Neurology Dr.

Shaf3y

neurology

2014 11 7

blood supply of the brain

Blood supply of the brain
anatomy

areas of the brain

frontal lobe
Motor area ( area 4), premotor area ( area 6 ), area of voluntary conjugate eye movement ( area 8),
Broca's area ( area 44), Exner's area ( area 45), prefrontal area and paracenteral lobule

parietal lobe
Cortical sensory area (areas 1,2 and 3), angular Gyrus ( area 39) and supramarginal gyrus ( area 37)

temporal lobe
Auditory sensory area (area 41 and 42), auditory associative area (area 22) and limbic system

occipital lobe
Visual sensory area (area 17) and visual associative
area ( area 18 and 19)

internal capsule
fibers internal capsule
genu Posterior limb anterior limb

Internal capsule
dorsal ventral

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 Neurology Dr. Shaf3y

pyramidal fibers genu fibers

anterior limb fibers

area 37 fibers of association

vision optic radiation

sensation fibers
hearing fibers

two arteries brain blood supply

Internal carotid artery carotid artery

common carotid artery aorta

common carotid artery
External carotid artery 
internal carotid artery 
thyroid Upper border

supply neck internal carotid

carotid foramen << foramen skull
carotid canal

cavernous sinus carotid canal

branches cavernous sinus

two terminal branches cavernous sinus

middle cerebral artery 
anterior cerebral artery 

bifurcation of common carotid artery internal carotid artery

branches neck
carotid canal carotid foramen skull
cavernous sinus carotid canal
branches cavernous sinus
ophthalmic 
C.S.F. choroid plexus supply anterior choroidal 
posterior communicating artery 

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 Neurology Dr. Shaf3y

middle cerebral artery

One of the two terminal branches internal carotid artery
branches Middle cerebral artery
cortex supply Cortical 
internal capsule supply Capsular 

cortical middle cerebral artery branch

frontal branch
frontal lobe supply
Motor speech area Lower part of the motor area
Medial surface lower limb except lower limb << area 4
area 6, 8 , 44 , 45

branch
Infarction
lower limb area 4
Upper limb head and neck paralysis
faciobrachial monoplegia

Area 6
hyperreflexia hypertonia

Area 8
paralysis of conjugate eye movement to the opposite side

Area 44
expressive aphasia

Area 45
agraphia

parietal lobe branch

lower part of the sensory area, the angular and supramarginal and the parietal lobe
upper fibers of the optic radiation
except lower limb area 1, 2 and 3
area 37, 39

branch

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Neurology Dr. Shaf3y

Upper limb head and neck Cortical sensory loss

apraxia alexia

temporal lobe branch

auditory areas and the lower fibers of the optic radiation supply
temporal lobe
area 41, 42 and 22 uncus

branch branch
bilaterally represented << smell << Uncus

loss of hearing
hear is bilaterally represented

auditory agnosia

brain tumors optic radiation fibers

supply << Parietal lobe fibers
supply << temporal lobe fibers

Parietal lobe infarction

Lower quadrant

temporal lobe infarction

upper quadrant


capsular branch
Lenticulo-striate Artery
embolism artery hemorrhage artery

supply
dorsal half of the internal capsule

pyramidal fibers supply

sensory hearing vision association fibers

branch
hemipelgia << pyramidal

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 Neurology Dr. Shaf3y

apraxia << association fibers

contralateral homonymous hemianopia << vision fibers
Optic radiation fibers

hearing

hearing is bilaterally represented

sensory
Hemianesthesia

middle cerebral artery

areas sensory Motor
capsular hemiplegia << motor
frontal branch of cortical faciobrachial monoplegia
hemiplegia <<

affecting upper limb more than lower limb

Upper limb

sensation
Hemianesthesia

Hemianesthesia with cortical sensory loss in head, neck and upper limb

superficial and deep Hemianesthesia

cortical

Hemianesthesia with cortical sensory loss in head, neck and upper limb
lower limb cortical sensation
deep superficial Lower limb

areas
agraphia expressive aphasia Paralysis in conjugate eye movement
auditory agnosia apraxia Alexia

middle cerebral artery

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 Neurology Dr. Shaf3y

Occlusion
Main artery capsular cortical
capsular cortical main

middle cerebral artery

Internal carotid artery branch

anterior cerebral artery
middle cerebral artery supply

frontal lobe
Prefrontal area lower limb

parietal lobe
sensory Lower limb

temporal lobe

anterior cerebral artery

Middle cerebral artery supply

Lower limb sensory Lower limb motor

medial surface

area of urinary bladder

anterior cerebral artery artery

corpus callosum
prefrontal area branch lower limb sensory branch lower limb motor
corpus callosum urinary bladder

anterior cerebral artery

cortical branches
mentality, personality and behavior changes
reappearance of primitive reflexes
loss of cortical sensation in lower limb Lower limb Monoplegia

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 Neurology Dr. Shaf3y

Incontinence
two cerebral hemispheres Corpus callosum And finally
apraxia << coordination

capsular branch anterior cerebral artery

Heubner's artery capsular branch

artery
Anterior cerebral artery

capsular branch
Heubner's artery

anterior limb of the internal capsule << ventral part supply << anterior cerebral
<< dorsal part of the internal capsule

fibers supply
head, neck and upper limb pyramidal association

branch
apraxia faciobrachial monoplegia

anterior cerebral artery

Motor
cortical branch Lower limb
capsular branch head and neck upper limb
hemiplegia <<

sensation
Loss of cortical sensation in lower limb

areas
Mentality, personality and behavior changes
apraxia urinary incontinence
anatomy blood supply anatomy

anterior cerebral artery

middle cerebral artery

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 Neurology Dr. Shaf3y

internal carotid artery

etiology
The most common cause for internal carotid artery occlusion is thrombosis on top of atherosclerosis
etiology

clinical pictures
atherosclerosis is more common in males male
diabetic and hypertensive Old age
atherosclerosis risk factors

internal carotid artery

motor
Hemipelgia

sensory
Hemianesthesia

areas
auditory agnosia apraxia alexia agraphia Expressive aphasia

blindness
ophthalmic branch

manifestations
areas sensory hemianesthesia Motor hemiplegia
blindness in one eye

transient manifestations
blindness hemianesthesia hemiplegia
transient ischemic attack

pulsation of the internal carotid artery

Internal carotid artery pulsation

common carotid artery 
anterior border of the sternomastoid below the upper border of the thyroid cartilage

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 Neurology Dr. Shaf3y

external carotid artery Level of thyroid cartilage 

neck Internal carotid artery 

tonsillar fossa

vascular
Pulsation

investigations
MRA Duplex
coagulation profile blood glucose serum cholesterol

treatment
thrombotic hemiplegia
symptomatic physiotherapy anti coagulant TPA
squeeze itself << RBCs  general measures

Internal carotid artery occlusion Middle cerebral artery

brain artery
vertebrobasilar artery
brain supply system vertebrobasilar artery


vertebrobasilar system
subclavian artery aorta

subclavian arteries
vertebral << branch

vertebral
neck
cervical vertebrae transverse process
foramen magnum

foramen magnum
subclavian arteries

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 Neurology Dr. Shaf3y

basilar artery artery

Pons Upper border brain stem basilar artery

posterior cerebral arteries two terminal branches

vertebral arteries two subclavian arteries

cervical vertebrae transverse process
basilar artery foramen magnum
two posterior cerebral arteries
upper border of pons

brain stem branches brain stem

paramedian arteries

cerebellum
superior, middle and inferior cerebellar arteries << cerebellum

Posterior cerebral artery branch

vertebrobasilar two terminal branches

cortex Posterior cerebral artery

area 17, 18 and 19 occipital lobe

cortical branch
contralateral homonymous hemianopia with macular sparing
vascular

capsular branch
Thalamogeniculate artery

posterior cerebral artery branch thalamogeniculate artery

basal ganglion thalamus <<

Internal capsule ventral posterior limb posterior cerebral

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 Neurology Dr. Shaf3y

branch
blood supply

basal ganglion thalamus

infarction thalamus
followed by loss of all types of sensation pain

basal ganglion
extra pyramidal manifestation

Posterior cerebral artery

branches
paramedian
paramedian supply
brain stem

brain stem paramedian branches

syndromes
Jackson Avellis Foville Millard Gubler Benedict Weber
already

cerebellar branches
superior, middle and inferior cerebellar arteries

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 Neurology Dr. Shaf3y

 




target


Posterior cerebral artery
syndromes paramedian branches

cerebellar branches
inferior Middle superior
middle superior
inferior cerebellar artery occlusion

inferior cerebellar artery

Cerebellum
lateral part of the medulla

cranial nerves medulla

motor

sensory
pain and temperature spinal nucleus
vestibular nucleus
equilibrium

two tracts Lateral part of medulla

lateral lemniscus sympathetic fibers tract

pain and temperature from opposite side sensation lateral lemniscus

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 Neurology Dr. Shaf3y

cerebellum supply lateral part of medulla inferior cerebellar artery

tracts sensory Motor lateral part of medulla

inferior cerebellar artery

cerebellum ataxia

Motor
nasal regurge nasal tone dysarthia dysphagia bulbar 
trapezius sternomastoid 
dysarthia tongue 

Sensory
spinal nucleus face pain and temperature
vestibular vertigo

Sympathetic
Horner syndrome

Lateral lemniscus
opposite side of the body pain and temperature

occlusion of inferior cerebellar artery

Wallenberg syndrome
Lateral medullary syndrome
inferior cerebellar artery Posterior cerebellar artery

Inferior cerebellar artery occlusion

lateral medullary syndrome Wallenberg inferior cerebellar

basilar artery

brain stem infarction basilar artery

respiratory embarrassment quadriplegia

Coma
basilar artery

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 Neurology Dr. Shaf3y

transient << basilar branches

transient ischemic attack T.I.A. manifestations

basilar T.I.A. manifestations

cranial nerves

carotid transient ischemic attack

areas
affection to areas carotid

affect cranial nerves basilar

basilar Transient ischemic attack

cranial nerves
ophthalmopelgia
facial pain
facial paralysis
vertigo
bulbar
reticular formation brain stem syncope

basilar transient ischemic attack

cranial nerves

carotid transient ischemic attack

brain areas

circle of Willis
Circle of Willis
circle of Willis

two posterior cerebral arteries basilar artery

internal carotid arteries

Anterior cerebral and middle cerebral internal carotid
anterior cerebral and middle cerebral


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 Neurology Dr. Shaf3y

anterior cerebral artery

anterior communicating artery
anterior cerebral anterior communicating

posterior communicating artery

cavernous sinus Internal carotid artery
cavernous sinus branches internal carotid artery
posterior communicating artery anterior choroidal artery Ophthalmic artery

posterior communicating artery

internal carotid artery

Posterior communicating artery

Posterior cerebral artery

posterior communicating artery

Internal carotid artery

basilar posterior cerebral artery

circle of Willis

circle of Willis
 carotid

blood basilar

circle of Willis
collapse

Pressure gradient
carotid carotid Pressure

is collapsed << circle of Willis

Old age

atherosclerosis carotid Old age

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 Neurology Dr. Shaf3y

Pressure
circle of Willis

An infarction in old age is smaller than cerebral infarction in young patient

well developed in old age << collateral

maintain blood supply

anatomy brain blood supply

anatomy of the blood supply of the brain

circle of Willis

Middle cerebral artery occlusion

internal carotid artery occlusion

inferior cerebellar artery occlusion

transient ischemic attacks

Transient Ischemic Attacks T.I.A.

definition
It is a neurological deficit of vascular etiology, which is completely reversible within 24 hours

Neurological deficit
neurological manifestations

Of vascular etiology
vascular

Which is completely reversible

completely normal
24

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 Neurology Dr. Shaf3y

concussion

neurological deficit

T.I.A.

vascular etiology traumatic etiology

transient ischemic attack

vascular etiology

48 completely normal hemiplegia branch embolism

transient ischemic attack

reversible ischemic neurological deficit RIND

24 normal T.I.A.
48 normal RIND
time

transient ischemic attack T.I.A.

completely normal neurological deficit
completely normal

etiology
etiology
cholesterol embolism << etiology
embolism detachment atherosclerosis

cerebral vessels spasm

vasculitis

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 Neurology Dr. Shaf3y

polycythemia increase viscosity of the blood

clinical pictures
areas << carotid transient ischemic attack
cranial nerves << basilar transient ischemic attack

investigations
Investigations
atherosclerosis << carotid Duplex
blood glucose serum cholesterol
risk factors

polycythemia CBC
magnetic resonance angiography MRA

vasculitis anti nuclear antibody

treatment
T.I.A.
is preventive << T.I.A.

Is a retrospective diagnosis << T.I.A.

T.I.A. hemiplegia

Normal
TIA Normal TIA
it is a retrospective diagnosis

further attacks aim

further attacks
atherosclerosis
statins anti platelets
diabetes hypertension control

carotid duplex
carotid endarterectomy << TIA carotid 70 % stenosis

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Neurology Dr. Shaf3y

stent

stent results surgery

stent
unfit for surgery
surgery refuse
surgery

lacunar infarction T.I.A.

Lacunar infarction
lacunar infarction
lacunae

Infarction in small branches supplying the brain lacunar infarction

brain infarction small arteries

necrosis Liquefaction infarction

liquefied
lacunae C.S.F.
lacunar infarction

hypertensive
completely normal Old age hypertensive
multiple lacunar infarction MRI CT
hypertensive old age
infarction occlusion of small branches

infarctions
internal capsule Pons basal ganglion thalamus

<< thalamus
Pure sensory manifestations

<< Internal capsule

monoplegia

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 Neurology Dr. Shaf3y

basal ganglion parkinsonism

Just control of hypertension


cerebrovascular stroke
Cerebrovascular stroke
discuss cerebrovascular stroke

definition
It is a neurological deficit of vascular etiology

causes
brain vascular lesion term cerebrovascular stroke

all embolic infarction of the brain thrombosis

cerebral hemorrhage
lacunar infarction
T.I.A.

clinical pictures
occlusion of the main carotid artery T.I.A. clinical pictures clinical pictures
branches main occlusion of the main basilar artery

Investigations
T.I.A. investigations

treatment
T.I.A. treatment
hemorrhage embolism thrombosis treatment
hemiplegia
hemiplegia treatment T.I.A. treatment

cerebrovascular stroke
20 15

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Neurology Dr. Shaf3y

Extra pyramidal
extra pyramidal system
the brain neurology text book

extra pyramidal system

Is the most mysterious system in the CNS

Most mysterious

Neurology

mysterious extra pyramidal text book



Pyramidal fibers extra pyramidal

anterior horn cells

anterior horn cells pyramidal fibers

Muscle contraction

fibers
basal ganglion

islands of grey matter white matter

basal ganglia
lentiform nucleus caudate nucleus

brain
brain

frontal lobe

occipital temporal parietal

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 Neurology Dr. Shaf3y

hypothalamus

thalamus subthalamus

medulla midbrain Pons brain stem

cerebellum cerebellum

fibers
Origin

Origin
tract
Pyramidal

rubrospinal olivospinal tract reticulospinal tract

fibers

function
function extra pyramidal


emotion expression function

extra pyramidal parkinsonism

monotonous speech masked face
emotion expression

extra pyramidal chorea

exaggerated emotion expression
sudden cry sudden laugh

emotions extra pyramidal tract

exaggerated emotion extra pyramidal tract

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 Neurology Dr. Shaf3y

function
function
Inhibition of tone

rigidity tone extra pyramidal parkinsonism

cogwheel Lead pipe

Hypotonia extra pyramidal chorea

inhibition of static movement extra pyramidal

static tremors Parkinsonism extra pyramidal

irregular Movement << chorea

static tremors extra pyramidal
Parkinsonism continuous

irregular Movement chorea

attack

function
 function

recent
serotonin dopamine extra pyramidal

manifestations
dopamine parkinsonism
chorea

basal ganglia
disease

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 Neurology Dr. Shaf3y

lesion in extra pyramidal is chemical rather than anatomical lesion

parkinsonism
Parkinsonism
extra pyramidal << lesion Parkinsonism
Which is characterized by static regular rhythmic involuntary movement

static
involuntary movement

Regular and rhythmic

rate

etiology
etiology of parkinsonism
Primary and secondary parkinsonism

Parkinson disease Primary parkinsonism

paper parkinsonism
New England Journal of Medicine 1883

shaking palsy parkinsonism

parkinsonism

primary parkinsonism
Michael J. Fox

Michael J. Fox
back to the future

Back to the future

scientist

Michael J. Fox

baby face Michael J. Fox

28

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Neurology Dr. Shaf3y

40 disease Michael J. Fox

Progressive disease
dementia

Parkinsonism
30

Parkinsonism research
dementia

 Myasthenia neurologist
 parkinsonism
parkinsonism


primary parkinsonism researches

Primary parkinsonism

autopsy primary parkinsonism

substantia nigra basal ganglia
Pale

melanin
melanin degeneration
pale

dopamine degenerate
dopamine Melanin
dopamine

degenerate
electron microscope
Inclusion bodies
Lowe bodies

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 Neurology Dr. Shaf3y

prion bodies
prion
smallest infectious organism

virus Infected agent

Prion virus organism

prion two diseases

Primary parkinsonism 


primary parkinsonism
Michael J. Fox
Connecticut
tremors
parkinsonism stem cells transplant

tremors

primary parkinsonism

secondary parkinsonism
secondary parkinsonism
atherosclerosis
tremors

atherosclerosis

 encephalitis encephalitis

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Neurology Dr. Shaf3y

Repeated head trauma

Atherosclerosis, encephalitis, repeated

head trauma

reserpine << drugs

hypertension

carbon monoxide poisoning manganese poisoning

Lysergic acid diethylamide LSD

LSD

chemical << LSD

the dust of angels

LSD


parkinsonism clinical pictures

extra pyramidal 3
Loss of emotion expression 
Infrequent blinking monotonous speech Masked face

<< emotion stress

infrequent blinking

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 Neurology Dr. Shaf3y

tone 

Lead pipe rigidity rigidity

cogwheel

flexors affect rigidity

flexors affect
Lower limb upper limb flexion of trunck

Gorilla like attitude

ape like attitude

tone
fexors

extension
flexors tone

shuffling gait
flexors tone extension

gravity <<
gravity <<

Lumbar lordosis
Lumbar lordosis

gravity

propulsion

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 Neurology Dr. Shaf3y

forward << Propulsion

backward movement << retropulsion
to correct the centre of gravity

sudden forward or backward to correct the center of gravity and prevent the patient from
falling


tremors
static tremors
rhythmic regular
 pill rolling hand

pure Egyptian modification <<

emotion stress tremors

voluntary movement

ataxia cerebellum

kinetic tremors tremors

kinetic tremors cerebellum

during sleep voluntary movement static tremors parkinsonism
emotion stress

clinical pictures of the underlying cause

clinical pictures of the underlying cause

parkinsonism
encephalitis primary parkinsonism atherosclerosis

Primary parkinsonism
40 Age

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Neurology Dr. Shaf3y

stationary regressive Progressive course

Progressive
dementia

rigidity Tremors

Primary parkinsonism

age atherosclerosis
Old
course
atherosclerosis Progressive

Atherosclerosis

tremors rigidity

brain atherosclerosis
atherosclerosis

encephalitis
age
encephalitis age

course
inflammation Regressive

encephalitis
Equal << E
rigidity tremors

basal ganglia encephalitis

other features

Hypothalamus encephalitis
diabetes insipidus hypersomnia polyphagia

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 Neurology Dr. Shaf3y

 
 diabetes insipidus

excessive sebaceous gland secretions

sialorrhea

Idiot

oculogyric crisis



oculogyric crisis
Sudden vertical deviation of the eye upward

 idiot

Treatment

treatment parkinsonism


dopamine parkinsonism parkinsonism treatment
acetyl choline

dopamine 
acetyl choline 

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Neurology Dr. Shaf3y

dopamine
G.I.T. Oral oral

L.dopa
L. dopa

L.dopa
Dopamine

dose brain

systemic side effects dose

nausea and vomiting Palpitation tachycardia
And even chorea

carbidopa L.dopa

L. Dopa
dopamine L. Dopa carbidopa
L. Dopa

L. Dopa brain

blood brain barrier carbidopa

dopamine L. Dopa

brain dose
systemic side effects
Sinemet

Sinemet
Phenomena Sinemet

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 Neurology Dr. Shaf3y

Sinemet
parkinsonism chorea parkinsonism
on and off phenomena

3 Sinemet
fluctuating level
chorea Level

level
parkinsonism

on and off phenomena

drug level
sustained release Sinemet SR
level

On and off phenomena

dopamine agonist
L. dopa dopamine receptors

drug action Dopamine agonist

Parlodel bromocriptine dopamine agonist
prolactin endocrine

severe nausea and vomiting Parlodel bromocriptine

Piribedil Trivastal dopamine agonist

dopamine agonist dopamine antagonist
squeeze itself RBCs 

Amantadine dopamine agonist

drug Amantadine
virus

parkinsonism 

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Neurology Dr. Shaf3y

 parkinsonism

parkinsonism

 parkinsonism

Ischemic heart disease

coronaries
indication side effects side effects
Iam serious

Cordarone amiodarone
ischemic heart disease anti arrhythmic

actions

Amantadine

surgical treatment
 Egyptian style of thinking

dopamine basal ganglion




dopamine
basal ganglia
thalamotomy and pallidotomy 

basal ganglia

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 Neurology Dr. Shaf3y

thalamotomy and pallidotomy

stereotactic surgery

stereotactic surgery


neurosurgery

Neurosurgery
 9

Neurosurgery

medical engineering

basal ganglion
dopamine basal ganglia stimulation

severe manifestations button

for life

stereotactic surgery

stereotactic surgery by implantation of electric device

near the basal ganglia

Gray's anatomy

Neurosurgery Gray's anatomy

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 Neurology Dr. Shaf3y

Derek Shepherd
Gray's anatomy
tremors machine brain base

fetus supra renal

dopamine Noradrenaline adrenaline Medulla supra renal gland

fetus
Increased intracranial pressure
rejection antigenic presentation

abortion females Parkinsonism

fetus supra renal gland
for ethical issues

trials
supra renal

implantation of fetus supra renal gland

parkinsonism
dopamine

acetyl choline
atropine

Oral parentral << atropine

systemic side effect
Tachycardia, dryness of mouth, retention of urine, blurring of vision

basal ganglia

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Neurology Dr. Shaf3y

selective anti cholinergic drug

Parkinol

Parkinol

Psychic craving

visual hallucinations




side effect

Parkinsonism
chorea extra pyramidal manifestation
Chorea
chorea
extra pyramidal << Lesion

Parkinsonism Static 
parkinsonism Involuntary 
regular and rhythmic parkinsonism Irregular and dysrhythmic 
Pseudopurposive movement 
female chorea
involuntary << chorea female

involuntary movement

etiology
rheumatic fever rheumatic chorea etiology

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Neurology Dr. Shaf3y

chorea

hemiballismus
Huntington's chorea
chorea gravidarum
chorea basal ganglia tumors

rheumatic
rheumatic chorea
Rheumatic fever

5 major criteria chorea

chorea
3 rheumatic attack

3 rheumatic attack
inflammation
normal C reactive protein ESR

3
arthritis chorea arthritis
<< Maximum arthritis

erythema marginatum subcutaneous nodules

chorea
carditis

clinical pictures
extra pyramidal
sudden cry sudden laugh emotion expression
 Normal female

hypotonia tone

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 Neurology Dr. Shaf3y

hypotonia
scaphoid hand

hypotonia
milkmaid grip
milkmaid

When the patient elevates and supinates his arms they deviate downwards and laterally and become pronated

darting tongue
she cannot maintain her tongue protruded without support << darting tongue

Involuntary, sudden, static, irregular and dysrhythmic movement

shoulder abnormal movement of the limb shake hair smack her lips Grimace

Female

Is it abnormal
Chorea is very difficult to diagnose
This is the normal female

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Neurology Dr. Shaf3y

Hemichorea
manifestations

chorea mollis
paralyzed Severe hypotonia
transient paralysis transient paralysis

chorea gravis
Severe involuntary movement
interfere with eating and even talking Involuntary movement

Maniacal chorea
Severe mania
Severe motion stress

treatment
corticosteroid acetyl salicylic acid chorea

Haloperidol
Serenace

<< associated carditis

carditis

rheumatic chorea

Dystonia Athetosis
Athetosis & Dystonia
Athetosis
It is a snake like movement of hand

Dystonia
It is a snake like movement of trunk

involuntary

Snake like movement of the hand and snake like movement of the trunk

dystonia athetosis

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 Neurology Dr. Shaf3y

D.D. of extra pyramidal irregular movements

Feature Chorea Athetosis Dystonia
Movement Rapid, jerky Slow, snake like Very slow, twisting like
pseudopurposive
Site of movement Trunk & extremities Mainly extremities & Mainly in the trunk & if
distal, more than in the extremities
proximal mainly proximal
Tone Hypotonia Hypertonia Hypertonia during
movement and normal
inbetween
Causes Commonly, rheumatic Congenital or post- Familial ( in the
fever encephalitis generalized type )

114
D.D. of static tremors

dystonia athetosis rheumatic chorea

static tremors differential diagnosis

chorea
Huntington's chorea
Huntington's chorea
very famous

abnormality
DNA repeats
box DNA

chorea Huntington's chorea

Prefrontal area
mentality, personality and behavior changes

dementia
heredofamilial

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 Neurology Dr. Shaf3y

Thirteen disease

House MD Thirteen

treatment trial
Huntington's chorea

research

DNA analysis

DNA repeats defect

carrier for the gene Huntington's chorea

genetic disorder
it is very famous

static tremors D.D.

1. Parkinsonism.
2. Senile : occur in old age; they are finer, more rapid than in parkinsonism and are not associated
with rigidity.
3. Essential ( Familial) : occur below the age of 25 years; there may be positive family history. They
remain stationary throughout life; they respond to Propranolol (Inderal).
4. Hysterical : irregular, vary from time to time, associated with other hysterical manifestations.
5. Hyperthyroidism: fine, rapid, seen in the outstretched hands and associated with symptoms
and signs of thyrotoxicosis.
6. Hepatic failure : flapping tremors seen in the outstretched arms; associated with other
symptoms and signs of hepatic failure.
7. Toxic : as in alcohol, mercury and cocaine intoxication.

neurology

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 Neurology Dr. Shaf3y

2014 12 46

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