1. Principles of Neurological Diagnosis
1. Localization
2. Etiology

2. Example 1
A 25 YO male, acute paraparesis with urinary incontinence, severe LBP:
Localization: spinal cord
Etiology: acute disc herniation

3. Example 2
A 75 YO female with diabetes and HBP, sudden weakness of left side limbs
Localization: right hemisphere
Etiology: intracerebral hemmorhage

4. Gross Anatomy of the CNS

15. Subsystems for this talk
Motor system
Sensory system
Visual and ocular
Blood supply

16. Motor system Lower motor neuron
Upper motor neuron (origin of the corticospinal tract)
Brainstem nuclei that project to the cord
Basal ganglia
Cerebellum
Premotor frontal cortex
Prefrontal cortex

17. Lower motor neuron Motor unit Fasciculation Weakness & atrophy
Root – plexus – nerve

18. Upper motor neuron Origin at prerolandic motor cortex
Humunculus, somato-topic arrangement
Posterior capsule
Isolated movements evoked by electrical stimulation

19. Paralysis due to UMN lesion
Weakness distribution (additional systems, crossed syndromes, sparing of midline bilateral muscles)
‘Classic UMN’ picture: spasticity, increased tendon reflexes, positive Babinski’s, (spinal shock)

20. Patterns of paralysis Monoplegia without atrophy
Monoplegia with atrophy
Hemiplegia
Paraplegia
Tetraplegia

21. Cortico Bulbar Tract

22. Basal ganglia Negative signs: hypokinesia, bradykinesia
Positive signs: involuntary movements

23. Extrapyramidal Clinico-Pathological Correlations
Morbid anatomy
Symptom
Contralat Substantia Nigra
Unilateral Rigidity + Tremor
Contralat subthalamic nuc (Luis)
Unilateral hemibalismus
Caudate and putamen
chorea

24. Cerebellar dysfunction
Incoordination – ataxia (dysmetria, dysdiadochokinesis)
Intention tremor
Dysarthria (slurred speech)
Nystagmus
Disordered gait and equilibrium

25. Sensory system Skin or visceral sense organs Primary afferent (DRG)
Distribution by nerve, root, CNS
Primary afferent (DRG)
Spinal tracts:
Dorsal columns
Spinothalamic
Spinocerebellar
Thalamus and cortex
Descending analgesic tract

26. Dorsal Columns

27. Sensory dysfunction
Positive - paresthesia, pain, allodynia, hyperalgesia
Negative – hypesthesia, anesthesia, analgesia

28. Symptoms and Signs in Neurology- +
Weakness paralysis
Hypotonia
Fasciculation
Involuntary Movement
Motor
Hyp/anesthesia
Hyp/analgesia
Paresthesia, pain, allodynia, hyperalgesia
Sensory
Impotence
Orthostatism
Hyperhydrosis
Diarrhea
Autonomic

29. Visual system
Retina, optic nerve, chiasm, tract, radiation, cortex

30. Ocular movements

31. Blood supply Circle of Willis

32. MRA of the Circle of Willis

33. Middle cerebral artery

34. Ant & Post Cerebral Arteries

35. Exercise I 30 YO man, weakness of right lower limb On exam: Weak, spastic, hyper-reflexic right leg Loss of touch on Rt leg Loss of pain and temp. on Lt leg Hemi-Sensory level D8
Spino Dorsal
Thalamic Columns

36. Exercise II
70 YO female, weakness of right side, speech difficulty
On exam:
Rt hemiparesis
Motor dysphasia

37. Exercise III
60 YO male, Rt side weakness
On exam:
Rt hemi-paresis
Lt facial weakness