Neurology

Question 1

Lateral medullary syndrome and lateral pontine syndrome mnemonic

Answer 1

Lateral medullary syndrome: PICAchew (dysphagia - nucleus ambiguus)

Lateral pontine syndrome: fACIAl (facial involvement - facial nucleus/facial nerve)

Lateral medullary syndrome (Wallenberg’s Syndrome)
- due to lesion in lateral part of medulla
- PICA occlusion

Lateral pontine syndrome

• due to lesion to lateral part of pons
• AICA occlusion

What they have in common

• Ipsilateral horner’s syndrome (Descending hypothalamic tract affected)
• Contralateral loss of pain and temperature (lateral spinothalamic tract)
• Ipsilateral cerebellar ataxia (cerebellar peduncles - inferior in medullary, middle in pons)
• Nausea, nystagmus, vertigo, vomiting (vestibular nuclei)
• Ipsilateral loss of pain and temp from face (spinal trigeminal nucleus)
• Ipsilateral hearing loss (cochleal nuclei and intraxial nerve fibers involved)

Question 2

Millard-Gubler Syndrome

Answer 2

7 letters = 7th nerve palsy

Facial palsy and contralateral hemiparesis

Question 3

CN 12 deviation (LMN)

CN 5 deviation (LMN)

Answer 3

The tongue licks it’s wounds
Jaw deviation towards affected side

The muscles of the tongue keep the tongue in midline by pushing towards the opposite side. If one side is atrophies, the other side muscles are stronger and push the tongue to the side of the lesion

Question 4

Contraindications of thrombolytic therapy

Answer 4

B = Bleeding disorder .
I = Intracranial Hemorrhage.
S = Stroke past 3 months .
H = Head injury past 3 months 
O =Oesophageal varices.
P = Pregnancy.
S = Surgery

Question 5

GCS

Answer 5

Eye - pictorial
1 - Does not open eyes (Picture 1 as eyes shut)
2 - Opens eyes in response to painful stimuli (Two with the pointy end causes pain)
3 - Opens eyes in response to voice (Picture 3 as lips, calling out)
4 - Opens eyes spontaneously (The holes is 4 are eyes :P )

Verbal - VOICE
1 - Makes no sounds (VOICELESS)
2 - Incomprehensible sounds (OOOH)
3 - Utters inappropriate words (INAPPROPRIATE WORDS)
4 - Confused, disoriented (CONFUSED)
5 - Oriented, converses normally (ELEGANT SPEECH)

Motor - OLD BEN
1 - Makes no movements (NONE)
2 - Extension to painful stimuli (decerebrate response) (EXTENDS)
3 - Abnormal flexion to painful stimuli (decorticate response) (BENDS)
4 - Flexion / Withdrawal to painful stimuli (DRAWS FROM PAIN)
5 - Localizes painful stimuli (LOCALIZES)
6 - Obeys commands (OBEYS)