Neuroscience Clinical Case Conference

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
Case I - Physical Exam

• 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

Discuss Clinico-temporal profile (Q5),
localization (Q6), path. (Q7)
4
Medulloblastoma
5
(No Transcript)
6
Pilocystic astrocytoma
7
Median Cerebellar Syndrome
8
Cerebellar Connections
9
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

10
Case 8.2 Physical Exam

• 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

Discuss Clinico-temporal profile (Q7),
localization (Q5 and 6), pathology (Q8)
11

• Hemiballism - Subthalamic nucleus
• Flinging, throwing movements of the UELE
• Athetosis
• Slow, uncoordinated, writhing, wide amplitude,
  Distal UEgtLEgtaxial 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, axialappend.
• Tremor
• constant rhythm, steady oscillation amplitude
  and frequency may vary

12
(No Transcript)
13
(No Transcript)
14
Penumbra
15
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

16
(No Transcript)