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Neuroscience Clinical Case Conference

Neuroscience Clinical Case Conference. VIII - MOTOR Katalin Juhasz-Pocsine, M.D. 4.4.03. Case 8.1. HPI: 8 y.o. girl; nausea X 7mo, vomiting X 3 mo., unsteady broad based gait - recently, unsteady while sitting, occasionally fell over ROS: Headache, dizziness Development and PMH:

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Neuroscience Clinical Case Conference

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  1. Neuroscience Clinical Case Conference VIII - MOTOR Katalin Juhasz-Pocsine, M.D. 4.4.03

  2. Case 8.1 • HPI: • 8 y.o. girl; nausea X 7mo, vomiting X 3 mo., unsteady broad based gait - recently, unsteady while sitting, occasionally fell over • ROS: • Headache, dizziness • Development and PMH: • Normal / negative

  3. General exam:papilledema (Q10) Mental:Normal CN:Normal (Q1) Motor:Normal (Q2) Reflexes:Normal (Q2) Sensory:Normal (Q3) Coordination:(Q2) Horizontal nystagmus on lateral gaze to either side (Q9) Broad based gait Head titubation Truncal ataxia (Q8) No axial/limb ataxia Case I - Physical Exam Discuss: Clinico-temporal profile (Q5), localization (Q6), path. (Q7)

  4. Medulloblastoma

  5. Pilocystic astrocytoma

  6. Median Cerebellar Syndrome

  7. Cerebellar Connections

  8. Case 8.2 • HPI: • 54 yo. Woman, right handed • Rapid onset right hemiparesis and hemiparesthesia 9 mo. • Slow onset of involuntary and flinging motion of the right arm and writhing and jerky motion of the right leg within the last 9 months. These movements were absent during sleep. • PMH: • Smoker • HTN • CVA

  9. Mental:Emotional(Q1) Language:Normal(Q1-Q10) CN:Normal(Q2) Motor:(Q3) R. hemiparesis ? Reflexes:(Q3) Normal on the left ? on the right Sensory:Normal(Q2) Coordination and gait:(Q3) R.UE: violent flinging superimposed on a writhing jerky movement Gait is difficulty due to violence of the above movements Case 8.2 Physical Exam Discuss: Clinico-temporal profile (Q7), localization (Q5 and 6), pathology (Q8)

  10. Hemiballism - Subthalamic nucleus • Flinging, throwing movements of the UE&LE • Athetosis • Slow, uncoordinated, writhing, wide amplitude, {Distal UE>LE}>axial muscles, face • Chorea • Sudden, brief, stereotyped, involuntary, purposeless, irregular, continuous,appendicular, facial or truncal • Dystonia • Slow, long-sustained, contorting, proxiamal and axial muscles • Tics • Sudden, rapid, brief, spontaneous, involuntary, could be suppressed willfully, eye, mouth, neck, shoulder or generalized • Myoclonus • Unexpected, sudden, brief, shocklike, repetative, (a)synchronous, axial&append. • Tremor • constant rhythm, steady oscillation; amplitude and frequency may vary

  11. Penumbra

  12. Penumbra • “Shadow zone” • Ischemic penumbra is a region of reduced cerebral blood flow with absent spontaneous or induced electrical potentials that still maintains ionic homeostasis and transmembrane electrical potentials. • An ischemic tissue that potentially reversible. • Target of acute stroke therapy

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