Mathemagical clinical neurology

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Mathemagical clinical neurology

  1. 1. MATHEMAGICAL CLINICAL NEUROLOGY Prof.A.V.SRINIVASANM.D.D.M. Ph.D.F.I.A.N. F.A.A.N. Additional Prof.of Neurology Madras Institute of Neurology TO TEACH IS AN HONOUR THAT IS SACRED MIN - MOTTO
  2. 2. Mathemagical Clinical Neurology ABSTRACTOBJECTIVE: To construct a teaching model for easier clinical neurological examination to help the medical students and paramedical personal to understand the neuroanatomy and etiopathological disorders of the nervous system.BACKGROUND: Neurophobia is a fear of neural sciences and clinical neurology and half of the medical students and paramedical personal experience this disorder during their training. We have evolved an easy, faster ten step approach in clinical neurological examination using mathematical numbers.METHODS: One characterizes consciousness / mind, Two represents the two cerebral hemispheres and Three, the major functions of the brain namely cognition, conation and affect. Four represents the four lobes and four ventricles. Five represents five special senses. Six explains the six major functional systems of the brain, basal ganglia (programmer), cerebellum (computer), cerebral and its efferents (output), sensory systems (input), autonomic nervous system (emergency situations) and the limbic system (integrator of all). Seven characterizes the LMN (anterior horn cells anterior nerve root posterior nerve root  peripheral nerve  neuromuscular junction  muscle  intracellular organelles. Eight represents eight language disorders, four with normal repetition and four with abnormal repetition. The Nine etiologies in fingertips Thumb (Tumour, Toxin, Trauma), Index Finger (Infection), Middle finger (Metabolic), Diamond finger (Demyelination), Little finger (vascular) and Hand (Hereditary and nutritional disorders). Ten represents the ten pairs of cranial nerves with olfactory and optic nerves, which are extensions of brain.CONCLUSION: This faster and easier method of neurological examination will help the epidemiological field workers. Ten step approach of clinical neurology teaching will replace Neurophobia with Neurophilia, and will effectively integrate the basic sciences with clinical neurology.
  3. 3. ALBERT EINSTEINEVERY THING SHOULD BE MADE SIMPLE, BUT NOT SIMPLER -
  4. 4. AIMS AND OBJECTIVES To Evolve a teaching model for easier,faster clinical neurological examination tohelp the Neuroscientists including medicalstudents and paramedical personal to understand the Neuroanatomy,Neurophysiology and Etiopathologicalapproach of the nervous system.
  5. 5. BACKGROUND Neurophobia is a fear of Neuro sciences andclinical neurology. Most of the medical students andparamedical personal experience this disorder duringtheir training. Physical examination in the chapter of thenervous system in Hutchison’s Clinical methods 2002W.B.Saunders,London, expanded more than 50% from19,110 words to 29,632 words,while in Respiratory andCardiovascular system decreased by 47% and 70%respectively when compared to the first edition ofclinical methods-A guide to the practical study ofmedicine in 1897(Alisdair Mcneill-Practicalneurology,2005,5,180-3).Clinical evaluation of thenervous system becoming too unwieldy for routine useand certainly for the modern medical studentcurriculum.We have evolved an easy, faster ten stepapproach in clinical neurological examination usingmathematical numbers
  6. 6. MATHEMAGICAL CLINICAL NEUROLOGYONE - CONSCIOUSNESS/MINDTWO - CEREBRAL HEMISPHERESTHREE - FUNCTIONS OF BRAIN COGNITION CONATION AFFECTFOUR - LOBES OF BRAINFIVE - SPECIAL SENSES
  7. 7. SIX - UPPER FUNCTIONAL MOTOR NEURON SYSTEMS OF BRAINSEVEN - LOWER FUNCTIONAL MOTOR NEURON SYSTEMS OF BRAINEIGHT - LANGUAGE DISORDERSNINE - ETIOLOGYTEN - TEN CRANIAL NERVES WITH OLFACTORY AND OPTIC NERVES – EXTENSIONS OF BRAIN
  8. 8. TEACHING METHODS-TEN STEPS I AM HAPPY THAT PROF.A.V.SRINIVASAN HAS THOUGHT IT FIT TO INTRODUCE A NEWER CONCEPT OF NEUROLOGICAL EXAMINATION WHICH IS BASED ON AREAS OF ANATOMY AND FUNCTION IN A STEP WISE FASHION STARTING AT THE CORTICAL LEVEL AND RIGHT DOWN TO THE NEUROMUSCULAR LEVEL AND INCURS THE ABILITY TO TRANSLATE THIS INTO A RESORTMENT PATTERN IN NEUROLOGICAL INTERPRETATION.THIS IS A NEW CONCEPT WHICH,HE HAS ENTERED, HAS DONE EXTREMELY WELL TO SHOW IT TO HIS COLLEAGUES.I AM SURE THAT THE ARDENT GROUP OF STUDENTS OF NEUROLOGY AND EVEN STUDENTS OF INTERNAL MEDICINE AND NEUROSURGEONS WILL BENEFIT WITH THIS NEW TECHNIQUE,METHOD OF A WAY OF EVALUATING NEUROLOGICAL DISEASES Prof.K.V.THIRUVENGADAM B.Sc,M.D.,D.Sc(hon).F.R.C.P(EDIN), FAMS,FCCP,FCAI FORMER DIRECTOR OF MEDICINE MADRAS MEDICAL COLLEGE AND GOVT.GENERAL HOSPITAL CHENNAI,TAMIL NADU, INDIA .
  9. 9. CLINICAL DIAGNOSIS IN NEUROLOGY IS USUALLY ARRIVED AT BY DETECTING SIGNS WHICHINDICATE DISTURBANCE OF A FUNCTION IN THE CEREBRAL SPINAL AXIS.IN THE PRESENT SYSTEMOF DIAGNOSIS,BY VIRTUE OF COMBINING POSITIVE SIGNS TO FIND A MEANINGFUL LOCATION INTHE CENTRAL NERVOUS SYSTEM OR THE PERIPHERAL NERVOUS SYSTEM.THIS METHOD OFARRIVING AT CLINICAL DIAGNOSIS HAS STOOD THE TEST OF TIME BUT HAS AN INHERENT DEFECTBEING TIME CONSUMING. THE NEW SYSTEM BY VIRTUE OF DETECTING THE DEFECTS IN THE SYSTEM STRAIGHT WAY BYVIRTUE OF THE SIGNS PICKED UP AT THE TIME OF THE EXAMINATION HELPS IN THE BEDSIDEDIAGNOSIS EASIER AND QUICKER.ELECTROPHYSIOLOGICAL STUDIES AND IMAGING TECHNIQUESARE USED ONLY TO CONFIRM THE CLINICAL IMPRESSION GIVING EASIER RECOGNITION OFANATOMICAL LEVELS OF INVOLVEMENT. DEMONSTRATION OF SOME OF THE CASES EXAMINED BOTH WAYS REVEAL THE ACCURACY OFDIAGNOSIS MORE IN THIS SYSTEM AS AGAINST THE CONVENTIONAL ONE. THIS SYSTEM WILL HELP LEARNING AND DIAGNOSING NEUROLOGICAL AILMENTS.IT IS BOTHCOMPLIMENTARY AND PRIMARY IN CLINICAL EXAMINATION AT THE BED SIDE PROBABLY GIVINGA BETTER INSIGHT TO THE STUDENT REGARDING THE FUNCTIONAL DERANGEMENT CORRELATINGWITH FUNCTIONAL ANATOMY AND WILL BE USEFUL IN EVALUATING NATURAL EVOLUTION OFMANY NEUROLOGICAL DISORDERS. WITH THE REDUCTION OF TIME IN THE PRIMARY AND FOLLOW UP EXAMINATION,PATIENTCARE IMPROVES.THIS SYSTEM IS ALSO COMPUTER COMPATIBLE BY PROPER DATA COLLECTIONAND ANALYSIS. THIS SYSTEM WILL BE A GREAT BOON IN HELPING QUICKER AND MORE SPECIFICTREATMENT SCHEDULES. Prof.K.JAGANNATHAN M.D.,D.T.M.,F.R.C.P.,F.A.M.S Former Head and Prof. of Neurology Madras Medical College and Govt.Gen.Hospital Chennai,Tamilnadu, India
  10. 10. EXAMINATION OF CONSCIOUSNESS(COMA)GLASGOW COMA SCALE RANCHO LOS AMIGOSEYE OPENING COGNITIVE SCALE SPONTANEOUS 4 TO LOUD VOICE 3 NO RESPONSE 1 TO PAIN 2 GENERALIZED RESPONSE 2 NIL 1 LOCALIZED RESPONSE 3VERBAL RESPONSE CONFUSED/AGITATED 4 ORIENTED 5 CONFUSED- NOT APPROPRIATE 5 CONFUSED,DISORIENTED 4 CONFUSED-APPROPRIATE 6 INAPPROPRIATE WORDS 3 INCOMPREHENSIBLE SOUNDS 2 AUTOMATIC-APPROPRIATE 7 NIL 1 PURPOSEFUL-APPROPRIATE 8MOTOR RESPONSE OBEYS 6 LOCALIZES 5 WITHDRAWS(FLEXION) 4 ABNORMAL FLEXIONPOSTURE 3 EXTENSION POSTURE 2 NIL 1
  11. 11. LEFT RIGHTHEMISPHERE HEMISPHERE (VERBAL) (VISUAL) ARTISTIC ANALYSISDEDUCTION CREATIVE FACTS HOLISTIC LOGICAL INTUITION ORDER IDEASMATHEMATIC IMAGINATION PRACTICAL SPATIAL
  12. 12. THREE FUNCTIONSCOGNITION -- Perception & ThinkingCONATION -- MovementAFFECT -- Motor expression of Emotions
  13. 13. EXAMINATION OF COGNITIVE DECLINE-DEMENTIA IDEAL BED SIDE MMSE RESEARCH ICD-10 DSM-IV NINCDSADRDA ADDTC-VASCULAR DEMENTIA
  14. 14. CONATION –MOVEMENT SECOND FUNCTION OF BRAIN WHAT ARE THE MOVEMENTS? IDENTIFY THE OVERALL SYNDROME. DECIDE THE DISEASE.
  15. 15. AFFECT- MOTOR EXPRESSION OF EMOTIONS THIRD FUNCTION OF BRAINEXAMINATION OBJECTIVE MEASUREMENT DIFFICULT, SUBJECTIVE SCALES ARE AVAILABLE NORMAL EMOTION EMOTIONAL LABILITY EMOTIONAL INCONGRUITY
  16. 16. FOURLOBES OF CEREBRUMANDFOUR VENTRICLES
  17. 17. EXAMINATION OF HIGHER FUNCTIONS AND LOBAR FUNCTIONSHIGHER FUNCTIONS TRADITIONALFRONTAL LOBE EXECUTIVE FUNCTION EMOTIONAL RESPONSE SOCIAL BEHAVIOURPARIETAL LOBE CALCULATION STEREOGNOSIS SPATIAL ORIENTATION
  18. 18. TEMPORAL LOBE AUDITORY PERCEPTION MUSIC TONE SEQUENCES OLFACTION SPEECHOCCIPITAL LOBE VISION
  19. 19. FIVE SPECIAL SENSESSMELLVISION TRADITIONALHEARINGTASTETOUCH
  20. 20. UPPER MOTOR NEURON SIX FUNCTIONAL SYSTEMS OF THE BRAIN (ABOVE FORAMEN MAGNUM)1. Basal ganglia – Programmer2. Cerebellum – Computer TRADITIONAL SPINOMOTOR3. Cerebral hemisphere & SYSTEM connections - effector system4. Sensory System5. Autonomic nervous system – flight or fight6. Limbic system - Holistic integrator of all
  21. 21. BASAL GANGLIA-INVOLUNTARY MOVEMENTSPLENTY OF MOVEMENTS PAUCITY OF MOVEMENTS AKINETIC RIGID STATES A THETOSIS B ALLISMUS PARKINSONISM DRUG INDUCED C HOREA IDIOPATHIC D YSTONIA WILSONS DISEASE E SSENTIAL TREMOR PROGRESSIVE SUPRANUCLEAR PALSY F ASCICULATIONS MULTIPLE SYSEM ATROPHY M YOCLONUS CORTICOBASAL DEGENERATION HUNTINGTONS -JUVENILE VARIANT NIEMMAN-PICK DISEASE TYPE C
  22. 22. CEREBELLUM-(computer)FUNCTIONS-COORDINATIONGAIT ANTERIOR LOBETRUNCAL VERMISLIMBS AND LANGUAGE HEMISPHEREEYE MOVEMENTS FLOCCULONODULAR LOBE
  23. 23. SIGNS OF CEREBELLAR DYSFUNCTIONINCOORDINATION OF EYE- NYSTAGMUS HEAD-TITUBATION SPEECH-DYSARTHRIA TRUNK-ATAXIA LIMB-ATAXIA GAIT-ATAXIA WRITING-MACROGRAPHIA
  24. 24. CEREBRAL HEMISPHERES (key board)MOVEMENT - FRONTAL LOBESENSATION -PARIETAL LOBEMEMORYAND HEARING –TEMPORAL LOBEVISION - OCCIPITAL LOBE
  25. 25. FUNCTIONS OF AUTONOMIC NERVOUS SYSTEMSYMPATHETIC PARASYMPATHETIC HEART RATE INCREASED  HEART RATE DECREASED BLOODPRESSURE INCREASED  BLOOD PRESSURE DECREASED INCREASED BLADDER SPHINCTER TONE  VOIDING (DECREASED TONE) DECREASED BOWEL MOTILITY  INCREASED BOWEL MOTILITY BRONCHODILATATION  BRONCHOCONSTRICTION SWEATING  DECREASED SWEATING PUPIL DILATATION  PUPIL CONSTRICTION
  26. 26. SEVEN LOWER MOTOR NEURON SYSTEMS ANTERIORHORN CELL ANTERIOR NERVE ROOT POSTERIOR NERVE ROOT PERIPHERAL NERVE NEUROMUSCULAR JUNCTION MUSCLE INTRACELLULAR ORGANELLES
  27. 27. SPINAL CORD SPASTICITY WEAKNESS FASCICULATIONS EARLY BLADDER AND BOWEL TROPHIC CHANGESANTERIOR NERVE ROOT SEGMENTAL WEAKNESS SEGMENTAL WASTINGPOSTERIOR NERVE ROOT PAIN PARESTHESIA NUMBNESS
  28. 28. LOWER MOTOR NEURON SYSTEMS-CONTD4. PERIPHERAL NERVE BILATERAL DISTAL SYMMETRICAL NUMBNESS AND WEAKNESS WITH WASTING(NEUROPATHIC)5. NEUROMUSCULAR JUNCTION DIURNAL VARIATION WITH FATIGABILITY OF MUSCLES6. MUSCLE BILATERAL SYMMETRICAL PROXIMAL MUSCLE WEAKNESS AND WASTING( MYOPATHIC)7. INTRACELLULAR ORGANELLES MITOCHONDRIA, SARCOGLYCANS
  29. 29. EIGHT-LANGUAGE
  30. 30. DISORDERS OF LANGUAGE ABNORMAL REPITITION  BROCAS APHASIA  WERNICKES APHASIA  GLOBAL APHASIA  CONDUCTION APHASIA
  31. 31. DISORDERS OF LANGUAGE NORMAL REPITITION  TRANSCORTICAL SENSORY  TRANSCORTICAL MOTOR  ANOMIC  ALEXIA
  32. 32. NINE –ETIOLOGIESTHUMB - TUMOR, TOXIN, TRAUMAINDEX FINGER - INFECTIONMIDDLE FINGER- METABOLICDIAMOND FINGER- DEMYELINATION,DEGENERATIONLITTLE FINGER - VASCULAR (LITTLE FLOW/ABSENT FLOW)HAND - HEREDITY AND NUTRITIONAL DISORDERS
  33. 33. TEN PAIRS OF CRANIAL NERVESCRANIAL NERVES III,IV,VI NERVES - OCULAR MOVEMENTS V NERVE - FACIAL SENSATIONS MUSCLES OF MASTICATION VII NERVE - MUSCLES OF FACIAL EXPRESSION SECRETORY FUNCTIONS IX AND X NERVE - PALATAL AND PHARANGEAL MUSCLES XI NERVE - STERNOMASTOID AND TRAPEZIUS XII NERVE - TONGUE MOVEMENTS
  34. 34. MATHEMAGICAL CLINICAL NEUROLOGYONE - CONSCIOUSNESS/MINDTWO - CEREBRAL HEMISPHERESTHREE - FUNCTIONS OF BRAIN COGNITION CONATION AFFECTFOUR - LOBES OF BRAINFIVE - SPECIAL SENSES
  35. 35. SIX - UPPER MOTOR NEURONS SYSTEMS OF BRAINSEVEN - LOWER MOTOR NEURONS SYSTEMS OF BRAINEIGHT - LANGUAGE DISORDERSNINE - GENERAL PRAESENS AND OTHER SYSTEMSTEN - ETIOLOGIES
  36. 36. ACKNOWELDGEMENTSOUR SINCERE THANKS TO THE HEAD OFTHE DEPARTMENT OF NEUROLOGY,DIRECTOR OF INTERNAL MEDICINE OFMADRAS MEDICAL COLLEGE AND ALLTHE FACULTY MEMBERS OF THEDEPARTMENT OF NEUROLOGY ANDMEDICINE

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