-Brown-S�quard syndrome.

Brown-S�quard syndrome.
(Hemisection of spinal cord.)

*Aetiology:-
lesion in one side of the spinal cord as:-

• Stab wound.
• Disc prolapse.
• D.S.
• Tumor.
  
  

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- Horner's syndrome.

Horner's syndrome

*Def:-

It is a clinical syndrome caused by damage to the sympathetic nerve supply to head and neck.

*synonymes:-

• Bernard-Horner syndrome
• oculosympathetic palsy.

*Causes:-

Due to lesion or compression of one side of the cervical or thoracic sympathetic chain which generates symptoms on the ipsilateral (same side as lesion) side of the body:-Read more �

- Medical treatment of hydrocephalus.

Medical treatment of hydrocephalus

*Aim:-

Medical treatment is used to delay surgical intervention.

*Medical treatment is not effective in long-term treatment of chronic hydrocephalus. It may induce metabolic consequences and thus should be used only as a temporizing measure.

*Lines of TTT:- "Fair"

• Furosemide:1mg/kg/day.(Decreasing CSF secretion).
• Acetazolamide 5mg/kg/day.(Decreasing CSF secretion).
• Isosorbide (Increasing CSF reabsorption).
• Restriction of water and salts.

Dr Ibrahim

- Skull causes of macrocephaly.

Skull causes of Macrocephaly.

"Oscar"

Osteogenesis imperfecta.
Secondaries especially neuroblastoma.
Chronic hemolytic anemia.
Achondroplasia.
Rickets.

Dr Ibrahim

-Guillain Barr� syndrome.

Guillain Barr� syndrome

Aetiology(theories):-

• Postinfection:50% of cases have preceding respiratory or GIT viral infection.
• Post vaccination:following vaccination against swine flu virus.
• Lymphoma.
• Autoimmune theory.

Clinical Picture:-
1-Initial febrile illness.
2-Motor affection:-

• Bilateral symmetrical ascending affection of both lower limbs,trunk,upper limbs,Bulbar muscles,facial muscles then diphragm and respiratory muscles.
• The Affection is proximal more than distal in adult.
• The Affection is proximal more than distal in infant and childrens.
• Weakness is associated with hypotonia and areflexia.
  

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-Lambert-Eaton syndrome.

Lambert-Eaton syndrome
or
Myasthenic-myopayhic syndrome.

*Pathophysiology:-

• a myasthenic syndrome due to autoimmune orocess targeting the mechanism of releasing A.CH from nerve terminals.
• It often associated with bronchogenic carcinoma or other malignancies.

*Clinical picture:-
Proximal weakness,wasting and fatigue but with less common ocular and bulbar affection than Myasthenia.

*Diagnosis:-

• EMG:- shows paradoxical increase  in successive muscle contractions.
• No significant response to prostigmine,but respond to guanidine HCL 20 mg/Kg/day or prednisolone+imuran.
• No acetylecholine receptor antibodies.
• CXR to determine if associated with bronchogenic carcinoma or not.

*Treatment:-

• Treatment of the underlying neoplasm.
• Plasmapheresis.
• Immunosuppression.

Dr Ibrahim

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-Risk factors of cerebral infarction.

Risk factors of cerebral infarction

A)Non-modifiable risk factors:- "Maps"
Male gender.
African-American.
Age(Old age).
Positive family history.
Prior Stroke.

B)Modifiable risk factors by medical treatment:- "Third"
Transient ischemic attacks.
Heart diseases.
Increase Blood pressure(HTN).
Raised Hematocrite.
Diabetes Mellitus.

C)Modifiable risk factors by changing lifestyle:- "chops"
Cigarette smoking.
Hyperlipidemia.
Obesity.
Physical inactivity.
Stressful life.

Dr Ibrahim

-Grades for quantitative assessment of muscle power.

Grades for quantitative assessment of muscle power

Grade(0):-Total paralysis.
Grade(1):-Visible or palpable flicker of contraction but no movement of joint or limb.
Grade(2):-contraction of the muscle  only when the effect of gravity is eliminated.
Grade(3):-Normal movement against gravity but not against additional resistance.
Grade(4):-Normal movement against gravity and additional resistance but not in full range.
Grade(5):-Intact(Normal) muscle power.

Dr Ibrahim

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-Deep tendon reflex grading.

Deep tendon reflex grading

Grade(-):- Absent.
Grade(+):- Hypoactive(Weak).
Grade(++):- Normal(Average).
Grade(+++):- Hyperactive without clonus or moderate exaggeration without clonus.
Grade(++++):- Hyperactive with clonus or marked exaggeration with clonus.

Dr Ibrahim

 

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