Neurology and NRŞ

How distinguish meningismus from cervical mechanical stiffness?

Meningismus mainly limits flexion but preserves lateral rotation; mechanical disease limits movement in multiple directions.

When should brain CT be obtained before LP?

CNS disease/mass history, severe immunocompromise, new seizure, papilledema, altered consciousness, focal neurological deficit.

Epilepsi patogenezi de gaba-a ve nmda reseptörleri?

GabaA dan cl giremez gaba azaldığı içim

Nmda dan na ve ca çok girer

Epilepsi patogenez?

paroxisomal depol kayması

Burst ap ler

Senkron

İnteritektal deşarj jenerasyonu

Tonik klonik nöbetin fazlarının özellikleri

Tonik- yüzeyel solunum,sphincter kontrolü kayıp

Klonik-solunum geri döner

Basit ve kompleks parsiyel nöbetlerin farkı

Basitte-şuur yerinde

Komplekste -şuur yok

-koku halusinasyonu

-adolescents

-mesial temporal scleroz

-febril konfüzyon

Hang. Epilepsi

Complex parsiyel

-kontralatersl tarafa etki

-jacksonian yayılma

-baş göz fokusun karşısına döner

-frontal cx

Basit parsiyel motor

Nöbete benzer paroxisomal durumlae

• Senkop

• Nefes tutma nöbetleri

• Hiperventilasyon

• Benign çocukluk çağı parokzismal vertigosu

• Reküren abdominal belirtiler

• Migren

• Transient global amnezi

• Serebrovasküler olay

• Toksik metabolik durumlar

• Narkolepsi/uyku bozuklukları

• Hareket bozuklukları

• Epizodik kontrol bozukluğu

• Psikojenik nöbet

Seeding metastaz yapan tümörler

High grade glioma

Pnet

Ependymoma

Pineositoma

Oligodendroglioma

Hemangioblastoma

Medullablastoma

Primaery cns tumors

8. Kraniyel sinire baskı yapıp akustik sorunlara yol açan tümör

Schwannoma

Most common benign intracranial tumor

Meningioma

Surgery is first step for which type of adenoma

GH/ACTH secreting pituitary adenomas

Kemoterapiye en hassas tümör

Oligodendroglioma

Patojenlerin cns e 4 geçiş yolu

1-hematojen

2-local infecrion

3-direct inoculation

4-retrograde intraneural

Most common cause of bacterial meningitis overall

Most common cause of recurrent meningitis

Strep pneumonia

Most common cause of neonatal meningitis

Group B Streptococcus (Streptococcus agalacti

Meningitis in neonates, elderly, and pregnant women

Listeria monocytogenes

Meningitis in an unvaccinated infant

H. Influenza

Lipid soluble cns antibiotics

Chloramphenicole

Vankomisin

Penisilin

Ceftriaxon

Cns enfeksiyonunda dexamethason ne zaman verilir

Antibiyotiğe başlamadan önce

Hsv 1 ensepaltinde immediate ilaç

Acyclovir

ICP arttıran primer sebepler

Trauma

Mass lesion

Cerebrovascular events

Csf dynamics

Idiopatic intracranial hypertension

Hallmarks of icp

Papilledema

Cn 3-6 palsies

Cushing triad: systemik hipertansiyon,bradikardi,respiratory depression

Encephalitis klinik bulguları?

• Encephalopathy

• Seizures sık

• Focal neurologic deficits:

  • Cranial nerve deficit

  • Hemiparesis

  • Hyperreflexia

-diffuse mr da early diffusion restriction

-asimetrik t2 hyperintense lesions in mesiotemporal and orbitofrontal lobes and insular cx

-beyinde hemorajik peteşiyal kanamalar

Tanı?

Hsv-1 encephalitis

Viral menenjit ve tuberculosis menenjitini ne ayırır

Viral: lymphocyte yüksek glukoz normal csf basınç normal

Tb: glukoz düşük hyponatremi csf basıncı artmış

-acute-subacute

-new psychiatric symptoms

-faciobrachial dystonic seizures

-unexplained hyponatremia

Diagnosis?

Autoimmune encephalitis

Anti-Musk ab napar

Ach reseptörlerinin kümelenmesini bozar

Clinical findings of MG?

-fluctuating weakness as muscle works

-asimetrik ptosis-diplopia

-bulbar symptoms-chewing difficulty eg

-30 sn upward gaze ile pitosis

-sneer smile

Myasthenia gravis de korunan fonksiyonlar

-no sense loss

-pupil normal

-tendon reflex normal

-atrofi yok

-smooth ve cardiac tutulum yok

Cholinesterase ingibitörleri hangi tip mg de işe yaramaz

Anti-musk- hatta fasciculation yaparlar

Diagnostic tests for mg and expected results?

-edrophonium

-single fiber emg

-ice pack

-chest image:thymoma

-repetitive nerve stimulation:decrementing response

Treatment for mg

CheI:pyridostigmine

Plasma exchange

IvIG

Steroid

Immunosuppressant:azathioprine

Lambert-eaton mg den farkı

Lower weakness

Autonomic dysfunction

Due to malignancy

Myasthenic ve cholinergic crisis farkı

Myasthenic:resp failure,midriasis

Cholinerrgic: sludgem,fasciculations,miosis,bradikardi

Wallenberg sendromunda hangi arter alanı etkilenir?

PICA alanı; lateral medulla enfarktı.

Wallenberg bulguları

vertigo, bulantı-kusma, diplopi, yutma güçlüğü, yüzde

ipsilateral/vücutta kontralateral ağrı ve ısı kaybı, ipsilateral

serebellar ataksi, ipsilateral Horner sendromu

Periferik vertigoda nistagmus tipi?

Horizontal + torsiyonel; yönü değişmez.

Pozisyonel nistagmus

Santral vertigoda tipik nistagmus özelliği?

Vertikal olabilir veya bakış yönüyle yön değiştirebilir.

Narkolepsi tip 1 ve 2 fark

Tip 1 de cataplexy var ve hemicretin düşük

Diagnostic duration/frequency for chronic insomnia?

≥3 times/week for ≥3 months.

Typical symptoms of OSAS?

Loud snoring, choking during sleep, cessation of breathing, excessive daytime somnolence, memory/motor impairment, irritability, morning headache.

What is the key abnormality in REM Sleep Behavior Disorder (RBD)?

Loss of normal REM muscle hypotonia/atonia → patient physically acts out dreams.

X-link distrofiler

- Duchenne (Xp21.2)

- Becker (Xp21.2)

- Other Xp21 myopathies

Dystrophinopathies

Non-dystrophic Xp21 myopathies

- Emery Dreifuss (Xq28

Otosomal dominant distrofiler

- Facioscapulohumeral (4q35)

- Myotonic (19q13.2)

- Oculopharyngeal (5q 22–34)

- Scapuloperoneal

- Limb-girdle

Duchenne ve becker fark

Duchenne de distrofin hiç yok

Becker de distrofin anormal yapılı ama var ve slow progress

Differential diagnosis for myotonia

➢Hyperkalemic periodic paralysis

➢Myotonia congenita

➢Paramyotonia congenita

➢Schwartz-Jampel Syndrome

➢Isaacs Syndrome: Pseudomyotonia

Mitochondrial muscle diseases?

CHRONIC PROGRESSIVE EXTERNAL OPHTHALMOPLEGIA

Melas

Kearns-sayre

Narp

Merrf

Leigh syndrome

Lhon

Neuralgia ve neuropathy farkları

Neuralgia:elektirk şok gibi,minutes,sense deficit yok

Neuropathy:burn,tinle,persistent,hours,sense deficit var trigger yok

Trigeminal nevralji özellikleri

-neuro examination normal

-unilateral

-speak-chew-wash trigger

-upper lip-lower jaw eg

Cn3 palsy aciliyeti nasıl değerlendirilir

Pupil dahilse acil

Cn4 palsy aciliyeti nasıl

Cerebellar bulgular-post fossa tumörü

Cn6 aciliyeti

Bilateralse

Internuclear optalmıplegia özellikle pedistric malign

New onset back pain ve known cancer ne emergency

Spinal metastas causing spinal cord compression syndrome

Spinal cord compression syndrome ve disch- herniation fark

Compression da yatınca ağrı kötüleşir

Conus ve cauda compression fark

Conus: ani-bilateral-simetirk-hiperrefleksi-loss of sense in perineum-early sfinkter signs

Cauda:slow-unilateral-radiculsr pain-non reflex paraplegi-saddle like sensory loss-late sfinkter signs

Intramedullary ve extramedullary compression fark

Intra:burning pain-hard localize-sacral sparing-rapid

Extra:radicular pain-premature sense loss-slow-esrly spastic paresis

Tetamy sebep

Hypocalceöia-alkalosis

Chvostek and trosseau sign show..

Latent tetany

Which tumor responsible for tetany

Parathyroid

SUNCT-SUNA nın Trigeminal nevralji den farkı

Otonomik bulgular verir

Cluster ache profilaksisi ilaçlae

Verapamil-steroid

Tension type headache ilaçlar

Tca-snri

Migren patofisyolosi

Inflammation-vasodilation-Trigeminovascular sistem activation

migren aura wo headache neyle karışır ve nası ayırt

Transient ischemic atak

Aura 2 saat iç.nde lezyonsuz geçer

Migren ilacı öncesinde hangi ilaç

Antiemetik

Vasküler hastalara contraindike migren ilacı

Triptan

Hamilelik planı olanlara kontraindike migren ilacı

Valproate

Ms riskleri faktörleri

-hla mutasyon

-adolesan dönemde ebv

-obez

-düşük vitamin d

Ms tanı kriterleri

Unilateral optic neuritis

Imtranuclear opthalmoplegia

Cerebbelar sendrom

-happen before last for a day

Oligoclonal bands

Intratecal ıgG

Smoldering ms(pira) pato

Microglia-Leptomeningeal folikül-chronic

ADEM in ms den farkı

Encephalopathy

Bilateral optic neuritis

Lypmhocitosiz in csf

After inf

NMOSD ve MOGAD fark

nmosd:aqp4-ıgG

mogad:mog-ıgG

Parkinson tanı kriter

-asimetrik-unilateral kesşn

-bradikinesia kesin

-rest tremor-rigidityden biri

İdiopatic parkinson olmayanlar bulguları

-acute

-rapid

-cerebellar bulgular

-no response to levadopa

-early postural reflex kaybı,ortostatic hypertension,constipation

Cardinal signs of ataxia

-wide gait

-stance

-dismetri

-intention tremor

-excessive rebound

Paraneoplastic ataxia özellikler

-subacute

-anti purkinje antibodies due to tumor

Antigliadin antibodies hangi tip ataxia da

Celiac-gluten sensitive encephalopathy

Türkiyede en yaygın ataxia ve özellikleri

Friedrich: auto-res,babinski,dtr az,cardiac miyopati,diabet

Treatable ataxia sebepler

Vit e def

Vit b12 def

Vaskülit

Essential tremor özellikleri

-postural and action

-simetric

-respond to alkol

-no-no,yes-yes head tremor

-familial

Wing beating tremor hangisi

Wilson

Lab tests for dementia

-lyme antibody titer

-hiv

-romatoloji

-endokrin

-arterial blood gas

What are treatable cognitive disfunction reasons

Infection

B12 def

Paraneoplastik

Hipotiroid

Depresyon

What proteins accumulate in alzheimer

Amyloid-beta-42

Hyperphosphorylated tau-nörofibrillar tangle

Treatment for amiloid in alzheimer

Anti-amiloid monoclonal antibody

Cranial base fractured görülen 2 yer ve özellikleri

Frontal-periorbital eccyhmosis(racoon eyes) cn 1-2 effected

Temporal-mastoid eccyhmosis(battle sign) cn 7-8 effected

Risk factors for chronic subdural hematoma

• Elderly

• Trauma

• Coagulopathy

• Anticoagulant – Antiplatelet Agents

• Chronic renal failure

• Chronic alcoholism

-crescent shape on ct

-venous

-worsening headache

Subdural hematoma

-arterial

-lentiform

-acute

Which hematoma

Epidural

GCS sıralaması nedir?

Check → Observe → Stimulate → Rate

Medium rish for screening

➢ Unconsciousness (>1 min)

➢ Progressive lethargy

➢ Vomiting (>3)

➢ Post-traumatic seizure

➢ Signs of skull base fx

➢ Signs of depressed skull fx

➢ Child abuse (?)

➢ Age (< 2 years)

➢ GCS score 13-14

Umn paralysis özellikler

-Spastic posture(arm-wrist flex, leg extend)

-no skilled moves

-clasp knife movement

-hypertonicity

-hyperreflexia

-babinski

What are umn diseases

-hereditary spastic paraperesis

-human t-cell lymphotropic virus type 1 myelitis

-adrenomyeloneuropathy

-primary lateral sclerosis

Human T-cell Lymphotropic Virus type1 associated Myelitis in ms den farkı

Ms periferik etki yok

Amn nin ald den farkı

Ald daha ağır occipital lob tutulur ve daha adrenal insufficiency

Lmn paralysis özellikleri

-weakness

-flaccid

-hypotonia

-hyporeflex

-atrofi

-fasciculations

Acute poliomyelitis özellik 2tane

-asimetrik paralysis quickly

-no paresthesia

Normal pressure hydrocephalus 3 bulgu

-walking disorder

-dementia

-urinary incontinence

-relieved w lp