Professional Documents
Culture Documents
Neuro
Neuro
over the visual field, the mcc is retinal ischemia due to carotid atherosclerotic emboli so duplex US of
the neck.
MMSE score <24 dementia, lack of insight into the condition, CT in early Alzheimer is normal, cortical &
subcortical atrophy is seen in later stage, atrophy is prominent in parietal & temporal lobes, particularly
hippocampi. Progression over period of years, no incontinence.
Cholinesterase inhibitors improve quality of life & cognitive functions (memory, language, reasoning).
DX: MMSE, crieria: 2 or more areas of cognitive deficits, worsening memory & other cognitive function,
no disturbance of consciousness, age>60, absence of other disorder.
NPH: abnormal gait (the most prominent clinical feature & early), dementia & urinary incontinence
Multi-infarct dementia: 20%, cognitive, motor & sensory dysfunction. Sudden with a stepwise
deteroration of memory after each attack.
Dementia with lewy bodies: parkinsonism, dementia, visual hallucinations. Visuospatial dysfunction
occurs early, & memory deficits later.
BPPV: calcium crystals within semicircular canals, brief, recurrent episodes as feeling of the room
spinning/vertigo sensation when turning the head to one direction or looking up, nystagmus, nausea.
Semicircular canal dysfunction. Dix-Hallpike maneuver: vertigo and nystagmus are triggered as the
patient quickly lies back into a supine position with the head rotated 45 degrees. BPPV resolves
spontaneously in most cases but can recur months or years later. Symptoms can be relieved
with the canalith repositioning maneuver (Epley maneuver).
Meniere disease: excess end lymphatic fluid pressure in the inner ear, triad of episodic dizziness, low-
frequency hearing loss & tinnitus, also vertigo that lasts days, nausea, horizontal nyztagmus during the
episode.
Ototoxicity: damage to cochlear cell so hearing loss; Vestibuopathy: damage to sensitive hair cells in the
inner ear, both vestibular end organs are equally affected so not vertigo, neither left or fight imbalance,
oscillopsia ( sensation of objects moving around in the visual field when looking any direction), the
deficient vestibule-ocular reflex lead to gait disturbance, abnormal head thrust (patients are unable to
maintain their eyes on the target, the eyes move away and then return back with a horizontal saccadeg)
** Descending first face, upper limbs, trunk and ultimately lower limbs.
DX requires CT guided aspiration or surgical biopsy to obtain tissue for gram stain & culture (bacterial,
fungal, mycobacterial). TX: IV mtz, ceftriaxone & vancomycin.
Tabes, walking with the legs wide apart, the feet are lifted higher than
usual, make a slapping sound when they come in cntact with the floor,
romberg’s sign (+).
Conus medularis: part of spinal cord (both upper & lower MN)