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1
Q

Bulbar is? Nucleus included?

A

MEDULLA

9 10 11 12 nerve nucleus

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2
Q

What is pseudo bulbar palsy

A

Lesion above the bulbar region— CORTICOBULBAR TRACT

UMN

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3
Q

Bulbar vs Pseudobulbar palsy

A

Both have Dysphagia and Dysarthria
But Bulbar palsy ++++ severe (flaccid)

Rest features are only seen in Pseudobulbar palsy

LABILE EFFECT**
(Uncontrolled emotions)

GAG REFLEX +++ (brisk)
(Sensory by 9th nerve- Coughing motor by 10th nerve)

JAW JERK +++

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4
Q

Which conditions Jaw jerk is brisk?

A

MS
Neurodegenerative disorders
Pseudobulbar palsy

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5
Q

Trigeminal nerve Sensory and Motor functions

A

Sensory- CORNEA (V1)
FACE (V2)

Motor- MASTICATION (Mandible-V3)

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6
Q

Lemniscus if Trigeminal nerve and Auditory pathway

A

Trigeminal lemniscus

Lateral lemniscus

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7
Q

End nucleus of Trigeminal nerve pathway

A

VPM nucleus of THALAMUS

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8
Q

Where are nuclei (Sensory and motor ) of TGN located

A

PONS

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9
Q

Total nuclei of TGN

A

4

Spinal nucleus

Primary sensory nucleus

VPM

Primary Motor nucleus

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10
Q

Lemniscus of any tract, nature of affected side?

A

ALWAYS CONTRALATERAL

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11
Q

Motor nuclei examples

A

7th—SMILE (Rizorius)

5th—Masticate

10th—Deglutition

12th— Articulation

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12
Q

Jaw jerk root

A

CN5

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13
Q

Tic doloreux

A

Trigeminal NEURALGIA

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14
Q

Mc branch involved in TGN

A

Maxillary&raquo_space; Mandible

Lc= Opthalmic

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15
Q

Clf TGN

A

Lips Cheek Gums

30s-2min

Mc complaint- Pain while washing face

Attack ppt on chewing

Pt is lucid in between attacks

DOC- CBZ

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16
Q

UMN facial paralysis features

A

C/L lower 1/3 gone

FRONTALIS AND O.OCULI SPARED

BUCCONATOR/ZYGOMATICUS/ORIS GONE

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17
Q

LMN facial palsy features

A

7th nerve gone at the tip

I/L half face gone

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18
Q

U/L Etiology if FNP

A

Trauma

HZV (RAMSAY HUNT***)

Idiopathic (BELLS PALSY)

MELKERSON-ROSENTHAL SYNDROME***
-recc FNP with permanent Facial edema

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19
Q

B/L etiology of FNP

A

GBS
HIV
SARCOIDOSIS

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20
Q

Lacrimal glands receive parasympathetic supply from which nerve

A

FACIAL

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21
Q

Cranial nerve nuclei location

Motor= medial

A 
3 = sup col— Midbrain
4 = Inf col—Midbrain

5s&m—Pons
6 -Pons
7- Pons

8- Lateral junction of Pons and medulla

9-10-11= NAmbiguus—Lateral Medulla
12= Medial medulla

7-9s = NTS—- Lateral medulla

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22
Q

Lateral midbrain damage which nuclei compromised

A

NA + NTS + 5th sensory

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23
Q

Midbrain syndromes

WCB

A

WEBER

CLAUDE

BENEDIKT

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24
Q

Pons Syndromes

MFM

A

Miillard Gubler

Fov-illes

Marie fox

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25
Medulla syndromes
Medial medullary Lateral medullary (WALLENBERG)
26
WEBER SYNDROME
CN3 I/L FrontoPontine fibres—7th CN UMN CST — C/L weakness (As crosses below at medulla)
27
CLAUDE SYNDROME
Red Nucleus—C/L ATAXIA 3CN I/L
28
Benedikt syndrome
Claude + Weber
29
Millard Gubler syndrome
6th CN I/L 7th CN LMN CST —C/L weakness CROSSED HEMIPARESIS***** (Half face-CN7 ; and other half body-Cst)
30
Fov Illes syndrome
``` Millard Gubler + Medial lemniscus- C/L loss of DC tract + MLF lesion - INO+ ```
31
Marie Fox Syndrome
ST traxt 5th sensory (I/L face sensation) MCP(Middle cerebellar peduncle)- ATAXIA
32
Medial medullary syndrome
CST- C/L weakness Medial Lemniscus- C/L DC tract 12th CN- I/L : TONGUE TOWARDS LESION
33
WALLENBERG SYNDROME cause and features
Occlusion of Vertebral A > PICA 8th CN (I/L) - ATAXIA & Vertigo ICP- Ataxia 5th sensory- I/L N. ambiguus- Hoarseness ST- C/L loss of pain and temp Sympathetic trunk- HORNERS (I/L) CROSSED HEMIANESTHESIA*** (TGN face ; Other half of body ST tract)
34
Function of Spino cerebellar tract
SUBCONCIOUS PROPRIOCEPTION (Unknowing flexion and extension of Knee while walking) Posterior SCT- FINE** movement Anterior SCT- GROSS** Movement
35
Types of ataxia
Friedrich Ataxia Tabes dorsalis SACD
36
Friedrich’s Ataxia tracts involved? DTR? BABINSKI?
DC CST(UMN) SCT DTR -ve (As 1st involved = DRG-Prevents ‘VIBRATION’ of sensory component of reflex from reaching the cortex) Babinski +ve (Superficial reflex—Crude touch is taken up by STT and thus reflex +)
37
Titubation (Tamhankar) and frequent falls are characteristics of which ATAXIA
FREIDRICH
38
Diseases a/w FA | HOS-DVP
HOCM (mc) Optic Atrophy SCOLIOSIS*** DM Vit E deficiency Pes Cavus
39
Genetics of FA
Trinucleotide repeats- GAA > 200 AR Chr 9- FRAXATIN gene***
40
Tracts involved jn TABES (emaciated) DORSALIS DTr? Babinski?
DC only DTR -ve Babinski -ve
41
TD a/w which diseases
Neurosyphillis (ARGYLL-Rob pupil) Bladder disturbances Acute abdomen& Visceral symptoms HIGH STEPPAGE GAIT (typical of DC lesion)
42
SACD Tracts? DTR? Babinski?
DC CST (UMN) Peripheral Nerves (late) DTR: +ve —> -ve Babinski: +ve
43
SACD diseases
B12 def Megaloblastic anemia
44
D/D SACD
HYPOCUPRIC MYELOPATHY | Causes reversible dementia
45
Neuropathies list?
GBS- AIDP , AMAN , AMSAN , MFS CIDP CMT
46
Organisms causing GBS
Campylobacter (mc) ``` HIV HHV EBV CMV HepE Zika ```
47
Vax causing GBS
Rabies | Influenza
48
Cl/f GBS
``` Ascending paralysis (Flaccid/Symmetrical) -Max at 4wks ``` Arreflexia Minor sensory loss Mc CN affected= 7th (LMN) (B/L) —50% pt ``` Bladder involvement (ONLY in severe cases/ transient) ```
49
AIDP features (Acute inflamm Demy Polymeuropathy)
MC type Motor>>Sensory Ab= Anti GM1 Antibodies—> attack shwann cells (cross reaction)
50
AMAN (Acute Motor Axonal Neuropathy) features
Only motor involvement Ab= Anti GM1b & Ga1a (IgG)— attack Node of Ranvier
51
AMSAN (Acute Motor Sensory axonal Neuropathy)
Motor and sensory involvement Ab = Gm1b Ga1a GD1a—Attack NOR WORST PROGNOSIS***
52
MFS (Miller Fischer Syndrome) features
5% GBS pt Arreflexia + Opthalmoplegia + Ataxia WEAKNESS is -ve *** Ab = GQ1b— Attack shwann cells
53
Ix in GBS
Brighton Criteria 1) NERVE CONDUCTION STUDY - Slow velocity - Dec AP - F waves absent*** 2) CSF Analysis - Albumin INCREASE** - Pleocytosis -ve ACD+ (ALBUMINO-CYTOLOGICAL DISSOCIATION)—48 hrs after onset of weakness
54
Rx GBS
IVIG- 2g/kg over 5 days Plasma pheresis Both equally effective— given within 14 days STEROIDS ARE NOT RECOMMENDED
55
CIDP definition
Progression of weakness beyond 9 weeks >3 relapses
56
CIDP C/f
WEAKNESS - symmetrical - Asymmetrical : LEWIS SUMNER SYNDROME*** Multifocal Acq Demyelinating Sensory Motor Neuropathy (MADSAM) = Lewis Sumner syndrome
57
Ix CIDP
CSF- ACD+ Nerve Bx- ONION BULB APP***
58
Rx CIDP
IVIG PLASMAPHERESIS STEROIDS
59
CMT (Charcot Marie FOOT Neuropathy)
4 types present CMT1: - AD - 10-30 y ``` Symptoms : FOOT DROP** (mc) Paresthesias DTR reduced Sensory loss + ``` ATROPHY BELOW KNEE (inverted Champagne bottle) Nerve conduction rate reduced to 20-25m/s ONION BULB APP***
60
Genetics DMD
XLR Dystrophin protein misfold (Sub-sarcolemmal protective protein)
61
Pathology of DMD
Deletion at 5’ end of SHORT ARM OF X Chr—-x Dystrophin gene —-No dystrophin—-2° loss of SARCOGLYCAN & DEXTROGLYCAN—Muscle atrophy
62
C/F of DMD at 6y 8y 12y 18y 25y
Onset at 3-5 y HEEL CORD THICKEN** LORDOTIC POSTURE. @ 6 y Braces for walking @ 8 y Wheelchair bound @ 12 y Pulmonary infection @ 18y Death @ 25y PSEUDO MUSCLE HYPERTROPHY *** (Collagen deposits in DELTOID/CALVES/INFRASPINATUS) ``` Gower sign Valley sign (infraspinatus) ```
63
Ix DMD
Creatine Kinase increases 20-200 times! Bx of muscle
64
Rx DMD
STEROIDS
65
BMD features
XLR Dystrophin gene -ve PSEUDOHYPERTROPHY- Early/ Prominent Onset 3-4th decade Mental retardation DMD>>BMD CARDIAC ABNORMALITIES** (BMD>>DMD) Weakness/ Wasting LL>>UL
66
MC adult muscular dystrophy?
MYOTONIC DYSTROPHY
67
Inheritance of MD
AD Trinucleotide CTG repeats Chr 19
68
C/F MD | PATW-MFM
Palatal Pharyngeal Tongue muscle weakness (Dysarthria/dysphagia) Atrophy of TEMPORALIS (HATCHET FACE APP***) Testicular Atrophy Weakness (distal>>Proximal) Myotonia (Delayed relaxation of Handgrip) FRONTAL ALOPECIA** Mental Retardation
69
Rx MD
MEXILITENE | Improves myotonia

Neurology (11 decks)

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