In patients with hemifacial spasm due to peripheral VII cranial nerve lesion, when they close their eyes there is paradoxical elevation of the ipsilateral eyebrow (contraction of frontalis muscle) which can't be produced by patients with somatoform disorders (conversion/factitious)
Miller Fischer Triad
Triad of Opthalmoplegia – Ataxia – Areflexia.
Partially restores the saltatory conduction in demylinated fibers by blocking voltage-dependent potassium channels (present in perinodal myelinated segments), limiting conduction to the Na channels at the nodes of Ranvier.
Timed Up & Go test
TUG test is used to evaluate patients with NPH before and after lumbar tapping. A difference of > 5 seconds is a useful measure for predicting success after shunt surgery. The test involves Timing the time the patient needs to get up from a chair, walk 3 meters and come back to his chair.
Xadago (safinamide) is the latest MAO-B agent for Parkinson's disease. It is unique that it reduces Off time and improves On time without dyskinesia. More details in Neuro-Pharm page.
Anti-CD20 medication was approved by FDA on March 28 for both RRMS and PPMS to be the latest disease modifying medication for multiple sclerosis patients. For more details, visit Neuro-Pharm
Babiniski's Toe sign Equivalents
You may be surprised to know how many methods have been described to elicit a planter response!, Oppenheimer, Schaeffer, Gordon, Gonda, Rossolimo, Chaddock, Stransky and Krawczyk. Click here for more details!
Nucleus basalis of Meynert
Located in basal forebrain, principal site for brain synthesis of Ach. Sends widespread projections to neocortex, lesion would cause marked decrease in mental capacity and learning as seen in Alzheimer.
At some point you may be consulted for a unilateral hypoglossal palsy after surgery manifesting with tongue paralysis and atrophy. Tapia syndrome is caused by hypoglossal nerve compression from the cuff of the endotracheal tube, resulting in hypoglossal and sometimes recurrent laryngeal palsy.
The highly selective vesicular monoamine transporter 2 inhibitor valbenazin is the first FDA approved drug for patients with Tardive Dyskinesia as of 4/11/17. The main reported side effects were sedation and QT prolongation.
Hemineglect, Why usually left?
Superior parietal lobule on right side receives inputs from sensory areas from both sides of the brain, while on left side receives input from adjacent left sensory area only. So, right side of body is bilaterally represented while left side is represented only in right side.
Reverse Ptosis Sign
Ptosis can have different causes, however with Horner syndrome there will be associated "Reverse Ptosis" which is mild elevation of the lower eyelid, making the palpebral fissure narrower.
A prodrug for norepinephrine that can cross blood brain barrier. It restores the depleted levels of norepinephrine in both PNS and CNS in patients with nOH (neurogenic orthostatic hypotension).
Wernicke’s Encephalopathy Triad
Triad of Opthalmoplegia, Ataxia & Confusion. MRI will show signal hyperintensity in 3 locations (mamillary bodies, medial thalami & periaquiductal gray matter
Lack of attention and concentration leading to complains of memory impairment. Patients complain of easy forgetting (short term memory) in spite of normal scores in psychometric tests. Usually caused by anxiety, depression or sleep disturbance.
Triad of agitation, hallucinations and fluctuation of consciousness are characteristic of delirium
a sphingosine-1 phosphate-receptor subtypes 1 & 3 modulator. Subtype 1 sequestrates lymphocyte lymph nodes. Subtype 3 reduces heart rate and prolongs the PR interval. The cardiac effects of fingolimod are maximal after the first dose but persist for about 14 days.
A complication of mastoiditis with spread on infection to petrous apex: triad of persistent ear discharge, retro-orbital pain (1st division of trigeminal) and 6th nerve palsy.
Triad of Encephalopathy (with callodal involvement), branch retinal artery occlusion, hearing loss .
Alice in Wonderland Syndrome (AIWS)
a rare syndrome with abnormal perception of size and time (metamorphopsia), associated with different lesions affecting parieto-occipital lobes. Encephalitis is the most common cause in children and migraine is more common in adults.
Triad of GI symptoms (diarrhea-weight loss) followed by cognitive dysfunction then CNS excitability (hyperekplexia, myoclonus, seizures) over a few months period. .
A systemic disease with extensive IgG4 plasma cell proliferation and lymphocytic infiltration of various organs. For us in neurology, it can cause hypertrophic pachymeningitis. Diagnosis is usually difficult since IgG4 level is elevated in only 50% of patients and biopsy is the gold standard.
Also called idiopathic orbital inflammation, an inflammatory process involving one or more of the extra ocular muscles. Usually responds to steroids. You will need to differentiate it from Tolosa-Hunt and from thyroid orbitopathy.