NBE CME programme for DNB consultants - National Board Of ...

NBE CME programme for DNB consultantsSensory involvement; Bladder bowel involvement; Seizures, speech, cognitive impairment; Gait;Involuntary movements; Cerebellar signs, root pains; Visual disturbanceExamination-Pallor,petichae,cyanosis,clubbing; Dysmorphic face; Rash, arthritis’s, nodules; Lensdislocation; BP in UL and LL; Pulses; Carotid bruit; Ear discharge; Lymphadenopathy,hepatosplenomegqaly; Fundus for Roth spots; CVS for any cardiac disease; CNS examinationhigher function abnormalities, altered sensorium or speech or visual defects; Cranial nerves-Ipsilateral hemiplegia- lesion above brain stem and Crossed hemiplegia lesion below brainstem; Motor examination upper motor neuron signs in both upper and lower limb; Sensorysystem for cortical sensations for cortical involvement; Peripheral sensations if ipsilateral loss ofdorsal column sensation and contralateral loss of pain and temperature then hemisection ofspinal cord in upper cervical lesion; Cerebellar signs; Meningeal signs; InvoluntarymovementsDiscussion-Site of leison; Upper motor neuron lesion above mid cervical cord; Cortex- language, cortical sensations, cognitive and visual apraxia, seizures; Internal capsule posteriorlimb- dense hemiplegia, pure motor, similar in cerebral peduncle and upper Pons; Brain stem -cranial nerve involvement; High cervical cord ipsilateral loss of dorsal column sensation andcontralateral loss of pain and temperature. Absence of cranial nerve involvementAcuteness andlikely etiology - Acute- vascular, abcess; Subacute (days to weeks ) Subdural hematoma, bacterialabcess, fungal granuloma, meningitis, AIDSChronic( months ) -Neoplasm, chronic subduralhematoma, degenerative disease ParaplegiaHistory-Like hemiplegia + - H/O birth asphyxia,backache, bowel bladder abnormalities, spinalabnormality , trauma; H/O Tb ,increasing head size ( hydrocephalous) ;Examination - Spinal deformities, gibbus, spina bifida ( tuft of hair ),head size; Complete CNSexaminationDiscussion - UMN or LMN type; UMN type; Cortical signs- If present then ACA ischemia, superiorsaggital or cortical venous thrombosis, acute hydrocephalous; No cortical signs-spinal lesionbelow cervical cord, bowel bladder involvement, sensory level,LMN type- Cauda acquina lesion,Anterior horn cells, Gullen Barre syndrome, Myopathy Neuropathy,PolioQuadriplegia(cord leison,cerebral palsy)History-Examination similar to hemiplegiaDiscussion-UMN lesion- anoxia, hypotension trauma,upper cervical cord (bowel bladderinvolvement+sensory loss) ; Mixed- lower cervical cord (LMN in upper limb and UMN in lowerlimb)LMN type distal weakness-Peripheral nerve -symmetric,distal weakness, numbness, lesssevere weakness GBS, neuropathies; Anterior horn cell symmetrical, no numbness WerdingHoffman’s disease (Proximal type of weakness), fasciculations; Muscle disease symmetricaldisease myopathies, AHC-asymmetric polio-Neuromuscular junction fluctuating, symmetricalbotulinism, ,myasthenia gravis, periodic paralysisMonoplegiaHistory - Examination similar tohemiplegiaDiscussion – Rare cortical lesion localized disease UMN type mass effectLMN type – nerve injurye.g. sciatic nerve injury ,polio, erbs palsy, median nerve or ulnar nerve injury.Floppy InfantHistory-Onset of weakness, Birth asphyxia, Fluctuating in myasthenia with ptosis,weak cry,difficultyin crying, H/O mgso4 in mother, phenpbarb, cocaine, warfarin in mother, Botulinism, Repeatedaspirations and pneumonias, Features of increased ICT (SOL) ; Forceps delivery in neonate; Injat buttock causing sciatic nerve injury; Polio or polio vaccine; Lower spinal cord injury;pseudoparalysisExamination-Sepsis, congenital intrauterine infections, Ptosos, arthrogryposis,resp difficulty talipes,maternal hydroamnios in myotonic dystrophy, mothers handshake clinches the diagnosis,Thinextremities, ptosis, jt contactures at birth cong muscular dystrophy kernicturus early stage, Syndrome140