Why studying neurosciences? Neurological symptoms account for high % of consultation in general...
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Why studying neurosciences?
• Neurological symptoms account for high % of consultation in general practice.
• Accounts for 20% of acute admissions to hospitals, trauma, critical illness, anesthesia & surgery.
• Dx. is primarily clinical, based on history and physical exam.
• Any investigations can only supplement but never replace the process of clinical assessment.
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The brain
• The brain weighs 2 % of body weight.
• The brain utilizes 20% of total energy expenditure.
• It contains about 100 billion neurons.
• Each neuron has about 10000 (200 – 200000) input.• Single output (axon)
• brain is one of the most complex systems
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The brain
Dinosaur
1600 KgBW, 0.07 Kg brain weight
0.004%
Human
70KgBW, 1.4Kg Brain weight
2%
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The Symptomatology of a nervous disease
1. Negative symptoms; •Lesion to a center in the CNS may diminish or abolish the function of that center.
2. Positive symptoms; Produced by;• Centers are liberated from the control of a damaged center.• or their activities intensified to compensate for the missing function•or because of unbalanced activities.
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The Symptomatology of a nervous disease
1. Negative symptoms;
paralysis blindness, deafness….
2. Positive symptoms;
epileptic focus, spasticity, Babinski sign, rigidity, parasthesia and ataxia.
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Babiniski Reflex
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http://www.gen.umn.edu/courses/1135/lab/reflexlab/corticospinaltract.htmlhttp://www.gen.umn.edu/courses/1135/lab/reflexlab/corticospinaltract.html
http://medicine.ucsd.edu/clinicalmed/neuro3.htmhttp://medicine.ucsd.edu/clinicalmed/neuro3.htm
BABINSKIBABINSKI
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Dx. Of Neurological Diseases
1. Anatomical factors; It determines signs, symptoms and localization of the lesion.
2. Non-anatomical factors; It helps to determine the etiology of the disease.
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Non – Anatomical factors include;
1. The speed of development of signs and symptoms (Acute, subacute or chronic)
2. The course of the signs and symptoms; (progressive, fluctuating)
3. The outcome.
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The disturbance of function involves first;
1. The most recently acquired task.
e.g. native language versus acquired language.
1. The most complex features.
e.g. writing, speaking, playing musical instruments versus grasp reflex.
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Signals within the CNS
Action potential
Electrotonic potential
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http://www.neuro.wustl.edu/neuromuscular/pathol/nervenl.htmhttp://fulton.edzone.net/cites/winkler-science/team1/chap8.html
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Compound Action Potential, CAP
http://www.unmc.edu/Physiology/Mann/mann12.html
Stim
ulus
Str
engt
h
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CAP: Conduction Velocity
Haines, Fundamental Neuroscience, Elsevier, Fig 3-11
• Conduction velocities: ~0.2m/s to >100m/s• Give indication on health of nerve fiber• Demyelination decreases velocity
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Electroneurography(ENG(
Definition:
• ENG is the measurement of the speed of conduction of impulses down a peripheral nerve.
also known as
• nerve conduction studies (NCS(
• nerve conduction velocity (NCV(
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EMG machine
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Compound Motor Action Potential:CMAP
Motor nerve is stimulated and muscle response is calculated. Latency includes synaptic transmission etc. By subtracting the two latencies, the conduction velocity can be calculated.
http://www.mmi.mcgill.ca/Dev/chalk/lect72p2.htm
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Mallik, A et al. J Neurol Neurosurg Psychiatry 2005;76:ii23-31ii
Figure 2 Median orthodromic sensory study. The index finger digital nerves are stimulated via ring electrodes and the response recorded over the median nerve at the wrist.
SNAP: Sensory Nerve Action Potential
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NCV disorders
• Demyelination is indicated if conduction velocities have fallen below 50 % of normal.
• Even significant loss of axons commonly reduces conduction velocities by only about 30% based on a loss of the fastest conducting fibers.
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• MuscleMuscle
• NerveNerve
• RootRoot
• Spinal CordSpinal Cord
• BrainstemBrainstem
• BrainBrain
How do I approach a patient with muscle weakness?
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