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Amaurosis fugax: painless, rapid & transient (<10 min) monocular vision loss, like curtain descending

over the visual field, the mcc is retinal ischemia due to carotid atherosclerotic emboli so duplex US of
the neck.

MMSE score <24 dementia, lack of insight into the condition, CT in early Alzheimer is normal, cortical &
subcortical atrophy is seen in later stage, atrophy is prominent in parietal & temporal lobes, particularly
hippocampi. Progression over period of years, no incontinence.

Cholinesterase inhibitors improve quality of life & cognitive functions (memory, language, reasoning).
DX: MMSE, crieria: 2 or more areas of cognitive deficits, worsening memory & other cognitive function,
no disturbance of consciousness, age>60, absence of other disorder.

NPH: abnormal gait (the most prominent clinical feature & early), dementia & urinary incontinence

Frontotemporal dementia: personality changes (euphoria, disinhibition, apathy), compulsive behaviours,


mute, immobile &incontinent. Visual & spatial functions are usually intact.

Multi-infarct dementia: 20%, cognitive, motor & sensory dysfunction. Sudden with a stepwise
deteroration of memory after each attack.

Dementia with lewy bodies: parkinsonism, dementia, visual hallucinations. Visuospatial dysfunction
occurs early, & memory deficits later.
BPPV: calcium crystals within semicircular canals, brief, recurrent episodes as feeling of the room
spinning/vertigo sensation when turning the head to one direction or looking up, nystagmus, nausea.
Semicircular canal dysfunction. Dix-Hallpike maneuver: vertigo and nystagmus are triggered as the
patient quickly lies back into a supine position with the head rotated 45 degrees. BPPV resolves
spontaneously in most cases but can recur months or years later. Symptoms can be relieved
with the canalith repositioning maneuver (Epley maneuver).

Meniere disease: excess end lymphatic fluid pressure in the inner ear, triad of episodic dizziness, low-
frequency hearing loss & tinnitus, also vertigo that lasts days, nausea, horizontal nyztagmus during the
episode.

Ototoxicity: damage to cochlear cell so hearing loss; Vestibuopathy: damage to sensitive hair cells in the
inner ear, both vestibular end organs are equally affected so not vertigo, neither left or fight imbalance,
oscillopsia ( sensation of objects moving around in the visual field when looking any direction), the
deficient vestibule-ocular reflex lead to gait disturbance, abnormal head thrust (patients are unable to
maintain their eyes on the target, the eyes move away and then return back with a horizontal saccadeg)
** Descending first face, upper limbs, trunk and ultimately lower limbs.
DX requires CT guided aspiration or surgical biopsy to obtain tissue for gram stain & culture (bacterial,
fungal, mycobacterial). TX: IV mtz, ceftriaxone & vancomycin.

NOCARDIA brain abscess in Immunocompromised (HIV with CD4 < 100/mm3).


Brain mets most common intracranial tumors cause >50% of all brain tumors, usually seen at
the grey-white matter junction, 80% lung Ca so CT chest to identify the source.
Single brain METS – surgical resection, followed by stereotatic radiosurgery (SRS) or whole brain
radiation therapy to the tumor bed. Choose SRS when not candidates for surgery, inaccessible
lesion or smaller mets (<3cm). Multiple brain Mets, OR POOR performance status - WBRT or
supportive care.

Brachytherapy involves implantation of a radioactive source directly into an


intracerebral mass or surgical cavity, allowing higher radiation doses to be
delivered directly into the brain without affecting other organs. It is typically
used in conjunction with surgery, or after recurrence following WBRT or
surgery.
cerebellar dysfunction, ipsilateral
cerebellar tumor, ipsilateral ataxia, especially if it is located within the
hemisphere, fall towards the side of the lesion, tends to sway to the
affected side, and may exhibit titubation, which is a forward and backward
movement of the trunk, also nystagmus, intention trmor, ipsilateral
hypotonia. Increased ICP.

Tabes, walking with the legs wide apart, the feet are lifted higher than
usual, make a slapping sound when they come in cntact with the floor,
romberg’s sign (+).

Hemiparesis, leg is swung outward in a semicircle as patient walks.


Brain death is a clinical diagnosis. The characteristic findings are absent
cortical and brain stem functions (pupillary light reaction & oculovestibular
reaction, heart rate fails to accelerate after atrophine, no spontaneous
respiration at PCO2 of >50 mHg). The spinal cord may still be functioning;
therefore, deep tendon reflexes may be present. An isoelectric EEG can be
used as a confirmatory test, but it is not absolutely necessary. Other
diagnostic tools (e.g., Doppler ultrasonography, angiography) can
demonstrate cerebral blood flow cessation, but these are not commonly
employed.
cauda equina syndrome (CES), compression of spinal nerve
roots from mets prostate cancer, disc herniation or rupture, spinal stenosis,
tumors, infection, hemorrhage or iatrogenic injury. Cauda equine (lower
motor neuron - peripheral nervous system) provides sensory
innervation to saddle area, motor inervation to sphincters (anal & urethral)
& parasympathetic innervation to the bladder & lower bowel. Management:
emergency MRI, neurosurgical & IV glucocorticoids.

Conus medularis: part of spinal cord (both upper & lower MN)