Neurology_vignettes

24/08/2023

NV 49-

Of course, here's a more academic and in-depth version of the question:

Question:
In the realm of epilepsy management, the utilization of deep brain stimulation (DBS) has gained prominence as a potential therapeutic avenue for patients with refractory focal epilepsy. Among the various targets investigated, recent trials have shed light on a particular DBS target that exhibits promise in ameliorating seizure frequency and enhancing the overall quality of life in such individuals. Considering the evolving landscape of DBS interventions in epilepsy, which specific brain region has emerged as a focal point of interest, demonstrating notable efficacy in mitigating seizures and improving patient outcomes?

A) Ventral intermediate nucleus (VIM) of the thalamus
B) Subthalamic nucleus (STN)
C) Nucleus accumbens
D) Anterior nucleus of the thalamus

24/08/2023

NV 48-

A 68-year-old male presents to the emergency department with sudden-onset dizziness, dysarthria, and difficulty walking. His medical history is significant for hypertension. Neurological examination reveals left-sided weakness, dysarthria and horizontal nystagmus. A non-contrast CT scan of the head is unremarkable. Given the clinical presentation, the patient is suspected to have a basilar artery occlusion. Which of the following findings is supported by the findings of the BAOCHE trial - Trial of Thrombectomy 6 to 24 Hours after Stroke Due to Basilar-Artery Occlusion?

A) Immediate anticoagulation therapy is the preferred treatment.
B) Mechanical thrombectomy performed only within 6 hours improves outcomes.
C) Thrombectomy performed between 6 to 24 hours after stroke onset is beneficial.
D) Intravenous thrombolysis is the only effective treatment option.

18/09/2022

Cytotoxic lesions of the corpus callosum (CLOCCs)

17/09/2022

Abducens nerve (CN VI). Schematic drawing
(left) shows the facial geniculum around the CN VI
nucleus in the tegmentum of the pons. MR images showing
cisternal segment of CN VI including the entry into
Dorello’s canal in axial (middle) and sagittal (right) planes.

17/09/2022

The trochlear nerve is the only nerve that exits
from the posterior aspect of the brainstem and after coursing through the ambient cistern, runs closely along CN III
toward the cavernous sinus and superior orbital fissure
cranial nerves. Right: 27-year-old woman with NF-2. On
surveillance MRI, a neurinoma was found dorso-laterally
to the mesencephalon, which can only arise from the trochlear nerve.

Source - Clinical Neuroradiology

17/09/2022

Schematic drawing of the oculomotor nerve in the
mesencephalon and its peripheral course and composite
MR image (axial oblique, coronal oblique, and sagittal
oblique reconstructions of 3DT2 post-Gad) illustrating
CN III including cisternal, cavernous, and orbital segments. Note the typical anatomic location/course of CN
III between the PCA and the SCA.

06/09/2022

06/09/2022

The pudendal nerve entrapment syndromes subdivide into four types based on the level of compression:

Type I - Entrapment below the piriformis muscle as the pudendal nerve exits the greater sciatic notch.

Type II - Entrapment between sacrospinous and sacrotuberous ligaments is the most common cause of nerve entrapment.

Type III - Entrapment in the Alcock canal.

Type IV - Entrapment of terminal branches.

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06/09/2022

Anatomy of the Pudendal Nerve:

The pudendal nerve emerges from the S2, S3, and S4 roots' ventral rami of the sacral plexus.

It carries sensory, motor, and autonomic fibers; however, an injury to the pudendal nerve causes sensory deficits more than motor.

It courses between two muscles, the piriformis and coccygeus muscles.

It departs the pelvic cavity through the greater sciatic foramen ventral to the sacrotuberous ligament.

It passes medial to and under the sacrospinous ligament at the ischial spine level to re-enter the pelvic cavity through a lesser sciatic foramen.

The pudendal nerve then courses in the pudendal canal, which is also called the Alcock canal.

The three last branches of the pudendal nerve terminate in the ischioanal fossa. These are the inferior re**al branch, perineal branch, and dorsal sensory nerve of the p***s or cl****is.

06/09/2022

Pudendal neuralgia caused by pudendal nerve entrapment (PNE) is a chronic and severely disabling neuropathic pain syndrome.

It presents in the pudendal nerve region and affects both males and females.

It is mostly underdiagnosed and inappropriately treated and causes significant impairment of quality of life.

05/09/2022

Cerebellar cognitive affective syndrome (CCAS; Schmahmann's syndrome) is characterized by deficits in executive function, linguistic processing, spatial cognition, and affect regulation. Diagnosis currently relies on detailed neuropsychological testing.

05/09/2022

Cerebellum