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

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NBE CME programme for DNB consultantssensory and motor function, but cause paralysis of bladder and anal sphincters and saddleanesthesia - Muscle bulk/joint deformity/contractures, Head size/shape/fontalnelles, Scar onabdomen(VP shunt), Tender spine, Cutaneous markers of T.B., Herpetic vesicles(Herpes-myceletis),Cafa au lait spots(Neuro fibromatosis)Q. In compressive myelopathy what is the order of involvement of tracts?A. In general i. Pyramidal tracat; ii. Posterior column; iii. Spinothalamic tractDifferentiation between Intra/Extra medullary lesionFeatures Extra IntraMotorUMN – spasticity - Common and persist Less commonLMN – a) Atrophy1-2 segments at the site Wide due to ant.hornOf involvementb) Tropic Not common Presentchangesc) Fasciculation Rare CommonSensoryRoot pain Common Rare148
NBE CME programme for DNB consultantsParenthesis Rare CommonDissociated Absent PresentSensory lossJoint position Lost SparedAutonomicBowel, Bladder Late EarlydisturbanceQ. How to differentiate between Automatic Autonomous bladderAutomaticAutonomousSite of lesion UMN LMNSymptoms Frequency/Urgency O v e r f l o wincontinenceBladder size Decreased IncreasedPyramedal sign + _Q. What questions do you ask about bladder functiona) Sensation of bladder fillingb) Starting micturitionc) Sustainingd) Stoppinge) Satisfaction of emptyingQ. What is Paraplegia in flexionA. Involvement of pyramidal tract + posterior columnQ. What is Paraplegia in extensionA. Involvement of only pyramidal tractQ. Salient features of Transverse MyectisA. i) Motor loss of below the level; ii) Sensory loss below the level(all modalities) ; iii) Bladderinvolvement; iv) Most common site – Mid-thoracic region; v) Evolves over a period of several daysto weeksQ. How will you mention the diagnosisA. 5 levels-1) Motor level; 2) Sensory level; 3) Reflex level; 4) Vertebral level; 5) Autonomic involvementSpinal ParaplegiaEtiolgoy- Congenital malformation - Arachnoid cyst; AV malformation; Atlanto aial dislocation;Arnold chiari malformation; Myclomeningocele;Familial spastic paraplegia - Autosomal Dominant(A.D) ; Autosomal Revessive (A.R.) ; X linked Recessive (X.R.); Infections - T.B. ; Hopkinspaxalysis(Post Mycoplasma) ; Diskitis; Epidural abscess; Herpes Zoster; Metabolic - Adrenomyeloneuropathy; Argininemia; Krabbes disease; Transverse Myelities - Devic’s disease;Encephalomyelitis; Idiopathic ; Trauma - Consussion; Epidural hematoma; Dislocaton/fracture;Tumors - Astrocytoma; Ependymoma; Neuroblastoma; Ewings sarcomaInvestigations– MRI- Single most important investigation but clinical findings should guide thisinvestigation; CT-Important role in identifying extent of bony defect in spina bifida, Also investgationof choice in Atlantoaxial anomalies or instability; Plain X-Ray – Spina bifida Atlantoaxial anomalies;Lumbar Puncture(L.P)—Tuberculosis-Total Count(T.C) – usually > 500, lymphocyte predominant;Protein – increased; Glucose – decreased; AFB +/- (Acid Fast Bacillus) ; PCR +ve (>95%)149
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