Cases for Discussion Case 1: 32 year old school teacher is referred for evaluation of headache. She has had headaches since age15 mainly during her 'periods'. She experiences mood disturbance, irritability and depressive symptoms 2 days prior to her periods before the onset of headache. Either before or during her headache she sees some hazy spot from the center of her vision with shimmering light of different patterns spreading across her peripheral vision, followed by constriction of her visual field and this lasts for 20-30minutes. Her headache is usually in the fronto-temporal area (one

Methodology of nerve conduction studies Motor nerves Sensory nerves Myoanatomic Atlas for Clinical EMG For a patient with weakness due to neuromuscular disease , the EMG and nerve conduction studies are probably reasonably diagnostic in about 75% of cases. Role of EMG evaluation in muscle hyperactivity syndromes . This article reviews the electromyographic features and pathophysiology of fasciculations, high frequency discharges, myokymia, and neuromyotonia. Nerve conduction studies Electrodiagnostic criteria for the diagnosis of acute and chronic inflammatory demyelinating polyneuropathies

Cases for Discussion Case #1: Highest level gait disorder? This 84-year-old man was referred for deteriorating gait and memory, beginning 3-5 years ago. These problems began insidiously and progressed gradually. Throughout this time, he had been sleeping in a Lazy Boy chair because of chronic low back pain. He now walks with a walker. Carbidopa-levodopa 25/100 two tablets tid did not help. Exam revealed orientation to place but not time. Recall was 0 of 3 words. He could not spell WORLD backward and could not draw intersecting pentagons. He was mildly bradykinetic and had mild paratonia in all

Pearls, Perils, and Pitfalls In the Use of the Electroencephalogram Omkar N. Markand, M.D., F.R.C.P.C. Semin Neurol 23(1):7-46, 2003. © 2003 Thieme Medical Publishers Posted 07/22/2003 Abstract and Introduction Abstract Despite advances in neuroimaging techniques over the past three decades that have helped in identifying structural lesions of the central nervous system, electroencephalography (EEG) continues to provide valuable insight into brain function by demonstrating focal or diffuse background abnormalities and epileptiform abnormalities. It is an extremely valuable test in patients

KEY TERMS nystagmus: An involuntary rhythmic oscillation of the eyes. internuclear ophthalmoplegia (INO): With attempted gaze to one side, failure of the adducting eye to move beyond the midline, with nystagmus developing in the abducting eye. INO is due to a lesion affecting the medial longitudinal fasciculus on the same side as the adducting eye. optic disk: The area of the retina entered by the optic nerve. Marcus Gunn pupil: A pupil that may react to light but does not hold the reaction, or, paradoxically, may dilate slowly; the consensual reflex may be more prompt than the direct reflex

A 20-year old woman has fluctuating weakness A 20-year old woman with past medical history of hypertension presented with a two-year history of fluctuating muscle weakness. She has increasing difficulty raising her arms to comb her hair and standing up from a chair. Six months ago she started to have intermittent double vision and difficulty chewing at night. She has no numbness or pain. On neurological exam, mild left ptosis and mild bilateral facial weakness. Limb muscle strength is 4/5 in the proximal and 5/5 in the distal muscles. No muscle atrophy. Deep tendon reflexes, sensation, and

A 65 yr old male develops the acute onset of weakness of the right face, arm and leg. There is associated numbness of face, arm, and leg. He has an expressive aphasia. Eyes are deviated to the left and he has a right homonymous hemianopia. a) What vascular territory is involved? b) Name the vessel this artery branches off from. c) Which artery or arteries supply the body and head of the caudate, upper part of the anterior limb, genu, and anterior part of the posterior limb of the internal capsule, putamen, and pallidum? d) What are the possible etiologies of stroke in this patient? A 75 yr old

Case 1 72 year old with vision problem HPI 72 y/o man 4 months ago found to have squamous cell CA of lung. 3 days ago he had lung surgery. Yesterday he developed a "vision problem". Exam by internal medicine resident and MSIII. Fundus exam shows bilateral cataracts, retinas appear normal. CN normal except "temporal deficit" in L eye, normal R eye visual field, and bilateral hearing deficit. Rest of exam normal. Labs none relevant Questions 1. What is the location of a lesion that could cause this deficit? Case 2 67 y/o with CC falling HPI 72 y/o woman with history of intermittent atrial