two types of causes for bronchospasms in a patient with myasthenia gravis①cholinergic crisis
excessive acetylcholine in the synaptic cleft→ neuromuscular junction becomes insensitive to acetylcholine, edrophonium infusion produces ☆no improvement in symptoms
②myasthenic crisis
edrophonium increases neuromuscular transmission and can provide temporary improvement in symptoms
ratio of sproradic SCD to hereditary SCD
common type of hereditary SCD(spinocerebellar ataxia)
2:1
Machado-Joseph disease(SCA-3)
SCA-6
→both are triplet repeat disease neurology HirotoShishido
prophylaxis for multiple sclerosisIFN-β
natalizumab(monoclonal antibody targetting α-4 integrin on WBC→may cause PML)
glatiramer acetate
dimethyl fumarate neurology HirotoShishido
blood flow from superior saggital sinus to internal carotid veinsuperior saggital sinus→ superior anastomotic vein(Trolard vein)→ Sylvian vein→ cavernous sinus→ inferior petrosal sinus→ internal carotid vein neurologyneurosurgery HirotoShishido
CN Ⅲ damage
differences of the symptoms between vascular disease, compressionvascular disease(e.g. DM)→ motor output to extraocular muscles is affected=ptosis, down and out gaze
ideational apraxia
ideomotor apraxia観念失行 t→tool
neurological disorder which explains the loss of ability to conceptualize, plan, and execute the complex sequences of motor actions involved in the use of tools
観念運動失行
deficits in properly performing pantomimes and communicative gestures. These deficits are typically identified with movements made to verbal command or imitation neurology HirotoShishido
neuromyelitis optica
symptom, difference from MSmost patients(90%) are female(MS→60%)
acute myelitis+ optic neuritis(worse prognosis than MS)
area postrema→ vomiting, nausea, hiccup
+ serum anti aquaporin 4 antibody
spinal cord MRI with T2 weighted signal abnormality extending over three or more vertebral segments(⇔MS two or less) neurology HirotoShishido
When facial nucleus is affected at the level of lower-pons, what nucleus is likely to be affected too?abducens nucleus(CN Ⅵ) neurologyneurosurgery HirotoShishido
trigeminal nucleus
homunculusonion-skin pattern
upper portion of nucleus→ innervate A region
lower portion of nucleus→ C region
trigeminal nucleimesencephalic nucleus→ reflex proprioception of the periodontium and of the muscles of mastication in the jaw
chief sensory nucleus(mid pons)→ sensation and light touch of the face as well as conscious proprioception of the jaw
spinal trigeminal nucleus(mid pons-C2)→ information about deep/crude touch, pain, and temperature from the ipsilateral face neurologyneurosurgery HirotoShishido
aggravating factor for multiple sclerosissymptoms may exacerbate with increased body temperature(e.g. hot bath, exercise)
=Uhthoff sign neurology HirotoShishido
first line for neonates seizure
first line for eclampsia seizure+ adverse effectneonates→phenobarbital(↑GABAa)
pregnant→IV magnesium sulfate (benzodiazepine can be used but not first line)
☆↓DTR neurologypharmacology HirotoShishido
