KAPSEL NEURO.ppt

8/10/2019 KAPSEL NEURO.ppt

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KAPITA SELEKTA

NEUROLOGI

Dept. Neurologi

FKUAJ/RSA


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Human Nervous System


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Neurological Levels

Brain

Brainstem

Spinal cord

Motor neuron

Peripheral nerveNeuromuscular junction

Muscle


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Neurological Levels

Brain Brainstem

Spinal cord Motor neuron

Peripheral nerve

Neuromuscular junction

Muscle

Often unilateral

Motor and/or sensory

Language Consciousness

Memory

Behavior

Vision Seizures

Movement d/o


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Neurological Levels

Brain

Brainstem Spinal cord Motor neuron

Peripheral nerve


Muscle

Often unilateral


Consciousness

Cerebellar

Movement d/o

Cranial nerves

Diplopia

Vertigo

Face

Swallow

Tongue


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Neurological Levels

Brain

Brainstem


Peripheral nerve


Muscle

Often bilateral


Head OK Bowel and bladder


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Neurological Levels

Brain

Brainstem

Spinal cordMotor neuron Peripheral nerve


Muscle

Asymmetric bilateral

Motor only

Proximal and distal Insidious onset

Fasciculations


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Neurological Levels

Brain

Brainstem

Spinal cord

Motor neuron

Peripheral nerve Neuromuscular junction

Muscle

Symmetric or focal

Sensory > motor

Often distalStocking-glove

If proximal think

Demyelinating (UE + LE)

Cauda equina (LE)


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Neurological Levels

Brain

Brainstem

Spinal cord

Motor neuron Peripheral nerve

Neuromuscular

junction Muscle

Asymmetric bilateral

Motor only

Proximal and distalEyes involved in

myasthenia gravis

Fatigable weakness

Myasthenia gravis

Progressive weakness

Lambert-Eatonmyasthenic syndrome


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Neurological Levels

Brain

Brainstem


Peripheral nerve


Muscle

Symmetric bilateral

Motor only

Usually proximal


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!ase "

History of Present Illness (HPI)

This is a 42 yo woman with progressive leg weakness

and numbness over the last 6 months. The left is a littleworse than the right. The sensory loss involves most ofthe left leg, and below the knee on the right. Urinaryfrequency and urgency are present.

Review of System: (+) mild back pain, constipation, andpoor balance walking with one fall.(-) fever, speech, cognition, swallow, hearing, dizziness,

vision, diplopia, or headache.


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!ase "

Past Medical History (PMH)HTN, hypothyroid, psoriasis, hysterectomy

MEDICATIONS: enalapril, synthroid, MVI

Family History (FH)Mother with lupus, father is healthy, sister with type 2 DM

Social History (SH): Stay at home mom. One EtOHper week. Smoked in college. No illicet drugs.


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LO!ALI#E

A. Brain

B. Brainstem

C. Spinal cord

D. Motor neuron

E. Peripheral nerve

F. Neuromuscular

junctionG. Muscle


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!ase "

Physical Examination (PE):Vitals: 128/64, 72, 14Mental Status: AlertCranial Nerves: Normal

Motor:Mild 4/5 weakness in left hip flexion, knee flexion and footdorsiflexion. Spastic tone L > R.No atrophy.Sensory:Mild diffuse decrease in light touch in the L > R legcompared to the arm. Vibration reduced in the left toe. Theabdomen also had mild reduced sensation to pinprick.Reflexes: UE 2/4.3/4 knees, 3/4 R ankle, 4/4 (clonus) L ankle.

L (+) Babinski sign.Cerebellar: FNF normal.HKS impaired by spasticity.Gait:Gait unstable with left circumduction.Movements: None


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LO!ALI#E

A. Spinal cord

B. Peripheral nerve


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$i%erential& 'IN$I!ATE(O

Vascular

Infection

Neoplastic

Drugs/Toxins Inflammatory/Autoimmine

Congenital/Inherited

Allergic

Trauma Endocrine

Other

Vascularmalformation


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Vascular

Infection

Neoplastic



Allergic

Trauma Endocrine

Other

HTLV-I, II

Abscess


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Vascular

Infection

Neoplastic



Allergic

Trauma Endocrine

Other

Primary spinal cordtumor

Metastatic cancerwith cordcompression


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Vascular

Infection

Neoplastic



Allergic

Trauma Endocrine

Other

Multiple sclerosis

Lupus myelitis


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Vascular

Infection

Neoplastic



Allergic

Trauma Endocrine

Other

Hereditary spasticparaparesis


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Vascular

Infection

Neoplastic



Allergic

Trauma Endocrine

Other

Spinal stenosis fromosteophyte or disc


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Vascular

Infection

Neoplastic



Allergic

Trauma Endocrine

Other

B12 deficiency

Copper deficiency


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$i%erential& Summary

Vascular

Infection

Neoplastic

Inflammatory/Autoimmine Congenital/Inherited

Trauma

Endocrine

Prioritize thepossible causes and

start your work-up. Experience.


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Testing

Labs: B12 and copper normal

MRI: Thoracic parenchymal mass


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)RI

Axial T2Saggital T1 + gadolinium


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$iagnosis

Ependymoma

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KAPSEL NEURO.ppt