Transcript of Localising the lesion Ed Hutchison and Paul Swift.
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- Localising the lesion Ed Hutchison and Paul Swift
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- Aims Approach UMN vs. LMN Spinal tracts Cerebellum Cerebrum
Visual lesions Cases
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- Approach to localising the lesion
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- Muscle e.g. diabetic myopathy NMJ e.g. myasthenia gravis
Peripheral nerve e.g. GBS Spinal cord e.g. cord compression
Cerebrum e.g. Stroke
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- Timeline Immediate Intermediate Long-term
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- UMN vs. LMN ???
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- UMN vs. LMN UMNLMN HyperreflexiaHyporeflexia
HypertoniaHypotonia ClonusMuscle wasting No muscle
wasting/fasciculationFasciculation Plantars upgoing (lower
limbs)Plantars downgoing (lower limbs)
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- Pyramidal vs. Extrapyramidal PyramidalExtrapyramidal
WeaknessTremor SpasticityChorea Pronator driftHemiballismus Loss of
skilled movementAthestosis HyperreflexiaDystonia Change in
tone/tendon reflexes Plantars upgoing Loss of abdominal/cremasteric
reflex
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- Clonus http://www.youtube.com/watch?feature=player_detailp
age&v=8GC8F2UMYbQ#t=42
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- Facial nerve palsies Bulbar vs. pseudobulbar Pseudobulbar = UMN
of CN IX-XII Spastic tongue Sparing of forehead Bulbar = LMN of CN
IX-XII Tongue wasting/fasciculation Affects all facial muscles
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- The tracts Dorsal column Corticospinal Spinothalamic ? ? ?
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- Lateral Spinothalamic Pain and temperature Decussates at the
level of the spinal cord
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- Anterior Spinothalamic Crude touch and pressure Decussates at
the level of the spinal cord
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- Dorsal columns Discrimination, proprioception, vibration.
Crosses at the medulla. Subacute combined degeneration of the cord,
Tabes dorsalis, Spinal trauma.
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- Corticospinal Tracts Descending motor tracts. Cross at the
medulla.
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- Brown-Sequard
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- Brainstem Symptoms/signs: Dysarthria Dysphagia/drooling Tongue
weakness Absent palatial movement CN IX-XII
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- Cerebellum Cerebellospinal tracts Ipsilateral DO NOT CROSS
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- Blood Supply
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- Cerebellar Signs dysdiadochokinesia ataxia (truncal and limb)
nystagmus intention tremor slurred speech hypotonia
DANISHDANISH
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- Causes Alcohol Thiamine deficiency CVA Friedreichs ataxia Etc
etc
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- The Homunculus
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- Cerebral Artery Territories
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- Circle of Willis Anterior cerebral artery Middle cerebral
artery Posterior cerebral artery Basilar artery A = ? B = ? ?
Anterior spinal artery Vertebral artery
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- Speech Centres
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- Tono man http://www.youtube.com/watch?v=6CJWo5TDHLE
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- Brocas dysphasia
http://www.youtube.com/watch?v=1aplTvEQ6ew
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- Stroke Syndromes TACS all 3PACS 2 of 3LACSPOCS Hemiplegia/hemi
sensory loss See leftNo visual field defect Bilateral motor or
sensory Visual field disturbance Pure motorConjugate eye movement
disturbance Disturbance in higher function e.g. dyphasia/dysphag ia
Pure sensoryCerebellar dysfunction Sensory-motorHemiplegia or
cortical blindness Ataxia
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- Visual Defects Ipsilateral blindess Bilateral hemianopia Left
homonymous hemianopia Left superior quadrantanopia Left homonymous
hemianopia with macular sparing
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- Cases
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- Case 1 57 year old man complaining of weakness and altered
sensation in upper limbs and lower limbs Loss of sensation from
shoulders and down, urinary incontinence On Examination: CN intact
Upper limbs weakness, hypotonia, reduced reflexes Lower limbs
spasticity, hyper-reflexia and Babinski +ve, reduced sensation from
shoulders down
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- Case 2 85 year old man with long standing (20yr) history of
balance problems worse in the dark. Gait is high stepping On
Examination: CN intact Motor intact Loss of proprioception with +ve
Rombergs test
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- Case 3 23, female presents to her GP with a 2 week history of
bilateral leg weakness having started with pins and needles and
numbness in her hands and feet. She has had a few days of urinary
incontinence which has resolved. 2 years ago she had an episode of
blurred vision and pain in the right eye which lasted a month and
fully resolved
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- Case 4 56 male 6 month history of progressive weakness of his
right hand. Also had problems with swallowing and has choked whilst
eating on several occasions o/e he has wasting of his upper and
lower limbs and some fasciculation's were noted his right plantar
was up going and his reflexes were generally brisk
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- Things weve not had time to cover Peripheral neuropathies Motor
neurone Parkinsons Huntingtons GBS Myasthenia gravis
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- Peripheral Neuropathies A alcohol B B12 deficiency C CKD D
drugs/diabetes E every vasculitis