CN III, IV, & VI palsies are caused by lesions within the cavernous sinus. Horner's syndrome is caused by ipsilateral brainstem lesions or lesions of the cervical sympathetic chain, and presents with ptosis, miosis, and other symptoms. CN V palsies can be caused by ganglion/sensory root lesions or post-ganglionic lesions.
It involves CN III, IV, and VI: ophthalmoplegia (diplopia), proptosis, and ptosis
; Ophthalmic (V1) division of the trigeminal nerve: ipsilateral hypoaesthesia of the forehead, upper eyelid, and cornea;
Optic nerve (II): visual deficit that can lead to
blindness
Contact: arishbharathi1999@gmail.com
It involves CN III, IV, and VI: ophthalmoplegia (diplopia), proptosis, and ptosis
; Ophthalmic (V1) division of the trigeminal nerve: ipsilateral hypoaesthesia of the forehead, upper eyelid, and cornea;
Optic nerve (II): visual deficit that can lead to
blindness
Contact: arishbharathi1999@gmail.com
Cranial nerve problems
Neuroanatomy
In simple terms, the cranial nerve nuclei are in 4 groups:
• Cortex: CN1 (olfactory bulb), CN2 (occipital lobe).
• Midbrain: CN3-4.
• Pons: CN5-8.
• Medulla (aka 'bulb'): CN9-12.
Upper motor neuron cranial nerve lesions
Pathophysiology
• Lesions of the cortex or corticobulbar tract.
• The corticobulbar tract supplies all the cranial nerves (except 3, 4, 6) on its way to the medulla.
Cranial nerve assessment..Simple and Easy to perform for medics and Physiothe...pawan1physiotherapy
Cranial Nerve Assessment is a crucial step in neurological assessment. By following the simple theoretical aspects it can be made on your fingertips....here is an try to make the stuff easier for you....
HIV discrimination among health providers in Malaysia by Dr RubzDr. Rubz
Although doctors took oath that they will treat everyone the best they can and without judging anyone but discrimination still exist especially in HIV affected people. Due to this issue, Pertubuhan Advokasi Masyarakat Terpinggir Malaysia has taken a step to engage with doctors at government sector and desensitize them and find the line to stand together.
Testicular cancer for public awareness by Dr RubzDr. Rubz
A presentation prepared for Charity Dinner with Fun Charity. All the profits of the event will go to FReHA (a NGO which supports women's and reproductive health.)
Prostate cancer for public awareness by DR RUBZDr. Rubz
A presentation prepared for Charity Dinner with Fun Charity. All the profits of the event will go to FReHA (a NGO which supports women's and reproductive health.)
Breast Cancer for public awareness by Dr RubzDr. Rubz
A presentation prepared for Charity Dinner with Fun Charity. All the profits of the event will go to FReHA (a NGO which supports women's and reproductive health.)
This is the first phase (qualitative) of the current project we are working on with the supervision of University Malaya and Yale School of Medicine.It will be publish as IBBS 2013 by end of the year. This slide is just a rough picture of what we are doing at the moment. This is copyright protected!
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
1. Cranial Nerve Lesions – common patterns of presentation CN III, IV & VI palsy
- Site of lesion:
Horner’s syndrome - Symptoms: ptosis, miosis, narrowed i) within cavernous sinus – CN III, IV, V & VI palsies
palpebral fissure, anhidrosis, flushing & ii) entrance to orbit (superior orbital fissure)
sinking in of eyeball iii) within orbit
- Causes: Ipsilateral brainstem lesion,
Cervical cord lesion, CN V palsy
Cervical sympathetic chain injury, Ganglion / Sensory root lesion
Cervical rib, – total loss of sensation in all 3 divisions
Cancerous involvement of stellate
ganglion, Post-ganglionic lesion
Pancost tumour – Total loss of sensation in ONE division (usu ophthalmic division
in a/w CN III, IV & VI palsies too due to lesion in cavernous sinus
CN II palsy - Homonymous hemianopia – optic tract/radiation
lesion Brainstem / Upper spinal cord lesion
- Bitemporal hemianopia – optic chiasmal lesion eg - Symptoms: dissociated sensory loss of face – loss of
pituitary gland tumour temp & pain but retention of touch and
proprioception sensations of face
CN III palsy - Symptoms: ‘Down & out’ pupils, ptosis, papillary
dilatation, loss of papillary light reflex, loss of Unilateral CN V, VII & VIII palsy
accommodation - cerebellopontine angle lesion eg tumour
- Site of lesion – oculomotor Nc within midbrain, or
along its peripheral course
CN VI palsy - Symptom: unable to abduct eye
- Site of lesion: lesion of abducens Nc in pons, or lesion
along peripheral course
*However, it is a Non-localising sign as it has
a long course and is easily affected by raised
ICP due to lesions in any part of the brain
- If bilateral: consider raised ICP, trauma, Wernicke’s
encephalopathy (triad of ophthalmoplegia,
confusion & ataxia) & mononeuritis multiples
CN VII palsy - UMN vs LMN lesion: paradoxical sparing of upper CN IX-XI palsy - Symptoms: dysphonia, unilat weakness, wasting &
parts of face in UMN lesion fasciculation of tongue, depression of gag
- Site of lesion - Internal acoustic meatus injury by reflex, unilat wasting of SCM & trapezius
tumour, Bell’s palsy (facial n. canal), parotid muscles
gland tumour/Sx - Site of lesion: along their peripheral course as they
exit the skull together at the foramina of skull
Pattern Causes base (jugular foramen)
UMN lesion Vascular lesions
Tumours Pseudobulbar palsy (bilat UMN lesion of CN IX, X & XII)
LMN lesion Pontine lesion – a/w CN V & VI lesions - degeneration of corticobulbar tracts, which project to:
Post. Fossa lesions i) Nc ambigus → cranial root of CN XI →vagus n.
o Acoustic neuromas → soft palate, pharynx & larynx
o Meningiomas ii) Hypoglossal Nc → tongue
Petrous temporal bone – - Symptoms: dysphonia, dysphagia, dysarthria, tongue weakness
o Bell’s palsy (commonest cause of CN VII palsy) & spasticity
o Ramsay Hunt syndrome Bulbar palsy (bilat LMN lesion of CN IX, X & XII)
o Fractures - degeneration of Nc ambigus & hypoglossal Nc themselves
o Ottitis media - Symptoms: dysphonia, dysarthria, dysphagia, wasting
Parotid gland – tumour, surgery fasciculation & weakness of tongue
Bilateral Guillain-Barre syndrome
Pseudobulbar Bulbar
Gag reflex ↑/N Absent
Bell’s palsy - acute unilat inflammatory lesion of CN VII along its Tongue Spastic Wasted, fasciculations
course through the skull Jaw jerk ↑ Absent / N
- Symptoms: ear pain, unilat facial muscle paralysis, Speech Spastic dysarthria Nasal
absent corneal reflex, hyperacusis Other Bilat limb UMN signs Signs of underlying cause
(exceptional acute sense of hearing) of Labile emotions eg limb fasciculations
affected side, loss of taste in ant 2/3 of Normal emotions
tongue Causes BIlat CVA (eg both internal Motor neurone disease
Ramsay-Hunt syndrome – VZV associated Bell’s palsy with vesicular capsules) Guillain-Barre syndrome
rash in ext acoustic canal & mucous memb of oropharynx
Multiple sclerosis Polio
Motor neurone disease Brainstem infarction
Acoustic Neuroma - CN VII neuroma
- Symptoms: dizziness, deafness, ataxia, CN V-VII
palsy & paralysis of limbs
- a/w neurofibromatosis
2. Causes of Multiple CN palsies Interpretation of Peripheral Nervous System Examination
1. Guillain-Barre syndrome – sparing of sensory nerves
2. Mononeuritis Multiplex (rare) eg DM Site of Lesion:
3. Brainstem lesions UMN vs LMN lesion
– usu due to vascular disease causing crossed sensory UMN: Cortical vs brainstem vs cord lesions
or motor paralysis (ie CN signs on one side and LMN: Radiculopathy vs plexus lesion vs major nerve trunk lesion
contralat long tract signs) Others: Peripheral neuropathy (eg glove & stocking neuropathy of
- Brainstem tumour may also have similar signs DM), parkinsonism
4. NPC
5. Arnold-Chiari malformation Tone LMN lesion – Fasciculations, wasting & hypotonia
6. Paget’s disease UMN lesion – Hypertonia on knee lift and clonus
7. Chronic meningitis Parkinsonism – cog-wheeling & lead-pipe rigidity
8. Trauma
Reflex LMN lesion – Hyporeflexia
Causes of Nystagmus UMN lesion – Hyperreflexia
Horizontal Radiculopathy – Hyporeflexia in corresponding nerve root region
1. Vestibular lesion Major nerve trunk lesion – Hyporeflexia of distribution of nerve
– if acute, saccadic movt away from side of lesion. roots contributing to nerve trunk
– If chronic, saccadic movt towards side of lesion Motor nerve problem (neuropathy)
2. Cerebellar lesion – saccades to side of lesion of unilat
3. Toxic – phenytoin, alcohol Power Major nerve trunk lesion – reduced power in distribution of nerve
4. Intranuclear ophthalmoplegia (lesion of medial longitudinal roots contributing to nerve trunk
fasciculus) – nystagmus in abducting eye + failure of adduction of Radiculopathy – decrease power in affected nerve roots
contralat (affected) side.
Vertical Sensation Peripheral neuropathy – glove & stocking distribution
1. Brainstem lesion Major nerve trunk – sensation loss over sensory
2. Drugs – Phenytoin, alcohol distribution of nerve trunk
Radiculopathy – dermatomal distribution of sensory
loss
Pain & Temp – Second-order neurons of the Spinothalamic tract
decussate within one segment of their origin and ascend
contralaterally.
Vibration, proprioception & light touch – Axons of Pri afferent
neurons ascend in Dorsal Column ipsilaterally and terminate on
Second-order neurons in the medulla oblongata. Second-order
neurons decussate in the medulla
Screening test for Upper Limb Examination Radial Nerve Palsy (C5-8)
- Wrist drop
1) Extend arm outwards - Weak wrist extension
- Proximal myopathy? - Weak elbow extension if lesion level is high
- Cerebellar signs – pronator drift? - Thumb: weak extension of thumb
2) Clench fist Medial Nerve Palsy (C6-T1)
- Slow clenching – Myotonic Dystrophy - Simian hands
- Weak flexion of index finger – Median nerve palsy - Flattened thenar eminence (thumb side)
- Wrist lesion & above – unable to abduct thumb (ie point upwards)
3) Turn hand around - Lesion in cubital fossa – index finger unable to flex on clasping
hands together
4) Flex fists - Thumb: weak abduction of thumb; weak opposition function of
- Test of Median Nerve motor function - Weak flexion @ wrist thumb
accompanied by adduction
Ulnar Nerve Palsy (C8-T1)
5) Extend fists - Claw hand and ulnar paradox
- Test of Radial Nerve function - Flattened
- Froment’s sign – grasp paper btwn thumb and lat aspect of index
6) Unclench fists finger – affected thumb will flex
- Slow unclenching – Myotonic Dystrophy - Weak interreosei muscles – unable to grasp paper btwn fingers;
- Test of Radial nerve motor function of finger extension weak spreading of fingers
- Claw hand – Ulnar nerve palsy - Thumb: weak adduction of thumb
3. Femoral Nerve Palsy (L2-4)
- Slight hip flexion weakness
- Weak knee extension
- Absent knee jerk
- Sensory loss over inner thigh & leg
Sciatic Nerve Palsy (L4-S2)
- Loss of power below knee – Weak knee flexion & Foot drop
- Absent ankle jerk
- Absent plantar response
- Sensory loss over lateral & posterior calf and foot
Common Peroneal Nerve Palsy (L4-S1)
- Foot drop – weak dorsiflexion & eversion of foot
- Intact reflexes
- Minimal sensory loss over lateral aspect of dorsum of foot
Digitally signed by DR WANA HLA SHWE
DN: cn=DR WANA HLA SHWE, c=MY,
o=UCSI University, School of Medicine, KT-
Campus, Terengganu, ou=Internal Medicine
Group, email=wunna.hlashwe@gmail.com
Reason: This document is for UCSI year 4
students.
Date: 2009.02.24 14:21:14 +08'00'