AN INTRODUCTION    TO CLINICAL NEUROSIENCES                  WALID MAANI           PROFESSOR OF NEUROSURGERY08/18/12      ...
IT IS VERY DIFFICULT TO            DO     THIS IN ONE HOUR08/18/12   FOURTH YEAR LECTURE   2
PRESENTATON OF CENTRAL NERVOUSSYSTEM PROBLEMS• HOW DO CRANIAL LESIONS PRESENT?• HOW DO SPINAL PROBLEMS PRESENT?08/18/12   ...
PRESENTATION OF CRANIAL LESIONS                                             SULCI    THIS IS HOW THE     INTRACRANIAL     ...
PRESENTATION OF CRANIAL LESIONS   SUDDEN:       CEREBRO-VASCULAR ACCIDENTS           INTRACEREBRAL HEMORRHAGE         ...
PRESENTATION OF CRANIAL LESIONS SUDDEN:   CEREBRO-VASCULAR ACCIDENTS      INTRACEREBRAL HEMORRHAGE      SUBARACHNOID H...
INTRACEREBRAL HEMORRHAGE08/18/12   FOURTH YEAR LECTURE                             7
INTRACEREBRAL HEMORRHAGE MAY CAUSE DEATH MAY CAUSE LOC DESTRUCTION OF BRAIN AREAPRESENTS WITH: SUDDEN HEADACHE SUDDEN...
PRESENTATION OF CRANIAL LESIONS SUDDEN:   CEREBRO-VASCULAR ACCIDENTS      INTRACEREBRAL HEMORRHAGE      SUBARACHNOID H...
SUBARACHNOID HEMORRHAGE08/18/12   FOURTH YEAR LECTURE                             10
SUBARACHNOID HEMORRHAGE   MAY CAUSE DEATH   SUDDEN HEADACHE   LOC   EPILEPSY   NECK RIGIDITY   MAY BE ASSOCITAED    ...
PRESENTATION OF CRANIAL LESIONS SUDDEN:   CEREBRO-VASCULAR ACCIDENTS      INTRACEREBRAL HEMORRHAGE      SUBARACHNOID H...
INFARCTION08/18/12     FOURTH YEAR LECTURE                               13
INFARCTION   MAY BE ISCHAEMIC   MAY BE HEMORRHAGIC   MAY BE UN-NOTICED   LOC   EPILEPSY   DESTRUCTION OF BRAIN:    ...
PRESENTATION OF CRANIAL LESIONS SUDDEN:   CEREBRO-VASCULAR ACCIDENTS      INTRACEREBRAL HEMORRHAGE      SUBARACHNOID H...
TRAUMAEXTRADURAL HEMATOMA BRAIN CONTUSION 08/18/12   FOURTH YEAR LECTURE                              16
TRAUMA   HISTORY OF TRAUMA   DEATH   LOC   EPILEPSY   PARALYSIS   SPEECH PROBLEMS   VISUAL PROBLEMS08/18/12       F...
PRESENTATION OF CRANIAL LESIONS SUDDEN:   CEREBRO-VASCULAR ACCIDENTS      INTRACEREBRAL HEMORRHAGE      SUBARACHNOID H...
INFECTIONTHE UNDERSURFACE OF THE BRAIN IN MENINGITIS  08/18/12    FOURTH YEAR LECTURE                                19
INFECTION   GRADUAL   FEVER   LETHARGY   NECK RIGIDITY   LOC   EPILEPSY   PARALYSIS   DEATH08/18/12            FOU...
PRESENTATION OF CRANIAL LESIONS SUDDEN:   CEREBRO-VASCULAR ACCIDENTS      INTRACEREBRAL HEMORRHAGE      SUBARACHNOID H...
NEOPLASTIC LESIONSBRAIN METASTASES     BRAIN GLIOMA08/18/12   FOURTH YEAR LECTURE                             22
NEOPLASTIC LESIONS   GRADUAL   EPILEPSY   PARALYSIS   SENSORY PROBLEMS   SPEECH PROBLEMS   VISUAL PROBLEMS   BALANC...
THE NORMAL PICTURET1 WEIGHTED MRI      T2 WEIGHTED MRI08/18/12   FOURTH YEAR LECTURE                             24
NOW IMAGINE IF WE ADD SOMETHING       ELSE TO THE CONTENTSDISPLACED           BRAIN OEDEMA MIDLINE                        ...
ADDITION OF NEW CONTENTS•   INCREASE IN THE INTRACRANIAL PRESSURE•   IRRITATION OF THE AREA•   PRESSURE ON THE AFFECTED AR...
INCREASE IN THE INTRACRANIAL PRESSURE• SYMPTOMS:   • HEADACHE   • VOMITING   • VISUAL PROBLEMS   • INCREASE IN THE SIZE OF...
INCREASE IN THE INTRACRANIAL PRESSURE• SYMPTOMS:                       IS A MORNING   •   HEADACHE                 HEADACH...
INCREASE IN THE INTRACRANIAL PRESSURE                                   IS A MORNING• SYMPTOMS:                      VOMIT...
INCREASE IN THE INTRACRANIAL PRESSURE                                 COULD BE IN THE• SYMPTOMS:                     FORM ...
INCREASE IN THE INTRACRANIAL PRESSURE• SYMPTOMS:                   THIS OCCURS   • HEADACHE                            ONL...
INCREASE IN THE INTRACRANIAL PRESSURE                       IS SWELLING OF THE• SIGNS                  OPTIC DISC AND   • ...
IRRITATION OF THE AREA                       THERE ARE MANY FORMS    THIS LEADS TO           OF EPILEPSY:   EPILEPSY IF T...
PRESSURE ON THE AFFECTED AREA                                          or                                       tum val   ...
PRESSURE ON THE AFFECTED AREADESTRUCTION OF THE AFFECTED AREA• SUPRATENTORIAL:   • FRONTAL   • TEMPORAL   • PARIETAL   • O...
PRESSURE ON THE AFFECTED AREADESTRUCTION OF THE AFFECTED AREA SUPRA TENTORIAL LESIONS: FRONTAL LOBE AFFECTION:   DISTUR...
PRESSURE ON THE AFFECTED AREADESTRUCTION OF THE AFFECTED AREA TEMPORAL LOBE AFFECTION:   EXPRESSIVE DYSPHASIA OR APHASIA...
PRESSURE ON THE AFFECTED AREADESTRUCTION OF THE AFFECTED AREA PARIETAL LOBE AFFECTION:    RECEPTIVE DYSPHASIA OR APHASIA...
PRESSURE ON THE AFFECTED AREADESTRUCTION OF THE AFFECTED AREA OCCIPITAL LOBE AFFECTION:    VISUAL FIELD DEFECTS     (HOM...
PRESSURE ON THE AFFECTED AREA  DESTRUCTION OF THE AFFECTED AREA INFRATENTORIAL TUMORS    ATAXIA    NYSTAGMUS    OBSTRU...
DESTRUCTION COULD RESULT FROMOCCLUSION OF A MAJOR ARTERY INTERNAL CAROTID ARTERY   ANTERIOR CEREBRAL   MIDDLE CEREBRAL...
DESTRUCTION COULD RESULT FROM OCCLUSIONOF A MAJOR ARTERY  INTERNAL CAROTID ARTERY    ANTERIOR CEREBRAL    MIDDLE CEREBR...
DESTRUCTION COULD RESULT FROM OCCLUSION OF A MAJOR ARTERY                         • CONTRALATERAL INTERNAL CAROTID       ...
DESTRUCTION COULD RESULT FROM OCCLUSION OF A MAJOR ARTERY INTERNAL CAROTID       • COMA   ARTERY               • CONTRAL...
DESTRUCTION COULD RESULT FROM OCCLUSION OF A MAJOR ARTERY INTERNAL CAROTID  ARTERY   ANTERIOR CEREBRAL    • CONTRALATERA...
OBSTRUCTION OF CSF PATHWAYS        WILL LEAD TO DILATATION OF THE      VENTRICULAR SYSTEM AND SIGNS AND                SYM...
OBSTRUCTION OF CSF PATHWAYS  IN INFANTS AND LITTLE     CHILDERN IT WILL LEAD TO ENLARGMENT OF  THE HEAD DUE TO THE   FACT ...
OBSTRUCTION OF CSF PATHWAYS     BESIDE ENLARGMENT OF THE HEAD,  DILATATION OF THE VENTRICULAR SYSTEM    WILL LEAD TO DETER...
OBSTRUCTION OF CSF PATHWAYS            THE GLASGOW COMA SCALE Points    Eye Opening    Best Verbal Response   Best Motor R...
THE GLASGOW COMA SCALE• A NORMAL PERSON WOULD SCORE 15   • 6 FROM FOLLOWING COMMAND   • 5 FROM APPROPRIATE VERBAL RESPONSE...
HORMONAL PROBLEMS  USUALLY IN PROBLEMS OF THE PITUITARY       GLAND OR THE PINEAL BODY. INCREASE PITUITARY SECRETION LEADS...
HORMONAL PROBLEMS  USUALLY IN PROBLEMS OF THE PITUITARY       GLAND OR THE PINEAL BODY. INCREASE PITUITARY SECRETION LEADS...
HORMONAL PROBLEMS      DUE TO THE OVER     SECRETION OF THE     GROWTH HORMONE    AFTER THE EPIPHYSIS        HAD UNITED: ...
HORMONAL PROBLEMS  USUALLY IN PROBLEMS OF THE PITUITARY       GLAND OR THE PINEAL BODY. INCREASE PITUITARY SECRETION LEADS...
HORMONAL PROBLEMS  DUE TO THE OVER  SECRETION OF THE  GROWTH HORMONEBEFORE THE EPIPHYSIS    HAD UNITED.08/18/12      FOURT...
HORMONAL PROBLEMS  USUALLY IN PROBLEMS OF THE PITUITARY       GLAND OR THE PINEAL BODY. INCREASE PITUITARY SECRETION LEADS...
EXAMPLES OF PITUITARY LESIONS08/18/12   FOURTH YEAR LECTURE                             57
PRESENTATION OF SPINAL LESIONS• SUDDEN:   • VASCULAR ACCIDENTS      • INTRASPINAL HEMORRHAGE      • INFARCTION• RAPID:  • ...
PRESENTATION OF SPINAL LESIONS SPINAL CORD LESIONS   LOSS OF POWER BELOW THE LEVEL   LOSS OF SENSATION BELOW THE LEVEL ...
PRESENTATION OF SPINAL LESIONS ACUTE PRESENTATION       CHRONIC PRESENTATION   LOSS OF POWER            LOSS OF POWER ...
PRESENTATION OF CORD LESIONS    EXAMPLE OF A  SPINAL CORD LESION       (TUMOUR)                      INTRADURAL SPINAL    ...
PRESENTATION OF ROOT LESIONS     EXAMPLE OF A  SPINAL ROOT LESION   (PROLAPSED DISC)                      PROLAPSED DISC O...
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Introduction to neurosciences to 4 th year medical students

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A presentation introducing medical students who have just finished their basic sciences years to clinical neurosciences.

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Introduction to neurosciences to 4 th year medical students

  1. 1. AN INTRODUCTION TO CLINICAL NEUROSIENCES WALID MAANI PROFESSOR OF NEUROSURGERY08/18/12 FOURTH YEAR LECTURE 1
  2. 2. IT IS VERY DIFFICULT TO DO THIS IN ONE HOUR08/18/12 FOURTH YEAR LECTURE 2
  3. 3. PRESENTATON OF CENTRAL NERVOUSSYSTEM PROBLEMS• HOW DO CRANIAL LESIONS PRESENT?• HOW DO SPINAL PROBLEMS PRESENT?08/18/12 FOURTH YEAR LECTURE 3
  4. 4. PRESENTATION OF CRANIAL LESIONS SULCI THIS IS HOW THE INTRACRANIAL CONTENTS ARE VENTRICLE ARRANGED AS SEEN ON MAGNETIC CHOROID PLEXUS RESONANCE MIDLINE IMAGING (MRI) T1 WEIGHTED MRI08/18/12 FOURTH YEAR LECTURE 4
  5. 5. PRESENTATION OF CRANIAL LESIONS SUDDEN:  CEREBRO-VASCULAR ACCIDENTS  INTRACEREBRAL HEMORRHAGE  SUBARACHNOID HEMORRHAGE  INFARCTION  TRAUMA RAPID:  INFECTION GRADUAL:  NEOPLASTIC LESIONS08/18/12 FOURTH YEAR LECTURE 5
  6. 6. PRESENTATION OF CRANIAL LESIONS SUDDEN: CEREBRO-VASCULAR ACCIDENTS INTRACEREBRAL HEMORRHAGE SUBARACHNOID HEMORRHAGE INFARCTION TRAUMA RAPID: INFECTION GRADUAL NEOPLASTIC LESIONS08/18/12 FOURTH YEAR LECTURE 6
  7. 7. INTRACEREBRAL HEMORRHAGE08/18/12 FOURTH YEAR LECTURE 7
  8. 8. INTRACEREBRAL HEMORRHAGE MAY CAUSE DEATH MAY CAUSE LOC DESTRUCTION OF BRAIN AREAPRESENTS WITH: SUDDEN HEADACHE SUDDEN PARALYSIS SPEECH PROBLEMS SENSORY DISTURBANCES VISUAL DISTURBANCES08/18/12 FOURTH YEAR LECTURE 8
  9. 9. PRESENTATION OF CRANIAL LESIONS SUDDEN: CEREBRO-VASCULAR ACCIDENTS INTRACEREBRAL HEMORRHAGE SUBARACHNOID HEMORRHAGE INFARCTION TRAUMA RAPID: INFECTION GRADUAL NEOPLASTIC LESIONS08/18/12 FOURTH YEAR LECTURE 9
  10. 10. SUBARACHNOID HEMORRHAGE08/18/12 FOURTH YEAR LECTURE 10
  11. 11. SUBARACHNOID HEMORRHAGE MAY CAUSE DEATH SUDDEN HEADACHE LOC EPILEPSY NECK RIGIDITY MAY BE ASSOCITAED WITH PARALYSIS IF ACCOMPANIED BY INTRACEREBRAL HEMORRHAGE08/18/12 FOURTH YEAR LECTURE 11
  12. 12. PRESENTATION OF CRANIAL LESIONS SUDDEN: CEREBRO-VASCULAR ACCIDENTS INTRACEREBRAL HEMORRHAGE SUBARACHNOID HEMORRHAGE INFARCTION TRAUMA RAPID: INFECTION GRADUAL NEOPLASTIC LESIONS08/18/12 FOURTH YEAR LECTURE 12
  13. 13. INFARCTION08/18/12 FOURTH YEAR LECTURE 13
  14. 14. INFARCTION MAY BE ISCHAEMIC MAY BE HEMORRHAGIC MAY BE UN-NOTICED LOC EPILEPSY DESTRUCTION OF BRAIN:  PARALYSIS  SPEECH PROBLEMS  VISUAL PROBLEMS  SENSORY PROBLEMS08/18/12 FOURTH YEAR LECTURE 14
  15. 15. PRESENTATION OF CRANIAL LESIONS SUDDEN: CEREBRO-VASCULAR ACCIDENTS INTRACEREBRAL HEMORRHAGE SUBARACHNOID HEMORRHAGE INFARCTION TRAUMA RAPID: INFECTION GRADUAL NEOPLASTIC LESIONS08/18/12 FOURTH YEAR LECTURE 15
  16. 16. TRAUMAEXTRADURAL HEMATOMA BRAIN CONTUSION 08/18/12 FOURTH YEAR LECTURE 16
  17. 17. TRAUMA HISTORY OF TRAUMA DEATH LOC EPILEPSY PARALYSIS SPEECH PROBLEMS VISUAL PROBLEMS08/18/12 FOURTH YEAR LECTURE 17
  18. 18. PRESENTATION OF CRANIAL LESIONS SUDDEN: CEREBRO-VASCULAR ACCIDENTS INTRACEREBRAL HEMORRHAGE SUBARACHNOID HEMORRHAGE INFARCTION RAPID: INFECTION GRADUAL NEOPLASTIC LESIONS08/18/12 FOURTH YEAR LECTURE 18
  19. 19. INFECTIONTHE UNDERSURFACE OF THE BRAIN IN MENINGITIS 08/18/12 FOURTH YEAR LECTURE 19
  20. 20. INFECTION GRADUAL FEVER LETHARGY NECK RIGIDITY LOC EPILEPSY PARALYSIS DEATH08/18/12 FOURTH YEAR LECTURE 20
  21. 21. PRESENTATION OF CRANIAL LESIONS SUDDEN: CEREBRO-VASCULAR ACCIDENTS INTRACEREBRAL HEMORRHAGE SUBARACHNOID HEMORRHAGE INFARCTION RAPID: INFECTION GRADUAL NEOPLASTIC LESIONS08/18/12 FOURTH YEAR LECTURE 21
  22. 22. NEOPLASTIC LESIONSBRAIN METASTASES BRAIN GLIOMA08/18/12 FOURTH YEAR LECTURE 22
  23. 23. NEOPLASTIC LESIONS GRADUAL EPILEPSY PARALYSIS SENSORY PROBLEMS SPEECH PROBLEMS VISUAL PROBLEMS BALANCE PROBLEMS BEHAVIOUR CHANGES08/18/12 FOURTH YEAR LECTURE 23
  24. 24. THE NORMAL PICTURET1 WEIGHTED MRI T2 WEIGHTED MRI08/18/12 FOURTH YEAR LECTURE 24
  25. 25. NOW IMAGINE IF WE ADD SOMETHING ELSE TO THE CONTENTSDISPLACED BRAIN OEDEMA MIDLINE BRAIN OEDEMATHE ORIGINAL DEFORMED MIDLINE VENTRICLE TUMOR MASS TUMORS MENINGIOMA ON MRI T2 MULTIPLE LESIONS ON CT 08/18/12 FOURTH YEAR LECTURE 25
  26. 26. ADDITION OF NEW CONTENTS• INCREASE IN THE INTRACRANIAL PRESSURE• IRRITATION OF THE AREA• PRESSURE ON THE AFFECTED AREA• DESTRUCTION OF THE AFFECTED AREA• OBSTRUCTION OF THE CSF PATHWAYS• HORMONAL PROBLEMS 08/18/12 FOURTH YEAR LECTURE 26
  27. 27. INCREASE IN THE INTRACRANIAL PRESSURE• SYMPTOMS: • HEADACHE • VOMITING • VISUAL PROBLEMS • INCREASE IN THE SIZE OF THE HEAD08/18/12 FOURTH YEAR LECTURE 27
  28. 28. INCREASE IN THE INTRACRANIAL PRESSURE• SYMPTOMS: IS A MORNING • HEADACHE HEADACHE WHICH • VOMITING RESPONDS TO • VISUAL PROBLEMS SIMPLE ANALGESIA. IT • INCREASE IN THE SIZE DOES NOT INDICATE OF THE HEAD TYPE OF PROBLEM08/18/12 FOURTH YEAR LECTURE 28
  29. 29. INCREASE IN THE INTRACRANIAL PRESSURE IS A MORNING• SYMPTOMS: VOMITING AND IS • HEADACHE PROJECTILE IN • VOMITING NATURE. IT RESEMBLES • VISUAL PROBLEMS • MIGRAINE VOMITING INCREASE IN THE SIZE OF THE HEAD OR THE VOMITING ASSOCIATED WITH PREGNANCY08/18/12 FOURTH YEAR LECTURE 29
  30. 30. INCREASE IN THE INTRACRANIAL PRESSURE COULD BE IN THE• SYMPTOMS: FORM OF BLURRED • HEADACHE VISION OR DECREASED • VOMITING ACUITY OR FIELD • VISUAL PROBLEMS • DEFECT IN ONE OR INCREASE IN THE SIZE OF THE HEAD BOTH EYES. DEFECTS CAN INDICATE SITE OF PATHOLOGY08/18/12 FOURTH YEAR LECTURE 30
  31. 31. INCREASE IN THE INTRACRANIAL PRESSURE• SYMPTOMS: THIS OCCURS • HEADACHE ONLY IN CHILDREN • VOMITING BECAUSE THE • INCREASE IN THE SIZE OF THE HEAD CRANIAL SUTURES HAVE NOT UNITED YET.08/18/12 FOURTH YEAR LECTURE 31
  32. 32. INCREASE IN THE INTRACRANIAL PRESSURE IS SWELLING OF THE• SIGNS OPTIC DISC AND • PAPILLOEDEMA IS SEEN BY OPHTHALMOSCOPY NORMAL FUNDUS08/18/12 PAPILLOEDEMA LECTURE FOURTH YEAR 32
  33. 33. IRRITATION OF THE AREA THERE ARE MANY FORMS THIS LEADS TO OF EPILEPSY: EPILEPSY IF THE GRAND MAL LESION IS ON THE PETIT MAL PARTIAL COMPLEX SURFACE OF THE ETC.CEREBRUM. THE CORTEX EPILEPSY MAY LEAD TO:MUST BE IRRITATED TO SUFFOCATION PRODUCE EPILEPSY TEMPORARY PARALYSIS (TODD’S) OR PERMANENT BRAIN DAMAGE08/18/12 FOURTH YEAR LECTURE 33
  34. 34. PRESSURE ON THE AFFECTED AREA or tum val e of o• DEPENDS ON WHETHER: Sit r rem a fte • SUPRATENTORIAL • INFRATENTORIAL 08/18/12 FOURTH YEAR LECTURE 34
  35. 35. PRESSURE ON THE AFFECTED AREADESTRUCTION OF THE AFFECTED AREA• SUPRATENTORIAL: • FRONTAL • TEMPORAL • PARIETAL • OCCIPITAL• INFRATENTORIAL: • LATERAL • MIDLINE08/18/12 FOURTH YEAR LECTURE 35
  36. 36. PRESSURE ON THE AFFECTED AREADESTRUCTION OF THE AFFECTED AREA SUPRA TENTORIAL LESIONS: FRONTAL LOBE AFFECTION: DISTURBANCE OF ORIENTATION BEHAVIORAL CHANGES SPHINCTER PROBLEMS MOTOR SYMPTOMS ON THE OPPOSITE SIDE08/18/12 FOURTH YEAR LECTURE 36
  37. 37. PRESSURE ON THE AFFECTED AREADESTRUCTION OF THE AFFECTED AREA TEMPORAL LOBE AFFECTION: EXPRESSIVE DYSPHASIA OR APHASIA VISUAL FIELD DEFECTS SENSORY SYMPTOMS ON THE OPPOSITE SIDE MOTOR SYMPTOMS ON THE OPPOSITE SIDE08/18/12 FOURTH YEAR LECTURE 37
  38. 38. PRESSURE ON THE AFFECTED AREADESTRUCTION OF THE AFFECTED AREA PARIETAL LOBE AFFECTION:  RECEPTIVE DYSPHASIA OR APHASIA  SENSORY SYMPTOMS ON THE OPPOSITE SIDE  MOTOR SYMPTOMS ON THE OPPOSITE SIDE  ASTEREOGNOSIS  LACK OF TWO POINT DISCRIMINATION  SPATIAL DISORIENTATION  FINGER AGNOSIA08/18/12 FOURTH YEAR LECTURE 38
  39. 39. PRESSURE ON THE AFFECTED AREADESTRUCTION OF THE AFFECTED AREA OCCIPITAL LOBE AFFECTION:  VISUAL FIELD DEFECTS (HOMONYMOUS HEMIANOPIA)08/18/12 FOURTH YEAR LECTURE 39
  40. 40. PRESSURE ON THE AFFECTED AREA DESTRUCTION OF THE AFFECTED AREA INFRATENTORIAL TUMORS  ATAXIA  NYSTAGMUS  OBSTRUCTION OF CSF FLOWTOP:MEDULLOBLASTOABOTTOM:ASTROCYTOMA 08/18/12 FOURTH YEAR LECTURE 40
  41. 41. DESTRUCTION COULD RESULT FROMOCCLUSION OF A MAJOR ARTERY INTERNAL CAROTID ARTERY ANTERIOR CEREBRAL MIDDLE CEREBRAL BASILAR ARTERY POSTERIOR CEREBRAL08/18/12 FOURTH YEAR LECTURE 41
  42. 42. DESTRUCTION COULD RESULT FROM OCCLUSIONOF A MAJOR ARTERY  INTERNAL CAROTID ARTERY ANTERIOR CEREBRAL MIDDLE CEREBRAL  BASILAR ARTERY POSTERIOR CEREBRAL 08/18/12 FOURTH YEAR LECTURE 42
  43. 43. DESTRUCTION COULD RESULT FROM OCCLUSION OF A MAJOR ARTERY • CONTRALATERAL INTERNAL CAROTID HEMIPLEGIA ARTERY • MILD SENSORY DEFICIT  ANTERIOR CEREBRAL  MIDDLE CEREBRAL • MENTAL CONFUSION BASILAR ARTERY • CLOUDING OF THE  POSTERIOR CEREBRAL CONSCIOUSNESS 08/18/12 FOURTH YEAR LECTURE 43
  44. 44. DESTRUCTION COULD RESULT FROM OCCLUSION OF A MAJOR ARTERY INTERNAL CAROTID • COMA  ARTERY • CONTRALATERAL  ANTERIOR CEREBRAL FLACCID HEMIPLEGIA  MIDDLE CEREBRAL • HEMIANESTHESIA BASILAR ARTERY • HEMIANOPIA  POSTERIOR CEREBRAL • MOTOR APHASIA • SENSORY APHASIA 08/18/12 FOURTH YEAR LECTURE 44
  45. 45. DESTRUCTION COULD RESULT FROM OCCLUSION OF A MAJOR ARTERY INTERNAL CAROTID ARTERY  ANTERIOR CEREBRAL • CONTRALATERAL  MIDDLE CEREBRAL HEMIANESTHESIA BASILAR ARTERY • CONTRALATERAL  POSTERIOR CEREBRAL HOMONYMOUS HEMIANOPIA • SENSORY APHASIA 08/18/12 FOURTH YEAR LECTURE 45
  46. 46. OBSTRUCTION OF CSF PATHWAYS WILL LEAD TO DILATATION OF THE VENTRICULAR SYSTEM AND SIGNS AND SYMPTOMS OF INCREASED INTRACRANIAL PRESSURE. SEEPAGE OF CSF DILATED VENTRICLES NORMAL ABNORMAL08/18/12 FOURTH YEAR LECTURE 46
  47. 47. OBSTRUCTION OF CSF PATHWAYS IN INFANTS AND LITTLE CHILDERN IT WILL LEAD TO ENLARGMENT OF THE HEAD DUE TO THE FACT THAT SUTURES ARE NOT CLOSED. HYDROCEPHALUS COULD BE OBSTRUCTIVE OR COMMUNICATING08/18/12 FOURTH YEAR LECTURE 47
  48. 48. OBSTRUCTION OF CSF PATHWAYS BESIDE ENLARGMENT OF THE HEAD, DILATATION OF THE VENTRICULAR SYSTEM WILL LEAD TO DETERIORATION OF THE LEVEL OF CONSCIOUSNESS.ASSESSMENT OF THE LOC IS DONE GENERALLY BY THE USE OF THE GLASGOW COMA SCALE (GCS)08/18/12 FOURTH YEAR LECTURE 48
  49. 49. OBSTRUCTION OF CSF PATHWAYS THE GLASGOW COMA SCALE Points Eye Opening Best Verbal Response Best Motor Response 6 Follows command 5 Appropriate Localizes pain 4 Inappropriate Withdraws 3 To voice Moaning Flexion 2 To pain Incomprehensible Extension 08/18/12 FOURTH YEAR LECTURE 49
  50. 50. THE GLASGOW COMA SCALE• A NORMAL PERSON WOULD SCORE 15 • 6 FROM FOLLOWING COMMAND • 5 FROM APPROPRIATE VERBAL RESPONSE • 4 FROM SPONTANEOUS EYE OPENING• A DEAD PERSON SCORES 3 • 1 FROM NO MOTOR RESPONSE • 1 FROM NO VERBAL REPONSE • 1 FROM NO EYE OPENING08/18/12 FOURTH YEAR LECTURE 50
  51. 51. HORMONAL PROBLEMS USUALLY IN PROBLEMS OF THE PITUITARY GLAND OR THE PINEAL BODY. INCREASE PITUITARY SECRETION LEADS TO:  ACROMEGALLY  GIGANTISM  GALACTORRHOEA  AMENORRHOEA DECREASED SECRETION LEADS TO: HYPOPITUITRISM08/18/12 FOURTH YEAR LECTURE 51
  52. 52. HORMONAL PROBLEMS USUALLY IN PROBLEMS OF THE PITUITARY GLAND OR THE PINEAL BODY. INCREASE PITUITARY SECRETION LEADS TO:  ACROMEGALLY  GIGANTISM  GALACTORRHOEA  AMENORRHOEA DECREASED SECRETION LEADS TO: HYPOPITUITRISM08/18/12 FOURTH YEAR LECTURE 52
  53. 53. HORMONAL PROBLEMS DUE TO THE OVER SECRETION OF THE GROWTH HORMONE AFTER THE EPIPHYSIS HAD UNITED: INCREASE NOSE SIZE INCREASE HAND SIZE INCREASE FEET SIZE INCREASE JAW SIZE08/18/12 FOURTH YEAR LECTURE 53
  54. 54. HORMONAL PROBLEMS USUALLY IN PROBLEMS OF THE PITUITARY GLAND OR THE PINEAL BODY. INCREASE PITUITARY SECRETION LEADS TO:  ACROMEGALLY  GIGANTISM  GALACTORRHOEA  AMENORRHOEA DECREASED SECRETION LEADS TO: HYPOPITUITRISM08/18/12 FOURTH YEAR LECTURE 54
  55. 55. HORMONAL PROBLEMS DUE TO THE OVER SECRETION OF THE GROWTH HORMONEBEFORE THE EPIPHYSIS HAD UNITED.08/18/12 FOURTH YEAR LECTURE 55
  56. 56. HORMONAL PROBLEMS USUALLY IN PROBLEMS OF THE PITUITARY GLAND OR THE PINEAL BODY. INCREASE PITUITARY SECRETION LEADS TO:  ACROMEGALLY  GIGANTISM  GALACTORRHOEA  AMENORRHOEA DECREASED SECRETION LEADS TO: HYPOPITUITRISM08/18/12 FOURTH YEAR LECTURE 56
  57. 57. EXAMPLES OF PITUITARY LESIONS08/18/12 FOURTH YEAR LECTURE 57
  58. 58. PRESENTATION OF SPINAL LESIONS• SUDDEN: • VASCULAR ACCIDENTS • INTRASPINAL HEMORRHAGE • INFARCTION• RAPID: • INFECTION • DEMYLINATION• GRADUAL: • NEOPLASTIC LESIONS08/18/12 FOURTH YEAR LECTURE 58
  59. 59. PRESENTATION OF SPINAL LESIONS SPINAL CORD LESIONS LOSS OF POWER BELOW THE LEVEL LOSS OF SENSATION BELOW THE LEVEL LOSS OF SPHINCTERIC CONTROL ROOT LESIONS PAIN ALONG A ROOT LOSS OF POWER IN A MUSCLE OR GROUP LOSS OF SENSATION IN A DERMATOME LOSS OF A REFLEX OR REFLEXES LOSS OF SPHINCTERIC CONTROL 08/18/12 FOURTH YEAR LECTURE 59
  60. 60. PRESENTATION OF SPINAL LESIONS ACUTE PRESENTATION  CHRONIC PRESENTATION  LOSS OF POWER  LOSS OF POWER  LOSS OF SENSATION  LOSS OF SENSATION  HYPOTONIA  HYPERTONIA  DECREASED REFLEXES  INCREASED REFLEXES  MUTE PLANTER REFLEX  EXTENSOR PLANTER REFLES ( BABINISKI) 08/18/12 FOURTH YEAR LECTURE 60
  61. 61. PRESENTATION OF CORD LESIONS EXAMPLE OF A SPINAL CORD LESION (TUMOUR) INTRADURAL SPINAL CORD TUMOR ON T2 WEIGHTED MRI08/18/12 FOURTH YEAR LECTURE 61
  62. 62. PRESENTATION OF ROOT LESIONS EXAMPLE OF A SPINAL ROOT LESION (PROLAPSED DISC) PROLAPSED DISC ON T1 WEIGHTED MRI08/18/12 FOURTH YEAR LECTURE 62

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