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Principles of Neurological Diagnosis

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Presentation on theme: "Principles of Neurological Diagnosis"— Presentation transcript:

1 Principles of Neurological Diagnosis
1. Localization 2. Etiology

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

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

4 Gross Anatomy of the CNS











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

16 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

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

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

19 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)

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

21 Cortico Bulbar Tract

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

23 Extrapyramidal Clinico-Pathological Correlations
Morbid anatomy Symptom Contralat Substantia Nigra Unilateral Rigidity + Tremor Contralat subthalamic nuc (Luis) Unilateral hemibalismus Caudate and putamen chorea

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

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

26 Dorsal Columns

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

28 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

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

30 Ocular movements

31 Blood supply Circle of Willis

32 MRA of the Circle of Willis

33 Middle cerebral artery

34 Ant & Post Cerebral Arteries

35 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

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

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

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