NEUROLOGY

WORKBOOK
By
Dr. Priyansh Jain
 MEDICINE

NEUROLOGY
BY

DR. PRIYANSH JAIN

ABOUT AUTHOR

DR. PRIYANSH JAIN

Dr. Priyansh Jain

• MBBS (Gold Medalist)

• MD (General Medicine) — JLN Medical college
• Consultant Physician & Assistant Professor
• USMLE/MRCP qualified
• 7 International Publications
• National Level Faculty - NEET-PG, FMGE/NExT
• President's Award (Scouts)
• Selected for Research and Training at NIH, USA
(sponsored by USA Government)
• Delivered lectures in International and National
Medical Colleges
• Instagram: drpriyanshjain
• Contactno.: +91 704-236-3461

1 DR. PRIYANSH JAIN MEDICINE

 Index

INDEX OF NEUROLOGY WORKBOOK

CHAPTER 1: STROKE/CEREBRO-VASCULAR ACCIDENT………3

CHAPTER 2: MENINGITIS

CHAPTER 3: DEMENTIA

CHAPTER 3B: PARKINSONISM

CHAPTER 4: HEADACHE

CHAPTER 5: APHASIA

CHAPTER 6: EPILEPSY

CHAPTER 7: NEURO-MUSCULAR JUNCTION DISORDER

CHAPTER 8: DYSTROPHINOPATHIES

CHAPTER 8B: MULTIPLE SCLEROSIS & GBS

CHAPTER 9: MOTOR NEURON DISEASE

DR. PRIYANSH JAIN MEDICINE 2

 NEUROLOGY:STROKE/CVA

CHAPTER 1
STROKE/CEREBRO-VASCULAR ACCIDENT

BLOOD SUPPLY OF BRAIN

Subarchnoid Hemorrhage — Rupture of

• C/F —
• Neck stiffness —
Defect of tunica ............ + .................
• MC site —
If — Post. Commu. Art. —
• Score —
• Risk of Rupture, if size —
• CSF ECG —
• Complication —
SAH leads to release of ...........-->
• DOC —

DR. PRIYANSH JAIN MEDICINE 3

NEUROLOGY:STROKE/CVA

EDH —

— CT -

— Lucid Interval

SDH —

— CT -

— Lucid Interval

ICP — Sign -

— MC CN involved -

— Complication -

— Rx — Most effective —

— Other -

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 NEUROLOGY:STROKE/CVA

LESION OF — ACA - Loss of motor & sensory innervation in-

Urine & stool -
Anal area sensation -
— Paracentral lobule

— MCA- Loss of motor & sensory innervation in -

Speech -

Superior division - suppy - ............... area

Inferior division - suppy - ............... area

— PCA

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NEUROLOGY:STROKE/CVA

Lesion of — Frontal Lobe [ACA] — Gait -

— Gaganhalton
??.

— Temporal Lobe

— Occipital Lobe

— Parietal Lobe [MCA]

Dominant Non-Dominant

Patient A Patient B

CEREBELLAR LESION

• Neo-cerebellum —

• Archi-Cerebellum —

• Nystagmus also seen in —

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 NEUROLOGY:STROKE/CVA

TREMOR
Contraction of agonist and antagonist muscle
• Intentional tremor
Goal

Starting
Point

• Resting tremor
Goal

Starting
Point

• ESS: Tremor — MC

— Rx -
Goal
Starting
Point
Lesion of Basal Ganglia — Caudate Nucleus

— Putamen

— Subthalamic Nucleus

Thalamus — Ventro-Posterolateral Nucleus —

Lesion of — Amygdala -Appetite -

-Sexuality -
-
— Mamillary Body

DR. PRIYANSH JAIN MEDICINE 7

 NEUROLOGY:STROKE/CVA

CEREBRO-VASCULAR ACCIDENT [CVA]

Types of CVA

a-

b-

c-

Hemorrhagic
MANAGEMENT OF TREMOR AND STROKE
55 year / male / uncontrolled HTN

C/F-

Inv- 1st-

Rx-

C/I -
8 DR. PRIYANSH JAIN MEDICINE
 NEUROLOGY:STROKE/CVA

MANAGEMENT OF ISCHEMIC STROKE

70 year / male / DM/ Smoker

C/f -

Inv - 1st-
- radiological investigation -

Rx- If patient present within ........hours

Indication for Thrombolysis —

— Time

— Age

Contra-indication — BP

for Thrombolysis — Infarction Size -

TRANSIENT ISCHEMIC ATTACK [TIA]

If patient present after ..... hours

DR. PRIYANSH JAIN MEDICINE 9

 Transient Ischemic stroke

TIA is a indicator of future risk of stroke and for risk assessment

----> ............................ score is used .
 !
NEUROLOGY:HEADACHE

SUMMARY

# match the following

A) worst headache of life 1 - frontal lobe

B) homonymous hemianopia 2- occipital lobe
C) gaganholtan 3- non dominant parietal lobe
D) prospognosia 4- putamen
E) hemineglect 5- cerebellum
F) intentional tremor 6 -SAH
G)atheotosis 7 - temporal lobe
H) kluver bucy syn 8- mamillary body

A...... B...... C..... D....... E...... F....... G...... H....

#MC type of stroke - ischemic/ hemorrahagic

#1st investigation in ischemic stroke - NCCT / CECT ./ MRI / RBS

#C/f of stroke + NCCT - grossly normal - probable diagnosis

Hemorragic stroke / ischemic stroke

# Thrombolysis is done if patient comes within ........ hours

DR. PRIYANSH JAIN MEDICINE 3

 NEUROLOGY:MENINGITIS

CHAPTER 2
MENINGITIS

ETIOLOGY
a) Bacterial meningitis
MCC-

Other -

b) Viral meningitis
MCC -
Other - HSV- 1

HSV -2
10 DR. PRIYANSH JAIN MEDICINE
NEUROLOGY:MENINGITIS

c) Fungal Meningitis
Seen in -
MC-

C/F OF MENINGITIS

O/E —

Investigation

CSF - production by -
- absorbtion by -
- color -
- cell -
- protein -
- glucose -

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NEUROLOGY:MENINGITIS

CSF ANALYSIS

OPENING CELL NUMBER CSF PROTEIN

PRESSURE & TYPE. SUGAR
NORMAL
BACTERIAL
MENINGITIS
VIRAL
TUBERCULAR

Poly-morphic nuclear cell (PMN ) -

TB meningitis —

IDIOPATHIC INTRACRANIAL HTN

• Seen in -

• Risk Factor - C/F -

• Fundus -

• Rx -

DR. PRIYANSH JAIN MEDICINE 3

NEUROLOGY:HEADACHE

SUMMARY

# prophylaxis for nesseria meningitis - azithromycin

penicillin
Ceftriaxone
# mollorate meningitis - HSV-1/ HSV 2

# meningitis symptom + complex hallucination -

# match the following

A) normal glucose in CSF 1 - bacterial meningitis

B) increase PMN in CSF 2- viral meningitis
C) increase lymphocyte + decrease suagr 3- SAH
D) xanthocromia 4 - tubercular meningits

A....B.....C.....D

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NEUROLOGY:DEMENTIA

CHAPTER 3
DEMENTIA

Definition
Decrease in .......................

Causes of Dementia

NORMAL PRESSURE HYDROCEPHALUS [NPH]

Strech of periventricular limbic system

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NEUROLOGY:DEMENTIA

ALZHEIMER’S DISEASE
Patho-physiology

Intracellular accumulation of -

Extracellular accumulation of -

Severity of alz. Dis -

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NEUROLOGY:DEMENTIA

Alz. Disease

Sporadic Familial
Chromosome - ... - ..................... ........... gene
Chromosome - ... - ...................... .............. gene
Chromosome - ... - ............... ........... gene
Chromosome - ... - ............ .. ..........

Structure involved in Alz. Disease

Temporal ..... parietal ........ frontal ......... occipital lobe

C/F
Unable to recall name of objects -

Unable to domlearned motor acitivity -

Lack of insight of disease -

Investigation:

Treatment:

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NEUROLOGY:DEMENTIA

MULTI-INFARCT DEMENTIA

C/f C/f C/f

C/F

Time

FRONTO-TEMPORAL DEMENTIA

Patho-physiology : Involvement of ______________ lobe

____________ is spared

So
__________________

Due_______________
to accumulation of tau _______
LEWY BODY DEMENTIA
D/t accumulation of _________ Protein
|
LEWY ____
|
Damage to ___________
|
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NEUROLOGY:DEMENTIA

HUNTINGTON CHOREA = Autosomal ________

Patho-physiology : Ch — __________ gene

|
| | number - _____ codon
|
Damage to ___________
|

C/F
— | Severity of disease in
successive generations

Investigation : MRI — Damage to

Rx - Mc

Rx
Parkinson’s related dementia —

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NEUROLOGY:DEMENTIA

CRETZFELD-JAKOB DISEASE

Patho-physiology
CH
Prp (prion related Protien)
Found in cytoplasm

Types Of CJD 1. Mc —
2.
3. Contaminated meats —
4.

C/F

• EEG -

• CSF -

• MRI -
(Brain)

Rx

DR. PRIYANSH JAIN MEDICINE 3

 !
Neurology - demantia

Summary of demantia

Normal pressure hypdrocephalus - C/F - Triad -

- rx -

Alzheimer’s disease - patho - intra- neuronal accumulation of …………protein

C/a-

- extra neuronal -
C/a -
Severity of alz. Disease depends on -
MC lobe involved in alz disease -

fronto temporal demantia - ………………….Is spared.

Huntington’s chorea - ch ……-> increase in ………. Codon repeats leads to

damage at ……………. Nucleus.
- autosomal ………….
- MRI Brain -

CJD - ch …. —> ……………protein accumulation leads to …………………

encephalopathy —>MRI —> ……………………………….
CSF —>
 Chapter - 3B
PARKINSONISM
NEUROLOGY:DEMENTIA

PARKINSONISM

Types of Parkinsonism [Based on Etiology]

1 2

Types of Parkinsonism [Based on C/F]

C/f C/f

Eg - Multi-system atrophy(MSA)
Eg - Parkinson d/s Progressive supra-nuclear palsy(PSP)
Cortico-basal degeneration (CBD)

DR. PRIYANSH JAIN MEDICINE 3

NEUROLOGY:DEMENTIA

PARKINSON DISEASE

Patho-physiology

Bodies
Protien Substantia
Nigra
Degenerate

n PD

Limbs>axis

C/F
____ hypothesis is related to Parkinson’s d/s

C/f - Motor — T —

R—

A—

P—
Treatment

Non motor

DR. PRIYANSH JAIN MEDICINE 3

SUBJECT:TOPIC

Treatment:

Last Rx —

Electrode is placed in

Best initial Rx for PD in old age —

— Rx —
S/E of — L-DOPA
— ROPINIROLE

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NEUROLOGY:DEMENTIA

ATYPICAL PARKINSONISM
a) Multisystem Atrophy (MSA)
|
Atypical Parkinsonism
|
Bradykinesia & Rigidity (neck&spine) +
In axis
Q) MRI brain

b) Progressive Supranuclear Palsy(PSP)

Atypical Parkinsonism +

C/f —

MRI —

c) Cortico-Basal Degeneration
Atypical Parkinsonism +

DR. PRIYANSH JAIN MEDICINE 3

NEUROLOGY:DEMENTIA

Protein Accumulation

Parkinson Disease Alz. Disease

Lewy Body Dementia F-T dementia

MSA Cortico Basal Degeneration

Progressive Supranuclear Palsy

DEMENTIA PUGLISTICA
— seen in

— C/F —

— a/c/a — Syndrome

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NEUROLOGY:HEADACHE

SUMMARY

Parkinsonism - ……………………+ ………………………

Typical - C/F are more in …………

Atypical -C/F are more in …………

Parkinson’s disease - protein ………………………. Accumulation at

……………………. …………… leads to decrease
In ………………
C/F - motor -
- non motor -

- Gait -

match the following feature of atypical Parkinsonism

A) orthostatic hypotension 1) cortico basal degeneration

B) vertical gaze palsy 2) multi system atrophy
C) demantia 3) PSP
D) hot bun cross sign
E) hummingbird sign

A……. B…. C….. D…… E……

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NEUROLOGY:HEADACHE

CHAPTER 4
HEADACHE

TYPES OF HEADACHE

1 (idiopathic) 2

MIGRAINE • F M
• B/w. YR
• Last for Hr
• Type headache
• Disabling in character
• Mostly
• Hint MCQ — asso. c
Patho-physiology
Vasodilation
Vascular theory Meninges Stretch in Rx Vasoconstriction
meninges

Cortical wave
Of depolarisation

DR. PRIYANSH JAIN MEDICINE 3

NEUROLOGY:HEADACHE

Types of Migraine
— _________ migraine — migraine c

— _________ migraine — migraine c

— _________ migraine
• Variant Migraine

— Retinal Migraine — Migraine headache + monocular blindness

— Focal Migraine — Migraine headache + dysphagia

— Opthalmoplegic Migraine — 3/4/6 CN palsy

— Migraine sine Migraine — No Headache + only visual complaints

— Basilar Migraine — Migraine headache + vertigo + dizziness + ataxia

• Disability of Migraine calculated by

TREATMENT OF MIGRAINE
a) For acute attack 1st line
DOC

Other Dx
b) For Prevention of migraine

Verapamil —
SSRI — DR. PRIYANSH JAIN MEDICINE 3
NEUROLOGY:HEADACHE

c) Other Modalities

STATUS MIGRANOSUS

If migraine last for >72 hours

TENSION TYPE HEADACHE MC cause of headache

• F M
• _________ headache (B/L)
• Not disability in character
• _______ 4 hr to (7-11)

Rx —
— cluster headache
-

TRIGEMINAL AUTONOMIC CEPHALGIAS — paroxysmal

hemicranial headache

— SUNCT/SUNA

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NEUROLOGY:HEADACHE

a) Cluster Headache MCQ Hint —

C/F • M F
• Trigger —
• Pain (___________ in nature)
+
+
Last for 30 mins to 2 hour
— Ist Line —
Rx — For acute attack
— DOC

— For Prevention

b) Paroxysmal c) SUNCT/SUNA
-
-
S-
Hemicranial Headache
- U-
N-
C-
T-

M F M F

10-20 20-100

Indomethaline
Indomethacin Indomethacin

Rx Rx

DR. PRIYANSH JAIN MEDICINE 3

NEUROLOGY:HEADACHE

• Analgesic abuse Headache —

• Metabolic Headache — PCO2 —

— PO2 —

— S. Na —

• Trigeminal Neuralgia — Trigger —

— Character —

— Lasting —

— Rx —

No autonomic symptoms

DR. PRIYANSH JAIN MEDICINE 3

 !
NEUROLOGY:HEADACHE

SUMMARY

match the following

A) retro orbital headache + tearing + alcohol 1) focal migraine

B) headache + nausea + pulsating type 2) basilar migraine
C) headache in Trigeminal area + runny nose 3) sunct
D) headache in Trigeminal area + without runny nose 4) migraine
E) headache + dysphagia 5) cluster headache
F) headache + 3 /4/6 CN palsy - 6) Trigeminal neuralgia
G) headache + vertigo + ataxia 7) opthalmoplegic migraine

A….B……C……D…….E……..F………G….

migraine treatment -
acute attack -
Prophylaxis -

cluster headache - Rx - acute -

- prophylaxis -

status migranosus - if migraine attack last for > ……… hours .

DOC for Trigeminal neuralgia -

DR. PRIYANSH JAIN MEDICINE 3

NEUROLOGY:APHASIA

CHAPTER 5
APHASIA
Unable to
SPEECH-CIRCUIT Or
Aphasia Unable to

Area Area

Cortex Cortex

Blood supply — BROCA area — _________ division (MCA)

— WERNICKE area — _________ division (MCA)

So, for Repitation -

DR. PRIYANSH JAIN MEDICINE 3

NEUROLOGY:APHASIA

TYPES OF APHASIA

APHASIA COMPREHENSION REPITATION FLUENCY

(Sensory aphasia)
WERNICKE’S
Non - fluent
Motor BROCA’S
Aphasia

CONDUCTION

TRANSCORTICAL

SENSORY

TRANSCORTICAL

MOTOR

ISOLATION
(Echolalia)
GLOBAL

MC Aphasia —
• Comp —
• Rep —
• Fluency —
• Naming —

Pure word deafness -

Pure word deafness
Pure word blindness -

DR. PRIYANSH JAIN MEDICINE 3

 !
NEUROLOGY:APHASIA

SUMMARY

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NEUROLOGY:APHASIA

CHAPTER 6
EPILEPSY

SEIZURE

EPILEPSY — Tendency to develop recurrent seizures

CLASSIFICATION OF SEIZURE
Generalised Focal
Both Hemispheres involved One Hemisphere involved

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NEUROLOGY:APHASIA

GENERALIZED
a) GTCS (Gen. Tonic clonic seizures)
A) Stages — Ist
IInd

IIIrd
IVth

DOC —

MC electrolyte abnormality leading to GTCS —

b) Myoclonic

— Occurs — Yr

— Pt. in morning —

— EEG —

Rx — DOC —

JME — Trigger —

MC presentation of JME
Myoclonic epilepsy + Lafita body in —
sweat gland Bx
JME associated with —
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NEUROLOGY:APHASIA

c) Tonic Seizure

d) Atonic Seizure

e) Absence Seizure

_____ yr

EEG —

Trigger of Absence Seizure —

Rx —

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NEUROLOGY:APHASIA

FOCAL SEIZURE
a) Focal aware

(Marching/progression)
Of C/F d/t involvement
Rx -
of nearby neuron

b) Focal impaired awareness

MC site —

C/F —

Rx —

Focal impaired awareness with — cognition

—
— Behaviour change
— Rx

DR. PRIYANSH JAIN MEDICINE 3

NEUROLOGY:APHASIA

EPILEPSY SYNDROME
a) LENNOX-GESTAUT Syndrome
H/o

EEG —
Rx —

b) Infantile Spasm [1 year]

Salam seizure

Infantile spasm — DOC —

Infantile spasm + tuberous sclerosis —

S/E of Vigabatrin —

DRUG RESISTANT EPILEPSY

Epilepsy not
Controlled despite — __________ anti-epileptic medication c max dose

DR. PRIYANSH JAIN MEDICINE 3

NEUROLOGY:APHASIA

STATUS EPILEPTICUS If seizure episodes lasting ____ mins

Or
Rx — If 2 seizure episode c out ___________________
Rx - sharp
— Periodic

EEG — Triphasic

— Hypsarrythmia

— 3Hz spike & wave

— 2.5Hz spike & wave

— 4-6Hz

SPECIAL POINTS
— Rx of GTCS if NO I/V access —

— Anti-epileptic drug can only be stopped after —

— Seizure to brain tumor — DOC —

— GTCS in pregnancy — Ist time -

— old case -

— Photosensitive seizure — Rx —

— Rolandic epilepsy — Age -

— C/F -

— EEG -

— Rx -

— Sudden/Rapid/Multidirectional eye movement

DR. PRIYANSH JAIN MEDICINE 3

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!
NEUROLOGY:APHASIA

SUMMARY

GTCS - stages -………………/………………../…………………/…………….

- DOC -
juvenile myoclonic epilepsy - myoclonic …………. F/b …………../……………

- EEG - ……………HZ polispike pattern

absence seizure - hallmark -………………. ………….

- EEG …………hz spike and wave patter.
- Rx -
focal seizures- aware - ……………………… march F/b ……………. Palsy
- impaired awareness - hallmark - A………….……
Lennox gestaut syn - >……. Types of seizure

status epilepticus - seizure episode lasting > ……. Min .

DR. PRIYANSH JAIN MEDICINE 3

NEUROLOGY:APHASIA

CHAPTER 7
NEURO-MUSCULAR JUNCTION DISORDER

NEURO-MUSCULAR JUNCTION

A) MYASTHENIA GRAVIS
Patho-physiology

Type ___ HSR

M.gravis is associated with —
— Thyroid
Pathology

DR. PRIYANSH JAIN MEDICINE 3

NEUROLOGY:APHASIA

C/F —

Cogan lid twitch

Types of M.G.
— Ocular M.G.

— Generalised M.G.

— M. Crisis

Investigation — Most sensitive

— Most specific

• Nerve conduction test —

• Repeated Nerve stimulation —

DR. PRIYANSH JAIN MEDICINE 3

NEUROLOGY:APHASIA

Treatment
1) Only ocular M.G. —

2) Generalise M.G. —

3) M. Crisis —

B) LAMBORT-EATON SYNDROME
Patho-Physiology

L.E. Syn — Associated c

C/F —

DR. PRIYANSH JAIN MEDICINE 3

NEUROLOGY:APHASIA

Investigation —

Treatment —

MYASTHENIA GRAVIS LAMBORT-EATON SYNDROME

____ synaptic disorder ____ synaptic disorder
Associated with Associated with
Antibody — Antibody —
Repeated Nerve Repeated Nerve
stimulation stimulation
Morning Evening Morning Evening
C/F — C/F —

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NEUROLOGY:APHASIA

SUMMARY

DR. PRIYANSH JAIN MEDICINE 3

NEUROLOGY:APHASIA

CHAPTER 8
DYSTROPHINOPATHIES
Dystrophin

Patho-Physiology
| Quality | Quantity

Other causes of Proximal Myopathy —

Distal myopathy -

TYPES OF DYSTROPHINOPATHY

DUCHENE’S BACKER’S

Inheritance -

Pathogenesis -

C/F -

GOWER sign -

Age group -

Cardiomyopathy -

IQ -

Rx -

Cause of Death -

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NEUROLOGY:APHASIA
Chapter 8b
Multiple sclerosis & GBS
MULTIPLE SCLEROSIS
• Saltatory conduction

• Patho-Physiology F>M — Cold/Ch. Smoker/| sunlight/EBV

• C/F
— MC —
— optic neuritis —

— cerebellum involvement —

— spinal cord —
— involvement of MLF —
(medial longitudinal fasiculus)

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NEUROLOGY:APHASIA

• Types of MS

Time

• Uth Off Phenomenon

• Useless Hand of Oppenheimer -

If M.S — involves hand — paralysis

• Lhermitte sign

Can also be seen in —

• Investigation - CSF —

For Optic neuritis —

DR. PRIYANSH JAIN MEDICINE 3

NEUROLOGY:APHASIA

IOC —

• Rx — Acute —

— Prophylaxis — MOST EFFECTIVE —

DEVIC DISEASE / NEUROMYELITIS OPTICA

Patho-Physiology

Rx —

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NEUROLOGY:APHASIA

GULLIAN BARRE SYNDROME

Patho-Physiology

Urine & stool incontinence

O/E
DTR —

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NEUROLOGY:APHASIA

Investigation — Diagnosis criteria -

— CSF -

— Nerve conduction test -

— Antibody -

Rx -

Steroid

MILLER FISHER VARIANT

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NEUROLOGY:APHASIA

SUMMARY

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NEUROLOGY:APHASIA

CHAPTER 9
MOTOR NEURON DISEASE

CORTICO-SPINAL TRACT
Motor cortex

Corona radiata

Internal capsule

Post limp — Blood supply —

UPPER MOTOR LESION LOWER MOTOR LESION

[UMN LESION] [LMN LESION]

DR. PRIYANSH JAIN MEDICINE 3

NEUROLOGY:APHASIA

TYPES OF MND
a) UMN type

b) LMN type

c) Mixed type

AMYOTROPHIC LATERAL SCLEROSIS

Patho-Physiology

Tounge —
C/F — UL —
HMF —
— LL —
Eye Ball —

Investigation —

Rx —

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NEUROLOGY:APHASIA

SPINAL CORD DISORDER

TABESDORSALIS
Patho-Physiology

Joint sense
Gait - Position sense
Vibration sense

Pupil -

ROMBERG TEST

Eye Open Eye close

Subacute combined degeneration of spinal cord -

• Similar C/F — seen with —

• Reflex — Finger flexion

• Hint — CBC —

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 NEUROLOGY:APHASIA

SYRINGOMYELIA
Patho-physiology

Joint sense Temprature Temprature Joint sense

Position sense Pain Position sense
Pain
Vibration sense Vibration sense

C/F —

Investigation — IOC —

Rx —

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NEUROLOGY:APHASIA

CAUDA EQUINA vs CONUS MEDULLARIS

CAUDA EQUINA CONUS MEDULLARIS

Ankle reflex
[S1/S2]

Knee reflex
[L2/L3/L4]

Saddle sensation
[S2/S3/S4]

Bowel & Bladder

Symmetry

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NEUROLOGY:APHASIA

BRAIN STEM
Mid Brain — 3 CN

— 4CN

PONS — 5 CN

— 6 CN
— 7 CN
— 8 CN

Medulla — 9 CN — Brain

10 CN

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NEUROLOGY:APHASIA

11 CN SUPPLY
Supply —

12 CN

Midline

Tracts in B-stem

— cortico-spinal tract

— dorsal column — medial leminiscus

— spinothalamic tract

BRAIN STEM SYNDROME

• Medulla — Medial Medullary Syndrome

— Lateral Medullary Syndrome

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NEUROLOGY:APHASIA

MEDIAL MEDULLARY SYNDROME

Etiology

C/F

12 CN

M.L.

CST CST

LATERAL MEDULLARY SYNDROME

Etiology

8 CN

Sympathetic tract
Spinothalamic tract
Sensory nuclei of CN 5
N. ambiguous
– CN 9 —
– CN 10 —
– CN 11 —

• Fine touch & proprioception —

• Hemiparesis can be seen in — _______
— But not in — ______

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NEUROLOGY:APHASIA

PONTINE SYNDROME
Millard Gubler Syndrome Foville Syndrome

• Locked in Syndrome

• Fever + pinpoint pupil —

Mid Brain
• Weber Syndrome
— Artery involved

• Nothnagel syndrome —

DR. PRIYANSH JAIN MEDICINE 3

NEUROLOGY:APHASIA

Facial palsy — onset — Acute

Facial palsy — if idiopathic — c/a

— taste sensation

DR. PRIYANSH JAIN MEDICINE 3

NEUROLOGY:APHASIA

Brain dead — B. Stem —

— S. cord —

— Planter Reflex -

— GAG Reflex

— Pupil

— EEG

DR. PRIYANSH JAIN MEDICINE 3

 !
NEUROLOGY:APHASIA

SUMMARY

DR. PRIYANSH JAIN MEDICINE 3

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