NEUROLOGY

SEIZURE DISORDER
Vascular Metabolic
Infection Idiopathic
Trauma Neoplastic
Autoimmune ETIOLOGY Drugs
Unprovoked Provoked
EPILEPSY

UNPROVOKED
SEIZURE
>2 sz. 24 hours apart 1 sz reoccurrence @60%
EPILEPTOGENESIS
Ca2+ Cl-
Depolarize +ve RMP -ve
+ NEURON +
GLUTAMATE GABA
2 LIVE RAPID REVISION

FOCAL SEIZURE
3). Secondary Generalization
(Cerebral edema)
- AWARENESS +
1). Impaired 2).Intact
FOCAL SEIZURE

-Post Ictal Paralysis Proximal Distal

-Self recoverable
TODDS PALSY JACKSONIAN MARCH

ABSENCE SEIZURE
Age of onset@4-8 years
Aura -
Confusion- PETIT MAL
EPILEPSY
ICTAL PHASE EEG- 2-4 Hz Spike & wave
“Stare look” ppt. by hyperventilation
 NEUROLOGY 3

GENERALIZED TONIC CLONIC SEIZURE (GTCS)

TONIC -Decorticate posturing
-Ictal cry
-Jerking -Incontinence
-Frothing -Flaccidity
CLONIC POST ICTAL
JUVENILE MYOCLONIC EPILEPSY (JME)
JUVENILE ONSET
-Myoclonus (M.C)
-GTCS
Family history + -Absence seizure
IDIOPATHIC MANY SEIZURES TYPE
MESIAL TEMPORAL LOBE EPILEPSY
FOCAL SEIZURE with impaired awareness
-Febrile seizure
Hippocampal -Déjà vu
Sclerosis -Temporal lobectomy
TEMPORAL LESION SURGERY (TOC)
4 LIVE RAPID REVISION

TREATMENT OF SEIZURE
-Febrile sz- Antipyretics -Status epilepticus
-Alcohol withdrawal sz -Family history +
BZD -Abnormal-Imaging
-EEG
PROVOKED UNPROVOKED
DISCONTINUATION OF AED
COMPLETE REMISSION for 3-5 years

Normal EEG
SINGLE SZ type NO deficit/ family history
1st LINE AED

Good EFFECT Less SIDE EFFECTS

 NEUROLOGY 5

1st LINE AED

(Steven Johnson) LAMOTRIGINE/LEVETRIACETAM -Irritability
Syndrome) 1% -Hydantoin Syndrome
- Na+ (SIADH) -Hypersensitivity
-Aplastic anemia FOCAL SZ -Hepatitis
CBZ/OXCBZ PHENYTOIN
GTCS
-Hyper NH3
-Neural Tube Defect
-Alopecia
VALPROATE (DOC) LAMOTRIGINE
ETHOSUXIMIDE (DOC)

ABSENCE SZ
VALPROATE LAMOTRIGINE
VALPROATE (DOC)
Exacerbate CBZ
Myoclonus PHENYTOIN
J.M.E
LAMOTRIGINE LEVETRIACETAM
6 LIVE RAPID REVISION

STATUS EPILEPTICUS
DEFINITION
LOC >30 mins
Seizure Duration -Interictal
>5 minutes -Post ictal
Convulsive Non-Convulsive
BZD -Lorazepam (DOC)
-Drug Defaulter -Midazolam
Restart AED Refractory-Early >30 mins-MDZ
-New case -Late >48 hrs-Thiopentone
AED SEDATION
PREGNANCY
SEIZURE FREQUENCY – Increased (30%)-Emesis
Unchanged-50% -Decreased (20%)
Progesterone
Increases Sz.Threshold
MONOTHERAPY ALREADY ON AED
@lowest effective dose CONTINUE same therapy
Lamotrigine

SAFE AED
Ox-CBZ Levetiracetam
 NEUROLOGY 7

MOVEMENT DISORDERS
Slow “Crawling”

ATHETOSIS
Distal limb Lesion-Globus Pallidus
Dance “Semi purposeful”

CHOREA
Distal limb Lesion- Caudate Nucleus
Flinging “High amplitude”

BALLISMUS C/L
PROXIMAL Lesion- Subthalamic Nucleus
TREMORS
INTENTIONAL-Cerebellar lesion

FLAPPING-Encephalopathy FINE -Thyrotoxicosis

“Negative Myoclonus”
“Asterixis”
8 LIVE RAPID REVISION

ESSENTIAL TREMORS
AD trait (50%)

Dec.by alcohol

Ppt by ANXIETY PROPANOLOL (DOC)

RIGIDITY
COG WHEEL -PD

LEAD PIPE-Extra Pyramidal CLASP KNIFE-Pyramidal

lesion lesion
PARKINSONISM(Pk)
ATROPHY MIDBRAIN

Hypopigmentation Decreased
of SNpc DOPAMINE
α SYNUCLEIN LEWY BODY
(Misfolded) (Eosinophilic Inclusion bodies)
 NEUROLOGY 9

PARKINSONISM
ETIOLOGY
IDIOPATHIC (M.C type)
DA-

DA depletors 3I LRRK 2 gene (Chr.12)-AD trait

IATROGENIC INHERITED
TRAUMA-boxers
-Carbon Monoxide

3T -Manganese

TUMOR TOXINS -MPTP (Heroin addicts)

CLINICAL FEATURES
TREMORS-Resting

RIGIDITY-Cog wheel BRADYKINESIA

STOOPED POSTURE
-Shorter strides PULL TEST
-Poor arm swing Unstable on
Retropulsion

FESTINATING POSTURAL INSTABILITY-Fall

10 LIVE RAPID REVISION

OTHER MOTOR SYMPTOMS

MICROGRAPHIA
Progressive small
Handwriting

MONOTONOUS SPEECH MASK LIKE FACE

“Whispering voice quality” “Expressionless face”

NON-MOTOR SYMPTOMS
DEPRESSION ++

DEMENTIA-Late onset ANOSMIA

SYMPTOMOTOLOGY
1st Symptom -ANOSMIA
1st Motor symptom- TREMORS
Last symptom – POSTURAL INSTABILITY
Most essential symptom- BRADYKINESIA
 NEUROLOGY 11

PROGRESSIVE SUPRANUCLEAR PALSY

EXTENDED POSTURE
Wrinkles

DEFECTIVE DOWN GAZE DYSTONIA -forehead

DEMENTIA OF LEWY BODY
PK

DEMENTIA-early onset VISUAL HALLUCINATIONS

MULTIPLE SYSTEM ATROPHY
PK Orthostatic
Hypotension

MSA-c MSA -a
CEREBELLAR Symptoms AUTONOMIC instability
CORTICO BASILAR DEGENERATION
CORTICAL SENSORY LOSS
Unintentional
Limb movement

DYSTONIA ALIEN LIMB

12 LIVE RAPID REVISION

TREATMENT OF PD
LEVODOPA (DOC) Oral-Ropinirole
Patch-Rotigotin
Increases DA Injectable-Apomorphine

AMANTIDINE DA agonist
DECARBOXYLASE -Carbidopa
Entacapone Selegiline
Tolcapone Rasagiline
INHIBITORS
COMT MAO B
SURGERY

Intractable INDICATIONS Drug induced

TREMORS DYSKINESIA
DEEP BRAIN STIMULATION(DBS)

SITE
STN GLOBUS PALLIDUS
DOC <60 yrs- DA agonist Neuroprotective-Rasagiline
>60 yrs- Levodopa Rescue therapy-Apomorphine
 NEUROLOGY 13

CORTICAL FUNCTIONS
FRONTAL LOBE
Motor PRIMARY
activity
Sensorimotor MOTOR Inhibits
Integration AREA Primitive reflexes
PRE-MOTOR SUPPLEMENTARY

FRONTAL EYE FIELD (FEF)

I/L GAZE C/L GAZE

Preference LESION Preference
DESTRUCTIVE IRRITATIVE
MICTURATION AREA -Social Incontinence
Antisocial
Word formation Behaviour
BROACAS PRE FRONTAL
14 LIVE RAPID REVISION

PARIETAL LOBE Stereognosis

SENSORY AREA
Localization
Of stimulus 2 point discrimination Graphesthesia

PRIMARY ASSOCIATION
LEFT ANGULAR GYRUS
DYSGRAPHIA -Cannot read/write

GERSTMAN
SYNDROME
DYSLEXIA DISORINTATION to direction
RIGHT ANGULAR GYRUS
HEMISPATIAL NEGLECT

Lesion
CONSTRUCTIONAL APRAXIA DRESSING
OTHER AREAS
“Pie on the floor”
TASTE OPTIC RADIATION
 NEUROLOGY 15

TEMPORAL LOBE
(Hearing ) AUDITORY /WERNICKES AREA
“Comprehension”

“Pie in the sky”

OLFACTORY AREA OPTIC RADIATION
SHORT TERM -Medial temporal lobe

Hippocampus Neocortex
MEMORY
CONSOLIDATION LONG TERM
OCCIPETAL LOBE
VISUAL AREA

Perception Analysis
PRIMARY IMAGE SECONDARY
16 LIVE RAPID REVISION

ACA INFARCTION
LL WEAKNESS +URINARY INCONTINENCE (P.C Lobule)

Supplementary Pre-Frontal
Motor Area Area
PRIMITIVE REFLEXES + ANTISOCIAL BEHAVIOUR
LEFT MCA INFARCTION-M1 DIVISION
APHASIA -Global
-Paresis
-Anaesthesia
GERSTMAN SYND HEMI -Nopia (Homonymous)
LEFT MCA INFARCTION-M2 SUPERIOR DIVISION
APHASIA-Brocas

HEMIPARESIS HEMIANAESTHESIA
LEFT MCA INFARCTION-M2 INFERIOR DIVISION
APHASIA-Wernicke

C/L
GERSTMAN Syndrome HEMINOPIA(Homonymous)
 NEUROLOGY 17

RIGHT MCA INFARCTION-M1 DIVISION

APHASIA -
-Paresis
-Anaesthesia
HEMINEGLECT HEMI -Nopia
RIGHT MCA INFARCTION-M2 SUPERIOR DIVISION
APHASIA -

HEMIPARESIS HEMIANAESTHESIA
RIGHT MCA INFARCTION-M2 INFERIOR DIVISION
APHASIA -

HEMINEGLECT HEMINOPIA
18 LIVE RAPID REVISION

PCA INFARCTION
CORTICAL BLINDNESS with macular sparing

всего наилучшего 一切顺利

(Hippocampus) (Corpus callosum)
AMNESIA ALEXIA(Pure word blindness)
DEJERINE ROUSSY SYNDROME (DRS)
ANAESTHESIA

(Lateral nucleus)
PARAESTHESIA THALAMIC LESION
ANTON’S SYNDROME
PARTIAL BLINDNESS

Occipital lesion (Persistence of image)

UNAWARE PALINOPSIA
BALINT’S SYNDROME
SIMULATAGNOSIA (Cannot integrate)
Oculomotor
Apraxia (Cannot scan)
 NEUROLOGY 19

APHASIA

COMPREHESION
Auditory

Follow

Command Sensory speech

Wernicke Association area

REPETETION
Repeat Auditory
1+1
Wernicke Arcuate
Brocas
City ? Fibres
NAMING
AUDITORY

Wernickes Brocas
Sensory assoc Arcuate Motor assoc
fibres
FLUENCY

Brocas Motor speech

assoc area
20 LIVE RAPID REVISION

WERNICKE APHASIA
COMPREHENSION -
JARGON SPEECH
Wernicke NEOLOGISM
-NAMING Area FLUENCY -Increased
-REPETETION
BROCAS APHASIA
COMPREHENSION + Melodic speech
Depression + Telegraphic speech
- NAMING Brocas Area FLUENCY-Decreased
- REPETETION
CONDUCTION APHASIA
COMPREHENSION -Normal

- NAMING Arcuate fibres FLUENCY -Intact

- REPETETION
ANOMIC APHASIA Seen in
Lesion NAMING - -Alzheimer
Angular gyrus -Head trauma
-Encephalopathy
COMPREHENSION+ FLUENCY+
REPETETION +
 NEUROLOGY 21

TRANSCORTICAL SENSORY APHASIA

Lesion COMPREHENSION-Impaired
Sensory speech
Assoc area REPTN-intact
NAMING - FLUENCY-Intact
TRANSCORTICAL MOTOR APHASIA
Lesion COMPREHENSION -Normal
Motor speech
Assoc area REPETN-intact
NAMING - FLUENCY -Impaired

MIXED TRANSCORTICAL APHASIA

COMPREHENSION -

REPETN-Intact
NAMING- FLUENCY-
GLOBAL APHASIA
COMPREHENSION-

REPETETION-
NAMING- FLUENCY-
22 LIVE RAPID REVISION

TREATMENT OF ACUTE ISCHEMIC STROKE

THROMBOLYSIS -rtpa
-AF
-Prosthetic valve
ASPRIN ANTICOAGULANTS
INDICATIONS OF THROMBOLYSIS
I/V < 4.5 hours
Large Vessel DW MRI
Occlusion (LVO) Window Deficit>Infarct size
<6 hours Period <24 hours

CONTRAINDICATIONS FOR THROMBOLYSIS

BP >185/110 mm of Hg

BLEEDING DIASTHESIS HEMM.CVA

 NEUROLOGY 23

UMN PARALYSIS
SPASTICITY +

Plantar -Extensor
HYPERREFLEXIA + BABINSKI +
LMN PARALYSIS
FLACCIDITY +
Fasciculation
(AHC lesion )
HYPOREFLEXIA + WASTING ++

COMPLETE HEMIPARESIS
CORTICAL LESION
Face -Paralyzed

MCA INFARCT
UL >> WEAKNESS >> LL
DENSE HEMIPARESIS
INTERNAL CAPSULE LESION
Face-Spared
MCA INFARCT
UL = WEAKNESS = LL
24 LIVE RAPID REVISION

HEMMORHAGIC STROKE

ICH ECH
ICH

ETIOLOGY
SUBCORTICAL CORTICAL
INTRACEREBRAL HEMMORHAGE (ICH)
(M.C site) PUTAMEN -Hemiparesis

THALAMUS-Hemianesthesia CEREBELLUM-Ataxia
PONTINE BLEED
PIN POINT PUPILS
Tachy -Cardia
-pnea
QUADRIPARESIS HYPER Thermia/hidrosis
 NEUROLOGY 25

SUBARACHNOID HEMMORHAGE
ETIOLOGY
TRAUMA (M.C.C)
M.C.C
Spontaneous SAH
AVM Berry Aneurysm rupture
CLINICAL FEATURES
HEADACHE-Thunderclap

NECK RIGIDITY + LOC-transient

DELAYED DEFICIT
RERUPTURE (M.C.C -Mortality)

VASOSPASM(Morbidity) HYDROCEPHALUS
INVESTIGATIONS

IOC
NCCT ANGIOGRAPHY-Aneurysm
SAH
CSF-Xanthochromia
26 LIVE RAPID REVISION

Coiling TREATMENT
Aneurysm SURGICAL
Clipping -HTN
SAH -Hypervolemia
NIMODIPINE 3H -Haemodilution
Intracerebral CCB inhibits VASOSPASM
SUBDURAL HEMMORHAGE
RUPTURE of Cortical bridging veins

DEFICIT-gradually progressive CT-Concavo-Convex opacity

EXTRADURAL HEMMORHAGE
RUPTURE of Middle meningeal artery

DEFICIT-Rapid CT -Biconvex

EDH SDH
ICH SAH
 NEUROLOGY 27

ALZHEIMER DISEASE
AMYLOIDOSIS Amyloid precursor protein(APP)
Secretase
Temporo Parietal Aβ42
ATROPHY AMNESIA
(Down Syndrome) Chr.21 (encodes for APP)
Dec.Clearance of Aβ42
MUTATIONS Inc.risk
Chr. 14,1 + secretase Chr.19 -Apo E4 gene
Neurofibrillary tangles (NFT)
α Severity
BIOPSY
Senile Neuritic plaques(SNP) TAU proteins -Atrophy
α Age
AMNESIA (Anterograde)

SYMPTOMS
APHASIA(Anomic) APRAXIA
TREATMENT

Ach-Dec
NMDA - Memantine AchE – Donepezil
28 LIVE RAPID REVISION

FRONTO TEMPORAL DEMENTIA (FTD)

BEHAVIOURAL abnormality CAPGRAS SYNDROME
(Delusion of doubles)

AMNESIA -Late onset TAU proteins

NORMAL PRESSURE HYDROCEPHALUS
CSF PRESSURE -180-200 cm of H2O
-SAH
-Meningitis
HYDROCEPHALUS CSF ABSORPTION -Decreased

GAIT ATAXIA

HAKIM’S
TRIAD
URINARY INCONTINENCE DEMENTIA
TREATMENT

Drain 30ml MILLER Ataxia

CSF FISCHER Improves
TEST
Therapeutic LP VP SHUNTING
 NEUROLOGY 29

HUNTINGTON DISEASE
AD INHERITANCE -Chr 4 (Short arm)
Father Larger defect
Early onset HUNTINGTON Early onset
GENE More severe
ANTICIPATION LENGTHENING
CLINICAL FEATURES
CHOREA

BEHAVIUORAL ABN DEMENTIA

ATROPHY @Caudate nucleus
Increased Intrastriatal loss of
DA Ach ,GABA
TREATMENT
DA - DA DEPLETORS (DOC)
(Haloperidol) (Tetrabenazine)
30 LIVE RAPID REVISION

WERNICKES ENCEPHALOPATHY
PREDISPOSING FACTORS
ALCOHOL intake (M.C)

HEMODIALYSIS MALNUTRITION-Beri Beri

GLOBAL CONFUSION

SYMPTOMS
OPTHALMOPLEGIA ATAXIA
THIAMINE INFUSION

(1st to correct) TREATMENT

OPTHALMOPLEGIA CONFUSION(Persistent)

KORSOKOFF PSYCHOSIS
False story AMNESIA(Anterograde>Retrograde)
To hide
Memory loss
CONFABULATION THALAMIC LESION
 NEUROLOGY 31

CREUTZFELD JACKOB DISEASE (CJD)

INITIATION

PATHOGENESIS
PROPOGATION AGGREGRATION
SPORADIC (M.C type)
PRNP gene -Dural grafts
-Chr.20 TYPES -Corneal grafts
FAMILIAL IATROGENIC
MYOCLONUS-startle

SYMPTOMS
ATAXIA DEMENTIA
BIOPSY -Spongiform degeneration
Bi/triphasic
Spikes
Cortical
INVESTIGATIONS Ribboning
EEG MRI
32 LIVE RAPID REVISION

MYASTHENIA GRAVIS
THYMIC ABNORMALITIES

HYPERPLASIA (65%) THYMOMA(10%)

CLINICAL FEATURES
OCULAR (1st/M.C)

Easy fatigue
FACIAL-Snarling appearance SKELETAL-Proximal
DTR

SENSORY NORMAL BLADDER

INVESTIGATION
SCREENING TEST
ICE PACK TEST

SPECIFIC TEST SENSITIVE TEST

Ach Receptor Abs SFEMG -Jitter ++
 NEUROLOGY 33

TREATMENT
(DOC) AchE- Pyridostigmine

IMMUNOSUPRESSION THYMECTOMY
IMMUNOSUPRESSION Resp.fatigue
IMMEDIATE - I/V Ig Myasthenic
-Plasmapheresis Crisis
-Steroids -Mycophenolate
SHORT TERM DELAYED Mofetil
THYMECTOMY
<15 yrs (Immunodef)
Most 15-55 yrs >55yrs (Vestigial)
Useful Generalized MG Ocular MG (High risk)
THYMOMA DOUBTFUL
LAMBERTON EATON MYASTHENIC SYNDROME
SCC LUNG

Dec Ach release

Ca channel Abs Skeletal weakness(M.C)
34 LIVE RAPID REVISION

HEADACHE
PSEUDOTUMOR CEREBRI
HEADACHE -on awakening
-on straining
Raised ICT
PAPILLEDEMA NO focal Neuro. Deficit (FND)
IDIOPATHIC (M.C type)
-HyperVitA
-OCP ETIOLOGY
IATROGENIC CSF ABSORPTION-decreased
TENSION HEADACHE
DULL ACHING-Band like

DEPRESSION ++ TCA-Amitriptyline (DOC)

MIGRAINE
PULSATILE
Inc. on
Movement
UNILATERAL NAUSEA ++
Photo/phono PHOBIA
 NEUROLOGY 35

AURA (Visual) Fortification spectra

(Flashes of light)
+ TYPES -
CLASSICAL(20%) COMMON(80%)

SEROTONERGIC AGENT – TRIPTANS (DOC)

Rizatriptan (Best)
Rx Ubro GEPANT
NSAIDS CGRP- Rami GEPANT
BETA BLOCKERS -Propranolol (Widely used)

PROPHYLAXIS
CCB-Flunarizine TCA-Amitriptyline
CLUSTER HEADCHE
CLUSTERED ATTACKS

PERIORBITAL PAIN-Explosive LACRIMATION ++

OXYGEN @10-12 L/min for 10-15 minutes
Acute attack
Rx Prophylaxis
SUMATRIPTAN 6mg s/c VERAPAMIL (DOC)
36 LIVE RAPID REVISION

PYOGENIC MENINGITIS
N. Meningitidis -Adolescents

Adults/Elderly ETIOLOGY
S. Pneumoniae Listeria- Neonates/Elderly
CLINICAL FEATURES
FEVER ++

Kernig’s sign Brudzinski sign

HEADACHE + NECK RIGIDITY+

CSF ANALYSIS
CELL COUNT -10-10000 (N>L)
Pleocytosis
Turbid
PROTEIN-Increased GLUCOSE-Decreased
TREATMENT

Listeria-Ampicillin X21days
DEXA 10 mg i/v ANTIBIOTIC
N.meningitidis -Ceftriaxone i/v for 7 days
S.pneumoniae -Ceftriaxone +Vancomycin for 14 days
 NEUROLOGY 37

TUBERCULAR MENINGITIS (TBM)

BASAL EXUDATES

TUBERCULOMA INFARCT -Endarteritis

CSF ANALYSIS
CELL COUNT- Pleocytosis L>>N

Cob Web
PROTEIN -Increased GLUCOSE-Decreased
TREATMENT

Endarteritis Reactivation
STEROIDS X 2 mths ATT X 12-18 months
HSV ENCEPHALITIS
FEVER +

ALTERED SENSORIUM SEIZURE +

Haemorrhagic lesions in TEMPORAL lobe
38 LIVE RAPID REVISION

CSF ANALYSIS
Treatment CELL COUNT-Pleocytosis L>N
i/v Acyclovir X 21 days
Xanthochromia
PROTEIN -Increased GLUCOSE-Normal
NEUROCYSTICERCOSIS
AGENT-Taenia Solium

HOST
HUMAN-Definitive PIG-Intermediate
SEIZURE (M.C)

HEADACHE HYDROCEPHALUS
VESICULAR (Viable)

STAGES
COLLOIDAL(Dying) CALCIFIED(Dead)
ALBENDAZOLE -15mg/kg/day for 8-28 days
-Vesicular
Rx -Colloidal
STEROIDS AED
 NEUROLOGY 39

GUILLIAN BARRE SYNDROME

POST INFECTIOUS -C.Jujeni

DEMYELINATING POLYNEUROPATHY
Symmetrical ASCENDING PARALYSIS-onset-max wk <28 days
B/L LMN VII n.palsy Mild Sensory loss
SYMPTOMS
AREFLEXIA ABSENT FEVER
TYPES OF GBS
Acute Inflammatory Demyelinating Polyneuropathy (AIDP)
Acute Motor Acute Motor Sensory
Axonal Neuropathy Axonal Neuropathy
AMAN-M>S AMSAN- M=S
MILLER FISCHER SYNDROME (MFS)
ATAXIA

Gq1b Abs +
AREFLEXIA OPTHALMOPLEGIA
40 LIVE RAPID REVISION

INVESTIGATIONS
Decreased NCV Increased Albumin
Absent F wave No Pleocytosis
NERVE CONDUCTION CSF -ACD
TREATMENT
Best in 14 days of onset Both equally effective

I/V Ig-2gm/kg over 5 days PLASMAPHERESIS

CHRONIC INFLAMMATORY DEMYLENATING
POLYNEUROPATHY (CIDP)
Weakness beyond DEFINITION >3 Relapses
9 weeks of onset -Steroids
Onion bulb -i/v Ig
Appearance -Plasmapheresis
NERVE BIOPSY TREATMENT
CHARCOT MARIE TOOTH DISEASE (CMT)
AD trait FOOT DROP ++
Inverted Champagne
Bottle appearance Onion bulb
Appearance
LL ATROPHY NERVE BIOPSY
 NEUROLOGY 41

MULTIPLE SCLEROSIS (MS)

INFLAMMATION
Trigger Antibodies
Myelin Basic Protein Oligodendrocytes
(MBP) CNS
DEMYELINATION SCLEROSIS
OPTIC NEURITIS -U/L
Uthoff sign Lhermitte sign
Inc. on heat Paraesthesia on flexion
SYMPTOMS of neck
WEAKNESS SENSORY SYMPTOMS

Relapsing MS (RMS)- 90%

a/w
-Vit D deficiency Onset@20-40 yrs
-EBV infection F>M
TYPES
Primary progressive MS Secondary progressive MS
(PPMS)-10% (SPMS) 2% per yr.risk
42 LIVE RAPID REVISION

MRI - Demyelination + Plaques

Dawson
Oligoclonal Fingers Fingers
Bands(OCB) INVESTIGATIONS
CSF EVOKED POTENTIALS(Visual)
ACUTE ATTACK
Methyl
Prednisolone
STEROIDS(DOC) PLASMAPHERESIS
DISEASE MODYFYING AGENTS
Fingolimod ORAL
Dimethyl fumarate Disability-Mitoxantrone
Teriflunomide Relapses
Natalizumab
SAFE-INF(DOC) BEST
NEUROMYELITIS OPTICA
OPTIC NEURITIS-B/L
-MMF
AQP4 Abs - Azathioprine
TRANSVERSE MYELITIS Area postrema SY
>3 segments
 NEUROLOGY 43

MYELOPATHY
SENSORY LOSS

At the level-AHC Below the level -CS tract

LMN UMN
SPINAL SHOCK
-Flaccidity +
Below -Areflexia +
Level -Urinary retention +
TRANSIENT LMN (4-72 hrs) WASTING absent
BROWN SEQUARD SYNDROME
ST LOSS

PC LOSS WEAKNESS
SYRINGOMYELIA
DISSOCIATED ANAESTHESIA -ST loss
-PC intact
Trauma/Tumor/TB Cervical Cape like loss
SYRINX WEAKNESS
a/w Chiari Malformation type 1
44 LIVE RAPID REVISION

CONUS MEDULLARIS SYNDROME

SADDLE ANAESTHESIA

KNEE JERK normal BLADDER-overflow incontinence

CAUDA EQUINA SYNDROME
AREFLEXIA

ASSYMETRICAL LMN PARALYSIS

TRIGEMINAL NERVE
SENSORY NUCLEUS -Spinal (C1,C2)
-Pons

Pons Lesion above Pons

MOTOR NUCLEUS JAW JERK-Brisk
FACIAL PALSY

UMN LMN
 NEUROLOGY 45

MOTOR NEURON DISEASES (MND)

ALS

PLS SMA

AMYOTROPHIC LATERAL SCLEROSIS

WEAKNESS -UMN -CS atrophy
-LMN -AHC atrophy

FASICULATIONS(Pathognomic) BLADDER intact

MUTATIONS

GGGGCC rpts
>200
C9 orf 72 gene(M.C) SOD gene
TREATMENT

Glutamate release
Inhibitor Antioxidant
RILUZOLE EDARAVONE
46 LIVE RAPID REVISION

SPINAL MUSCULAR ATROPHY (SMA)

(chr 5) SMN GENE mutation -loss of
Survival motor neuron
AHC atrophy Incorporate protein
SMN gene
Nusinersen TREATMENT Zolgensma
FRIEDRICH ATAXIA
ATAXIA Deficit -PC
-CS
Pes Cavus Vit E defn. Scoliosis
ARELEXIA EXTENSOR PLANTAR
TABES DORSALIS
NEUROSYPHILLIS

Romberg sign + PC deficit

AREFLEXIA ATAXIA
SUBACUTE COMBINED DEGENERATION
ATAXIA Deficit -PC
-CS
Per.neuritis -Per.nerve Glossitis
AREFLEXIA VIT B12-low
NEUROLOGY 47