Short Note_Neurology

1. Write a Short Note on Clumsy child. (Aug, 18), (Feb, 17)

Definition:
A clumsy child is characterized by difficulties in performing coordinated movements,
leading to challenges in daily activities.

Types:
1. Motor Clumsiness: Difficulty in controlling body movements.
2. Visuomotor Clumsiness: Challenges in hand-eye coordination.
3. Spatial Clumsiness: Difficulty in understanding spatial relationships.

Symptoms
- Awkward movements and posture.
- Frequent tripping or falling.
- Difficulty in handwriting and other fine motor skills.
- Poor performance in sports and physical activities.
- Struggles with tasks requiring coordination.
Causes:
- Developmental Factors: Delayed motor skill development.
- Neurological Issues: Brain-related conditions affecting coordination.
- Sensory Processing Disorders: Difficulty in processing sensory information.
- Genetic Factors: Inherited predisposition.
Treatment and Management:
Physical Therapy:
- Targeted exercises to improve coordination.
- Balance and proprioception training.
Occupational Therapy:
- Fine motor skill development.
- Activities enhancing hand-eye coordination.
Speech Therapy:
- For addressing oral and facial motor coordination.
Sensory Integration Therapy:
- Activities to improve sensory processing.
Parental Involvement:
- Encouraging and practicing activities at home.
- Providing a supportive environment.
Educational Support:
- Collaborating with teachers to accommodate learning needs.
- Implementing strategies to aid academic performance.
 Psychological Support:
- Addressing any emotional or social challenges.
- Building self-esteem and confidence.

2. Myasthenia gravis- (Aug, 18), (Feb, 16)

Definition:
It is an auto-immune disorder affecting the myoneural junction, is characterized by
varying degrees of weakness of the voluntary muscles.

Aetiology/Causes:
- The Unknown cause.
- Defect in the transmission of nerve impulses to muscles.
- Antibodies against acetyl choline receptors at the NMJ.
- Thymic abnormalities.
Pathophysiology
- Autoantibodies against acetylcholine receptor sites.
- Impaired transmission of impulses across the myoneural junction.
- Availability of fewer receptors for stimulation.
- Voluntary muscle weakness that escalates with continued activity.
Diagnosis
- History
- Physical examination
- Anticholinesterase test
- Acetylcholine receptor antibody titers
Treatment
There are four basic therapies:
- Symptomatic treatment – acetylcholinesterase inhibitors
- Rapid short-term - plasmapheresis and intravenous immunoglobulin
- Chronic long term: immunomodulating treatment - glucocorticoids &
immunosuppressive drugs
- Surgical treatment
Medical management
- Anticholinesterase drugs. (pyridostigmine bromide)
- Immunosuppressive therapy. (prednisolone)
- Plasmapharesis.
- Intravenous immunoglobulin (IVIG) therapy.
- Thymectomy.
3. Peripheral neuropathy - (aug,17)
Definition:
Peripheral neuropathy maybe defined as generalized term including disorders of any cause
affecting the PNS which may involve sensory nerves, motor nerves or both.
Types
 Mono neuropathy - Affecting a single nerve.
 Poly-neuropathy -Diffuse, symmetrical disease
 Mononeuritis multiplex -Affect several or multiple nerve.
 Radiculopathy -Disease affecting nerve root.
There are another 3 types of neuropathies according to nerve injury.
 Neuropraxia
 Axonotmesis
 Neurotmesis
Clinical feature
The clinical features of peripheral neuropathy may include:
- Gradual onset of numbness, prickling, or tingling in your feet or hands.
- Sharp, jabbing, throbbing or burning pain
- Extreme sensitivity to touch.
- Lack of co-ordination and Falling
- Muscle weakness
- Feeling as you are wearing not a gloves or sock when you are not.
- Paralysis if motor nerves are affected

Investigation:
1. Urine: glucose, protein
2. Haematology: FBC, ESR, Vitamin B12, folate,
3. Bio-chemistry: Fasting glucose, RFT. [Link].
4. Neurophysiology testing:
- Nerve conduction studies.
- Needle electromyography.
5. Nerve biopsy.

General management:
1. Need to find the cause of neuropathy to treat.
2. If pain can give anti-epileptic, antidepressant drugs or tramadol.
3. Food care - good shoes.
4. Weight reduction.
5. Walking aids for those with severe leg weakness
6. Occupational therapy.
7. Physiotherapy.
If autonomic are affected, sign symptom may include:
- Heat intolerance.
- Excessive sweating
- Bowel, bladder and digestive problem.
- Drops in BP, causing dizziness or light headiness.

4. Action potential - (mar, 22)

Definition:
Action potential is the rapid change in the membrane potential depolarization followed by
repolarization.

Phases of action potential:

A. Depolarization phase
B. Repolarization phase.
C. Plateau phase: This phase is present in cardiac muscle

We can also divide Action potential into 5 stages.

1. The resting potential
2. Threshold
3. The rising phase
4. The falling phase
5. The recovery phase
 A. Depolarization phase
 Definition; is change from negative direction toward the positive direction.
 Cause: Na enter inside the cell = (+)
 From: -70 mV up to +35 mV
B. Repolarization phase
 Definition: is change from positive direction toward the negative direction.
 Causes: more k exists outside the cell = 0
 From: +35 mV down to -70 mV.

Importance
 Transmission of impulses along nerve fibres
 Release of neurosecretions or chemical tonometer in synapses.
 Contraction of muscles.
 Activation or inhibition of glandular scentions.

5. Bells palsy -(mar, 22), (aug, 18), (aug,19)

Definition:
Bells palsy is the paralysis or severe weakness of the seventh cranial nerve that controls
the facial muscles on the side of the neck.
Cause:
 Unknown cause ( Idiopathic)
 Evidence shows that reactivated herpes simplex virus (HSV) maybe involved in
some cases.
 Headache
 Chronic ear infection
 High blood pressure
 Diabetes
 Sarcoidosis
 Tumors
 Lyme disease
 Trauma
Risk factors:
 Herpes simplex
 Diabetes
 A common cold
 The flue
 High blood pressure
 Lyme disease
 Mononucleosis
 HIV/ any autoimmune disorder
 Clinical features:
When the facial muscles malfunctions, the following symptoms may immerge.
 It may be difficult or impossible to close one of eyelids
 Irritation in the eye because it doesn’t blink and becomes too dry. Changes in the
amount of tears the eye produces.
 Parts of the face may turn droop such as one side of the mouth.
 Drooling from one side of the mouth.
 Difficulty with facial expressions.
 Sense of taste may become altered
 An affected ear may lead to sensitivity to sound. (Hyper occusis)
 Pain Infront or behind the ear on the affected side.
 Headache.
Investigation:
Careful history:
- Associated symptoms
- recurrent
 Physical exam
 CT scan
 MRI
Electrophysiology Treatment:
1. Medicine
- Corticosteroids
- Vitamins
2. Physical therapy
- Short wave diathermy
- Massage
- Electric stimulation
- Therapeutic heat and cold

6. MND - (mar, 22)

Definition:
Motor neuron disease are a group of conditions that causes the nerves of spine and brain to
progressively loss function.

Classification:
 Clinical features:
UMN:
- Weakness
- Slowed rapid alternating movement
- Spasticity
- Hyperreflexia
- Pathologic reflexes
- Pseudobular palsy
- Speech, dysarthria, brisk jaw jerk, gag reflex
LMN:
- Weakness
- Muscle atrophy
- Fasciculations
- Cramps
- Bulbular palsy
Treatment of MND:
No cure is presently available for this disease.
Goal of therapy is improving the quality of life.
 Medication: Riluzole
 Rehabilitation:
o PT
o OT
o SLT
 Other management:
 Walking assistants

7. Trigeminal neuralgia - (feb, 18)

Definition:
Trigeminal neuralgia is a neurological disorder characterized by severe, sudden-onset,
stabbing or electric shock-like pain along the trigeminal nerve, which is responsible for
sensation in the face. The pain is typically intense and recurrent, affecting specific areas of
the face, most commonly the jaw and cheek.

Causes and Diagnosis:

1. Compression of the Nerve: Trigeminal neuralgia is often associated with compression
of the trigeminal nerve by a blood vessel, leading to irritation and the development of
the characteristic pain.
2. Neurological Examination: Diagnosis involves a detailed medical history and
neurological examination to identify the specific features of the pain and rule out other
potential causes.
3. Imaging: Magnetic resonance imaging (MRI) may be conducted to visualize the
trigeminal nerve and identify any compression or abnormalities.
 Treatment:
1. Medications: Anticonvulsant medications, such as carbamazepine, are commonly
prescribed to reduce nerve excitability and alleviate pain.
2. Surgical Interventions: In cases where medications are ineffective, surgical options
may be considered. Microvascular decompression involves relieving pressure on the
trigeminal nerve, and other procedures like gamma knife radiosurgery or percutaneous
balloon rhizotomy may be considered.
3. Botox Injections: Botulinum toxin injections may be used to temporarily paralyze
specific facial muscles, providing relief from trigeminal neuralgia symptoms.
4. Pain Management: For some patients, pain management techniques, including
counselling, biofeedback, and relaxation exercises, may be beneficial.

8. Write a short note on Cranial nerve –

Definition:
The cranial nerves are a set of 12 paired nerves that arise directly from the brain. The first
two nerves (olfactory and optic) arise from the cerebrum, whereas the remaining ten
emerge from the brain stem.

Function of cranial nerves:

Cranial nerve Modality Function
1. Olfactory Sensory Smell
2. Optic Sensory Sense of sight
3. Oculomotor Motor Movement of eyeball, contraction of pupil
4. Trochlear Motor Movement of eyeball
5. Trigeminal Mixed Movement of mandible
6. Abducens Motor Lateral movement of eyeball
7. Facial Mixed Facial expressions
8. Vestibulocochlear Sensory Sense of hearing
9. Glossopharyngeal Mixed Elevation of larynx
10. Vagus Mixed Movement of palate pharynx
11. Accessory Motor Movement of palate, pharynx and larynx
12. Hypoglossal Motor Movement of tongue
9. Wilsons disease - (feb, 18), (aug, 18), (feb, 20)
Definition:
Wilsons disease is a rare genetic disease that requires the patient to inherit two abnormal
copies of the gene ATP7B. In other words both parents must be carriers (have one
abnormal copy of this gene).
Signs & Symptoms
- Swelling of the liver or spleen
- Jaundice, or yellowing of the skin and whites of the eyes
- Fluid buildup in the legs or abdomen
- A tendency to bruise easily
- Tremors or uncontrolled movements
- Muscle stiffness
- Behavioural changes
Diagnosis
- Wilson disease is diagnosed by a number of laboratory and physical test.
- They look for Kayser-ischer rings. A special light called a slit lamp is used to look for
Kayser-Fleischer rings in the eyes. Kayser-Fleischer rings are present in almost all
people with Wilson disease who show signs of neurologic damage but are present in
only 50 percent of those with signs of liver damage alone
- Laboratory test measure the amount of copper in the blood

Treatment
• Treatment for Wilson disease is a life long process
• Drugs: d-penicillamine and trientine hydrochloride → Both of these drugs release copper
from organs into the bloodstream. Most of the copper is then filtered out by the kidneys
and excreted moment.
• Zinc acetate → prevents your body from absorbing copper from the food you eat.
• Liver Transplant →removes your diseased liver and replaces it with a healthy liver from a
donor.
• Diet→ Reduced copper levels in food. Including chocolate, nuts, shellfish, and
mushrooms.

10. Glasgow coma scale - (feb, 17, 20), (aug, 18, 22)
GCS= Glasgow Coma Scale
Aim= This scale was developed to assess the neurologic injury and includes assessment of
movement, speech and eye opening.
 Behaviour Response Score
Eye moving response Spontaneously 4
To speech 3
To pain 2
No response 1
Best verbal response Oriented to time, place or person 5
Confused 4
Inappropriate words 3
Incomprehensive sound 2
No response 1
Best motor response Obeys command 6
Move to localized pain 5
Flexion withdrawal from pain 4
Abnormal flexion 3
Abnormal extension 2
No response 1
Total score Best response 15
Comatose client 8 or less
Totally unexpansive 3

Total score ( sum of scores for each of the three groups)

Total score Interpretation

15 Normal
13-15 Minor head injury
9-12 Moderate head injury
3-8 Severe head injury
≥7 Coma
3 Deep coma or brain death
11. Multiple sclerosis - (aug, 19)
Multiple sclerosis:
Multiple sclerosis is an autoimmune inflammatory disease of the white matter
characterized by a relapsing or progressive course.
The clinical features of MS :
 Weakness, numbness, tingling, or unsteadiness of the limbs are the most common
signs.
 Ataxia due to involvement of the tracts of the Cerebellum may occur, and spastic
Paralysis may also be Present.
 Urinary urgency or retention, blurry and double vision are all common initial
manifestations of the disease.
 Symptoms may persist for several weeks or may resolve spontaneously over a few
days.
Investigation:
 MRI(with contrast)
 Inhancement of lesions with gadolinium
 CSF analysis
Treatment:
Multiple sclerosis cannot cured but symptoms can be [Link] treatment of MS can
be divided into disease modifying therapy, treatment of symptomic relief during an acute
exacerbation
 In relapsing remitting disease, three disease modifying agents(IFN-B1a, IFN-B1b and
glatıramer
 acetate)
 Plasma exchange
 Gabapentin, pherytoin, pregabalin
 Rehabilitation

12. CSF - (feb, 20), (Aug, 22)

Definition:
Cerebrospinal fluid is the clear, colourless and transparent fluid that circulated through
ventricles of brain, sub arachnoid space and central canal of spinal cord.
Composition

CSF

Water - 99.13% Solids -0.87%

Inorganic Substance Organic Substance

- Proteins - Sodium
- Amino acids - Calcium
- Sugar - Potassium
- Cholesterol - Magnesium
- Urea - Chlorides
- Uric acid - Phosphate
- Creatinine - Bicarbonates
- Lactic acid - Sulphates
- Lymphocytes
-

Circulation
 Function
1. Cushioning and Protection
2. Buoyancy
3. Nutrient Transport
4. Regulation of Intracranial Pressure

13. Cerebral palsy - (feb, 17)

Definition:
Cerebral palsy is a disorder of posture, movement & tone due to static encephalopathy
acquired during brain growth in fetal life, infancy or early childhood, and the disorder is
often associated with epilepsy, abnormalities in speech, vision and intellect.
Types:
There are three types of CP mainly.
1. Spastic CP (90%)
2. Dyskinetic CP (6%)
3. Ataxic CP (4%)
Spastic CP has 3 main clinical types
1. Unilateral (hemiplegia)
2. Bilateral (quadriplegia)
3. Bilateral (diplegia)
Cause:
 Before birth: → Congenital abnormalities in brain development
→Infection in the mother during pregnancy
 During birth: →Brain injury due to oxygen deficiency due to difficult labour
→Brain haemorrhage in premature babies.
 After birth: → Infection of the brain such as encephalitis and meningitis
Treatment:
Cerebral palsy can't be cured, but treatment will often improve a child's capabilities.
Therapies-
- Physiotherapy
- Occupational therapy
- Speech & language therapy
- Recreation therapy
Drug treatment -
- Oral medication
- Botulinum toxin
- Intrathecal baclofen therapy
Surgery-
- Orthopaedic surgery
 Assistive devices -
- Orthotic devices
- Braces and splints
- Wheelchair, rolling walkers and powered scooters
- Vision aids
- Hearing aids

14. Head Injury - (feb, 17)

Head Injury:
A head injury is any sort of injury to the brain, skull, or scalp. This can range from a mild
bump or bruise to a traumatic brain injury.
Clinical features:
 Common features of minor head injury:
- Headaches
- Light headedness
- A spinning sensation (vertigo)
- Nausea
- Temporary ringing in the ears.
 Common features of severe head injury:
- A loss of consciousness
- Seizures
- Vomiting
- Balance or coordination problem
- Serious disorientation
- An inability to focus on eyes
- Abnormal eye movements
- A loss of muscle control
- A persistent or worsening headache
- Memory loss
- Changes in mood
Investigations:
 Physical examination:
- Looks for signs of trauma including brushing and swellings.
- Neurological examination: Assessing muscle control and eye- movement
 Imaging tests:
- CT scan
- MRI
 Laboratory investigations:
- Sodium level
- Magnesium level
- Coagulation studies
- Blood alcohol level & drug screen
 Other tests
 - Electro encephalography
Treatment:
The treatment of head injury depends on both the type and severity of the injury.
If the injury is minor:
- Take acetaminophen for pain
- Should not take NSAIDs such as ibuprofen or aspirin because they can make any
bleeding worse.
If someone has an open cut, he may use sutures or staples to close it and then cover it with
bandages.
Patients may need to be hospitalized if have a serious head injury. He may need -
- Supportive measures
- Surgical evacuation of hematoma
- Medical therapy

15. Brain Tumor - (feb, 17)

Brain tumor: A brain tumor is a collection, or mass, of abnormal cells in the brain. The
skull, which encloses the brain, very is rigid, any growth inside this restricted place can
cause problems.

Different types of brain tumor:

Brain Tumor

Benign brain tumor Malignant brain tumor

Primary brain Tumor

 Meninges: Meningioma Secondary brain Tumors
 Glial Cells: Glioma  Metastatic brain tumor
 Nerve Sheath: Schwanoma, Neurofibroma
 Embryonal: Medulloblastoma,
Neuroblastoma
 Blood Vessels: Angioma, angiosarcoma
 Other epithelial:
- Pituitary (craniopharyngioma),
- Pineal gland tumors (pinloplastoma)
 Clinical features of brain tumors
 The symptoms of a brain tumor depend on tumor size, type and location.
 Most Common symptoms of brain tumors are:
- Headaches (usually worse in the morning).
- Nausea and vomiting.
- Changes in speech, vision or hearing.
- Changes in mood, personality, or ability to concentrate
- Problems with memory
- Muscle jerking on twitching (seizures or convulsions)
- Numbness or tingling in the arms or legs.
Treatment:
1. Medical Surgical management-
- Traditional surgery
- Chemotherapy
- Radiation therapy
- Stereotactic radiosurgery
2. Supportive care
3. Rehabilitation includes
- Physiotherapy
- Occupational therapy
- Speech & language therapy
- Physical medical specialists
4. Evaluation
- Comprehensive examination
- Assessment of all system

16. Neuroglia – (aug, 22)

Neuroglia:
Cells that provide metabolic support and immune protection for neurons. Neuroglia
outnumbers neurons by about 10:1 in the Central Nervous System. Neuroglia do not
generate or conduct nerve impulses. However, unlike neurons, glial cells regenerate if
injured.
Neuroglia do not generate or conduct nerve impulses.
They support neurons by:
• Forming the Blood Brain Barrier (BBB)
• Forming the myelin sheath (nerve insulation) around neuronal axons
• Making the CSF that circulates around the brain and spinal cord
• Participating in phagocytosis
Types of Neuroglia Cells
[Link]:
Bind blood vessels to nerves. Form blood-brain barrier. Star shaped with numerous arms
attached to blood vessels and neurons. In CNS:
[Link] cells:
Form and circulate cerebrospinal fluid. Columnar cells with cilia. In CNS.
3. Microglia:
Mobile, phagocytic cells. Protect neurons by engulfing bacteria and other invaders. Small
unattached cells with numerous arms. In CNS
4. Oligodendrocytes:
Form myelin sheaths around axons in the CNS. Small cells with a few long arms attached
to myelin sheath
5. Schwann cells:
Form myelin sheaths around axons in the PNS. Involved in nerve fiber regeneration