🟦تلخيص معمول من زمايلنا 38
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🟦اهم ال notes في كل مواضيع الباطنه نيورو مكتوبة من زميلتنا عدا coma . cranial n
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Stroke كلها مهمه جدااا

➡️ Most common cause.. Hypertension
➡️ Sites ..بالترتيب
Putman ..lober.. thalamus..cebeller ..pons
➡️ Clinical ( ICT + focal)
➡️ classic of pontine hemmorge
( Coma quadriplegic..pin point
Pupil.. Hyperthermia..Bad prognosis)
➡️ First investigation..CT
➡️ cause of death
1 Brainstem compression that affect vital centres
2 Affect brain perfusion..brain Hernitaion
➡️ prognosis
1 level of consciousness
2 Age 3 premorbid state
4 Extent of lesions..

➡️ Subarachnoid hemorrhage..
Most cause .. Rupture circle of. willis
➡️ Artery circulation and post circulation... posterior communicating artery
➡️ clinical..
ICT + Focal sign + meningial irritation
➡️ TTT
Conservative..4A
Decrease pressure,Analgesic . Anticonvulsant.Antifibrinolytic.Avoid straining.

Surgical ( clipping anurysm )
Embolization..coiling

Indications of surgery in hemmorgic stroke ?
1 cerebellar hemmarge 3cm
2 structural vascular lesions
3 young patient+lobar hemmarge

➡️ Death
Hemmorgic stroke. 50%
Ischemic stroke. 10 %
➡️ TIA مهمه جدا
➡️ Commonst cause of hemmorgic stroke.. hypertension
🥀🥀🥀🥀🥀🥀🥀🥀🥀🥀🥀🥀🥀
Iscemic stroke

➡️ Ischemic stroke clinical
Rapid devloping
Focal loss
Negative in nature
Maximam at onst
➡️ iscemic stroke 80 %
Hemmorgic stroke 20%
➡️ Most cause of Ischemic stroke
Arterial Disease 75 %
➡️Most non modifiable Risk factor
Age
➡️ Most modifiable Risk factor
Hypertension
➡️ Benefits of CT ??
1 Detect site size extension of infraction
2. To differ Hemmorgic from iscemic
3 Excluse non vascular cause tumor

➡️ middle cerebral artery is most affected

➡️ CT finding ?
Low dentist
Hemmgnous
Anatomical distributing
Cortical base
Non inhansied

➡️Ct may normal ??
1 very small <0.5 cm
2 in posterior fossa
3 immediately

➡️predictors ..
Level of consciousness.
Age .. premorbid state
Extent

➡️cause ..of Death ? مهمه
💥First few days..
Due to brain edma ..if large infarction
Brain stem affect vital centres
💥 After first weak
Bronchopneumonia.. pulmonary embolism
➡️ Main TTT ...
Tissue plasminogen activator
Actylase 0.9 ml / kg iv over 60minute

➡️ surgical intervention
If cartoid stenosis > 70 %

Epilepsy

Clinical types مهمه
➡️ Investigation..فاينل
Clinically diagnose ..
EEG ..spikes (sharp waves ) and slow waves complex

MRI ..to differentiate between symptomatic and idiopathic..
As symptomatic= TTT for life
Idiopathic. = 2 years TTT
Lab .. to measure level of antiepliptic drug ..and excluse ather metabolic causes ..

➡️ status epilepsy
Most cause .. inappropriate withdrawal of antiepliptic drug
➡️ Mangment of status epilepsy..مهم
Genral and spesific measures ..
.. Attacks of genralised convulsions in between not to normal consciousness

Genral..1 A BC
2 mouth Gag .. oxygen
3 vital signs Recording
4 Arterial sample ( pH ..
Po2. PCO2 ..)
5 venous sample..
( Level of drug ..CBC ..
Glucose.. electrolyte)
6 iv ..normal saline 500
7 Dehydration.. dexa
Specific treatment.....
➡️ Epanutin+ Valium given immediately
Diazepam 5 ml iv slowly
Repeated after 5 min
Maximam dose 20 mg

2 epanutin 15 mg slow
Rate 50 ml /min

3 phenobarbitone..
If seizure more than 20 min
Dose. ..200 mg

4 Resistance.. general anesthesia

➡️ صفحه الادويه مهمه ..

Multiple sclerosis مهم
.. degnration of myelin sheath
Mainly white matter of CNS

➡️ investigation of multiple sclerosis
1 CSF
2 visual evoked potential
3 MRI

➡️ Csf examination
Celle elevation up to 40%
Total protein increase
Gamma globulin increase mainly igG ..
Oligoclonal bands is found
➡️loss of superficial reflex ( abdominal reflex) .
➡️ B interferon ..cause flu like manifestation

➡️lines of TTT
1 corticosteroids ( methyl prednisolone 1 gm iv 7 days

2 Beta interferon (Avonex ..Rebif)
3 immunosuppressive
4 vitamins
بتيجي في case ..
Female ..(30..40) years ..
عندها optic manifestation+ cerebellar manifestation..اكتر حاجه بتتكرر
First investigation..MRI


➡️ modifying drug of Ms=Fingolimod

Peripheral neuropathy
💥 Classification of PN..?
1 Anatomical
Mononeuropaty.. polyneuropathy
Mononeuropaty multiplex
2 clinical..
Motor, sensory, autonomic.mix
3 pathological
Axonal neuropathy
Demyelinating
Mixed

➡️ sensory Manifestation of Polyneuropathy
.. irritation statge= pins and needle
distal >proximal
Stock and Gloves
Deep sensory loss
Sensory ataxia
Trophic ulcer


➡️ Trigeminal neuralgia drug of choice..carbamazepine
➡️ Gullian Barri بتيجي كده ..
Case ..( infection mainly Respiratory+ febrile statge + become free + paralytic stastge )
➡️ Manifestation of paralytic stage.
1 Assending course ..
L.L limb weakness..Trunk ..uL ..
Respiratory..
2 cranial nerves 7 9 10
3 Proximal> distal
4stock and gloves
5 Automatic Fluctuations
6 no wasted muscles
7 csf ..cytoalbumin dissociation
8 nerve conduction
9 TTT ..
💥ICU .. plasmapheresis..IVIG
Respiratory support
No Role of steroids.

➡️ Charcot Marie Tooth neuropathy
مهم
1 Gradual slow progression
2mainly motor ..
Sever muscle wasted..mild weakness
Perneal muscle atrophy
Pes cavus
3 mild sensory Manifestation

➡️Mono neuropathy multiplex
.. Asymmetric multiple nerves
Cause ( Vasculitis..DM ..
Hiv leprosy sarcidosis Amyloidosis

💥Vitamin B1 deficiency= Beri Beri
💥 Vitamin B12 deficiency=
Subacute combined degnration
= 3 p
Peripheral nerve
Pyramidal
Posterior coloum
Cause lost ankel reflex with exgarated knee

💥 Niacin= pellgra
4 D
Diarrhea Dermatitis Dementia Death
Pyramidal affection
Peripheral nerve

💥 muscle disorder
Myasthenia gravis
Clincally ..
Female 30 ..40 years
Excessive fatigue, diplopia
No sensory affaction
Deep reflex is normal



➡️ Investigation..
Electromyography..decrimital Rospnse
..Anti AChR ANTIBODIES
..MRI of mediastinum..thymuy
.. pharmacological test ..
IM prostagmine ..
Iv tensilon test

TTT ? Surgical.. thymectomy
Medical....
Plasma exchange
,IVIG .
Corticosteroids. Prednisolone
Pyridostigmine 60 mg
Prostagmine 15 mg
Tensilon ( Edrophonium) in crisis

Headache..

💥 Red flags?
SNOOP
S. Systematic secondary symptom
N. Neurogical deficit
O. Onst ..sudden , thunderclap
O. Onst in old age
P. Progressive, pregnant
Postional
Papilledema
Presiptate by valsva . exertion

Examination..
Brain imaging most important
.MRI + contrast= TACs
CT without contrast = sudden headache

Chronic headache= MRI + contrast
Stable headache Don't require image

💥💥 Migraine
➡️most common cause of moderte to sever headache

Diagnose= POUND
Pulstile , One day , Unilatera
Nausea. Disabling

💥 International Headache Society Criteria ..
➡️ Headache without aura
5 4 3 2 1
.🛑at least 5 attacks
🛑.lasting 4 hours _ 3 days
.🛑2 symptoms of
Unilateral
Pulstile
Position
Decrease activity
🛑 1 of association
( Nausea.vomit.photophobia
Phonophobia) .
🛑 Not better accounted by another

➡️ With Aura
🛑 2 attacks
🛑 One or more aura symptoms
Visual.sensory .motor . Brainstem.retinal
🛑 At least 3 of 6
1 at least one aura poitive
2 one aura unilateral
3 one aura > 5 min
4 two aura succive
Each one of two 5 - 60 minite
6 after 60 minite there is
Headache
🛑 Exclusion of TIA

➡️ Chronic headache > 15 days / month

💥 Mangment?
Ttt shouldn't be more than 10 days per month

➡️ Mild to moderate headache
= Actemonephen
Aspirin . ibuprofen.

➡️sever cases ?
Sertonine agonist
Dihydroergtamine
Tryptan

💥 Prevention of headache

🛑🛑 Tension Headache
Episode < 15 day
Chronic> 15 day
🛑 Chriteria..
🦋 At least 10 episodes
Each episode 30min ..7 days
🦋 Two of . Biltral
.mild to moderate
.not afffect by position
. Pressing
🦋 No nausea .vomit
No phonophobia
No photophobia
💥 Ttt? Analgesic
Behaviour psychology.
Amitriptyline

🛑🛑 Cluster Headache
Unilateral preorbital tempral
With autonomic lacrimation.ptosis....

➡️Ttt?
During attck
Triptan, dihydroergtamine,O2
➡️ Prevention..?
Long; verapmil . lithium.Divolprx
Short . Steroids.occiptal N block.

🛑🛑 Pseudo tumor cerberi

Hemiplegia
مقارنه cortical ..capsuler.

💥 Brown sequard syndrome
At one side of cord between C1..C5
..due to disc prolpse ..MS ..Tumor
At level .. ipsilateral LMNL
Ipsilateral all sensary loss
Below level ..
Ipsilateral hemiplegia
Ipsilateral deep sensory loss
Contralateral superficial sensory loss
Touch deminished on both sides