Professional Documents
Culture Documents
Clinical Neurology
Mohamed Abdelhalim
Main topics
Back pain Spinal cord injury Motor neurone lesions Peripheral neuropathy Head injury Assessment of conscious level
Back Pain
3 categories
Serious pathology (tumour or infection)
1-2%
Disc prolapse
5%
And especially
Incontinence Gait disturbance Saddle anaesthesia
Cauda equina syndrome!!
Disc prolapse
Unilateral leg pain radiating to foot Numbness and tingling in same distribution Localised symptoms/signs Straight leg raise
Disc prolapse
Refer soon
Questions to ask!
Is there leg weakness? Is there sensory involvement? Is there a motor and sensory level? Is there bowel and bladder involvement?
Presentation
Depends on the level of the lesion
Levels to remember
C3, 4, 5 keep the diaphragm alive C3-T1 arms T4 nipple line T10 umbilicus L1-S3 legs
Spinal Shock
Areflexia Hyperreflexia
3 days
Flaccidity Spasticity
A definition
A phase beginning immediately after a spinal cord injury during which all functions of the distal segment of spinal cord are depressed
Spinal shock
Conscious inhibition
L1 L2 L3 L4 L5 S1 S2 S3 S4 S5
Conscious inhibition
L1 L2 L3 L4 L5 S1 S2 S3 S4 S5
Automatic bladder
Conscious inhibition
L1 L2 L3 L4 L5 S1 S2 S3 S4 S5
Lumbar injury
Brain
C T
Neurogenic bladder
Conscious inhibition
L1 L2 L3 L4 L5 S1 S2 S3 S4 S5
X +
Sacral injury
Brain
C T
Conscious inhibition
L1 L2 L3 L4 L5 S1 S2 S3 S4 S5
+ X
Brain
Upper motor neurone Lower motor neurone
Medulla
Spinal Cord
Fasciculations No
Peripheral Neuropathy
Mononeuropathies
Mononeuropathy
Multiple mononeuropathy
Polyneuropathy
Mechanisms
Demyelination Axonal degeneration Wallerian degeneration Infarction
Common causes
Diabetes
Infarction Alterations in polyol pathway cause accumulation of fructose & sucrose in Schwann cells
Alcohol
Toxic to nerves
Other causes
Autoimmune (RA, SLE) Infection (HIV) Hypothyroidism Kidney disease Vitamin deficiencies
Head Injury
Classification
Primary
Local contusions Shearing of axons
Secondary
Bleeding
Dura Dura
Extradural
Subdural
Intracerebral bleed
Intracranial pressure
Critical volume
Midline shift
Herniation
Tonsillar herniation
High ICP
Low BP
Hypoxia
Cerebral Ischaemia
Ca2+ influx
Below 8 = ventilate
Why do we use it?
Questions?
ma.abdelhalim@gmail.com
Fasciculations No
Bleeding
Dura Dura
Extradural haematoma
Subdural haematoma
Peripheral neuropathy
Mononeuropathy
Multiple mononeuropathy
Polyneuropathy