0.lesion topical

8/9/2019 0.Lesion Topical

1/45

Lesion?

Neuroscience Core Lecture

Anwar Wardy, MD.Neu

Department of Neurology

FKK UMJ

fkk umj anwar wardy w

Why,…. Sign and Symptom!!!


2/45

Anwardy,….?

“My balance is of.”

Multiple E !i"it" for fall#related trauma

“I’m losing the ne control o my ngers.”

$o"" of manual de%terity

“I’ve had neumonia three times.”

Dy"p&agia to li'uid"("olid"



3/45

All of )omplaint" Neurologi* in+rigin

W&ere" t&e le"ion, ????……… "omew&ere in

t&e neura%i".



4/45

Di!i"ion" of t&e Neura%i"

)orti*al -rain

u/*orti*al

-rain -rain"tem

)ere/ellum

pinal )ord oot

0erip&eral Ner!e

Neuromu"*ular Jun*tion

Mu"*le



5/45

+1 t&e 2op of my 3ead . . .

4m/alan*e 5 )ere/ellum

0neumonia 5 -rain"tem 6relateddy"p&agia7

$o"" of De%terity 5 0erip&eral Ner!e



6/45

Neurologi* E%amination

3ig&er )orti*al Fun*tion

)ranial Ner!e"

)ere/ellar Fun*tion Motor

en"ory

Deep 2endon e8e%e" 0at&ologi* e8e%e"



7/45

2&e Neuro E%am &ouldE!aluate t&e Entire Neura%i"

3ig&er )orti*al Fun*tion9 *orte%

)ranial Ner!e"9 "u/*orte%, /rain"tem

)ere/ellar Fun*tion9 *ere/ellum

Motor9 motor &omon*ulou", "u/*orti*alpyramidal tra*t", -, *ord, radi*le, 0N, mu"*le

en"ory9 a"*ending tra*t", t&alamu",

"u/*orti*al tra*t", "en"ory &onon*ulou" Deep 2endon e8e%e"9 a1erent 0N, radi*le,

*ord, e1erent 0N, mu"*le

0at&ologi* e8e%e"9fkk umj anwar wardy w


8/45

*ott" E%am &owed9

3ig&er )orti*al Fun*tion9 normal

)ranial Ner!e"9 orop&aryngeal dy"art&ria

)ere/ellar Fun*tion9 &ypotonia, a""ynergy,dy"metria, "ta**ato dy"art&ria, intentiontremor, appendi*ular ata%ia

Motor9 &ypotonia, normal "trengt&

en"ory9 de*rea"ed !i/ration and temperature Deep 2endon e8e%e"9 are8e%ia

0at&ologi* e8e%e"9 plantar 8e%ing



9/45

o W&ere" t&e

$e"ion?



10/45

Goals of MD Testing

Localization Severity

Nerve NMJ Anterior HornMuscle

Fiber type Pathology Temporal

courseAda ted rom i !"# Preston and Sha iro anwar ward w

neurologi fkk umj


11/45


)orti*al -rain

u/*orti*al

-rain -rain"tem

)ere/ellum

pinal )ord oot

0erip&eral Ner!e


Mu"*le



12/45

fkk umj 09 anwar wardy dept.neurology

Hypothalamus

Brain stem

Cereral orte"

Thalamus

#medial$

Basal nulei#lateral to thalamus$

Cereellum

Spinal ord

Midrain

%ons

Medulla

Brain component

Cereral orte"

Basal nulei

Thalamus

Hypothalamus

Cereellum

Brain stem

#midrain, pons,

and medulla$


13/45

fkk umj 09 anwar wardy dept.neurology

Ma&or 'untions Brain component

(. Sensory pereption). *oluntary ontrol of mo+ement

. -anguage. %ersonality traits

/. Sophistiated mental e+ents, suh as thin0ing memory,deision ma0ing, reati+ity, and self1onsiousness

(. 2nhiition of musle tone). Coordination of slo3, sustained mo+ements

. Suppression of useless patterns of mo+ements

(. 4elay station for all synapti input). Crude a3areness of sensation. Some degree of onsiousness

. 4ole in motor ontrol

(. 4egulation of many homeostati funtions, suh as temperature ontrol, thirst, urine output, and food inta0e

). 2mportant lin0 et3een ner+ous and endorine systems. 5"tensi+e in+ol+ement 3ith emotion and asi eha+ioral patterns

(. Maintenane of alane

). 5nhanement of musle tone. Coordination and planning of s0illed +oluntary musle ati+ity

(. 6rigin of ma&ority of peripheral ranial ner+es

). Cardio+asular, respiratory, and digesti+e ontrol enters

. 4egulation of musle refle"es in+ol+ed 3ith e7uilirium and posture

. 4eeption and integration of all synapti input from spinal ord8

arousal and ati+ation of ereral orte"/. 4ole in sleep13a0e yle

Cereral orte"

Basal nulei

Thalamus

Hypothalamus

Cereellum

Brain stem

#midrain, pons,

and medulla$


14/45

)orti*al -rain

Depend" upon &emi"p&eri* dominan*e

Non#neurologi"t" generali:e9 rig&t9 !i"ual;"patial, per*eption and memory

left9 language and language dependentmemory

$oo< for ahasias! ara"ias! and agnosias



15/45

Cerebral Cortex 2&ree "pe*iali:ation"

en"ory area" # "en"ory input tran"lated intoper*eption

Motor area" # dire*t "


16/45

Neurologi* E%amination w&en)orti*al -rain i" $e"ioned

3ig&er )orti*al Fun*tion9 ap&a"ia, apra%ia,agno"ia

)ranial Ner!e"9 normal

)ere/ellar Fun*tion9 normal

Motor9 wea


17/45

Primary Somatosensory Cortex

$o*ated in t&epo"t*entral gyru", t&i"area9 e*ei!e" information from

t&e "


18/45

Primary Motor Cortex

$o*ated in t&e pre*entralgyru"

)ompo"ed of pyramidal*ell" w&o"e a%on" ma


19/45


)orti*al -rain

u/*orti*al

-rain -rain"tem

)ere/ellum

pinal )ord

oot

0erip&eral Ner!e


Mu"*le



20/45

u/*orti*al -rain

Deep w&ite radiating >/er" produ*ee'ual in!ol!ement of fa*e;arm;leg

wea/er" are

interrupted9 deep parietal9 pie on t&e 8oor

deep temporal9 pie in t&e "


21/45

Neurologi* E%amination w&enu/*orti*al -rain i" $e"ioned


)ranial Ner!e"9 !i"ual >eld *ut"

)ere/ellar Fun*tion9 u"ually normal

Motor9 wea


22/45

Di!i"ion" of t&eNeura%i"

)orti*al -rain

u/*orti*al

-rain -rain"tem

)ere/ellum

pinal )ord

oot

0erip&eral Ner!e


Mu"*le



23/45

-rain"tem

2&e -rain"tem i" /a"i*ally "pinal *ordwit& em/edded *ranial ner!e",produ*ing t&e following a/normalitie"

*ranial ner!e a/normalitie"

*la""i* "pinal *ord *omplaint"

/owel and /ladder pro/lem"

long tra*t "ign"9 6/ilateral and *ro""ed7 *orti*o"pinal 6pyramidal79 motor

"pinot&alami*9 pain;temp to t&e t&alamu"

dor"al *olumn"9 prioprio*eption;!i/ration tot&al.fkk umj anwar wardy w


24/45

Neurologi* E%amination w&en-rain"tem i" $e"ioned


)ranial Ner!e"9 444, 4, 49 diplopia

9 de*rea"ed fa*ial "en"ation

449 drooping

4449 deaf and di::y

4@, @, @449 dy"art&ria and dy"p&agia

@49 de*rea"ed "trengt& in ne*< and "&oulder"


Motor9 &emi#pare"i", UMN

en"ory9 &emi#dy"e"t&e"ia"

Deep 2endon e8e%e"9 &emi#&yper#re8e%ia

0at&ologi* e8e%e"9 -a/in"


25/45


)orti*al -rain

u/*orti*al

-rain -rain"tem

)ere/ellum

pinal )ord

oot

0erip&eral Ner!e


Mu"*le



26/45

)ere/ellar Fun*tion

ome people /elie!e t&at one *an not te"t"pe*i>*ally for *ere/ellar a/normalitie" no one te"t on e%amination relia/ly e!aluate" t&e *ere/ellum

39 &ypotonia

A9 a""ynergy of 6ant7agoni"t mu"*le"

N9 ny"tagmu"

D9 dy"metria, dy"art&ria

9 "tan*e and gait

29 tremorfkk umj anwar wardy w


27/45

Neurologi* E%amination w&ent&e )ere/ellum i" $e"ioned



)ere/ellar Fun*tion9

ny"tagmu"

"ta**ato dy"art&ria 6a/normality of pro"ody7

Motor9

&emi#&ypotonia

intention ( po"itional tremor

a%ial in"ta/ility wit& dy"metria en"ory9 normal

Deep 2endon e8e%e"9 normal

0at&ologi* e8e%e"9 none



28/45


)orti*al -rain

u/*orti*al

-rain -rain"tem

)ere/ellum

pinal )ord

oot

0erip&eral Ner!e


Mu"*le



29/45

Spinal Cord

en"ory le!el 6&ori:ontal7

Wea


30/45

Neurologi* E%amination w&ent&e pinal )ord i" $e"ioned



)ere/ellar Fun*tion9 normal Motor9 wea


31/45


)orti*al -rain

u/*orti*al

-rain -rain"tem

)ere/ellum

pinal )ord

oot

0erip&eral Ner!e


Mu"*le



32/45

oot;adi*ulopat&y

0ain i" t&e &allmar< of a radi*ulopat&y

en"ory a/normalitie" in a dermatome

pro!o*ati!e maneu!re" e%a*er/ate t&epain

Weanding"


N l i E i ti &


33/45

Neurologi* E%amination w&ena oot i" $e"ioned




Motor9 a""ymetri* weaned to

a dermatome Deep 2endon e8e%e"9 &ypo# to a#re8e%ia

if t&e root *arrie" a re8e%

0at&ologi* e8e%e"9 nonefkk umj anwar wardy w


34/45


)orti*al -rain

u/*orti*al

-rain -rain"tem

)ere/ellum

pinal )ord

oot

0erip&eral Ner!e


Mu"*le


0 i & l N


35/45

0erip&eral Ner!e6pre"uming nonfo*ality7

Wea


36/45

Neurologi* E%amination wit&Di1u"e 0N $e"ioning




Motor9 wea


37/45


)orti*al -rain

u/*orti*al

-rain -rain"tem

)ere/ellum

pinal )ord oot

0erip&eral Ner!e


Mu"*le



38/45


Fatigua/ility i" t&e &allmar<

Wea


39/45


40/45


)orti*al -rain

u/*orti*al

-rain -rain"tem

)ere/ellum

pinal )ord oot

0erip&eral Ner!e


Mu"*le



41/45

Mu"*le

Wea


42/45

Neurologi* E%amination inDi"order" of Mu"*le


)ranial Ner!e"9 pto"i", dy"*onugate ga:e,dy"p&agia, dy"p&onia, 6dy"art&ria7


Motor9 pro%imal wea


43/45

*ott" $e"ion $o*ali:e" to9

Almo"t e%*lu"i!ely t&e )ere/ellum,t&oug& to a minor degree t&e - and

0N are in!ol!ed.

4"olated &erita/le *ere/ellar

dy"fun*tion i" rare, "o we woulde%pe*t to "ee ot&er part" of t&e )Nin!ol!ed.



44/45

pino )ere/ellar Ata%ia 6)A7

0rior to *ott" diagno"i", &i" *ou"in wa" t&e pro/and for t&i"entity.

*ott &a" a BC#family mem/er, generation pedigree of t&i"di"order

3i" family entered into a "tudy, and &i" family led to t&e*la""i>*ation of )A9

ata%ia wit& a%onal "en"ory neuropat&y



45/45

Thank U

Wa""alam, Wr W/r

Ja

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