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

NBE CME programme for DNB consultantsNote- LP is contra indicated in acute stage, since it aggravates parapareis Herpes zoster myelitis—TC- Pleocytosis, Protein- mild evelation, Glucose –normal or decreased;Tumours (e.g)(Astrocytoma) (Secondaries –Acute myeloid leukemia(AML), Acute lymphocytic leukemia(ALL)Electromyography(EMG)- When suspecting metabolic myopathies (e.g.) Severe CongenitalAutosomal Recessive Muscular Dystrophy (SCARMD) ; To delineate segmented involvement topatchy lesionsNerve Conduction Velocity (NCV)-When features are suggestive of peripheral neuropathyArteriography- A.V. malformationANA/Anti ds DNA—SLE – Lupres myciopathyMonoplegiaHistory - Establish if the case is a monoplegia (or) part of hemiplegia, quadriplegia or paraplegia.Then the following history is a must.Age of onset -Infant-Brachial plexitis(ERB’s Palsy); 10-15 yrs-Monomelic spinal Muscular;Atrophy; any age-Injury to plexus or Nerve – Infection; Sex - Male-Monomelic spinal muscularatrophy; Family History - Hereditary brachial plexopathy; Homocystinuria; Birth History -Birth injury-C.P; ERB’s Palsy-Trauma-Extended arm during prolonged surgery; Fall & Injury to plexus; Trivical-Hereditary brachial plexopathyInfection- Poliomyclitis; Osteomyelitis leadin to neuropathy; Osteomyelitis humerus upper endplexitis – neuritis;Immunisation-OPV; Tetanus Toxiod precipitating hereditary Brachial plexopathy;Asthma(Hopkins syndrome-Asthmatic Amyotrophy; Site of Involvement-Promixal muscles; DistalMuscles; Pain- At rest; Increased by movement; Inability to use Limb - Ex. Trauma/others; Pain +Inability to use Limb - Plexitis; Trauma; Sensation - Present/absent/extend of loss of sensation; H/o. Bleeding Diathesis; Duration-Acute; Chronic; Progressive; Recurrent eg. Hereditary BrachialPlexopathy—Improving or not; H/o. ICT- Headache, Vomiting and seizures; Contractures; Foot drop– peroneal nerve palsy;Clinical Features - General appearance- ( Facies-Storage disease – mucolipidosis, Causescompression at the carpal tunnel in children; Eyes- Cataract, Storage disease subluxation lens –homocystinuria; Lymph adenopathy – Neuroblastoma etc.; Anemia – bleeding disorder; SkinPurpunt Spot;System examination-Higher Functio; CNS- Conscious/unconscious; Group accordingto Glasgow coma scale; Cranial Nerves— Cr. Nerve- Visual impairment – subluxation lens –homocystinciria, FUNDUS- Bleeding/Chroid tubercle or secondaries; Cranial Nerve- Fascial palsya part of ERB’s Palsy; Other Cranial nerves - Particularly lower cranial nerves at the atlanto accipitalregion; motor system- Inspection-; Nutrition-; Wasting – Poliomyclitis; Wrist Drop – PeronealNerve Palsy/Contractures; Faciculation; Trauma; Power-; Tone-; Hypertonia/Hypojonig – CerebralPalsy; Hypotonia - Poliomyelitis/Plexitis; Reflexes-DTR, Brish & Exagerrated – CP(Hypotonic);DTR Plexitis/neuropathy; Superficial reflexes ; Plantar extensor – C.P ; Neonatal Replexes- (Ex.)Moro present or absent; spine-Local tenderness/swelling; Abnormality eg. Short neck; Gait-Assessing Recovery- Proximal to distal. This is plotted by Tinel Sign(Tingling in the distal part of alimb caused by tapping over the regenerating segment of a nerve);Resp System-Wheeze – Asthma;Paradoxical breathing – Diaph paralysis. As part of ERB’s (T1 Involvement);Cardiovascular System-Myxoma of the heart - recurrent Monoplagia; Cynotic heart disease eg. Fallots producingThromoembolism; Abdomen- Hepato splenomegaly – storage diseaseDifferential Diagnosis - Hypotonic Cerebral Palsy-Tone but DTR exaggerated. Plantar extensor/H/o of birth injury; Plexopathy/Neuropathy-Involvement of proximal muscles with or without sensoryloss. There is gradual improvement over the years Eg. Brachial Palsy; Aneterior Horn Cells-Poliomyelitis; Tumours-Primary – malignanat schwannoma secondary – neuroblastoma; Trauma-Neonatal brachial Neuropathy ; To plexus;To bone Osteomyelitis - neuritis; In born error of Metabolis-Homocystinuria,Storage disorder – Carpal tunnel syndrome; Spinal abnormality- Cervical & lumbar;Degenerative disorder (Monoplegia + fasciculation, Tremar, Blindness + Consanguinity)—monomelic spinal muscular atrophy. This is a rare disorder Fasciculation common, SCHINDLER’s150