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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
CONDITIONS OF THE NERVOUS SYSTEM
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.
INTRACEREBRAL HEMATOMA
\u2022
Result of severe head trauma that destroys part of the brain. Not usually something you need to DDX: trauma will be
obvious.
\u2022
Symptoms will depend on the part of the brain that is affected. Can be fatal, or full recovery is possible.
\u2022
On CT: the hemorrhage is white in colour. Looks like bone.
SPINAL CORD INJURY
\u2022
Nerves can stretch, withstand some shearing force, don\u2019t like compression, and cuts easily.
\u2022
Transection: can cut cord, or lose part of it: will have different symptoms.
\u2022
There is redundancy in our \u201cwiring\u201d to protect from injury
\u2022

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.

\u2022
Flexion injury (example given was hanging!): stretch posterior aspect, compression of anterior. Cause of death in
hanging is shearing force applied to C1-C0.
\u2022
Transection: motor vehicle accident, surgical mistakes, space-occupying lesions. If you survive this, there is
permanent disability. Loss of autonomic functions.
CORD SYNDROMES
\u2022
Presentation of pathologies that are clinically relevant.
\u2022
The history is about 80% of the case: helps you find out where damage is.
\u2022
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.
\u2022
Injury to lower motor neuron: no reflexes, flaccid paralysis.
\u2022
Look at injury and see if it is unilateral or bilateral.
BROWN-SEQUARD\u2019S SYNDROME
\u2022
Severed half of spinal cord.
\u2022
Can trace the areas of sensory deficit on their skin.
\u2022
Clean-cut vs. slanted cut: pattern to loss of sensation.
\u2022
See functions of tracts in notes.
\u2022
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
cord.
\u2022
Patient can still feel crude touch, but not pain. Can tell that they are being touched, but can\u2019t determine what it is,
quality.
CENTRAL CORD SYNDROME
\u2022
Several patterns: LMN pattern.
\u2022
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.
\u2022
Radicular disease: refers to anything happening at the nerve root.
\u2022
Can be from inflammation: deposit of calcium, narrowing of foramena.
\u2022
Narrowed foramena where spinal roots pass. Can tolerate some narrowing.
\u2022
Look at the symptoms to see where the problem is. See chart in notes. Causes weakness, not absence.
\u2022
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.
\u2022
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.
\u2022

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).

\u2022
Peripheral nerves are made of more than one root. Cut these nerves, you lose all of their function. Complete loss.
\u2022
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.
HEADACHES
\u2022

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.

\u2022
(A \u201cworst_______ ever!\u201d should always get your attention)
\u2022
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.
\u2022
Most headaches are benign. If you get the flags above, there is a much more serious underlying cause: no
watching/waiting.
See list of \u201cfactoids and red flags\u201d
\u2022
\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.
SEIZURES
\u2022
Rigor: children that have seizures. Not related to epilepsy
\u2022
Seizures in children are NOT a sign that the body isn\u2019t doing well. Children may just have a slightly higher incidence
of epilepsy.
\u2022
Doesn\u2019t mean that you don\u2019t need to address it. Is there an underlying cause? Dehydration, electrolyte imbalance\u2026
ETIOLOGY OF EPILEPSY
\u2022
Can measure electrical activity during seizure. Electro-chemical, magnetic event.
\u2022
Hypoxia: can get seizures from this. Pass out and have seizures while regaining consciousness.
\u2022
Storage diseases: make you more susceptible to seizures.
\u2022
Epilepsy is a diagnosis of exclusion
THE NEXT 6 ARE ALL DIFFERENT TYPES OF EPILEPTIC SEIZURE
SIMPLE PARTIAL SEIZURE
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.
COMPLETE PARTIAL SEIZURE

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)

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

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