personalhistory

MalepatientnamednaderibrahimAttiaAged43yrsfromDumiat Kafrsaad
Marriedwith4offspringtheyoungestaged12yrs Heworks asdriver
He is righthandedwithnosignificanthabits
complain
unable to move his htsidethenhefainted
present history
theconditionstarted 2aysfromhisadmissionwherehehadanincreasein
bloodpressurefor2daysthenon thethirddayhebecamesuddenlyunabletomove
I theLeftsideof hisbody It wasntassociatedwith headache Nausa
vomitingandblaringofvision Afterthathefaintedandwasadmitted
j
hisbleedingdisorderthenreferef to ice

e patient is hypertensive Nohistoryofsimilarconftion

Familyhistory
No consanguinitybetweenparents
General examination
2 incooperative so history was taken from hisson
pulse 180 BP 140 80 temp 370C
 Motorexamination
NoMuscleWasting
Inspection No abnormal Movement
scars trophicchanges ordeformity
Palpation
hypotonia on L t side
planter reflex
A reflexia in Lt side
Cranial nerve examination

upper Motor neuron Lesion

Facial Nerveaffection
Bulbar nerves affectionpresentedbydysphagia
sensorynerve examination
Nothing sign if cant
Investigationsdone
echo Ctangion MRI Brain totoscreen Ecg

Prousionaldiagnosis Acutehemorrhagic stroke

personalhistory
Malepatientnamed Gamal elsabahiaged
64 From DumiyatMarriedwith 2offsprings
yrs
theyoungestaged 34yrs works asemployee
He is ex smoker He is rightsidedhand
complain of swallowing so he
Hecomplain of difficulty
Matt for ryle tube
was referred to
presenthistory course was
the
Theconditionstarted monthago withocularMuscles
ratual andpro ressive it starts the hesuffered
anddiplopia
Affection in form ofptosis dysphagia dysarthria
tetrad ofdysphonia
From bulbar then itdetoriatesto Abdominal
and nasal regurgtation Neck Muscleswereaffected
also
andchest musclespain also Lost control
Leading to Lalling ofhead He
of Micturtion and defecation Hewas referred
to Mutt For ryle tubeinsertion
past history
No previous surgicaloperations
No history of fever or drug in take
Familyhistory
Nohistoryofsimilarcondition Noconsanguitybetween
parents

Motorexamination
Inspection No abnormal Movement NoMusdewasting
oscars trophicchangesordeformity
Palpation Normal Muscle tone
cranial nerve examination
There was cranial nerve affection
occularneroes informofdiplopiaandptosis
Bulbar nerves dysphagia dysphonia
dysarthria nasalregurg
sensory nerve examination
Nothing significant
investigation done
2 pelvi Abd ultrasound
1 X
ray of chest

3 Noncontrastctofchest 4 et angiography of Ned

and cerebral vessels

Treatment
4 Anticholestrasedrugs
2 plamapheresis
provosionaldiagnosis Myatheniagravis
personalhistory
Malepatientnamed Redael saeedaged 63 yrsold
From Talkha He is worker with 3 sons the
youngest is 30 yrs He is smoker and Rt
handed
Complain ofwalking
gradual progressivedifficulty
associated with tremors
presenthistory
Theconditionstartedwithgradualonsetand
progressivecourse presentedwithrigidityof lil
and LL affectingpatientdailymovementup to
patientwalking with supportassociatedwith
Tremorsinvolving uh and it decreased by
sleep and Movement There was Bradykinesia
and hypotonia
past history
No previous surgicaloperations
No history of fever or drug in take
Familyhistory
No history of similarcondition Noconsanguitybetween
parents

He was in flexed attitude and hasMaskFace

Motorexamination
Inspection No abnormal Movement NoMuscleWasting
scars trophicchanges ordeformity
Palpation There was Milt rigdity
cranial nerve examination
Nothingabnormaldetected
sensory nerve examination
Nothingabnormaldetected
Treatment
Dopaminergictherapy
L dopa themosteffectiveagentfor tttofPDandtheresponse
is used as diagnosticcriteria
Dopaminereceptorsagonist
Drugsinhibitsmetabolism of L dopa dopamine
Amantadine
Anticholengricdrugs

provisionaldiagnosis parkinson disease

 personalhistory
MalepatientnamedHamedabdelmoneimaged38yrs
From Belgas Heismarriedwith 4offspring the
youngest is 2 yrsold He is righthandedandworker
with no specialhabits
complain
generalfeeling oftirednesspainandheavinessall over
the body
presenthistory
Theconditionstartedwith acuteandprogressive
course of Muscleweaknessof LL it affects
ascendingly Mus des proximalMorethan distal the
condition precededbyAcuteviral infection not
relievedbyanalgesics hehadnumbnesssensations
and Bulbarsymptoms asdysphagiaanddysarthria
No atom in Cdysfunction No HINandDM
pasthistory
infection
history of feverand viral
No history of bloodtransfusion orsurgeries
Familyhistory
Nohistoryofsimilar
consanguinitybetweenparents condition
 Motorexamination
Inspection No abnormal Movement NoMuscleWasting
scars trophicchanges ordeformity
hypotonia grade 215
Palpation There was generalised
bilateral in all musclesgroup with are flexi a
power
Coordinationandgait cann't beassesseddue toMuscleweakness
cranial nerve examination
Nothingabnormaldetected
sensory nerve examination
There was Numbnesssensations
investigations
Emg Csf analysis for cytoalbuminous dissociation
Treatment
5 sessions of plasmapheresis
provosionaldiagnosis Guillain Barre syndrome
 personalhistory
MalepatientnamedMosaadsaidelsaeedaged45yrs
From Belgas Heismarriedwith 4offspring the
youngest is 2 yrsold He is righthandedandworker
with no specialhabits
complain
seizure in form ofgenarlizedcontractionwith
confusionand Loss of consciousness
presenthistory
Theconditionstartedwithseizuressince 3days 5 6
episodes day eachLastingfor5min generalisedtonic
clonic seizures associatedwith Loss ofconsiousness
confusion Loss ofMentalactivityandataxia
pasthistory
historyof seizuredisorderwithpoordrugcompliance
No historyof headtrauma or previousoperations
Familyhistory
consanguinitybetweenparents
history of Motherof similar condition
 General Examination
andperson
The patient was fullyconsious oriented totime place
pulse 100 BP 120180 temp 370 RR 181min
Motor examination
Noabnormalitiesdetected
sensoryexamination
No abnormalitiesdetected
cranial Nerve examination
No abnormalities detected
investigations
EEg was done and findings was showingseizure disorder

Treatment
Ceftriaxonetoreduceinfection
Thiamine as vitamin supplement
Phenytoin for seizures
Pan toprazole toreduce gi
Chlordiazepoxide to reduceanxiety

provisional diagnosis epilepsy

personalhistory
Femalepatientnamedsabreandsaidsaeed
aged 34 yrs old married with 3offspringsthe
youngestaged 3 yrs from Batala sheworks
as teacher she is righthandedperson with
no special habits
complain
suddenLoss of vision inrighteyeassociated
withprogressivenumbnessand difficulty of
Movementin at side of body
presenthistory
theconditionstartedwithsudden Lossof
vision in rt eyeassociatedwith progressive
numbnessanddifficultyof Movement in Rt side
of body she hasalso blurringvision in Lt eye
slurringspeech diffality in Mastication abnormal
Facesensationin Rtside decreaseacuityofhearing
Mictruitionand
and dysphagia she lost controlof
deflation shehadconvulsions thecondition Icp
associatedwithheadachevomitingandblaringvision sym
tonsof
 past history
the patient suffers from Rheutasim sin le earlychildhood
and she was receiving penicillin For that
Familyhistory
No similar condition
No consanguinitybetweenparents

General Examination
andperson
the patient was fullyconsious oriented totime place
pulse 100 BP 120180 temp 370

Motor examination
Um NL Lesion signs in form of hypertonia hyperreflexia
and Babniski sign
sensoryexamination
numbness and parathesia on Rt side ofbody
cranial nerves examination
opticnerveaffection Il LossofvisioninRteyeandblurringvisionin Lt eye
Trigeminal affection
nerve r DifficultMastication Motor AbnormalFace sensation sensory
cochlea vestibular
VI vacuityofhearingandtinnitus
Bulbarnerves Ix x XI XI
andvagus Dysphagia
glossopharyngeal anddysarthria
cranialaccessory Dysphonia hoarsenessofvoice
hypoglossal Nasalregurgitation
 Done MRIofBrainandorbit
Investigations to bedone CSFexamination
corticosteroids for 5Lays
wellbalanceddietandhighdosesofvitamins B Bo B
Treatment symtomatic treatment
physiotherapy tomaintainMobilityand
avoidcontractures

prousionaldiagnosis Multiple sclerosis

personal history
FemalepatientnamedHanim Salah aged 30
From sherbin with two offspringthe
youngest
lo yrs she ishousewife with nospecial
aged
habits
complain
of
gradualprogressivepulsatingpain in rightside
head accompained by nausea and vomiting
presenthistory
where an
the condition started 2daysago
attack of pulsatingpain is Rt side ofhead
in gradual andprogressive courseassociated
with nause vomitingandphotophobia the pain
decreased bysleepandlying in dark andincreased
by physical activities andtriggers smoking
alcoholsleepdisturbancesandMenstration Pain
usually Lasts for 2 3 days
pasthistory
History of same condition
No History of head trauma
No Historypreviousoperation
Familyhistory
No similar condition
No consanguinitybetweenparents

General Examination
placeandperson
hepatientwasfullyconsious oriented totime
pulse 100 BP 120180 temp 37é
Motor examination
Noabnormalitiesdetected
sensoryexamination
No abnormalitiesdetected
cranial nerves examination
Noabnormaties detected
Treatment Medicaltttasinon selective
Inacuteattack SATsagonist selective SATI
agonist NSAIDs
Nonmedicalttt induction of
sleep darkroom icebag
propylactic SATsantagonist Nsaids
B blockers Cattchannelblockers
provisionaldiagnosis migraine
personalhistory
Femalepatientnamed zein bhassanFromagha
aged 68yrs Married with 4offspringtheyoungest
is 35 yrsold she is righthandedwith nospecial
habits
complain
stationaryFacialasymmetrywith deviation
acute and food in
of Mouth to Rtside with aslumlation of
cheeks
presenthistory
Theconditionstartedwithacuteandstationarycourse
of Facialasymmetry in form ofMouthdeviationto
Rt side absenceof nasolabialFoldon Leftside
to dose lefteyeor raise Lt eyebrow
inability
in Masticationandaccumlation of
foot in
diffcality exposure to
cheeks This condition wasfollowing
cold air thepatient is diabetic
pasthistory
Nohistoryof headtrauma orpreviousoperations
No history of fever or infection
forDM
patientreceive drugs
stroke
history of previous
Familyhistory
No similar condition
No consanguinitybetweenparents
General Examination
andperson
he patient was fullyconsious oriented totime place
pulse 100 BP 120180 temp 370
Motor examination
Noabnormalitiesdetected
sensoryexamination
No abnormalitiesdetected
cranial Nerve examination
LM NL of Facial nerve on Left side
Treatment
cortisone
antiviral drugs
Antiinflammatorydrugs
eyepatch artificial tears toprevent corneal
ulcers
provisional diagnosis facial palsy
personalhistory
Malepatientnamed Mosaad SaeeddsharkanyFrom
Aghaaged toyrs old Heismarriedwith 4sons
theyoungestaged 38 yrs He isrighthandedwith
no special habits
complain
acute Rt sideweakness of Ahand LL
presenthistory
The condition start with acuteweaknessof
Right side ofbody ul and LL proximal distal
He also sufferFromdysarthria dyspneaand
dysphagia His Mouthwas deviated to Lt side
with dropof Rt Mouthangle Heshows nosigns
of elevating Icp
pasthistory
He is diabetic and hypertensiveand takingdrugs
For that
Nohistoryofheadtraumarprevioussurgicaloperations
Familyhistory
No similar condition
No consanguinitybetweenparents
General Examination
oriented totime andperson
place
the patient was fullyconsious
pulse 100 BP 120180 temp 370 GCS 15
Motor examination
There was hypotonia in Rt side
cerebellar function Cann't be assessed diminished reflexes
Powergrade of Wl o LL L
sensoryexamination
No abnormalitiesdetected
cranial Nerve examination
Rt UM NL in Form of Mouthdropat Rt side anddeviationofMouth
to Left side
Bulbar palsy in Form of dyspnea dysarthria dysphagia
investigations
CT was done revealed Left basalganglioninfarction
Treatment
Fluids salineandringersolution antiplatletsasaspirinanddopey
prophlacticanticoagulant anti hypertipedemiaasstatin

provosionaldiagnosis acute ischemic stroke

personalhistory
Malepatientnamed saeed dsaid Ahmed From
Dumyat age 68 yrsold Heismarriedwith 2 sons
theyoungestaged 30 yrs He isrighthandedwith
no special habits
complain
acute Rt sideweaknesswith difficulty to
understandspokenwords
presenthistory
The condition start with acute weaknessof
Right side ofbody Healsofind it diffudtto
understandwrittenandspokenwords buthe can
speak Fluently
pasthistory
he has HTand DMandtakesdrugsforthat
history of previousstrokeaffecting Ltside ofbodys2ince
yrs
Familyhistory
No similar condition
No consanguinitybetweenparents
 General Examination andperson
The patient wasfullyconsious oriented totime place
BP 120180 temp 370 GCS 15
pulse 100
Motor examination
There was hypotonia in Rt side
cerebellar function cannot beassessed diminished reflexes
Powergrade of Wl o LL L
sensoryexamination
No abnormalitiesdetected
cranial Nerve examination
Rt UM NL in Form of MouthdropatRt side anddeviationofMouth
to Left side
Bulbarpalsy inFormof dyspnea dysarthria dysphagia
Treatment
Fluids salineandringersolution antiplatletsasaspirinanddopey
prophlacticanticoagulant anti hypertipedemiaasstatin

provosionaldiagnosis acute ischemic stroke

 EEg
personalhistory
Femalepatientnamed AmalMohamed Fromagha
with cerebralpalsy andgenarlised tonic colonic
aged 38yrs
Technique ofprocedure
the electrodes areattached to thescalpand
attachedtoEeg recordingMachine thepatientwas
awake butdosing his eyes andrelaxing the
recording was done utilizingthe international
10 20 systemelectrodeon channel D Lightdistal
EEG system For 20 40 mins with photic
stimulation and hyperventilation
Backgroundactivity
It shows organised 9 lo CI s thetawaves
it
showed no focal or paroxysmaldischarge
provocation didnotadd furtherabnormalties
EEG Findings
Generalised diptogenic dysfunction
 Emgand nerve conduction

personalhistory
FemalepatientnamedMaiNaderMohamed
she is student from Mansoura she is single
right handedand with no special habits
Medical condition
she feels painand numbness in her Rthand so
n eulogist refer her to do EMG and nerve
conduction as Dr suspectcarpel tunnelsynd
Technique ofprocedure
one or more smallneedlescalledelectrodes are
inserted through the skin in to themuscle the
electrical activitypickedupbytheelectrodes is
then displayed on an oscilloscope amonitor
that displays electricalactivity in form of
waves an audio amplifier is used so the
activity can be heard After anelectrodehas
beeninserted patient is asked to contract the
muscle the actionpotential sizeandshapeof
the wave that this creates onoscilloscopeprovides
informationabout ability of muscle to con tract
 Findings
For NCS
Normal Motor T L Ampiltude and Normalconductionvelocity
of right Median Motornerve and Right ulnar Motor nerve
conductionvelocity
Normal sensorypeak Latency Ampiltudeand
of right Median sensory nerve and right ulnarsensory nerve

For E MG
Normal Emg

conclusion

Normal Emg Not suggestingcarpel tunnelsyndrome

 Lumbar puncture

patient'sMedicalcondition
Malepatientnamed HamedAbdelmoniemaged 38 yrs complain
ascendLingaffecting
ofprogressive weakness all over thebody
He asked For CSFanalysis
proximal More than distal
was

diagnosis which probably Gullion Barre syndrome

for
as Gul lian
and to exclude infectionscausing symptoms
barre syndrome
Technique
lie in Lateralposition with knee
Flexed
patient
Skin over back is cleaned and numbedby Local
an athesia

Needle inserted in to 23 24 or 24 15

Sample of fluid is taken Needleremoved once procedure

done and plasterapplied
Indications
Diagnostic
O ons infections 20 AutoimmuneCNSdisease as GBS
C Ns u a sail its Ctnegativesubarchanoid hemorrhage
Malignant cells in Mets
Forinjection of fluoresceindye toidentify site of Csf Leaks
 Therapeutic
Benign intracranial hypertension acute communicating
infections
hydrocephalus cryptosoccalmeningitis in HIV
For CSF Leaks
Delivery of intrathecaldrugs
delivery ofantineoplasticdrugs
Delivery of antibiotics
precautions
patient is asked to sign a consent form
Ask about taking any Medications
Allery to any Medications
any bleeding problems
If patient takes aspirin or Warfarin
IF Female patient is pregnant
empty bladder before procedure
complications
post Lumbarpuncture headache brain herniation
Infection Backache subduralorepiduralhematoma
Subarchanoidhemorrhage implantation of
epidermoid

tumor Root irritation Radicalor pain

 Botox injection

patient's Medicalcondition
Malepatient named Hamed el said aged Yo yrs with previous
stroke since 2 yrs causing him permanent stifness in R t LL
Leading to difficulty in walking
technique
skin is numbedwith cooling spray and a thin needle
with Botolnium toxin is injected slowly to the targeted
area

Indications
Myclonus Tics parkinson Disease Tremors
HemiFacial spasm Limbdystonia cervical dystonia

Laryngealdystonia oromandibulardystonia10spasticity

Blepharospasm 120 Restless Legssyndrome

precautions
patient hadto stop blood thinnersbefore procedure
areainjected isn't Massaged to preventspread oftoxin
to unwanted areas
Don t drink for 24 hrs
beforeprocedure
Complications
Most of them are Milt and improve in one or twoday
at treatmentsite
pain swellingrednessor bruising
Flu Like symptoms
headache
Neck pain
upset stomach indigestion
Temporarydrooping eye lids ptosis
eye irritation or redness