Category neurology

D|D of tremors 

Tremor, an involuntary, rhythmic, oscillatory movement of a body part, is the most common movement disorder encountered in clinical practice. Rest tremors occur in a body part that is relaxed and completely supported against gravity. Action tremors occur with voluntary contraction of a muscle and can be further subdivided into postural, isometric, and kinetic tremors. […]

old man and the ward!

This i read on a friends fathers blog Mr. J.k Chandana i hope u all read it When an old man died in the geriatric ward of a nursing home in an Australian country town, it was believed that he had nothing left of any value. Later, when the nurses were going through his meagre […]

doctor-heal thyself

ew Delhi: The white coat, those knowing eyes, that reassuring voice when in pain, a mere glimpse of a doctor puts us at ease. Little does one realise that their back-breaking schedule, odd working hours and “emotional labour” during patient care sometimes takes a toll on doctors’ health, pushing them to seek help themselves. Dr […]

migraine

Recently a systematic review examined the available literature on acute care treatments for migraine for effectiveness and tolerability, graded each medication’s level of available evidence, and gave recommendations regarding its use.1 The review was limited to double-blind prospective RCTs in adults treated in an emergency department or equivalent acute care setting. Only studies that defined […]

 Subarachnoid Hemorrhage

Subarachnoid hemorrahge CT scan Figure 1. CT scan of head, read as normal in ED. Subarachnoid hemorrahge CT scan Figure 2. Additional CT cut Subarachnoid hemorrahge CT scan Figure 3. CT showing subarachnoid blood to right of brainstem. A 35-year-old Asian man presents to the emergency department with a severe headache. He states he rarely […]

difference between inpatient and day clinic therapy for depression

  In a pilot study, German researchers investigated whether inpatient treatment of depression is more successful than treatment in a day clinic. However, no significant differences were found, they report in “Psychotherapy and Psychosomatics”. The study, carried out by the University of Heidelberg, involved 44 patients with major symptoms of depression. They were randomised to […]

lead poisoning

Lead poisoning (also known as plumbism, colica pictorum, saturnism,Devon colic, or painter’s colic) is a medical condition in humans and othervertebrates caused by increased levels of the heavy metal lead in the body. Lead interferes with a variety of body processes and is toxic to many organs and tissues including the heart, bones, intestines, kidneys, and reproductive andnervous systems. It interferes with the development of the nervous system and is therefore […]

sudden death in epilepsy

Sudden unexpected death in epilepsy Sep 24, 201317 views 4 stars Retrospective study of SUDEP cases occurring in monitoring units Background Sudden unexpected death in epilepsy (SUDEP) is the leading cause of death in people with chronic refractory epilepsy. Very rarely, SUDEP occurs in epilepsy monitoring units, providing highly informative data for its still elusive […]

How has the human brain evolved over the years?

How has the human brain evolved over the years? —Emma Schachner, Salt Lake City John Hawks, a professor of anthropologyat the University of Wisconsin–Madison, answers: Humans are known for sporting big brains. On average, the size of primates’ brains is nearly double what is expected for mammals of the same body size. Across nearly seven million years, the […]

syncope

Back    Syncope Lyall A. J. Higginson last modified in November 2012 In this topic Syncope • Pathophysiology • Etiology • Evaluation • Treatment • Geriatrics Essentials • Key Points AudioSyncope: A Merck Manual of Patient Symptoms podcast Syncope is a sudden, brief loss of consciousness (LOC) with loss of postural tone followed by spontaneous revival. The patient is motionless and limp […]

coma

Coma is unresponsiveness from which the patient cannot be aroused. Impaired consciousness refers to similar, less severe disturbances of consciousness; these disturbances are not considered coma. The mechanism for coma or impaired consciousness involves dysfunction of both cerebral hemispheres or of the reticular activating system (also known as the ascending arousal system). Causes may be […]

all mental illness have common genes

The biggest study yet into genetics and mental health has come up with a stunning result: The five most common mental illnesses — autism, attention deficit disorder, bipolar disease, schizophrenia and major depression — all have a common genetic root. The finding, published in the journal Lancet on Wednesday, may eventually lead to a complete […]

hydrocephalus

Hydrocephalus is a build-up of fluid on the brain. The excess fluid puts pressure on the brain, which can cause it to be damaged. The damage to the brain can result in a wide range of symptoms, including: Headache Being sick Blurred vision Difficulty walking Hydrocephalus can usually be treated using a piece of equipment […]

huntington’s chorea

_ _ _ _ _ _ _ _ (Huntington’s Chorea; Chronic Progressive Chorea; Hereditary Chorea) Huntington’s disease is an autosomal dominant disorder characterized by chorea and progressive cognitive deterioration, usually beginning in middle age. Diagnosis is by genetic testing. Treatment is supportive. First-degree relatives are encouraged to have genetic testing. Huntington’s disease affects both sexes […]

fragile x associated tremors/ataxia syndrome

_ Fragile X–associated tremor/ataxia syndrome (FXTAS) is a genetic disorder affecting mostly men and causing tremor, ataxia, and dementia. FXTAS affects about 1/3000 men. A premutation (an increased number of CGG repeats) occurs in the fragile X mental retardation (FMR1) gene on the X chromosome; if the mutation is full, > 200 repeats occur, causing […]

chorea

_ _ _ Chorea is nonrhythmic, jerky, rapid, nonsuppressible involuntary movements, mostly of distal muscles or the face; movements may merge imperceptibly into purposeful or semipurposeful acts that mask the involuntary movements. Athetosis is nonrhythmic, slow, writhing, sinuous movements predominantly in distal muscles, often alternating with postures of the proximal limbs to produce a continuous, […]

cerebellar dysfunctions

_ _ Voluntary movement requires interaction of the corticospinal (pyramidal) tracts, basal ganglia, and cerebellum (the center for motor coordination). The pyramidal tracts pass through the medullary pyramids to connect the cerebral cortex to lower motor centers of the brain stem and spinal cord. The basal ganglia (caudate nucleus, putamen, globus pallidus, subthalamic nucleus, and […]

demyelinating diseases

Myelin sheaths cover many nerve fibers in the central and peripheral nervous system; they accelerate axonal transmission of neural impulses. Disorders that affect myelin interrupt nerve transmission; symptoms may reflect deficits in any part of the nervous system. Myelin formed by oligodendroglia in the CNS differs chemically and immunologically from that formed by Schwann cells […]

Internuclear ophthalmoplegia

Internuclear ophthalmoplegia is characterized by paresis of eye adduction in horizontal gaze but not in convergence. It can be unilateral or bilateral. During horizontal gaze, the medial longitudinal fasciculus (MLF) on each side of the brain stem enables abduction of one eye to be coordinated with adduction of the other. The MLF connects the following […]

conjugate gaze palsies

A conjugate gaze palsy is inability to move both eyes in a single horizontal (most commonly) or vertical direction. Gaze palsies most commonly affect horizontal gaze; some affect upward gaze, and fewer affect downward gaze. Horizontal gaze palsies: Conjugate horizontal gaze is controlled by neural input from the cerebral hemispheres, cerebellum, vestibular nuclei, and neck. […]

Neuro-ophthalmologic disorders

Dysfunction of certain cranial nerves may affect the eye, pupil, optic nerve, or extraocular muscles and their nerves; thus, they can be considered cranial nerve disorders, neuro-ophthalmologic disorders, or both. Neuro-ophthalmologic disorders may also involve dysfunction of the central pathways that control and integrate ocular movement and vision. Cranial nerve disorders can also involve dysfunction […]

subacute meningitis

Meningeal inflammation that lasts > 2 wk (subacute meningitis) or > 1 mo (chronic meningitis) may have infectious or noninfectious causes (eg, cancer). Diagnosis requires CSF analysis, usually after CT or MRI. Treatment is directed at the cause. Etiology Subacute or chronic meningitis may have infectious or noninfectious causes and may be an aseptic meningitis […]

meningitis

For brain infections, see Brain Infections, for neonatal meningitis, see Infections in Neonates: Neonatal Bacterial Meningitis ) Meningitis is inflammation of the meninges of the brain or spinal cord. Meningitis is often infectious and is one of the most common CNS infections. Inflammation involves both the meninges and brain parenchyma (meningoencephalitis). Meningitis may become evident […]

overview of cerebellar functions

The cerebrum is divided by a longitudinal fissure into 2 hemispheres, each containing 5 discrete lobes. The frontal, temporal, parietal, and occipital lobes cover the brain’s surface; the insula is hidden under the Sylvian fissure (see Fig. 1: Function and Dysfunction of the Cerebral Lobes: Areas of the brain.). Although specific functions are attributed to […]

Neuropathic Pain

Neuropathic Pain Share This view related topics in this manual Neuropathic pain results from damage to or dysfunction of the peripheral or central nervous system, rather than stimulation of pain receptors. Diagnosis is suggested by pain out of proportion to tissue injury, dysesthesia (eg, burning, tingling), and signs of nerve injury detected during neurologic examination. […]

chronic pain

Chronic pain is pain that persists or recurs for > 3 mo, persists > 1 mo after resolution of an acute tissue injury, or accompanies a nonhealing lesion. Causes include chronic disorders (eg, cancer, arthritis, diabetes) and injuries (eg, herniated disk, torn ligament), and many primary pain disorders (eg, neuropathic pain, fibromyalgia, chronic headache). Various […]

treatment of pain

Nonopioid and opioid analgesics are the main drugs used to treat pain. Antidepressants, anticonvulsants, and other CNS-active drugs may also be used for chronic or neuropathic pain and are first-line therapy for some conditions. Neuraxial infusion, nerve stimulation, injection therapies, and neural blockade can help selected patients. Cognitive-behavioral interventions (eg, incremental gains in function; changes […]

evaluation of pain

Clinicians should evaluate the cause, severity, and nature of the pain and its effect on activities and psychologic well-being. Evaluation of the cause of acute pain (eg, back pain, chest pain—see elsewhere in The Manual) differs from that of chronic pain (see Pain: Symptoms and Signs). The history should include the following information about the […]

overview of pain

Overview of Pain Share This Pain is the most common reason patients seek medical care. Pain has sensory and emotional components and is often classified as acute or chronic. Acute pain is frequently associated with anxiety and hyperactivity of the sympathetic nervous system (eg, tachycardia, increased respiratory rate and BP, diaphoresis, dilated pupils). Chronic pain […]

Pure autonomic failure

Pure autonomic failure results from neuronal loss in autonomic ganglia, causing orthostatic hypotension and other autonomic symptoms. Pure autonomic failure, previously called idiopathic orthostatic hypotension or Bradbury-Eggleston syndrome, denotes generalized autonomic failure without CNS involvement. This disorder differs from multiple system atrophy because it lacks central or preganglionic involvement. Pure autonomic failure affects more women, […]

multiple system atrophy

Multiple System Atrophy view related topics in this manual Multiple system atrophy is a relentlessly progressive neurodegenerative disorder causing pyramidal, cerebellar, and autonomic dysfunction. It includes 3 disorders previously thought to be distinct: olivopontocerebellar atrophy, striatonigral degeneration, and Shy-Drager syndrome. Symptoms include hypotension, urinary retention, constipation, ataxia, rigidity, and postural instability. Diagnosis is clinical. Treatment […]

horner’s syndrome

Horner’s Syndrome Horner’s syndrome is ptosis, miosis, and anhidrosis due to dysfunction of cervical sympathetic output. Etiology Horner’s syndrome results when the cervical sympathetic pathway running from the hypothalamus to the eye is disrupted. The causative lesion may be primary (including congenital) or secondary to another disorder. Lesions are usually divided into Central (eg, brain […]

Autonomic Neuropathies

Autonomic Neuropathies Share This view related topics in this manual Autonomic neuropathies are peripheral nerve disorders with disproportionate involvement of autonomic fibers. The best known autonomic neuropathies are those accompanying peripheral neuropathy due to diabetes, amyloidosis, or autoimmune disorders. Autoimmune autonomic neuropathy is an idiopathic disorder that often develops after a viral infection; onset may […]

ans

Overview of the Autonomic Nervous System Share This The autonomic nervous system (ANS) regulates physiologic processes. Regulation occurs without conscious control, ie, autonomously. The 2 major divisions are the sympathetic and parasympathetic systems. Disorders of the ANS cause autonomic insufficiency or failure and can affect any system of the body. Anatomy The ANS receives input […]

pain

Overview of Pain Share This Pain is the most common reason patients seek medical care. Pain has sensory and emotional components and is often classified as acute or chronic. Acute pain is frequently associated with anxiety and hyperactivity of the sympathetic nervous system (eg, tachycardia, increased respiratory rate and BP, diaphoresis, dilated pupils). Chronic pain […]

fatal insomnia

Fatal insomnia is a typically hereditary prion disorder causing difficulty sleeping, motor dysfunction, and death. FI, a very rare disease, usually results from an autosomal dominant mutation, but several sporadic cases have been identified. Average age at onset is 40 yr (ranging from the late 30s to the early 60s). Common early symptoms include difficulty […]

creutzfeldt jacob disease

Creutzfeldt-Jakob Disease (CJD) Share This Creutzfeldt-Jakob disease is a sporadic or familial prion disease. Bovine spongiform encephalopathy (mad cow disease) is a variant form. Symptoms include dementia, myoclonus, and other CNS deficits; death occurs in 1 to 2 yr. Transmission can be prevented by taking precautions when handling infected tissues and using bleach to clean […]

prions disease

Overview of Prion Diseases (Transmissible Spongiform Encephalopathies) Share This Prion diseases are progressive, fatal, and untreatable degenerative brain disorders. They include Creutzfeldt-Jakob disease (CJD), the prototypic example Gerstmann-Sträussler-Scheinker disease (GSS) Fatal insomnia (FI) Variant CJD (vCJD) Kuru Prion diseases usually occur sporadically, with a worldwide annual incidence of about 1/1 million. Prion diseases result from […]

psp

Progressive supranuclear palsy is a rare, degenerative CNS disorder causing loss of voluntary eye movements, bradykinesia, muscular rigidity with progressive axial dystonia, pseudobulbar palsy, and dementia. The cause of progressive supranuclear palsy is unknown. Neurons in the basal ganglia and brain stem degenerate; neurofibrillary tangles containing an abnormally phosphorylated tau protein are also present. Multiple […]

apraxia

Apraxia is inability to execute purposeful, previously learned motor tasks, despite physical ability and willingness, as a result of brain damage. Diagnosis is clinical, often including neuropsychologic testing, with brain imaging (eg, CT, MRI) to identify cause. Prognosis depends on the cause and extent of damage and patient age. There is no specific treatment, but […]

aphasia

Aphasia is language dysfunction that may involve impaired comprehension or expression of words or nonverbal equivalents of words. It results from dysfunction of the language centers in the cerebral cortex and basal ganglia or of the white matter pathways that connect them. Diagnosis is clinical, often including neuropsychologic testing, with brain imaging (CT, MRI) to […]

amnesia

Amnesia is partial or total inability to recall past experiences. It may result from traumatic brain injury, degeneration, metabolic disorders, seizure disorders, or psychologic disturbances. Diagnosis is clinical but often includes neuropsychologic testing and brain imaging (eg, CT, MRI). Treatment is directed at the cause. Processing of memories involves registration (taking in new information), encoding […]

intracranial tumors

Intracranial tumors may involve the brain or other structures (eg, cranial nerves, meninges). The tumors usually develop during early or middle adulthood but may develop at any age; they are becoming more common among the elderly. Brain tumors are found in about 2% of routine autopsies. Some tumors are benign, but because the cranial vault […]

rehabilitation

Rehabilitation aims to facilitate recovery from loss of function. Loss may be due to fracture, amputation, stroke or another neurologic disorder, arthritis, cardiac impairment, or prolonged deconditioning (eg, after some disorders and surgical procedures). Rehabilitation may involve physical, occupational, and speech therapy; psychologic counseling; and social services. For some patients, the goal is complete recovery […]

exercise

Exercise stimulates tissue change and adaptation (eg, increase in muscle mass and strength, cardiovascular endurance), whereas rest and recovery allow such change and adaptation to occur. Recovery from exercise is as important as the exercise stimulus. Regular physical activity reduces the likelihood of medical illness, decreases the incidence of the major causes of death, and […]

foreign travel

About 1 in 30 people traveling abroad requires emergency care. Illness in a foreign country may involve significant difficulties. Many insurance plans, including Medicare, are not valid in foreign countries; overseas hospitals often require a substantial cash deposit for nonresidents, regardless of insurance. Travel insurance plans, including some that arrange for emergency evacuation, are available […]

air travel

Air travel can cause or worsen certain medical problems; some are considered a contraindication to flight (see Table 1: Medical Aspects of Travel: Contraindications to Flying), and others may cause discomfort. Serious complications are rare. During a flight, any health care practitioner among the passengers may be asked to help fellow passengers who become ill. […]

exercise in elderly

At least 75% of people age > 65 yr do not exercise at recommended levels despite the known health benefits of exercise Longer survival Improved quality of life (eg, endurance, strength, mood, flexibility, cognitive function) Furthermore, many elderly people are not aware of how hard to exercise and also do not appreciate how much exercise […]

suicide

Suicidal behavior includes 3 types of self-destructive acts: completed suicide, attempted suicide, and suicide gestures. Thoughts and plans about suicide are referred to as suicide ideation. Completed suicide is a suicidal act that results in death. Attempted suicide is an act intended to be self-lethal, but one that does not result in death. Frequently, suicide […]

gad

Generalized anxiety disorder (GAD) is characterized by excessive, almost daily anxiety and worry for ≥ 6 mo about many activities or events. The cause is unknown, although it commonly coexists in people who have alcohol abuse, major depression, or panic disorder. Diagnosis is based on history and physical examination. Treatment is psychotherapy, drug therapy, or […]