The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
- The document classifies open fractures using the Gustilo-Anderson classification system based on wound size, soft tissue injury, and degree of contamination. Grade I fractures have a clean wound less than 1 cm, while Grade III fractures have extensive soft tissue damage or injury over 8 hours old.
- Management of open fractures aims to prevent infection through prompt debridement, antibiotics, splinting, and wound coverage. Early debridement within 5 hours can significantly reduce infection rates compared to later debridement.
- Risk of infection increases with higher fracture grade, from 0-12% for Grade I up to 9-55% for Grade III fractures. Prompt antibiotics, debridement, and wound management seek
The document discusses various types of abdominal incisions used in surgery. It describes incisions like vertical incisions (median, paramedian), transverse incisions (Kocher, McBurney), and pelvic incisions (Pfannenstiel, Maylard). The ideal incision allows easy access to structures, can be extended if needed, and heals with minimal scarring. Factors like the surgery type, target organ, and patient characteristics influence the choice of incision. Complications can include hematoma, wound infections, and hernia.
(SOCRATES) is a mnemonic used by health professionals to evaluate a patient's pain. It stands for:
Site - Where is the pain located?
Onset - When did the pain begin and was the onset sudden or gradual?
Character - How would the patient describe the pain, such as an ache, stabbing, burning?
Radiation - Does the pain radiate or spread to other areas?
Associations - Are there any other signs or symptoms associated with the pain?
Time course - Does the pain follow any patterns in terms of duration, frequency, or changes in severity?
Exacerbating/Relieving factors - What makes the pain better or worse, such
Tuberculous cervical lymphadenitis is caused by Mycobacterium tuberculosis infection of the cervical lymph nodes, usually through the tonsils. Clinically, it presents with fever, cough, and swollen lymph nodes in the neck. Left untreated, the infection can progress from a non-tender cold abscess to a collar stud abscess under the skin that ruptures, forming draining sinus tracts. Diagnosis involves aspiration or biopsy of lesions for staining, culture and cytology. Treatment consists of a 6-9 month course of anti-tuberculosis drugs. Aspiration or incision and drainage may be used for abscesses. Surgery is indicated for drug-resistant cases or persistent sinuses.
1. Open fractures are classified using the Gustilo-Anderson Classification based on the wound size and degree of soft tissue damage.
2. Essential treatment of open fractures includes administration of antibiotics, prompt wound debridement and irrigation, stabilization of the fracture, and early definitive wound cover.
3. Potential complications of open fractures include infection, osteomyelitis, compartment syndrome, and vascular injury which may require further intervention.
Greenstick fractures are incomplete fractures of long bones most commonly seen in young children under 10 years old. They typically occur from bending forces that break the convex surface of the bone while leaving the concave surface intact. Common sites are the forearm and lower leg. On x-ray, greenstick fractures show a break on one side of the bone with the other side remaining intact and the bone angulated at the fracture site.
- The document classifies open fractures using the Gustilo-Anderson classification system based on wound size, soft tissue injury, and degree of contamination. Grade I fractures have a clean wound less than 1 cm, while Grade III fractures have extensive soft tissue damage or injury over 8 hours old.
- Management of open fractures aims to prevent infection through prompt debridement, antibiotics, splinting, and wound coverage. Early debridement within 5 hours can significantly reduce infection rates compared to later debridement.
- Risk of infection increases with higher fracture grade, from 0-12% for Grade I up to 9-55% for Grade III fractures. Prompt antibiotics, debridement, and wound management seek
The document discusses various types of abdominal incisions used in surgery. It describes incisions like vertical incisions (median, paramedian), transverse incisions (Kocher, McBurney), and pelvic incisions (Pfannenstiel, Maylard). The ideal incision allows easy access to structures, can be extended if needed, and heals with minimal scarring. Factors like the surgery type, target organ, and patient characteristics influence the choice of incision. Complications can include hematoma, wound infections, and hernia.
(SOCRATES) is a mnemonic used by health professionals to evaluate a patient's pain. It stands for:
Site - Where is the pain located?
Onset - When did the pain begin and was the onset sudden or gradual?
Character - How would the patient describe the pain, such as an ache, stabbing, burning?
Radiation - Does the pain radiate or spread to other areas?
Associations - Are there any other signs or symptoms associated with the pain?
Time course - Does the pain follow any patterns in terms of duration, frequency, or changes in severity?
Exacerbating/Relieving factors - What makes the pain better or worse, such
Tuberculous cervical lymphadenitis is caused by Mycobacterium tuberculosis infection of the cervical lymph nodes, usually through the tonsils. Clinically, it presents with fever, cough, and swollen lymph nodes in the neck. Left untreated, the infection can progress from a non-tender cold abscess to a collar stud abscess under the skin that ruptures, forming draining sinus tracts. Diagnosis involves aspiration or biopsy of lesions for staining, culture and cytology. Treatment consists of a 6-9 month course of anti-tuberculosis drugs. Aspiration or incision and drainage may be used for abscesses. Surgery is indicated for drug-resistant cases or persistent sinuses.
1. Open fractures are classified using the Gustilo-Anderson Classification based on the wound size and degree of soft tissue damage.
2. Essential treatment of open fractures includes administration of antibiotics, prompt wound debridement and irrigation, stabilization of the fracture, and early definitive wound cover.
3. Potential complications of open fractures include infection, osteomyelitis, compartment syndrome, and vascular injury which may require further intervention.
Greenstick fractures are incomplete fractures of long bones most commonly seen in young children under 10 years old. They typically occur from bending forces that break the convex surface of the bone while leaving the concave surface intact. Common sites are the forearm and lower leg. On x-ray, greenstick fractures show a break on one side of the bone with the other side remaining intact and the bone angulated at the fracture site.
Conjunctivitis, also known as pink eye, is an inflammation of the transparent membrane that lines the eyelid and covers the white part of the eye. The most common cause is viral infection. Symptoms may range from mild to severe and include eye redness, swelling of the eyelids, increased tearing, irritation, sensitivity to light, and discharge. It is diagnosed based on symptoms, and while most viral cases will clear up on their own in 1 week, bacterial infections are usually treated with antibiotic eye drops or ointment. Conjunctivitis is highly contagious and can spread through direct contact, so proper hand washing and avoiding sharing towels/tissues is important to prevent spread.
1) Treatment of fractures prioritizes first aid, transport, and treatment of shock over directly treating the fracture. 2) Reduction of bone fragments can be done manually or through traction. Splinting or casting is then used to hold the fragments in place until healing. 3) Exercise and early weight bearing are encouraged to promote healing through muscle activity and bone loading.
This document discusses hip dislocations, including anatomy, classification, clinical features, imaging, treatment approaches, and complications. It describes the ball-and-socket anatomy of the hip joint and ligaments that provide stability. Hip dislocations are most commonly posterior or anterior, depending on the direction the femoral head is displaced from the acetabulum. Treatment involves closed or open reduction, sometimes along with fixation of any fractures. Complications can include myositis ossificans or avascular necrosis leading to osteoarthritis.
The document discusses various types of upper extremity trauma including fractures and dislocations of the clavicle, humerus, forearm, distal radius, shoulder, and elbow. For each injury, it describes the epidemiology, mechanism of injury, clinical evaluation including important exam findings, radiographic evaluation, classification systems, treatment options for both nonoperative and operative management, and any associated injuries. Key points covered include the classification of different types of clavicle, proximal humerus, forearm, and distal radius fractures as well as shoulder and elbow dislocations and their typical management approaches.
This document discusses different types and classifications of fractures. It begins by describing the key components of anatomic fracture description: type, comminution, location, and displacement. It then defines and provides examples of different fracture types, levels of comminution, anatomical locations, and degrees of displacement. The document also discusses several common fracture classification systems including AO classification and Salter-Harris classification of pediatric fractures. It concludes by defining types of fractures such as oblique, comminuted, spiral, compound, and greenstick fractures.
Chronic osteomyelitis is difficult to treat and eradicate completely. It is characterized by infected dead bone within scarred soft tissue. Treatment requires long-term antibiotics as well as extensive surgical debridement to remove all infected and dead bone. Multiple surgical procedures may be needed to eliminate residual infection by removing bone sequestra and draining sinus tracts. Even with aggressive treatment, complications like reinfection, joint stiffness, and limb deformity are common.
This document discusses bone healing and repair. It begins with an introduction and overview of bone structure and function. There are several cell types involved in bone healing including osteoblasts, osteoclasts and fibroblasts. Bone healing can occur directly through primary healing or indirectly through secondary healing which involves callus formation. Several factors can affect bone healing such as nutrition, age, infection and vascularity. Complications of bone healing include nonunion, malunion and delayed union. Bone grafts undergo revascularization from the recipient site and healing of extraction sockets occurs in stages from coagulum to bone development.
Trophic ulcers develop due to impaired wound healing caused by issues like poor circulation, neuropathy or prolonged pressure. They are classified based on their underlying cause such as diabetic ulcers, pressure sores or venous stasis ulcers. Treatment involves identifying the cause, wound debridement, dressing, offloading pressure, and correcting nutritional deficiencies or vascular issues. For non-healing ulcers, surgical reconstruction with flaps may be needed along with patient education on self-care. A multidisciplinary team approach is required for managing trophic ulcers.
Monteggia fracture & galeazzi fractureBipulBorthakur
A Monteggia fracture involves a break in the proximal ulna shaft combined with dislocation of the radial head. It most commonly occurs in children following a fall on an outstretched hand. Treatment involves closed or open reduction of the radial head and restoration of the ulna length, with casting or plating depending on patient age. Complications can include nerve injuries or radial head instability.
A Galeazzi fracture is a break of the radius near the middle-distal junction with disruption of the distal radio-ulnar joint. It typically results from a fall onto an outstretched, pronated forearm. Treatment is always surgical via open reduction and internal fixation of the radius and potential K-wiring or
This document provides information about culdocentesis, including:
1. Culdocentesis is a procedure to obtain peritoneal fluid from the pouch of Douglas in the female pelvis for diagnostic purposes.
2. The pouch of Douglas is located between the rectum and posterior uterus and often contains small amounts of peritoneal fluid.
3. Culdocentesis may be used to diagnose conditions like ectopic pregnancy, ruptured ovarian cysts, and pelvic inflammatory disease.
This is a lecture presentation on applying external fixator on open fracture specially on tibia. This method is a classical method. Various new and dynamic fixators are there but the basics are the same.
Preoperative investigation and preoperative teachingRiyaBaghele
The document discusses preoperative investigations and teaching. For investigations, it describes conducting a full blood count, urea and electrolytes tests for patients over age 65, with certain medical conditions, or at risk of blood loss. Preoperative teaching aims to prepare patients for what to expect before, during, and after surgery through sensory, procedural, and process information. Sensory information covers sights, sounds, temperatures etc. in operating rooms. Procedural information explains preparations, restrictions, and the surgical and anesthesia process. Process information outlines what happens in admission, holding, operating and recovery areas. The goal is patient safety and understanding through addressing priority details.
Osteomyelitis is inflammation of bone and bone marrow that is usually caused by bacterial infection. Acute hematogenous osteomyelitis is the most common type seen in India, typically affecting the distal femur or proximal tibia in children. Staphylococcus aureus is the main causative organism. It presents with fever, pain, and swelling over the affected bone. Diagnosis is made through clinical features, lab tests showing elevated inflammatory markers, and imaging showing bone changes. Treatment involves antibiotics, surgical drainage of abscesses, and rest.
Maternal changes during pregnancy can affect many body systems. The reproductive tract undergoes significant changes, including enlargement of the uterus from 50g to 1100g and a change in shape from pyriform to globular. The cardiovascular system also changes substantially, with a 40% increase in cardiac output and a 10-15% decrease in blood pressure. Renal changes include a 50% increase in glomerular filtration rate and increased frequency of urination. Many other systems are impacted as well, such as a slight enlargement of the kidneys and changes in skin pigmentation and elasticity.
Compartment syndrome occurs when increased pressure within a closed muscle compartment reduces blood flow, potentially causing tissue death. It is caused by factors that increase swelling such as fractures. Symptoms include pain disproportionate to the injury that worsens with stretching of muscles. Diagnosis involves measuring compartment pressure. Early fasciotomy, in which fascia is cut to release pressure, can prevent complications if performed within 6-8 hours of onset. Later surgery risks muscle death and contractures.
Compartment syndrome occurs when increased pressure within an osseofascial compartment reduces blood flow, causing ischemia and potential tissue necrosis. It is often caused by fractures, bleeding, edema, or tight casts/dressings. Left untreated, it leads to irreversible muscle and nerve damage within 6 hours. Early diagnosis by measuring compartment pressures and treatment through fasciotomy decompression of the compartment is crucial to prevent necrosis.
This document discusses the principles and management of malunion, which is the consolidation of a fracture in an abnormal position resulting in deformity or functional deficit. It outlines the causes of malunion, types of deformities, classification systems, evaluation methods including imaging, and surgical and non-surgical treatment options. Treatment is tailored based on the location and characteristics of the deformity, and may involve osteotomies, external fixation, or joint replacement to correct angular, rotational, translational or length discrepancies while avoiding complications. Close follow up is needed to monitor for issues like under/overcorrection and ensure proper healing.
This document provides tips and instructions for using a PowerPoint presentation on abscesses. It discusses actively engaging students by showing blank slides first to elicit what they know before presenting content. The PPT covers topics like introduction/history, etiology, pathophysiology, clinical features, investigations, diagnostic studies, and operative therapy of abscesses. It also lists some common types of abscesses and provides links to access the full PPT collection.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
This document provides information on the 12 cranial nerves, with a focus on the trigeminal nerve (CN V) and its three divisions - the ophthalmic (V1), maxillary (V2), and mandibular (V3) nerves. It describes the origin, course, branches, and functions of these cranial nerves, including their roles in sensory innervation and motor control of structures in the head, neck, face, and oral cavity. The autonomic ganglia associated with CN V, such as the ciliary and sphenopalatine ganglia, are also discussed.
Conjunctivitis, also known as pink eye, is an inflammation of the transparent membrane that lines the eyelid and covers the white part of the eye. The most common cause is viral infection. Symptoms may range from mild to severe and include eye redness, swelling of the eyelids, increased tearing, irritation, sensitivity to light, and discharge. It is diagnosed based on symptoms, and while most viral cases will clear up on their own in 1 week, bacterial infections are usually treated with antibiotic eye drops or ointment. Conjunctivitis is highly contagious and can spread through direct contact, so proper hand washing and avoiding sharing towels/tissues is important to prevent spread.
1) Treatment of fractures prioritizes first aid, transport, and treatment of shock over directly treating the fracture. 2) Reduction of bone fragments can be done manually or through traction. Splinting or casting is then used to hold the fragments in place until healing. 3) Exercise and early weight bearing are encouraged to promote healing through muscle activity and bone loading.
This document discusses hip dislocations, including anatomy, classification, clinical features, imaging, treatment approaches, and complications. It describes the ball-and-socket anatomy of the hip joint and ligaments that provide stability. Hip dislocations are most commonly posterior or anterior, depending on the direction the femoral head is displaced from the acetabulum. Treatment involves closed or open reduction, sometimes along with fixation of any fractures. Complications can include myositis ossificans or avascular necrosis leading to osteoarthritis.
The document discusses various types of upper extremity trauma including fractures and dislocations of the clavicle, humerus, forearm, distal radius, shoulder, and elbow. For each injury, it describes the epidemiology, mechanism of injury, clinical evaluation including important exam findings, radiographic evaluation, classification systems, treatment options for both nonoperative and operative management, and any associated injuries. Key points covered include the classification of different types of clavicle, proximal humerus, forearm, and distal radius fractures as well as shoulder and elbow dislocations and their typical management approaches.
This document discusses different types and classifications of fractures. It begins by describing the key components of anatomic fracture description: type, comminution, location, and displacement. It then defines and provides examples of different fracture types, levels of comminution, anatomical locations, and degrees of displacement. The document also discusses several common fracture classification systems including AO classification and Salter-Harris classification of pediatric fractures. It concludes by defining types of fractures such as oblique, comminuted, spiral, compound, and greenstick fractures.
Chronic osteomyelitis is difficult to treat and eradicate completely. It is characterized by infected dead bone within scarred soft tissue. Treatment requires long-term antibiotics as well as extensive surgical debridement to remove all infected and dead bone. Multiple surgical procedures may be needed to eliminate residual infection by removing bone sequestra and draining sinus tracts. Even with aggressive treatment, complications like reinfection, joint stiffness, and limb deformity are common.
This document discusses bone healing and repair. It begins with an introduction and overview of bone structure and function. There are several cell types involved in bone healing including osteoblasts, osteoclasts and fibroblasts. Bone healing can occur directly through primary healing or indirectly through secondary healing which involves callus formation. Several factors can affect bone healing such as nutrition, age, infection and vascularity. Complications of bone healing include nonunion, malunion and delayed union. Bone grafts undergo revascularization from the recipient site and healing of extraction sockets occurs in stages from coagulum to bone development.
Trophic ulcers develop due to impaired wound healing caused by issues like poor circulation, neuropathy or prolonged pressure. They are classified based on their underlying cause such as diabetic ulcers, pressure sores or venous stasis ulcers. Treatment involves identifying the cause, wound debridement, dressing, offloading pressure, and correcting nutritional deficiencies or vascular issues. For non-healing ulcers, surgical reconstruction with flaps may be needed along with patient education on self-care. A multidisciplinary team approach is required for managing trophic ulcers.
Monteggia fracture & galeazzi fractureBipulBorthakur
A Monteggia fracture involves a break in the proximal ulna shaft combined with dislocation of the radial head. It most commonly occurs in children following a fall on an outstretched hand. Treatment involves closed or open reduction of the radial head and restoration of the ulna length, with casting or plating depending on patient age. Complications can include nerve injuries or radial head instability.
A Galeazzi fracture is a break of the radius near the middle-distal junction with disruption of the distal radio-ulnar joint. It typically results from a fall onto an outstretched, pronated forearm. Treatment is always surgical via open reduction and internal fixation of the radius and potential K-wiring or
This document provides information about culdocentesis, including:
1. Culdocentesis is a procedure to obtain peritoneal fluid from the pouch of Douglas in the female pelvis for diagnostic purposes.
2. The pouch of Douglas is located between the rectum and posterior uterus and often contains small amounts of peritoneal fluid.
3. Culdocentesis may be used to diagnose conditions like ectopic pregnancy, ruptured ovarian cysts, and pelvic inflammatory disease.
This is a lecture presentation on applying external fixator on open fracture specially on tibia. This method is a classical method. Various new and dynamic fixators are there but the basics are the same.
Preoperative investigation and preoperative teachingRiyaBaghele
The document discusses preoperative investigations and teaching. For investigations, it describes conducting a full blood count, urea and electrolytes tests for patients over age 65, with certain medical conditions, or at risk of blood loss. Preoperative teaching aims to prepare patients for what to expect before, during, and after surgery through sensory, procedural, and process information. Sensory information covers sights, sounds, temperatures etc. in operating rooms. Procedural information explains preparations, restrictions, and the surgical and anesthesia process. Process information outlines what happens in admission, holding, operating and recovery areas. The goal is patient safety and understanding through addressing priority details.
Osteomyelitis is inflammation of bone and bone marrow that is usually caused by bacterial infection. Acute hematogenous osteomyelitis is the most common type seen in India, typically affecting the distal femur or proximal tibia in children. Staphylococcus aureus is the main causative organism. It presents with fever, pain, and swelling over the affected bone. Diagnosis is made through clinical features, lab tests showing elevated inflammatory markers, and imaging showing bone changes. Treatment involves antibiotics, surgical drainage of abscesses, and rest.
Maternal changes during pregnancy can affect many body systems. The reproductive tract undergoes significant changes, including enlargement of the uterus from 50g to 1100g and a change in shape from pyriform to globular. The cardiovascular system also changes substantially, with a 40% increase in cardiac output and a 10-15% decrease in blood pressure. Renal changes include a 50% increase in glomerular filtration rate and increased frequency of urination. Many other systems are impacted as well, such as a slight enlargement of the kidneys and changes in skin pigmentation and elasticity.
Compartment syndrome occurs when increased pressure within a closed muscle compartment reduces blood flow, potentially causing tissue death. It is caused by factors that increase swelling such as fractures. Symptoms include pain disproportionate to the injury that worsens with stretching of muscles. Diagnosis involves measuring compartment pressure. Early fasciotomy, in which fascia is cut to release pressure, can prevent complications if performed within 6-8 hours of onset. Later surgery risks muscle death and contractures.
Compartment syndrome occurs when increased pressure within an osseofascial compartment reduces blood flow, causing ischemia and potential tissue necrosis. It is often caused by fractures, bleeding, edema, or tight casts/dressings. Left untreated, it leads to irreversible muscle and nerve damage within 6 hours. Early diagnosis by measuring compartment pressures and treatment through fasciotomy decompression of the compartment is crucial to prevent necrosis.
This document discusses the principles and management of malunion, which is the consolidation of a fracture in an abnormal position resulting in deformity or functional deficit. It outlines the causes of malunion, types of deformities, classification systems, evaluation methods including imaging, and surgical and non-surgical treatment options. Treatment is tailored based on the location and characteristics of the deformity, and may involve osteotomies, external fixation, or joint replacement to correct angular, rotational, translational or length discrepancies while avoiding complications. Close follow up is needed to monitor for issues like under/overcorrection and ensure proper healing.
This document provides tips and instructions for using a PowerPoint presentation on abscesses. It discusses actively engaging students by showing blank slides first to elicit what they know before presenting content. The PPT covers topics like introduction/history, etiology, pathophysiology, clinical features, investigations, diagnostic studies, and operative therapy of abscesses. It also lists some common types of abscesses and provides links to access the full PPT collection.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
This document provides information on the 12 cranial nerves, with a focus on the trigeminal nerve (CN V) and its three divisions - the ophthalmic (V1), maxillary (V2), and mandibular (V3) nerves. It describes the origin, course, branches, and functions of these cranial nerves, including their roles in sensory innervation and motor control of structures in the head, neck, face, and oral cavity. The autonomic ganglia associated with CN V, such as the ciliary and sphenopalatine ganglia, are also discussed.
This document provides an overview of the 12 cranial nerves, including their functions, methods of testing, and common causes of lesions. It discusses each cranial nerve individually, describing the purpose of testing, functional components, and how to examine sensory and motor functions. The cranial nerves control important functions like smell, vision, eye movement, facial expression, hearing, taste, swallowing and neck movement. Testing of the cranial nerves provides insight into neurological impairments localized to specific brain regions or cranial nerves.
The document provides information on examining the 12 cranial nerves. It describes testing various functions for each nerve including smell, vision, eye movements, facial sensation and movement, hearing, taste, swallowing and neck movement. Examinations include identifying smells and visual acuity, checking eye movements, testing facial muscle strength and sensation.
This document summarizes the 12 cranial nerves, including their component (motor, sensory, mixed), function, origin point in the brain, and opening through the skull. It describes that cranial nerves I, II, and VIII are sensory nerves involved in smell, vision, and hearing respectively. Cranial nerves III, IV, VI control eye movement and pupil constriction. The trigeminal nerve (V) is mixed and innervates face sensation and muscles of mastication. The facial nerve (VII) is also mixed and controls face muscles and taste. The vagus nerve (X) is the longest and most complex, controlling heart rate, digestion and more.
The document summarizes the examination of the 12 cranial nerves. It describes tests for each nerve including smell (I), visual acuity and fields (II), eye movements and pupillary responses (III, IV, VI), sensation (V), facial expression (VII), hearing (VIII), swallowing and speech (IX, X), neck and shoulder movement (XI), and tongue movement (XII). Common abnormalities and localizing signs are provided.
Functional components of the cranial nerves (animated)Ashfaqur Rahman
The document discusses the functional components of cranial nerves. It explains that cranial nerves can carry somatic and visceral afferent fibers for general and special sensation, as well as somatic and visceral efferent motor fibers for general and special motor functions. Each cranial nerve has a unique combination of sensory and motor fibers that innervate specific regions like muscles, glands, and organs. Diagrams are also provided to illustrate the pathways and targets of each cranial nerve.
There are 12 pairs of cranial nerves that originate from the brain. They are the olfactory, optic, oculomotor, trochlear, trigeminal, abducens, facial, vestibulocochlear, glossopharyngeal, vagus, accessory, and hypoglossal nerves. Each nerve has specific functions, such as carrying sensory information for smell, vision, and taste, or controlling eye and facial muscle movement. Damage to certain cranial nerves can cause issues like Bell's palsy or an inability to speak or swallow.
The document provides guidance on performing a neurological examination. It outlines assessing the cranial nerves, reflexes, motor system, and sensory system. The cranial nerve examination involves testing each nerve individually. Reflex testing grades reflexes on a scale from 0 to 4. The motor exam evaluates muscle strength on a scale from 0 to 5. Finally, the sensory exam tests sensations like pain, touch, and position sense. The goal is to identify which parts of the neurological system may be affected.
Jill Blumenthal, MD of the UC San Diego AntiViral Research Center presents "Cryptococcal Meningitis with Cranial Nerve Neuropathies: Predictors of Outcome and Review of ART Initiation"
This document provides an overview of disorders of thought. It discusses different types of thought disorders including disorders of thought tempo like flight of ideas and inhibition of thinking. It also covers disorders of thought continuity like perseveration and thought blocking. Additionally, it examines disorders of thought possession such as obsessions and compulsions. The document aims to classify and describe various thought disorders and their presentations to help with proper diagnosis and understanding of these conditions.
This document discusses schizophrenia and its symptoms, classifications, causes, and treatment options. It describes Bleuler's 4 A's of schizophrenia symptoms. Positive symptoms include hallucinations and delusions, while negative symptoms involve a lack of emotion and motivation. Schizophrenia progresses through prodromal, acute, and chronic phases. Antipsychotic medications work by blocking dopamine and serotonin receptors. Nursing diagnoses for schizophrenia patients include noncompliance, risk for violence, impaired social interactions, and risk for suicide. Nursing interventions aim to address symptoms, promote medication adherence, and ensure safety and self-care.
Christina, a 44-year-old woman, was arrested for harassing a local television newscaster, asserting he had fathered and taken her child. However, there was no evidence of a relationship and the newscaster denied it. Christina maintained her delusional belief with extraordinary conviction despite no signs of hallucinations, mood disorder, or organic illness. Her delusional beliefs had existed for years and involved fantasizing about a relationship with the newscaster that did not exist in reality. This case demonstrates a primary delusion arising de novo that is held with unusual conviction and not amenable to logic despite the absurdity being apparent to others.
This document summarizes various motor disorders seen in psychiatry, including both subjective and objective motor disorders. Subjective motor disorders include obsessions/compulsions and delusions of passivity. Objective motor disorders include disorders of adaptive movements like expressive movements, reactive movements, and goal-directed movements. It also discusses various non-adaptive movements like tics, tremors, chorea, athetosis, and stereotypies. Other topics covered are motor speech disturbances, disorders of posture, and movement disorders associated with antipsychotic medication.
• The Facial nerve is the 7th of twelve paired cranial nerves.
• It is a mixed nerve with motor and sensory roots.
• It also supplies pre-ganglionic parasympathetic fibres to several
head and neck ganglia
Branches
1. Greater superficial petrosal – arises from the geniculate ganglion.
2. Branches within the facial canal:
• i) nerve to stapedius
• ii) Chorda tympani
3. After exit from stylomastoid foramen:
• i) Posterior auricular
• ii) Nerve to posterior belly of digastric
• iii) Nerve to stylohyoid.
4. On the face - Five major branches:
• i) Temporal
• ii) Zygomatic
• iii) Buccal
• iv) Marginal mandibular
• v) Cervical
The document provides information on several cranial nerves:
- The olfactory nerve can cause CSF leakage through the nose if fractured in the anterior cranial fossa. Complete anosmia can result if all filaments on one side are torn.
- The oculomotor nerve supplies most extraocular muscles except the superior oblique and lateral rectus. It also supplies levator palpebrae superioris and parasympathetic fibers to the eye.
- The trigeminal nerve has large sensory and small motor roots. Its branches include the ophthalmic, maxillary, and mandibular nerves which provide sensory innervation to the face and motor innervation to the muscles of mastication.
This document provides an overview of the neurological examination in psychiatry. It describes the major sections that are examined which include mental status, cranial nerves, motor function, sensory function, reflexes, cerebellar functions, gait and station, and abnormal movements. It then goes on to provide details on how to examine each of these sections, such as tests for various aspects of mental status, how to examine each of the 12 cranial nerves, and descriptions of different types of reflexes.
1. Injury to cranial nerves is common after skull fractures and can be caused by trauma, tumors, or aneurysms. Injury to cranial nerve I results in loss of smell or false smell perceptions.
2. Injury to cranial nerve II can cause vision loss and visual field defects through optic neuritis or demyelinating diseases like multiple sclerosis. Injury to cranial nerve III causes eyelid drooping and eye movement issues.
3. Other cranial nerve injuries include facial paralysis from nerve VII injury, hearing loss and dizziness from nerve VIII injury, swallowing issues from nerve X injury, and tongue deviation from nerve XII injury. Precise symptoms depend on the injured nerve
This document provides an overview of the components of a psychiatric history taking and examination. It describes collecting personal data, the patient's complaint, history of present illness, past medical and psychiatric history, personal history including development, relationships, and sexual history. It also includes obtaining a family psychiatric and medical history. The examination involves a mental status exam assessing appearance, behavior, mood, affect, speech, thought content and process, perception, and insight. The goal is to chronologically understand the patient's life and current symptoms from their perspective and an informant to make an accurate diagnosis.
Cranial nerves emerge directly from the brain and brainstem. There are 12 cranial nerves with both sensory and motor functions. Examination of the cranial nerves involves testing specific functions like smell, vision, eye movements, facial expression, hearing and swallowing. Abnormal findings provide clues to lesions or damage along the course of individual cranial nerves.
Cranial nerves /certified fixed orthodontic courses by Indian dental academy Indian dental academy
Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
The document provides information about the oculomotor nerve (CN III), including its origin in the midbrain, course through the subarachnoid space and divisions within the orbit. It describes the nerve's motor and parasympathetic functions and supply to the extraocular muscles and sphincter pupillae muscle. Clinical features of CN III palsies are outlined such as ptosis, deviation of the eye, and a fixed dilated pupil. Key locations along the nerve's course and different types of palsies including complete and incomplete are also summarized.
The document discusses the optic nerve and oculomotor nerve. It provides details on:
1. The anatomy and pathways of the optic nerve, including its four portions from the eye to the optic chiasm. It carries vision and pupillary light reflexes.
2. The anatomy and projections of the oculomotor nerve, including its nuclei in the midbrain and innervation of extraocular muscles and pupillary sphincter.
3. Clinical correlations of injuries or compression of the optic nerve and oculomotor nerve, such as visual field defects from chiasmal lesions.
The document summarizes the anatomy and physiology of the eye and visual pathway. It describes the main parts of the eyeball including the sclera, cornea, choroid, retina, iris, pupil, lens, vitreous body and their functions. It then discusses the blood supply to the eye, the optic nerve, optic chiasm, optic tracts, lateral geniculate nucleus, optic radiations and visual cortex in the brain. The visual pathway transmits visual information from the retina to the brain for processing.
Anatomy of Olfactory nerve, Optic Nerve, Trigeminal NervePiyushThombare
This document provides an overview of the anatomy and function of the olfactory and optic nerves and related structures. It discusses:
- The olfactory nerves arising from olfactory receptor cells and projecting to the olfactory bulb, where they synapse with mitral cells.
- The optic nerve consisting of ganglion cell axons that project from the retina to the optic chiasm and decussate. Some fibers continue to the ipsilateral optic tract while others cross to the contralateral tract.
- The optic tracts terminating in the lateral geniculate bodies (LGB) and projecting via the optic radiations to the primary visual cortex in the occipital lobe.
- Common lesions that can affect
The document summarizes several sensory pathways in the human body. It describes the taste pathway, which involves taste buds transmitting signals via cranial nerves to the nucleus solitarius and gustatory cortex. It also describes the olfactory pathway, involving olfactory receptors in the nose transmitting signals to the olfactory bulb, tract and piriform cortex. Finally, it summarizes the visual pathway, involving photoreceptors in the retina transmitting signals via the optic nerve, chiasm and tract to the lateral geniculate nucleus and primary visual cortex.
The cranial nerves originate from specific areas in the brainstem and travel through the cranial cavity to innervate structures in the head and neck. The olfactory nerve transmits smell signals from the nose to the brain. The optic nerve transmits visual signals from the retina to the visual cortex. The oculomotor, trochlear, abducens and trigeminal nerves innervate muscles that control eye movement and sensation in the face respectively.
The document discusses the 12 pairs of cranial nerves. It provides detailed information on the olfactory, optic, oculomotor, trochlear, trigeminal, abducent, and facial cranial nerves. It describes the embryology, course, distribution and functions of these nerves. It also discusses various clinical conditions that can arise from injuries or lesions to the different cranial nerves.
The document summarizes the anatomy of the orbit, eyelids, and lacrimal apparatus. It describes the nerves that pass through the superior orbital fissure to the orbit, including the oculomotor, trochlear, and abducent nerves. It also discusses the branches of the ophthalmic and lacrimal nerves, as well as the structures and relations of the eyelids, lacrimal apparatus, conjunctiva, and lacrimal gland.
The document provides an overview of the 12 cranial nerves, including their names, development, classification, and key details about each individual nerve. It discusses the olfactory, optic, oculomotor, trochlear, trigeminal, abducens, facial, vestibulocochlear, glossopharyngeal, vagus, accessory, and hypoglossal nerves. For each nerve, it describes their origin, course through the skull, innervation targets, clinical implications, and applied anatomy. The document is intended as a comprehensive reference for the cranial nerves.
Seminar innervation of maxillofacial structuresdviya jain
This document provides an overview of the innervation of maxillofacial structures. It begins with basics of the nervous system, including definitions of neurons, nuclei and ganglia. It then describes the 12 cranial nerves in detail, including their origins, pathways, functions and clinical significance. Specific focus is given to the trigeminal nerve and its three divisions that provide sensory innervation to the face and motor innervation to the muscles of mastication. The document concludes with a section on secretomotor fibers that innervate the major salivary glands.
The third cranial nerve, also known as the oculomotor nerve, originates from nuclei located in the midbrain and controls most of the extraocular muscles as well as the iris and ciliary body. It is responsible for eye movement, pupil constriction, and accommodation. Damage to the third cranial nerve results in ptosis, external ophthalmoplegia, mydriasis, and loss of accommodation due to paralysis of the extraocular muscles, sphincter pupillae, and ciliary body respectively.
H & E Ass.t.pptx assignment of anatomy year oneAmanuelIbrahim
The document describes the anatomy and structures of the human eye and orbit. It discusses the iris, retina, choroid, sclera, lens, vitreous humor, muscles, blood vessels, and nerves of the eye. It provides details on the layers of the retina including the photoreceptors and vascular supply. Additionally, it outlines the structures and functions of the iris, ciliary body, choroid, sclera, vitreous humor, eyelids, extraocular muscles and their nerve innervation. Blood vessels including the ophthalmic artery and veins are also mapped out.
The document discusses the extraocular muscles of the eye. It describes the four rectus muscles - superior, inferior, lateral and medial rectus muscles. It also describes the two oblique muscles - superior and inferior oblique muscles. It discusses the origins, insertions and actions of each muscle. It further discusses the nerve supply, axes of movements and individual muscle movements. Factors maintaining stability of the eyeball are also summarized.
ENT and Maxillofacial and Ophtha course.pptxsamirich1
This document provides an overview of ophthalmic anesthesia. It begins with discussing the anatomy and physiology of the eye, including structures like the orbit, eyeball, extraocular muscles and nerves. It then covers topics like the oculo-cardiac reflex and how certain ophthalmic drugs can impact anesthesia management. The learning objectives are to discuss anatomy/physiology of the eye, the oculo-cardiac reflex, effects of ophthalmic drugs, patient assessment, regional anesthesia techniques and anesthesia management for various eye surgeries.
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MRI is the best imaging modality for evaluating cranial nerves due to its high contrast resolution. It can visualize cranial nerves as dark structures against the bright CSF. CT is useful for evaluating bony structures. The 12 cranial nerves were described in detail, including their anatomy, pathways, and imaging appearance. Common pathologies that can involve cranial nerves include tumors such as schwannomas and meningiomas, inflammation such as optic neuritis, and infections.
The document discusses the abducens nerve (CN VI), which innervates the lateral rectus muscle. It has three key points:
1. CN VI has only a motor component, originating from the abducens nucleus in the pons and innervating the ipsilateral lateral rectus muscle. It also sends interneurons through the medial longitudinal fasciculus to innervate the contralateral medial rectus.
2. CN VI passes through the subarachnoid space, pierces the dura at the dorsum sellae, traverses the cavernous sinus, and enters the orbit through the superior orbital fissure to reach the lateral rectus.
3. Les
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This document discusses dental casting investment materials. It describes the three main types of investments - gypsum bonded, phosphate bonded, and ethyl silicate bonded investments. For gypsum bonded investments specifically, it details their classification, composition including the roles of gypsum, silica, and modifiers, setting time, normal and hygroscopic setting expansion, and thermal expansion. It provides information on how the properties of gypsum bonded investments are affected by their composition. The document serves as a comprehensive overview of dental casting investment materials.
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বাংলাদেশের অর্থনৈতিক সমীক্ষা ২০২৪ [Bangladesh Economic Review 2024 Bangla.pdf] কম্পিউটার , ট্যাব ও স্মার্ট ফোন ভার্সন সহ সম্পূর্ণ বাংলা ই-বুক বা pdf বই " সুচিপত্র ...বুকমার্ক মেনু 🔖 ও হাইপার লিংক মেনু 📝👆 যুক্ত ..
আমাদের সবার জন্য খুব খুব গুরুত্বপূর্ণ একটি বই ..বিসিএস, ব্যাংক, ইউনিভার্সিটি ভর্তি ও যে কোন প্রতিযোগিতা মূলক পরীক্ষার জন্য এর খুব ইম্পরট্যান্ট একটি বিষয় ...তাছাড়া বাংলাদেশের সাম্প্রতিক যে কোন ডাটা বা তথ্য এই বইতে পাবেন ...
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Chapter wise All Notes of First year Basic Civil Engineering.pptxDenish Jangid
Chapter wise All Notes of First year Basic Civil Engineering
Syllabus
Chapter-1
Introduction to objective, scope and outcome the subject
Chapter 2
Introduction: Scope and Specialization of Civil Engineering, Role of civil Engineer in Society, Impact of infrastructural development on economy of country.
Chapter 3
Surveying: Object Principles & Types of Surveying; Site Plans, Plans & Maps; Scales & Unit of different Measurements.
Linear Measurements: Instruments used. Linear Measurement by Tape, Ranging out Survey Lines and overcoming Obstructions; Measurements on sloping ground; Tape corrections, conventional symbols. Angular Measurements: Instruments used; Introduction to Compass Surveying, Bearings and Longitude & Latitude of a Line, Introduction to total station.
Levelling: Instrument used Object of levelling, Methods of levelling in brief, and Contour maps.
Chapter 4
Buildings: Selection of site for Buildings, Layout of Building Plan, Types of buildings, Plinth area, carpet area, floor space index, Introduction to building byelaws, concept of sun light & ventilation. Components of Buildings & their functions, Basic concept of R.C.C., Introduction to types of foundation
Chapter 5
Transportation: Introduction to Transportation Engineering; Traffic and Road Safety: Types and Characteristics of Various Modes of Transportation; Various Road Traffic Signs, Causes of Accidents and Road Safety Measures.
Chapter 6
Environmental Engineering: Environmental Pollution, Environmental Acts and Regulations, Functional Concepts of Ecology, Basics of Species, Biodiversity, Ecosystem, Hydrological Cycle; Chemical Cycles: Carbon, Nitrogen & Phosphorus; Energy Flow in Ecosystems.
Water Pollution: Water Quality standards, Introduction to Treatment & Disposal of Waste Water. Reuse and Saving of Water, Rain Water Harvesting. Solid Waste Management: Classification of Solid Waste, Collection, Transportation and Disposal of Solid. Recycling of Solid Waste: Energy Recovery, Sanitary Landfill, On-Site Sanitation. Air & Noise Pollution: Primary and Secondary air pollutants, Harmful effects of Air Pollution, Control of Air Pollution. . Noise Pollution Harmful Effects of noise pollution, control of noise pollution, Global warming & Climate Change, Ozone depletion, Greenhouse effect
Text Books:
1. Palancharmy, Basic Civil Engineering, McGraw Hill publishers.
2. Satheesh Gopi, Basic Civil Engineering, Pearson Publishers.
3. Ketki Rangwala Dalal, Essentials of Civil Engineering, Charotar Publishing House.
4. BCP, Surveying volume 1
This presentation was provided by Steph Pollock of The American Psychological Association’s Journals Program, and Damita Snow, of The American Society of Civil Engineers (ASCE), for the initial session of NISO's 2024 Training Series "DEIA in the Scholarly Landscape." Session One: 'Setting Expectations: a DEIA Primer,' was held June 6, 2024.
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it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
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LAND USE LAND COVER AND NDVI OF MIRZAPUR DISTRICT, UPRAHUL
This Dissertation explores the particular circumstances of Mirzapur, a region located in the
core of India. Mirzapur, with its varied terrains and abundant biodiversity, offers an optimal
environment for investigating the changes in vegetation cover dynamics. Our study utilizes
advanced technologies such as GIS (Geographic Information Systems) and Remote sensing to
analyze the transformations that have taken place over the course of a decade.
The complex relationship between human activities and the environment has been the focus
of extensive research and worry. As the global community grapples with swift urbanization,
population expansion, and economic progress, the effects on natural ecosystems are becoming
more evident. A crucial element of this impact is the alteration of vegetation cover, which plays a
significant role in maintaining the ecological equilibrium of our planet.Land serves as the foundation for all human activities and provides the necessary materials for
these activities. As the most crucial natural resource, its utilization by humans results in different
'Land uses,' which are determined by both human activities and the physical characteristics of the
land.
The utilization of land is impacted by human needs and environmental factors. In countries
like India, rapid population growth and the emphasis on extensive resource exploitation can lead
to significant land degradation, adversely affecting the region's land cover.
Therefore, human intervention has significantly influenced land use patterns over many
centuries, evolving its structure over time and space. In the present era, these changes have
accelerated due to factors such as agriculture and urbanization. Information regarding land use and
cover is essential for various planning and management tasks related to the Earth's surface,
providing crucial environmental data for scientific, resource management, policy purposes, and
diverse human activities.
Accurate understanding of land use and cover is imperative for the development planning
of any area. Consequently, a wide range of professionals, including earth system scientists, land
and water managers, and urban planners, are interested in obtaining data on land use and cover
changes, conversion trends, and other related patterns. The spatial dimensions of land use and
cover support policymakers and scientists in making well-informed decisions, as alterations in
these patterns indicate shifts in economic and social conditions. Monitoring such changes with the
help of Advanced technologies like Remote Sensing and Geographic Information Systems is
crucial for coordinated efforts across different administrative levels. Advanced technologies like
Remote Sensing and Geographic Information Systems
9
Changes in vegetation cover refer to variations in the distribution, composition, and overall
structure of plant communities across different temporal and spatial scales. These changes can
occur natural.
6. CRANIAL NERVES
• Nerves that emerge directly from the brain
(spinal nerves emerge from segments of the
spinal cord)
• 12 pairs of cranial nerves.
www.indiandentalacademy.com
10. Cranial Nerve I: Olfactory
• It is the first cranial nerve and nerve of
smell and form first order neuron of
olfactory pathway.
• Type → Special Sensory type.
• Origin → From olfactory epithelium in the
olfactory region of nasal cavity (superior
nasal concha and opposed part of nasal
septum).
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11. • Course → Fibers run through the olfactory bulb
( mitral cells)olfactory tract and terminate in the
primary olfactory cortex
• Innervation → Nasal Mucous Membranes.
• Enter → Cribriform plate of the ethmoid bone.
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13. Peculiarities
• 3000 different odours
• I sensation to appear in vertebrate
evolution
• II order neuron ( mitral cells) reaches
cortex directly without involvement of
thalamus
• Ipsilateral - no significant decussation
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14. APPLIED ANATOMY
• Anosmia (Olfactory anaesthesia)
• Head Injuries -–> CSF Rhinorrhoea.
• CVA -> Effusion of blood into base of frontal lobe
• Tumours of the Frontal lobe, or those arising near the
pituitary gland
• Infections –tuberculous meningitis infections like common
cold, Viral Hepatitis, syphilis, osteomyelitis of frontal or
ethmoidal regions.
• Unilateral Anosmia may be of diagnostic significance in
localizing brain lessons.
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15. APPLIED ANATOMY
• Reduction – hyposmia – local abn of nose
• Distortion of smell – parosmia – Head
injury or local abnormalities of nose
• Increased smell – hyperosmia – In neurotic
patients
• Olfactory hallucinations & delusions –
epilepsy, migraine, psychiatric patients.
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17. Cranial Nerve II - Optic
• Part of the CNS as it is derived from an
outpouching of the diencephalon during
embryonic corrospondence
• The fibres are covered with myelin produced by
oligodendrocytes rather than the Schwann cells of
the peripheral nervous system and are encased
within the meninges
• Therefore peripheral neuropathies like GuillainBarré syndrome do not affect the optic N
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18. • ORIGIN: Arises from the retina of the eye.
• COURSE: Optic nerves pass thru’ the optic canals
and converge at the optic chiasma
• They continue as optic tract to the thalamus
where they synapse
• From there, the optic radiation fibers run to the
visual cortex of occipital lobe.
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21. APPLIED ANATOMY
•
•
•
•
•
•
•
Right-sided circumferential blindness due to retrobulbar neuritis.
Total blindness of the right eye due to lesion of right optic nerve.
Right nasal hemianopia due to partial lesion of right optic chiasm.
Bitemporal hemianopia due to a complete lesion of the optic chiasm.
Left temporal and right nasal hemianopias due to a lesion of the right
optic tract (homonymous hemianopia)
Left temporal and right nasal hemianopia due to a lesion of the right
optic radiation.
Left temporal and right nasal hemianopia due to a lesion of the right
visual cortex.
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22. APPLIED ANATOMY
• Damage before the optic chiasm causes loss of
vision in the visual field of the same side only.
• Damage in the chiasm causes loss of vision
laterally in both visual fields (bitemporal
hemianopia). It may occur in large pituitary
adenoma
• Damage after the chiasm causes loss of vision on
one side but affecting both visual fields: nasalsame ½ ; temporal – opp ½
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24. VISUAL FIELDS
• Ask the patient to cover one eye while the
examiner tests the opposite eye
• The examiner wiggles the finger in each of
the four quadrants and asks the patient to
state when the finger is seen in the
periphery
• The examiner's visual fields should be
normal, since it is used as the baseline.
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26. Cranial Nerve III - Occulomotor
• ORIGIN: Originates from the oculomotor nucleus
located in the rostral midbrain at the level of the superior
colliculus.
• COURSE: Fibres leaving the occulomotor nucleus
travel ventrally in the tegmentum of the midbrain passing
through medial portion of the cerebral peduncle to emerge
at the junction of the midbrain and pons.
• Upon emerging from the brainstem the oculomotor nerve
passes between the posterior cerebral and superior
cerebellar arteries and pierces the dura mater to enter the
cavernous sinus.
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27. • The nerve runs along the lateral wall of the cavernous sinus just
superior to the trochlear nerve and enters the orbit via the superior
orbital fissure.
• Within the orbit, CN III fibers pass through the tendinous ring of the
extraocular muscles and divide into superior and inferior divisions.
• The superior division ascends lateral to the optic nerve to innervate
the superior rectus and levator palpebrae superioris muscles on their
deep surfaces.
• The inferior division of CN III splits into three branches to innervate
the medial rectus and inferior rectus muscles on their ocular surfaces
and the inferior oblique muscle on its posterior surface.
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28. FUNCTIONS
• The somatic motor component of CN III innervates the
following four extraocular muscles of the eyes:
Ipsilateral inferior rectus muscle
Ipsilateral inferior oblique muscle
Ipsilateral medial rectus muscle
Ipsilateral superior rectus muscle
• The remaining extraocular muscles, the superior oblique and lateral
rectus muscles, are innervated by the trochlear nerve (CN IV) and
abducens nerve (CN VI), respectively
• The somatic motor component of CN III also innervates the Bilateral
levator palpebrae superioris muscles. These muscles elevate the
eyelids.
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29. FUNCTIONS
• Viseral motor component:
Provides parasympathetic innervation of
the constrictor pupillae and ciliary muscles
of the eye. The visceral motor component of
CN III is involved in the pupillary light and
accommodation reflexes.
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30. Pupillary reflex
• The reaction of the pupils to light and
accommodation
• In the direct light reflex, the normal pupil
reflexly contracts when a light is shown into
the patient's eye
• The nervous impulses pass from the retina
along the optic nerve to the optic chiasma
and then along the optic tract
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31. • Before reaching the lateral geniculate body,
the fibers concerned with this reflex leave
the tract and pass to the pretectal nuclei
• The pretectal nucleus in turn projects
bilaterally to the Edinger-Westphal nucleus
• Preganglionic parasympathetic fibers from
each half of the Edinger-Westphal nucleus
then project to the ciliary ganglion of the
ipsilateral orbit
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32. • Post-ganglionic parasympathetic fibers exit the ciliary
ganglion to innervate the constrictor pupillae muscle of
the ipsilateral eye
• Due to the bilateral projections from the pretectal nuclei
to the Edinger-Westphal nuclei, light shined into one eye
produces pupillary constriction in both eyes
• Direct pupillary light reflex - response in the stimulated
eye
• Consensual pupillary light reflex - response in the opposite
eye.
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33. Pupillary eye reflex - test
• The patient stares into the distance as the
examiner shines the penlight obliquely into
each pupil
• Pupillary constriction should be noted on
the eye examined (direct response)
and on the opposite eye (consensual
response)
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34. Testing the oculomotor nerve
• Cranial nerves III, IV and VI are usually tested together
• The examiner typically instructs the patient to hold his
head still and follow only with the eyes a finger or penlight
that circumscribes a large "H" in front of the patient
• By observing the eye movement and eyelids, the examiner
is able to obtain more information about the extraocular
muscles, the levator palpebrae superioris muscle, and
cranial nerves III, IV, and VI.
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36. LMN Lesions- Oculomotor
Ophthalmoplegia
• Due to the close proximity of the oculomotor and EdingerWestphal nuclei and the fact that the fibers of both
components travel together all the way to the orbit of the
eye, a LMN lesion will most likely affect both components
of CN III
• Downward, abducted eye on the affected side due to the
unopposed actions of the superior oblique and lateral
rectus muscles.
• Strabismus as a result of extraocular muscle paralysis.
This leads to diplopia (double vision).
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38. • Ptosis (eyelid droop) on the
affected side due to inactivation
of levator palpebrae superioris
muscle and the unopposed
action of the orbicularis oculi
muscle (CN VII)
• The patient may compensate
for the ptosis by contracting the
muscles of the forehead to raise
the eyebrow and lid.
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39. • Dilation of the pupil on the affected side
due to decreased tone of the constrictor
pupillae muscle.
• Loss of the accomodation reflex on the
affected side.
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41. Cranial Nerve IV: Trochlear
• ORIGIN: Fibres emerge from the dorsal
midbrain and enter the orbits via the
superior orbital fissures.
• The fibers of the trochlear nerve originate
from the trochlear nucleus located in the
tegmentum of the midbrain at the level of
the inferior colliculus.
• The nucleus is located just ventral to the
cerebral aqueduct
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42. COURSE
• Fibers leaving the trochlear nucleus travel dorsally to
wrap around the cerebral aqueduct
• All fibers of the two trochlear nerves decussate and exit
the dorsal surface of the brainstem just below the
contralateral inferior colliculus.
• Then trochlear nerve curves around the brainstem in the
subarachnoid space and emerges between the posterior
cerebral and superior cerebellar arteries (along with CN
III fibers)
• • The trochlear nerve then enters and runs along the
lateral wall of the cavernous sinus with CN III, V, and VI.
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43. • From the cavernous sinus the trochlear nerve enters the
orbit through the superior orbital fissure
• Innervate the superior oblique muscle along its proximal
one-third
• The only nerve to exit from the dorsal surface of the brain.
• Is the only nerve in which all the lower motor neuron
fibers decussate.
• Has the longest intracranial course.
• Has the smallest number of axons.
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45. ACTIONS
• The superior oblique muscle normally depresses,intorts,
and abducts the eye
• Damage to the trochlear nerve will present as Extorsion
(outward rotation) of the affected eye due to the unopposed
action of the inferior oblique muscle.
• Vertical diplopia (double vision) due to the extorted eye
• Weakness of downward gaze most noticeable on mediallydirected eye. This is often reported as difficulty in
descending stairs.
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46. • Head tilt: patient will often tilt his head
opposite the side of the affected eye in an
attempt to compensate for the outwardly
rotated eye
• Due to its long peripheral course around
the midbrain CN IV is particularly
susceptible to head trauma.
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47. Applied anatomy
If the nerve is injured, downward and
lateral movement of eyeball will not be
possible and no difficulty so long the patient
looks above the horizontal level.
Double vision will occur if he looks
downward and the patient has a pathetic
look and so this nerve is known as pathetic
nerve.
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48. Cranial nerve V Trigeminal
nerve
• It is the fifth cranial nerve and largest of all cranial nerves.
• Type → Mixed so both Motor & Sensory.
• ORIGIN AND COURSE: Superficial origin: Two roots: Motor
and sensory emerge from the ventral aspect of the pons. Sensory root
larger and motor root smaller and motor root lies ventrimedial to
sensory root.
• The sensory root passes forward from the posterior cranial fossa and
joins the concave posterior margin of trigeminal ganglion.
• The motor root passes forward and then passes below the sensory root
and trigeminal ganglion in the trigeminal cave and finally joins with
the sensory part of mandibular nerve in the foramen ovale and from
trunk of mandibular nerve.
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49. • Branches
• Ophthalmic Nerve (V1) → Purely Sensory
Nerve.
• Maxillary Nerve (V2) → Sensory.
• Mandibular Nerve (V3) → Mixed and
consisting of two roots
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50. OPHTHALMIC
It is one of the divisions of trigeminal nerve.
- It is purely a sensory nerve.
- Arises from the convex anterior margin of
trigeminal ganglion.
- After origin it lies on the lateral wall of
cavernous sinus below 4th cranial nerve
and above maxillary division.
- In the anterior part of cavernous sinus it
terminates by dividing into a) Frontal, b)
Lacrimal, c) Nasociliary.
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51. MAXILLARY
• It is the intermediate division of trigeminal nerve.
• Origin: from the convex aspect of trigeminal ganglion.
• Course: After origin it runs forwards along the lower
part of lateral wall of cavernous sinus below the
ophthalmic nerve.
• Then it leaves the skull by passing through foramen
rotundum and enters into the pterygopalatine fossa.
From there it inclines to the posterior surface of maxilla
and enters the orbit through inferior orbital fissure. It is
then named infraorbital nerve It passes through
infraorbital groove and canal on the floor of the orbit.
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52. • Branches:
1) Within cranium: Meningeal. It supplies duramater of middle and
partly in the anterior cranial fossa.
2) In the pterygopalatine fossa:
1) Ganglionic:
2) Zygomatic:
a. zygomaticotemporal
b. zygomaticofacial.
3) Posterior superior alveolar.
3) In the infraorbital canal:
i. Middle superior alveolar.
ii. Anterior superior alveolar.
4) In the face:
1. Palpebral.
2. Nasal.
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3. Superior labial.
53. MANDIBULAR
It is the largest division of trigeminal nerve.
• Origin: Larger sensory root arises from
convex aspect of trigeminal ganglion and
smaller motor root from motor nucleus of
trigeminal nerve in the pons.
• Course: The united trunk enters the
infratemporal fossa by passing through
foramen ovale and lies in between tensor
veli palate-medially and lateral pterygoid
laterally.
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54. Branches
1) From the trunk, i.e. before division:
i) Nervous spinous or meningeal branch
ii) Nerve to medial pterygoid.
2) From anterior divisions:
Motor branches:
i) Deep temporal
ii) Nerve to lateral pterygoid
iii) Massetric
Sensory branch: Buccal nerve and skin
3) From posterior division:
i) auriculo temporal
ii) lingual www.indiandentalacademy.com
55. • Inferior alveolar nerve: It is the branch of posterior trunk
of mandibular nerve.
• Course: it runs downward deep to lateral pterygoid and
passes between sphenomandibular ligament and ramus of
mandible upto mandibular foramen and enters the
mandibular canal and runs below the teeth as far as
mental foramen and terminates by dividing into mental
and incisive branch.
• Branches:
1) Nerve to myolohyoid
2) Mental
3) Incisive branch
4) Dental branch www.indiandentalacademy.com
56. Applied anatomy
The sensory root of this nerve is divided
into three divisions, each division may be
tested by light touch or pinprick on the skin
overlying its respective area of
distribution.
The motor root of trigeminal supplies the
muscles of mastication and can be tested by
palpating the temporalis and masseter
during clenching movements.
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57. Applied anatomy
Lesion of whole of trigeminal nerve,
1) Anesthesia of the corresponding anterior half of scalp,
face(except the area at the angle of mouth, because of supply by
great auricular), cornea, conjunctiva, mucous membrane of nose,
mouth, anterior 2/3rd of tongue.
2) Paralysis and atrophy of muscles supplied by the nerve and so
when patient tries to open the mouth the mandible will thrust to the
paralysed side.
Lesions of any divisions of nerve.
Lesion of lingual nerve below the point of joining of chorda tympani
Pain or neuralgia is of very common.
In case of frontal or ethmoidal sinusitis or glaucoma severe
supraorbital pain occurs. It is also a case of referred pain.
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58. Trigeminal neuralgia
It is a disorder of unilateral (usually right-sided) facial pain. While the
exact cause is unknown, it is thought that TN results from irritation of
the trigeminal nerve. This irritation results from damage due either to
changes in the blood vessels or the presence of a tumor or other
lesions that cause compression of the nerve.
The pain quality is usually sharp, stabbing, lancinating (cutting or
tearing), and burning. It may have an "electric shock"-like character.
In some individuals the attacks may be initiated by non-painful
physical stimulation of specific areas (trigger points or zones) that are
located on the same side of the face as the pain.
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60. Cranial nerve VI-Abducens nerve
• It is the sixth cranial nerve which supplies
lateral rectus muscle.
• Type → Motor nerve.
• Origin → The fibres arise from a small
nucleus situated in the dorsal aspect of the
pons in the floor of the fourth ventricle
close to the median plane and beneath the
facial colliculus.
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61. • Course → The abducent nerve after leaving the brain stem
runs upwards laterally and forwards through cisterna
pontis. As it proceeds forwards it will be crossed by
anterior inferior cerebellar artery ventrally and then loses
its dural sheath at the lateral side of dorsal sellae. Then it
bends sharply forwards at the apex of petrous part of
temporal bone to the lateral margin of dorsum sellae. After
that enters into orbital cavity through middle part of
superior orbital fissure within annulous tendinous
communis. Finally it terminates in the orbit.
• Enter → Superior Orbital Fissure.
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62. Applied anatomy
It is liable to be damaged during fracture of skull. When
intracranial pressure increases, pons is pushed backwards and
downwards and this nerve may get stretched and may lose its
function.
Effects of paralysis:
– Convergent squint due to unopposed action of medial rectus.
– Often diplopia with convergent squint will be present.
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63. Cranial nerve VII- Facial nerve
• Type of nerve: It is a mixed nerve
consisting of two roots – sensory and motor
roots. The sensory root is known as Nervus
intermedius.
• Developmental representation: It is the
nerve of second branchial arch.
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64. • Branches of distribution:
– Within facial canal
– Nerve to stapedius muscle.
– Chorda tympani nerve.
– Just at its exit from stylomastoid foramen.
– Posterior auricular.
– Nerve to stylohyoid.
– Nerve to posterior belly of diagastric.
– In the face:
– Temporal.
– Zygomatic.
– Buccal.
– Marginal mandibular.
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– Cervical.
65. Applied anatomy
• Supra nuclear lesions- Hemiplegia.
• Infra nuclear lesions- Bells palsy.
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68. VIII Nerve- Vestibulocochlear
• Type: Special sensory nerve and nerve of hearing and
equilibrium.
• Have two components vestibular component and cochlear
component.
• ORIGIN: Cochlear nerve ( two nuclei) ventral cochlear
and dorsal cochlear nuclei.
• Vestibular nerve (four nuclei) superior, inferior, medial,
lateral.
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69. • COURSE: The vestibulocochlear nerve along with two
roots of facial nerve after emergence from the brain stem
runs laterally to internal acoustic meatus accompanied by
internal acoustic branch of basilar artery and
corresponding veins.
• In the meatus the motor root of facial nerve lies on upper
and anterior surface of vestibulocochlear and the sensory
root lies between them.
• Then the vestibulocochlear nerve divides into two
components- (a) Vestibular and (b) Cochlear nerves.
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70. actions
• The vestibular nerve is sensory from
receptors in the inner ear that provide
information concerning movement of the
body, balance, and body position in relation
to gravitational force.
• The cochlear nerve is sensory from auditory
(hearing) receptors in the cochlea of the
inner ear.
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71. Applied anatomy
• Vestibulocochlear nerve is frequently injured
along with facial nerve in fracture of middle
cranial fossa involving internal acoustic meatus.
• Nerve may be injured by violent blows of the head
or by loud explosions and deafness may occur.
• Tumors at cerebello-pontine angle may involve
both the facial and vestibulocochlear nerve.
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72. Applied anatomy
• Disturbances in the vestibular nerve function include
giddiness(VERTIGO) and NYSTAGMUS. Vestibular nystagmus is
uncontrollable rhythmic oscillations of the eyes. This form of
nystagmus is essentially a disturbance in reflex control of the
extraocular muscles, which is one of the function of the semicircular
canals. The causes of vertigo include diseases of the labrynth, lesions
of the vestibular nerve and cerebellum, multiple sclerosis, tumors and
vascular lesions of brainstem.
• Disturbances in the cochlear nerve include deafness and tinnitus. Loss
of hearing may be due to defect in the auditory conducting mechanism
in the middle ear, damage to receptor cells in spinal organ of corti in
cochlea, lesions of the cochlear nerve due to acoustic neuroma and
trauma, or lesion of the cerebral cortex of temporal lobe due to
multiple sclerosis.
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73. TESTS
• Rinne’s test: vibrating tuning fork is held in the
ear and then placed on the mastoid process
patient is asked to compare the relative loudness
of the two.
• Weber’s test: vibrating tuning fork is placed in
middle of forehead – the sound will be heard
better in the middle ear diseased side than on the
normal side.
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75. IX Nerve- Glossopharyngeal
• Mixed nerve
• Deep origin: The nuclei are: 1. Upper part of nucleus ambigus: It
gives branchiomotor fibres. 2. Inferior salivatory nucleus: origin of
parasympathetic secretomotor fibres to parotid gland.
• Upper part of nucleus of spinal tract of trigeminal nerve: for general
somatic afferent.
• Upper part of tractus solitarius: for special sense taste (special
Visceral afferent) and other general visceral sensations from
posterior one third of tongue, tonsil, palate, oral part of pharynx.
• Superficial origin: The nerve emerges out as two or three rootlets
from the posterolateral sulcus of medulla oblongata above the rootlets
of vagus nerve.
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76. Applied anatomy
• Glossopharyngeal nerve is not involved separately usually. It may be
injured along with tenth nerve.
• Acute pharyngitis may cause referred pain in the ear but
inflammation of pharyngotympanic tube must be excluded.
• Reflex contraction of muscles of throat if posterior wall of pharynx is
stimulated and 9th nerve can be tested in this way.
• Taste sensation of posterior one-third of tongue will be lost in case of
involvement of 9th nerve.
• After a series of coughing carotid sinus may be subjected to pressure
and results in syncope or cardiac arrest. This is due to stimulation of
cardioinhibitory centre reflexly by sinus nerve.
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78. X Nerve- Vagus
• The vagus nerve supplies motor fibers to constrictor
muscles of the pharynx, intrinsic muscles of the larynx,
and involuntary muscles of the bronchi, heart, esophagus,
stomach, small intestine, and part of the large intestine.
Secretory motor fibers of the vagus supply the pancreas
and secretory glands of most of the alimentary canal. The
vagus is sensory from the laryngeal mucosa, heart, lungs,
esophagus, stomach, small intestine, and part of the large
intestine. In addition, vagal sensory fibers convey taste
from the epiglottis and blood pressure and chemistry
information from the aorta. The ninth and tenth cranial
nerves are tested together because their functions overlap.
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79. Applied anatomy
• Auricular branch of vagus is irritated by scratching, or by
earwax or syringing the ear with warm water. This
irritation may cause reflex vomiting and also stoppage of
heart by reflex irritation of vagus.
• Recurrent laryngeal nerve may be injured during
operation on thyroid and application of ligature of inferior
thyroid artery. It may also be compressed during
enlargement of thyroid, specially a growth. Its affection
causes hoarseness of voice.
• Vagotomy i.e. section of anterior and posterior or vagal
trunks are sometimes done in treatment of peptic ulcer.
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81. XI Nerve- Spinal accessory
• The spinal accessory nerve, cranial nerve XI,
innervates the sternocleidomastoid and trapezius
muscles. It is composed of spinal fibers
originating in the anterior horn cells of the first
five cervical cord segments and an accessory
component, which travels briefly alongside the
vagus nerve. The dorsal and ventral roots from the
first five cervical cord segments unite to enter the
skull through the foramen magnum and exit
through the jugular foramen.
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82. Actions
• The eleventh cranial nerve supplies some motor
fibers to the muscles of the larynx and pharynx via
the pharyngeal plexus (C.N. IX-X-XI), but its
principal distribution is motor to the
sternocleidomastoid and trapezius muscles. The
sternocleidomastoid turns the head to the opposite
side, and the trapezius muscle elevates the
shoulder on the same side.
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83. Applied anatomy
• When the sternocleidomastoid and trapezius are weak on
the same side, an ipsilateral peripheral accessory palsy,
involving cranial nerves X and XI, is implied as may be
seen with a jugular foramen tumor, ie, glomus tumor or
neurofibroma. Because the cerebral hemisphere innervates
the contralateral trapezius and ipsilateral
sternocleidomastoid, a large right hemisphere stroke will
result in weakness of the left trapezius and right
sternocleidomastoid. Bilateral wasting of the
sternocleidomastoid may be seen with myopathic
conditions such as myotonic dystrophy and polymyositis or
motor neuron disease, the latter usually associated with
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85. XII Nerve- Hypoglossal
• The hypoglossal nerve is a pure motor nerve,
innervating the muscles of the tongue. It obtains
supranuclear innervation from the contralateral
motor cortex. The nucleus of the hypoglossal
nerve sits in the medial aspect of the medulla, near
the floor of the fourth ventricle and exits the skull
through the hypoglossal canal.
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87. Applied anatomy
• Tongue deviation, combined with wasting on the side to
which it is deviated, implies a unilateral, lower motor
neuron, hypoglossal nucleus or nerve lesion as may be
seen with syringobulbia (a degenerative cavity within the
brainstem), with basilar meningitis, or foramen magnum
tumor. If the tongue deviates and is of normal bulk, one
should consider an upper motor neuron lesion, such as
stroke or tumor in the hemisphere contralateral to the side
of deviation, and look for associated hemiparesis on the
side of tongue deviation.
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89. References
• HUTCHISON’S CLINICAL METHODS 23 EDITION.
• ESSENTIALS OF NEUROANATOMY- A K DATTA.
• PRINCIPLES AND PRACTICE OF EMERGENCY NEUROLOGY:
HAND BOOK FOR EMERGENCY PHYSCIANS BY CAMBRIDGE
UNIVERSITY.
• INDIAN JOURNAL OF NEUROTRAUMA -2007 VOL 4.
• THE NEUROLOGICAL EXAMINATION- RAYMOND A.MARTIN
• ESSENTIALS OF CLINICAL NEUROLOGY: HEAD TRAUMA- L A
WEISBURG.
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