Plexopathy is a disorder affecting nerve networks like the brachial or lumbosacral plexus. Symptoms include pain, motor control loss, and sensory deficits. It is usually caused by localized trauma or compression. Brachial plexopathy specifically affects the network of nerves from the cervical spine to the shoulder, arm, and hand. Lumbosacral plexopathy affects the network of nerves from the lumbar spine and sacral spine. Diabetic plexopathy commonly affects the lumbosacral plexus and causes anterior thigh pain and proximal leg muscle weakness.
The document discusses various spinal cord syndromes classified as either complete or incomplete cord syndromes. It provides details on complete cord transection which results in paralysis, loss of sensation, and autonomic dysfunction below the level of injury. Brown-Sequard syndrome and central cord syndrome are discussed as examples of incomplete cord syndromes characterized by mixed upper and lower motor neuron findings on one or both sides of the body. The document also covers syndromes involving specific regions of the spinal cord including conus medullaris, cauda equina, and anterior spinal artery syndromes.
Neurosyphilis is an infection of the nervous system caused by the bacterium Treponema pallidum, which causes syphilis. It typically develops after many years of untreated syphilis. Symptoms vary depending on the areas affected but may include mental deterioration, paralysis, meningitis, tabes dorsalis resulting in girdle pain and joint damage, and ocular symptoms. Treatment involves intravenous penicillin, but neurosyphilis can still cause permanent damage. Nursing care focuses on maintaining patient health, safety, and independence through measures like seizure precautions, skin care, physiotherapy, and partner screening.
The document discusses various movement disorders, classifying them as either hypokinetic-hypertonic (such as Parkinson's disease) or hyperkinetic-hypotonic (including tremors, chorea, dystonia, tics, myoclonus, and ballism). Parkinson's disease is primarily caused by dopamine loss in the basal ganglia. Its treatment involves levodopa drugs and dopamine agonists. Tremors can be essential, physiological, or pathological, and are treated with beta-blockers or anti-epileptics. Dystonia causes abnormal muscle contractions and is treated with medications, botulinum toxin, or surgery. Chorea involves irregular movements and its causes include Huntington's disease and
1. Stroke is defined as a nontraumatic brain injury caused by occlusion or rupture of cerebral blood vessels that results in sudden neurological deficits.
2. The most common types of stroke are ischemic (85%) and hemorrhagic (15%). Ischemic strokes are further classified as thrombotic, embolic, or lacunar.
3. Major risk factors for stroke include hypertension, heart disease, diabetes, smoking, and older age. Location of brain injury determines the specific neurological symptoms, such as deficits on one side of the body for middle cerebral artery strokes.
The lumbosacral plexus is formed by the anterior rami of the L1-S3 nerve roots. It is divided into the lumbar plexus (L1-L4), lumbosacral trunk (L4-L5), and sacral plexus (S1-S4). The lumbar plexus forms branches including the femoral, obturator, lateral femoral cutaneous, and genitofemoral nerves. The sacral plexus forms the sciatic nerve and its tibial and common fibular divisions, as well as the superior and inferior gluteal and posterior cutaneous nerves of the thigh. Injuries and disorders like trauma, tumors, radiation, and diabetes can
Cerebellar dysfunction can cause ataxia, a lack of muscle coordination. The cerebellum controls fine movements and posture. Damage to the cerebellum disrupts these functions. Ataxia affects walking, limb movements, speech, and eye movements. It is diagnosed through clinical exams like finger-nose and Romberg tests. The causes include lesions, tumors, or injuries to the cerebellum. While incurable, treatment focuses on easing symptoms to improve quality of life.
The basal ganglia are a group of subcortical nuclei that help regulate motor control and learning. They modulate movements through neuronal circuits and help produce purposeful movements while suppressing unwanted ones. Damage to different parts of the basal ganglia can result in either hypokinetic or hyperkinetic movement disorders. Parkinson's disease involves degeneration of dopaminergic neurons in the substantia nigra, leading to reduced excitation of motor cortex and hypokinesia. Other disorders like athetosis, hemiballism, chorea, and Wilson's disease each involve damage to specific basal ganglia structures and circuits.
Syringomyelia is a condition where a cyst, called a syrinx, develops in the spinal cord. It most commonly affects the lower cervical spine. It is often associated with abnormalities of the skull or spinal column. The majority of cases are linked to Chiari malformation type 1, where the cerebellar tonsils are displaced into the spinal canal. Symptoms vary depending on the location of the syrinx but can include pain, loss of sensation, muscle weakness or atrophy, and autonomic dysfunction. Diagnosis is made using imaging like MRI. Treatment involves surgery to decompress pressure on the spinal cord like laminectomy with the goal of resolving the syrinx.
The document discusses various spinal cord syndromes classified as either complete or incomplete cord syndromes. It provides details on complete cord transection which results in paralysis, loss of sensation, and autonomic dysfunction below the level of injury. Brown-Sequard syndrome and central cord syndrome are discussed as examples of incomplete cord syndromes characterized by mixed upper and lower motor neuron findings on one or both sides of the body. The document also covers syndromes involving specific regions of the spinal cord including conus medullaris, cauda equina, and anterior spinal artery syndromes.
Neurosyphilis is an infection of the nervous system caused by the bacterium Treponema pallidum, which causes syphilis. It typically develops after many years of untreated syphilis. Symptoms vary depending on the areas affected but may include mental deterioration, paralysis, meningitis, tabes dorsalis resulting in girdle pain and joint damage, and ocular symptoms. Treatment involves intravenous penicillin, but neurosyphilis can still cause permanent damage. Nursing care focuses on maintaining patient health, safety, and independence through measures like seizure precautions, skin care, physiotherapy, and partner screening.
The document discusses various movement disorders, classifying them as either hypokinetic-hypertonic (such as Parkinson's disease) or hyperkinetic-hypotonic (including tremors, chorea, dystonia, tics, myoclonus, and ballism). Parkinson's disease is primarily caused by dopamine loss in the basal ganglia. Its treatment involves levodopa drugs and dopamine agonists. Tremors can be essential, physiological, or pathological, and are treated with beta-blockers or anti-epileptics. Dystonia causes abnormal muscle contractions and is treated with medications, botulinum toxin, or surgery. Chorea involves irregular movements and its causes include Huntington's disease and
1. Stroke is defined as a nontraumatic brain injury caused by occlusion or rupture of cerebral blood vessels that results in sudden neurological deficits.
2. The most common types of stroke are ischemic (85%) and hemorrhagic (15%). Ischemic strokes are further classified as thrombotic, embolic, or lacunar.
3. Major risk factors for stroke include hypertension, heart disease, diabetes, smoking, and older age. Location of brain injury determines the specific neurological symptoms, such as deficits on one side of the body for middle cerebral artery strokes.
The lumbosacral plexus is formed by the anterior rami of the L1-S3 nerve roots. It is divided into the lumbar plexus (L1-L4), lumbosacral trunk (L4-L5), and sacral plexus (S1-S4). The lumbar plexus forms branches including the femoral, obturator, lateral femoral cutaneous, and genitofemoral nerves. The sacral plexus forms the sciatic nerve and its tibial and common fibular divisions, as well as the superior and inferior gluteal and posterior cutaneous nerves of the thigh. Injuries and disorders like trauma, tumors, radiation, and diabetes can
Cerebellar dysfunction can cause ataxia, a lack of muscle coordination. The cerebellum controls fine movements and posture. Damage to the cerebellum disrupts these functions. Ataxia affects walking, limb movements, speech, and eye movements. It is diagnosed through clinical exams like finger-nose and Romberg tests. The causes include lesions, tumors, or injuries to the cerebellum. While incurable, treatment focuses on easing symptoms to improve quality of life.
The basal ganglia are a group of subcortical nuclei that help regulate motor control and learning. They modulate movements through neuronal circuits and help produce purposeful movements while suppressing unwanted ones. Damage to different parts of the basal ganglia can result in either hypokinetic or hyperkinetic movement disorders. Parkinson's disease involves degeneration of dopaminergic neurons in the substantia nigra, leading to reduced excitation of motor cortex and hypokinesia. Other disorders like athetosis, hemiballism, chorea, and Wilson's disease each involve damage to specific basal ganglia structures and circuits.
Syringomyelia is a condition where a cyst, called a syrinx, develops in the spinal cord. It most commonly affects the lower cervical spine. It is often associated with abnormalities of the skull or spinal column. The majority of cases are linked to Chiari malformation type 1, where the cerebellar tonsils are displaced into the spinal canal. Symptoms vary depending on the location of the syrinx but can include pain, loss of sensation, muscle weakness or atrophy, and autonomic dysfunction. Diagnosis is made using imaging like MRI. Treatment involves surgery to decompress pressure on the spinal cord like laminectomy with the goal of resolving the syrinx.
This ppt describes various movement disorders found commonly in elderly persons. It also describes hyper and hypokinetic disorder categorization with cause and pathophysiology of movement disorders.
The craniovertebral junction (CVJ) refers collectively to the occiput, atlas, axis, and supporting ligaments. It is a transition zone between the mobile cranium and spinal column, enclosing the soft tissue structures of the cervicomedullary junction. The CVJ has important implications for embryology, anatomy, classification of anomalies, investigations, and clinical management. Anomalies can involve bony, soft tissue, arterial, and neural structures in this region. A variety of imaging modalities like X-rays, CT, MRI are used to classify and characterize CVJ anomalies.
Extrapyramidal System and Disorders of Extrapyramidal SystemChetan Ganteppanavar
The document discusses the extrapyramidal system and disorders of the extrapyramidal system. It begins by defining the extrapyramidal system as referring to the basal ganglia and array of brainstem nuclei. It then lists the components and tracts of the extrapyramidal system. The document goes on to discuss disorders like Parkinson's disease, classifying extrapyramidal disorders and listing clinical features. It also covers etiology, pathogenesis, diagnosis and treatment of Parkinson's disease.
This document provides information about transverse myelitis (TM), including its definition, etiology, presentation, diagnosis, treatment, and prognosis. Some key points:
- TM is defined as acute spinal cord inflammation and injury that causes neurological deficits. It can be post-infectious, post-vaccination, or associated with MS.
- Presentation involves varying degrees of motor weakness, sensory alterations, and autonomic dysfunction below a certain spinal level. Up to half of idiopathic cases follow a respiratory or gastrointestinal illness.
- Diagnosis involves ruling out other causes through MRI, CSF analysis showing inflammation, and clinical features meeting criteria. Treatment begins with high-dose steroids to reduce inflammation,
The document discusses cerebellar ataxia, a disorder caused by damage to the cerebellum that controls coordination. It causes loss of coordination, balance problems, and slurred speech. The cerebellum coordinates muscle movement and is located in the hindbrain. Causes include viruses, alcohol, tumors, and toxins. Symptoms are diagnosed through neurological exams, imaging scans, and lab tests. Treatment focuses on physical therapy, assistive devices, and treating any underlying causes to ease symptoms and improve quality of life. Prevention involves vaccinations to reduce risk of viral infections that can lead to cerebellar ataxia.
Peripheral neuropathy refers to damage to peripheral nerves. There are three main types: mononeuropathy affecting a single nerve, mononeuritis multiplex affecting multiple nerves asymmetrically, and polyneuropathy affecting multiple nerves concurrently and symmetrically. Polyneuropathy can be classified as axonopathy, myelinopathy, or neuronopathy depending on whether the axons, myelin sheaths, or neurons are affected. Symptoms and signs include both negative symptoms like numbness and weakness as well as positive symptoms like tingling and pain. Evaluation involves taking a history and examining for patterns of onset, progression, fluctuations, and other systemic diseases. Diagnosis involves nerve conduction studies and sometimes nerve biopsies. Treatment focuses
The document discusses central nervous system infections, listing the main causes as bacterial, viral, fungal, and protozoal. It then provides more detailed information on specific types of infections, including listings of examples for each category. It also includes sections on meningitis that describe the introduction, clinical features, types (pyogenic bacterial, tubercular, and viral), investigations, treatment, and physical therapy management goals for meningitis patients.
This presentation provides an overview of demyelinating diseases, focusing on multiple sclerosis (MS). It defines demyelinating diseases as those that cause myelin destruction while sparing other nervous system elements. MS is described as an autoimmune, inflammatory demyelinating disease of the central nervous system (CNS) that is more common in women. The presentation covers the pathology, clinical features, investigations, and treatment approaches for MS.
The document discusses vestibular disorders and the anatomy and function of the inner ear's role in balance. It describes how the semicircular canals and otolith organs detect movement and orientation. Common causes of dizziness include Meniere's disease, BPPV, vestibular neuritis, and migraines. Diagnosis involves a case history and vestibular testing like VNG, rotary chair, and VEMPs. Treatment options depend on the underlying cause but may include medications, repositioning maneuvers, surgery, or vestibular rehabilitation therapy.
This document discusses sensory ataxia, including its causes, clinical presentation, and differential diagnosis. Sensory ataxia results from disorders of the cerebellum, vestibular system, or sensory pathways. It is characterized by incoordination without significant weakness. Key findings include impaired proprioception, positive Romberg's sign, pseudoathetosis, and loss of vibration or joint position sense. Causes include peripheral neuropathies, paraneoplastic disorders, infections like HIV, autoimmune conditions like Sjogren's syndrome, and medications like chemotherapy. Dorsal root ganglionopathies commonly underlie sensory ataxia and can be assessed through nerve conduction studies and lumbar puncture. Distinguishing sensory
Upper motor neurons originate in the brain and convey signals for voluntary movement through descending pathways to lower motor neurons. Lower motor neurons originate in the spinal cord and brainstem and directly innervate skeletal muscles. An upper motor neuron lesion causes spastic weakness without atrophy while a lower motor neuron lesion causes flaccid paralysis with atrophy.
This document summarizes tabes dorsalis, a condition caused by untreated syphilis infection that results in demyelination of the dorsal columns of the spinal cord. It affects males more than females and symptoms onset typically in mid-life. Symptoms include weakness, diminished reflexes, pains, impaired sensation, coordination and gait issues. Diagnosis involves CSF and imaging tests. Treatment focuses on antibiotics while physiotherapy aims to improve strength, balance, mobility and coordination through exercises like Frenkel's exercise which focuses on precision and repetition to compensate for lost sensory function.
Meralgia Paresthetica (MP) is a condition caused by impingement of the lateral femoral cutaneous nerve, causing numbness and pain along the front of the thigh. It is often caused by entrapment of the nerve under the inguinal ligament. Diagnosis involves history, physical exam including the pelvic compression test, and may include imaging or nerve blocks. Treatment options include removing any underlying causes, medications, physical therapy, injections, or surgery.
This document discusses the anatomy, landmarks, measurements, common anomalies, syndromes, and injuries of the craniovertebral junction. It begins with a brief description of the craniovertebral junction's development and components. It then outlines several key anatomical landmarks and measurements used to evaluate the region on imaging. The remainder of the document details various congenital anomalies, developmental abnormalities, syndromes, and acquired conditions that can affect the craniovertebral junction.
This document discusses various pathologies that can cause damage to the spinal cord as seen on MRI. It focuses on diseases that appear as high signal on T2-weighted imaging. The most common etiologies are degenerative compressive myelopathy, inflammatory disorders, and demyelinating diseases such as multiple sclerosis. Imaging is important for determining the location, extent, and severity of abnormalities in order to accurately diagnose the underlying cause and guide treatment.
A herniated cervical disc occurs when the gel-like nucleus pulposus ruptures through the annulus fibrosus in the cervical spine. It commonly occurs at the C5-C6 or C6-C7 levels. Symptoms may include neck pain radiating into the arm with numbness/tingling. Diagnosis involves MRI or CT scans. Treatment first focuses on rest, medications, and physical therapy. Surgery such as discectomy may be needed if conservative measures fail.
1) Entrapment neuropathies occur when nerves are injured by chronic compression, angulations, or stretching forces, causing mechanical damage. Carpal tunnel syndrome is an example where the median nerve is compressed as it passes through the wrist.
2) Clinical features of entrapment neuropathies include pain, numbness, tingling, burning, and weakness in the affected area. Electrodiagnostic tests like nerve conduction studies and electromyography are important diagnostically.
3) Treatment involves conservative measures like splinting, steroid injections, and physical therapy. Surgery is considered if conservative treatment fails or for severe cases. Proper identification of the site of nerve entrapment is key to determining appropriate treatment
Tuberculous infection of the central nervous system (CNS) can occur via hematogenous spread or direct extension from a local infection. It most commonly manifests as tuberculous meningitis or tuberculomas. Tuberculous meningitis involves thick exudate in the subarachnoid space and can lead to hydrocephalus or ischemic infarcts. Tuberculomas appear as ring-enhancing lesions on imaging. Pott's disease is spinal tuberculosis that causes vertebral body collapse and kyphosis. Management involves antituberculous medications for at least 6-9 months.
This document discusses brachial plexus disorders including their anatomy, causes, clinical presentation, diagnostic approach, management, and specific conditions like idiopathic brachial plexitis and injuries. Key points covered include the brachial plexus anatomy and branches, common causes of brachial plexus disorders like injury and idiopathic plexitis, clinical features of shoulder pain and weakness, and electrodiagnostic and imaging studies used in evaluation and diagnosis. Management depends on the underlying cause but may include corticosteroids, physiotherapy, and conservative treatment.
This document discusses the principles and management of various congenital hand anomalies. It covers topics such as:
- Surgical management should aim to improve function and appearance with minimal risk. Hand function depends on thumb mobility and pinch grip.
- Timing of surgery depends on technical difficulty and cortical plasticity. Surgery may be delayed to treat other conditions.
- Transverse deficiencies are often managed non-surgically with prosthetics. Longitudinal deficiencies often benefit from surgery.
- Specific procedures are described for conditions like symbrachydactyly, radial hypoplasia, central ray deficiency, thumb and finger hypoplasia/aplasia. Syndactyly and poly
This ppt describes various movement disorders found commonly in elderly persons. It also describes hyper and hypokinetic disorder categorization with cause and pathophysiology of movement disorders.
The craniovertebral junction (CVJ) refers collectively to the occiput, atlas, axis, and supporting ligaments. It is a transition zone between the mobile cranium and spinal column, enclosing the soft tissue structures of the cervicomedullary junction. The CVJ has important implications for embryology, anatomy, classification of anomalies, investigations, and clinical management. Anomalies can involve bony, soft tissue, arterial, and neural structures in this region. A variety of imaging modalities like X-rays, CT, MRI are used to classify and characterize CVJ anomalies.
Extrapyramidal System and Disorders of Extrapyramidal SystemChetan Ganteppanavar
The document discusses the extrapyramidal system and disorders of the extrapyramidal system. It begins by defining the extrapyramidal system as referring to the basal ganglia and array of brainstem nuclei. It then lists the components and tracts of the extrapyramidal system. The document goes on to discuss disorders like Parkinson's disease, classifying extrapyramidal disorders and listing clinical features. It also covers etiology, pathogenesis, diagnosis and treatment of Parkinson's disease.
This document provides information about transverse myelitis (TM), including its definition, etiology, presentation, diagnosis, treatment, and prognosis. Some key points:
- TM is defined as acute spinal cord inflammation and injury that causes neurological deficits. It can be post-infectious, post-vaccination, or associated with MS.
- Presentation involves varying degrees of motor weakness, sensory alterations, and autonomic dysfunction below a certain spinal level. Up to half of idiopathic cases follow a respiratory or gastrointestinal illness.
- Diagnosis involves ruling out other causes through MRI, CSF analysis showing inflammation, and clinical features meeting criteria. Treatment begins with high-dose steroids to reduce inflammation,
The document discusses cerebellar ataxia, a disorder caused by damage to the cerebellum that controls coordination. It causes loss of coordination, balance problems, and slurred speech. The cerebellum coordinates muscle movement and is located in the hindbrain. Causes include viruses, alcohol, tumors, and toxins. Symptoms are diagnosed through neurological exams, imaging scans, and lab tests. Treatment focuses on physical therapy, assistive devices, and treating any underlying causes to ease symptoms and improve quality of life. Prevention involves vaccinations to reduce risk of viral infections that can lead to cerebellar ataxia.
Peripheral neuropathy refers to damage to peripheral nerves. There are three main types: mononeuropathy affecting a single nerve, mononeuritis multiplex affecting multiple nerves asymmetrically, and polyneuropathy affecting multiple nerves concurrently and symmetrically. Polyneuropathy can be classified as axonopathy, myelinopathy, or neuronopathy depending on whether the axons, myelin sheaths, or neurons are affected. Symptoms and signs include both negative symptoms like numbness and weakness as well as positive symptoms like tingling and pain. Evaluation involves taking a history and examining for patterns of onset, progression, fluctuations, and other systemic diseases. Diagnosis involves nerve conduction studies and sometimes nerve biopsies. Treatment focuses
The document discusses central nervous system infections, listing the main causes as bacterial, viral, fungal, and protozoal. It then provides more detailed information on specific types of infections, including listings of examples for each category. It also includes sections on meningitis that describe the introduction, clinical features, types (pyogenic bacterial, tubercular, and viral), investigations, treatment, and physical therapy management goals for meningitis patients.
This presentation provides an overview of demyelinating diseases, focusing on multiple sclerosis (MS). It defines demyelinating diseases as those that cause myelin destruction while sparing other nervous system elements. MS is described as an autoimmune, inflammatory demyelinating disease of the central nervous system (CNS) that is more common in women. The presentation covers the pathology, clinical features, investigations, and treatment approaches for MS.
The document discusses vestibular disorders and the anatomy and function of the inner ear's role in balance. It describes how the semicircular canals and otolith organs detect movement and orientation. Common causes of dizziness include Meniere's disease, BPPV, vestibular neuritis, and migraines. Diagnosis involves a case history and vestibular testing like VNG, rotary chair, and VEMPs. Treatment options depend on the underlying cause but may include medications, repositioning maneuvers, surgery, or vestibular rehabilitation therapy.
This document discusses sensory ataxia, including its causes, clinical presentation, and differential diagnosis. Sensory ataxia results from disorders of the cerebellum, vestibular system, or sensory pathways. It is characterized by incoordination without significant weakness. Key findings include impaired proprioception, positive Romberg's sign, pseudoathetosis, and loss of vibration or joint position sense. Causes include peripheral neuropathies, paraneoplastic disorders, infections like HIV, autoimmune conditions like Sjogren's syndrome, and medications like chemotherapy. Dorsal root ganglionopathies commonly underlie sensory ataxia and can be assessed through nerve conduction studies and lumbar puncture. Distinguishing sensory
Upper motor neurons originate in the brain and convey signals for voluntary movement through descending pathways to lower motor neurons. Lower motor neurons originate in the spinal cord and brainstem and directly innervate skeletal muscles. An upper motor neuron lesion causes spastic weakness without atrophy while a lower motor neuron lesion causes flaccid paralysis with atrophy.
This document summarizes tabes dorsalis, a condition caused by untreated syphilis infection that results in demyelination of the dorsal columns of the spinal cord. It affects males more than females and symptoms onset typically in mid-life. Symptoms include weakness, diminished reflexes, pains, impaired sensation, coordination and gait issues. Diagnosis involves CSF and imaging tests. Treatment focuses on antibiotics while physiotherapy aims to improve strength, balance, mobility and coordination through exercises like Frenkel's exercise which focuses on precision and repetition to compensate for lost sensory function.
Meralgia Paresthetica (MP) is a condition caused by impingement of the lateral femoral cutaneous nerve, causing numbness and pain along the front of the thigh. It is often caused by entrapment of the nerve under the inguinal ligament. Diagnosis involves history, physical exam including the pelvic compression test, and may include imaging or nerve blocks. Treatment options include removing any underlying causes, medications, physical therapy, injections, or surgery.
This document discusses the anatomy, landmarks, measurements, common anomalies, syndromes, and injuries of the craniovertebral junction. It begins with a brief description of the craniovertebral junction's development and components. It then outlines several key anatomical landmarks and measurements used to evaluate the region on imaging. The remainder of the document details various congenital anomalies, developmental abnormalities, syndromes, and acquired conditions that can affect the craniovertebral junction.
This document discusses various pathologies that can cause damage to the spinal cord as seen on MRI. It focuses on diseases that appear as high signal on T2-weighted imaging. The most common etiologies are degenerative compressive myelopathy, inflammatory disorders, and demyelinating diseases such as multiple sclerosis. Imaging is important for determining the location, extent, and severity of abnormalities in order to accurately diagnose the underlying cause and guide treatment.
A herniated cervical disc occurs when the gel-like nucleus pulposus ruptures through the annulus fibrosus in the cervical spine. It commonly occurs at the C5-C6 or C6-C7 levels. Symptoms may include neck pain radiating into the arm with numbness/tingling. Diagnosis involves MRI or CT scans. Treatment first focuses on rest, medications, and physical therapy. Surgery such as discectomy may be needed if conservative measures fail.
1) Entrapment neuropathies occur when nerves are injured by chronic compression, angulations, or stretching forces, causing mechanical damage. Carpal tunnel syndrome is an example where the median nerve is compressed as it passes through the wrist.
2) Clinical features of entrapment neuropathies include pain, numbness, tingling, burning, and weakness in the affected area. Electrodiagnostic tests like nerve conduction studies and electromyography are important diagnostically.
3) Treatment involves conservative measures like splinting, steroid injections, and physical therapy. Surgery is considered if conservative treatment fails or for severe cases. Proper identification of the site of nerve entrapment is key to determining appropriate treatment
Tuberculous infection of the central nervous system (CNS) can occur via hematogenous spread or direct extension from a local infection. It most commonly manifests as tuberculous meningitis or tuberculomas. Tuberculous meningitis involves thick exudate in the subarachnoid space and can lead to hydrocephalus or ischemic infarcts. Tuberculomas appear as ring-enhancing lesions on imaging. Pott's disease is spinal tuberculosis that causes vertebral body collapse and kyphosis. Management involves antituberculous medications for at least 6-9 months.
This document discusses brachial plexus disorders including their anatomy, causes, clinical presentation, diagnostic approach, management, and specific conditions like idiopathic brachial plexitis and injuries. Key points covered include the brachial plexus anatomy and branches, common causes of brachial plexus disorders like injury and idiopathic plexitis, clinical features of shoulder pain and weakness, and electrodiagnostic and imaging studies used in evaluation and diagnosis. Management depends on the underlying cause but may include corticosteroids, physiotherapy, and conservative treatment.
This document discusses the principles and management of various congenital hand anomalies. It covers topics such as:
- Surgical management should aim to improve function and appearance with minimal risk. Hand function depends on thumb mobility and pinch grip.
- Timing of surgery depends on technical difficulty and cortical plasticity. Surgery may be delayed to treat other conditions.
- Transverse deficiencies are often managed non-surgically with prosthetics. Longitudinal deficiencies often benefit from surgery.
- Specific procedures are described for conditions like symbrachydactyly, radial hypoplasia, central ray deficiency, thumb and finger hypoplasia/aplasia. Syndactyly and poly
The document discusses several common orthopedic hand problems including congenital anomalies, acquired deformities, infections, and contractures. It describes the pathology, clinical features, and treatment options for conditions like mallet finger, boutonniere deformity, swan neck deformity, trigger finger, Dupuytren's contracture, nail fold infection, pulp infection, and deep fascial space infections. The treatment principles focus on antibiotics, drainage of abscesses, splinting, and rehabilitation.
Alzheimer's disease and dementia cause progressive cognitive decline that affects memory, thinking, and behavior. The document outlines the main types of dementia, including Alzheimer's, vascular, Parkinson's, Lewy body, Huntington's, and frontotemporal dementia. It describes the stages of Alzheimer's from mild cognitive impairment to very severe decline. Tips for communicating with confused individuals emphasize treating them with dignity, speaking simply, maintaining eye contact, and preventing or calmly managing severe behaviors.
The document discusses types of dementia like Alzheimer's disease and provides details about its pathophysiology and diagnostic criteria. It notes the growing prevalence of dementia worldwide and defines the condition. It describes the amyloid cascade hypothesis of Alzheimer's and discusses current and potential future treatments like cholinesterase inhibitors and memantine.
Peripheral neuropathy can be caused by damage to peripheral nerves outside of the brain and spinal cord. Symptoms may include numbness, tingling, pain or weakness in the hands, feet, arms and legs. Peripheral neuropathy has many potential causes including diabetes, nutritional deficiencies, toxins, infections and autoimmune disorders. Evaluation may involve neurological exams, nerve conduction studies and biopsies. Treatment depends on the underlying cause but aims to relieve symptoms and prevent further nerve damage when possible.
The document discusses peripheral neuropathy including definitions, symptoms, classifications, epidemiology, differential diagnosis, diagnostic workup, and case examples. It provides an overview of peripheral neuropathy including common causes like diabetes and idiopathic neuropathy as well as diagnostic testing and examination techniques. Specific case examples are used to demonstrate the clinical presentation and workup of peripheral neuropathy.
Peripheral neuropathy is inflammation and degeneration of the peripheral or cranial nerves, impairing conductivity. There are several types including mononeuropathy affecting a single nerve, mononeuropathy multiplex affecting multiple nerves, and polyneuropathy affecting many nerves. Polyneuropathy can have many causes including diabetes, hereditary factors, infections, toxins and metabolic disorders. Symptoms of polyneuropathy include motor weakness, sensory loss like numbness and tingling, and autonomic dysfunction affecting sweating and temperature control. Specific types like diabetic neuropathy and Guillain-Barre syndrome are also discussed. Testing includes nerve conduction studies and electromyography to diagnose peripheral neuropathies.
Peripheral neuropathy refers to damage or dysfunction of the peripheral nervous system, which can involve single nerves (mononeuropathy), multiple individual nerves (mononeuropathy multiplex), or nerve plexuses (plexopathy). Mononeuropathy affects a single nerve and can result from pressure or injury. Mononeuropathy multiplex involves multiple individual nerves in a random pattern, often due to vascular or connective tissue diseases. Plexopathy involves damage to nerve plexuses, commonly the brachial plexus, which can be caused by trauma, tumors, or other medical conditions.
Osteochondrosis is a common joint disorder seen in many animal species that is caused by a failure of blood supply to growing cartilage. It occurs in focal areas of cartilage and bone, especially in weight bearing joints. While factors like heredity, rapid growth, anatomy and trauma may play a role, current evidence suggests the primary cause is ischemic necrosis of vessels in cartilage canals during adolescence. This leads to necrosis of cartilage that later fails to properly ossify. Prophylactic measures should focus on this growth period when vulnerable blood vessels are present.
This document discusses chemotherapy-induced peripheral neuropathy (CIPN). It begins by explaining that CIPN results from nerve damage caused by certain chemotherapy drugs and causes sensory symptoms like numbness, tingling and pain. It then notes that 30-60% of patients receiving neurotoxic chemotherapy will experience CIPN. The document outlines several chemotherapy agents commonly associated with CIPN and their risk levels. It describes the pathogenesis of CIPN and discusses factors that can contribute to its development. The clinical manifestations and potential consequences of CIPN are also summarized. The document reviews methods for assessing CIPN and discusses some pharmacological and non-pharmacological treatment strategies, noting that prevention and management options remain limited.
Pulmonary rehabilitation is a comprehensive intervention designed to improve the physical and psychological condition of people with chronic respiratory disease. It includes exercise training, education, and behavior change therapies. Pulmonary rehabilitation aims to promote long-term adherence to health-enhancing behaviors. The summary describes restrictive and obstructive lung diseases, as well as various treatments used in pulmonary rehabilitation including exercise, airway clearance techniques, nutrition management, and psychosocial support.
This document provides an overview of stroke rehabilitation. It discusses the objectives and goals of rehabilitation, which include achieving functional independence, facilitating recovery, and reintegrating the patient back into their home and community. It then covers various aspects of rehabilitation including management in the acute phase, prevention of secondary strokes, and rehabilitation approaches for specific impairments like the upper limb, walking, swallowing, and more. A variety of therapeutic techniques and treatments are described for each impairment.
A description of the causes of sciatic nerve pain and subsequent treatment protocols using chiropractic care and acupuncture. Provided by Dr. Kirk Johnson of Johnson Chiropractic & Acupuncture P.A.
El plexo sacro está formado por las ramas anteriores de los nervios espinales L4-S4. Sus nervios principales incluyen el ciático, que inerva los músculos de la pierna y el pie, y el pudendo interno, que inerva los músculos del perineo y los genitales. La lesión del nervio ciático puede causar ciática, un dolor que se extiende desde las nalgas hasta el pie.
This document discusses radial club hand, which is a congenital deformity where there is failure of formation along the radial border of the upper extremity. Key points include:
- Radial club hand can range from mild shortening of the radius to total absence. It occurs in about 1 in 30,000 to 100,000 births.
- Surgical treatment involves centralizing the carpus on the distal ulna to provide support. Additional procedures like thumb reconstruction or tendon transfers may be needed.
- Nonsurgical treatment involves serial casting and splinting from birth to gradually correct the deformity. Surgery is usually done at 3-6 months if splinting is insufficient to provide radial support.
Professor Tony Elliott presents information on dementia and Alzheimer's disease, including:
1) Dementia is characterized by memory loss and functional decline, while Alzheimer's is the most common cause of dementia.
2) The prevalence of dementia doubles every 5 years after age 65, affecting 5% of those over 65 and up to 32% of those over 90.
3) The brain changes in Alzheimer's include plaques, tangles, and loss of connections between neurons.
4) Risk factors include age, family history, and genetic factors like ApoE4, while preventative factors include diet, exercise, and mental activity.
Sciatica is pain that radiates from the lower back down the back of the thigh and leg. It is caused by irritation or compression of the sciatic nerve, which can occur due to herniated discs, spinal stenosis, spondylolisthesis, or other causes like tumors or infections. Symptoms include pain that is worsened by certain movements and activities, numbness, and difficulty walking. Diagnosis involves physical examination including straight leg raise testing and neurological evaluation, as well as imaging like MRI or CT scan. Treatment options include medications, physiotherapy, surgery such as laminectomy or removal of bone compressing the nerve.
The document discusses various types of dementia, their causes and symptoms. It describes Alzheimer's disease, vascular dementia, dementia caused by Parkinson's disease, Huntington's disease, Pick's disease, Creutzfeldt-Jakob disease, Wernicke-Korsakoff syndrome, normal pressure hydrocephalus, mixed dementia, and dementia not otherwise specified. Symptoms include memory loss, confusion, problems with language and motor skills. Causes include neurological disorders, traumatic brain injuries, infections, substance abuse, and unknown etiologies.
Brachial plexus injuries can occur from trauma such as vehicle accidents or falls. The brachial plexus is formed by the ventral rami of spinal nerves C5-T1. Injuries are classified based on the site of injury and grade of nerve damage. Common injuries involve the upper trunks causing weakness of shoulder muscles or lower trunks resulting in hand weakness. Diagnosis involves clinical exam, electrodiagnostics, and imaging. Treatment depends on the severity but may involve surgery for open injuries or nerve grafts for severe damage.
This document discusses the anatomy, types of injuries, clinical presentation, investigations and classification of brachial plexus injuries.
It describes the formation of the brachial plexus from the cervical nerve roots and its divisions. Injuries can be preganglionic or postganglionic, and include traction injuries, avulsions or lacerations. Clinical exam focuses on assessing motor and sensory deficits. Investigations include imaging like MRI/CT, myelography and EMG/NCV to localize the lesion. Seddon's classification is used to describe the severity of injury.
A spinal cord injury can occur anywhere along the spinal cord and cause varying degrees of paralysis and loss of sensation depending on the level and completeness of the injury. The spinal cord is protected by 33 vertebrae in the cervical, thoracic, lumbar, sacral and coccygeal regions. Injuries in the cervical region can affect breathing and functions controlled by nerves in the neck region, while thoracic and lumbar injuries typically result in paraplegia or quadriplegia below the level of injury. Complete injuries cause total loss of function below the injury site, while incomplete injuries may allow some movement or sensation to remain.
Presentation2, radiological imaging of brachial plexus pathology.Abdellah Nazeer
The document provides details on radiological imaging of brachial plexus pathology. It begins with an overview of brachial plexus anatomy including its origin, course, branches and functions. It then discusses various pathologies that can affect the brachial plexus including traumatic injuries, infections, inflammation, benign and malignant neoplasms, radiation plexopathy, compression and vascular abnormalities. For each pathology, it describes relevant imaging findings such as edema, enhancement patterns, masses, pseudomeningoceles and atrophy that help in diagnosis. Example images demonstrate various brachial plexus injuries and conditions.
Peripheral nerve damage affecting the upper extremities can vary widely in cause and extent.
Many disorders, ranging from mild carpal tunnel syndrome to severe brachial plexopathy, need to be considered in a patient presenting with pain, sensory loss, or weakness involving the shoulder, arm, or hand.
Brachial plexus injury (BPI) is a severe peripheral nerve injury affecting upper extremities, causing functional damage and physical disability
Root injury is defined as root avulsion from the spinal cord and rupture in the preganglionic root zone or dorsal ganglion at the vertebral foramen
Post-ganglionic injury are injuries distal to the ganglion, which divided into supra and infra-clavicular injury
Thoracic outlet syndrome (TOS) refers to compression of the neurovascular structures in the thoracic outlet. There are two main types - neurogenic and vascular. Neurogenic TOS is more common and involves compression of the brachial plexus nerves, while vascular TOS involves compression of the subclavian artery or vein. Symptoms vary depending on the affected structure but may include pain, numbness, cold intolerance, or vascular symptoms like swelling. Diagnosis involves physical exam maneuvers and imaging tests like ultrasound or MRI. Treatment begins with conservative measures like stretching and strengthening, but refractory cases may require injections or surgeries like scalenectomy to decompress the area.
Thoracic outlet syndrome occurs when the blood vessels or nerves in the thoracic outlet - the space between the neck and upper chest - become compressed. It was first described in 1821 and various anatomical structures have been identified that can cause compression, including ribs, muscles, ligaments, and fibrous bands. The syndrome has three main types defined by whether the neurovascular structures compressed are nerves, the subclavian artery, or subclavian vein. The compression is usually caused by congenital anatomical variations but can also be due to acquired factors like injuries or repetitive stress.
Surgical anatomy of upper limb nerves and plexusPirah Azadi
The document discusses the surgical anatomy of the upper limb nerves and brachial plexus. It begins by outlining the brachial plexus and its main branches, including the axillary, musculocutaneous, radial, median, and ulnar nerves. It then provides details on specific nerves, describing their motor and sensory innervation, clinical presentations of injuries, and dermatome patterns. Common nerve entrapment syndromes like carpal tunnel syndrome are also summarized.
Brachial plexus and peripheral nerve injuries.pptxGauravPuri42
This document provides information on peripheral nerve lesions, focusing on the brachial plexus and specific nerves. It discusses:
- The anatomy and components of the brachial plexus, including the roots, trunks, divisions, and cords.
- Common brachial plexus injuries like Erb's palsy (upper plexus injury) and Klumpke's palsy (lower plexus injury).
- Individual nerves like the median nerve, including its anatomical course and common injuries from compression or laceration.
- Other topics like causalgia, Tinel's sign, mechanisms and classifications of nerve injuries, and treatments.
The brachial plexus is formed by the ventral rami of cervical and thoracic spinal nerves C5-T1. It is vulnerable to injury from trauma such as motor vehicle accidents, falls, or excessive traction during childbirth. Injuries are classified based on the location and roots involved. Evaluation involves neurological and sensory exams along with imaging like MRI. Management may include physiotherapy, splinting, nerve grafts or transfers to restore function. The goals are restoration of elbow flexion, shoulder abduction, and medial forearm sensation. Surgical options depend on if the injury is open or closed.
1. The document discusses various types of spinal cord injuries including complete injuries which involve a complete loss of motor and sensory function below the level of injury, and incomplete injuries which partially compromise spinal cord function with some sensation and muscle movement retained below the injury site.
2. It provides details on specific spinal cord syndromes like anterior cord syndrome, Brown-Séquard syndrome, and central cord syndrome which are characterized by variable patterns of motor and sensory loss.
3. The management of spinal cord injuries involves stabilizing the spine, treating shock, addressing airway and breathing issues, screening for associated injuries, and preventing complications like pressure sores through regular turning of immobilized patients.
This document provides information on the diagnosis and classification of nerve injuries, as well as details on specific nerves including their anatomy, causes of injury, clinical features, and management approaches. It discusses the axillary, radial, ulnar, median, sciatic, femoral, and lumbosacral plexus nerves. Diagnosis involves history, examination, and investigations such as nerve conduction studies, electromyography, and imaging. Surgical management of nerve injuries includes neurolysis, nerve repair, grafting, and the use of nerve conduits.
Thoracic outlet syndrome is caused by compression of the neurovascular structures in the thoracic outlet. It has three main types - neurogenic, venous, and arterial. Neurogenic TOS is the most common, caused by scalene muscle anomalies compressing the brachial plexus. Symptoms include pain, numbness, and weakness in the arm. Conservative treatments focus on postural changes, stretching, and strengthening to relieve compression. Precise diagnosis relies on clinical examination, and surgery may be considered if conservative measures fail.
The document discusses brachial plexus injuries, including anatomy, etiology, classification, clinical features, and investigations. The brachial plexus is formed by the anterior rami of C5-T1 nerves and provides sensation and motor function to the upper limb. Common causes of injury include motorcycle accidents, falls, and obstetric injuries. Injuries are classified based on the level and mechanism. Clinical features depend on the location and severity of injury. Investigations include imaging, EMG, and nerve conduction studies to evaluate the nature and extent of injury.
This document discusses peripheral nerve diseases, focusing on individual nerve lesions. It describes the anatomy and clinical presentations of lesions of the dorsal scapular, long thoracic, suprascapular, subscapular, thoracodorsal, anterior thoracic, axillary, musculocutaneous, and median nerves. It also discusses median nerve variants, carpal tunnel syndrome, and ulnar nerve anatomy.
Dr. Stacy Arvinna presented on various endocrine emergencies including:
1. Diabetic ketoacidosis is characterized by hyperglycemia, ketosis and acidemia due to insulin deficiency. It requires fluid resuscitation and insulin therapy.
2. Thyroid storm is a severe exacerbation of hyperthyroidism with multi-organ involvement. It has a high mortality and requires beta blockade, antithyroid drugs, iodine and corticosteroids.
3. Myxedema coma is the severe manifestation of hypothyroidism leading to decreased mental status and hypothermia. It requires gradual rewarming and high dose thyroid hormone replacement.
This document summarizes the epidemiology and prevention of plague. It describes the history of plague pandemics, the causative bacterium Yersinia pestis, and modes of transmission. Key points are that plague is typically zoonotic, spreading from rodents to humans via flea bites. Historically, it caused urban epidemics but now occurs sporadically in rural areas. Prevention includes vaccination, respiratory droplet precautions, and post-exposure prophylaxis with antibiotics for exposed contacts to prevent person-to-person spread.
Waterhouse–Friderichsen syndrome (WFS) is defined as adrenal gland failure due to bleeding into the adrenal glands, most commonly caused by the bacterial infection meningococcus. It typically occurs in infants and children under 10 years old. Clinically, it presents with a sudden high fever, rash, shock, and disseminated intravascular coagulation. The adrenal glands hemorrhage and lead to adrenal insufficiency. Treatment involves antibiotics, adrenal support with hydrocortisone, and managing shock. Prevention includes routine meningococcal vaccination in certain groups.
This document discusses occupational noise and its effects. It defines noise and sound, describes how the ear works, and identifies common sources of occupational noise like machinery. It explains that prolonged exposure to high noise levels can cause temporary or permanent hearing loss. The document provides guidance on engineering controls, administrative controls, hearing protection, and compliance with regulations to prevent noise-induced hearing loss.
Fangotherapy is a treatment that uses thermal mud containing minerals spread over the body to cleanse and revitalize the skin, after which the mud is left on and a massage may be given; mud therapy has been used for centuries to treat diseases and is considered beneficial for healing wounds and skin conditions. The document further details the composition, properties, effects, indications, contraindications and methods of mud therapy and mud packs/baths.
This document discusses the dangers of excessive computer use, which can lead to behavioral, health, and ergonomic issues. Behaviorally, computer addiction can cause social isolation, attention problems, and depression. Health issues include bad posture, repetitive strain injuries, sleep deprivation, and potential long-term effects like cancer from radiation exposure. Ergonomically, improper seating and posture can cause back, neck, and shoulder pain. The document provides tips for recognizing computer addiction and setting limits to reduce overuse, as well as emphasizing the importance of ergonomics for comfort and injury prevention.
This document discusses cardiac arrhythmias and anti-arrhythmic drug treatment. It covers the types and mechanisms of arrhythmias including ventricular arrhythmias and re-entry involving abnormal conduction. It describes the cardiac action potential and relevant ion channels. It then classifies anti-arrhythmic drugs according to the Vaughan Williams system as class I-IV drugs that work by blocking sodium, beta, potassium, or calcium channels. Specific class I, III drugs are discussed along with their effects on re-entry and potential side effects like proarrhythmia. Alternative treatments like ablation and ICDs are also mentioned.
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.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
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.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
- 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
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• 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
2. Plexopathy is a disorder affecting a network of
nerves, blood vessels, or lymph vessels.
The region of nerves it affects are at the brachial
or lumbosacral plexus.
Symptoms include pain, loss of motor
control, and sensory deficits.
3. There are two main types of plexopathy; Brachial plexopathy and
Lumbosacral Plexopathy. They are usually caused from some sort of
localized trauma such as a dislocated shoulder. The disorder can also
be caused secondary to a compression, co-morbid vascular disease,
infection, or may be idiopathic with an unknown cause.
4.
5. The brachial plexus is a
network of nerves that
conducts signals from the
spinal cord, which is
housed in the spinal canal
of the vertebral column (or
spine), to the shoulder, arm
and hand.
These nerves originate in
the fifth, sixth, seventh and
eighth cervical (C5-C8), and Diagram illustrates basic anatomy of
first thoracic (T1) spinal brachial plexus. Brachial plexus is
nerves, and innervate the formed by anterior rami of C5-T1 nerve
muscles and skin of the roots. Roots are located in neural
foramina and trunks between scalene
chest, shoulder, arm and
muscles. Divisions are posterior to
hand. clavicle, and cords are inferior to it. LC
Brachial plexus injuries, or = lateral cord, PC = posterior cord, MC
lesions, are caused by = middle cord.
damage to those nerves.
6. Brachial plexus injuries, or lesions, can occur as a result of
shoulder trauma, tumours, or inflammation. The rare
Parsonage-Turner Syndrome causes brachial plexus
inflammation without obvious injury, but with nevertheless
disabling symptoms. But in general, brachial plexus lesions
can be classified as:
i) Obstetric injuries may occur from mechanical injury involving shoulder
dystocia during difficult childbirth.
The baby's shoulders may become impacted during the birth process
causing the brachial plexus nerves to stretch or tear.
The excessive stretch results in incomplete sensory and/or motor function
of the injured nerve.
ii) Traumatic injury may arise from several causes.
(Sports, high-velocity motor vehicle accidents, falls from a height on to the
side of the head and shoulder, whereby the nerves of the plexus are
violently stretched, injury from a direct blow to the lateral side of the
scapula, direct violence or gunshot wounds, by violent traction on the arm,
or by efforts at reducing a dislocation of the shoulder joint“)
7. Causes
In most cases the nerve roots are stretched or torn
from their origin, since the meningeal coverings of
the nerve roots are thinner than the sheaths enclosing
the peripheral nerves. The epineurium of the
peripheral nerve is contiguous with the dura
mater, providing extra support to the peripheral
nerves.
Brachial plexus lesions typically result from
•excessive stretching;
•rupture injury where the nerve is torn but not at the
spinal cord;
•avulsion injuries, where the nerve is torn from its
attachment at the spinal cord.
•build-up of scar tissue around a brachial plexus
injury site (put pressure on the injured
nerve, disrupting innervation of the muscles)
8. Brachial plexus lesions can be divided into two types:
1) An upper brachial plexus lesion, which occurs from
excessive lateral neck flexion away from the shoulder. Most
commonly, falling on the neck at an angle causes upper
plexus lesions leading to Erb's palsy. This type of injury
produces a very characteristic sign called Waiter's tip deformity
due to loss of the lateral rotators of the shoulder, arm flexors,
and hand extensor muscles.
2) Much less frequently, sudden upward pulling on an abducted
arm (as when someone breaks a fall by grasping a tree branch)
produces a lower brachial plexus lesion, in which the eighth
cervical (C8) and first thoracic (T1) nerves are injured "either
before or after they have joined to form the lower trunk. The
subsequent paralysis affects, principally, the intrinsic muscles
of the hand and the flexors of the wrist and fingers". This
results in a form of paralysis known as Klumpke's paralysis.
9. Injury Classification
The severity of brachial plexus injury is determined by the type of
nerve damage.There are several different classification systems
for grading the severity of peripheral nerve and brachial plexus
injuries. Most systems attempt to correlate the degree of injury
with symptoms, pathology and prognosis.
A more recent and commonly used system described by the late
Sir Sydney Sunderland, divides nerve injuries into five degrees:
•first degree or neurapraxia, following on from Seddon, in which
the insulation around the nerve called myelin is damaged but the
nerve itself is spared,
•second through fifth degree, which denotes increasing severity
of injury
•fifth degree injuries, the nerve is completely divided
10. Seddon's classification (based on three main types of nerve fiber
injury, and whether there is continuity of the nerve)
1) Neurapraxia: The mildest form of nerve injury. It involves an
interruption of the nerve conduction without loss of continuity of the
axon. Recovery takes place without wallerian degeneration.
2) Axonotmesis: Involves axonal degeneration, with loss of the relative
continuity of the axon and its covering of myelin, but preservation of
the connective tissue framework of the nerve (the encapsulating
tissue, the epineurium and perineurium, are preserved).
3) Neurotmesis: The most severe form of nerve injury, in which the
nerve is completely disrupted by contusion, traction or laceration. Not
only the axon, but the encapsulating connective tissue lose their
continuity. The most extreme degree of neurotmesis is
transsection, although most neurotmetic injuries do not produce gross
loss of continuity of the nerve but rather, internal disruption of the
nerve architecture sufficient to involve perineurium and
endoneurium as well as axons and their covering. It requires
surgery, with unpredictable recovery.
11. Presentation (Signs and Symptoms)
Signs and Symptoms may include a limp or paralyzed arm, lack of
muscle control in the arm, hand, or wrist, and lack of feeling or sensation
in the arm or hand. Although several mechanisms account for brachial
plexus injuries, the most common is nerve compression or stretch. The
most severe form of injury is nerve root avulsion, which results in
complete weakness in corresponding muscles. This usually accompanies
high-velocity impacts that occurs during motor vehicle or bicycle
accidents.
The cardinal signs of brachial plexus injury then, are weakness in the arm,
diminished reflexes, and corresponding sensory deficits.
Erb's palsy. "The position of the limb, under such conditions, is characteristic: the
arm hangs by the side and is rotated medially; the forearm is extended and
pronated. The arm cannot be raised from the side; all power of flexion of the elbow
is lost, as is also supination of the forearm".
In Klumpke's paralysis, a form of paralysis involving the muscles of the forearm
and hand, a characteristic sign is the clawed hand, due to loss of function of the
ulnar nerve and the intrinsic muscles of the hand it supplies.
12.
13. Diagnosis
The diagnosis may be
confirmed by an EMG
examination in 5 to 7
days. The evidence of
denervation will be
evident. If there is no
nerve conduction 72
hours after the
injury, then avulsion is
most likely.
14. Treatment
Treatment for brachial plexus injuries includes occupational or
physical therapy and, in some cases, surgery. Some brachial
plexus injuries may heal without treatment.
Many infants improve or recover within 6 months, but those that
do not have a very poor outlook and will need further surgery to
try to compensate for the nerve deficits. The ability to bend the
elbow (biceps function) by the third month of life is considered an
indicator of probable recovery, with additional upward
movement of the wrist, as well as straightening of thumb and
fingers an even stronger indicator of excellent spontaneous
improvement.
Gentle range of motion exercises performed by
parents, accompanied by repeated examinations by a
physician, may be all that is necessary for patients with strong
indicators of recovery.
15. Prognosis
The site and type of brachial plexus injury
determine the prognosis. Avulsion and rupture
injuries require timely surgical intervention for any
chance of recovery. For milder injuries involving
build-up of scar tissue and for neurapraxia, the
potential for improvement varies, but there is a fair
prognosis for spontaneous recovery, with a 90 -
100% return of function.
16.
17. The anterior divisions of the lumbar nerve, sacral nerve, and
coccygeal nerves form the lumbosacral plexus, the first
lumbar nerve being frequently joined by a branch from the
twelfth thoracic.
For descriptive purposes this plexus is usually divided into
three parts:
1. lumbar plexus
2. sacral plexus
3. pudendal plexus
18.
19. The lumbosacral plexus is
situated within the relative
protection of the axial
skeleton, making blunt trauma
a relatively uncommon cause
of injury. The most common
causes of a lumbosacral
plexopathy are usually by
direct compression, diabetic
neuropathy, complications of
pelvic surgery, or parturition.
Separating a plexopathy from
other neurological effects of
other spinal-related problems
is often a diagnostic challenge.
20. Diabetic plexopathy
Diabetic plexopathy typically affects the lumbosacral plexus more than a
brachial. It is distinguished from a peripheral polyneuropathy of long-
standing diabetes by its predominantly proximal symptoms. The majority
of patients are in their sixth and seventh decade and also have documented
distal peripheral polyneuropathy. Most frequent clinical presentation of a
diabetic lumbosacral plexopathy is anterior thigh pain, with secondary
proximal leg muscle weakness. The muscle weakness is most pronounced
in the quadriceps muscles. Sensory loss is generally less pronounced,
although patellar reflexes typically are absent or sluggish. With
progression, noticeable muscle wasting occurs, resulting in significant
atrophy and weight loss. There is a trend for progression from unilateral to
bilateral lower-extremity involvement.
Diagnosis is therefore based on presentation, presence of diabetes, and the
presence of acute electrodiagnostic findings to be discussed later.
Therapy is ultimately focused on the control of the hyperglycemia. Most
patients who achieve glucose control typically have significant, but
incomplete, recovery of muscle strength. Maximal improvement can
require more than one year. After control of the hyperglycemia,
rehabilitation strategies address pain management, maintenance of range of
motion, and compensatory mechanisms for knee extensor weakness.
21. Traumatic Plexopathy
Traumatic plexopathy of the lumbosacral plexus typically must be
sufficient to produce an unstable, vertical fracture of the pelvic
region since the plexus is other-vise well protected from direct
impact. Fractures to the sacroiliac joint usually involve the
intralateral lumbosacral trunk with impairment clinically seen at the
L5 and S1 levels. Fractures or dislocations of the hip joint can
produce traction injuries to the lumbosacral plexus. Treatment:
Surgical intervention is imminent and requires initial periods of
immobilization post-operatively. The initial lesions can slowly
recover during the post-operative rehabilitation.
Prognosis: Poor recovery
22. Hemorrhagic Plexopathy
Hemorrhagic plexopathy is usually caused in the retroperitoneal
region, which can compress on the plexus as it passes through either the
iliac or psoas muscles. An expanding hematoma within the more
laterally located iliopsoas muscle can cause local compression of the
femoral nerve at the point along its course from its origin to the inguinal
ligament.
Clinical presentation:
1) Compression (Diffuse) in psoas muscle
Weakness: Obturator & femoral nerve territory
Pain: Mild or none
Mass: None palpable
2) Compression of femoral nerve in iliacus muscle
Pain: In groin or iliac fossa
Radiates to anteromedial thigh & medial lower leg
Weakness: Quadriceps
Sensory: Reduced in anteromedial thigh & saphenous distribution
Reflex loss: Knee
Mass: May be palpable in groin
24. Radiation-Induced Lumbosacral Plexopathy
Radiation-induced lumbosacral plexopathy is similar to that affecting the
brachial plexus. Onset is difficult to determine, occurring from one to 31
years after radiation. Patients receiving an external beam or internal cavity
radiation are equally susceptible. Patients generally present with slowly
progressive, bilateral lower extremity weakness that tends to affect the distal
muscles more. Paresthesia and numbness are less frequently reported in the
initial symptoms. Symptom progression can eventually stabilize. Patients are
usually severely disabled by that time. Therefore, early diagnosis or proper
follow up by the oncologist/family physician is essential.
Weakness: Distal legs
Latency: Months to years
Progression: Slow
Pain: Late; Not disabling
Cancer type: Gynecological; Testicular
Predisposing treatment : High radiation dose: > 55 Gy
Chemotherapy
NOT hormonal
Electrodiagnostic : EMG: Myokymia
NCV: Absent late reflexes
Imaging: Multifocal fibrosis
25. Iatrogenic trauma plexopathy
Iatrogenic trauma to the lumbosacral plexus can occur during
surgical, gynecological, or anesthetic procedures. The mechanisms include
compression, traction, and vascular insult. Proper clinical and electrodiagnostic
differentiation is important with such plexopathies since the prognosis depends
on the cause and location.
Surgical laceration injuries are rare, but among the most severe, since the
progress to recovery is not possible. It is most likely to occur during a deep
pelvic procedure, such as a prostatic resection or a hysterectomy.
Blunt trauma from surgical retraction or during forceps delivery is more
common. The femoral and obturator nerves are the most frequently injured. The
lumbosacral trunk, lateral cutaneous nerve, and the sciatic nerves follow.
Arthroplasty of the hip results in a significant number of
femoral, obturator, and sciatic injuries through direct trauma, stretch, or the
effects of heat from cement polymerization. The chiropractor may be more apt to
see such a plexopathy resulting from an epidural anesthesia procedure. An
epidural may cause a rectoperitoneal hemorrhage that may result in a
diffuse, extensive, and neuropathic injury.
Another rare cause of iatrogenic lumbar plexopathy may be due to a pre-
existing atherosclerosis, intraoperative hypotension, or coagulopathy, which
may initiate a spinal artery syndrome. A spinal artery syndrome should always
be considered in the case of unexplained postoperative weakness, particularly in
the elderly population.
26. Neoplastic Plexopathy
Neoplastic plexopathy lesions originating in the pubic regions can
invade the lumbosacral plexus by direct expansion. The most
common is a colorectal carcinoma. However, uterine, prostatic, and
ovarian tumors can be locally invasive as well. Metastatic invasions
of the retroperitoneum and the lumbosacral plexus by breast,
thyroid, testicular cancers, lymphomas, myelomas, and melanomas
are also well known. Patients with neurofibromatosis can develop
grossly huge tumors involving any compartment of the plexus.
Neoplastic plexopathies generally present with unilateral pelvic pain
and, when progressive, show lower motor neuron signs. Weakness:
Proximal
Unilateral; Asymmetric
Progression: Rapid
Pain: Often severe
Mass: Palpable rectal
Cancer type: Colon; Prostate; Sarcoma
Imaging: Focal mass
27. Extrinsic tumor. STIR MR image in a patient with carcinoma of the cervix
showing an extensive soft tissue mass surrounding and infiltrating the entire
pelvis and the sacral plexus bilaterally (arrow) that is enlarged with loss of fat
planes and normal fascicular architecture. Note the hyperintense signal
consistent with extensive marrow infiltration by the mass lesion.
28. Immune (vasculopathy) plexopathy
Onset: Late-age
Clinical features : Sensory Pain: Variable; Occasionally severe
Sensory Loss: Distal; Often asymmetric
Weakness : Asymmetric,
Proximal, Distal or Both
Bilateral
Course: Progression over weeks to months
Association: Diabetes
Laboratory : EMG: Denervation in limbs & paraspinous muscles
Nerve biopsy
Inflammatory cells around small epineurial blood vessels
Differential fascicular loss of axons
High sedimentation rate
Prognosis: Recovery with treatment
Over months to years
Treatment: Corticosteroids
Intravenous Ig
29. Ischemic Lumbosacral plexopathy
Blood supply of lumbar & sacral plexus: Branches of the internal iliac artery
Clinical: Symptoms & Signs mostly after exercise
Exacerbated walking uphill
No effect of bicycle exercise
Distribution: Unilateral or bilateral
Exercise provocation: Walking uphill; Riding a bicycle
Examination at rest often normal
Sensory Pain: Gluteal region after exercise; 85% Paresthesias
Sensory Loss: Pan-modal; Not dermatomal; Distal or Proximal
Weakness: Distal ± Proximal Leg
Tendon reflexes: May be reduced after exercise
Electrodiagnostic: EMG & NCV often normal
Pelvic arteriography
Bilateral stenoses of the internal iliac arteries (75%)
Other stenosis
Distal abdominal aorta + bilateral common iliac artery
Ipsilateral internal & common iliac artery
Treatment: Percutaneous transluminal angioplasty; Stents
Parsonage-Turner syndrome is also known as acute brachial neuropathy and acute brachial radiculitis.Other names used are Parsonage-Aldren-Turner syndrome, neuralgic amyotrophy, brachial neuritis, or brachial plexitis. The syndrome refers to a rare set of symptoms resulting from inflammation of unknown etiology of the brachial plexus.
Erb's palsy (Erb-Duchenne Palsy) is a paralysis of the arm caused by injury to the upper group of the arm's main nerves, specifically the upper trunk C5-C6 is severed. These form part of the brachial plexus, comprising the ventral rami of spinal nerves C5-C8, and T1.These injuries arise most commonly, but not exclusively, from shoulder dystocia during a difficult birth.Depending on the nature of the damage, the paralysis can either resolve on its own over a period of months, necessitate rehabilitative therapy, or require surgery.Klumpke's paralysis (or Klumpke's palsy or Dejerine-Klumpke palsy) is a variety of partial palsy of the lower roots of the brachial plexus.The brachial plexus is a network of spinal nerves that originates in the back of the neck, extends through the axilla (armpit), and gives rise to nerves to the upper limb. Klumpke's paralysis is a form of paralysis involving the muscles of the forearm and hand, resulting from a brachial plexus injury in which the eighth cervical (C8) and first thoracic (T1) nerves are injured "either before or after they have joined to form the lower trunk. The subsequent paralysis affects, principally, the intrinsic muscles of the hand and the flexors of the wrist and fingers".[4][9][10] Forearm pronators and wrist flexors may be involved, as may dilators of the iris and elevators of the eyelid (both of which may be seen in the case of associated Horner's Syndrome). The classic presentation of Klumpke's palsy is the “claw hand” where the forearm is supinated and the wrist and fingers are hyperextended. If Horner syndrome is present, there is miosis (constriction of the pupils) in the affected eye.