neuro

• blood supply of brain

  A) Anterior cerebral artery 

  B) middle cerebral artery

  C) posterior communicating artery

  D) Posterior cerebral artery

  E) vertebral artery

  F) anterior spinal a.

  G) anterior communicating artery

  H) internal carotid artery

  I) Superior cerebellar artery

  J) basilar artery

  K) Anterior inferior cerebellar arteries.

  L) Posterior inferior cerebellar artery 

  
• blood supply

  A) Posterior cerebral artery

  B) middle cerebral artery

  C) Anterior cerebral artery 

  
• venous supply of brain

  A) emissary vein

  B) superior sagittal sinus

  C) inferior sagittal sinus

  D) great cerebral vein

  E) rectus sinus

  F) transverse sinus

  G) superior petrosal sinus

  H) inferior petrosal sinus

  I) occipital vein

  J) deep cervical vein ]

  K) frontal vein

  L) ophthalmic vein

  M) cavernous sinus

  N) pterygoid plexus

  O) anterior facial vein

  P) internal jugular vein

  
• cranial nerves

  A) olfactory

  B) optic

  C) oculomotor

  D) trochlear

  E) Trigeminal

  F) Abducens

  G) facial

  H) Vestibulocochlear

  I) Glossopharyngeal

  J) vagus

  K) Accessory

  L) Hypoglossal

  
• homunculus brain

  A) toes

  B) face

  
• John is a 92-year-old gentleman who presents with sudden onset weakness to his right side. It resolves after 5 hours.

  There is also associated slurred speech, Diagnosis?

  transient ischaemic attack (TIA)

  •Symptoms resolved within 24 hours

  •Treated with antiplatelets

  •Prevent further complications
• Middle Cerebral Artery Occlusion?

  •90% of all strokes

  •Supplies most of the outer surface of frontal, parietal and temporal lobes as well as basal ganglia

  •Gives: 1) Contralateral weakness 2) Homonymous Hemianopia  3) Aphasia 4) Neglect
• Anterior Cerebral Artery Occlusion?

  Supplies deep structures of frontal and parietal love, corpus callosum

  Causes: 1) Weakness +/- Sensory changes to contralateral side 2) Clumsy 3) Apathy 4) Disinhibition
• Posterior Cerebral Artery Occlusion?

  •5-10% strokes

  •Supplies the midbrain, basal ganglia, thalamus, occipital lobe, hippocampus and temporal and parietal lobes

  •Loss of contra-lateral sensation and paralysis, Nystagmus, Cranial nerve involvement, ataxia
• •‘Pyramidal’ pattern i.e. weaker upper limb extensors and  lower limb flexors

  •That is the pyramids, located in the medulla and contain the corticobulbar and corticospinal tracts.

  
• Bell's palsy is a neurological disorder that causes paralysis or weakness on one side of the face. It occurs when one of the nerves that controls muscles in the face becomes injured or stops working properly.
• •Roger is a 38-year-old gentleman who presents with weakness to the right-hand side of his face. On examination he is noted to be drooling. The weakness includes the forehead and he is unable to close his right eye. diagnosis?

  Bell’s Palsy

  
• Bell’s Palsy

  •Weakness of the face

  •Unilateral (pretty much always)

  •Rapid onset (<72 hours)

  •Commonest between age 15-45 years of age

  •Ear and postauricular pain in about 50% of pts

  •Hyperacuisis

  •Incomplete eye closing, dry eye, painful eye, excessive eye tearing

  •Precipitated by trauma or infection but sometimes idiopathic

  
• Incomplete eye closing, dry eye, painful eye, excessive eye tearing only happens in Bell’s Palsy and NOT stroke
• Bell’s palsy

  •Cause unclear – viruses and autoimmunity implicated

  •If in first 72 hours – consider prescribing prednisolone (50mg for 10 days or 60mg for 5 days followed by reducing regimen)
• Origins of the facial nerve

  upper part of the face receives A bilateral blood supply from both parts of the brain. So even if you have a stroke in the right hemisphere, you've still got this blood supply from the left hemisphere that will come down and supply both parts of the forehead and the eye, in a lower motor neuron lesion. You lose both sides of the upper motor neuron input

  
• the parotid gland is something that can cause a facial nerve palsy. So parotid gland tumour for example, the facial nerve passes through the parotid gland or certainly traverses very close to the parotid gland. So any pressure compression on those nerve fibres, those branches of the facial nerve, can cause facial nerve injury.

  
• Ramsay-Hunt Syndrome

  •Inflammation of the facial nerve as a consequence of varicella zoster

  •Ipsilateral facial weakness, otalgia and vesicles around ear canal

  •Can also affect vestibulocochlear nerve causing hearing loss, tinnitus and vertigo

  
• Bells phenomenon

  •Occurs in the case of LMN palsy

  •When the patient attempts to shut the eye on the affected side which causes upward movement of the eyeball and incomplete closure of the eyelid.
• Upper moter neurone diseases

  •Ischaemic or haemorrhagic stroke (including brainstem strokes)

  •Amyotrophic lateral sclerosis

  •Multiple sclerosis
• lower moter neurone diseases

  •Peripheral nerve trauma/compression

  •Spinal muscular atrophy

  •Amyotrophic lateral sclerosis

  •Guillain-Barré syndrome

  •Poliomyelitis
• An upper motor neurone (UMN) lesion will be in the central nervous system (brain and spinal cord).

  On neurological examination, typical signs of an upper motor neurone lesion include:

  • Disuse atrophy (minimal) or contractures
  • Increased tone (spasticity/rigidity) +/- ankle clonus
  • Pyramidal pattern of weakness (extensors weaker than flexors in arms, and vice versa in legs)
  • Hyperreflexia
  • Upgoing plantars (Babinski sign)
• A lower motor neurone (LMN) lesion affects anywhere from the anterior horn cell to the muscle. 

  On neurological examination, typical signs of a lower motor neurone lesion include:

  • Marked atrophy
  • Fasciculations
  • Reduced tone
  • Variable patterns of weakness
  • Reduced or absent reflexes
  • Downgoing plantars or absent response
• fatiguability-subjective lack of physical and/or mental energy perceived to interfere with usual or desired activities - fatigue
• •Trevor is a 56 year old gentleman who presents with ‘fatiguability’

  •He also complains of diplopia

  •He is noted to have a hoarse voice

  •Count to 50 – voice becomes hoarser

  •Looking up – eyelids droop more

  diagnosis?

  myasthenia gravis

  
• Disorder of Neuromuscular Junctions 

  
• How would you treat - myasthenia gravis •Pyrodistigmine – reduces acetylcholinesterase

  •Rapid reversal with plasmapheresis and IVIg

  •Future therapies

  
• Vertigo

  •Roger presents with unsteadiness on standing. He feels like the room is continuously spinning

  •This has left him feeling nauseous and he has vomited on a couple of occasions

  •He develops more symptoms on movement
• DANISH – cerebellar signs

  •Dysdiadokinesia / dysmetria.

  •Ataxia.

  •Nystagmus.

  •Intention tremor.

  •Speech - slurred or scanning.

  •Hypotonia.
• peripheral or central stroke

  A) sudden onset

  B) severe

  C) mild

  D) unidirectional

  E) vertical

  F) tinnitus