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NEUROLOGY REVIEWS
Most of the neurology reviews include common presentations, differential diagnosis, diagnostic testing, and treatment approaches. But keep in mind that the articles are just overviews and you shouldn’t use them for direct patient care. However, they are good resources for the RITE exam, USMLE step 1 or 2CK or 3, MKSAP , SESAP,and neurology
AMSAN - DOCNEURO
AMSAN, or acute motor and sensory axonal neuropathy, is a subtype of Guillain-Barré syndrome that is characterized by a combination of distal weakness (motor), reduction or complete loss of deep tendon reflexes (DTRs) and sensory abnormalities. The clinical presentation of AMSAN is similar to that of other GBS subtypes, incuding an illness OCULOCEPHALIC REFLEX Oculocephalic Reflex. The oculocephalic reflex is also called the doll’s eye reflex, so named because dolls that have movable eyes exhibit the same eye movement. In a comatose patient, if the head is tilted to one side, the eyes move towards the contralateral side. In a conscious patient, such movement is inhibited by the cerebellum.FACIAL NERVE PALSY
Lesions of the facial nerve cause paralysis of the top and bottom part of the face ipsilateral to the lesion. This is the classic “lower motor neuron” lesion of facial paralysis, and produces a facial nerve palsy. The paresis is called a Bell’s Palsy when the etiology for a facial nerve palsy is not known. Lesions in the pons that damage TYPES OF SENSORY FIBERS Fibers within a peripheral nerve are classified by conduction speed and diameter. Fast fibers (A-alpha and A-beta fibers) are fibers of the DC-ML system, so carry light touch, proprioception and vibratory information. Specifically, A-alpha fibers carry proprioception while A-beta fibers carry fine touch. Slow fibers (A-delta and C fibers) are fibers of the anterolateral system,PINEAL CYST
Pineal Cyst. The pineal gland is a small (6-8 mm) midline endocrine structure, partly responsible for the production of serotonin , a neurotransmitter responsible for the modulation of “mood”, expressed by its effect on such fundamental behaviors as appetite, sleep, sex and mood.NERNST EQUATION
EARLY SIGNS OF STROKE ON CT The commonly used signs of embolic stroke on head CT include: “Dense MCA sign” is caused by opacification of the MCA by a thrombus. When noted this is likely to be in the horizontal body of the MCA coming off of the Circle of Willis, but more subtly can also be sometimes seen in a branch of the MCA. In the figure below the right MCA is CAROTID ARTERY DISSECTION, MRA Carotid Artery Dissection, MRA. Carotid/vertebral artery dissection is an underdiagnosed disease that can result in substantial morbidity. It has an incidence of 1-1.5/100000 and disproportionately affects young patients. Diagnosis is challenging clinically because the symptoms are often non specific and most commonly include unilateral DISCITIS/OSTEOMYELITIS WITH EPIDURAL PHLEGMON Discitis/Osteomyelitis with Epidural Phlegmon. Christopher Buckle MD — February 21, 2013 comments off. Epidural abscess is a rare condition affecting about 2 in 10,000 patients. Spinal infection typically starts in the disc (discitis), which is seeded through hematogenous dissemination of infection, typically staph aureus and often in drug users.NEUROLOGY REVIEWS
Most of the neurology reviews include common presentations, differential diagnosis, diagnostic testing, and treatment approaches. But keep in mind that the articles are just overviews and you shouldn’t use them for direct patient care. However, they are good resources for the RITE exam, USMLE step 1 or 2CK or 3, MKSAP , SESAP,and neurology
AMSAN - DOCNEURO
AMSAN, or acute motor and sensory axonal neuropathy, is a subtype of Guillain-Barré syndrome that is characterized by a combination of distal weakness (motor), reduction or complete loss of deep tendon reflexes (DTRs) and sensory abnormalities. The clinical presentation of AMSAN is similar to that of other GBS subtypes, incuding an illnessFACIAL NERVE PALSY
Lesions of the facial nerve cause paralysis of the top and bottom part of the face ipsilateral to the lesion. This is the classic “lower motor neuron” lesion of facial paralysis, and produces a facial nerve palsy. The paresis is called a Bell’s Palsy when the etiology for a facial nerve palsy is not known. Lesions in the pons that damage TYPES OF SENSORY FIBERS Fibers within a peripheral nerve are classified by conduction speed and diameter. Fast fibers (A-alpha and A-beta fibers) are fibers of the DC-ML system, so carry light touch, proprioception and vibratory information. Specifically, A-alpha fibers carry proprioception while A-beta fibers carry fine touch. Slow fibers (A-delta and C fibers) are fibers of the anterolateral system, OCULOCEPHALIC REFLEX Oculocephalic Reflex. The oculocephalic reflex is also called the doll’s eye reflex, so named because dolls that have movable eyes exhibit the same eye movement. In a comatose patient, if the head is tilted to one side, the eyes move towards the contralateral side. In a conscious patient, such movement is inhibited by the cerebellum.PINEAL CYST
Pineal Cyst. The pineal gland is a small (6-8 mm) midline endocrine structure, partly responsible for the production of serotonin , a neurotransmitter responsible for the modulation of “mood”, expressed by its effect on such fundamental behaviors as appetite, sleep, sex and mood.NERNST EQUATION
EARLY SIGNS OF STROKE ON CT The commonly used signs of embolic stroke on head CT include: “Dense MCA sign” is caused by opacification of the MCA by a thrombus. When noted this is likely to be in the horizontal body of the MCA coming off of the Circle of Willis, but more subtly can also be sometimes seen in a branch of the MCA. In the figure below the right MCA is CEREBRAL SALT WASTING V. SIADH Cerebral Salt Wasting v. SIADH. Annie Lauer Castro — November 24, 2013 comments off. Both cerebral salt wasting and SIADH (sometimes both together) are commonly found in patients with intracranial hemorrhages. Differentiating between the two has important clinical implications, since the interventions are different for each syndrome. DISCITIS/OSTEOMYELITIS WITH EPIDURAL PHLEGMON Discitis/Osteomyelitis with Epidural Phlegmon. Christopher Buckle MD — February 21, 2013 comments off. Epidural abscess is a rare condition affecting about 2 in 10,000 patients. Spinal infection typically starts in the disc (discitis), which is seeded through hematogenous dissemination of infection, typically staph aureus and often in drug users.MENINGES - DOCNEURO
The meninges are made up of three layers (dura mater, arachnoid, and pia mater) that enclose the central nervous system. Working with the cerebrospinal fluid, they function to cushion and nourish the brain and spinal cord. The brain and cerebrospinal fluid both have the same specific gravity, so any trauma to the head causes uniform FRONTAL LOBE SYNDROMES Summary: This is a classic presentation of a traumatic contrecoup injury to bilateral orbitofrontal areas. The change in baseline behavior with emotional lability is often seen with orbitofrontal lesions, and the loss of smell and taste helps with localization. dorsolateral frontal lobe dorsomedial frontal lobe frontal lobeorbitofrontal.
ANTEROLATERAL SYSTEM The anterolateral system carries pain and temperature information from the periphery to the VPL nucleus of the thalamus, and on up into the somatosensory cortex. Peripheral Receptors Pain receptors (called nociceptors) are “free nerve endings,” that is, there is no extra-cellular matrix capsule or epithelial cell receptor coupled to the neuron. These free nerve endings CAROTID ARTERY DISSECTION, MRA Carotid Artery Dissection, MRA. Carotid/vertebral artery dissection is an underdiagnosed disease that can result in substantial morbidity. It has an incidence of 1-1.5/100000 and disproportionately affects young patients. Diagnosis is challenging clinically because the symptoms are often non specific and most commonly include unilateral BRAIN MRI SPECTROSCOPY MR spectroscopy gives a chemical profile of a region of brain. This is useful in differentiating normal brain tissue from tumor, regions with ischemia, or other tissue abnormalities. Abnormal areas identified on structural MRI are typically compared to the normal contralateral areaas a
DISCITIS/OSTEOMYELITIS WITH EPIDURAL PHLEGMON Discitis/Osteomyelitis with Epidural Phlegmon. Christopher Buckle MD — February 21, 2013 comments off. Epidural abscess is a rare condition affecting about 2 in 10,000 patients. Spinal infection typically starts in the disc (discitis), which is seeded through hematogenous dissemination of infection, typically staph aureus and often in drug users.WATERSHED INFARCT
Watershed infarcts typically present as multiple small infarcts in the specific regions described above. These small infarct, aligned in a watershed territory, create a “rosary” pattern. Most watershed infarcts result from hypoperfusion to the cortex. This might be from cardiac arrest, severe ICA stenosis or medical causes of hypotension.ACUTE INFARCT ON CT
Diagnosis: Acute embolic non hemorrhagic right middle cerebral artery infarct on CT. Figure 1: (a,red arrow) axial non contrast CT demonstrates a hyperdense middle cerebral artery. There is loss of grey white differentiation involving the insular cortex and right basal ganglia (b,blue arrow). CT is the initial imaging modalityperformed in the
CRITERIA TO GIVE TPA FOR STROKE Criteria to Give tPA for Stroke. tPA for ischemic stroke was first approved in 1996 based on the result of two NINDS studies that compared outcomes of placebo or IV tPA given in the first 3 hours of a stroke. The studies found that tPA improved outcomes for 1 in 3 patients (number needed to treat = 3 for improvement compared toplacebo) and
CEREBRAL SALT WASTING V. SIADH Cerebral Salt Wasting v. SIADH. Annie Lauer Castro — November 24, 2013 comments off. Both cerebral salt wasting and SIADH (sometimes both together) are commonly found in patients with intracranial hemorrhages. Differentiating between the two has important clinical implications, since the interventions are different for each syndrome.NEUROLOGY REVIEWS
Most of the neurology reviews include common presentations, differential diagnosis, diagnostic testing, and treatment approaches. But keep in mind that the articles are just overviews and you shouldn’t use them for direct patient care. However, they are good resources for the RITE exam, USMLE step 1 or 2CK or 3, MKSAP , SESAP,and neurology
AMSAN - DOCNEURO
AMSAN, or acute motor and sensory axonal neuropathy, is a subtype of Guillain-Barré syndrome that is characterized by a combination of distal weakness (motor), reduction or complete loss of deep tendon reflexes (DTRs) and sensory abnormalities. The clinical presentation of AMSAN is similar to that of other GBS subtypes, incuding an illness OCULOCEPHALIC REFLEX Oculocephalic Reflex. The oculocephalic reflex is also called the doll’s eye reflex, so named because dolls that have movable eyes exhibit the same eye movement. In a comatose patient, if the head is tilted to one side, the eyes move towards the contralateral side. In a conscious patient, such movement is inhibited by the cerebellum.FACIAL NERVE PALSY
Lesions of the facial nerve cause paralysis of the top and bottom part of the face ipsilateral to the lesion. This is the classic “lower motor neuron” lesion of facial paralysis, and produces a facial nerve palsy. The paresis is called a Bell’s Palsy when the etiology for a facial nerve palsy is not known. Lesions in the pons that damage TYPES OF SENSORY FIBERS Fibers within a peripheral nerve are classified by conduction speed and diameter. Fast fibers (A-alpha and A-beta fibers) are fibers of the DC-ML system, so carry light touch, proprioception and vibratory information. Specifically, A-alpha fibers carry proprioception while A-beta fibers carry fine touch. Slow fibers (A-delta and C fibers) are fibers of the anterolateral system,PINEAL CYST
Pineal Cyst. The pineal gland is a small (6-8 mm) midline endocrine structure, partly responsible for the production of serotonin , a neurotransmitter responsible for the modulation of “mood”, expressed by its effect on such fundamental behaviors as appetite, sleep, sex and mood.NERNST EQUATION
EARLY SIGNS OF STROKE ON CT The commonly used signs of embolic stroke on head CT include: “Dense MCA sign” is caused by opacification of the MCA by a thrombus. When noted this is likely to be in the horizontal body of the MCA coming off of the Circle of Willis, but more subtly can also be sometimes seen in a branch of the MCA. In the figure below the right MCA is CAROTID ARTERY DISSECTION, MRA Carotid Artery Dissection, MRA. Carotid/vertebral artery dissection is an underdiagnosed disease that can result in substantial morbidity. It has an incidence of 1-1.5/100000 and disproportionately affects young patients. Diagnosis is challenging clinically because the symptoms are often non specific and most commonly include unilateral DISCITIS/OSTEOMYELITIS WITH EPIDURAL PHLEGMON Discitis/Osteomyelitis with Epidural Phlegmon. Christopher Buckle MD — February 21, 2013 comments off. Epidural abscess is a rare condition affecting about 2 in 10,000 patients. Spinal infection typically starts in the disc (discitis), which is seeded through hematogenous dissemination of infection, typically staph aureus and often in drug users.NEUROLOGY REVIEWS
Most of the neurology reviews include common presentations, differential diagnosis, diagnostic testing, and treatment approaches. But keep in mind that the articles are just overviews and you shouldn’t use them for direct patient care. However, they are good resources for the RITE exam, USMLE step 1 or 2CK or 3, MKSAP , SESAP,and neurology
AMSAN - DOCNEURO
AMSAN, or acute motor and sensory axonal neuropathy, is a subtype of Guillain-Barré syndrome that is characterized by a combination of distal weakness (motor), reduction or complete loss of deep tendon reflexes (DTRs) and sensory abnormalities. The clinical presentation of AMSAN is similar to that of other GBS subtypes, incuding an illness OCULOCEPHALIC REFLEX Oculocephalic Reflex. The oculocephalic reflex is also called the doll’s eye reflex, so named because dolls that have movable eyes exhibit the same eye movement. In a comatose patient, if the head is tilted to one side, the eyes move towards the contralateral side. In a conscious patient, such movement is inhibited by the cerebellum.FACIAL NERVE PALSY
Lesions of the facial nerve cause paralysis of the top and bottom part of the face ipsilateral to the lesion. This is the classic “lower motor neuron” lesion of facial paralysis, and produces a facial nerve palsy. The paresis is called a Bell’s Palsy when the etiology for a facial nerve palsy is not known. Lesions in the pons that damage TYPES OF SENSORY FIBERS Fibers within a peripheral nerve are classified by conduction speed and diameter. Fast fibers (A-alpha and A-beta fibers) are fibers of the DC-ML system, so carry light touch, proprioception and vibratory information. Specifically, A-alpha fibers carry proprioception while A-beta fibers carry fine touch. Slow fibers (A-delta and C fibers) are fibers of the anterolateral system,PINEAL CYST
Pineal Cyst. The pineal gland is a small (6-8 mm) midline endocrine structure, partly responsible for the production of serotonin , a neurotransmitter responsible for the modulation of “mood”, expressed by its effect on such fundamental behaviors as appetite, sleep, sex and mood.NERNST EQUATION
EARLY SIGNS OF STROKE ON CT The commonly used signs of embolic stroke on head CT include: “Dense MCA sign” is caused by opacification of the MCA by a thrombus. When noted this is likely to be in the horizontal body of the MCA coming off of the Circle of Willis, but more subtly can also be sometimes seen in a branch of the MCA. In the figure below the right MCA is CAROTID ARTERY DISSECTION, MRA Carotid Artery Dissection, MRA. Carotid/vertebral artery dissection is an underdiagnosed disease that can result in substantial morbidity. It has an incidence of 1-1.5/100000 and disproportionately affects young patients. Diagnosis is challenging clinically because the symptoms are often non specific and most commonly include unilateral DISCITIS/OSTEOMYELITIS WITH EPIDURAL PHLEGMON Discitis/Osteomyelitis with Epidural Phlegmon. Christopher Buckle MD — February 21, 2013 comments off. Epidural abscess is a rare condition affecting about 2 in 10,000 patients. Spinal infection typically starts in the disc (discitis), which is seeded through hematogenous dissemination of infection, typically staph aureus and often in drug users.MENINGES - DOCNEURO
The meninges are made up of three layers (dura mater, arachnoid, and pia mater) that enclose the central nervous system. Working with the cerebrospinal fluid, they function to cushion and nourish the brain and spinal cord. The brain and cerebrospinal fluid both have the same specific gravity, so any trauma to the head causes uniform FRONTAL LOBE SYNDROMES Summary: This is a classic presentation of a traumatic contrecoup injury to bilateral orbitofrontal areas. The change in baseline behavior with emotional lability is often seen with orbitofrontal lesions, and the loss of smell and taste helps with localization. dorsolateral frontal lobe dorsomedial frontal lobe frontal lobeorbitofrontal.
ANTEROLATERAL SYSTEM The anterolateral system carries pain and temperature information from the periphery to the VPL nucleus of the thalamus, and on up into the somatosensory cortex. Peripheral Receptors Pain receptors (called nociceptors) are “free nerve endings,” that is, there is no extra-cellular matrix capsule or epithelial cell receptor coupled to the neuron. These free nerve endings CAROTID ARTERY DISSECTION, MRA Carotid Artery Dissection, MRA. Carotid/vertebral artery dissection is an underdiagnosed disease that can result in substantial morbidity. It has an incidence of 1-1.5/100000 and disproportionately affects young patients. Diagnosis is challenging clinically because the symptoms are often non specific and most commonly include unilateral BRAIN MRI SPECTROSCOPY MR spectroscopy gives a chemical profile of a region of brain. This is useful in differentiating normal brain tissue from tumor, regions with ischemia, or other tissue abnormalities. Abnormal areas identified on structural MRI are typically compared to the normal contralateral areaas a
DISCITIS/OSTEOMYELITIS WITH EPIDURAL PHLEGMON Discitis/Osteomyelitis with Epidural Phlegmon. Christopher Buckle MD — February 21, 2013 comments off. Epidural abscess is a rare condition affecting about 2 in 10,000 patients. Spinal infection typically starts in the disc (discitis), which is seeded through hematogenous dissemination of infection, typically staph aureus and often in drug users.WATERSHED INFARCT
Watershed infarcts typically present as multiple small infarcts in the specific regions described above. These small infarct, aligned in a watershed territory, create a “rosary” pattern. Most watershed infarcts result from hypoperfusion to the cortex. This might be from cardiac arrest, severe ICA stenosis or medical causes of hypotension.ACUTE INFARCT ON CT
Diagnosis: Acute embolic non hemorrhagic right middle cerebral artery infarct on CT. Figure 1: (a,red arrow) axial non contrast CT demonstrates a hyperdense middle cerebral artery. There is loss of grey white differentiation involving the insular cortex and right basal ganglia (b,blue arrow). CT is the initial imaging modalityperformed in the
CRITERIA TO GIVE TPA FOR STROKE Criteria to Give tPA for Stroke. tPA for ischemic stroke was first approved in 1996 based on the result of two NINDS studies that compared outcomes of placebo or IV tPA given in the first 3 hours of a stroke. The studies found that tPA improved outcomes for 1 in 3 patients (number needed to treat = 3 for improvement compared toplacebo) and
CEREBRAL SALT WASTING V. SIADH Cerebral Salt Wasting v. SIADH. Annie Lauer Castro — November 24, 2013 comments off. Both cerebral salt wasting and SIADH (sometimes both together) are commonly found in patients with intracranial hemorrhages. Differentiating between the two has important clinical implications, since the interventions are different for each syndrome.NEUROLOGY REVIEWS
Most of the neurology reviews include common presentations, differential diagnosis, diagnostic testing, and treatment approaches. But keep in mind that the articles are just overviews and you shouldn’t use them for direct patient care. However, they are good resources for the RITE exam, USMLE step 1 or 2CK or 3, MKSAP , SESAP,and neurology
AMSAN - DOCNEURO
AMSAN, or acute motor and sensory axonal neuropathy, is a subtype of Guillain-Barré syndrome that is characterized by a combination of distal weakness (motor), reduction or complete loss of deep tendon reflexes (DTRs) and sensory abnormalities. The clinical presentation of AMSAN is similar to that of other GBS subtypes, incuding an illnessFACIAL NERVE PALSY
Lesions of the facial nerve cause paralysis of the top and bottom part of the face ipsilateral to the lesion. This is the classic “lower motor neuron” lesion of facial paralysis, and produces a facial nerve palsy. The paresis is called a Bell’s Palsy when the etiology for a facial nerve palsy is not known. Lesions in the pons that damage OCULOCEPHALIC REFLEX Oculocephalic Reflex. The oculocephalic reflex is also called the doll’s eye reflex, so named because dolls that have movable eyes exhibit the same eye movement. In a comatose patient, if the head is tilted to one side, the eyes move towards the contralateral side. In a conscious patient, such movement is inhibited by the cerebellum. TYPES OF SENSORY FIBERS Fibers within a peripheral nerve are classified by conduction speed and diameter. Fast fibers (A-alpha and A-beta fibers) are fibers of the DC-ML system, so carry light touch, proprioception and vibratory information. Specifically, A-alpha fibers carry proprioception while A-beta fibers carry fine touch. Slow fibers (A-delta and C fibers) are fibers of the anterolateral system,PINEAL CYST
Pineal Cyst. The pineal gland is a small (6-8 mm) midline endocrine structure, partly responsible for the production of serotonin , a neurotransmitter responsible for the modulation of “mood”, expressed by its effect on such fundamental behaviors as appetite, sleep, sex and mood.NERNST EQUATION
EARLY SIGNS OF STROKE ON CT The commonly used signs of embolic stroke on head CT include: “Dense MCA sign” is caused by opacification of the MCA by a thrombus. When noted this is likely to be in the horizontal body of the MCA coming off of the Circle of Willis, but more subtly can also be sometimes seen in a branch of the MCA. In the figure below the right MCA is CAROTID ARTERY DISSECTION, MRA Carotid Artery Dissection, MRA. Carotid/vertebral artery dissection is an underdiagnosed disease that can result in substantial morbidity. It has an incidence of 1-1.5/100000 and disproportionately affects young patients. Diagnosis is challenging clinically because the symptoms are often non specific and most commonly include unilateral DISCITIS/OSTEOMYELITIS WITH EPIDURAL PHLEGMON Discitis/Osteomyelitis with Epidural Phlegmon. Christopher Buckle MD — February 21, 2013 comments off. Epidural abscess is a rare condition affecting about 2 in 10,000 patients. Spinal infection typically starts in the disc (discitis), which is seeded through hematogenous dissemination of infection, typically staph aureus and often in drug users.NEUROLOGY REVIEWS
Most of the neurology reviews include common presentations, differential diagnosis, diagnostic testing, and treatment approaches. But keep in mind that the articles are just overviews and you shouldn’t use them for direct patient care. However, they are good resources for the RITE exam, USMLE step 1 or 2CK or 3, MKSAP , SESAP,and neurology
AMSAN - DOCNEURO
AMSAN, or acute motor and sensory axonal neuropathy, is a subtype of Guillain-Barré syndrome that is characterized by a combination of distal weakness (motor), reduction or complete loss of deep tendon reflexes (DTRs) and sensory abnormalities. The clinical presentation of AMSAN is similar to that of other GBS subtypes, incuding an illnessFACIAL NERVE PALSY
Lesions of the facial nerve cause paralysis of the top and bottom part of the face ipsilateral to the lesion. This is the classic “lower motor neuron” lesion of facial paralysis, and produces a facial nerve palsy. The paresis is called a Bell’s Palsy when the etiology for a facial nerve palsy is not known. Lesions in the pons that damage OCULOCEPHALIC REFLEX Oculocephalic Reflex. The oculocephalic reflex is also called the doll’s eye reflex, so named because dolls that have movable eyes exhibit the same eye movement. In a comatose patient, if the head is tilted to one side, the eyes move towards the contralateral side. In a conscious patient, such movement is inhibited by the cerebellum. TYPES OF SENSORY FIBERS Fibers within a peripheral nerve are classified by conduction speed and diameter. Fast fibers (A-alpha and A-beta fibers) are fibers of the DC-ML system, so carry light touch, proprioception and vibratory information. Specifically, A-alpha fibers carry proprioception while A-beta fibers carry fine touch. Slow fibers (A-delta and C fibers) are fibers of the anterolateral system,PINEAL CYST
Pineal Cyst. The pineal gland is a small (6-8 mm) midline endocrine structure, partly responsible for the production of serotonin , a neurotransmitter responsible for the modulation of “mood”, expressed by its effect on such fundamental behaviors as appetite, sleep, sex and mood.NERNST EQUATION
EARLY SIGNS OF STROKE ON CT The commonly used signs of embolic stroke on head CT include: “Dense MCA sign” is caused by opacification of the MCA by a thrombus. When noted this is likely to be in the horizontal body of the MCA coming off of the Circle of Willis, but more subtly can also be sometimes seen in a branch of the MCA. In the figure below the right MCA is CAROTID ARTERY DISSECTION, MRA Carotid Artery Dissection, MRA. Carotid/vertebral artery dissection is an underdiagnosed disease that can result in substantial morbidity. It has an incidence of 1-1.5/100000 and disproportionately affects young patients. Diagnosis is challenging clinically because the symptoms are often non specific and most commonly include unilateral DISCITIS/OSTEOMYELITIS WITH EPIDURAL PHLEGMON Discitis/Osteomyelitis with Epidural Phlegmon. Christopher Buckle MD — February 21, 2013 comments off. Epidural abscess is a rare condition affecting about 2 in 10,000 patients. Spinal infection typically starts in the disc (discitis), which is seeded through hematogenous dissemination of infection, typically staph aureus and often in drug users.MENINGES - DOCNEURO
The meninges are made up of three layers (dura mater, arachnoid, and pia mater) that enclose the central nervous system. Working with the cerebrospinal fluid, they function to cushion and nourish the brain and spinal cord. The brain and cerebrospinal fluid both have the same specific gravity, so any trauma to the head causes uniform FRONTAL LOBE SYNDROMES Summary: This is a classic presentation of a traumatic contrecoup injury to bilateral orbitofrontal areas. The change in baseline behavior with emotional lability is often seen with orbitofrontal lesions, and the loss of smell and taste helps with localization. dorsolateral frontal lobe dorsomedial frontal lobe frontal lobeorbitofrontal.
ANTEROLATERAL SYSTEM The anterolateral system carries pain and temperature information from the periphery to the VPL nucleus of the thalamus, and on up into the somatosensory cortex. Peripheral Receptors Pain receptors (called nociceptors) are “free nerve endings,” that is, there is no extra-cellular matrix capsule or epithelial cell receptor coupled to the neuron. These free nerve endings CAROTID ARTERY DISSECTION, MRA Carotid Artery Dissection, MRA. Carotid/vertebral artery dissection is an underdiagnosed disease that can result in substantial morbidity. It has an incidence of 1-1.5/100000 and disproportionately affects young patients. Diagnosis is challenging clinically because the symptoms are often non specific and most commonly include unilateral BRAIN MRI SPECTROSCOPY MR spectroscopy gives a chemical profile of a region of brain. This is useful in differentiating normal brain tissue from tumor, regions with ischemia, or other tissue abnormalities. Abnormal areas identified on structural MRI are typically compared to the normal contralateral areaas a
DISCITIS/OSTEOMYELITIS WITH EPIDURAL PHLEGMON Discitis/Osteomyelitis with Epidural Phlegmon. Christopher Buckle MD — February 21, 2013 comments off. Epidural abscess is a rare condition affecting about 2 in 10,000 patients. Spinal infection typically starts in the disc (discitis), which is seeded through hematogenous dissemination of infection, typically staph aureus and often in drug users. NON-REM SLEEP ON EEG Non-REM sleep on EEG. Sleep stages can be identified by the appearance of characteristic electrical patterns on EEG. Sleep can initially be broken down into REM-sleep and non-REM sleep, with further parcelization of non-REM sleep into stages 1-4. Stage 1 of non-REM sleep is the state of being drowsy, while stage 2 usually constitutesjust more
ACUTE INFARCT ON CT
Diagnosis: Acute embolic non hemorrhagic right middle cerebral artery infarct on CT. Figure 1: (a,red arrow) axial non contrast CT demonstrates a hyperdense middle cerebral artery. There is loss of grey white differentiation involving the insular cortex and right basal ganglia (b,blue arrow). CT is the initial imaging modalityperformed in the
CEREBRAL SALT WASTING V. SIADH Cerebral Salt Wasting v. SIADH. Annie Lauer Castro — November 24, 2013 comments off. Both cerebral salt wasting and SIADH (sometimes both together) are commonly found in patients with intracranial hemorrhages. Differentiating between the two has important clinical implications, since the interventions are different for each syndrome. CRITERIA TO GIVE TPA FOR STROKE Criteria to Give tPA for Stroke. tPA for ischemic stroke was first approved in 1996 based on the result of two NINDS studies that compared outcomes of placebo or IV tPA given in the first 3 hours of a stroke. The studies found that tPA improved outcomes for 1 in 3 patients (number needed to treat = 3 for improvement compared toplacebo) and
NEUROLOGY REVIEWS
Most of the neurology reviews include common presentations, differential diagnosis, diagnostic testing, and treatment approaches. But keep in mind that the articles are just overviews and you shouldn’t use them for direct patient care. However, they are good resources for the RITE exam, USMLE step 1 or 2CK or 3, MKSAP , SESAP,and neurology
AMSAN - DOCNEURO
AMSAN, or acute motor and sensory axonal neuropathy, is a subtype of Guillain-Barré syndrome that is characterized by a combination of distal weakness (motor), reduction or complete loss of deep tendon reflexes (DTRs) and sensory abnormalities. The clinical presentation of AMSAN is similar to that of other GBS subtypes, incuding an illnessFACIAL NERVE PALSY
Lesions of the facial nerve cause paralysis of the top and bottom part of the face ipsilateral to the lesion. This is the classic “lower motor neuron” lesion of facial paralysis, and produces a facial nerve palsy. The paresis is called a Bell’s Palsy when the etiology for a facial nerve palsy is not known. Lesions in the pons that damage OCULOCEPHALIC REFLEX Oculocephalic Reflex. The oculocephalic reflex is also called the doll’s eye reflex, so named because dolls that have movable eyes exhibit the same eye movement. In a comatose patient, if the head is tilted to one side, the eyes move towards the contralateral side. In a conscious patient, such movement is inhibited by the cerebellum. TYPES OF SENSORY FIBERS Fibers within a peripheral nerve are classified by conduction speed and diameter. Fast fibers (A-alpha and A-beta fibers) are fibers of the DC-ML system, so carry light touch, proprioception and vibratory information. Specifically, A-alpha fibers carry proprioception while A-beta fibers carry fine touch. Slow fibers (A-delta and C fibers) are fibers of the anterolateral system,PINEAL CYST
Pineal Cyst. The pineal gland is a small (6-8 mm) midline endocrine structure, partly responsible for the production of serotonin , a neurotransmitter responsible for the modulation of “mood”, expressed by its effect on such fundamental behaviors as appetite, sleep, sex and mood.NERNST EQUATION
EARLY SIGNS OF STROKE ON CT The commonly used signs of embolic stroke on head CT include: “Dense MCA sign” is caused by opacification of the MCA by a thrombus. When noted this is likely to be in the horizontal body of the MCA coming off of the Circle of Willis, but more subtly can also be sometimes seen in a branch of the MCA. In the figure below the right MCA is CAROTID ARTERY DISSECTION, MRA Carotid Artery Dissection, MRA. Carotid/vertebral artery dissection is an underdiagnosed disease that can result in substantial morbidity. It has an incidence of 1-1.5/100000 and disproportionately affects young patients. Diagnosis is challenging clinically because the symptoms are often non specific and most commonly include unilateral DISCITIS/OSTEOMYELITIS WITH EPIDURAL PHLEGMON Discitis/Osteomyelitis with Epidural Phlegmon. Christopher Buckle MD — February 21, 2013 comments off. Epidural abscess is a rare condition affecting about 2 in 10,000 patients. Spinal infection typically starts in the disc (discitis), which is seeded through hematogenous dissemination of infection, typically staph aureus and often in drug users.NEUROLOGY REVIEWS
Most of the neurology reviews include common presentations, differential diagnosis, diagnostic testing, and treatment approaches. But keep in mind that the articles are just overviews and you shouldn’t use them for direct patient care. However, they are good resources for the RITE exam, USMLE step 1 or 2CK or 3, MKSAP , SESAP,and neurology
AMSAN - DOCNEURO
AMSAN, or acute motor and sensory axonal neuropathy, is a subtype of Guillain-Barré syndrome that is characterized by a combination of distal weakness (motor), reduction or complete loss of deep tendon reflexes (DTRs) and sensory abnormalities. The clinical presentation of AMSAN is similar to that of other GBS subtypes, incuding an illnessFACIAL NERVE PALSY
Lesions of the facial nerve cause paralysis of the top and bottom part of the face ipsilateral to the lesion. This is the classic “lower motor neuron” lesion of facial paralysis, and produces a facial nerve palsy. The paresis is called a Bell’s Palsy when the etiology for a facial nerve palsy is not known. Lesions in the pons that damage OCULOCEPHALIC REFLEX Oculocephalic Reflex. The oculocephalic reflex is also called the doll’s eye reflex, so named because dolls that have movable eyes exhibit the same eye movement. In a comatose patient, if the head is tilted to one side, the eyes move towards the contralateral side. In a conscious patient, such movement is inhibited by the cerebellum. TYPES OF SENSORY FIBERS Fibers within a peripheral nerve are classified by conduction speed and diameter. Fast fibers (A-alpha and A-beta fibers) are fibers of the DC-ML system, so carry light touch, proprioception and vibratory information. Specifically, A-alpha fibers carry proprioception while A-beta fibers carry fine touch. Slow fibers (A-delta and C fibers) are fibers of the anterolateral system,PINEAL CYST
Pineal Cyst. The pineal gland is a small (6-8 mm) midline endocrine structure, partly responsible for the production of serotonin , a neurotransmitter responsible for the modulation of “mood”, expressed by its effect on such fundamental behaviors as appetite, sleep, sex and mood.NERNST EQUATION
EARLY SIGNS OF STROKE ON CT The commonly used signs of embolic stroke on head CT include: “Dense MCA sign” is caused by opacification of the MCA by a thrombus. When noted this is likely to be in the horizontal body of the MCA coming off of the Circle of Willis, but more subtly can also be sometimes seen in a branch of the MCA. In the figure below the right MCA is CAROTID ARTERY DISSECTION, MRA Carotid Artery Dissection, MRA. Carotid/vertebral artery dissection is an underdiagnosed disease that can result in substantial morbidity. It has an incidence of 1-1.5/100000 and disproportionately affects young patients. Diagnosis is challenging clinically because the symptoms are often non specific and most commonly include unilateral DISCITIS/OSTEOMYELITIS WITH EPIDURAL PHLEGMON Discitis/Osteomyelitis with Epidural Phlegmon. Christopher Buckle MD — February 21, 2013 comments off. Epidural abscess is a rare condition affecting about 2 in 10,000 patients. Spinal infection typically starts in the disc (discitis), which is seeded through hematogenous dissemination of infection, typically staph aureus and often in drug users.MENINGES - DOCNEURO
The meninges are made up of three layers (dura mater, arachnoid, and pia mater) that enclose the central nervous system. Working with the cerebrospinal fluid, they function to cushion and nourish the brain and spinal cord. The brain and cerebrospinal fluid both have the same specific gravity, so any trauma to the head causes uniform ANTEROLATERAL SYSTEM The anterolateral system carries pain and temperature information from the periphery to the VPL nucleus of the thalamus, and on up into the somatosensory cortex. Peripheral Receptors Pain receptors (called nociceptors) are “free nerve endings,” that is, there is no extra-cellular matrix capsule or epithelial cell receptor coupled to the neuron. These free nerve endings CAROTID ARTERY DISSECTION, MRA Carotid Artery Dissection, MRA. Carotid/vertebral artery dissection is an underdiagnosed disease that can result in substantial morbidity. It has an incidence of 1-1.5/100000 and disproportionately affects young patients. Diagnosis is challenging clinically because the symptoms are often non specific and most commonly include unilateral FRONTAL LOBE SYNDROMES Summary: This is a classic presentation of a traumatic contrecoup injury to bilateral orbitofrontal areas. The change in baseline behavior with emotional lability is often seen with orbitofrontal lesions, and the loss of smell and taste helps with localization. dorsolateral frontal lobe dorsomedial frontal lobe frontal lobeorbitofrontal.
BRAIN MRI SPECTROSCOPY MR spectroscopy gives a chemical profile of a region of brain. This is useful in differentiating normal brain tissue from tumor, regions with ischemia, or other tissue abnormalities. Abnormal areas identified on structural MRI are typically compared to the normal contralateral areaas a
DISCITIS/OSTEOMYELITIS WITH EPIDURAL PHLEGMON Discitis/Osteomyelitis with Epidural Phlegmon. Christopher Buckle MD — February 21, 2013 comments off. Epidural abscess is a rare condition affecting about 2 in 10,000 patients. Spinal infection typically starts in the disc (discitis), which is seeded through hematogenous dissemination of infection, typically staph aureus and often in drug users. NON-REM SLEEP ON EEG Non-REM sleep on EEG. Sleep stages can be identified by the appearance of characteristic electrical patterns on EEG. Sleep can initially be broken down into REM-sleep and non-REM sleep, with further parcelization of non-REM sleep into stages 1-4. Stage 1 of non-REM sleep is the state of being drowsy, while stage 2 usually constitutesjust more
CEREBRAL SALT WASTING V. SIADH Cerebral Salt Wasting v. SIADH. Annie Lauer Castro — November 24, 2013 comments off. Both cerebral salt wasting and SIADH (sometimes both together) are commonly found in patients with intracranial hemorrhages. Differentiating between the two has important clinical implications, since the interventions are different for each syndrome.ACUTE INFARCT ON CT
Diagnosis: Acute embolic non hemorrhagic right middle cerebral artery infarct on CT. Figure 1: (a,red arrow) axial non contrast CT demonstrates a hyperdense middle cerebral artery. There is loss of grey white differentiation involving the insular cortex and right basal ganglia (b,blue arrow). CT is the initial imaging modalityperformed in the
CRITERIA TO GIVE TPA FOR STROKE Criteria to Give tPA for Stroke. tPA for ischemic stroke was first approved in 1996 based on the result of two NINDS studies that compared outcomes of placebo or IV tPA given in the first 3 hours of a stroke. The studies found that tPA improved outcomes for 1 in 3 patients (number needed to treat = 3 for improvement compared toplacebo) and
NEUROLOGY REVIEWS
Most of the neurology reviews include common presentations, differential diagnosis, diagnostic testing, and treatment approaches. But keep in mind that the articles are just overviews and you shouldn’t use them for direct patient care. However, they are good resources for the RITE exam, USMLE step 1 or 2CK or 3, MKSAP , SESAP,and neurology
AMSAN - DOCNEURO
AMSAN, or acute motor and sensory axonal neuropathy, is a subtype of Guillain-Barré syndrome that is characterized by a combination of distal weakness (motor), reduction or complete loss of deep tendon reflexes (DTRs) and sensory abnormalities. The clinical presentation of AMSAN is similar to that of other GBS subtypes, incuding an illnessFACIAL NERVE PALSY
Lesions of the facial nerve cause paralysis of the top and bottom part of the face ipsilateral to the lesion. This is the classic “lower motor neuron” lesion of facial paralysis, and produces a facial nerve palsy. The paresis is called a Bell’s Palsy when the etiology for a facial nerve palsy is not known. Lesions in the pons that damage TYPES OF SENSORY FIBERS Fibers within a peripheral nerve are classified by conduction speed and diameter. Fast fibers (A-alpha and A-beta fibers) are fibers of the DC-ML system, so carry light touch, proprioception and vibratory information. Specifically, A-alpha fibers carry proprioception while A-beta fibers carry fine touch. Slow fibers (A-delta and C fibers) are fibers of the anterolateral system, OCULOCEPHALIC REFLEX Oculocephalic Reflex. The oculocephalic reflex is also called the doll’s eye reflex, so named because dolls that have movable eyes exhibit the same eye movement. In a comatose patient, if the head is tilted to one side, the eyes move towards the contralateral side. In a conscious patient, such movement is inhibited by the cerebellum.PINEAL CYST
Pineal Cyst. The pineal gland is a small (6-8 mm) midline endocrine structure, partly responsible for the production of serotonin , a neurotransmitter responsible for the modulation of “mood”, expressed by its effect on such fundamental behaviors as appetite, sleep, sex and mood. CAROTID ARTERY DISSECTION, MRA Carotid Artery Dissection, MRA. Carotid/vertebral artery dissection is an underdiagnosed disease that can result in substantial morbidity. It has an incidence of 1-1.5/100000 and disproportionately affects young patients. Diagnosis is challenging clinically because the symptoms are often non specific and most commonly include unilateral CRITERIA TO GIVE TPA FOR STROKE Criteria to Give tPA for Stroke. tPA for ischemic stroke was first approved in 1996 based on the result of two NINDS studies that compared outcomes of placebo or IV tPA given in the first 3 hours of a stroke. The studies found that tPA improved outcomes for 1 in 3 patients (number needed to treat = 3 for improvement compared toplacebo) and
CEREBRAL SALT WASTING V. SIADH Cerebral Salt Wasting v. SIADH. Annie Lauer Castro — November 24, 2013 comments off. Both cerebral salt wasting and SIADH (sometimes both together) are commonly found in patients with intracranial hemorrhages. Differentiating between the two has important clinical implications, since the interventions are different for each syndrome. DISCITIS/OSTEOMYELITIS WITH EPIDURAL PHLEGMON Discitis/Osteomyelitis with Epidural Phlegmon. Christopher Buckle MD — February 21, 2013 comments off. Epidural abscess is a rare condition affecting about 2 in 10,000 patients. Spinal infection typically starts in the disc (discitis), which is seeded through hematogenous dissemination of infection, typically staph aureus and often in drug users.NEUROLOGY REVIEWS
Most of the neurology reviews include common presentations, differential diagnosis, diagnostic testing, and treatment approaches. But keep in mind that the articles are just overviews and you shouldn’t use them for direct patient care. However, they are good resources for the RITE exam, USMLE step 1 or 2CK or 3, MKSAP , SESAP,and neurology
AMSAN - DOCNEURO
AMSAN, or acute motor and sensory axonal neuropathy, is a subtype of Guillain-Barré syndrome that is characterized by a combination of distal weakness (motor), reduction or complete loss of deep tendon reflexes (DTRs) and sensory abnormalities. The clinical presentation of AMSAN is similar to that of other GBS subtypes, incuding an illnessFACIAL NERVE PALSY
Lesions of the facial nerve cause paralysis of the top and bottom part of the face ipsilateral to the lesion. This is the classic “lower motor neuron” lesion of facial paralysis, and produces a facial nerve palsy. The paresis is called a Bell’s Palsy when the etiology for a facial nerve palsy is not known. Lesions in the pons that damage TYPES OF SENSORY FIBERS Fibers within a peripheral nerve are classified by conduction speed and diameter. Fast fibers (A-alpha and A-beta fibers) are fibers of the DC-ML system, so carry light touch, proprioception and vibratory information. Specifically, A-alpha fibers carry proprioception while A-beta fibers carry fine touch. Slow fibers (A-delta and C fibers) are fibers of the anterolateral system, OCULOCEPHALIC REFLEX Oculocephalic Reflex. The oculocephalic reflex is also called the doll’s eye reflex, so named because dolls that have movable eyes exhibit the same eye movement. In a comatose patient, if the head is tilted to one side, the eyes move towards the contralateral side. In a conscious patient, such movement is inhibited by the cerebellum.PINEAL CYST
Pineal Cyst. The pineal gland is a small (6-8 mm) midline endocrine structure, partly responsible for the production of serotonin , a neurotransmitter responsible for the modulation of “mood”, expressed by its effect on such fundamental behaviors as appetite, sleep, sex and mood. CAROTID ARTERY DISSECTION, MRA Carotid Artery Dissection, MRA. Carotid/vertebral artery dissection is an underdiagnosed disease that can result in substantial morbidity. It has an incidence of 1-1.5/100000 and disproportionately affects young patients. Diagnosis is challenging clinically because the symptoms are often non specific and most commonly include unilateral CRITERIA TO GIVE TPA FOR STROKE Criteria to Give tPA for Stroke. tPA for ischemic stroke was first approved in 1996 based on the result of two NINDS studies that compared outcomes of placebo or IV tPA given in the first 3 hours of a stroke. The studies found that tPA improved outcomes for 1 in 3 patients (number needed to treat = 3 for improvement compared toplacebo) and
CEREBRAL SALT WASTING V. SIADH Cerebral Salt Wasting v. SIADH. Annie Lauer Castro — November 24, 2013 comments off. Both cerebral salt wasting and SIADH (sometimes both together) are commonly found in patients with intracranial hemorrhages. Differentiating between the two has important clinical implications, since the interventions are different for each syndrome. DISCITIS/OSTEOMYELITIS WITH EPIDURAL PHLEGMON Discitis/Osteomyelitis with Epidural Phlegmon. Christopher Buckle MD — February 21, 2013 comments off. Epidural abscess is a rare condition affecting about 2 in 10,000 patients. Spinal infection typically starts in the disc (discitis), which is seeded through hematogenous dissemination of infection, typically staph aureus and often in drug users. OCULOCEPHALIC REFLEX Oculocephalic Reflex. The oculocephalic reflex is also called the doll’s eye reflex, so named because dolls that have movable eyes exhibit the same eye movement. In a comatose patient, if the head is tilted to one side, the eyes move towards the contralateral side. In a conscious patient, such movement is inhibited by the cerebellum. EARLY SIGNS OF STROKE ON CT The commonly used signs of embolic stroke on head CT include: “Dense MCA sign” is caused by opacification of the MCA by a thrombus. When noted this is likely to be in the horizontal body of the MCA coming off of the Circle of Willis, but more subtly can also be sometimes seen in a branch of the MCA. In the figure below the right MCA isMENINGES - DOCNEURO
The meninges are made up of three layers (dura mater, arachnoid, and pia mater) that enclose the central nervous system. Working with the cerebrospinal fluid, they function to cushion and nourish the brain and spinal cord. The brain and cerebrospinal fluid both have the same specific gravity, so any trauma to the head causes uniformTBI DYSAUTONOMIA
Dysautonomia occurs in about a quarter (10% to 35%) of traumatic brain injury patients. TBI dysautonomia is characterized by a varible combination of signs ymptoms including tachycardia, hypertension (or hypotension), muscle rigidity, extensor posturing, tachypnea, and diaphoresis. Clinical presentation of TBI dysautonomia TBI dysautonomia typically presents 1-2 weeks after severe brain HOW TO PREPARE FOR THE NEUROLOGY BOARD EXAM How to prepare for the neurology board exam. Whether you’re taking the initial certification or a maintenance of certification neurology exam there are several good ways to prepare. Three complementary routes are available. 1. Lecture-based course. These can be either live or online courses, taught by well-respected academicneurologists.
NERNST EQUATION
The Nernst equation describes the voltage across a cell membrane at which there would be no net flow of a particular ion (assuming there are ion channels that passed that ion). This voltage is called any of the following names “reversal potential,” “Nernst potential,” or “equilibrium potential” of an ion. Form of Equation The Nernst DISCITIS/OSTEOMYELITIS WITH EPIDURAL PHLEGMON Discitis/Osteomyelitis with Epidural Phlegmon. Christopher Buckle MD — February 21, 2013 comments off. Epidural abscess is a rare condition affecting about 2 in 10,000 patients. Spinal infection typically starts in the disc (discitis), which is seeded through hematogenous dissemination of infection, typically staph aureus and often in drug users.ACUTE INFARCT ON CT
Diagnosis: Acute embolic non hemorrhagic right middle cerebral artery infarct on CT. Figure 1: (a,red arrow) axial non contrast CT demonstrates a hyperdense middle cerebral artery. There is loss of grey white differentiation involving the insular cortex and right basal ganglia (b,blue arrow). CT is the initial imaging modalityperformed in the
FACIAL NUMBNESS
Facial Numbness. Any symptoms that center on the head and neck are magnified by the fact that this is the most highly innervated part of the human body. Thus eye pain, ear pain, mouth pain are all tolerated to a lesser degree than extremity pain. It is also true that the amount of anxiety associated with these symptoms is greater. COBALAMIN DEFICIENCY Cobalamin Deficiency. Vitamin B12, also known as cobalamin, plays an important role in a number of physiological functions, Its deficiency has been associated with macrocytic anemia and number of neuropsychiatric disorders. Further, at the present time, B12 deficiency is being explored with relation to hyperhomocysteinemia andpromotion of
NEUROLOGY REVIEWS
Most of the neurology reviews include common presentations, differential diagnosis, diagnostic testing, and treatment approaches. But keep in mind that the articles are just overviews and you shouldn’t use them for direct patient care. However, they are good resources for the RITE exam, USMLE step 1 or 2CK or 3, MKSAP , SESAP,and neurology
AMSAN - DOCNEURO
AMSAN, or acute motor and sensory axonal neuropathy, is a subtype of Guillain-Barré syndrome that is characterized by a combination of distal weakness (motor), reduction or complete loss of deep tendon reflexes (DTRs) and sensory abnormalities. The clinical presentation of AMSAN is similar to that of other GBS subtypes, incuding an illnessFACIAL NERVE PALSY
Lesions of the facial nerve cause paralysis of the top and bottom part of the face ipsilateral to the lesion. This is the classic “lower motor neuron” lesion of facial paralysis, and produces a facial nerve palsy. The paresis is called a Bell’s Palsy when the etiology for a facial nerve palsy is not known. Lesions in the pons that damage TYPES OF SENSORY FIBERS Fibers within a peripheral nerve are classified by conduction speed and diameter. Fast fibers (A-alpha and A-beta fibers) are fibers of the DC-ML system, so carry light touch, proprioception and vibratory information. Specifically, A-alpha fibers carry proprioception while A-beta fibers carry fine touch. Slow fibers (A-delta and C fibers) are fibers of the anterolateral system, OCULOCEPHALIC REFLEX Oculocephalic Reflex. The oculocephalic reflex is also called the doll’s eye reflex, so named because dolls that have movable eyes exhibit the same eye movement. In a comatose patient, if the head is tilted to one side, the eyes move towards the contralateral side. In a conscious patient, such movement is inhibited by the cerebellum.PINEAL CYST
Pineal Cyst. The pineal gland is a small (6-8 mm) midline endocrine structure, partly responsible for the production of serotonin , a neurotransmitter responsible for the modulation of “mood”, expressed by its effect on such fundamental behaviors as appetite, sleep, sex and mood. CAROTID ARTERY DISSECTION, MRA Carotid Artery Dissection, MRA. Carotid/vertebral artery dissection is an underdiagnosed disease that can result in substantial morbidity. It has an incidence of 1-1.5/100000 and disproportionately affects young patients. Diagnosis is challenging clinically because the symptoms are often non specific and most commonly include unilateral CRITERIA TO GIVE TPA FOR STROKE Criteria to Give tPA for Stroke. tPA for ischemic stroke was first approved in 1996 based on the result of two NINDS studies that compared outcomes of placebo or IV tPA given in the first 3 hours of a stroke. The studies found that tPA improved outcomes for 1 in 3 patients (number needed to treat = 3 for improvement compared toplacebo) and
CEREBRAL SALT WASTING V. SIADH Cerebral Salt Wasting v. SIADH. Annie Lauer Castro — November 24, 2013 comments off. Both cerebral salt wasting and SIADH (sometimes both together) are commonly found in patients with intracranial hemorrhages. Differentiating between the two has important clinical implications, since the interventions are different for each syndrome. DISCITIS/OSTEOMYELITIS WITH EPIDURAL PHLEGMON Discitis/Osteomyelitis with Epidural Phlegmon. Christopher Buckle MD — February 21, 2013 comments off. Epidural abscess is a rare condition affecting about 2 in 10,000 patients. Spinal infection typically starts in the disc (discitis), which is seeded through hematogenous dissemination of infection, typically staph aureus and often in drug users.NEUROLOGY REVIEWS
Most of the neurology reviews include common presentations, differential diagnosis, diagnostic testing, and treatment approaches. But keep in mind that the articles are just overviews and you shouldn’t use them for direct patient care. However, they are good resources for the RITE exam, USMLE step 1 or 2CK or 3, MKSAP , SESAP,and neurology
AMSAN - DOCNEURO
AMSAN, or acute motor and sensory axonal neuropathy, is a subtype of Guillain-Barré syndrome that is characterized by a combination of distal weakness (motor), reduction or complete loss of deep tendon reflexes (DTRs) and sensory abnormalities. The clinical presentation of AMSAN is similar to that of other GBS subtypes, incuding an illnessFACIAL NERVE PALSY
Lesions of the facial nerve cause paralysis of the top and bottom part of the face ipsilateral to the lesion. This is the classic “lower motor neuron” lesion of facial paralysis, and produces a facial nerve palsy. The paresis is called a Bell’s Palsy when the etiology for a facial nerve palsy is not known. Lesions in the pons that damage TYPES OF SENSORY FIBERS Fibers within a peripheral nerve are classified by conduction speed and diameter. Fast fibers (A-alpha and A-beta fibers) are fibers of the DC-ML system, so carry light touch, proprioception and vibratory information. Specifically, A-alpha fibers carry proprioception while A-beta fibers carry fine touch. Slow fibers (A-delta and C fibers) are fibers of the anterolateral system, OCULOCEPHALIC REFLEX Oculocephalic Reflex. The oculocephalic reflex is also called the doll’s eye reflex, so named because dolls that have movable eyes exhibit the same eye movement. In a comatose patient, if the head is tilted to one side, the eyes move towards the contralateral side. In a conscious patient, such movement is inhibited by the cerebellum.PINEAL CYST
Pineal Cyst. The pineal gland is a small (6-8 mm) midline endocrine structure, partly responsible for the production of serotonin , a neurotransmitter responsible for the modulation of “mood”, expressed by its effect on such fundamental behaviors as appetite, sleep, sex and mood. CAROTID ARTERY DISSECTION, MRA Carotid Artery Dissection, MRA. Carotid/vertebral artery dissection is an underdiagnosed disease that can result in substantial morbidity. It has an incidence of 1-1.5/100000 and disproportionately affects young patients. Diagnosis is challenging clinically because the symptoms are often non specific and most commonly include unilateral CRITERIA TO GIVE TPA FOR STROKE Criteria to Give tPA for Stroke. tPA for ischemic stroke was first approved in 1996 based on the result of two NINDS studies that compared outcomes of placebo or IV tPA given in the first 3 hours of a stroke. The studies found that tPA improved outcomes for 1 in 3 patients (number needed to treat = 3 for improvement compared toplacebo) and
CEREBRAL SALT WASTING V. SIADH Cerebral Salt Wasting v. SIADH. Annie Lauer Castro — November 24, 2013 comments off. Both cerebral salt wasting and SIADH (sometimes both together) are commonly found in patients with intracranial hemorrhages. Differentiating between the two has important clinical implications, since the interventions are different for each syndrome. DISCITIS/OSTEOMYELITIS WITH EPIDURAL PHLEGMON Discitis/Osteomyelitis with Epidural Phlegmon. Christopher Buckle MD — February 21, 2013 comments off. Epidural abscess is a rare condition affecting about 2 in 10,000 patients. Spinal infection typically starts in the disc (discitis), which is seeded through hematogenous dissemination of infection, typically staph aureus and often in drug users. OCULOCEPHALIC REFLEX Oculocephalic Reflex. The oculocephalic reflex is also called the doll’s eye reflex, so named because dolls that have movable eyes exhibit the same eye movement. In a comatose patient, if the head is tilted to one side, the eyes move towards the contralateral side. In a conscious patient, such movement is inhibited by the cerebellum. EARLY SIGNS OF STROKE ON CT The commonly used signs of embolic stroke on head CT include: “Dense MCA sign” is caused by opacification of the MCA by a thrombus. When noted this is likely to be in the horizontal body of the MCA coming off of the Circle of Willis, but more subtly can also be sometimes seen in a branch of the MCA. In the figure below the right MCA isMENINGES - DOCNEURO
The meninges are made up of three layers (dura mater, arachnoid, and pia mater) that enclose the central nervous system. Working with the cerebrospinal fluid, they function to cushion and nourish the brain and spinal cord. The brain and cerebrospinal fluid both have the same specific gravity, so any trauma to the head causes uniformTBI DYSAUTONOMIA
Dysautonomia occurs in about a quarter (10% to 35%) of traumatic brain injury patients. TBI dysautonomia is characterized by a varible combination of signs ymptoms including tachycardia, hypertension (or hypotension), muscle rigidity, extensor posturing, tachypnea, and diaphoresis. Clinical presentation of TBI dysautonomia TBI dysautonomia typically presents 1-2 weeks after severe brain HOW TO PREPARE FOR THE NEUROLOGY BOARD EXAM How to prepare for the neurology board exam. Whether you’re taking the initial certification or a maintenance of certification neurology exam there are several good ways to prepare. Three complementary routes are available. 1. Lecture-based course. These can be either live or online courses, taught by well-respected academicneurologists.
NERNST EQUATION
The Nernst equation describes the voltage across a cell membrane at which there would be no net flow of a particular ion (assuming there are ion channels that passed that ion). This voltage is called any of the following names “reversal potential,” “Nernst potential,” or “equilibrium potential” of an ion. Form of Equation The Nernst DISCITIS/OSTEOMYELITIS WITH EPIDURAL PHLEGMON Discitis/Osteomyelitis with Epidural Phlegmon. Christopher Buckle MD — February 21, 2013 comments off. Epidural abscess is a rare condition affecting about 2 in 10,000 patients. Spinal infection typically starts in the disc (discitis), which is seeded through hematogenous dissemination of infection, typically staph aureus and often in drug users.ACUTE INFARCT ON CT
Diagnosis: Acute embolic non hemorrhagic right middle cerebral artery infarct on CT. Figure 1: (a,red arrow) axial non contrast CT demonstrates a hyperdense middle cerebral artery. There is loss of grey white differentiation involving the insular cortex and right basal ganglia (b,blue arrow). CT is the initial imaging modalityperformed in the
FACIAL NUMBNESS
Facial Numbness. Any symptoms that center on the head and neck are magnified by the fact that this is the most highly innervated part of the human body. Thus eye pain, ear pain, mouth pain are all tolerated to a lesser degree than extremity pain. It is also true that the amount of anxiety associated with these symptoms is greater. COBALAMIN DEFICIENCY Cobalamin Deficiency. Vitamin B12, also known as cobalamin, plays an important role in a number of physiological functions, Its deficiency has been associated with macrocytic anemia and number of neuropsychiatric disorders. Further, at the present time, B12 deficiency is being explored with relation to hyperhomocysteinemia andpromotion of
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