Neurology Notes.doc


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Neurology Notes.doc

  1. 1. Acute Transverse Myelitis (Myelopathy) •occurs over days to weeks •ascending parasthesia, back pain, weakness or urinary retention •no gender or age predilection •poor prognosis Toxic Myelopathy •occurs as a result of injection of chemotherapeutic agents into subarachnoid space to treat malignancy Ischemic Myelopathy •loss of blood for less than 30 minutes •occlusion of segmental spinal arteries •sudden onset of paraplegia •accompanying chest or abdominal pain as a “sharp, tearing” sensation Vascular Malformations •uncommon •most common spinal vascular abnormality •paresis, sensory changes, bowel and bladder dysfunction Anterior Spinal Cord Infarction •sudden onset of flaccid para- or quadraparesis •preservation of discriminative touch (dorsal column spared) Central Spinal Cord Syndrome •”cape-like” anesthesia •destruction of pain fibers as they cross in the ant. white commissure •”Man in a Barrel” sign -greater weakness in upper extremity vs. lower extremity •common cause is a whiplash injury Posterior Cord Syndrome •occurs with Vit B12 deficiency •affects dorsal columsn and corticospinal tracts •general weakness, “pins and needles” parasthesias of hands and feet Multiple Sclerosis •disease onset between 15-50 yrs (rare after 40) •female predominance •autoimmune disease against CNS myelin •extremity weakness, numbness, Babinsky sign, Lhermitte’s Phenomenon Brown-Sequard Syndrome •hemisection lesion of the spinal cord •ipsilateral spastic weakness below lesion level •ipsilateral loss of dorsal column below level •contralateral loss of spinothalamic tract •lesions at C8-T1 affect ciliospinal center of Budge – result in Horner’s Syndrome Conus Medullaris Syndrome •involves lower sacral-coccygeal cord segments •caused by tumor metastase or hemorrhagic infarcts •destruction of parasympathetics causes paralytic bladder and fecal incontinence •”saddle anesthesia” with absence of motor deficits in lower extremities
  2. 2. Cauda Equina Syndrome •involves spinal roots of lower lumber-coccygeal region •deficits similar to conus medullaris syndrome Syringomyelia •central cavitation of the spinal cord •damages decussating spinothalamic fibers •a CSF dissection thru the ependymal lining to form a paracentral cavity •”cape-like” loss of pain and temp over shoulders •muscular atrophy and weakness with decreased myotatic reflexes in UE Hydromyelia •an ependymal line distension of the central canal of the cord •same symptoms as syringomyelia Spondylosis •osteophytic bony spurs and disc bulges •stiffness, pain, radicular signs Neoplasms •epidural location most common •often metastatic in origin: prostate, breast, lung, etc. •common occurrence in thoracic cord •pain worse at night and in a recumbent position that increase with cough or a Valsalva maneuver Epidural Abcess •hematogenous spread of bacteria to reside above dura •fever, spine pain with focal tenderness to palpation Foster-Kennedy Syndrome •ipsilateral anosmia, optic atrophy and contralateral papilledema •result of a mass lesion like a meningioma -compresses the olfactory tract and optic nerve Wilbrand’s Knee •lesion at the junction of the optic nerve and the chiasm on one side •loss of ipsilateral temporal and nasal retinal fibers and contralateral loss of inferonasal retinal fivers •results in ipsilateral blindness and contralateral upper visual field loss •JUNCTIONAL SCOTOMA Adies Syndrome •tonically dilated pupil •secondary to damage to ciliary ganglion or short ciliary nerves •predominantly young females Holmes-Adies Syndrome •all symptoms of Adies syndrome •absent DTR’s Argyle-Robertson Pupil •small, irregularly shaped pupil •lack of constriction to direct light •will constrict upon accommodation-convergence reaction •associated with syphilis
  3. 3. Marcus-Gunn Pupil •afferent papillary defect •pupil on affected side will paradoxically dilate upon direct light •”swinging flashlight test” •common in demyelinating diseases Medial Longitudinal Fasciculus Syndrome •damage to one or more MLF between abducens and oculomotor nuclei •medial rectus palsy on side of lesion •effort horizontal nystagmus on contralateral eye One and a Half Syndrome of Fisher •frozen globe on the lesion side •effort nystagmus of the opposite eye •abducens nucleus lesion with ipsilateral MLF lesion Transtentorial Herniation •increased supratentorial pressure due to a mass lesion •oculomotor nerve crushed •parasympathetic innervation lost •dilated pupil Bielchowsky Sign •4th nerve palsy •patient presents with head tilted to opposite side of lesion - superior oblique lost therefore loss of intorsion Trigeminal Neuralgia (Tic douloureuz) •recurrent sharp, stabbing facial pain •one or more divisions of trigeminal nerve Herpes Zoster Opthalmicus •viral infection affecting the V1 distribution Raeder’s Paratrigeminal Syndrome •secondary to lesion of trigeminal ganglion •loss of sympathetic fibers •Horner’s like symptoms Numb Chin Syndrome •V3 distribution of numbness •associated with metastatic cancer Mobius Syndrome •congenital absence of both facial nuclei •also absence of abducens nuclei •crossed eyes •upper and lower facial palsy Central Facial Palsey •upper motor neuron lesion •contralateral paresis of lower portion of face Peripheral Facial Palsey •lower motor neuron lesion •Bell’s Palsy •paresis of upper and lower ipsilateral face
  4. 4. Hyperacusis •increased, painful acuity to sounds •due to stapedius muscle weakness Crocodile Tears Syndrome •destruction of facial nerve proximal to geniculate ganglion •preganglionic salivatory fibers regenerate •misdirected fibers to pterygopalatine ganglion •lacrimation while eating Conduction Hearing Loss •caused by interruption of the passage of sound waves thru the external or middle ear •due to: ear wax, otosclerosis, or otitis media Sensori-neural Hearing Loss •secondary to disease of the cochlea, nerve, or central auditory connections •may be from ototoxic drugs Acoustic Neuroma •a schwannoma associated with: •vertigo, nausea, hearing loss, tinnitus, nystagmus Ramsey Hun Syndrome •herpes zoster oticus Glossopharyngeal Neuralgia •extreme pain in pharynx •swallowing difficult