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Lecture 43 March 28th-Nervous

Lecture 43 March 28th-Nervous

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1DDX: LECTURE 43 \u2013 MARCH 28th, 2007
DDX feature of subarachnoid hemorrhage: pain does not go away. This is a headache telling you that there is bleeding
somewhere: it is trying to tell you something.
Result of severe head trauma that destroys part of the brain. Not usually something you need to DDX: trauma will be
Symptoms will depend on the part of the brain that is affected. Can be fatal, or full recovery is possible.
On CT: the hemorrhage is white in colour. Looks like bone.
Nerves can stretch, withstand some shearing force, don\u2019t like compression, and cuts easily.
Transection: can cut cord, or lose part of it: will have different symptoms.
There is redundancy in our \u201cwiring\u201d to protect from injury

In case of overextension of neck, chin, will always injure the part that is being stretched. Injuries that will cause this: whiplash (improperly positioned head rest in car accident). If head goes back, anterior part of cord will be stretched, and posterior will be compressed.

Flexion injury (example given was hanging!): stretch posterior aspect, compression of anterior. Cause of death in
hanging is shearing force applied to C1-C0.
Transection: motor vehicle accident, surgical mistakes, space-occupying lesions. If you survive this, there is
permanent disability. Loss of autonomic functions.
Presentation of pathologies that are clinically relevant.
The history is about 80% of the case: helps you find out where damage is.
Upper motor neurons: injury to these causes spastic paralysis. \u201cUpper\u201d is above decussation (where the neuron
crosses the spinal cord.) This happens in an area, around mid-brain (above and below this too). Reflexes still work.
Injury to lower motor neuron: no reflexes, flaccid paralysis.
Look at injury and see if it is unilateral or bilateral.
Severed half of spinal cord.
Can trace the areas of sensory deficit on their skin.
Clean-cut vs. slanted cut: pattern to loss of sensation.
See functions of tracts in notes.
Cut to the \u201cmiddle\u201d of the spinal cord, but a partial cut may have the same effect as a cut to the absolute centre of
Patient can still feel crude touch, but not pain. Can tell that they are being touched, but can\u2019t determine what it is,
Several patterns: LMN pattern.
Lesion: would be weakness in hands, not in legs. Nothing is cut, they still have movement, but weakness. Something
is being bothered, but function is not lost completely. Hands and legs? Lesion may be higher up.
Radicular disease: refers to anything happening at the nerve root.
Can be from inflammation: deposit of calcium, narrowing of foramena.
Narrowed foramena where spinal roots pass. Can tolerate some narrowing.
Look at the symptoms to see where the problem is. See chart in notes. Causes weakness, not absence.
C5 is one of nerve roots that affects abduction of shoulder. Other nerve roots have the same function, but this is the
main one. If it is non-functional, you will see a change in function.
Your treatment plan would change based on whether this is a nerve root or a peripheral nerve. Is it inflammation? Are
there calcium deposits? Or is it transient? (treat it as a wound, acute). Would change your TCM diagnosis,
DDX LECTURE 43, MARCH 28th, 2007 \u2013 PAGE 1
homeopathic treatment.

Re: dermatome chart: there is always overlap between these areas. When you identify an area as \u201cL3\u201d, this is the
nerve that dominates it, but L2 and L4 probably have some function here. Muscles don\u2019t have this kind of overlap (not
as much).

Peripheral nerves are made of more than one root. Cut these nerves, you lose all of their function. Complete loss.
Read the rest of this page, but chart and \u201cmyelopathy due to mass lesions\u201d not covered in class. We are still
responsible for it, but he is highlighting the most important sections.

What is a \u201cserious\u201d headache? ALARM SIGNS: One that won\u2019t go away. One that is recurrent that is now happening
more frequently, with more intensity, longer duration. Loss of vision, flashes of light. Crescendo: headache that
keeps getting worse, worse worse, then gives you a break. (Like an obstruction colic in the head). Meds have
stopped working that used to work. Headaches that wake someone up at night (sleep usually relieves headaches),
signs of meningial inflammation.

(A \u201cworst_______ ever!\u201d should always get your attention)
If you get a headache every day at the same time, for the same length of time, it is probably something in your
environment that you are reacting to.
Most headaches are benign. If you get the flags above, there is a much more serious underlying cause: no
See list of \u201cfactoids and red flags\u201d
\u201cpalpatory tenderness over temples\u201d: You touch their temples and they feel pain. This may be Giant cell arteritis,
exists with other AI conditions. Sudden loss of vision (usually comes back after first attack).
See chart of differentiation between migraine, tension, cluster headaches.
Rigor: children that have seizures. Not related to epilepsy
Seizures in children are NOT a sign that the body isn\u2019t doing well. Children may just have a slightly higher incidence
of epilepsy.
Doesn\u2019t mean that you don\u2019t need to address it. Is there an underlying cause? Dehydration, electrolyte imbalance\u2026
Can measure electrical activity during seizure. Electro-chemical, magnetic event.
Hypoxia: can get seizures from this. Pass out and have seizures while regaining consciousness.
Storage diseases: make you more susceptible to seizures.
Epilepsy is a diagnosis of exclusion
Consciousness never impaired.
This can be epilepsy, OR this can be a sign of a space-occupying lesion. Have to rule out focal neurological disease.

Same as above, but with loss of consciousness.
Happens in a paroxym, then it goes away.
Don\u2019t restrain in seizures, they won\u2019t swallow tongue (may bite it, but will bite your finger too if you try to pull it out)

Loss of awareness, not consciousness. Looks like they are purposely ignoring you! Can happen up to 100x / day
Postictal state: they want to retreat and heal.
DDX LECTURE 43, MARCH 28th, 2007 \u2013 PAGE 2

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