| Preparation | Probkem-1 +| Physiology + Sensory Sibers Sor specific sensafions (Fine touch & proprioception) are } more _yryelinaked l+Spotial summefion : more than 1 neuron —eT Firing robe | Temporal summabion» 4Freq, stimulation of 4 nenron only —» t Firing rate __ | Four events in sensabion :OStimulation @Transhuction @ Generation @ Inteerio. ch ion :COWSCions indery ion. ons Perception pyithouk sensebion —>Schizophyonia __|-Exterareceptors Cnearsg visor tock, paintong) JTvterovecephees (Thermotesspher, ___|__ Necceptors, Osmorece pte) |: Adaptabion: D Peripheral (change tarerepter activity © Central Gehibition af wuclei in pathuns) | Fence receptors paler ons Phasic receptors apron on with shimules dtepe — |- Sleky adapling (size & shape. of stinks) Rapidly adapling Cmmement aes since] __|Mechanoreceptes have lower threshol: enerabion “thus more. __| Sensetive) thas “nerve endings __ |: To test precise spinal segment lesion = most specific is > Pain Chess overlap)! __| of Feat & Toes 1-3), S1 (Toes sas 4 fal_mualleolus) ¢ C2 BCF (Posterior hed & neck) {| ___ tMechans receptors : OSkin (stereognesis), @ Muscles Bjcinks (Proprioception) _| _ __ | Mar superficial » Corpuscle “> rapidly adaptive , Type 1=? Spor ficial, small receptive felt SAT — Ruffini -Stretehing __ |: SAT Merkel (Braille) -» Pr { RA T-» Meissner so Flutler, ody @A eee co a = RATS Pacinjan —?Viblakion._+|-Theh—» Free nerve endings —pHishmne % BradjKinin oo __ Tickle Fr e s i 8 (can't tickle ce nm) | __ +t order» To CNS > 2" order —> To thalamus » 8 order —»To cortex | Spinsthabanic. pathway = anterolateral pabuey 1 Visceral sersay pathuny inpuls: DSotlary nucleus (CNVIL TX, X)p@T1-L2 (behseer > __| diaphragm & pelvis), @S2-S4Y Chelan pelvis) ~ all are interaceplrs __|: DC-ML first order newonepMedial bach =i em (Qracillis—o] & bells /cunestus © Te Babe cake foal lane FE Eee, + First order newon for tackile info from Sace renters af te level +f pons | Principel wicleus of trigeminel corresponds to dorsal columa nucle’ |: Secend erder wowon of face Sersehins crest He nillne & ascoud to VPM through Arigeminothalamic. tract (or trigenind Jamniscess) + Finger position by —» Joint yereptors togelier with RufPini |-Unconcions prepricception 7 Bel 12» no Clarkt =» ascend to teach Clarks (43) 7 ef Deel sd! coor mal uy Oetoams ol nat + Denble cross—r anterior spinocerebellar tract Cventrel —» Sup. combbliac paluncle. |- Posterior / dorsal spinocerebellar tracts —» don} cross—winl. cerebellar peduncle _ |-Mesencephabe trigeminal mclens (midbrrin) — Same side of the corebellom darsel cabin Fredreich’s afoxia > dejerersbion of fesse, Aver Bb-841—>Cutanesus shinuli Te Gmasdale & higeocamps 7 moor & Biraciake Are. Ba—rprepriceptors comtet, & plete Cortex Ao 2 bot (tea Boe) Fes f # - + 7 eee on \ Vertich posterior complex Thalame Be della. Pibers —» Cooling, Fast painy Crude Touch 7Sharp Pam re. __ | Arterelaterat eesspesific) Le C Sine x rumen rnin pain, lorgclasting (nob heated)Spinst Sicct_ord ‘spi Cm auterar—r tactile & presinre sensations) Spinetholanie > Cell bodies of firt order neuro tw VPL & it sends Schers te post-centrat Syvrus Hemispatial neglect —r right paritel lobe lesions» noject of the left side of spree. Somatosensory agnosia = Asteriognosi Ns of pain => Glutamake 1 Substance P | Endorphins inhibit substene P release fast pain in Lat Thalam —eNecspinethalamic tract Slow pain in Med. Thalam —> Paleospincthalamic tract - Spino reticular —» pain» ayousl —then-r Limbic system —remobion of nn Cingulake 337i) | Spino mesencephalic —» periagudactl grey region (par control) + Pathe Cibers that ferminaketn the Insula move invelved inebantonomic. stimula ion| LDorsel column pallary Sor visceral pain —Sluest Since # has 4 order nexrons. -Endojenous opicid Sister is _preseat ww the perionpteduetl gray matters Biochemistry | Vascular compicafins in diabetes -OPalyol pattunr@Oxidative stresi@)Prdcin Kasse C@ MEG! L Midose reductase Some Sorbitol, it har low affinity to Juecse (Tho) a tissues with both aldse reductere % sor biol gebadbtogerase sOLiver , © Ovaries GQ Speray Q@Serminal_vestles | dissuer will only aldose reductase: Lens Yetina, Schwann cells, Kidney (iil lead to NADPH depletion —so-r $ ghtathione Ri. bAvginine conversion to N WO —* Retrogade tyanspart —» activeles guanylyl eyclase (GTP te eGMP) NO functions DVaseditation (¥BP) @) inhibit GICs From adhesion to vascular endthelin HNO therapslic mplcahions:OCVD @asthna Owole impotance O Restore evbdhetons function im diabeles: Pharmacel ogy __ | Erection: @ Stimuhes OPatasyn relerse NO ix corpse cowernare GQ) activeke. guenglabe, cyclase BD) TcGMP @)Vasodilation of arteries @Erect:n OB PDE desrades GAP —rerection is lost FED if lasts more than 3 months +Gildenafil & VavdenSif Ti = 4 hours Ta data fil Tye = 17-5 hours sinhibition of PDEZ <7 Blindness “May also camse pviapsm §. hypotension if pofient on nilvele —rqve % day gap belween nitrate §& viagra /Morvasked) (Pere analogue) pt oAVAP —+ f fone of muscles in penis Sipe efectigny — __| So stip need Stimulus, if Ker either depisny oe by_injection. a - Other methots : OIntracavernal injection © AKedicated urctrel system fr erection. @Topic! cream @DVacumy erection device, G Penile implant Oly intensity sheckwate titers |-Apomorphine rdopaminery ie agonist (stimulake onytonersiy neurons) |} Att, Jelancen T &. Rremelanatide =7/Melanccertin agonist Gon hy prthalanss Youle across this strctue. iy Hans yather than intercellular reinforces BER ~Epineucium coves gronps of Sascicés, BS by vasa nervorun : |: Rripheral nerve Sibers are Separated from circulabing bleed hy a blood -neoe beng -Myelin is compned of 7% lipids B 20% proteins | Protems of wmyeln ave diffrent Sm. CvS & PNS -acuke a 2 Chronic :necrosis & + To dicgnee neurapgatly , WE can tele biapsy $ Styel nerve> || Activakion of protein synthesis in efder to regenerate jhe axon —|+ Tn lus (ubleran depaamfion, ue wil soe contrat chamabelpix shel efech + Newropathies cused by drags or chemicals are characharized by distal 4%onapitt + Focal weakness without sensery loss Ace ion 0 i lex uced nerve Iso there will be Avuetural breakdown of nerves + Diabetes autonomic neuropathy : postural hypotension diarrhens Constipabiog heuregenic bladder, wale impsbence iNOSi! -ATPase_activits i ifed anor anspor} | 2 \ ore WO duc: E. iL CIDP: Chronic Inflammatory Demyelinabirg Polyradiculoneure pats sccimotor poly + SAN Gena Seen ee | Mixed sensorimotor pal fon bulb” Sormehion | DAD Plater ne nerve enlary omc: - Brachial plexo pathy —» apical Jang dee malignan “HUAN ef ca HEE Tat tt snaslescalreciy b tanly Call “pernnael e0stober abr | NSF AR reary childneed x enlargement of peripheral necves -reburdank ‘onion telios” > Nerve biopsy of vasculitis patient: O necrotizing arteridis,® perivascular inflammebisy | @hemoyrhase ,@hemaiderix deposition 1G) neovascular izabion. + Obturefor —» pelvic malsgnane *Meningerl cay cinomatess poly radieutopatty __|+ Paraneuplactic neurepothy—» Small cell lg Ca §. yulbiple wyelorme {oo Anatomy + Perineurinm Constitutes bleod-nerve barrie: + Epinenrium 1S Continous with the dura mates | «Myelin primary ligid —» JalactsCere broside | Vascular sy stemsi@ Latrinace Copinenrial BU) Dintrinsic. (lovgibedinal Versele within endederrinny: Gorm blead nerve barrier — + endonenral Capillayies: large diameter, buff, ght Ti Clinical + Sensory Sibers —» Large ( Position) 9 Small Cpain, fempre tere) ___+___ few clare ‘Thiamin deficeney Can cause beriheri (polyneuropathy & Cardiac fatlure) || [Problem 2 | Avatomy “Until the 2% month of Petal lifes the spinal card occupies the entire length of the vertebral canal. is i li i ; ja {oo + Spinel nerve exits dhragh intervertebral Soramen. [As we ge dan in the spinal cord the mhife mater feduces in si + Segmental ies enter Hwowgh intervertebrol Soramen along ren _bArtery of AdamKiewicz (below T&) (arteria radiculacis magna) | ____ Aypically oxvises From a left pesteriom intercostal artery- 6 spinal veins (3 anterior +8 posteriae spinel veins) drain in| __| the? internal vertebral plexus in the extradural Cepidurel) spate || Sulcus artery Grom ASA _ |General visceral internal Capsle |The anterio corticospinal tract remains ipsilateral, descendisa inte thel inal cord. They then decussate B, terminate in jhe ventral hora of cerviel B_wwper thoracic Segmental levels. + Exxhrapsamidal tracts) = Dont cross—>Vest:bule spiral & reticulespinal Cross—» Fubraspinal & ects spiral & divepiel _ - UMNEL starts with Flced paralyris then after Seme deys sf become! Spastic 1 @.Physiology Tn UMWL, hyperreflerin occur since jhe corte usually inhibits all the rePlensts except be deminished in an UNE Axonet [ors Ye amoliiate Be pomal conduction velocity ion and L | HE sows all —raciske on chronic. (cneonie. torres stl mda + Radicwloy =Ponly motor Findings Champlitnde » ner. i } p locity = Nis ce (my JL 3) = ‘normaf) Carpal funnel» OPhalens test @Tinel sign @) Duckan test HG: autoantibodies to ACh veceeten | Lambert-Eaton myasthenic. Syndrome + Aubrontibedia agent pret 7” aS chankey +| Physisloay smuscle Siber — single voter Kenrom rimotor neuron innervetes multiple muscle fiber? LAM moter ewes innervating a rauscle is called a moter neuron pool + Whermenvons that inhibit antagonistic muscles =p (eCiprocal inhibition Shakics Posjure & ms tone Strebel. efiex€ oe pemeaaston) cette Glaketies tur: peste Primary affeyent—» Large —» Ta —» Bag & Chain +Seconbery al ferent —> Small TI—> Chain | extyefusalrOr 9 i sol > | Tendon. ceflex—rmonesynachic pete + Raoid strech Gynanic) —Phuclear bag 7 Stehe ae puclenr chain —» Masle. bee (Pino ond Tap Set seria fora the abdominal a ie weve the Corben sti so they eowld | Weakness: LM) jorenic_tisorders {| Chrome Spontaneant activikier disepeary Giart waver & pluprasin discharges gmerys — -Velocity= 0.32 /(0.015 = 0.0082) = 0-32 /0-01 18 = 27-1 mys (retrect-derystind“Haste lone facilitatory areas Aven + © Copebeliom @ Excitatory RF @Vestibuler N. — Posters Mus inhibitesy ovens: DAvea 6 sal nuclei @ Inhibitory RE@ Red N. —7 makes wioehiy -Corbicospi + Descending newons (pyran: bal treet) stimulates both alpha. and gamma neurons. (Alpra-damemn. estes Co-activabioneto maintain the sensitivity of puuscle spindies to all types of length Active. contraction =» Spindles inhibited» Golji. skioulated Possive stretcher Bolk stimulates Spashicity > UMNL-r ankavauihy muscles—e Pyrmmidel Irmct—> labk inhibition —rClasp-Kinke. Rigidity Parkinson» Fitve pyumcdal Plead gige & Coyuheel—efone beth ageut bawtageent AP ‘Normally Clabu vetlen —> Since pyramidal trict excite Flexo & inhibit extensors ad Lene fottdeee veflex HMeti al propriogpina—rilakeral > longer — posture —r Proximal muscles Labeval ipropriospind —> unilateral Short Fine movement —rdistel muscles «Indirect corticospial doesnt cress, & it projects to mediok white maler of Spinal cork —» mainkains posture & balance. Only Brainstera patheny tut crosses => Rubyo spinal tract -ranticigeked | _cotfrection omen) -(edial) Ponkine yeticulbsginal tract =>Shimulake antigravity muscles (extensors of! lower limb) Balenee ¥ | (Laberal) Medullary Veticulcpinel Hract -rinhibits the ankigravily muscle =CorhicoreticubSpinal tracts — insure excuion of the pavement + Colliculos pinal —r mainly to cervieel SC, wip gaze Shift trot in a, is weber ven 6 ¥. Ventrolakert ae lobe => WHivror wrober neurons 2jngitabion emo. rec taseinatt 5 luring rnovements => Primary motor cortex lechion & se raovernend ji sonny Pi con Rostral laberal => Broca's aren*Cingulake sulcus =pexpression of emotienal behavior Phy srology + Transveree myelitis yefers to an flammatory process of the gray & white moder 6f the spinal cord + Pronafer_ drift ~UO/ANL coon + UN, Spasticity : tin tone of exhensor muscles (lover labs) or Flexor muscles (upper limbs usr $4 + Trnaging Sor myclopsty-» MRI Central cord syndrome = Syrigomyelia “Brown Sequart Syndeme —r Spinal cord hemisection | Resolubion of Spinal shock pRulbocavenos reflex returns First : Neurogenie sheck —7 hypotension—> Dont give Fluid Coan lead to pulmanary edema)? “Newojenic Shecl triad —Dhypokension. @Beadyeartic. QObjpothermian «Nenvogenie shock is more common to injuries above. a F -Corticostereids Pros: Ob Sree vatical Lrration OF Spiral cord blood Slow @textaceluuler Ca” GG Frevent kK” Joss from cord -Corticostereids Cons: © frenmonia@SepsisO@LJounrd infection WGI bleeding ODeleyed healing| | Problem 3 TAvatonss “Pryamide —Pdorticospinal tracts + Olives—> inferior livery nuclei “Section of Clared part of the medulla =See=> Central canal on of C, = lesion in CN IV nucleus effect 1 ihe. Si alco its Ye anly CN that comer Grom. behind “layers of the Soalp: Skin DBConnestive tssue G)Aponeurosis QP loot. areotar brs @ feericraninn| ‘Merial supdy of the scalp by: _ |Oliternal ovotits @ Ophthal < OSupratrochlear © Suprecorbital ______—_— Liberal coretids © Cocterioe auricular Cnulted @ Preaur icalac (sagertiil terspel) ©Oceigihel GAN Gd meniged artes 8 = branch of Pathelogy -Cerelya Contusions and lacerations ave were commen ith ivpack injari Head injury ae Clinieal (Glasgo. coma seals) Lr Mechaniom (Ponetraking Copers brain injury OF Nav-Penetroliy (clael) inpa) +Morphalosy (Skull Sractnte ar intratronial le om Sire + Epsijurel hemabons -Sractee of tempol 6 paritel bares —btearig of middle neewingent | artery (less Commonly they result Sram fearing oF Venout Sinnser especially in pariebo- “Cccipitel vegion of posterioe Sessa. upper part of cerebrum —> Subfalcine herniakion~ Ciel 2 |» Henaforne 2 herniahion lover pack, of geretri F cerebrim vfranstentorieuncal” herninbitey rth. Sequcle of blain tranme' (DB(ain. Suising (Clems) © T Te OTentor, hernichion (CM 3 Bs Pyemital track Compression Hyponic injuer © Orainstem compression Oiinkction B Come] & def |-Bréin hema DVasogoric (TECE —che fo-= disruption of (285) | @Gtotonic (TICE =due tee Cell membrane injury —Melaelie dearrarored _ 3 Intershikiel (Hydoceprales in labored yendrbles oT Intiavettular pete) Tran calvavial-External thernishion =? lrtin sautere Frm Fiche or ssh sits.“Duet hemorrhages pr iidbrein to midjons —eSeomdbwy fofmmstertoricl hernistion— leads fo Stretching & ischemia of perforabing arterisles of beslee artery in porns + Subdural hematoma —rdicruphisn of bridging veins (lore ploqnotis than fir epidursl) — _t Brain tre idracephalus: . with time ne forms | cciter membrane by DURA Sibvoblast: = Fate—» @ Reabsocbes © Remain siabic @ yeny eng Creblesting) a ic aneurysms—+ infected emboli H Ye — deaenerfion of arteries — rapture ~» SAH SAH effects OT ICP QHIE @Hb relemsed causes yasculor spasm DV brois causinn hydrocephalas -Difluse axonal injury > accelerefion decelereb'on § Shaken baby —> Invelves deep Centre Gxial white matter —rAxons are damasel of nodes of Ranvier | DAI brain damage most severe glory midlixe. sfructures (corpus collesum, prain- rote] ston) & af He corten-thibe wutler junclian —P cn lod le persidaal vepelete sie - Cevvecah cord quadriplegia.» Thoracic cord —* paraplegic. p avraacalees hers <2Non-depolarizing eD tubscnrarine, Dancerroninm, Vocus oninen, Abc curims M ibn Gcar jam Depolarininy —? Succi! chaliaey Decwethanainm Conse sensititabian) | Spasmolybic ly acting Di hlorroxazene s Titan idine Bachfien | Directly eating Dantrolere MC drags hich end wif, =Curarrinm pb vagal fone (abnocnalites im CVS) {| _ | Host of diage which ent saith hppaensin} |. Succinyleholine also results in increased Wistarine (elere | Deprlarizing agents —Sasciculabienr Sollouel by Llaccid parabens __| ___ |-Nomdegolarizing—» Neashigmine ede | ~~ Directly Slaceid paralysis __|-Gomponents of General ia: DUnconsieusness OXwuesia Advolgesia Qbuxle relaxation @ukibition oF anctonoeie rePiener| ai [Stages of Jeli 9 |-Phases of GA Induction » Maintenance » Emergence, tMetrcherital is a barbituiake Gill shart durchin due 4 redistribubion) Eom. > Flered in pefients with CVD = Kehoamine—r Dis Seciabive anestberia » Sympathetic shimulabion , TMAP, TRrerchodilekion » TIP -NO -+Hegeloblestic anemic. ___|+Sevo Fluvane —»Non- pungent = preffered m ehiliren -Nephrotoxic wm clored circu Tsoffavene—perigherel Vasodiletion St coronary bleal Sl — Controlled hypotensis Alusicloay Facilibatory vehicular Sormabion =? Pons & Midbrain 7 has an Ascending bench! (Veliculethlamecotionl aattnway) & a. descending branch (to seinel cord) Inhibitory yeliculer Sormafion=>Medilla. oblonga rdesomds as the lateral eficulespinsl Track RF inkibil pain vio fhe Yophe magnus nucleus ¥ -Bulboretiowar Lacilitery oven. (ACh) Reticular (medullary) inhibitory area, (Serotonin) Hemi. pakicl neglect =» Right parietel lobe lesion + RE in maidheaie, AO Sessry thalamus AE ® to cortex evel cules Wuclens *Suprechiasmabic wutlens —r Circadian hy} +*Melonopsin Grypte phan) + Jight_ —yetinohypothalamic srack — SCN. Melatonin —rtREM. (tarygdala 9+ prefrrrtal) _YBl- LlokeSil > De synchronication. -7¥pil, lor anpliade ciaves Sleeparcyncheersnizabion —r Slow | : igh volbesre Vain ing REM Sle.of Oh e Sleep s, lex Hea. Slow wave _slee, fe. eras = vestorati +SWS => Basal Sore brain t REM=> Locus Caeruleus REM—rvivid dreams » ‘paradoxical sleep” (muscles During REM GABA neurons in pons are stimulabed which leads te pontine pile apperance > has 3 consaguerces: 1 Stimulation of cortex (desynchrenieakion) 2- Inhibition of DC-ML system SGlycine inhibits he muscles — paralyred + Jn REM amygdala & > Prefrortel 3 Ww Posterior cingulet 2 I. + Fondo Gens cule- Occipit ) complexs =piniti EY lee, VentvoLaterelPre O phic yucleus (VLA) => inibil NE, 5-HT, tlishemine — —leat te sleep MA |-Oyexin (hypscretin) Crom Posteriorlateral N of hypotaelaus stimuleber - $Orerin—r Nares lepsy 9 T 6vexin—r panic disorders rules WakeFelness | Vic _veurens) | VLPO— lesion. —> insomnia 2. ~VLPO Sunction ig cppodie te tuk of Osreuin. Caba.olesg —+ Saber log oftruscle fone —rduc to REM im jhe awake period [nacteleps) 3 Sheep wecilKing (Sonmarbulism) —? NRA Slow weave sles LREM lachavier diseder =7usumlly voilekt acts ‘ Phusiolog 4 een) lesion @ Caciel neve lesion @ MG 4 py Renal Srna rentes) Cevater palpethce siprion i i fosis «1 i jon +Nepwalal UG —»do ice tes) ji, VANE Bit of _spiv i fon of DOM y Wo muscle wasting =panterior cord syndromeJ tMass & reflex —> seen after spinal shack HLAANL in Lever limbs, Sadile type painy Aubenomic. dys fire Hon->Cauda, 7 nina, syntreme. | Syupsthetic innervation 4 the eye consis: of a S-newnarc ($ adler neurons) ___| “Second orler-goes = Firsh ofder—> From paslerier ‘eile soterminate of CE-72 leus (cilicspadl conter af Bulge) is i Vico ie “Thiet erteccwascens alors the inbernal Carotid (inert cavernous sinus) —*S4Pevior orbital Fimmee — The long ciliary nevver_inmervate the iris dileter & the Huller_muscle -[Rasdislery -CT is the best Sor head trawmna __ DSA CDisitel cublractional angicgraphy) Check for yaseular injury __[Squamenr pact of tempore! bone ic the twest=r Epidural hemeforn 2 Epidural — lens shaped - Subdurl—> mecn (cr cresewt) shape? __|+Contusiens—> Pabchy corticn Petechial hemorrhages with background edema (in Yris- condifran ARI ig betfer than CT) —— mostly in Frontal 8 temporal lobes fac in brain (uscwlly curgiol come) —» "Prenme cephalus)[ | | Reblem 4+ Anatomy __|+ anter i vonmrCarotid systen “Posterior Circubion=» Verte bro- basilar system. ACA —rfrombal pole» MCA Tenperal pde» PCA —+Occigibal pele Vertebral & basilar avterier > BYain stem» Cerebellum, pals of oxcipifel pale __| anterior Ii of internal capsle @ Lofe! icwloshricke arteries (branches oF McA) | __ Supp 4 posteriom inh of internal capsule — yelinal adder = Functional ent artery eramole pavteries which Spey Segmecnts of fhe bra: Sy Anastorsest is wot Sufficient | ber shed inferchiom apCartical border ene (belts ACA GHA or MCAS FCA) cotstinte Internal border zone (bebveen AaeBs 8 MCA) —edeep whihe aber Physiclesy . Face sponbanome exprenins —vertyapyrenidel pathnye Human aren 4 Primary weber cortex Human avea 6 —> prematorcortex -Cortichlbar tact rdiroct innervafon—> V, VIF» ¥I) XT ENo direct innerwhin—» IC, TV, VI S EN. ambigue—» IX) Ky XI “es CN ete yrieberat i | Wrilaberal lesion of UMN to N. ambiguus no effect Ceoz of bieberal iunerwbes) + Preubbabac paly —» VM NL in wit pons ‘Nucless soli barins: Inputs: @daste (WI, IX, X) Ocheme Mechan faceplore + Garctit be dy (LX) aortic bods) @ViscerA afferent (TX & Kp=nerts nedinbe> Gag Congr, bate veteptocs reflexes 9 Output aplyprtralamus (paraventricular nuclers) S Awuyg dela. sFace ta vessions —P primary ma n |Decevebrale => tuhibitin of avm flerers + yo inhibibion of leg extensore | Thumad brain eneray conmpption due te =Pi\eocortex __| Fecfors thee T ICP: tol Pence fend down me J Hyperonnen. QHydrace galas B Brie tamer (edema GCSE overgrajuction QCSF obstrastien -CpP= Mse-IcP Vain arterioles hich cohen BP is Yais ilate BP i | eee + Brain BP autoregulation =p befweer GO=[4O wm Hy Severe exernise —» Sympulhehz conttric small brain arterider fo prownt their Capture Aiake bbetred infarction —dre to hyplersion —» eseally bilefereh +Laberal Vetullag syndrome Vertebral avtey or PICA Hesial Hebdllay syrdrme—Vertebal © auterior spinel artery SnSn Padhology fs) + Stroke => non-trasmahic =>HIE (Hypoxic Lichen! ie Encephalopathy) to HIE: if inj a iebal neurons (5 5 esnsterl| -lUy are these mere vuluerable—r production of Mt glutamate — exci totoxin| (CVA: OIpfarction. (Thronbele. or Embols) @ Hema ryhege. of 9s is es ing, arrest Sion. [detshen —rnostiy peter MA &MCA— Sickle Shaged band of necrosis ___thominar necrosis —rpia. vessels ly in the 4 fo6™ new cell layers. __| Cv infarcts a Sn embolism but hemorrhage Lecunse whore» LU TAME risk Becturs > ages HTN, DMs SraokingsInfarct stages: = Imediake (Shour) > ho ges or microepic change Pyknorid ~Acuke (2 days) > edema, lose of gray white border, inflammn tion ea nerons, weutrophile __| + Inbermediafe. (2 weeks) soft febrile Hare cystss Macrophages liqu/Fackive weerests 1 __| Lake (4 weeky—rGliosis Cop vite rer maryin| 1 [655 of archikechure. {| _ +3 major sleoleesG) HY Cuphured eneyryson riovencns fon | HW intracranial emer se. i lin & the ras = HTN can caute:O Intracere mers Slit_hemeee! i Hyper tensive fopabiy © microonenrysms (Chareot-Douchard aneurycms) - Fok embplim—> toxic injury to endothelium (aggrerofed by platelet acti & vecristment of granubeytes. Physiology + Froressive aphasia => Broca’s (New fluent (Good Comprehension / poor re + Receptive aphasia => Wernicket (Flaent/ Poor Comprehension) cor _re petihi L Conduction aghasiamp arcuate Fasciulus (Fluent/Good camprehensienpeor Yepeti ies) __ | Dyslexia: imability to read (Developmental | ‘Alexia: aquired dyslexia Casually angular gyrus lesion) “Rnomic apha ja => inability to name objects __|+ Disarduriat dncoerdinafed Speec! or Prosophenssia: inability to Yecognice Saces Cusit for andioters) - medial undersid on 2 ; jo Fepeat «elon + Sta caste: Separcte Syllables —* lesion in cerebellum » MS -Stommering (or Stuthering)s lesion in Basel ganglia —eSeepocate Syllabus | __ _ [| Cant pane objects pheat on the left side => lesion in Corpus Callosnm oh Rk. Parietal lobe is involved im non-verbal aspect of language (pmobion)- TIA = transient ischemic athack We use CT +o detect brain hemorrhage. + Treskment of cheice to prevet stroltes pAwtithrambahies Physiologs BS cases Mi -Liebert strdomeMidbrain iabion? Ocdanter ply + Conbrlakerak Weriplegia. sKohasien + Rint hamb and avr (Lune => errbali_in. MCA + Pahiewk is paralysed » Can ony move_eyer=pbilatersl lesven of venkral ~Reneniae Heial inferior pontine syndome lusion) => Locked-in _S: | Eee - della brain weves_on LEG =>genevlizes encephalopathy Fr ve. me (Jejgine -rousty syndrome) is a Complication of Post-Meastes Once yar see the tongue is deviaked and atvephied fo the Vighh Yoh malay lec wil also see UML in limbs, / PICA thrombosis» degonerfion of dorsolateral area of the medullx. Coan ensephalits fal eDejering| rome offect spinocerebellar rack) J. anbigques & Spinal drigeminel nucleur [Superior sagitel sinus ncomboss —» TCP of vight_vertebrol artery bf HTN =p alery think of o hemorrhage +| Physiology Si 7 Tinian Blais Tn Fn _ |- Cerebellar ataxia lakerel lest an» * — tHedially stuafed CNs:.3,4,X 1 ~Thpat Sre~ Left Frontal eye Lielt —> Rb. PPRF -» abducense muclers chen goes to Lat. vectus & Rt MLE fir lef} Med vectus (bettey _|-Gorabine! loberel 6 medial udrome invelving vis to Tae Pet i5a| “f To leok Gaze) to the right we start by activating Jhe left PPRF Benedicks syndrome: CMI palsy + ipsiht hemiataxia (Sip. cerebellar padencle) + Corticospinal Gremerl * Weber S=> CN TI palsy + Contvalat Herniplegia. le Brainstem reflexes: Pupitiary VYeflex © Oculecephalic reflex (Dolls Eyes yranewer) also Cold caleric (flex) B Cornect reflex @ Pharynged | (Gas) veflee O Trachel (cough) reflex tN. ambiguus is mictor (swallowing, phoration, coughing)| | Problem 5) 4 Anatomy — ——, = « Coudate + Putamen= Striatun __ | Lentiform nucleus => Putamen tgbbus pallidus “BC cub flew is Grom: GPj to the thal “Soe + Striadum ie ohare emeee pa eee Nels Iriatel civewitey Corticosr takes —eSitarel are __|+ Striatel_aff pileneie nna || Nigrestriates —» dopaminersic Cart compacts) a Sseciakion Cortex —>Candate WACEns > Cortice strinke FOF sensorimetor Cotten —¥ Putarwen *Thalamestriake frm — feo fricetae pracians eGandahe wuclene i | Stratum efferent: OStriatopalli dal OStriatanigref | ___ - Direct patty project to GPi = Indirect _patluony ereject te GPe - “Nl GP efferends are GABAergic (Pallide thalamic & lanticwtris) = __|- Principal seurce of GP affereads is Srom Strmtopallidel fibers (Gksk) — |. Pays veticubte. => CARA -evgic ‘Parkinen—rloss of neuremelanin Som SN _ - Vesti bulocere bellum => F loceulo nodular lobe __|Spinacere bellum =pvermis & parevernal Zone __| Cerebrocerebellur~ => lakeral zones of the cerebellar hemispheres | __ | Olivecere bellar = 3 Climbing Fibers __|: MU other afferentr=>wmossy Fibers __ | Purkinje cells project reldiar nueler Phy siolog4 ; _ _ | Striahem is normally SD poten ip | "Globus altidus is tort cally active —— EE Pitamen=> mokr { premokr areas <> body movements ¥. Coudate > Frontal eye Lied averse eye moverods( OLimbic leopCeingutate & 79 dln) (emebion © mond shift leg) BN nenemoler Banetion sD Prefrontal loop Cinitivtion perminakin. sh copnetin reson) +BEpActivation of specific Suppression of other pre mee Bia Fiviva) + Remember» Micrographia in Par linsen + lesion is subthalamic pucless=? terriballisnns Surgery 3 Subthalame nuclear + Surgery im parkinson—Vereve < Biel Fi » Or Ke we con do DRG Deep brain Stimulation of STN te enter refractory poried) Pharmacology Dopamine is obtained Strom tyyosine -Dopouwine can} cros BBB + Carbidopa—> Peripheral dopa decarhaxylase inhibitor Ackicholinergice offer ton FA: Or phenadine B Pra + Nausea. & vowibivg with levodepe == us. ol cone, ___| *Jevdlopa abne wot common ADR» tochy corde (peripheral conversion) Ki YC = lesvedoga only trots symghome, if doe slau the Pegresion oF diserce + levodopa dys Kine‘. S. "Ono off pheramenan” => yabilily do shore dapamine in Vesicles + Pyridoxal phasphake (vit Be) activafes dopamine decarboylae enzyre in the periphery + Dont tke OA with [ovodom becawse of absorphion comrpitition we the jew -Tolcapone orks cCenterally & in the feriphery Patho logy | Pathephysiolasy af PD: Norarmally ia ubiquibin-akeasome spttem —p accunileon of XK-Syruclein fay boy» bind ubiquitin neuron dpfunction @) Oxidakive Stes: velaked to mitochondria —» tROS— protein damsye SsmwAatine| | } 2MPTP—rmibochondrral djs funchion —Pdamye chprminergic nerrnr—» PD + PD -relabed genes + o-symclein CSNCA)s PRKN2 LRIRIK 2 Clarcharin) “All Lewy bodies stain for X-Synuclein & most alte shain Sac ubiquitin. bodies deposit in neurens of SNPe rastrocytes Bali 7 . mt: Par Kivesn Plus syndrome PX Srnuclein —rMaltiple sytem ey Leds es ee ae with brain iron accubs) ME Multiple System abropy—» Parkinson. —rautonemic Sailure, Cerebellr dysfunchion Ri pytemthd sign __lincusions (GeD [Neurons & astrocytes are spared, ve see F ivon i Striakum- & SN» peuvotoncity %& promotes Sibril” Gorration Fram Ot | ake, Oligedendragiol & micraslal cells are predeminantty invelued —eShow slinl cybplasen'e Stnuclin leading to Gormation of GCL #1 pife ley body disease —> Rikinssn tAlechimer( due do ba) af ACh-proty sein, Herons Cin basal nucleus of Meynert in Sore brrin) __| Progressive. Supranucleac palty (PSP) paralysis af wertiola ere mov real rigidity, postral instability, will dementia, abnormal speech, pscrla-belbar palty Tau- protein inclusions in netrons & glial cells are present -Cortice basal ganptonic. degensration —pinvehe cerebral coftex $ BG + Cotticl atrophy esp. Gronte( § parictl lobes + Tau Orotein in __| wemrons 6. Glial cell +| Phy scolosy | Vestibulocere hellam —>Vestibuler nucki [Plocculorosular lobe | Cerebrocerebellamm Dentate (to Vi wcless of Holamas — water corte) y¥ 26 Nermis > Fasigial ae MH | Intermedictem> Inter pose Spinccere belle mene TER irespital ¥ LEvra correction by Chmbing Shers (rom In Oe) . Nerina —e Traneak abexin—> Tender ‘Mexia eerie ae Bi Reel-shin+ Neohel abuse pdegenerefion of cerebellar averior portion. - Da ia Vestiltecerebellum —rcen't stand Nashagmet,d muscle fone WARE S$ pinocere bella —» Diffrewtty contre Ving Cere brocerebelkun—p highly skilled proverents (speech, piana) | Cerebellar ataria—+Sweays to the affected side| [Problem 6 | Anateoney — _ + Dura layer:@ Periostead DMeningeal 7 Separafion amt sinuses) | Duva info ldings : Flax cerebri » lax coretelli sTentoriam. cerebell; Diaphragne Sellae. + Tentoriam Cerebelli > Supra- & wha tentorial areas -Leptomeninges —r Pia & arachinoid + Dura» Pachy meninx —_ - Sx Super Ficial epipial layer = former denticulate ligaments of Sc inkvima pi rons i vascular Virchows -Rebin e) | Tela choroidea: is a region of meningicl pia mater ap gues vitcle-»Choreid plew¢ — : Physi logy Gunctions of CSE:O¢OUS Went ©Support & protection @ Nutrition M Remove Woste product © maintain ion balance Otranspark Spite @ Control pul y yerrtelicbion and cerebral bleed flor BSovers as a lymphabc syeber— LCSE sprodnces fram

Cher O ne absorption in acachined Vili, or Obstruction in he subarachincid sence —>Can lead to head enlagemort in Sti babies - Plood-CSF barrier is at the choroid plexus (no tight junctions) EE avers lackiny BBB-ONven peshrere © Pesteriar pibsiary @ Pineal goad -BBB © lack pinoestotic vescles @4 mikachondri'a @ tight junctions @ thick asa | | loninn O Astrocyte Sot processer @ suvranded by pericytes |Pathol ay s infection of brain parenchymay encephalitis (if mith meninger mpmeningcencephalits) « infection of spinal cord >myelibis Chranic meningilicrif more then 4 Weeks ‘Meningitis ROT: Diveck —>Ohitis media Tndivect—r blood borne infections Neurosurgical sebtivgs Meningeal carcinamakosis Riphwed dermeid- chemical irritant slocakion of meningitic H- infla—r basel exufate S- Permro—» Ceve brat Converifier near Sagittal _sines Frdlminod: Coser—rNenbvicles £ adjacent brain parenchjnn Ontvecked coser—vlepromeniigeal Sbrss & obstructive hydrocephalus LComplicahion: Vasculitis ,Cevebral edema, HIE, tydrecephedos - Fingal preningifis —r Granvloma + enderteribis obliterans -Virel (aseptic) meningitis => HIV, polio, herpes, vabiey CAV. [Micro of vivel_meningitic hocsker OMicemlial nodules @ inbrawelear 6 in ti ions cts fm Deri FFs around blood vessels +Prain abscessrr Fronted lobe-r Frowel sinusitis phism ds *Cerehelin & tempor lobe > Hidble ear & mastoid sinuses Pariebl lobe—> Bleed stream FORGHLE —> Fraume | Shull frevchere | Bein abscess layers: -Jnner zone? necrotic yralerial & acute _inflammafery cells ~Hiddle zone > proliferating Sibotlasts & granulabion tissue -COtherwost Zonex>liosis & inflamed brain parenchymaPharmacaleay With meningitis we usualy use Bactericidal dings |. Penicillin Gar N- meningitidis - Ampicillin -? Listeria or Strep. preume Cale give amine glycosides fe iter) sHospihel aguivead # meningitis <> Piperacillin & Ticracillin. (Venco+ Ceflazidiqre) | 3% BY" gen cephalosporins can cross fhe [BR « Aminoglycosider are mainly used for aersbic gram —Vve bacilli Vancomycin —> Red man syndrome Ceftriaxone competes with pillubin. loinding fe albumin. 7 don't sive k neonates + Hinfla GN. meningihidis = Lune bar puncte is CI -ZN stein—+T meningitis (ale lowenstei-Tensen median) + Fletcher$ metinn—> Leptospiral meningitis Cols dact Pic meres ry, Clinical + Meningitis triad: fever, headache , Neck stiffness - Bacterial —pacuke—r within 2U hours > Virek— Subacute—> 1-2 7 days ~Newnabel meningitis Bulging fronbantl ; Paradonio’ irritability, High- pitched Crying, Wypoterc. * Signs of Menmsitial irritation, nucal rigidity, Ker nig 7 Brudzinsici[ | (Rotem 7 + Radiology MTS = Mesial temporal sclerosis. Physisleny EFC frm => pyramidal cells of the cortex (ager 5) -Thabmacectical neurons har J shoes: - Tonioly acti fe S=» Des rons: 2- OsciN\efucy ov bursting =» No Rds PSynchronized AGABA Sei i oh scfna ivabion of “Ttypa Ca®” chimnels LOwaves=p S- (2 HE ; B- waves /3-30 He “Thele caves 8-5-7-5 HE (haze f sleep! “Dele caves 1-4 H2 (deep sieeg) Most commen plece far epileptic. Reus —Hippicampes — c/ith surgient removet 1 will_be beHer fonia —r peuren swellisg —rover Firitg —> Seizure | Glutamabe recepluser MMPA _& NADA Y3 camer of seicuen OHyperercitcbity® H rans @) Propet “GBA ASCI7 pecmenbilt 2 GABA B= I permenbilty A. Tnterictsl spikes PDSCParontimal 0 Depolarieafion. Shift) > Tnibiele d by AMPA & maintained by NMDA Ehallnarl, of focal seicures) € \Terwivetion of seiwe involves: 4K" condeclnce QTGABA mb. @Ot*CN Conductonce - Prototype of generaliced Seizwe > Absence seizure cel) vt lee we wize. he re Hreular “Abscence Sa'vwe =» neurons of yebiadar vicles laut APs Spontancos) (even chen ver expression M Channele jm {~ IPSP Cinbibitor pact synaptic qatenticl) = limits excibadailily of hippocampus rif pactial seicwe reaches tholamuser Generalized seizure fe Physislegy led + Bleeding ora fume? delfa cover -EI 1: Diggnoris of isorders Ink ‘eh hemor) (on __| epilepsy © Generalired epider OViagnoris of brain deaf (rare Activation y 1G Tterinitan€ pholic stinuwlabion ----- OptionalD Sleep depravehion @ Sedabes| __|sleep @ Seizure preci, oe i ns EL O wi rasreh | Phavmacalogy ‘Mii-eglepticr are. category D Gobopotin is also used Sar evectile dysfunction & diabehic peripherl nenvepatty + Felbatrabe Hocks ghdomale NMOA veceptors *TTépiramale blocks Na” channels & potentiate GAGA & block glubwmale veces + Vigahafrin -» ifreversible imhibibion of GABA transaminase DOC for _partinl seicures Carbamazigine or phengtoin. | Carbamazipine Sur Complex garhiol Serrure |- DOC. Sor _generefized seiewes =>Val porte acid “CI drugs in absence seizures: OCarbamaze pine @Phenghoin @ Phenabarbiteel Bs chaytsin dose t—rthere 5 a shift fim Sorder to Zerrordor Kine tics (his ts Know as Michaelis-Menten Kinetics) oS Verne! te so a mild clevain of liver entyme wher using valproate -Grbawazigine Om ale lead Kepabtoricty (due to epevide melbebtes)| - DRESS + Prenytain, Lamehragerer Carbamazipine, Phersbartitone “LV phenytoin er cause > Thrimbophlerst's 1b Saregli week —id Shebur epilepticus iOLoyaripan, @ Fos phenytoin G) Phenebarbhl @ TV anesthetic with ve} Ss2icahar “Valproate is the only enzyme inhibiler mony the Sirk generabion. - Benzodiazepines neither induce /nkihit= Iver metsbliking entymer Antiepiecties Con ¥ effectiveness of Oc Ps + Lderfavin & AED @CYP 2CQ /I4 -Auto- (Wduction is Seen Wilk Carbomezipine (other d¥ugs from the Same (zephe) cabesery font have aube- induction) “if bab before getting pregnant —> Suit to Lamotrigine aor Levetyacetam (cafest im pYegnancy) alee give folate (ti) and vt K Cart pti) >Contincur Febrile Sef zeres=> Jer rectal diazepan—| } (Reblem 3) Physialogy +3 tyaes of tearing: Basal » Reflex » Eeachinal_ 2-Vasculac pact: Secretion of aqueous hancor _ Ciliary body +} Ciliary muscle (Conbval_refrac tion Oem of | | |-Accommodation OMyese OConvergence @Tncrersed lens converiby “Argyll Robertson pupitrabsent light reflex ith infact accommadafion. (vaidbrain. lescon| __ Iris: 2 sels of appring oction muscles (Control size of the epil) Macula>Centrel vision r Optic _dise=blind spot - Ra sympathetic > myosis —» Circular + Sympathetic mydriasis—» Radial ee -Normel_Cup/optic diss ratio=» Q-3 Cit becomes bigger in Glascona) Ganglion cells will male up the aptic dis Connect horizontally the bipsle & ganglionic colt. Depolarization) -Davkvesr a NT velere > Light» No NT rdease _|-Amacrine cell: Yeleare differnt wenrohoamitters hey are inhibitory. they | _|eOnly ganglionic Cells preduce AP : |+-Rods piguent (Rhodopsin) = Retinal + Opsin (Scotopsin) _ _| Cons pigment (coler pignrent)= Retinal + Opsin (Photopsin) | - Reds has lots of pigment » Cons has very liltle pignent | Less pigment in Vit A deficienes _|*Cons = Saster Adaption fe span af photo pigment is 12 days | deposits causing periphacl vision blindness _|+Rehwitis pigmentore <> Reds, periphery contains leh of piiments cach - Light +1 cis —vebinsl—eLl-trans — actinfe-r Tansducin activates PDE — hspdvelines—> (GAAP "Coley depends on 2 Opsin, _9 Retinoid cycle. carrer_is=> IRBP «Power in diopters = 1/Focel length Cin meters) (if focal lengh ir 50cm = 2 [Siopter) » Emmetropias Normal vision, | Myopia =Nearsightedness (Concave lens) -Hyperspia= Farsightedness (Conver lew) __ bAstigniactismn 7 ‘ ite planes Costin dyceal! lens - Myers leop=> termmarel Ice vadiatins venhel $e it Farvocell jer => ' “> tetinal Won calls => Tem lobe. Pariet -Magnocellelar layer—»"U)here' = Peri te 1 “Visual ges 4 or we How 4 preceive depth (rOSize @troving parallax @) Stereopss (Clore sbiests make -On-Center & Off -center Sarglion cells i he gery “Net teafed infacy Cataract =>l. tical bi 5 =e Wyapia” - Janslion cells on Cemmen line —Converge by way of the | GN anto—>Simee cell | « Several simple cells of the Same. orientshion converge ante a Complex cell. | _ LRespurse te which wave length is delermined by AA Compesition of opsin. Luhere does Geheeki ae i r Mnahons | Bacs of Orbicubaris ccusDOrbi al pebral ~ Facial sheaf oC the eyeball is also Knon as Saseie bulbi» Vagina bulbi Tridecorment augle Pimpartence in Wainage ef AQueas \unror | & Tenont Gapmle __|-Gorneoscleral junction =>limbus Vido cerned angle Trabecular meshwork Canal of Schlerun (Sinus Nenosus sclerae) > Veins eTiflornmation of chorsid=>UveitisJ Pharmacslogs - Fach eye drop is 3O-50n) =» its a Solution” Gabrerption & Clear) __| best is eye drop then s oe ne Gintoaent Nu asian etree eine ena :O-Tepiod ee creed __ | wide chotce) @ vot te inish Supya- chrot dal o Subretinal + Drugs b production ® B-blee nists @ Carbonic onks inhebiforr ates DOC fr open angle => Prostaglandin) Second is timolol ctastinas “Congeniel glancema —> Surgery + Ocular ljparkension. —» Frequent monitor af JOP Lassess risk fhctors Aggle chsure glaucoma ividodasty (iridotomy 5 hg > ts (steroiy); Comeal si in, Chlerogurs (Chleregnine) sb Optic Keurepattey (Ethambutel) +| Clinical Myopia types —-» refractive — VeFrachion ervor Le axial—lonrg eyeball (mere Comme) Re igheval vision=» Pevimetys 2 “Suifable lens—> Retina ina Scape go Proropter (serter of lowell [gl eiraruee pene ok Tenometry nrel ssi C61 “Cenbaul Scofoma =? atte deg enralln| [ Probolem. A i Physiology _ We an hew 20 He -20000 Hz -Tympanic membrane i Surfane even is 17 times of he “oval Cintas (main ampl'fer) +O ssicular system ap pragrifiy py 1S times on “Tensor ty meani —» CVV -Shapedius CN VIE » Frequency = pileh _Herte. -Amolihde = loudness Sound intensity —measmwed in->derihels > O is Buwhat the noruel shart Bony Labyrinth channels w temporal bone Silled parilynph= 3 regions « __| Vestibule, cae cochless & Semiciccular canals | Membranes Labyrinth - Sevier of membanans Sace & duct within the | bony labyrinth Filled with endelymph. _ _ ~The scale media has the ovgan'*ef cork _ | Deplarization in he ear by > Kt __|sh |= Peri lymph Cin Scale Veshivl & Scale tumeui) = like ECE (ta 4k) __| Brdolymple Cin Sale tpigiiied) =p like ICE C¥Na& TRY ‘Duel winder ig in Gantact ert Sepes oe _ 1 inner -raFrerent MA rows of hair cells K3 outer “sVskape tip embadses i tenbecia{ membene + Short sherescilia towed Kinociia =p Depolarization (Sly) 1 Oufer hair col —r depalrize Ceol Shortens hyperpolarize Cell lengthen) | —Eidaie cele donk ragnershe Pn nae ee ot +Heic cells leak Ca tonic yelaaw of NT Callow quick response) IT Febige. | Base => High Prequerey » Apex Low Srequenge | aie ace lear MWuclens » = Ap. Olivery Complecr Laker | lamniscs\y i allicelas ‘cube weleasy Breadonean tL. | Pubilaberad hearing les ae rr darage _¥ Menieres:Tinnihus of high Srequency & heaving loss of low Sroguorey slocebion of sound Intensity differance or tivae. difference KY Superior lve ¥ freq —>Time — Med. SOV t fleg —> Trtensity —» Lat. SON Phy siol osy Sacewle=> linear ywiticle movement __|: O to liths ase of eich. icire > whiche ristae icivcutm,» = io = + Vtricle-rlinea ke izenkal Movement Lg “The utricle & saccule haiy eli, are popubtes in two orentetion bY he "Shriota’ trlabiom yestibuler weclens shimusloled —Ceite otimnahian Debi coe Mi Cightene! -Molion sicknes —rgo ont eset on the deck Awakens + Hovizowkel Canals work togetfier: Movas ~h of 4he head towards the left > # excite the left and inhibite the right “enicircular Canads a» Left iddle eax relakions __|+ Development of nde, ne_(aron belwwn cr Baustech: = Pathology _ pMiddle arr is a Spac inicaking via te @stechion tube will. Outer Vs of oudiotory canal Conkain Ceruminons glands sinner Ye of ee @ 's bowy (not cartilage) (Shame) @ swale__binner +wpanic membrane => Won-Keratinized stratified SAuancous Li. ear —> Cubsidel epithe le __|. Fuskichien Hebe Vespii epithe frm k. id: Simol boi i Ossicles: typical syroviel joints [Taner ear: Vester labyvinth is lined by Flat 4 fom columnar epthelion averlying Vascular shrome -eloids ave Denign cubancong lesions Hut result Grom ewcesive, calagen # cyuthess § deposition. (Scars that don't mow chen to step) __|-Kelot nvcre :D bisarranged fibrocayel ir scattered Capillarier i (ontbtobe: neretis 7 Fesemble. Joma Puce - Griese of ae lesions: ® Peyichondritis OC he eee modular is __| chronica_helets @ relapsing AZ (autoimmune CS¥ereds) Malignant chilis erbema—b Prertimenas We |- Oils externa heenorrbasica —p virad Diffuse alitis extema canser(Dficessive mot (t pr bacterin) @Dbstrction J Pannen + Compliewbions of otibis media: destruction of ossicks GAcufe mastoiditi's | willle ear air—rNegatue presure—» Wansudeke Gran pasion, ~ Disuetion. of eustachian tube => Chronic otikis wedie. Clue ear => Conductive hearing loss Perforaked tyapanic wrembrne with persishet dia inage-pCSOANW (Chronic suppurative otitis media) __lhemosedrin laden. inecrophage -Okbis emtema Complicabiow: Dabscess OPerichondritts B) Fibrosis (stenesiy Iympanic membsane inflammation DOKES externa maligne | fous_chikis ia_(ver. => Swelling of can teberabserption of | “eh Gs anion L,celt ncconcnts (lebiel |= Taper of dischare: Lax Pass Muctes, Blood pftnined (044), Fresh blood Chrema) , CSF Ctrannne) Phare *Vomiking Center => in the medulla |: 7 Vorriting due to My & Hy Cecephes we bl lopars jom. toclopramide| | chick also inhibits SHTR) to shop the inhibition of ACh relesse Cin order | _ 4a t peristalsic —> + Vowiting) = Morning sickness anti -hishamine > Doxyalmine + Motion sickness —ank-cholinergic => Sceaolamine Chemotherapy induced—= > HT3 anhagorst -» Ond-astraen. ~*4 - Cispakin => NK anbagonist « Levodepe induced => Domeeridave “Drugs Lor Meniere's disease: O Anti-histamnes @Betahistine Cvasedlefe® Diuwetics QCorticosteraide Clinical Tn children ET is at an angle of 10° chile inadulls it is at an angle of 45° Signs of GUL: Vehtrchon of TM, Loss of come of fight puning fork (conductig desfnen) leker: loutging of TH & clouding of mashoit air cells - Stages of OM: Ohypevemic @ ext delive @ Suppuetion O vesolubisn Tf TH is_bulgig do =» Myringobouy (te let dizchage come ouf) + Abscess = de = asoidectonyy| | Problem -10 J} | Endogenass benzo-> Eadocapnes xX. Renzo: mechanism oF action =pposilive allotteric modulation #4. Benzo antagencst > flemazenil of Omega 2 receplr function. -|Pharmacdory |-Benzos shouts be given. to Alzchiner (rien mrfoenfiston % inpaier wera] + Benzes ion &_ovnesia “AI anticanxcl ve- hs x: Benzo inverse agonist —»B-carbdlines (produce seienre § anxily) Voadest spect +Renzos have moderate to extensive plasma probein binding (66-45%) Benzos induce liver en: types (CYP4SO) : Delon pecan be alcoholics = Chior dia vegoxide Pont Cut dma) + Wowie use short actixe 9 Ahyity rise long acdug 1. po 2 ae have voperties: Nouto induction (2) induction. Cr “b ¥ x Alprazolam. => rapid oral absorphion. - Diazepamererratic bicavalibilily after IM injection + “Chloride channel macromelecular conaplex” |- Zolpgdem —> Yo achive mebabelites > no drug depaudence | - Flunitrazepam—> date - fape drug ti: Benzo in baby=> Floppy-baby syndine (may need respiratory support): midkne __| cre bi P re _ | + lAlzehiner — Donepezt (Chelnesterae inhibitors) FL Hla to Measure crgnetie. Linchinin? Actinty Daily hing ADL) score Cehecks mprewers sft] [With Donepezit (dose - Fhect) —> dont wevease dose (Hs aff oy none) lA cor _alss give precursur te ACh biogutheris =? Choline» lecithin [Slow progression of disease NMDA (Gutenale) Yecepta antasenistrMemantine| | HL" Prevention of mulbininfack stroke with auti-thrombskics Hl -Hydergine ,erphy pentory fylive = imprve cerebral blood Flex,+1 Clinical Diagnosis of Alzehimer OSM V i Memory impairment ++ sre ov Wore as e ia, Dishurbance in ive Funclions a Phusiol egy +Flectrical syapres:Osap junctions @Very small diamelerCOhigly synchronized __ |Chemical Olay; ic ek has a_pre- & be ic element { Rae Criteria :@Present within the presynaptic terminal __| @Release is by depolarizafion. & is Ca” dependent —_ Tt has ific st ic_si { *NTs_ classification» ___|-Chemi. : i oe avineDNE, Epi) » Amincccids (Glubumale, aspartate, GABA); Reptiles (Samababatin Sub-P. ___| opioids gases (like NO) b+ Fanctionaly: Excitatory or inhibitory + Direct/Tonotropre (open ton channels] or Indirect/metahettepic (activate) G-proteins) Hak crenke a metabolic change in cof - Ch = excitatory => ligand gated Na* chonnel GABA = imhibitery=> ligand gafed Cl” channel - infancy, 3GABA is ercitakerg since IC Cr is vey high es. ishami in) 61 role AKAX| rautishics infants have to many neurons | too many axons: +Nexron apoptesir-oSteped by Neuvotropins (NGE) + Dif fer es of ‘ cues: O Extra. t hesion| Olelt surface adhesion @ Fasciculaf ion AChemoa tractor OCormbac t iwhibition © Chemorepulsion.|. Sources of brain. Ach: Puduneada ntine —tnginsedel muscles ——y —__| @ Latevedorsal tegmental nucleus j— @ Basel fore brain Complex CRFC) | ACh: Avansel obit nitive, . | = Physiology __|+ Deja vn =>by dentebe nucleus | __ | Centrel executive < prefrontal cortex => con & Working —_|_ Memory *Explicit/declavative memories inclile Carts, wamenemin stories, and meanings of words => by Frontal lobes (Retrievel)? & the encodirg and storage is by the temporal lobe Structures (hippocampse -role of Glutamate) much of the Consolidation Occuyy durivg sleep ici wdeclarative hex. and fos Dopamine skews play; a vole in formbcon of implicit memory - Short ferme memory (presynaptic) :OReverbereting @Bired- pulse fascilipabian Chon residual Cat) GHah itudtion Cignoving since ity not important by closing Cat chamnei) Sensitizabio. Intermediate memory (pre: a) HT Syncs - Long-term sensitizakier (Postetefanic potentistio)—> prespaphic > S-HT| -Lag-Jern potentishon (DOS TSYNACTIC)=Popening of NMDA rerphed + Paces => lateral areas (fusiform. face oven) ae Lychee | AK |- Places > ial ates tel lobe sAitekimer memory bss Giest to last OShatterm memory © Episedic memory @Semantic memory @ Procedural memoryPathology | Alzehiemers nit affect Consciousness : | | Causes of dementia: @ Vascular @Degenerabive® Neoplashic GTraumabicl OHydrocephalus @) Toxic @ infective ® Prion | + APP —> Beamyleid —> due fe error in protealysis—wSenile plaznes (iMsolabe amylid Bbrit) => Lxhracellular SPECIFIC te Al.) Coe renchine asheete Sat ya) + Hy perphesphorylakion of the micvohubule-associated protein, tau —r Neurchibilary tangler=r Intracellular - Siler Shain win pyvami del cellr of hippecameat Ta AD. AB is toxic po neurons in hignocamgns & entorhinal Cortex chile paring Cerebellar neurons ¥ eu MD mest impeckant genebic risk factor pApolipopotein & (ApsE) On. ChYomesome 14 = modulate APP Secreteases M|-APP 221 » PSL 14, PS2—1, Amer iq __|-AD ques #0 Cochionl abrophy Olvidenng of sulci @ Vertyicular enlargement | __ | Remember micro => Cerebral amuyled ongtopatty )*""Si aeons a ENE denser competion: © hynphaphectleh tx @MAPLO Ubiquitin Obes | ¥|- Picks disease (Frantotempural denenta) =? Projresive Venfluent aphasia »heve | __|_ Persenatty Changes happen befire memay leer =2ne SP or NET ) hyper- | | phospherg lated tears (Pick bodies = Ve _inmumunahistecheriea staining Using | anti-tan & anti- ubiquitin omtibe dies | 1? Tyans wissible Spongiform encephelopallyy = Prion disease =| mutefion m PRNP gene =Paduves>@ Spengifirm channe @yeuronal | loss Aastrocyporis Damyloid Plagues farmabion + + Kura Plaguer Shain like ovnyleid Cmamer of pric)