Hemiplegic Migraine
  5. Epiodic Ataxia 2
  6. Spinocerebellar Ataxia-2
  7. Central core disease

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