"Mastering the Basics: General Physical Examination in Neurology with Dr. Ganeshgouda"
đ Greetings, aspiring healthcare professionals! Dr. Ganeshgouda here, and today, we're delving into the fundamentals of neurological assessment through General Physical Examination (GPE). Whether you're a medical student, a resident, or anyone eager to understand the essentials of examining the nervous system, this discussion is tailored just for you.
This document discusses various types of birth injuries including:
- Head and neck injuries such as caput succedaneum, cephalhematoma, subgaleal hemorrhage, skull fractures, and intracranial hemorrhages.
- Nerve injuries including brachial plexus injuries (Erb's palsy and Klumpke's palsy) and facial nerve palsy.
- Risk factors for birth injuries include prolonged or difficult labor, fetal macrosomia, and instrument-assisted delivery. Birth injuries can cause impairments ranging from mild swelling to life-threatening hemorrhages requiring medical or surgical intervention.
This document discusses birth injuries, including definitions, risk factors, types, and descriptions of specific injuries. Some key points:
- Birth injuries occur in about 0.7% of births and account for under 2% of neonatal deaths. Factors like difficult delivery or fetal positioning can increase risk.
- Types of injuries include head/neck trauma, nerve injuries, fractures, and internal organ damage. Specific injuries discussed include brachial plexus injuries, skull fractures, intracranial hemorrhages, and others.
- Injuries are described in detail, along with typical presentations, diagnostic methods, and treatment approaches depending on severity. Head injuries commonly involve skull fractures or bleeding, while nerve injuries often affect the
Papilloedema is swelling of the optic disc caused by increased intracranial pressure. It is defined as disc swelling associated with raised ICP and is nearly always bilateral. The document discusses the anatomy of the optic disc, causes of papilloedema including tumors and idiopathic intracranial hypertension, pathogenesis related to alterations in pressure gradients, clinical features such as headache and diplopia, and epidemiology showing highest rates in obese women of childbearing age.
This document discusses various types of birth injuries including definitions, risk factors, and descriptions of specific injuries such as head and neck injuries, fractures, and nerve damage. It provides details on different types of extracranial head injuries (caput succedaneum, cephalhematoma, subgaleal hemorrhage), cranial injuries (linear skull fractures, depressed skull fractures), and various forms of intracranial hemorrhage. Signs, symptoms, risk factors, diagnosis, and management are described for each injury. Brachial plexus injuries including Erb's palsy and Klumpke's palsy as well as facial nerve palsy are also summarized.
This document discusses cerebral herniation syndromes which occur when increased intracranial pressure causes brain tissue to be squeezed through openings in the skull. It describes the four main types of herniation - subfalcine, central/downward transtentorial, temporal transtentorial/uncal, and cerebellar tonsillar. Clinical signs and prognosis are provided for each type of herniation. The Monro-Kellie doctrine is also summarized, which states that the intracranial compartment has a fixed volume, and increases in any component can increase intracranial pressure.
This document discusses the classification and types of intra cranial hemorrhages. It describes extra-axial hemorrhages which occur outside the brain tissue, including epidural, subdural and subarachnoid hemorrhages. Intra-axial hemorrhages occur within the brain tissue and include intra-parenchymal and intraventricular bleeds. Specific details are provided on the causes, locations, presentations and CT appearances of different hemorrhage types like epidural, subdural, subarachnoid, hypertensive intra-cerebral and intraventricular hemorrhages.
This document discusses various types of birth injuries including:
- Head and neck injuries such as caput succedaneum, cephalhematoma, subgaleal hemorrhage, skull fractures, and intracranial hemorrhages.
- Nerve injuries including brachial plexus injuries (Erb's palsy and Klumpke's palsy) and facial nerve palsy.
- Risk factors for birth injuries include prolonged or difficult labor, fetal macrosomia, and instrument-assisted delivery. Birth injuries can cause impairments ranging from mild swelling to life-threatening hemorrhages requiring medical or surgical intervention.
This document discusses birth injuries, including definitions, risk factors, types, and descriptions of specific injuries. Some key points:
- Birth injuries occur in about 0.7% of births and account for under 2% of neonatal deaths. Factors like difficult delivery or fetal positioning can increase risk.
- Types of injuries include head/neck trauma, nerve injuries, fractures, and internal organ damage. Specific injuries discussed include brachial plexus injuries, skull fractures, intracranial hemorrhages, and others.
- Injuries are described in detail, along with typical presentations, diagnostic methods, and treatment approaches depending on severity. Head injuries commonly involve skull fractures or bleeding, while nerve injuries often affect the
Papilloedema is swelling of the optic disc caused by increased intracranial pressure. It is defined as disc swelling associated with raised ICP and is nearly always bilateral. The document discusses the anatomy of the optic disc, causes of papilloedema including tumors and idiopathic intracranial hypertension, pathogenesis related to alterations in pressure gradients, clinical features such as headache and diplopia, and epidemiology showing highest rates in obese women of childbearing age.
This document discusses various types of birth injuries including definitions, risk factors, and descriptions of specific injuries such as head and neck injuries, fractures, and nerve damage. It provides details on different types of extracranial head injuries (caput succedaneum, cephalhematoma, subgaleal hemorrhage), cranial injuries (linear skull fractures, depressed skull fractures), and various forms of intracranial hemorrhage. Signs, symptoms, risk factors, diagnosis, and management are described for each injury. Brachial plexus injuries including Erb's palsy and Klumpke's palsy as well as facial nerve palsy are also summarized.
This document discusses cerebral herniation syndromes which occur when increased intracranial pressure causes brain tissue to be squeezed through openings in the skull. It describes the four main types of herniation - subfalcine, central/downward transtentorial, temporal transtentorial/uncal, and cerebellar tonsillar. Clinical signs and prognosis are provided for each type of herniation. The Monro-Kellie doctrine is also summarized, which states that the intracranial compartment has a fixed volume, and increases in any component can increase intracranial pressure.
This document discusses the classification and types of intra cranial hemorrhages. It describes extra-axial hemorrhages which occur outside the brain tissue, including epidural, subdural and subarachnoid hemorrhages. Intra-axial hemorrhages occur within the brain tissue and include intra-parenchymal and intraventricular bleeds. Specific details are provided on the causes, locations, presentations and CT appearances of different hemorrhage types like epidural, subdural, subarachnoid, hypertensive intra-cerebral and intraventricular hemorrhages.
- Marfan syndrome is a genetic disorder of connective tissue caused by mutations in the FBN1 gene that encodes fibrillin-1 protein.
- It is a multi-system disorder that mainly affects the skeletal, ocular, and cardiovascular systems. Key features include tall stature, long limbs, eye problems like ectopia lentis, and aortic root enlargement which can lead to aortic dissection.
- Treatment involves beta-blockers and surgery to repair an enlarged aorta when needed. Patients require lifelong monitoring of the aorta through echocardiograms or other imaging to screen for aortic complications.
Marfan syndrome is a genetic disorder of connective tissue caused by mutations in the FBN1 gene. It affects the skeletal, ocular, and cardiovascular systems. Key features include disproportionately long limbs, joint laxity, eye lens dislocation, and aortic root aneurysm/dissection which are the leading causes of mortality. Diagnosis is based on clinical criteria involving multiple organ systems. Ongoing monitoring of the aorta is critical as progressive dilatation can lead to dissection.
This document provides information about acute encephalitis syndrome, including important definitions, diagnostic criteria, and guidelines for evaluation and management of children presenting with acute encephalitis. It defines acute encephalitis syndrome as a person of any age with acute fever and altered mental status including confusion, disorientation or seizures. It outlines a six step approach to rapidly assess and stabilize the patient, conduct a clinical evaluation, perform investigations, provide empirical treatment, supportive care and treatment, and prevent complications through rehabilitation.
Intracranial hypertension occurs when cerebrospinal fluid (CSF) pressure within the skull is elevated above normal levels. It can be caused by brain injuries, tumors, strokes, or other conditions that increase the volume of brain components within the fixed skull space. Symptoms include headaches, nausea, vision changes, and altered mental status. Evaluation involves imaging tests like CT or MRI of the brain to identify potential causes, as well as lumbar puncture to measure CSF pressure directly. Invasive ICP monitors may also be placed to precisely track pressure and guide treatment to prevent further neurological injury.
This document provides guidance on performing a physical examination of the central nervous system. It outlines examination of various body systems and signs, including attitude, level of consciousness, head, facies, eyes, ears, mouth, neck, skin, extremities, and spine. It describes abnormalities to examine for, such as craniosynostosis deformities of the head, facial palsies, ptosis, neurocutaneous lesions, clubbing, and peripheral nerve disorders. The examination aims to detect neurological deficits or systemic diseases that may involve the CNS.
Subarachnoid haemorrhage occurs when there is bleeding into the subarachnoid space between the membranes surrounding the brain. The most common cause is rupture of a berry aneurysm. Patients typically experience a sudden and severe headache, vomiting, and may lose consciousness. Complications include rebleeding, hydrocephalus, cerebral vasospasm leading to ischemia, and hyponatremia. Prompt diagnosis and treatment are important to prevent neurological deficits and reduce mortality.
This document discusses approaches to macrocephaly and microcephaly. Macrocephaly is defined as a head circumference over 2 standard deviations above the mean, while microcephaly is under 3 standard deviations below the mean. Causes of macrocephaly include genetic factors, hydrocephalus, tumors, and metabolic disorders. Hydrocephalus results from abnormal CSF accumulation and can be obstructive or communicating. Microcephaly can be primary/genetic due to syndromes or secondary from infections, drugs, or hypoxia that impact brain development prenatally or in the first two years. Evaluation and treatment depends on the underlying cause.
This document discusses various types of birth injuries including definitions, risk factors, and clinical features. It covers injuries to the head such as cephalhematoma and subgaleal hemorrhage. It also discusses other types of injuries like brachial plexus injuries, facial nerve palsy, and spinal cord injuries. For each type of injury, the document provides details on symptoms, diagnosis, and treatment approaches.
Coma is a state of reduced alertness and responsiveness that can result from metabolic or structural causes affecting the brain. Metabolic causes include toxins, infections, electrolyte abnormalities, while structural causes are head trauma, hemorrhage, infarction. Patients may present with diffuse symptoms or focal neurological deficits depending on the location and extent of injury. Evaluation involves the Glasgow Coma Scale, neurological exam, and diagnostic imaging and labs to identify the underlying cause so that targeted treatment can be initiated. Subarachnoid hemorrhage commonly results from aneurysms and presents with a sudden, severe headache with potential complications like rebleeding and vasospasm requiring intensive monitoring and management.
PROGRESSIVE SUPRANUCLEAR PALSY-MRI SPOTTER WITH OTHER IMAGING SIGNSKannan Narayanan S
Â
Atypical parkinsonism is a group of neurodegenerative disorders where parkinsonism is a prominent feature but differs from IPD by associated atypical features.
References-Harrison textbook of Internal medicine,Various sourcres
This document discusses hydrocephalus, defined as an increase in cerebrospinal fluid volume within the ventricles of the brain. It can be caused by increased CSF production, decreased reabsorption, or obstruction of CSF outflow. The main types are communicating and obstructive. Clinical features include an enlarged head circumference, bulging fontanelles, and signs of increased intracranial pressure. Investigations include CT and MRI imaging and lumbar puncture. Treatment involves addressing the underlying cause, temporary external drainage, and longer term shunt procedures to drain CSF, though these carry risks of complications like over or underdrainage.
CLINICAL FEATURES, INVESTIGATIONS AND PROGNOSIS OF BRAIN SEMINAR 2.pptxcheshtasharma22
Â
This document provides information on brain tumors, including their anatomy, classification, clinical features, investigations, and prognosis. It discusses the various types of primary and secondary brain tumors, how they present depending on their location in the brain, common signs and symptoms like headaches and seizures. Investigations covered include neuroimaging techniques like MRI, CT, PET scans which are used to diagnose and characterize brain tumors. Prognosis depends on tumor type, grade, size and location.
This document discusses cerebral venous sinus thrombosis (CVT). It begins with an introduction and epidemiology, noting it affects 5 per million annually and is more common in young individuals, especially females. Risk factors include prothrombotic disorders, oral contraceptive use, pregnancy, infections, and genetic factors. Clinically, it presents with headaches in 90% of patients and seizures in 40-70%. Diagnosis is made primarily through MRI and MR venography. Treatment involves managing increased intracranial pressure, seizures, and underlying causes. Anticoagulation with heparin is the mainstay of treatment for aseptic CVT.
Also called Disc oedema
Passive disc swelling associated with increased intra cranial pressure
Bilateral and asymmetrical
Inflammations such as papillitis, neuroretinitis, papillophlebitis and uveitis.
Ocular hypotony
CRVO, AION (anterior ischemic optic neuropathy) and uremia
Orbital causes â tumors, graveâs orbitopathy and orbital cellulitis
Leukemia and lymphomas
1) Neurological signs that indicate dysfunction in a different area of the brain than would be expected given the location of pathology are known as false localizing signs.
2) False localizing signs can occur due to compression of brain structures distant from the site of a lesion, such as cranial nerve palsies resulting from compression against the skull base.
3) Dysfunction of motor or sensory pathways can also produce false localizing signs, like contralateral hemiparesis from transtentorial herniation compressing the cerebral peduncle.
This document discusses false localizing signs in neurology. False localizing signs are neurological signs that indicate dysfunction in a location distant from the actual site of pathology. The document provides several examples of false localizing signs involving the cranial nerves, motor system, cerebellum, and other areas. It also discusses the potential pathophysiological mechanisms and includes historical cases demonstrating false localizing signs.
This document discusses various types of birth injuries that can occur during labor and delivery. It begins by defining birth injuries and noting their prevalence. It then covers predisposing risk factors and provides a classification system for birth injuries involving soft tissue, the head/neck, facial structures, nerves, fractures, and internal organs. The remainder of the document delves into specific injury types like brachial plexus palsy, skull fractures, retinal hemorrhages, and clavicle fractures, describing their causes, signs/symptoms, diagnosis, and management.
The document discusses craniovertebral junction anomalies including definitions, classifications of bony and soft tissue anomalies, Arnold-Chiari malformation types, clinical presentations, investigations, and treatments. Major anomalies discussed include platybasia, occipitalization, basilar invagination, dense dysplasia, atlanto-axial disease, Arnold-Chiari malformations, syringomyelia, and syringobulbia. Clinical features, investigations using MRI/CT, and surgical treatments are described for various conditions.
Anaesthesia for posterior fossa surgery/NEUROANAESTHESIAZIKRULLAH MALLICK
Â
This document discusses the anatomy, contents, clinical presentation, and anesthetic considerations for posterior fossa surgery. The posterior fossa is bounded by bones and contains the cerebellum, brainstem, and cranial nerves. Common tumors present with non-specific symptoms like headache but can also cause neurological deficits depending on the location of the lesion. Anesthetic goals are to facilitate surgery while minimizing brain trauma and maintaining stability. Important considerations include patient positioning, monitoring, induction technique, and maintenance with low-dose inhalational agents and ventilation to reduce intracranial pressure.
The document discusses several craniofacial anomalies including craniosynostosis. Craniosynostosis occurs when one or more of the fibrous sutures in the skull fuse prematurely, restricting skull growth. It can be primary, due to a defect in ossification, or secondary, due to inadequate brain growth. Primary craniosynostosis affects a single suture and causes specific head shapes like scaphocephaly or brachycephaly, while secondary craniosynostosis involves multiple sutures fusing. Treatment involves surgery to reshape the skull if increased intracranial pressure develops by age 2-4 months.
The document provides information on Parkinson's disease (PD), including its causes, symptoms, diagnosis and management. Some key points:
- PD is caused by degeneration of dopamine-producing neurons in the substantia nigra, leading to motor symptoms like tremor, rigidity and bradykinesia.
- It also causes non-motor symptoms like depression, anxiety and sleep problems. Symptoms typically begin on one side of the body.
- Diagnosis is based on clinical criteria and can be supported by imaging and other tests. Management includes medications, exercise, dietary changes and other therapies to improve motor and non-motor symptoms.
This document provides an overview of movement disorders, including definitions, classifications, and descriptions of specific disorders. It defines movement disorders as neurological syndromes involving either excess or lack of voluntary movement. Major categories include hyperkinetic disorders like chorea, dystonia, and tics, which involve excessive involuntary movements, and hypokinetic disorders like Parkinson's disease, which involve lack of movement. It describes various disorders like akinesia, dystonia, chorea, ballism, athetosis, and myoclonus. It also covers topics like freezing of gait, hypokinesia, psychomotor retardation, and stiff muscles syndromes.
More Related Content
Similar to General Physical Examination(GPE) In Neurology Dr Ganeshgouda.pptx
- Marfan syndrome is a genetic disorder of connective tissue caused by mutations in the FBN1 gene that encodes fibrillin-1 protein.
- It is a multi-system disorder that mainly affects the skeletal, ocular, and cardiovascular systems. Key features include tall stature, long limbs, eye problems like ectopia lentis, and aortic root enlargement which can lead to aortic dissection.
- Treatment involves beta-blockers and surgery to repair an enlarged aorta when needed. Patients require lifelong monitoring of the aorta through echocardiograms or other imaging to screen for aortic complications.
Marfan syndrome is a genetic disorder of connective tissue caused by mutations in the FBN1 gene. It affects the skeletal, ocular, and cardiovascular systems. Key features include disproportionately long limbs, joint laxity, eye lens dislocation, and aortic root aneurysm/dissection which are the leading causes of mortality. Diagnosis is based on clinical criteria involving multiple organ systems. Ongoing monitoring of the aorta is critical as progressive dilatation can lead to dissection.
This document provides information about acute encephalitis syndrome, including important definitions, diagnostic criteria, and guidelines for evaluation and management of children presenting with acute encephalitis. It defines acute encephalitis syndrome as a person of any age with acute fever and altered mental status including confusion, disorientation or seizures. It outlines a six step approach to rapidly assess and stabilize the patient, conduct a clinical evaluation, perform investigations, provide empirical treatment, supportive care and treatment, and prevent complications through rehabilitation.
Intracranial hypertension occurs when cerebrospinal fluid (CSF) pressure within the skull is elevated above normal levels. It can be caused by brain injuries, tumors, strokes, or other conditions that increase the volume of brain components within the fixed skull space. Symptoms include headaches, nausea, vision changes, and altered mental status. Evaluation involves imaging tests like CT or MRI of the brain to identify potential causes, as well as lumbar puncture to measure CSF pressure directly. Invasive ICP monitors may also be placed to precisely track pressure and guide treatment to prevent further neurological injury.
This document provides guidance on performing a physical examination of the central nervous system. It outlines examination of various body systems and signs, including attitude, level of consciousness, head, facies, eyes, ears, mouth, neck, skin, extremities, and spine. It describes abnormalities to examine for, such as craniosynostosis deformities of the head, facial palsies, ptosis, neurocutaneous lesions, clubbing, and peripheral nerve disorders. The examination aims to detect neurological deficits or systemic diseases that may involve the CNS.
Subarachnoid haemorrhage occurs when there is bleeding into the subarachnoid space between the membranes surrounding the brain. The most common cause is rupture of a berry aneurysm. Patients typically experience a sudden and severe headache, vomiting, and may lose consciousness. Complications include rebleeding, hydrocephalus, cerebral vasospasm leading to ischemia, and hyponatremia. Prompt diagnosis and treatment are important to prevent neurological deficits and reduce mortality.
This document discusses approaches to macrocephaly and microcephaly. Macrocephaly is defined as a head circumference over 2 standard deviations above the mean, while microcephaly is under 3 standard deviations below the mean. Causes of macrocephaly include genetic factors, hydrocephalus, tumors, and metabolic disorders. Hydrocephalus results from abnormal CSF accumulation and can be obstructive or communicating. Microcephaly can be primary/genetic due to syndromes or secondary from infections, drugs, or hypoxia that impact brain development prenatally or in the first two years. Evaluation and treatment depends on the underlying cause.
This document discusses various types of birth injuries including definitions, risk factors, and clinical features. It covers injuries to the head such as cephalhematoma and subgaleal hemorrhage. It also discusses other types of injuries like brachial plexus injuries, facial nerve palsy, and spinal cord injuries. For each type of injury, the document provides details on symptoms, diagnosis, and treatment approaches.
Coma is a state of reduced alertness and responsiveness that can result from metabolic or structural causes affecting the brain. Metabolic causes include toxins, infections, electrolyte abnormalities, while structural causes are head trauma, hemorrhage, infarction. Patients may present with diffuse symptoms or focal neurological deficits depending on the location and extent of injury. Evaluation involves the Glasgow Coma Scale, neurological exam, and diagnostic imaging and labs to identify the underlying cause so that targeted treatment can be initiated. Subarachnoid hemorrhage commonly results from aneurysms and presents with a sudden, severe headache with potential complications like rebleeding and vasospasm requiring intensive monitoring and management.
PROGRESSIVE SUPRANUCLEAR PALSY-MRI SPOTTER WITH OTHER IMAGING SIGNSKannan Narayanan S
Â
Atypical parkinsonism is a group of neurodegenerative disorders where parkinsonism is a prominent feature but differs from IPD by associated atypical features.
References-Harrison textbook of Internal medicine,Various sourcres
This document discusses hydrocephalus, defined as an increase in cerebrospinal fluid volume within the ventricles of the brain. It can be caused by increased CSF production, decreased reabsorption, or obstruction of CSF outflow. The main types are communicating and obstructive. Clinical features include an enlarged head circumference, bulging fontanelles, and signs of increased intracranial pressure. Investigations include CT and MRI imaging and lumbar puncture. Treatment involves addressing the underlying cause, temporary external drainage, and longer term shunt procedures to drain CSF, though these carry risks of complications like over or underdrainage.
CLINICAL FEATURES, INVESTIGATIONS AND PROGNOSIS OF BRAIN SEMINAR 2.pptxcheshtasharma22
Â
This document provides information on brain tumors, including their anatomy, classification, clinical features, investigations, and prognosis. It discusses the various types of primary and secondary brain tumors, how they present depending on their location in the brain, common signs and symptoms like headaches and seizures. Investigations covered include neuroimaging techniques like MRI, CT, PET scans which are used to diagnose and characterize brain tumors. Prognosis depends on tumor type, grade, size and location.
This document discusses cerebral venous sinus thrombosis (CVT). It begins with an introduction and epidemiology, noting it affects 5 per million annually and is more common in young individuals, especially females. Risk factors include prothrombotic disorders, oral contraceptive use, pregnancy, infections, and genetic factors. Clinically, it presents with headaches in 90% of patients and seizures in 40-70%. Diagnosis is made primarily through MRI and MR venography. Treatment involves managing increased intracranial pressure, seizures, and underlying causes. Anticoagulation with heparin is the mainstay of treatment for aseptic CVT.
Also called Disc oedema
Passive disc swelling associated with increased intra cranial pressure
Bilateral and asymmetrical
Inflammations such as papillitis, neuroretinitis, papillophlebitis and uveitis.
Ocular hypotony
CRVO, AION (anterior ischemic optic neuropathy) and uremia
Orbital causes â tumors, graveâs orbitopathy and orbital cellulitis
Leukemia and lymphomas
1) Neurological signs that indicate dysfunction in a different area of the brain than would be expected given the location of pathology are known as false localizing signs.
2) False localizing signs can occur due to compression of brain structures distant from the site of a lesion, such as cranial nerve palsies resulting from compression against the skull base.
3) Dysfunction of motor or sensory pathways can also produce false localizing signs, like contralateral hemiparesis from transtentorial herniation compressing the cerebral peduncle.
This document discusses false localizing signs in neurology. False localizing signs are neurological signs that indicate dysfunction in a location distant from the actual site of pathology. The document provides several examples of false localizing signs involving the cranial nerves, motor system, cerebellum, and other areas. It also discusses the potential pathophysiological mechanisms and includes historical cases demonstrating false localizing signs.
This document discusses various types of birth injuries that can occur during labor and delivery. It begins by defining birth injuries and noting their prevalence. It then covers predisposing risk factors and provides a classification system for birth injuries involving soft tissue, the head/neck, facial structures, nerves, fractures, and internal organs. The remainder of the document delves into specific injury types like brachial plexus palsy, skull fractures, retinal hemorrhages, and clavicle fractures, describing their causes, signs/symptoms, diagnosis, and management.
The document discusses craniovertebral junction anomalies including definitions, classifications of bony and soft tissue anomalies, Arnold-Chiari malformation types, clinical presentations, investigations, and treatments. Major anomalies discussed include platybasia, occipitalization, basilar invagination, dense dysplasia, atlanto-axial disease, Arnold-Chiari malformations, syringomyelia, and syringobulbia. Clinical features, investigations using MRI/CT, and surgical treatments are described for various conditions.
Anaesthesia for posterior fossa surgery/NEUROANAESTHESIAZIKRULLAH MALLICK
Â
This document discusses the anatomy, contents, clinical presentation, and anesthetic considerations for posterior fossa surgery. The posterior fossa is bounded by bones and contains the cerebellum, brainstem, and cranial nerves. Common tumors present with non-specific symptoms like headache but can also cause neurological deficits depending on the location of the lesion. Anesthetic goals are to facilitate surgery while minimizing brain trauma and maintaining stability. Important considerations include patient positioning, monitoring, induction technique, and maintenance with low-dose inhalational agents and ventilation to reduce intracranial pressure.
The document discusses several craniofacial anomalies including craniosynostosis. Craniosynostosis occurs when one or more of the fibrous sutures in the skull fuse prematurely, restricting skull growth. It can be primary, due to a defect in ossification, or secondary, due to inadequate brain growth. Primary craniosynostosis affects a single suture and causes specific head shapes like scaphocephaly or brachycephaly, while secondary craniosynostosis involves multiple sutures fusing. Treatment involves surgery to reshape the skull if increased intracranial pressure develops by age 2-4 months.
Similar to General Physical Examination(GPE) In Neurology Dr Ganeshgouda.pptx (20)
The document provides information on Parkinson's disease (PD), including its causes, symptoms, diagnosis and management. Some key points:
- PD is caused by degeneration of dopamine-producing neurons in the substantia nigra, leading to motor symptoms like tremor, rigidity and bradykinesia.
- It also causes non-motor symptoms like depression, anxiety and sleep problems. Symptoms typically begin on one side of the body.
- Diagnosis is based on clinical criteria and can be supported by imaging and other tests. Management includes medications, exercise, dietary changes and other therapies to improve motor and non-motor symptoms.
This document provides an overview of movement disorders, including definitions, classifications, and descriptions of specific disorders. It defines movement disorders as neurological syndromes involving either excess or lack of voluntary movement. Major categories include hyperkinetic disorders like chorea, dystonia, and tics, which involve excessive involuntary movements, and hypokinetic disorders like Parkinson's disease, which involve lack of movement. It describes various disorders like akinesia, dystonia, chorea, ballism, athetosis, and myoclonus. It also covers topics like freezing of gait, hypokinesia, psychomotor retardation, and stiff muscles syndromes.
This document provides information on the management of migraine. It discusses:
- The prevalence of migraine is higher in females than males, and about 1/3 of patients are severely disabled during attacks.
- Diagnostic criteria for migraine without aura involves recurrent headaches with characteristics like pulsating pain and sensitivity to light/sound.
- Migraine pathophysiology involves the release of vasoactive neuropeptides in the trigeminal system and brainstem areas.
- Treatment includes acute options like NSAIDs, triptans, and ergotamines to stop attacks, and preventive options to reduce frequency and severity. Intranasal zolmitriptan and oral rizatriptan provide rapid relief
"Navigating Neurologic and Neurosurgical Emergencies: A Guide for Nursing Students"
đ Greetings, nursing students! Dr. Ganesh here, and today, we're embarking on a crucial journey into the realm of neurologic and neurosurgical emergencies. Whether you're on the path to becoming a registered nurse, nurse practitioner, or simply seeking foundational knowledge, this discussion is crafted to empower you in emergency care scenarios.
"Decoding Headaches: A Comprehensive Approach with Dr. Ganesh"
đ Greetings, everyone! Dr. Ganesh here, and today we're going to unravel the intricate world of headaches. Whether you're a healthcare professional refining your skills or someone seeking answers to those persistent head pains, this discussion is tailored just for you.
"Empowering Recovery: Hemorrhagic Stroke Management with Dr. Ganesh"
đ Hello, everyone! Dr. Ganesh here, and today we're delving into a critical aspect of neurology: the management of hemorrhagic strokes. Whether you're a healthcare professional, a caregiver, or someone interested in understanding the complexities of stroke care, this discussion is tailored just for you.
"Revolutionizing Stroke Care: Endovascular Therapy and Neuro Intervention in Acute Ischemic Stroke with Dr. Ganesh"
đ Greetings, everyone! Dr. Ganesh here, and today, we're exploring a groundbreaking topic that's transforming the landscape of stroke care: Endovascular Therapy and Neuro Intervention in Acute Ischemic Stroke (AIS). Whether you're a healthcare professional, a patient, or simply intrigued by medical advancements, this discussion is tailored for you.
"Navigating Cortical Cerebral Venous Thrombosis (CVT) Management with Dr. Ganesh"
đ Hello, everyone! Dr. Ganesh here, and today, we're delving into a critical topic in neurology: the management of Cortical Cerebral Venous Thrombosis (CVT). Whether you're a healthcare professional, a patient, or simply interested in understanding the complexities of cerebrovascular health, this discussion is crafted to provide valuable insights.
"Demystifying Common Neurological Disorders: A Primer for Future Healthcare Professionals with Dr. Ganesh"
đ Greetings, aspiring healthcare professionals! I'm Dr. Ganesh, and today, we're embarking on an educational journey tailored for undergraduate students in medicine, nursing, and pharmaceutical sciences. We'll be demystifying some of the common neurological disorders, laying the groundwork for your future careers in healthcare.
"Navigating Epilepsy: A Holistic Approach with Dr. Ganesh"
đ Hello, everyone! Dr. Ganesh here, and today, we embark on a journey to explore a topic close to my heart: the comprehensive approach to epilepsy. Whether you're a patient, a caregiver, or simply curious about understanding epilepsy, this discussion is crafted with you in mind.
"Decoding Antithrombotics in Acute Ischemic Events with Dr. Ganesh"
đ Greetings, everyone! I'm Dr. Ganesh, and today we're diving into a critical topic: Antithrombotics in Acute Ischemic Events. Whether you're a healthcare professional, a patient, or just someone keen on understanding the complexities of cardiovascular health, this discussion is for you.
"Navigating Anti-Epileptic Drug Choices with Dr. Ganesh"
đ Greetings, friends! Welcome back to the channel. I'm Dr. Ganesh, and today we're delving into a crucial topic: the selection of Anti-Epileptic Drugs (AEDs). If you or someone you know is dealing with epilepsy, understanding the choices and considerations involved in AEDs is vital for effective management.
"The Pivotal Role of Duty Doctors in Neurology Emergency Care: A Masterclass with Dr. Ganesh"
đ Greetings, medical professionals and aspiring duty doctors! Dr. Ganesh here, and today, we're delving into the dynamic and critical realm of neurology emergency care. Whether you're currently serving as a duty doctor or preparing for this role, this masterclass is crafted to empower you in managing neurologic emergencies effectively.
More from Dr Ganeshgouda Majigoudra Consultant Neurologist Nanjappa hospitals (13)
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Â
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
Â
⢠Pitfalls and pivots needed to use AI effectively in public health
⢠Evidence-based strategies to address health misinformation effectively
⢠Building trust with communities online and offline
⢠Equipping health professionals to address questions, concerns and health misinformation
⢠Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Recomendaçþes da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS â Objetivos do Desenvolvimento SustentĂĄvel e a EstratĂŠgia Global para a SaĂşde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pĂłs-natais devem expandir-se para alĂŠm da cobertura e da simples sobrevivĂŞncia, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pĂłs-natais essenciais e de rotina prestados Ă s mulheres e aos recĂŠm-nascidos, com o objetivo final de melhorar a saĂşde e o bem-estar materno e neonatal.
Uma âexperiĂŞncia pĂłs-natal positivaâ ĂŠ um resultado importante para todas as mulheres que dĂŁo Ă luz e para os seus recĂŠm-nascidos, estabelecendo as bases para a melhoria da saĂşde e do bem-estar a curto e longo prazo. Uma experiĂŞncia pĂłs-natal positiva ĂŠ definida como aquela em que as mulheres, pessoas que gestam, os recĂŠm-nascidos, os casais, os pais, os cuidadores e as famĂlias recebem informação consistente, garantia e apoio de profissionais de saĂşde motivados; e onde um sistema de saĂşde flexĂvel e com recursos reconheça as necessidades das mulheres e dos bebĂŞs e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendaçþes novas e jĂĄ bem fundamentadas sobre cuidados pĂłs-natais de rotina para mulheres e neonatos que recebem cuidados no pĂłs-parto em unidades de saĂşde ou na comunidade, independentemente dos recursos disponĂveis.
Ă fornecido um conjunto abrangente de recomendaçþes para cuidados durante o perĂodo puerperal, com ĂŞnfase nos cuidados essenciais que todas as mulheres e recĂŠm-nascidos devem receber, e com a devida atenção Ă qualidade dos cuidados; isto ĂŠ, a entrega e a experiĂŞncia do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendaçþes da OMS de 2014 sobre cuidados pĂłs-natais da mĂŁe e do recĂŠm-nascido e complementam as atuais diretrizes da OMS sobre a gestĂŁo de complicaçþes pĂłs-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências Ê contemplada.
Recomendamos muito.
Vamos discutir essas recomendaçþes no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação sĂł estĂĄ disponĂvel em inglĂŞs atĂŠ o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Â
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Â
Overall life span (LS) was 1671.7Âą1721.6 days and cumulative 5YS reached 62.4%, 10 years â 50.4%, 20 years â 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6Âą1723.6 days), 22 â more than 10 years (LS=5571Âą1841.8 days). 67 LCP died because of LC (LS=471.9Âą344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Muscles of Mastication by Dr. Rabia Inam Gandapore.pptx
Â
General Physical Examination(GPE) In Neurology Dr Ganeshgouda.pptx
1. DR GANESHGOUDA MAJIGOUDRA
CONSULTANT NEUROLOGIST
NANJAPPA HOSPITALS DAVANAGERE
ganeshgoudam4@gmail.com
9380906082
NEUROLOGY & GENERAL PHYSICAL EXAMINATION
2. VITALS-
BP
⢠Determining the BP in both arms is useful in patients with suspected CVA.
⢠SigniďŹcant asymmetries may reďŹect extracranial occlusive disease.
⢠Orthostatic hypotension is a frequent cause of syncope.
⢠Autonomic insufďŹciency due to peripheral causes, as in DM neuropathy, or due to failure of
central regulation, as in MSA.
⢠MC cause of orthostasis is as a side effect of antihypertensive therapy
3. CUSHING RFLEX
⢠Its a late sign of increasing ICP and indicates that brainstem herniation is imminent.
⢠Triad of hypertension, bradycardia and irregular respirations in a patient with ICP
.
⢠Increased BP occurs in some patients acutely with stroke or SAH before ICP has risen.
⢠Increased BP due to stroke is often due to peripheral attempts to compensate for cerebral
ischemia and usually resolves without treatment.
⢠Severe systemic hypotension is rarely due to a neurologic cause, except as a terminal event,
and is much more suggestive of a hemodynamic disturbance
4. THE PULSE
⢠The pulse rate & character are important, especially if increased ICP is
suspected.
⢠The pulse usually slows, but may occasionally accelerate.
⢠A bounding pulse occurs in AR or hyperthyroidism and a small, slow pulse in AS.
⢠Detecting the irregularly irregular pulse of AF is important in the evaluation of stroke
patients.
⢠Both brady & tacharrhythmias produce cerebral hypoperfusion.
5. RESPIRATION
⢠Neurologic complications of pulmonary disease are common. Note the respiratory rate, rhythm,
depth, and character of respirations.
⢠Abnormalities of respiration, such as Cheyne-Stokes, Biot, or Kussmaul breathing may be seen
in coma and other neurologic disorders.
⢠Either hyperpnea or periods of apnea may occur in increased ICP & in disturbances of the
hypothalamus.
⢠Use of accessory muscles of respiration may signal impending ventilatory failure in patients
with many NMJ disorders , GBS & MND.
8. GENERAL APPEARANCE
⢠Fever, pain, or distress;
⢠Evidence of weight loss;
⢠Abnormal posture of the trunk, head, or extremities; the general level of motor activity;
⢠Unusual mannerisms; bizarre activities; restlessness; or immobility
9. GENERAL APPEARANCE
⢠Weight loss and evidence of malnutrition may indicate hyperthyroidism, Alzheimerâs disease,
Whippleâs disease, malabsorption syndrome , or amyloidosis.
⢠The body fat level & distribution, together with the hair distribution & the secondary sexual
development are important in the diagnosis of endocrinopathies & disorders of the hypothalamus
10. GENERAL APPEARANCE
⢠Gigantism,
⢠DwarďŹsm,
⢠Gross deformities,
⢠Amputations, Contractures
⢠Disproportion or asymmetries between body parts.
11. ABNORMAL POSTURES
⢠Spastic hemiparesis causes ďŹexion of the upper extremity with ďŹexion and adduction at the
shoulder, ďŹexion at the elbow and wrist, and ďŹexion and adduction of the ďŹngers;
⢠In the lower extremity there is extension at the hip, knee, and ankle, with an equinus
deformity of the foot.
12.
13. ABNORMAL POSTURES
⢠In Parkinsonâs disease and related syndromes, there is ďŹexion of the neck, trunk, elbows, wrists,
and knees, with stooping, rigidity, masking, slowness of movement, and tremors.
⢠In myopathies there may be lordosis, protrusion of the abdomen, a waddling gait, and
hypertrophy of the calves.
⢠Peripheral nerve disease may cause wrist or foot drop or a claw hand or pes cavus.
18. HEAD
⢠Shape, symmetry, and size of the head note any apparent abnormalities or irregularities.
⢠Premature closure of cranial sutures can produce wide variety of abnormally shaped skulls â
craniosynostosis.
19. CRANIOSYNOSTOSIS
⢠Plagiocephaly.- involves fusion of either the right or left side of the coronal suture that runs
from ear to ear.
⢠Produces a ďŹattening of the forehead and the brow on the affected side, with the forehead
tending to be excessively prominent on the opposite side.
20.
21. ⢠Trigonocephaly is a fusion of the metopic (forehead) suture
⢠Early closure of this suture may result in a prominent ridge running down the forehead. The
forehead looks quite pointed, like a triangle, with closely placed eyes (hypotelorism).
22. ⢠Scaphocephaly is an early closure of fusion of the sagittal suture. This is the most common
type of synostosis. This suture runs front to back, down the middle of the top of the head.
This fusion causes a long, narrow skull.
23. CRANIOSYNOSTOSIS
⢠Severe craniosynostosis involving multiple sutures may causeincreased ICP .
⢠Craniosynostosis usually occurs as an isolated condition, but there are numerous
syndromes in Crouzonâs,Apertâs, and Carpenterâs syndromes.
24. HEAD
⢠Other deformities or developmental anomalies include:
⢠Hydrocephaly, macrocephaly, microcephaly, asymmetries or abnormalities of contour,
disproportion between the facial and the cerebral portions, scars, signs of recent trauma.
25. F
ACE
⢠Dilated veins, telangiectatic areas, or port-wine angiomas on the scalp or face.
⢠In those with head trauma, ecchymosis over the mastoid (Battle sign) or around the eyes but
not extending beyond the orbital rim (âraccoon eyesâ) suggests basilar skull fracture.
26.
27. SKULL
⢠Palpation of the skull may disclose deformities due to old trauma, burr hole, or craniotomy defects,
tenderness, or scars.
⢠The size and patency of the fontanelles is important in infants as bulging of the fontanelles &
suture separation can occur with increased ICP in children.
28. ⢠NeuroďŹbromas of the scalp occur in von Recklinghausenâs disease.
⢠Localized swelling of the scalp may occur with osteomyelitis of the skull.
⢠Exostoses may indicate an underlying meningioma.
⢠Giant cell arteritis may cause induration and tenderness of the superďŹ cial temporal arteries.
30. PERCUSSION OF SKULL
⢠Percussion of the skull may disclose dullness on the side of a tumor or subdural
hematoma
⢠Tympanitic percussion note in hydrocephalus & increased ICP in infants and children
(Macewenâs sign, or âcracked potâ resonance).
31. AUSCULTATION OF THE HEAD
⢠Bruits may be heard best over the temporal regions of the skull, the eyeballs, & the
mastoids
⢠Cephalic bruits may occur with angiomas, aneurysms, arteriovenou malformations,
neoplasms that compress large arteries, and in the presence of atherosclerotic plaques that
partially occlude cerebral or carotid arteries.
32. ⢠Ocular bruits usually signify occlusive intracranial cerebrovascular disease. A
carotid bruit may be transmitted to the mastoid
⢠An ocular bruit in a patient with a arteriovenous aneurysm may disappear on carotid
compression.
⢠Murmurs may be transmitted from the heart or large vessels
40. EYES
⢠Ophthalmologic abnormalities can provide many clues to the etiology of neurologic disease
as well as to the presence of underlying systemic disease that may be causing neurologic
symptomatology.
41. EYES
⢠Bilateral exophthalmos due to thyroid eye disease;
⢠Carotidcavernous Fistula,
⢠meningocele,
⢠encephalocele,
⢠corneal clouding from mucopolysaccharidosis;
42. EYES
⢠BrushďŹeld spots on the iris due to downâssyndrome
⢠Lisch nodules in neuroďŹbromatosis;
⢠Keratoconjunctivitis sicca due to sjĂśgrenâs syndrome
⢠Depositions of amyloid in the conjunctiva;
⢠Herpes zoster ophthalmicus;
⢠Kayser-fleischer rings in wilsonâs disease;
43. HYPERTELORISM- MEANS THE PRESENCE OF WIDE SPACED EYES. THIS IS
DIAGNOSED WHEN THE INTER INNER CANTHAL DISTANCE BETWEEN THE
TWO EYES IS MORE THAN HALF OF THE INTER PUPILLARY DISTANCE.
45. CAROTIDOCAVERNOUS FISTULA,
⢠A carotid-cavernous ďŹstula (CCF) results from an abnormal communication between the
arterial and venous systems within the cavernous sinus in the skull.
⢠It is a type of arteriovenous ďŹstula.
51. EARS
⢠Examination of the ears is particularly important in patients with hearing loss or vertigo.
⢠Examination of the ear canal may reveal a glomus tumor in a patient with jugular foramen syndrome,
vesicles due to herpes zoster infection, or evidence of a posterior fossa cholesteatoma.
⢠CSF otorrhea may cause a clear or bloody ear discharge.
⢠Hemorrhage into the middle ear may cause a bulging, blue-red tympanic membrane in patients
with basilar skull fracture.
52. HITZELBERGERâS SIGN
⢠Seen in acoustic neuroma.
⢠It occurs due to involvement of the 7th cranial nerve.
⢠There is early involvement of the sensory ďŹbers which causes hypoesthesia of the
posterior meatal wall.
53. NOSE
⢠Perforation of the nasal septum may be a clue to cocaine abuse.
⢠A saddle nose may be a sign of congenital syphilis, leprosy , wegeners
⢠Evidence of bacterial infection in dangerous area of face may be a sign of cavernous sinus
thrombosis;
⢠Watery drainage may be due to csf rhinorrhea.
54. TONGUE AND ORAL CAVITY
⢠A triple furrowed tongue is seen in myasthenia gravis;
⢠Lingua plicata in Melkersson-Rosenthal syndrome;
⢠Macroglossia in amyloid, myxedema, and Downâs syndrome.
⢠Other potential ďŹndings include xerostomia in SjĂśgrenâs ,a lead line along the gums in lead toxicity,
trismus in tetanus or polymyositis; and mucosal ulceration in Behçetâs disease.
⢠Notched teeth are a sign of congenital syphilis (Hutchinson teeth).
55. NECK
⢠Note any adenopathy, thyroid masses or enlargement, deformities, tenderness, rigidity, tilting or
other abnormalities of posture, asymmetries, changes in contour, or pain on movement.
56. ⢠Meningeal irritation may cause nuchal rigidity, head retraction, and opisthotonos. Neck
movement may also be restricted with cervical spondylosis cervical radiculopathy, and
dystonias.
⢠In meningeal irritation the primary limitation is in neck ďŹexion; in spondylosis the limitation is
either global or primarily in rotation and lateral bending
57. ⢠In the Klippel-Feil syndrome, syringomyelia, and platybasia, the neck may be short and broad,
movement limited, and the hairline low.
⢠The carotid arteries should be cautiously and lightly palpated bilaterally, one at a time, and,
followed by auscultation for carotid bruits.
58. EXTREMITIES
⢠Note any limb deformities, contractures, edema, or color changes.
⢠Any variation from the normal in the size or shape of the hands, feet, or digits, as well as
deformities, joint changes, contractures, pain or limitation of movement, localized
tenderness, wasting, clubbed ďŹngers, or ulcerations may be signiďŹcant.
⢠Edema may be evidence of CCF or cardiomyopathy.
⢠Arthropathy may be a sign of connective tissue disease, sarcoidosis, or Whippleâs
disease.
59. ⢠Painless arthropathy (Charcot joint) occurs when a joint is deafferented; painless
enlargement of the shoulder has been reported as the presenting manifestation of
syringomyelia.
⢠Palmar erythema may be a clue to alcohol abuse.
⢠Diseases of the nervous system are found in association with such skeletal and
developmental anomalies as syndactyly, polydactyly, and arachnodactyly.
62. SKIN
⢠Spider angiomas in alcohol abuse;
⢠Erythema chronicum migrans in lyme disease;
⢠Purpura and petechiae in ttp , meningococcemia, and rocky mountain spotted
fever.
⢠Livedo reticularis in apla and cryoglobulinemia;
66. SKIN
⢠Hyperpigmentation in nelsonâs syndrome, addisonâs disease;
⢠Other important ďŹndings include signs of scleroderma;
⢠Scars, needle marks or other evidence of intravenous substance.
⢠Numerous dermatologic manifestations of the neurocutaneous syndromes.
67.
68. DERMATOMYOSITIS- SKIN MANISFESTATIONS
⢠Grottonâs Sign:
âAn erythematous, scaly eruption over the extensor surfaces of the metacarpophalangeal
joints and digits
69. HELIOTROPE RASH:
âA reddish-
purple eruption on the upper
eyelid
âaccompanied by swelling of the eyelid
âMost speciďŹc rash in DM
âOnly present in a minority of patients.
74. PHAKOMATOSES -
NEUROCUTANEOUS SYNDROMES
⢠The phakomatoses or neurocutaneous syndromes are a phenotypically and genetically
diverse group of multisystem disorders that primarily affect the skin and central nervous
system.
75. LIST OF PHACOMATOSES
⢠NeuroďŹbromatosis type1
⢠NeuroďŹbromatosis type 2
⢠Noonan syndrome with multiple lentigines(LEOPARD syndrome)
⢠Tuberous sclerosis complex
⢠Ataxia telangiectasia
⢠Incontinentia pigmenti
76. SKIN â NEUROCUTANEOUS MARKERS
1. CafĂŠ-au-lait spots
⢠Dark brown hypermelanotic macules with smooth or irregular borders, commonly seen in
back, buttocks and trunk.
⢠Seen in neuroďŹbromatosis.
⢠Also seen in Albright's synd, Fanconi anemia, Bloom syndrome.
⢠-
Axillary Freckling -
similar small round spots in axilla and inguinal areas are pathognomonic in
NF.
77.
78. CAFĂ AU LAIT SPOTS. PIGMENTED MACULES(>1 CM) ON THE TRUNK.
PLEXIFORM NEUROMA SEEN.
79. CRITERIA 2
6/> CALMs : > 5 mm in diameter: Prepubertal individuals
> 15mm in greatest diameter in Postpubertal individuals
82. 2. NEUROFIBROMAS
⢠These are multiple subcutaneous papules and nodules in NF.
⢠Two types-
⢠Fusiform neuroďŹbromas â Firm discrete subcutaneous nodules attached to a nerve.
⢠Plexiform neuroďŹbromas â Subcutaneous elastic tumors, feel like a bag of worms over face,
scalp, neck and chest.
84. 3. LISCH NODULES
⢠Slightly raised well circumscribed melanotic iris nodules seen by slit lamp in 90% of
NF pts.
85. 4. ADENOMA SEBACEUM (FACIAL
ANGIOďŹBROMA)
⢠Numerous discrete smooth glistening round rubbery papules pinhead to pea size, over
butterďŹy area in the face and nasolabial folds, cheeks, nose, chin.
⢠These are slow growing angioďŹbroma.
⢠Seen in 90% of pts in Tuberous Sclerosis (TS) by 4 yrs of age.
⢠DD âAcne vulgaris.
88. 5. SHAGREEN PATCH
⢠These are Connective tissue naevi.
⢠Skin colored irregular lumpy cobblestone- like plaques in lumbosacral areas which grow to
the size of a palm.
⢠Satellite papules grow around a central plaque with orange peel like indentation.
⢠Seen in 70% of pts in TS.
⢠Also seen in MEN1, Cowden syndrome and Hunter's syndrome.
91. 6. SUBUNGUAL & PERIUNGUAL FIBROMAS
⢠Firm pink to skin colored papules, nodules from under the nail bed in toe & ďŹnger nails.
Seen in 90% of pts in TS.
93. 7. ASH LEAF MACULES
⢠Hypomelanotic polygonal macules grow upto 5 cm over trunk and buttocks.
⢠>3 lesions are seen in 90% of TS patients.
⢠Also seen in MEN1, vitiligo, nevus anemicus, koyanagi syndrome
94. ASH LEAF SPOTS. Hypopigmented macules. The average size
is 1 to 3 cm, and the common shapes are oval, polygonal, and
lance-ovate, whereas the less common shapes are dermatomal
and confettilike.
95. Ash leaf spots. "confetti" macules. Multiple, discrete, small, confetti- like,
hypopigmented macules of variable size on the leg.
96. Detection of ash leaf spots may require Wood's lamp
examination(UVA), especially in fair- skinned individuals. An
ash leaf spot on the scalp will result in poliosis, which is a
circumscribed patch of gray-white hair.
97. 8. PORT WINE STAIN (FACIAL NEVUS ďŹEMMENS)
⢠Congenital macular lesions light pink initially, can progress to red purple nodules
over the skin, choroidal and leptomeningeal vessels and other body areas.
⢠Seen in Sturge Weber syndrome.
99. RIGHT FACIAL PORT-WINE BIRTHMARK IN THE
DISTRIBUTION OF THE ďŹRST AND SECOND DIVISIONS
OF CRANIAL NERVE V,CAUSING FACIAL
HEMIHYPERTROPHY
100. 9. OCULAR TELANGIECTASIA
⢠Dilated blood vessels over sclera.
⢠Seen after development of ataxia, around 3 â 6 yrs of age in patients with Ataxia
Telangiectasia..
101.
102. 10. CUTANEOUS TELANGIECTASIA
⢠Venous angiomas over the bridge of nose, butterďŹy area of the face, ante cubital area, neck,
popliteal fossa.
⢠Seen in 90% of pts by 5-6 yrs in AT (louis- Bar disease) and also in Von Hippel Lindau
disease
106. SPINE
⢠Note any deformity, abnormality of posture or motility, localized tenderness, or muscle spasm.
⢠Tuberculosis and neoplasms of the spine may cause a marked kyphosis (gibbus)
⢠Muscular dystrophy often results in an increased lumbar lordosis.
⢠Scoliosis is common in syringomyelia and friedreichâs ataxia.
107. SPINE
⢠Localized rigidity with a slight scoliosis and absence of the normal lordosis are frequent
symptoms of lumbosacral radiculopathy.
⢠Tenderness to percussion over the spinous processes, using either the ďŹst or a reďŹex hammer,
can occur with localized processes such as spinal epidural hematoma or abscess.
108. DIMPLING OF THE SKIN OR UNUSUAL HAIR GROWTH OVER
THE
SACRUM SUGGEST SPINAL DYSRAPHISM
110. CVJ ANOMALIES
⢠The craniovertebral (or craniocervical) junction(CVJ) is a collective term that refers to the
occiput(posterior skull base), atlas, axis, and supporting ligaments.
⢠It is a transition zone b/w a mobile cranium & spinal column.
111. PARTS OF CV JUNCTION INCLUDE
ď The Occiput
ď First Cervical Vertebra (Atlas)
ď Second Cervical Vertebra (Axis)
ď Their articulations and
ď Connecting ligaments
112. NEURAL TRUCTURES RELATED
ARE â
CAUDAL BRAINSTEM
(MEDULLA)
Fourth ventricle
Rostral part of spinal cord
Lower cranial (9,10,11 {only N that passes through the FM}, 12) & upper cervical
nerves (The C1(SUBOCCIPITAL NERVE) , C2, and C3 nerves with both rami).
In cerebellum, only the tonsils, biventral lobules &the lower part of the vermis
(nodule, uvula & pyramid) ,
113. CLASSIFICATION
⢠Bony Anomalies Major Anomalies
1. Occipitalization
2. Basilar Invagination
3. Dens Dysplasia
4. Atlanto- axial dislocation.
5. Platybasia Minor Anomalies
6. Dysplasia of Atlas
7. Dysplasia of occipital condyles, clivus, etc.
8 . Soft Tissue anomalies
9.Arnold-Chiari Malformation Syringomyelia Syringobulbia
114. CLINICAL FEATURES
Cervical symptoms and signs- pain suboccipital region rediating
vertex,stifness in 85%
Myelopathic Features- long tract involvement and wasting
CN involvement- IX, X,XI,XI inI 20%
Vascular in15% Transient Attack of V-BinsufďŹciency
Sensory symptom of post.column involvement.
Cerebellar symptoms/signs- Nystagmus, Ataxia,intention tremor, dysarthria
Features of Raised ICT
-usually seen in Pts. Having basilar impresssion
and/or ACM
ATAXIA,ATROPHY,SYRINX âPOOR PROGNOSIS
115. KLIPPEL- FEIL SYNDROME
⢠Described patients who had a short, webbed neck; decreased range of motion (ROM) in the
cervical spine; and a low hairline.
⢠In majority of normal persons, hairline stops at or above the C4 spine.
116. ⢠Type 1- Massive fusion of cervical and often upper thoracic vertebra. Associated with
short neck, low hairline and restricted neck movements
⢠Type 2-associated with fusion of several cervical vertebra
⢠Type 3 â associated with fusion of 2 cervical vertebra.