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KAPITA SELEKTA
NEUROLOGI
Dept. Neurologi
FKUAJ/RSA
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Human Nervous System
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Neurological Levels
Brain
Brainstem
Spinal cord
Motor neuron
Peripheral nerveNeuromuscular junction
Muscle
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Neurological Levels
Brain Brainstem
Spinal cord Motor neuron
Peripheral nerve
Neuromuscular junction
Muscle
Often unilateral
Motor and/or sensory
Language Consciousness
Memory
Behavior
Vision Seizures
Movement d/o
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Neurological Levels
Brain
Brainstem Spinal cord Motor neuron
Peripheral nerve
Neuromuscular junction
Muscle
Often unilateral
Motor and/or sensory
Consciousness
Cerebellar
Movement d/o
Cranial nerves
Diplopia
Vertigo
Face
Swallow
Tongue
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Neurological Levels
Brain
Brainstem
Spinal cord Motor neuron
Peripheral nerve
Neuromuscular junction
Muscle
Often bilateral
Motor and/or sensory
Head OK Bowel and bladder
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Neurological Levels
Brain
Brainstem
Spinal cordMotor neuron Peripheral nerve
Neuromuscular junction
Muscle
Asymmetric bilateral
Motor only
Proximal and distal Insidious onset
Fasciculations
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Neurological Levels
Brain
Brainstem
Spinal cord
Motor neuron
Peripheral nerve Neuromuscular junction
Muscle
Symmetric or focal
Sensory > motor
Often distalStocking-glove
If proximal think
Demyelinating (UE + LE)
Cauda equina (LE)
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Neurological Levels
Brain
Brainstem
Spinal cord
Motor neuron Peripheral nerve
Neuromuscular
junction Muscle
Asymmetric bilateral
Motor only
Proximal and distalEyes involved in
myasthenia gravis
Fatigable weakness
Myasthenia gravis
Progressive weakness
Lambert-Eatonmyasthenic syndrome
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Neurological Levels
Brain
Brainstem
Spinal cord Motor neuron
Peripheral nerve
Neuromuscular junction
Muscle
Symmetric bilateral
Motor only
Usually proximal
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!ase "
History of Present Illness (HPI)
This is a 42 yo woman with progressive leg weakness
and numbness over the last 6 months. The left is a littleworse than the right. The sensory loss involves most ofthe left leg, and below the knee on the right. Urinaryfrequency and urgency are present.
Review of System: (+) mild back pain, constipation, andpoor balance walking with one fall.(-) fever, speech, cognition, swallow, hearing, dizziness,
vision, diplopia, or headache.
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!ase "
Past Medical History (PMH)HTN, hypothyroid, psoriasis, hysterectomy
MEDICATIONS: enalapril, synthroid, MVI
Family History (FH)Mother with lupus, father is healthy, sister with type 2 DM
Social History (SH): Stay at home mom. One EtOHper week. Smoked in college. No illicet drugs.
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LO!ALI#E
A. Brain
B. Brainstem
C. Spinal cord
D. Motor neuron
E. Peripheral nerve
F. Neuromuscular
junctionG. Muscle
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!ase "
Physical Examination (PE):Vitals: 128/64, 72, 14Mental Status: AlertCranial Nerves: Normal
Motor:Mild 4/5 weakness in left hip flexion, knee flexion and footdorsiflexion. Spastic tone L > R.No atrophy.Sensory:Mild diffuse decrease in light touch in the L > R legcompared to the arm. Vibration reduced in the left toe. Theabdomen also had mild reduced sensation to pinprick.Reflexes: UE 2/4.3/4 knees, 3/4 R ankle, 4/4 (clonus) L ankle.
L (+) Babinski sign.Cerebellar: FNF normal.HKS impaired by spasticity.Gait:Gait unstable with left circumduction.Movements: None
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LO!ALI#E
A. Spinal cord
B. Peripheral nerve
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$i%erential& 'IN$I!ATE(O
Vascular
Infection
Neoplastic
Drugs/Toxins Inflammatory/Autoimmine
Congenital/Inherited
Allergic
Trauma Endocrine
Other
Vascularmalformation
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$i%erential& 'IN$I!ATE(O
Vascular
Infection
Neoplastic
Drugs/Toxins Inflammatory/Autoimmine
Congenital/Inherited
Allergic
Trauma Endocrine
Other
HTLV-I, II
Abscess
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$i%erential& 'IN$I!ATE(O
Vascular
Infection
Neoplastic
Drugs/Toxins Inflammatory/Autoimmine
Congenital/Inherited
Allergic
Trauma Endocrine
Other
Primary spinal cordtumor
Metastatic cancerwith cordcompression
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$i%erential& 'IN$I!ATE(O
Vascular
Infection
Neoplastic
Drugs/Toxins Inflammatory/Autoimmine
Congenital/Inherited
Allergic
Trauma Endocrine
Other
Multiple sclerosis
Lupus myelitis
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$i%erential& 'IN$I!ATE(O
Vascular
Infection
Neoplastic
Drugs/Toxins Inflammatory/Autoimmine
Congenital/Inherited
Allergic
Trauma Endocrine
Other
Hereditary spasticparaparesis
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$i%erential& 'IN$I!ATE(O
Vascular
Infection
Neoplastic
Drugs/Toxins Inflammatory/Autoimmine
Congenital/Inherited
Allergic
Trauma Endocrine
Other
Spinal stenosis fromosteophyte or disc
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$i%erential& 'IN$I!ATE(O
Vascular
Infection
Neoplastic
Drugs/Toxins Inflammatory/Autoimmine
Congenital/Inherited
Allergic
Trauma Endocrine
Other
B12 deficiency
Copper deficiency
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$i%erential& Summary
Vascular
Infection
Neoplastic
Inflammatory/Autoimmine Congenital/Inherited
Trauma
Endocrine
Prioritize thepossible causes and
start your work-up. Experience.
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Testing
Labs: B12 and copper normal
MRI: Thoracic parenchymal mass
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)RI
Axial T2Saggital T1 + gadolinium
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$iagnosis
Ependymoma