Neurology

Unconsciousness

Locked-In Syndrome Persistent Vegetative State Coma Brain Death Alertness Wakeful Aware Retained cognition Wakeful NOT aware Eyes open and close Sleep/wake cycle present Unconscious Eyes closed NO sleep/wake cycle Unconscious Eyes closed NO sleep/wake cycle Voluntary Motor ability Eyes and eyelids ✖︎ ✖︎ ✖︎ Respiratory Drive ✓ ✓ ✓...

Horner Syndrome

Triad Ptosis Miosis Anhidrosis Sympathetic denervation of face Spinal cord lesion above T1 Pancoast tumor Brown-Sequard syndrome Syringomyelia Any interruption in the path

Cranial Nerves

Olfactory Sensory → Smelling Optic Sensory → Vision Oculomotor Motor Eye movement Medial rectus Superior rectus Interior rectus Inferior oblique Levator palpebrae Pupillary constriction (Edinger-Westphal nucleus) Accommodation Trochlear Motor → Superior oblique Trigeminal Sensory Tongue anterior 2/3 sensation Face sensation Motor Mastication Abducence Motor → Lateral Rectus Facial Sensory...

Aphasia

Broca Aphasia Motor aphasia Intact comprehension Telegraphic words No repetition Arm/face hemiparesis and hemisensory loss Left Posterior inferior frontal lobe Left superior MCA Wernike Aphasia Sensory aphasia Impaired comprehension Lack of awareness Word salad No repetition Left Posterior superior temporal lobe Left posterior/inferior MCA

Cavernous Sinus Thrombosis

Etiology Septic thrombosis sue to S. aureus infection of head and neck Presentation Headache Fever Orbital pain Visual disturbance Later → Mental status changes Diagnosis Best initial → MRI with gadolinium or CT angiography ↑WBC Blood culture Complications Confusion Sepsis Treatment Best initial → Aggressive treatment with broad-spectrum antibiotic...

Cushing Triad

Cushing Triad for imminent cerebral herniation ↑BP ↓HR Irregular RR

Spinal tracts

Spinothalamic, Dorsal column/medial lemniscus Corticospinal tract

Coma

Vertigo

Menier’s Disease Etiology Unknown Presentation Hearing loss Tinnitus Vertigo 30m-1h episodes Diagnosis Clinical Treatment Salt restriction HCTZ Meclizine Betahistine

Dementia

Alzheimer’s Disease Etiology Most common dementia Plaques and Tangles Ch 21 → Down’s Syndrome Presentation Progressive dementia Memory goes first First short term → Then long term Spares social graces Diagnosis Mainly clinical MRI/CT Temporal and parietal atrophy or diffuse symmetrical cortical atrophy VDRL/RPR → To rule out syphilis B12,...

Peripheral Neuropathy

Bell’s Palsy CN 7 palsy Etiology Idiopathic Lyme disease Sarcoidosis Herpes zoster Tumor Presentation Paralysis of entire half of face Can NOT wrinkle forehead In stroke only the lower half is involved → CAN wrinkle forehead Sloppy eating → Difficulty closing lips Hyperacusis → Stapedius muscle is a shock absorber...

Charcot-Marie-Tooth Disease

CMT Etiology Genetic Loss of both motor and sensory innervation Presentation Distal weakness/sensory loss Leg wasting ↓DTRs Tremor Foot deformity High arch (pes cavus) Legs look like inverted champagne bottles Diagnosis Most accurate...