Medicine Lecture -Dr.

Proddyut Sir

NERVOUS SYSTEM Consists of1.CNS Br in S!in " cord #. PNS Cr ni " ner$e Peri!%er " ner$e &unction " c" ssific tion' i. ii. So( tic )uto(ic Sy(! t%etic

P r sy(! t%etic &unctions' 1. CNS contro"- PNS Contro""ed *y UMN- Ce"" *ody nd !rocesses "ies e in t%e CNS rc e,. Corticos!in " tr ct Corticoru*r " tr ct O"i$os!in " tr ct Ru*ros!in " tr ct O$er s!in " cord -contro""ed. - Pyr (id " - EP -Cere*e""u( LMN- ce"" *ody e in CNS *ut +ons co(es out / ends into t%e effector or, n. -Musc"e0 ," nds. E,. & ci " ner$e nuc"eus- e in ! ns / ends into t%e (usc"e of f ce. "oc " s!in " ref"e+ Motor unit'

UMNL' corticos!i n" P r "ysis of (o$e(ents of t%e "o1er end (usc"e of o!!osite site to o!!osite 2 !yr (id. Pyr (id " ce"" of Bets fi*res e rises fro( cere*r " LMNL

Note' Most of t%e tr ct decuss te t of (edu"" / ,oes side nd for(s

UMNL

1. P r "ysis of (o$e(ent of (usc"e of o!!osite site s (e side #. )"so ffects fine (o$e(ent of o!!osite site

1. P r "ysis of (usc"e of

Note' E+cit tory neuron / in%i*itory neuron of cere*ru( contro"d s!in " cord. Tone ref"e+ c"ones #. Ed tone. - ed P" nter res!onse- Re( in ed 4Bris5. Un ffected unti" L60 S1is in$o"$ed

3. E+ ,,er tion of tone. ref"e+ or *sent. E+ ,,er tion of ref"e+.

Su!erfici " ref"e+ 7 "ost e+ce!t !" nter res!onse. -e+tension of ,re t toe f nnin, out of ot%er toe. P" nter res!onse- E+ ,,er ted. - E+tensor . Note' P" nter res!onse- !o"ysyn !tic ref"e+ 8nee 9er5' Monosyon tic ref"e+. B *inis5i si,n' :. ::. ; (ont%es of ,e- it is !ositi$e- due to " c5 of (yc" n tion.. UMNL

Ner$e fi*re' T%e (usc"e- *so in LMNL t%ere is (usc"e 1 stin, T1itc%in, (o$e(ent

3. Musc"e 1 stin,. & scicu" tion-

of ,rou! of (usc"e *y <. Disuse tro!%y & scicu" tion- *sent n 5ed eye.

is $isi*"e

&i*ri"" tion- Sin,"e (usc"e fi*re0 detected *y EM=

Contro" of (o$e(ent' Pyr (id " syste( -$o"unt ry (o$e(ents. EPS -:n$o"unt ry (o$e(ents. E,. Surin,in, (o$e(ents of % nd. B"in5in,. Noddin, of %e d durin, t "5in,. Co(!osition of EPS' C ud te Neuc"eus ="o*us ! ""idus Put (en Red nuc"ei Su* t% " (ic nuc"ei Su*st nti ni ,r &unctions'

:. ::. :::. :V.

:t is e+tr to !yr (id " tr ct. -contro"s t%e functions of !yr (id " tr ct. :t contro"s (otor functions :t "so contro"s in$o"unt ry (o$e(ent. E,. De,"utition

E!s "esion' :. ::. :::. :V. )t%etosis' T1istin, / s"u,,is% e+tr !yr (id " (o$e(ent C%ore ' Se(i!ur! si$e0 ->u si!er! si$e. in$o"unt ry 9er5 (o$e(ent of one or (ore "i(*. ?un,tin,tons c%ore - one "i(* Syden% (s- t1o "i(*s C%ore ' C uses' i. ii. ?un,tin,tons c%ore - )utose( " do(in nt dise se Syden% (@s c%ore -R%eu( tic c%ore 0 St. $itus d nce0 D ncin, c%ore . iii. Dru, induced c%ore . E,. C%"or!ro( Aine Syden% (- cordio"o,ist st. $itus- is" nd Tics C%ore )t%etosis Tre(or

i$.

Due to second ry dise se' SLE - S rcoidosis - 1i"son@s dise se.

? e(oc%ro M tosis

$.

C%ore ,r $id ru(

Cere*ru(' Cere*e""u(' Centr " !rocessor. :n!ut- !yr (id " tr ct S!in " cord- su!. S!ino cere*e""" r tr ct. :nf. S!ino cere*e"" r tr ct &unctions'

Contro" of "" $o"unt ry (o$e(ent M inten nce of !ostur " e>ui"i*riu(- c"ose"y connected $esti*u" r ner$e.

-$o"unt ry (o$e(ent is !erfor(ed *y !yr (id " tr ct Pyr (id " tr ct cere*e""u( Cere*r " corte+ T% " ( s Efffects of cere*u"" r "esion' C uses' s!in " cord

Su!erior cere*e"" r !edunc"e

. Mu"ti!"e sc"erosis *. Cere*e"" r inf rction c. Tr u( d. Neo!" s( e. V scu" r ( "for( tion Effects occur on i!si" ter " side of *ody:. :nco-ordin tion of (o$e(ent of "i(* of s (e side

&in,er nose test-! st !ointin,. ! st !ointin, is 5no1n s dys(etri Tre(or-intention. or ction tre(or- )!!e rs durin, ction. Dyssyner,i - - deco(!osition of 9oint (o$e(ent. syner,istic (o$e(ent of 9oints ( int in (o$e(ent. :n *i"ity to !erfor( r !id"y re!e ted "tern tin, (o$e(entDysdi doc%o 5inesi E,. Pron tion / su!in tion ?ee"-s%in test. ?ee"-toe test Dr 1in, of in$isi*"e circ"e.- !t. f i"s to do.

::.

)t +i - "oss of * " nce. -*ro d-* sed , it. *ody 1i"" ti"t to1 rds t%e side of "esion s it

to c tc% t%e centre of ,r $ity ! tient 1i"" rot te- ree"in, , te. N.B' % "f circ"e , it:::. :V. V. Distur* nce of s!eec%' sc nnin,0 st cc to s!eec%. Loss of f"uency- e,. Britis% constition. Nyst ,(us' :n$o"unt ry0 9er5y osci"" tory (o$e(ent of t1o eye * "".

?oriAont " nyst ,(us-is found in cere*e"" r "esion. Vertic " nyst ,(us. )t +ic nyst ,(us- due to (edi " "on,itudin " *und"e "esion found in (u"ti!"e sc"erosis - :t is fr ,(ent "0 %oriAont " nyst ,(us. V:. V::. Tone- ?y!otoni Tendon 9er5' Di(inis%ed V:::. :B. Pendu"" r 5nee 9er5

?e d tre(or- ne$er in ! r5inson@s dise se. ?e d ti"tin, to1 rds t%e side of t%e "esion.

C. &i$e i(!ort nt c uses of cere*e"" r "esionD &i$e fe tures of cere*e"" r "esionD &ront " "o*e- function ""y sin,"e Occi!it " "o*e- function ""y sin,"e P riet " "o*e-# neuron " Te(!or " "o*e-# :nf rction' Co(!"ete cess tion of circu" tion "e din, to

d ( ,e.

Ri,%t % nded !erson Lt. ! riet " nd te(!or " "o*e is do(in nt. Do(in nt ! riet " "o*e C "cu" tion- "esion "e d to dysc "cu"i . L n,u ,e- "esion "e d to dys!% si P" nned (o$e(ents )!!reci tion of siAe0 s% !e0 content of su*st nce- stereo,nosis. )stereo,nosis )!r +i ?o(ony(ous %e(i no!i

 Do(in nt ! riet " "o*e'

Dys"e+i ),nosi

&unction-&ro( !re$ious. Lesion- dysc "cu"i 0 Dys!% si 0 )stereo,nosis0 )!r +i 0 ?o(ony(ous %e(i no!i 0 Dys"e+i 0 ),nosi Non-do(in nt ! riet " "o*e' &unction Lesion "e ds to' S! ti " disorient tion Construction " !r +i - 3 ( tc% stic5 to for( Dressin, !r +i ?o(ony(ous %e(i n !i construction " s5i"" s! ti " orient tion- t1o !oint discri(in tion.

tri n,"e.

Do(in nt te(!or " "o*e' &unctions'

?e rin, S!eec%-sensory re . )udition L n,u ,e Ver* " (e(ory S(e""- unc s / ! r %i!!oc (! " ,yrus o"f ctory ner$e ends

Lesions' Dys!% si -Rece!ti$e !% si . Dys"e+i - :n *i"ity to re d *ut c n ,o t%rou,% t%e "etter. :(! ir(ent of (e(ory ? ""ucin tion -s(e""0 sound / $isu ". = ,s ?o(ony(ous %e(i n !i

Non-do(in nt te(!or " "o*e' &unctions' Lesions' :(! ir(ent of non-$er* " (e(ory Music s5i"" defect Co(!"e+ % ""ucin tion 1%o"e. E(otion " res!onse "oss' 1.!ic5@s dise se #.)"A%ei(er@s dise se 3.Neurosy!%i"is <.CED Lesions' Disin%i*ition- ?e c n not *e !ro%io*ited fro( doin, 1ron, t%in,s. Correction of uditory !erce!tion. Music tone Non$er* " (e(ory

&ront " "o*e' - cts s &unctions'

Person "ity E(otion " res!onse Soci " *e% $ior

L c5 of initi ti$eness )nte soci " cti$ity Me(ory i(! ir(ent -!oet- 8 Ai N Aru" :s" (. C%i"d "i5e cti$ity

Occi!it " "o*e' Lesion' Visu " fie"d defect Cr ni " ner$es' O!tic "tro!%y P !i""oede( . Def. Oede( of ! !i"" (e ns 1%ere t%e undue s1e""in, of o!tic disc. C used' R ised intr ction " !ressureBr in tu(our0 *scess0 %ydroce!% "ous0 % e( rr% ,e0 intr cere*r " % e( to( . O*struction to t%e dr in ,e of retin " $ein CRVO C $ernous sinus t%ro(*osis- !u"s ti"e !ro!tosis0 P !i""oede( .

Syste( tic dise se' O!tic tro!%y' Def. tro!%y of o!tic disc. M y "e d to 1%itis% co"our. M "i,n nt ?TN V scu"itis

C uses' Pre$ious o!tic neuritis Pre$ious P !i""oede( -second ry o!tic tro!%y. Pituit ry tu(our =" uco( Tr u( tic De,ener ti$e dise se of ner$ous syste( e,. &riedric%@s t +i

Tri,e(in " neur ",i ' -Tic- dou"oureu+' (e ns ! in frenc% 1ord. Very ! infu"". Midd"e ,ed nd e"der"y P in "on, tri,e(in " ner$e distri*ution :t in$o"$es o!%t% "(ic F ( +i"" ry P in tri,,ers t%e tic of (uscu" ture of f ce' Tic- dou"oureu+. :t is (ost co((on in ( "e :f detected in e r"y ,e0 ( y *e (u"ti!"e sc"erosis. :t 1 s !re$ious"y 5no1n s idio! t%ic in ori,in

Recent studies' ,rou! of et ry crosses cross t%e 6 t% cr ni " ner$e t%e ! ns co(!reses t%e ner$e. Di ,nostic criteri ' :. ::. :::. :V. :t is usu ""y uni" ter ". :t is unusu " *efore (idd"e ,e. P ro+ys( " ! in0 ne$er continuous. -Sudden / se$ere. On E+ (in tion-

No neuro"o,ic " deficit0 e+ce!t %y!er est%esi V. Res!nd to c r* n A !ine.

' ? ""( r5 C r* ( A !ine -1GG(,0 d i"y u!to #GG(,. Side effects 7 SES P%enyt in -16G-6GG(,4d y. C"on Ae! ( -G.#-#(,0 H %r"y.

Sur,ic "' = sseri n , n,"ion' :n9. P%eno"F)"co"%o" R diofre>uency t%er(oco ,u" tion. Stereot ctic sur,ery. Tri,e(in " , n,"ion= sseri n , n,"ion. & ci " ner$e , n,"ion=enicu" te , n,"ion. & ci " ner$e'

Motor Sensory Viscer "' L cri( " ," nd S "i$ery ," nd Motor' Musc"es of f ci " e+!ression Sensory' =ener " sens tion S!eci " sens tion

& ci " ner$eSu!r nuc"e r ! rt- cere*r " corte+. :nfr nuc"e r ! rt-

UMNL of f ci " ner$e' -"esions of f ci " ner$e. . CVD *. :CSOL-)cuostic n. 0 cere*r " *scess. c. Mu"ti!"e sc"erosis d. Be""@s ! "sy- "so in DM0 M stoiditis0 s rcoidosis0 Le!rosy0 =BS0 My st%eni ,r $is0 R (s y ?unt syndro(e.

Be""@s ! "sy' :dio! t%ic M y *e $ir " or $ scu" r d ( ,e

Site of tension' f ci " c n ". :t is c4f' P in in e r S%eurrin, of s!eec% & i"ure to 1rin5"e & i"s to c"ose t%e eye. De$i tion of n5"e of (out% & i"s to 1%ist"e Dri**"in, :f c%ord te ty(! ni is in$o"$ed- "oss of s!eci " sense ?y!er cusis- if ner$e to st !edious *r nc% is in$o"$ed. "o1er (otor ty!e of f ci " ! "sy.

IG-HGJ c ses res!onds s!ont neous"y. <H-I# %rs -steroidF )cyc"orir. -de+ (et% sone or !redniso"ene. Re"ie$es oede( . &urt%er d ( ,e !re$ention. Cuic5 reco$ery.

?e d c%eK

?e d c%e' C uses' 1. Tension %e d c%e4 !syc%o,enic %e d c%e -2GJ. #. CSOM 3. )coustic neuro( . <. Meniere@s dise se 6. )cute nd cronic sinusitis ;. Eye -=" uco( / refr cti$e error. I. Toot% c%e. H. Te(!or " rteritis4 cr ni " rteritis4 ,i nt rteritis. 2. Tri,e(in " neur ",i . 1G. ?er!es Aoster o!t% "(icus. 11. Menin,itis0 Ence!% "itis0 Br in tu(our. 1#. Su*dur " % e( to( . 13. M "i,n nt ?TN. 1<. CVD. Ty!es of %e d c%e' C. 6 i(!ort nt c uses of uni" ter " %e d c%eD 1. Mi,r ine #. Tri,e(in " neur ",i 3. Te(!or " rteritis. <. ?-L o!t% "(icus. -?er!es Aoster o!t% "(icus. 6. Tr u( . ;. Boi"4 *scess.

Mi,r ine' Co((on in fe( "e C uses uni" ter " %e d c%e. C% r cteristics of %e d c%e' E!isodic -durin, sunset. Usu ""y uni" ter " )cco(! nied *y $ nitin, / $isu " distur* nce. Very r re"y 7 Bite(!or "4 ,ener "iAed ?e d c%e. P t%o,enesis' )t t%e (o(ent of onset of tt c5 "on, T%ere is cere*r " *"ood f"o1 Circu" tion in cere*ru( Cere*r " dysfunction of occi!it " nd ! riet " "o*e. )t t%e (o(ent of tt c5Di" t tion of e+tr cr ni " $esse" -due to f"uctu tion of "e$e" of 6?T. Predis!osin, f ctors' ur -!re(onitory st ,e..

6GJ !t. % s %istory of s (e dise se in 1st de,ree re" ti$es. Diet ry f ctors- c%oco" te0 c%e1in, ,u(0 c%eese0 "co%o". So(e re ction OCP P%o*i !re(enstru " st ,e.

c4f' )!!e rs fter t%e !u*erty. 6G-66 ye rs Not continuous dise se -Re(ission / re" !se. PUD0 R)0 My st%eni ,r $i"s0 Mu"ti!"e sc"erosis. Mont%s to ye r , ! Pre(onitory tt c5' -Sy(!to(s. Visu " distur* nce -!%oto!%o*i . Dys!% si Me 5ness of one side of *ody- %e(i! resis %e(i no!i . T%en ctu " %e d c%e P ""or )st%eni -!rostr tion.

Ty!es'
.

Mi,r ine

ur 4 c" ssic " Mi,r ine ur 4 co((on Mi,r ine

*. Mi,r ine

c. ?e(i!"e,ic Mi,r ine d. B si" r Mi,r ine- Occi!it " %e d c%e occurs. e. Mi,r nous neur ",i 4 C%uster %e d c%e. M n ,e(ent' ?istory- Preci!it tin, f ctors OCP ' Re"ief of sy(!to(s. . )n ",esic- s!irin4 ! r cet (o" *. Metoc%"or!ro(ide c. Er,ot (ine t rt te G.6-1(,0 su*"in,u "4Rectu "4in% "er. )d$erse effect' C uses intense n use nd $o(itin,.

V sos! s(- "e ds to R yn ud@s syndro(e. P r do+ic " %e d c%e- due to 1it%dr 1 " of dru,. Contr indic tion' Pre,n ncy :?D

 Seronine ,onist'

Peri- $ scu" r dise se - Buer,er@s dise se.

Su( tri!t n-1GG(, t * -Su( tri!tin. 3GG(,4d y )$ i" *"e in in9.- ; (,4sc. Note' is "ess i(!. t% n !ro!%y" +is.

Pro!%y" +is' 1. &re>uent tt c5.. #. Distur* nce of soci " "ife0 office "ife. Dru,s' o Non-se"ecti$e N *"oc5er -!ro! no"o"- <G-6G(,0 H %r"y. PiAotifen-1.6-3(,?s d i"y. )(itri!ty"ine-#6-1GG(,4d y ?s.

Br in tu(our' -#J de t% due to it. -( in"y cere*r " tu(our. Pri( ry . Besi,n' -(einin,i ( . -Neurofi*r ( . -!ituit ry deno( . -Cr ni !% ryn,io( of rot%5is !ouc% Second ry "un, c . Bre st c . C .5idney. C . =:T

*. M "i,n nt' )strocyto( O E!endy( ( Medu"o*" sto(

See(s s tu(our' c4f' )ccordin, to site of "esion / r te of e+! nsion Loc " fe tures R ised :CP SeiAures & "se "oc "iAin, si,n Tu*ercu"o( . S rcoidosis. =r nu"o( . ?istocytosis.

). Loc " fe turesB. R ised :CP' C used *y o*struction to CS& f"o1 1. Cere*r " tu(our #. Cere*r " oede( 3. Vi""eus ! !i""o( of $entric"es c4f'

?e d c%e Vo(itin, :(! ired consciousness Br dyc rdi ?y!ertension P !i""oede(

C. E!i"e!sy4seiAure' )fter 1H ye rs of ,e !t. D. & "se "oc "iAin, si,n' &e tures re f r 1 y fro( 3rd ner$e ! "sy ( ss0 ;t% ner$e ! "sy De cere*r " ri,idity Loss of consciousness. Sudden de t% effect. Co(!ress t%e(edu"" -conin, . -Do1n1 rd dis!" ce(ent of te(!or " "o*e *y " r,e cere*e"" r tensi"- do1n1 rd dis!" ce(entseiAure0 CT sc n is done to e+c"ude :CSOL.

:n$esti, tions'
1. Recent onset of !ro,ressi$e neuro"o,ic " deficit

!ro,ression.

#. &e tures of r ised :CP.

3. Pt. *o$e 1H ye rs

seiAures4

<. Pt. 1it% unconsciousness due to une+!" ined c use. :n$esti, tion' 1. CT sc n of *r in. #. B-r y of s5u""-!ituit ry deno( 0 cr nio 3. B-r y c%est. <. MR:- !ost foss / cere*e""u( is $isu "iAed M+'
1. Sur,ic "

#. R diot%er !y 3. Occ sion " c%e(ot%er !y. E!i"e!sy' Disorder in t%e e"ectric " i(!u"se. Def. E!i"e!sy is not :t is sin,"e disorder. . t%ere is recurrent

,rou! of disorders in

E!isodes of "tered cere*r " function nd is )ssoci ted ! ro+ys( "0 e+cessi$e0 %y!er sync%ronous

Disc% r,e of cere*r " neurons.

C" ssic ""y it is ssoci ted

seiAure- ( y or ( y not !resent.

Neutr ns(itter' . E+cit tory *. :n%i*itory- e.,. =)B)- = (( )(ino Butyric cid.

-T%ere is "1 ys

* " nce *et1een t%e(.

- M%en in%i*itory neurons re su*(er,ed0 e+cit tory neurons t 5es u!!er % nd. C uses' . Dru,s -:n%i*itory neurons. *. )cety"c%o"ine0 ,"ut ( te0 soert te -E+cit tory neurons.

P t%o,enesis' C" ssific tion'

P rti " Te(!or " "o*e e!i"e!sy &ront " "o*e

P rti " si(!"e- (e ns no "oss of consciousness. P rti " co(!"e+- "oss of consciousness. Reticu" r cti$ tin, syste( is in$o"$ed.

)etio"o,y' =ener "iAed seiAures' :ncidence- =r du ""y reducin,. Dru,s' )ntide!r ss nt )nti-!syc%otic-!%enot%i Aine. Metronid Ao"e )(!%et (ine :dio! t%ic4!ri( ry- ( y % $e so(e !redis!osition Diffuse cere*r " "esion- %y!o+i 0 ence!% "itis. Met *o"ic-%y!oc "c e(i 0 %y!o,"yce(i 0 %y!on tr e(i . Ren " f i"ure ?e! tic f i"ure Por!%yri To+icity- "co%o" -Sudden 1it%dr 1 "- e+cessi$e int 5e.

P rti " seiAure' Cere*r " tr u( . -*irt% in9ury. ?e d in9ury. -RT). Cere*r " ?,e0 inf rction. Structur " "esion' )rterio- $enous ( "for( tion. Cere*r " neurys(. Cere*r " tu(our

Cyst ?ydroce!% "us. Menin,itis. Ence!% "itis0 cere*r " *scess0 sy!%i"is0 ?:V0 to+o!% s(osis SLE0 s rcoidosis0 (u"ti!"e sc"erosis

Motor seiAure' Lesion in t%e !re-centr " ,yrus. e.,. Tu(our0 )VM0 neurys(. E c5soni n ty!e' St rts fro( fin,er )n,"e of (out% t%en %e(i!"e,i . tics to o!!osite side. Todd@s ! r "ysis

T%en f" ccid ty!e of ! r "ysis Todd@s ! r "ysis' Pt. 1i"" st rt con$u"sion Loss consciousness &" ccid ! r "ysis. Sensory e!i"e!sy' Site' !ost contro" ,yrus. )"so 5no1n s E c5soni n e!i"e!sy. c4f'

tin,"in,0 nu(*ness0 ! r est%esi contr " tent site. Versi$e seiAure' S>uint'

&ront " "o*e "esion. (o$e(ent.

Loss of ! r ""e"is( of eye

c4f' forcefu" de$i tion of eyes of *ot% side to1 rds o*9ect. Visu " e!i"e!sy' Lesion in occi!it " "o*e. c4f' Li,A , "ine V rious co"oured "i,%t Psyc%o(otor e!i"e!sy' - not%er n (e- te(!or " "o*e e!i"e!sy.

:n t%is ty!e t%ere is !syc%o"o,ic " co(!onent F (otor co(!onent / "esion in te(!or " "o*e. T%e seiAure c use c% n,es in t%e (ood0 (e(ory nd !erce!tion0 risin,

fro( (edic " te(!or " "o*e 1i"" ,i$e rise to it. c4f' De9 - Vu !%eno(enon E ( is- $u !%eno(enon :t ( y c use ! rti "4 ,ener "iAed seiAure. Very r re"y rises fro( inf. &ront " ,yrus.

De9 - Vu !%eno(enon'

f (i"i rity

E ( is- $u !%eno(enon' Note' S " ( e!i"e!sy- (i(ics t%e s " ( of (o% ((ed n. Te"e$ision e!i"e!sy=ener "iAed e!i"e!sy 4 ,r nd( e!i"e!sy' tonic c"onic )"so 5no1n s tonic-c"onic seiAure. Distur* nce of s(e"". &ee"in, of unre "ity No con$u"sion. Co(!"e+ % ""ucin tion )*nor( " (o$e(ent- "i! s( c5in,0 re!e ted de,"utition. E!i, stric ! in.

tone re" + tion !% se

NB' in tet ny- on"y tonic !% se is !resent. Se>uenti " !% ses of ,r nd( e!i"e!sy' . Prodo( " !% se- !ersists for %rs0 d ys nd e$en 15s. &ee"in, of une siness :rrit ti$eness

*. )ur !% se' Persists for seconds to (inutes

&rot%y disc% r,e0 "i! *itin,

c. Tonic s! s(' -!ersists for 1G-3G sec. d. C"onic s! s(' -!ersists for 6 (ins. e. Post-ict " !% se4 uto( tis(' -!ersists for (in to %rs. Petit( "' -)*sence4c" ssic " *sence4dro! tt c5. c" ssic " *sence seiAure 1GG-#GG tt c5s4d y. Re( in undected.

Preci!it in, f ctors' . S"ee! distur* nce *. E(otion " stress c. P%ysic " nd (ent " e+ertion d. Menin,itis e. Ence!% "itis f. Enteric fe$er ,. M " ri %. ?y!er!yre+i

i. Dru,s 7 "co%o" - e+cessi$e int 5e / sudden 1it%dr 1 ". 9. &"ic5erin, "i,%ts 5. E+cessi$e sounds ". M tc%in, TV fro( fro( c"ose dist nce (. ?ot * t%4 co"d * t% Di ,nosis' . ?istory ' - &ro( t%e 1itness. - Eye 1itness inter$ie1

S!eci " >uestion' M% t re t%e e$ents "e ds to tt c5D )"co%o"D Dru,D Mo(ent of tt c5D C" ssic " sy(!to(s of ur / its dur tion. &rot%y disc% r,eD )ny uto( tis(D Cy nosisD :ncontinence fter su*sidence of tt c5D :s t%ere ny in9uryD :ntense %e d c%e in !ost ict " !% se P r "ysis -todd@s ! r "ysis.

&" ccid0 neuron " s%oc5 Undue dro1siness

*. O4E' Sc" !- in9ury Nec5- c rotid *ruit Eye- c $ernous sinus t%ro(*osis Pu"se- )&. ?e rt sound- )ny $ "$u" r dise se BP- ?TM ence!% "o! t%y )ny s5in dise se' Tu*erous sc"erosis N& :n$esti, tions' . CBC inc"udin, ESR. *. B. ure 0 S. cre tinine c. S. e"ectro"ytes.
d. B. ,"ucose- ?y!o / ?y!er,"yce(i

Visu " fie"d &undosco!y T%rou,% neuro"o,ic " e+ (in tion

E!i"e!sy

e. L&T- ?e! tic !reco( . f. TP?)

,. B-r y s5u""- Tu*erous sc"erosis0 To+o!% s(osis

c "cific tion.

%. B-r y c%est- *ronc%o,enic c . i. ?:V )*. 9. EC=- rr%yt%(i . 5. EE= ". CT (. MR: M n ,e(ent' . :((edi te t 5e c re of seiAure' :so" tion of ! tient. Re(o$ " of ! tient fro( t%e source. &ro( firinf !" ce0 1 ter etc. *. )fter su*sidence of con$u"sion' Se(i!rone !osition )ir1 y c"e rin, 6 (in'

c. :f Con$u"sion

-to !re$ent %y!o+i d. Pre$ention of ton,ue f "" e. )fter contro" of seiAure0 so(e restrictions to t%e !t Do not 1or5 t %i,%er !" ce. Do not 1or5 1it% %e $y ( c%inery Pt. is not ""o1ed to t 5e%e $y * t%. Do not "oc5 t%e door fro( inside )$oid fire 0 1 ter0 cyc"in,0 s1i((in,0 nd dri$in,.

f. Dru, t%er !%y' )nticon$u"s nts' -contro" t%e tt c5 of con$u"sion.

C r* ( Ae!ine -te,reto" .P%eno* r*itone.

d$erse effect SES.

P%enyt in- =u( %y!er!" si 0 *"ood dyscr ,i 0 *ortion0 Me, "o*" stic n e(i 0cere*e"" r de, ner

Pri(idone. N -$ "!ro te.

Princi!"es of nti-con$ "s nts t%eory' . )"1 ys st rts 1it% s in,"e dru,.
*. :f dru,s !roduces sed tion

s%ou"d *e st rted 1it% "o1 dose

=r du ""y es to c%ie$e <-; 15s. c. T%er !eutic r n,e s%ou"d *e "o1 t st rtin,.
d. :f not contro""ed t%e dose to %i,%er t%er !eutic r n,e.

C r* ( Ae!ine' <GG-1;GG(,4#<%r. St rted fro( <GG nd t%en u!to 1;GG

to contro" con$u"sion. :f not contro""ed t%en dd not%er dru,.

e. Use # dru, if not contro""ed 1it% sin,"e dru, *y reducin, t%e dose of initi " one.

f. )dd 3rd dru, if not contro""ed 1it% # dru,s. - "tern te 1it% !re$ious dru,.
,. :f not contro""ed %. Dur tion of

use co(*in tion for( of dru,s

' 3 ye rs fter t%e "ost tt c5

St tus e!i"e!ticus'

:t si

condition

e+ist 1%en

series of seiAures

out !t. re, inin,

1 reness *et1een P tt c5s. c4f' Recurrent tt c5s of tonic-c"onic seiAure ' M int in t%e ir1 y *y Endotr c%e s tu*e ?i,% f"o1 .

To contro" con$u"sion- di Ae! ( -1G-#G(, :V o$er 6 (in. BP- *y di Ae! ( Tr nsfer t%e ! tient to :CU. -BP0 EC=0 EE=0 )B=). T%en di Ae! ( is ,i$en t%rou,% :V route. :f not contro""ed0 P%enyt in HG(,48= *ody 1t. :f not contro""ed0

:V c%"or(et% :f not contro""ed0 T%io!ent " )fter contro" of seiAure ' Re$ie1 t%e c se

Aone.

)ny e"ectro"yte i(* " nce. SOL.

Dru,s used in seiAures' C r* ( Ae!ine. P%eno* r*itone P%enytoin Pri(idone. N $ "!ro te. Et%osu+i(ide. L (otri,ine = *!entine. C"or(et% Aone C"on Ae! ( Stro5es- d (@s syndro(e' Co(!"ic tion of co(!"ete %e rt *"oc5.

Stro5e' (e ns cere*r " dise se

Stro5e' -cere*ro$ scu" r dise se. CV)- is !re$ious n (e. :t is not n ccident0 it is

dise se s it % s definite c use0 ! t%o"o,y etc.

Def.

T%is is condition c% r cteriAed *y r !id de$e"o!(ent of foc " neuro"o,i$c " deficit. Resu"tin, fro( d ( ,e to *r in tissue fo""o1in, cere*r " ?E4 :nf rction. More co((on in ( "e. Youn,er ,e ,rou!' )V ( "for( tion. B"ood dyscr si . Tr u( )neurys(

QQ HG-H6J c ses re due to inf rction -co(!"ete cess tion of circu" tion. QQ 1G-#GJ - due to % e(orr% ,e. )etio"o,y' )t%erosc"erosis )rteriosc"erosis OO.. E(*o"is tion SLE P)N =i nt ce"" rteritis. V sos! s(' S)? V sos! s( ! r do+i " s! s(

(i,r ine

c rotid n,io,r !%y. NB'

P r do+i " e(*o"iA tion' Due to !resence of !ersist nt for (en o$ "e.

Stro5e' Ris5 f ctors' So(e !ersons re $ery (uc% susce!ti*"e.

. Re$ersi*"e4(inor4tre t *"e4(odifi *"e E+cessi$e "co%o" consu(!tion. OCP Tr u(

*. M 9or4 irre$ersi*"e4non-cur *"e' )rteri " ?TN DM &4? ?y!er"i!id e(i Po"ycyt% e(i . T%ro(*ocyt% e(i . stro5e t%in5 first'

:f ny youn,er !t. !resent -

Ru!ture of *erry@s neurys(. )V ( "for( tion. Den,ue % e(orr% ,ic fe$er.

Site of inf rction'

 QQ Su*c" $i n rtery

Cere*r " corte+. :nt. c !su"e -interior "i(*. Pons Medu"" $erte*r " rtery * si" r rtery !erfor tin, *r nc%

Lenticu"o stri te *r nc% is ru!ture tt c5ed.

% e(orr% ,e- s (idd"e cere*r " rtery is

C"inic " c" ssific tion' &our ty!es ' . Co(!"eted stro5e
1. M 9or -"oss of consciousness0 %e(i!"e,i .

!t. ( y e+!ires.

#. Minor - ,r du " 1e 5ness0 dys rt%ri 0 t%en co(!"ete"y i(!ro$ed. *. E$o"$in, stro5e' -!ro,ressin, stro5e4 stro5e in e$o"ution. :t % s *een initi ted

:niti tion % s no foc " neuro"o,ic " deficit. c. T:)' -Tr nsient :sc% e(ic tt c5. -

:t is due to isc% e(i . :t is re$ersi*"e L st for #< %rs so(e neuro"o,ic " deficit / re$erse in #< %rs.

Def. is

situ tion 1%ere t%ere is foc " deficit for #< %rs

T% t foc " deficit is re$ersi*"e 1it% in #< %rs. e.,. ( urosis fu, +' Uniocu" r *"indness. Due to reti n " $ scu" r s! s(. Sudden 1e 5ness of rt-side of *ody t%en fro( ,ettin, fro( s"ee! 0 !t. *eco(e "ri,%t.

d. R:ND -Re$ersi*"e :sc% e(ic neuro"o,ic " deficit. E$o"$in, stro5e ' L st for %rs to d ys. T%ese re t%e t%e situ tion due to isc% e(i "e din, to foc " neuro"o,ic " deficit0 Dur tion' #< %r to I d ys

e.,. su*dur " % e( to( :n$esti, tions' Most of t%e CVD is inf rcti$e in ori,in0

. CT sc n of *r in' *. MR: of *r in c. CBC- !o"ycyt% e(i d. ESR- ?i,%' M "i,n ncy e. RBS. f. B. ure / s. cre tinine. ,. S. e"ectro"yte. %. CBR- Bronc%o,enic c . )fter fe1 %rs of onset.

i. EC=- )& 9. Test for sy!%i"is. 5. )N)0 nti dsDN) )*. ". Ec%o c rdio,r !%y. (. C rotid n,io,r !%y. NB' :f c"inic " sus!icion is "esion in 7 Br in ste(- )t +i 0 $erti,o0 synco! " tt c50 res! / c rdio$ scu" r fe tures0 !in!oint!u!i"0 %y!er!yre+i . Post cr ni " foss - OO.. of $ision

Do MR:. M n ,e(ent' Pre re>uisite is de>u te nursin,. . =ener " (e sures' Mid !rone4 (id su!ine !osition. ?e d e+tended Posture c% n,e' # %r"y. C%est !%ysiot%er !%y' SneeAin,0 1nin,0 cou,%in,0 s%outin, re ,ood !ro,nostic si,n. B d !ro,nostic si,n' "oss of ref"e+ dee!"y co( tose e+tern " ,e. T c%yc rdi . Pin!oint !u!i". Vo(itin,. M inten nce of f"uid of nd e"ectro"yte. P%ysiot%er !%y.

S!eec% ter !%y' )s "i5e s c%i"d s!eec% t%er !%y.

NB' s!eec% distur* nce' - rt-sided !erson (otor !% si . So0 in "" CVD t%ere is no (otor !% si . NB' Broc @s re ' -(otor re of s!eec%. Post ! rt of inf. &ront " ,yrus! rs tri n,u" ris ! rs o! cu" ris No. of re - <</<6
*. Medic "

if "eft cere*r " %e(is!%ere is in$o"$ed

' 1. Contro" of BP. #. Contro" of DM. 3. :sc% e(ic- ntico ,u" nt. <. ? e(orr% ,ic- No ntico ,u" nt.
6. :f t%e "esion is *i,,er

CT sc n s%o1s !erifoc " oede(

Mit% no s%iftin, of OOOO. But :CP is r ised' Os(otic diuretic- ( nnito"-#GJ. #GGcc :V0 st t t%en 1#Gcc0 ; %r"y. T%en steroid is ,i$en. :sc% e(ic CVD' $ sodi" tor. Neurosur,ery

S)?' -su* )r c%noid % e(orr% ,e. Sudden se$ere %e d c%e nd $o(itin, nd stiff nec5. Nec5 stiffness.

C uses' E+tension of intr cere*r " ?,e. . Ru!ture neurys( e.,. Berry neurys(. - round circ"e of 1i""is.

*. )rterio$enous ( "for( tion c. ?,e into intr cere*r " inf rct - ? e(orr% ,eic inf rct. d. ?,e into intr cere*r " tu(our. e. Ru!ture of t%er( tous !" >ue. f. C"ottin, disorder. :n$esti, tion' . CT sc n *. MR: c. Lu(*or !uncture. -if CT sc n / MR: is not $ i" *"e. Tre t(ent' ccordin, to c use Menin,itis / Ence!% "itis' Menin,itis' . Pyo,enic s! ce *. Tu*ercu" r s! ce c. Vir " Def. inf" (( tion of !i ( tter nd OOOO. M tter. C uses' . B cteri " *. Vir "- s"o1 $ir " dise se. - su*!i " s! ce - su* r c%(oid - su* dur " - e+tr dur s! ce

c. &un, " d. P r sitic e. M "i,n ncy f. Dru,s ,. S)? B cteri "' OOO' E. Co"i0 !roteus. ' B?stre!tococcus0 "isteri (onocyto,enus. Pre-sc%oo"' ?. inf"uenA . N. (enin,itides. - (enn,ococcus. S. !neu(oni . - !ne(ococcus. )du"t' - N. (enin,itides. - S. !neu(oni . - M. TB -st !% ureus. - ?. inf"uenA - Cry!tococcus neofor( ns -?:V !t..

Present tion'

&e$er0 con$u"sion0 $o(itin,0 s5in r s%2in (enin,ococc " (enin,itis. N. (enin,itis' Present tion' Nec5ri,idity0 8erni,@s si,n0 BrudAins5i@s si,n. - due to (enin,i " irrit tion. )not%er !resent tion' M&S- s%oc5 2 dren " crisis.

M y !resent R s%

'

D:C -consu(!tion co ,uo! t%y. Se!tice(i NB' in co"" r stud *scess' !t. c n not (o$e nec5 side to side. But in (enin,itis' nec5 ri,idity o!ist%otonos ttitude.

Life t%re teninin, (enin,ococc " (enin,itisMenin,itis' Modes of !resent tion' :n du"t'
. M y !resent

)dren " f i"ure :C Se!tice(i .

c" ssic " fe tures'

*. &e$er c. ?e d c%e d. Vo(itin, e. Rest"essness f. :rrit *i"ity

,. &e tures of (enin,e " irrit tion.- ( y t%e nec5 ri,idity is confused

*i" ter "

cer$i c " "y(!% deno! t%y. Menin,is(us' -%e d c%e -!%oto!%o*i -$o(ittin, -%i,% fe$er 8er(i,@s si,n' O!!osite %i! f"e+ due to !rotecti$e (ec% nis( BrudAins5i@s si,n' E"e$ te "i(* to re" + t%e irrit tion :n s%oc5 st ,e

%. :n s%oc5 st ,e i. D:C 9. Se!tic e(i 5. Cr ni " ner$e ! "sy. e.,. TB (enin,itis

". M y re( in sy(!to( tic in $ir " (enin,itis- &"y "i5e syndro(e. NB- P. (enin,itis' su!erfici " (e nin,s is in$o"$ed. TB. Menin,itis' * s " (e nin,s is in$o"$ed0 so cr ni " ! "sies re co((on. Lo1 ,r de fe$er 0 ?4O cont ct TB !t. e$enin, rise of te(!.

C%oroid of eye * "" is in$o"$ed- c%oroid " Tu*erc"e &ound in o!t% "(o-s"o!e -C"inic " !resent tion F in$esti, tion. CS& study CBC

CS& Study' L-P need"e' Site' "o1er *order of s!in " cord t t%e "e$e" of "o1er *order of
-

R tr ns!y" ric !" ne.

But t%e (enin,es e+tends u!to LP is done in *et1een $erte*r e.

Position' Lyin, !osture 7 (id !rone -unconsciousness ! tient. Sittin, !ostureC uses of *"ood st ined CS& '

1. Tr u( tic -on"y 1st s (!"e cont in *"ood. 3 s (!"e is t 5en.

#. S)?- "" 3 s (!"e cont in *"ood. Pyogenic .Pressure-6G1GG(( of ?,. *.Co"our-cryst ". c.Ce"" count d.="ucose-#43 of *"ood ,"ucose. e.!rotein-6GG(,4". f.(icro*io"o,ic "-c4 s. Or, nis( found &ound -9et "i5e. C"oudy PMN-u!to 6G0GGG C"e r4 tur*id Ly(!%ocyte 6G-6GGG Tubercular Viral Nor( "

C"e r Ly(!%ocytosi 6G#GG nor( "

-so(eti(es. Not found

C. 1rite do1n t%e CS& findin,s of !yo,enic (enin,itis. M n ,e(ent of (enin,itis' . Dr 1 s (!"e of *"ood.
*. St rt

i((edi te"y on c"inic " sus!icion

*ro d s!ectru( nti*iotic.

c. :f (enin,ococc "' BenAy" !enici""in. d. :f sensiti$e to !enici""in' Cefuro+i(e or C%"or (!%enico"

e. Pneu(ococc "' Dru, of c%oice cefuro+i(e :f sensiti$e t%en C%"or (!%enico". f. ?. inf"uenA ' C%"or (!%enico". ,. &or neon tes' Cefot +i(e OOOOOO Or =ent (icin F )(!ici""in.

%. &or TB (enin,itis' nti- TB dru,. F steroid - s t%ere is c% nce of d%esion "e din, to o*structi$e %ydroce!% "us. De!ends on etio"o,ic " f ctor' . Menin,ococc "' *. TB' o*s. ?ydroce!% "us cr ni " ner$e Tu*ercu"o( De fness M&S Mu"ti!"e *r in *scess D:C

Cr ni " ner$e ! "sy

c. Vir "' Ence!% "itis' :nf" (( tion of ence!% "on -*r in. :t is usu ""y $ir " in ori,in. - "(ost "1 ys. :t is ( in"y c used *y' SS TB does not occur in Br in T%yroid ?e rt S5e"eto" E ! nese B Ence!% "itis. ?er!es co(!"e+ Ence!% "itis- ty!e #. Ni! % -is" nd of :ndonesi .- N:P)? Ence!% "itis. Den,ue R *ies :nf"uenA Mu(!s Me s"es ?:V Se"f "i(itin, if untre ted Menin,oence!% "itis

E(er,in, dise se' Re-e(er,in, dise se' -den,ue NB' ?u(idifi fe$er'

Sto( c% P ncre s

Bird f"u. S)RS

-due to (oe* .

E ! nese B Ence!% "itis' Mos>uito *orn. -cu"e+ trit enio r%incus- $ector. Virus is f" $i$irid e. Rice ,ro1in, country is co((on"y ffected. ),ent' EB ence!% "itis $irus. T%is cu"e+ (os>uito feeds on !i,s. - "" f r(ers re ffected s t%ey re n tur ""y i((uniAed. *ites %u( n / tr ns(its t%e dise se. NB' it is co((on in ur* n !eo!"e *ut "ess in rur " !eo!"e. c4f' ?i,% fe$er S%i$erin, ?e d c%e M " ise Ri,or =ross 1t. "oss

Ri,id nec5 Neuro"o,ic " fe ture- "oss of consciousness0 con$u"sion0 %e(i!"e,i . co(

Mort "ity r te' u!to <GJ -in 1estern country. :n BD- 1GGJ Pt. ( y sur$i$e ' ' M in"y c"inic ". Seru( )* titre- :,) )* , inst $irus. De,ener ti$e dise se' Mo% ((ed )"i 7 % s ,ot ! r5insonis( P r5insonis(' 1 s introduced *y Dr. =. P r5inson s ! r "ysis ,it ns. P r "ysis ,it ns -1 s t%e n (e !re$ious"y. Punc%- drun5 syndro(e.- re!e ted %e d tr u( . de fness %e(i!"e,i (ent ""y confused

-due to "esion in su*st nti ni,r - )s it cont ins (e" nin0 it is *" c5 in co"our. P r5insonis(' -De,ener ti$e neuro"o,ic " dise se. :t is de,ener ti$e neuro"o,ic " dise se in$o"$in, EPS (ost"y t%e * s " , n,"i . :t is (ost"y due to de,ener tion of su*st nti ni,r .

QQ cross section of (id *r in s%o1s co"our SS = n,"ion' Co""ection of ner$e ce"". SS B s " , n,"i '

*utterf"y "i5e su*st nce

is *" c5is% in

!ercursor of drener,ic neurotr ns(itter.

Co""ection of ner$e in * s " ! rt of *r in. C uses' . :dio! t%ic' :t is descri*ed *y Dr. P r5inson s ! r "ysis ,it ns. *. Post $ir " ence!% "itis' c. Tr u( tic' -!unc% drun5 syndro(e Ence!% "itis "et% r,i E ! nese B ence!% "itis.

d. Dru,s' MPTP- Met%y" !%eny" tetr %ydro !yridine Tetr *enAene riser!ine

e. Ot%ers' P r5insonis(' NB' )drener,ic 4 sy(! t%o(i(etic syste( / c%o"iner,ic syste(s re "1 ys in * " nce. :f ny i(* " nce occurs :n P r5insonis( t%ere 1i"" *e *nor( " (o$e(ent of *ody. de!" tion of do! (ine cti$ity =rou! of disorder. P r5inson dise se is Mi"son@s dise se Sy!%i"is ?untin,ton@s dise se

c use of P r5insonis(

destruction of su*st nti ni,r

fe tures of P r5insonis(. c4f' it is ( in"y di ,nosed on t%e * sis of c4f. initi ""y' Tri d' 1. Tre(or #. Ri,idity 3. ?y!o5inesi F *rody5inesi . <. Distur* nce of !ostur " ref"e+ e.,. if e+ (iner ""o1 t%e !t. to sit or st nd fro( st nd sittin,- !t. fee"s difficu"ties. S%ort note' Tre(or.

Criteri ' )ny t1o of *o$e four confir( di ,nosis :t is !ro,ressi$e Dr ( tic res!onse to L-do! No ot%er neuro"o,ic " disorders c n not s tisfy t%is condition.

NB' ri,idity of UMNL in$o"$in, t%e !yr (id " tr ct c" s! 5nife ri,idity. Ri,idity of e+tre!yr (id " syste(K Co,-1%ee"4 "e d !i!e ri,idityK s it is ssoci ted ?y!o5inesi ' L c5in, of initi tion of (o$e(ent. c4f' O4=4E' 1. E+!ression "ess f ce- "so in %y!ot%yroidis(0 de!ression. #. =re sy s5in-rou,%. 3. Distur*ed s!eec%- s%ort0 r !id0 indistinct s!eec%. <. &"e+ed !osture 6. = it' SS &esti n nt , it' L c5 of initi tion &"e+ed ttitude = ! *et1een t1o ste! is s( "" L c5 of initi tion S%ort s! de R !id0 s( "" ste! tre(or.

Di(inis%ed s1in,in, (o$e(ents of r( Difficu"ty in turnin, Pro!u"sion / retro!u"sion

C. descri*e t%e , it of ! r5insonis(. ;. Tre(or' - :t initi tes fro( t%u(*' dductionF *duction. Ot%er fin,ers' f"e+ion F e+tension. U!!er "i(*' !ron tion / su!in tion NB' t%ere is no %e d tre(or. Tre(or of ton,ue ( y *e !resent. :nter(ittent0 !resent t rest - restin, tre(orG Di(inis%ed on ction. QQs! de' , ! *et1een ste! QQNB' intention or ction tre(or' cere*e"" r "esion :n$esti, tion' :f ,e 6G yrs0 uni" ter " "esionK "so !yr (id " si,n' CT sc n TP?)-test. Mi"son@s dise se- %e! to "enticu" r de,ener tion. M n ,e(ent' Seru( co!!er. Seru( ceru"o!" s(in. #< %rs urin ry co!!er.

. )t first detect t%e c use /

t%e c use.

-if dru, c usin, P r5inson' sto! t%e dru,. *. :f no c use found' -idio! t%ic Dru,s used in ! r5insonis(' 1. )nti-s%o"ener,ic dru,s' -*enAe+o" -or!%en drine

#. )( nt dine- it !otenti te t%e cti$ity of Do! (ine 3. Se"e,i"ine- M)O: -sin,"e t%er !%y. :t cts *y reducin, t%e r te of (et *o"is( of do! (ine in t%e centr " syn !se / !otenti te ction. <. L- Do! -Le$odo! Fc r*ido! . 6. Do! (ine rece!tor , inst' -Bro(ocri!tine )d$erse ffects of nti-! r5insonis( dru,' &ro( *oo5. )d$erse ffects' Le$edo! ' Postur " %y!otension0 N use 0 Vo(ittin,0 Orof ci " dys5inesi 0 "i(* / ri " dystoni

)nti-c%o"ener,ic' Dry(out%0 consti! tion0 retention0 B"urred $ision.

)( ntidine' Li$edo reticu" ris- !eri!%er " oede( 0 confusion nd seiAures.

Do! (ine rece!tor ,onists' N use 0 Vo(ittin,0 confusion0 % ""ucin tion.

Ot%er

' Sur,ery' -stereot ctic sur,ery -(icrosur,ery.

P%ysiot%er !%y

De(ye"ion tin, dise se' NB' Mye"in s%e t% is re>uired for tr ns(ission of i(!u"se. -To !erfor( s(oot% neuro"o,ic " function (ye"in s%e t% is re>uired Best e+ (!"e' Mu"ti!"e sc"erosis.

Mu"ti!"e sc"erosis' -!re$ious n (eK disse(in ted sc"erosis. Sc"erosis' P renc%y( ?e "in, of CNS in9ury *y sc"erosed tissue.

T%ere re sc"erosed "esion in (u"ti!"e site of *r in. SS cere*e"" r "esion' Mu"ti!"e sc"erosis )VM ? e(orr% ,e :nf rction Perio!tic Peri $entricu" r :ntern " c !su"e Cere*e""u( V rious site of s!in " cord.

C. Mrite do1n t%e (odes of !resent tion of ,"o(eru"one!%riris. 1. C" ssic "' Puffy f ce0 % e( turi 0 O"i,uri 0 nore+i . N use 0 Con$u"sion. #. Co(!"ic tion' ?y!ertensi$e ence!% "o! t%y0 )R&0 )cute LV&. C. Urin ry findin,s of )=N. C. Lines of of )PS=N. Mu"ti!"e sc"erosis' Bed rest )nti*iotic Diuretics Su!!orti$e.

)etio"o,y' -:dio! t%ic

:t is De(ye"ion tin, dise se. M y *e due to i((uno"o,ic " c use. R re in BD

But t%ere re so(e !redis!osin, f ctors-

En$iron(ent " f ctors' it is ?L) '

of te(!er te Aone.

incidence in first de,ree re" ti$es MenoAy,otic t1ins. synt%esis of :, in CS&

T%ere is ed no. of T ce"" in CS& / -

So0 it is (u"tif ctori " dise se -!o"y,enic.

:n$esti, tion' MR:' )cute- 1e"" circu(scri*ed re of de(ye"in tion. S!eci " !" ces' c4f' Peri$entricu" r Perio!tic Cere*e""u( S!in " cord- su* !i " re,ion of s!in " cord. Br in ste(

C. Mrote do1n 6 i(!ort nt 1. =:T' PUD0 :BS.

, s re(issin / re" !se.

#. ner$ous syste(' MS0 SCD of s!in " cord. 3. Muscu"os5e"et "' R) - Re(ission / re" !se-% ""( r5. Modes of !resent tion' - !t. ( y !resent 1e 5ness of one4 (ore "i(* -6G6.

- $isu " distur* nce -#GJ.' - Retro*u"* r neuritis. - o!tic neuritis. - o!tic tro!%y - sensory sy(!to(s. Youn, !t. !resented '

B"urred $ision -retro*u"" r4 o!tic neuritis. P in in * c5 in f"e+ion of nec5.-touc%in, t%e c%in on c%est. L?ERM:TTE@s !%eno(enon Li,%tin, -E"ectric " tin,"in, / nu(toness.

&o""o1in, e+ercise or %ot * t%' ( y ,,rer te. 6G yrs of ,e!t. M y !resnt tri,e(in " neur ",i .

tt c5s of f ci " ner$e ! "sy.

for 3 (ont%es :f fre>uent re" !se

re" !se

inco(!"ete reco$ery of neuro"o,ic " fe ture'

Si,ns' :n$esti, tions' MR: of *r in nd s!in " cord. -% ""( r5. CS&' Ce"" count :, "e$e" Protein e"ectro!%oresis' o"i,oc"on " * nd !f :,. UMNL O!tic tro!%y. Co"our $ision distur*ed Nyst ,(ous Dys rtri )t +i Di(inis%ed !osition / $i*r tion sense.

CT sc n' To ru"e out ot%er dise se E$o5ed !otenti " defects' Visu " defect So( tosensory

' :t is incur *"e dise se.

Steroid- !u"se. OOO C re of *" dder of co(!"ic tion

QQ!eri!%er " neuro! t%y' . )cute *. C%ronic c. Sensory d. Motor e. Mi+ed )etio"o,ic "' . :nfecti$e' cute !ost infecti$e !o"yneuro! t%y-=BS. *. To+ic c. Dru,
d. Syste(ic

e. Misce"" neous' =ui"" in- B rre syndro(e' =ui"" in- is ,ent"e( n of U8.

B rre- is " dy Bot% of t%e( in$ented t%e dise se. =BS' Pt. ( y !re$ious f"u "i5e syndro(e

T%en de$e"o! fin,"in,0 nu(*ness of "i(* c4f' Sensory neuro! t%y Motor neuro! t%y Mi+ed-co((on. )scendin, ! r "ysis )ref"e+i . -,ener "iAed.-c% r cteristics Sensory sy(!to(s. Motor $ riety of =BS- " ndry@s syndro(e. -res!. (usc"e ( y *e ! r "ysed.

Di ,nosis' C"inic " CS& study ' )"*u(ino- cyto"o,ic " dissoci tion. - ed !rotein *ut ce"" count is nor( ". Ner$e conduction $e"ocity. ' -

IG to HGJ ' se"f "i(itin, steroid.

interferon :V :,

QMyo! t%ies

Q(y st%eni ,r $is Q Motor neuron dise se QQc uses of *sent 5nee 9er5'
-

LMNL in$o"$in, t%e se,(ent

Dise se' PN0 DM0 "e!rosy0 di!%t%eri 0 =BS. Dru,s' isoni Aid0 nitrofur ntoin. UMNL ( y c use *sent 5nee 9er5 fter #-3 15s. ! r "ysis st te !resent. 1%en f" ccid