Neurology

.
 Question
- ~

( Page -920)

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C. Chngh)

t scheoosingpanencephah.tt brain
subacute
dialling
deadly
measles
IA ) .

( progressive
,

/ to
related
disorder
 -
Meningitis -

(930-932)
① Pyogenes Meningitis ? P.ec Das

•
Aetiology -

causative organism
Source of Infection
•
•
Classification -

A.B.C Y , ,
W -
135 and Ñ

• clinical features -

irritation
Stage of ert
Meningeal
Fee •
spotted fevers
Neck rigidity baekoeigiditg
µ →
"
→ of Meningeal compression

feature
•
, -40=1 marked
•

photophobia clinical
•
Gunn hummer position Babinski
sign
Generalised flexed position
.

sign →
µ
•

•
Headache C. brushing) Region
Ijn
'
.
•

Hoenig sign
stage of
coma
/ Paralysis .

Brind2-in ski sign to

marked
•

• Planter ref lez

① Blood

IN-vtigati.IS ProteinC)
-

•
① csf →
sugar Ci (1)
,

Twe bid .

⑨ Pressure
⑨ capsular polysaccharides or
, Nmeningitides
④ CT scan

•
Complication h(z
• Differential Diagnosis -

p
From any
antibiotics ② circulatory ↳qsapse
④ SymptomaticTreatment
•
Treatments ① Rest ④ ④ Vaccines
④ Fluid electrolyte
- .

① coma
④ Lumber
puncture
Rct ) -
Das
② TI2eIngi±s .
✓
Coma_→ Destination -

Best -15
Goading _ofc•ma_ [ worst (5)
-

coma ① Cerebral
of
-

causes
- -

① cardiac
-

Eye opening STSTPN)

(
-

①
⑨ Pulmonary
OCIIN)
② Best verbal
oeesponse (
② metabolic and endocrine

①
Poisoning ⑨ Best motor
response
④ Hysteria GOLFF- NW)
①
Lodged in syndrome
Cliñicalfeatwees -

Nervous System
History from relation ÉEÉ Pupil -

Cardiovascular
BPC)
Embolism → Mitral stenosis
atrial fibrillation
Myocardial
infraction .

Respiratory
Alimentary Metabolic
-
-

Hemisphere, dieencephalig's
-
-

①
-
-

enlarged liver ,
spleen ascites ,
disorder -
eneyne stoke
-

respiration
abdominal vein
Brainstem
integmentumof
-

① lesion
Hyperventilation
⑨ Lesion in
poms in Apmeustie breathing
-

_÷;÷
Basilar
artery lesions

lesion atae.ie
④
Lowoetegmentivm
-

breathing
abscess > bronchial Garecinoma
④ Embolism wing
.

rqanagement
-
 Spontaneous Haemorrhage
Subarachnoid
it
- Haemorrhage
- -
 ✓ headache and
Migraine episodic ,
heini cranial
or unilateral
throbbing often associated with nausea

and visual disturbance

vomiting
.

Many have bi temporal .

Pathogenesis ⇐ Familial type of migraine

→ mutation For
P/Qtgpe voltage gated ca channel on chromosome

related
- -

calcitonin
19 → Release of neutro peptide gene
peptide ( CoeRP
)→ associated with vasodilatation .

Rest flowchart → 969 (Dos) .

Precipitating factor
- -
-
-

ciinicaefeature .
-

① Prodromal symptoms
-

a
① Aura -

to

⑨ Headache -

Urination 4 and sleep T

with
C. Classical
7 Migraine aurea
most common)
Main 3 types /→ without aurea (
Iypes_ :
Migraine
-

↳ Migraine
variants unilateral
(
motor on
stroke)
sensory features stimulating .

Others .

itemiplegic Migraine Retinal migraine

€ mig.ae.n.egm.IE??*-
⑨ Basilar ④post tram
Migraine
-

⑨ face ④
Migrainous neuralgia )
:peegic Migraine (cluster headache
①
Optnalmoplegic migraine
.

Treatment : -

-
general treatment
① -

④ AcuteAltack_
⑥
p÷phyEanis_
?⃝
Earhinson-e-osmdiseae.es#
 an alter physiological state in which there is rhythmic
discharge of many
Eptlepsfes E.pileps.pe#anrepetativewypeeesynehromous
• neuron
•

brain F- Ebr
in of localized seen in
-
-

area
- -

a ,

voltage high activity

:
Classification ① Low

|
⑧ ④ Give
-
-
① high voltage spike ⑨ spike and wave -

I v t
primary focal /
Jacksonian
seizure primary generalised unclassified maybe
seizure focal
clonic
and
generalised
#
g-
Tonic -

- Tonic or clonic -

Epileptic spasms
-
Akinetic
simple 's

focal Kwame
not
,•ss)
complexawareness
Focal seizures -
Myoclonic
less )
)
seizures with zndevey mal
focaec Absence (Petit typical
.

00
-
,
seizures
-
Motor

Sensory Temporal lobe

generalisation atypical
/ \
-
-

visual
-

symptom - frontal Lobe

versiove Tonic and Tonic

sign
-

and clonic or
pshycomotor clonic
signs
-

lobe
temporal
.

Clonic Sizwees ) → Gtmgh (909-905)

Focal sizwees .
and Grand Mahftonic
6906)
Management chough
.
-

Status
murmur Epilepticus : ewgh -9£ .

pharmacological
(repeat after
15min
)
-
-

IN
Diazepam 10mg
Or,

Ivfrepeat after
10min )
Lorazepam 9mg
.

t
not use patient ( 15mg / ) atasrateof 50mg 1min
phenytoin)
.

Drip of Phenytoin Ky
on
( oral
given .

fiomglkg ) 100mg
Iv 1min
Pheno barbitone
↳
.

Then use

after 30 -60min if sizwees continue

.

sodium
Lzomglkg -100mg / )
50 win
Iv dirp of Tiniopentone , .

122MW 24 '
or
assisted ventilation in
,
' ' Icy

Propofol
.

under

midz-olamco-2mglkgko.amglkglu.ro)
or
,

SubseqnentTnerapy_ 800
/
-1200mg orally
vatproate
.

Sodium
/ day orally
Phenytoin 300mg
.

carbamazepine -12001mg / day / orally

,

qoo
 ¥-1 UMM
LM M

o-Ei-effacealnoeve-palsyA-tpon-s.ro
• Infraction
Pontine lesions ( ,
tumor
6th and 7th nerve affected
① both
.

Millard Crubler
Syndrome 6th and 7th
-

hemiplegia
'
-

① crossed involve

slide
of
ner ve on one

② Paralysis of andlower limb

upper
opposite side .

7th and 8th l vestibule cochlear nerve affected)

dtÉmange : •

fsupranuctear-J-E.AT
)
•
By tumor
cheering ? oma
,
acoustic neuroma
④
•
Deafness ,
tinnitus ,
vertigo + facial palsy .

(middle infection trammed

.

middle ear : • Rumor ear ,

involve → nypeeeacusis (
painful )
-
to
•
Nerve to stepidius loud sound
'd taste
Anterior
213 of tongue gone
-

:
✓

÷
Facial Nerve Course :
.
Nerves
✓
The facial nerve exits the brain stem from its ventrolateral surface at
✓
the
✓cerebellopontine angle. It consists of two parts: a proper facial nerve and the-
✓
✓intermediate nerve. The proper facial nerve contains only a motor component and a
very small general somatic afferent component,rwhereas the intermediate nerve-
✓ -
carries sensory and parasympathetic visceromotor components.

The facial nerve anatomy can be divided based on its relation to the cranium and the
temporal bone into intracranial, intratemporal, and extratemporal parts.[4]

Intracranial Part
r n
The upper motor neuron (UMN) of the facial nerve is located
-
in the primary motor-
✓ ✓
cortex of the frontal lobe. UMN axons descend ipsilaterally as the corticobulbar tract
-
,
via the genu of the internal capsule and reach the facial nucleus in the pontine
-
-
tegmentum. The facial nucleus is divided into a dorsal and ventral region. It contains
-
the cell bodies of the facial nerve lower motor neurons (LMN). The dorsal region -

supplies innervation of the muscles of the upper face,-

whereas neurons in the ventral-
- -
region innervate muscles of the lower face. The dorsal aspect of the facial nucleus
-
-
-
receives input from both the left and right cerebral hemispheres.-
This results in both hemispheres having control over the muscles of
the upper face. The ventral aspect of the facial nucleus receives
mainly contralateral inputs. As a result, the left hemisphere partially
controls the upper left and right side of the face partially and fully
the lower right side of the face.

The intermediate nerve carries descending parasympathetic GVE

fibers from the superior salivatory nucleus and ascending GVA,
GSA, and SVA fibers from the geniculate ganglion.

Intratemporal : -

The two roots travel through the internal acoustic meatus, a 1cm long opening in the petrous part of
the temporal bone. Here, they are in very close proximity to the inner ear.,
' Still within the temporal bone, the roots leave the internal acoustic meatus, and enter into the facial canal.
The canal is a ‘Z’ shaped structure. Within the facial canal, three important events occur:

Firstly the two roots fuse to form the facial nerve.

Next, the nerve forms the geniculate ganglion (a ganglion is a collection of nerve cell bodies).
Lastly, the nerve gives rise to:
Greater petrosal nerve – parasympathetic fibres to mucous glands and lacrimal gland.
Nerve to stapedius – motor fibres to stapedius muscle of the middle ear.
Chorda tympani – special sensory fibres to the anterior 2/3 tongue and parasympathetic fibres to
the submandibular and sublingual glands.
The facial nerve then exits the facial canal (and the cranium) via the stylomastoid foramen. This is an exit
located just posterior to the styloid process of the temporal bone.
 : Recurrent Paroxysmal headache
Migraine
- -
one side of tuehead-
in childhood → adult life .

Beginning
Pathogenesis Disturbance of carotid and vertebra basilar system with
neurotransmitter intra andeauial vessel
- -

of Parti apboh .
-

"
_uaemia
time
?ÉiÑwin
" to

efango.oooocom#Y.:z%Éññ°
.w*isod
" vasoconstriction leads to cgÉÉem

g.
to
I
Anna

rÑ•o?yg§oe
.

sing t
☒
vessels
not masdialatiomofentracrani.ae
-

given be
and
-
a
-

arterial wall headache

StregaIrritating
in the cause
ending
-

neyye
.

andprotongheadaehei.lu
emasculate contraction
I
which

actual headache
maintains

start serotonin(4), noradrenaline

substance P④
Before

rei-H-reweopqTEeomdkadingan.nu#
,

I
Tnirigeminat
-

inflammation
-
reactions

ciinicalofeatures
① weakness ,
lassitude ,
depression →
Prodromus
symptoms .

actual attack starts

① Aura - •
after waking from sleep .

of half
-

•
Aura with some visual disturbance drizzling scintillating scotoma, blinding
pain
-
, -

field vision, hemiplegia, aphasia ,

ocular ,

lacrimation .

• 15min -
30min .

character
throbbing
.

splitting type
→
② Here
-

-
•

bilateral
generalised
.

•
uni or or
may even

and excessive of external the carotid artery .

•
dialation pulsations
• visual disturbance → luminous visual hallucination, uniformed light flashes , geometric
and
zigzag path of night
.

④ After attack urine output increase sweating, vomiting ,

nausea
patient feels Beefy ①
.

Avoid mental
and
physical fatigue
.

Treatment oeeueeealtreatment -

and Codeine
Aspirins paracetamol
-

Aeutetftaek ① mild
-

useful medicine
-

,
most
⑥
Erg cÉÑte both orally parenting suppository
→
as

↳
,
,

Ti by aerosol
-2mg orally
or .

preqna①
totaldose is reached
)
in till a

Avoid ↳ half announce

g-
omg
→

IM 0.5
✓
may
-

Aerosol 300
900mg
a☒ÉY
✓
- -

""

÷F
④ combined with
Loong of caffeine • Patient
?
darkroom -

subcutaneous auto injection device

.

or

④ Seunatriptan →
barbiturates trans qnilliseees
-

Ghlordiazepoouiae .

→ sedative -
,
-

dose a. in 3 divided dose

pizotifin
dairy 5g
-

→
soong →
-

ggn.io#wy . aÉ*
'

,
Parkins