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

دا كتاب د. هاشم هتلاقيه متنسق أفضل من كتاب ربيع الطب ومجمع كل حاجه نيورو وسيكاتري ممكن تطبعه وتمشي منه افضل 🩵
مواضيع dementia , headache , come شوفهم من المحاضرات.

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https://t.me/+LjlNz_Psq7s4YmJk
ودعواتكم ليه ع مجهوده🩵🩵

👇🏻فيدوهات د. لميا أطفال الجديدة👇🏻

Hydrocephalus 👆👆

Abnormal head shape 👆👆