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Principles of Neurological Diagnosis 1. Localization 2. Etiology.

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Presentation on theme: "Principles of Neurological Diagnosis 1. Localization 2. Etiology."— Presentation transcript:

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2 Principles of Neurological Diagnosis 1. Localization 2. Etiology

3 Example 1 A 25 YO male, acute paraparesis with urinary incontinence, severe LBP: Localization: spinal cord Etiology: acute disc herniation

4 Example 2 A 75 YO female with diabetes and HBP, sudden weakness of left side limbs Localization: right hemisphere Etiology: intracerebral hemmorhage

5 Gross Anatomy of the CNS

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16 Subsystems for this talk Motor system Sensory system Visual and ocular Blood supply

17 Motor system Lower motor neuron Upper motor neuron (origin of the corticospinal tract) Brainstem nuclei that project to the cord Basal ganglia Cerebellum Premotor frontal cortex Prefrontal cortex

18 Lower motor neuron Motor unit Fasciculation Weakness & atrophy Root – plexus – nerve

19 Upper motor neuron Origin at prerolandic motor cortex Humunculus, somato- topic arrangement Posterior capsule Isolated movements evoked by electrical stimulation

20 Paralysis due to UMN lesion Weakness distribution (additional systems, crossed syndromes, sparing of midline bilateral muscles) ‘Classic UMN’ picture: spasticity, increased tendon reflexes, positive Babinski’s, (spinal shock)

21 Patterns of paralysis Monoplegia without atrophy Monoplegia with atrophy Hemiplegia Paraplegia Tetraplegia

22 Cortico Bulbar Tract

23 Basal ganglia Negative signs: hypokinesia, bradykinesia Positive signs: involuntary movements

24 Extrapyramidal Clinico- Pathological Correlations Morbid anatomySymptom Contralat Substantia NigraUnilateral Rigidity + Tremor Contralat subthalamic nuc (Luis)Unilateral hemibalismus Caudate and putamenchorea

25 Cerebellar dysfunction Incoordination – ataxia (dysmetria, dysdiadochokinesis) Intention tremor Dysarthria (slurred speech) Nystagmus Disordered gait and equilibrium

26 Sensory system Skin or visceral sense organs Distribution by nerve, root, CNS Primary afferent (DRG) Spinal tracts: Dorsal columns Spinothalamic Spinocerebellar Thalamus and cortex Descending analgesic tract

27 Dorsal Columns

28 Sensory dysfunction Positive - paresthesia, pain, allodynia, hyperalgesia Negative – hypesthesia, anesthesia, analgesia

29 Symptoms and Signs in Neurology -+ Weakness paralysis Hypotonia Fasciculation Involuntary Movement Motor Hyp/anesthesia Hyp/analgesia Paresthesia, pain, allodynia, hyperalgesia Sensory Impotence Orthostatism Hyperhydrosis Diarrhea Autonomic

30 Visual system Retina, optic nerve, chiasm, tract, radiation, cortex

31 Ocular movements

32 Blood supply Circle of Willis

33 MRA of the Circle of Willis

34 Middle cerebral artery

35 Ant & Post Cerebral Arteries

36 Exercise I 30 YO man, weakness of right lower limb On exam: Weak, spastic, hyper- reflexic right leg Loss of touch on Rt leg Loss of pain and temp. on Lt leg Hemi-Sensory level D8 Spino Dorsal Thalamic Columns

37 Exercise II 70 YO female, weakness of right side, speech difficulty On exam: Rt hemiparesis Motor dysphasia

38 Exercise III 60 YO male, Rt side weakness On exam: Rt hemi- paresis Lt facial weakness


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