DEMENTIA

Dementia + sensory Ataxia + PNP(polyneuropathy) + UMN(babinski's sign) = B12 deficiency

Dementia + cerebellar ataxia + ophtalmoplegia = B1 def (Wernicke's syndrome)

Dementia + high cholesterol = hypothyroidism

Dementia + myoclonus = Creutzfeldt-Jakob disease

Dementia + gait apraxia + urinary incontinence = NPH (non-pressure hydrocephalus)

Dementia with stepwise progression + pseudobulbar palsy(PBP) = Binswanger's disease (vascular dementia)

Dementia + PBP + gaze abnormality + torticollis = PSP (progressive supranuclear palsy)

Dementia + chorea= Huntington's disease

Dementia + Parkinsonism + syncopal attack = Shy-Drager syndrome (multiple system atrophy)

Dementia that is fluctuating + Parkinsonism= Lewy body dementia

Dementia with sparing visuospatial skills + personality change = Frontotemporal dementia

CVA

#CVA (cerebrovascular accident) synopsis

CVA most common cause
Ischemia >emboli> thrombus> heamorrhage

In Haemorrhage -
Intracerebral> SAH > SDH ~ EDH

Among intracerbral -
Mc cause - HTN
Site - putamen>basal ganglia>thalamus> cerebellum> pons

Among SAH
Cause -
Headtrauma > saccular anneursym > berrys aneurysm > circle of wills

Mc site - anterior cerebral artery circulation

Fibromyalgia Treatment

Pharmacologic Agents Effective for Treatment of Fibromyalgia

Antidepressants: balanced serotonin:norepinephrine reuptake inhibition

Amitryptiline

Duloxetinea

Milnaciprana

Anticonvulsants: ligands of the alpha-2-delta subunit of voltage-gated calcium channels

Gabapentin

Pregabalina

Broadmans areas

Broadmann's areas

A. Somatosensory cortex I - ----3, 1, 2 (post central gyrus of parietal lobe)----sensations (touch, pressure, vibration, pain, temp)

B. Somatosensory cortex II - ---- superior wall of lateral sulcus---- – memory attached to sensations

C. Somatosensory association area---- 5 & 7 --- nature of the object sensed

D. primary motor cortex  ---- 4 (pre central gyrus) ---- control simple voluntary movements

E. Premotor cortex – ---6 - ----Programme sequence of movements, movement of motor joints and motor learning

G. Primary visual cortex------ 17----visual sensation

H. secondary visual cortex ---- 18----visual sensation

I. Visual association area- 19 --- nature of visual sensation

J. Primary auditory cortex----41------auditory sensation

K. Auditory association area-  22 & 42 --- nature of perceived sound

L. cingulate gyrus --- 24

M. angular gyrus-------39

N. Wenekies area------22 ( post end of superior temporal gyrus)--- word comprehension---#l/t sensory fluent aphasia

O. Taste area --------- 43 (Area I- post central gyrus….Area II- insular cortex)

P. Brocas area-44 (inferior frontal gyrus)----word expression (#l/t motor or nonfluent aphasia)

Q .arcuate fasciculus- connect brocas to wernikes- ---#l/t fluent faulty speech

Midbrain syndromes

Midbrain syndromes
Benedikt’s-Ipsilateral Oculomotor palsy and CL tremors,chorea,athetosis.Injury to red nucleus
Nothnagel’s-IL 3rd N palsy and CL cerebellar ataxia.Due to superior cerebellar peduncle injury
Claude’s-Benedikt’s+Nothnagel’s
Webers-IL 3rd N palsy with CL hemiplegia.Due to cerebral peduncle injury.
Pontine syndromes
Foville-Lateral gaze palsy,ipsilateral facial palsy,CL hemiparesis.Dorsal pontine injury.
Millard Gubler- Similar to Foville,but only LR palsy.Ventral pontine injury.
Reymond Cestan Syndrome
Eaton Lambert’s myasthenic syndrome-Autoimmune disorder that affects voltage-gated calcium channels on the pre-synaptic membrane of the neuromuscular junction.Repeated stimulus improves response and invokes contraction.
Blindloop syndrome-
Short bowel syndrome-
LEOPARD syndrome-
Lentigens
ECG abnormalities-primary conduction defects
Ocular hypertelorism
Pulmonary stenosis and subaortic stenosis
Abnormal genitalia-cryptorchidism hypospadiasis
Retardation of growth
Deafness-sensorineural
Wunderlich syndrome – spontaneous, nontraumatic renal hemorrhage confined to the subcapsular and perirenal space. It may be first manifestation of a renal angiomyolipoma (AML). Massive hemorrhage is seen.
kostman sundrome-absolute neutrophil count (ANC) chronically less than 500/mm3
leriche syndrome—impotence,pain in thigh and buttock both sides on walkng(claudication),absent or weak lower limb pulses,bruit over iliac region.cause is aorto iliac obstruction.
joubert’s syndrome-bat wing deformity of the ventricles seen,vermis absent,molar tooth appearence
Irvine-Gass Syndrome-Fluid accumulation within the sensory retina in the macular area,triad of vitreous touch,bullous keratopathy and cystoid macular oedema
Mirizzi syndrome– obstruction of biliary duct d/t stone impacted in hartmann’s pouch or cystic duct
Potters syndrome-B/l renal agenesis.Condition is incompatible wit extrauterine life and death is mc d/t pulmonary hypoplasia
Cat eye syndrome-Partial Trisomy(22pter-22q11)
Lady Windermere syndromeis mycobacterium avium complex pulmonary disease described in fastidious elderly women in the dependent portion of the lingula or the right middle lobe due to proposed habitual voluntary suppression of cough leading to the development of nonspecific inflammatory processes in these poorly draining lung regions – upon which MAC-PD engrafted.
Alagille syndromeis inherited cholestatic syndrome – associated with biliary hypoplasia (ductopenia) – vertebral anomalies – prominent forehead – deep-set eyes – peripheral pulmonic stenosis
Rubinstein-Taybi syndrome is congenital condition characterized by mental and growth retardation – short broad thumbs and/or halluces – and typical facial features
Poland syndrome is amastia associated with hypoplasia of ipsilateral musculature (microsyndactyly or lack of one hand) and chest wall (atrophy of the ipsilateral pectoralis major) and GU abnormalities; 10% have dextrocardia or dextroversion
Li-Fraumeni syndromeis mutant p53 allele inherited – predisposition toward breast carcinomas – sarcomas – leukemia – brain tumors – and adrenocortical carcinoma; half have tumors before age 30 – 70% before age 90
Gerstmann-Straussler-Scheinker syndromeis slow central nervous system disease – hereditary as well as transmissible prion disease with same mutation – point mutation in codon 102 of prion protein as CJD; characterized by cerebellar dysfunction with multiple plaques
Benedikt syndrome– clinical picture from paramedian midbrain infarction from occlusion of the paramedian penetrating branches of the basilar artery affecting the third nerve root fiber – red nucleus – cerebral peduncle resulting in ipsilateral medial rectus palsy with a fixed dilated pupil and contralateral tremor – chorea – and athetosis
Meckel-Gruber syndrome–sloping forehead – posterior encephalocele – polydactyly – and polycystic kidneys
Jorvell and Lange Neilson syndrome- potasium chanellopathy,Consists of deafness, prolongd QT n arrhythmia
senear-Usher syndrome is pemphigus erythematosus; a localized variety of pemphigus foliaceus confine

Gerstmann syndrome

Gerstmann syndrome is characterized by four primary symptoms:
1.Dysgraphia/agraphia: deficiency in the ability to write
2.Dyscalculia/acalculia: difficulty in learning or comprehending mathematics
3.Finger agnosia: inability to distinguish the fingers on the hand
4.Left-right disorientation