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Lecture 42 March 23rd-Nervous

Lecture 42 March 23rd-Nervous

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1DDX: LECTURE 42 \u2013 MARCH 23rd, 2007
CONDITIONS OF THE NERVOUS SYSTEM
Page 1
CEREBRAL PALSY
\u2022
\u201cPalsy\u201d: damaged, something is wrong with it. It is an old word.
\u2022
Applied to a group of congenital nervous system disorders.
\u2022
Christy Brown in \u201cMy Left Foot\u201d (1989) had CP
\u2022
Main indications in baby is movement. Kids usually have \u201ccat\u201d response: will move body to protect selves in case they
fall. CP kids don\u2019t have this response. This is a brain response, not spinal cord.
\u2022
Pathology is in BRAIN, not in spinal cord
\u2022
Spastic paralysis: they have nerves going to all systems, but they have an inability to response. Could be
bulbar/cerebellar/cerebral centre that is responsible.
\u2022
Spastic: usually cerebral pathology.
\u2022
Flaccid: usually peripheral pathology
\u2022
They have speech impairments: can make sounds, but hard to understand without spending time with them.
\u2022
Intellectual deficits .
Etiology
In notes, in order of most likely to least likely.
Brain injury: not likely because we see this in all types of delivery.

Picture above: examples of movements that you might see in CP.
Teach them the way that you would teach any other child: may just take them a little longer.
On autopsy, the source of the pathology is not visible in the brain.

STROKE
\u2022
Can be caused by atherosclerotic plaque, air embolus, injected substance\u2026
\u2022
Air: would need 60-100 mL of air to block an artery. Less than this: it would just dissolve in blood.
\u2022
Blood exchanges nutrients/oxygen with brain tissue via CSF.
\u2022
Rapidly evolving symptoms, can be focal or global.
\u2022
DDX ischemia: symptoms won\u2019t last >24 hours; stroke is permanent, TIA is reversible. You do recoverso me function
in stroke\u2026
\u2022
Stroke: in brain, always looks triangular due to pattern of blood flow (\u201cflowers\u201d). Area that is not perfused will die.
\u2022

Lacunes: can form from chronic hypertension. A unique type of infarct that is associated with hypertension. These
happen in the pons: which is a commissure. Connections between different parts of the brain. Associated with cranial
nerves: get focal movement problems. Spastic paralysis in one area\u2026 Usually the other side of the brain can
compensate for some amount of damage.

\u2022
CTs are generally \u201cmessy\u201d in early strokes, MRIs easier to read. Looking for areas of varying density, liquification, on
CT.
DDX LECTURE 42, MARCH 23rd, 2007 \u2013 PAGE 1

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