Spine Healing Therapy

Dorn Spinal Therapy

Dorn Spinal Therapy has been in uses in the past 40 years. The credit of this method goes to Dieter Dorn, who has made a significant impact in the medical field. DORN- Method has been used on various patients where results could get witnessed instants. Due to the impact, this method has brought in the country. It has been declared the standard practice in treating Pelvical Disorders, Spinal, and Back pain. Dieter Dorn first used this method on his family, which was a sign of confidence in a method, which later gained much attention from different people in the country and also globally. Every day Dorn was able to offer treatment to 15- 20 patients in a day. His services were purely free which attracted attention both in the local and also global. The primary treatment that DORN-Method which could be treated using this method include spine healing therapy, misalignments of the spine, resolving pelvis and joints, and also solving out significant problems which could get attributed to vertebrae.

Dorn Spinal Therapy Summary


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Chiropractic Efficacy and the Safety of Spinal Manipulation

Meeker and Haldeman reviewed and reported on the impressive accrual of evidence supporting spinal manipulative therapy (SMT) for acute and chronic neck and low back pain (20). Similarly, clinical trials support the use of SMT for tension and migraine headaches (21-24), fibromyalgia (25), and cervical vertigo (26).

Six Healing Sounds Practice Lung Sound

Mantak Chia Six Healing Sounds

Position Now move the hands to cover the kidneys. Smile to your kidneys, and be aware of any excess cold or heat in the kidney region. Then bring your legs together, ankles and knees touching. Lean forward and clasp the fingers of both hands together around your knees. Inhale and pull your arms straight from the lower back while bending the torso forward (this allows your back to protrude in the area of the kidneys). Tilt your head upward as you look straight ahead, still pulling on your arms from the lower back. Feel your spine pulling against your knees.

How is a diagnosis of MS made

George Schumacher was the head of a National Institutes of Health committee that was charged with the responsibility of coming up with simple standardized minimal criteria that were to be used in making a diagnosis of MS in patients entering clinical trials in MS. The criteria reiterated the need to establish that the lesions (plaques) were disseminated in both time and space. In other words, to make a diagnosis of MS, there must be evidence of at least two separate affected areas in the brain and spinal cord, and the lesions must have occurred at least at two different times separated by at least 1 month. Bearing in mind that this preceded diagnostic imaging, this was a challenge. diagnosis of MS from diagnostic imaging and improvements in spinal fluid examination was a major advance. The terms clinically definite, clinically probable, and laboratory-supported diagnoses come into use in academic circles but were rarely used elsewhere. Nevertheless, the committee recommendations...

Preoperative abnormalities

The occurrence of brady- or tachyarrhythmias during anaesthesia may reduce cardiac output and compromise cerebral or coronary artery circulation.A number of such episodes have been described during both spinal and general anaesthesia. Sinus bradycardias unresponsive to repeated doses of atropine or glycopyrronium (Pratila & Pratilas 1976, Levy 1990), recurrent episodes of sinus arrest with nodal escape (Burt 1982), and severe bradycardias (Levy 1990), have been reported. Sinus arrest occurred during gastrectomy in a 70 year old with scleroderma. A temporary pacemaker was inserted, after which she became pacemaker dependent (Kihira et al 1995). Asystole, which responded to cardiopulmonary resuscitation and atropine, occurred 10 min after administration of a spinal anaesthetic for prostatectomy in a patient with sinus bradycardia and RBBB (Cohen 1988). Several periods of asystole were reported in a 46-year-old woman, some hours after spinal anaesthesia for varicose vein surgery...

Sensing Gravity and Movement

The inner ear contains a fluid-filled labyrinth with associated cells sensitive to the orientation and movement of the individual with respect to the outside world. The labyrinthine cells are innervated by sensory axonal processes of nerve cells located in a ganglion near the inner ear (Scarpa's ganglion). Central processes of these afferent neurons reach the brain stem by way of the vestibular branch of cranial nerve VIII and synapse with secondary sensory neurons in the vestibular nuclei located in the dorsolateral portion of the rostral medulla oblongata (Figs. 2c and 2d). In turn, the neurons in the vestibular nuclei project widely to brain stem nuclei (including those regulating eye movements) as well as to the spinal cord motor control regions. The particular vestibular projection which gives rise to the feeling of nausea associated with motion sickness has not been characterized.

Syndromes Table 17 p369

Neurogenic ECG abnormalities (ST depression or elevation, T-wave inversion) can occur in the setting of cerebral hemorrhage or infarction but are often difficult to distinguish from changes due to myocardial ischemia. Hemodynamic abnormalities. Hypertension Cerebral hemorrhage, Cushing reflex (accompanied by bradycardia) in response to elevated ICP, porphyria, Wernicke encephalopathy (accompanied by arrhythmia), and posterior fossa tumors. Hypotension Head injuries, spinal lesions (syringomyelia, trauma, myelitis, funicular myelosis), multisystem atrophy, progressive su-pranuclear palsy, Parkinson disease, peripheral neuropathies (e. g., in diabetes mellitus, amy-loidosis, Guillain-Barre syndrome, or renal failure). Neurocardiogenic syncope (vasovagal syncope) is due to pooling of venous blood in the arms and legs. Underfilling of the left ventricle activates baroreceptors, which, in turn, project via CN X to the NST. The ensuing increase of parasympathetic outflow, if large enough,...

Clinical Presentation

Low-pressure headache, similar or identical to the headache associated with a persistent CSF leak after a spinal tap, is also a primary complaint in patients with active PLFs.62 The typical PLF headache is unilateral and almost always present on the side of the active PLF. In the case of bilateral PLFs, the pain is often worse on the most active side. The PLF headache is severe, sometimes throbbing, and often accompanied by hypersensitiv-ity to light and sound. Headaches persist as long as PLFs are active when the PLFs are closed surgically or with bed rest, the headaches resolve immediately, similar to the resolution of symptoms after successful blood patching of postspinal tap CSF leaks. Because headache is not a standard part of most otologic questionnaires and interview forms, and many PLF patients have significant short-term memory impairment and are poor or incomplete historians, this important symptom may be missed if not specifically sought.

Treatment of Diving Casualties

Both computed tomography (CT) and magnetic resonance imaging (MRI) have been used in this regard. Regrettably, conventional CT has not been found to be an efficient investigative tool for the posttreatment evaluation of DCS, and CT imaging of spinal cord lesions (which constitute the majority of neurologic DCS) is not feasible. In contrast, limited clinical data support the feasibility and efficacy of MRI of these conditions, especially when intracranial injury is present.

Categories and Manifestations of Blast Injury

Pulmonary Manifestations The lungs are generally the organs most severely affected by blast injury, and these injuries are likely to present a threat to life. (Of course, the severe injuries resulting from windage in the immediate vicinity of the explosion are also life-threatening). The blast wave causes widespread alveolar damage because of its effects on tissue-gas interfaces, producing interstitial and intra-alveolar hemorrhage and edema, parenchymal and pleural lacerations, and alveolar-venous fistulas. Because of the widespread nature of this damage a variety of specific injuries may be found, including pulmonary edema, pneumothorax and other extra-alveolar air syndromes, and air embolism. Similarly, pulmonary contusions result from compression of the lung between the spine, thoracic wall, and rising diaphragm, as well as from being thrown against solid objects in the environment.

Post Operative Nausea and Vomiting

Intavenous induction agents are incriminated to varying degrees. Propofol is associated with less PONV than thiopentone and may have specific anti-emetic properties. Thiopentone is less emetogenic than methohexitone or etomidate. Nitrous oxide is thought to be associated with PONV possibly as a result of gut distension and raised pressure in the middle ear. Neuromuscular blocking agents are not implicated but reversal with neostigmine has been shown to increase emesis. This is despite concurrent administration of atropine which has anti-emetic properties. The development of hypotension after spinal anaesthesia is associated with almost twice the incidence of PONV when compared with those patients where hypotension did not occur.

Neurologic manifestations

Recurrent attacks of prostrating headaches may occur and are often associated with stiff neck, photophobia, nausea, and vomiting. Patients are frequently afebrile. Such severe attacks may last weeks and alternate with periods of milder headache. Spinal fluid shows a lymphocytic pleocytosis with increased production of immunoglobulin G (IgG). Evidence of local antibody to Bb may be found. Oligoclonal banding may also be seen.

Gender Ethnicracial And Life Span Considerations

Spinal cord lesions lead to motor and sensory impairment of the trunk and limbs. Ask if problems have occurred with bowel and bladder dysfunction. Determine if the patient has experienced a feeling of heaviness or weakness, numbness, or tingling in the extremities. Determine the patient's ability to perform activities of daily living with attention to the fine movement of fingers, as when dressing or picking up small objects. Ask if the patient has experienced burning sensation or pain, decreased temperature sensation, intention tremor (a tremor during a voluntary activity), foot-dragging, staggering, dizziness, or loss of balance. Ask if the patient has experienced decreased motor function after taking a hot bath or shower (Uhthoff's sign), which is caused by the effects of heat on neuromuscular conduction. Roughly 50 of patients with MS lose the ability to sense position, vibration, shape, and texture. Cerebrospinal fluid (CSF) analysis

Peripheral Chemoreceptors

The aortic and carotid bodies are not stimulated directly by blood CO2. Instead, they are stimulated by a rise in the H+ concentration (fall in pH) of arterial blood, which occurs when the blood CO2, and thus carbonic acid, is raised. The retention of CO2 during hypoventilation thus stimulates the medullary chemoreceptors through a lowering of cerebrospinal fluid pH and stimulates peripheral chemoreceptors through a lowering of blood pH.

Clinical Features

Laboratory features included thrombocytopenia and elevated hepatic transaminases in approximately one-third. The most common abnormalities of the cerebrospinal fluid were elevation of the white blood cell count and protein levels. Magnetic resonance imaging revealed multiple, discrete high signal intensity lesions disseminated throughout the brain with 10 lesions occurring in 70 of patients. 16 Diagnosis of NiV infection can be confirmed by detection of type-specific antibodies in cerebrospinal fluid or serum. Serum IgM capture enzyme-linked immunosorbent assay (ELISA) was positive in 65 within 4 days after onset of infection and in 100 by day 12, and IgG

Function Of Madula Of Longgata

Improved ability of a presynaptic neuron that has been stimulated at high frequency to subsequently stimulate a postsynaptic neuron over a period of weeks or even months. This may represent a mechanism of neural learning. low-density lipoproteins (lip o-pro' te-inz) (LDLs) Plasma proteins that transport triglycerides and cholesterol to the arteries. LDLs are believed to contribute to arteriosclerosis. lower motor neuron The motor neuron that has its cell body in the gray matter of the spinal cord and that contributes axons to peripheral nerves. This neuron innervates muscles and glands. motor neuron (noor on) An efferent neuron that conducts action potentials away from the central nervous system to effector organs (muscles and glands). It forms the ventral roots of spinal nerves. motor unit A lower motor neuron and all of the

Pain Digest 2000 10 16-23

Spinal opiate anesthesia characteristics and principles of action. Pain 11 293-346, 1981. 3. Yaksh TL, Rudy TA. Analgesia mediated by a direct spinal action of narcotics. Science 192 1357-1358, 1976. 10. Muller H, Lueben V, Zierski J, Hempleman G. Long-term spinal opiate treatment. Acta Anaesthesiol Belg 39 83-86, 1988. Harbaugh RE, Coombs DW, Saunders RL. Implanted continuous epidural morphine infusion system. J Neurosurg 56 803-806, 1982. Krames ES, Gershow J, Glassberg A, et al. Continuous infusion of spinally administered narcotics for the relief of pain due to malignant disorders. Cancer 56 696-902, 1985.

Hemorrhagic Stroke Syndromes

SUBARACHNOID HEMORRHAGE SAH occurs more commonly in women, but men dominate among patients younger than age 40. Patients present with sudden onset of a severe constant headache that is often occipital or nuchal. A recent history suggestive of a sentinel hemorrhage with a severe headache lasting for days can be obtained in 15 to 31 percent of cases. Vomiting often presents with the onset of headache, and patients may be noted to have a decreased level of consciousness. Presentation is usually sudden, and a carefully recorded history may reveal activities such as defecation or coughing at onset. Occasionally, the pain is only nuchal, misleading clinicians to consider only local C-spine etiologies. Neurologic deficits may be present due to the aneurysm compressing adjacent brain tissue or cranial nerves. A grading classification based on neurologic condition can aid in determining prognosis and eligibility for surgery (see Table .2,2.0.-2.).

Functional abnormalities

The external sphincter mechanism is involved in maintaining continence. During normal micturition this sphincter relaxes as the detrusor muscle contracts. If this does not take place in a coordinated manner, for example following interruption of spinal micturition pathways after spinal cord injury, the sphincter remains closed, causing detrusor-sphincter dyssynergia (DSD). This can result in high-pressure chronic retention and irreversible obstructive nephropathy. Medical treatment aims to block the adrener-gic receptors, using uroselective alpha-blockers (e.g. tamsu-losin) to reduce sphincter tone. Surgical treatment consists of endoscopic division of the sphincter, but the patient must be warned about irreversible retrograde ejaculation, following division of the internal sphincter.

TABLE 2444 Risk Groups for Head Computed Tomographic Evaluation

BASILAR SKULL FRACTURES Unlike the other skull fractures, basilar skull fractures are best seen on a CT scan. Signs that suggest the presence of a basilar skull fracture include periorbital bruising (raccoon eyes), hemotympanum, mastoid bruising (Battle sign), and cerebrospinal fluid atorrhea or rhinorrhea. Management is usually symptomatic and requires neurosurgical expertise.

Common Symptoms Of Multiple Sclerosis

Double vision, another common symptom, is caused by plaques in the brainstem, the part of the brain directly above the spinal cord. Brainstem plaques may also cause vertigo, a sensation of spinning, or dizziness. The spinal cord is frequently affected by MS. Individuals sometimes experience a sharp, seemingly electrical sensation, called L'hermitte'ssign, when they flex their necks. Plaques in the spine can cause a variety of symptoms, including numbness, weakness, bowel or bladder difficulty, or gait imbalance. Plaques in the brainstem or higher levels of the brain can also cause these symptoms, but the hallmark of MS involvement in the spinal cord is simultaneous involvement of both the right and left sides of the body. In addition to muscle weakness, spasticity may also occur. This results when communication from the brain to the motor cells that directly control muscle movement in the spinal cord is interrupted and primitive spinal cord reflexes take over. Spastic weakness may...

Computerised Tomography Ct Scanning

The development of this non-invasive technique in the 1970s revolutionised the investigative approach to intracranial pathology and it is now used routinely for 'body' and spine. Selecting different window levels displays tissues of different X-ray density more clearly. Some centres routinely provide two images for each scanned level of the lumbar spine, one to demonstrate bone structures, the other to show soft tissue within and outwith the spinal canal. Intrathecal water-soluble contrast medium combined with CT scanning outlines the basal cisterns, the spinal cord and the lumbosacral nerve roots.

The Vestibular System

However, more recently, like the vestibulo-ocular and vestibular spinal circuits, pathways have been established that appear to integrate vestibular and autonomic information. These may be relevant to the autonomic manifestations of vestibular dysfunction, gastrointestinal discomfort, nausea, and vomiting and complement the cerebellar complexes that influence

Disorders That Occur When Awake

These episodes are usually not paroxysmal and tend to last longer (49). Inflammatory, developmental, and neo-plastic disease of the cervical cord, spine, and neck also tend to produce sustained torticollis, but not a series of brief episodes. If no secondary cause can be discovered, spasmodic torticollis of infancy usually subsides in the first 3 years of life. No treatment is indicated.

General Information

Baclofen is a chlorophenyl derivative of gamma-aminobutyric acid (GABA), a naturally occurring inhibitory neurotransmitter in the brain and spinal cord. It is of proven therapeutic value in reducing the severity of flexor or extensor spasms resulting from spinal cord injury or disease. The recommended oral dose is 5 mg tds, which can be carefully increased however, the total daily dose should not exceed 80 mg (20 mg qds). It is also used for the treatment of intractable hiccups, especially in patients with uremia.

See also General anesthetics General Information

The addition of ketamine to bupivacaine for spinal anesthesia has been studied in 60 patients undergoing spinal anesthesia for insertion of intracavitary brachyther-apy implants for cervical carcinoma (8). They were randomly assigned to receive either bupivacaine 10 mg or bupivacaine 7.5 mg plus ketamine 25 mg. Motor recovery was significantly quicker in the ketamine group. Blood pressure was significantly lower in the bupivacaine group 5 minutes after administration, and perioperative intravenous fluid requirements were significantly higher. Patients given ketamine reported more sedation and dizziness, both intraoperatively and postoperatively. There were no nightmares or dissociative features. Overall satisfaction was better with bupivacaine. The study was abandoned after 30 patients, because of the high rate of adverse effects with ketamine. Although ketamine had local anesthetic-sparing properties, its adverse effects made it unsuitable for intrathecal administration.

Drug Administration Drug administration route

The addition of ketamine to bupivacaine for spinal anesthesia has been studied in 60 patients undergoing spinal anesthesia for insertion of intracavitary brachyther-apy implants for cervical carcinoma (8). They were randomly assigned to receive either bupivacaine 10 mg or bupivacaine 7.5 mg plus ketamine 25 mg. Motor recovery was significantly quicker in the ketamine group. Blood pressure was significantly lower in the bupivacaine group 5 minutes after administration, and perioperative

Differences between individual agents

The more novel routes of administration of opioids, including oral, nasal, rectal, transdermal, spinal, and by patient-controlled methods, have been outlined (SEDA-17, 78). Oral transmucosal fentanyl administration, avoiding first-pass metabolism, produces analgesia and sedation in both adults and children undergoing short, painful outpatient procedures. The quality of analgesia is good, and the adverse effects are those typical of the opioids.

General adverse effects

Chronic intoxication with vitamin A has been reported to cause variously hypercalcemia, hyperglycae-mia, increased alkaline phosphatase, hypoproteinemia, hypoprothrombinemia, increased sulfobromphthalein retention, raised serum transaminases, low serum ascorbic acid, reduced protein content of the cerebrospinal fluid, raised urinary hydroxyproline, and hypercalciuria (SED-8, 800) (14). It is not always clear, however, whether these deviations are a cause or an effect of hypervitaminosis A.

Vogt KoyanagiHarada Disease

Other head and neck symptoms may consist of tinnitus, vertigo, scalp sensitivity, and dysacousia. These symptoms, together with meningismus and headache, most frequently characterize the prodromal stage of VKH. Prodromal findings may also include low-grade fever, nausea, and vomiting. Cerebrospinal fluid analysis often reveals a lymphocytic pleo-cytosis indicative of meningeal inflammation. Other stages include the acute uveitic stage, the chronic stage when depigmentation occurs, and the chronic recurrent stage, characterized

Evaluation Guidelines Tables125 and 126

Skull films, cervical spine films, computed tomography (CT) scans of the head, and CT scans of the sinuses are not routinely recommended in the evaluation of vertigo or hearing disturbances. Magnetic resonance imaging (MRI) of the head can be used to evaluate Cerebrospinal Fluid. Lumbar puncture has limited usefulness in disorders of cranial nerve VIII. Occasionally, it may be indicated in pursuit of the diagnosis of neurosyphilis, Lyme disease, and meningeal carcinomatosis.

Bcl2 Family Proteinsregulators Of Cytochrome c Release And More

Of either ions (colicins) or proteins (diphtheria toxin) across membranes. At least in vitro, antiapoptotic Bcl-2 family proteins such as Bcl-2 and Bcl-XL have been documented to form multiconductance ion channels in synthetic membranes, thus providing further experimental evidence in support of a role as channel pore proteins. Second, antiapoptotic Bcl-2 family proteins also possess at least one hydrophobic pocket on their surface which mediates interactions with other proteins, thus altering the function or intracellular targeting of other proteins which may be relevant in some contexts to cell death. Proteins reported to interact directly or indirectly with antiapoptotic Bcl-2 family members such as Bcl-2 or Bcl-XL include the caspase activator Apaf-1, the p53-binding protein p53BP2, the Ca2+-dependent phosphatase calcineurin, the protein kinase Raf-1, the Hsp70 Hsc70 molecular chaperone regulators Bag1 and Bag3, the spinal muscular atrophy gene product Smn, the DED-containing...

Evaluation Guidelines Table142

EMG NVC , electromyogram nerve conduction velocity CSF, cerebrospinal fluid CBC, complete blood count BAER, brain stem auditory evoked response PPD, purified protein derivative N A, not applicable Cerebrospinal Fluid. Cerebrospinal fluid (CSF) analysis may aid in the diagnosis of lesions of CN XI and XII. Elevated CSF protein level is a feature of multiple sclerosis, neurosarcoidosis, tuberculous meningitis, and poliomyelitis. A low CSF glucose level may be present in tuberculous meningitis, carcinomatous meningitis, and neurosarcoidosis. CSF leukocytosis may be found in neurosarcoidosis and tuberculous meningitis. Albuminocytological dissociation (elevated CSF protein level in the relative absence of CSF leukocytosis) is a feature of Guillain-Barre syndrome. CSF oligoclonal bands are a feature of multiple sclerosis. Cytological examination of cellular material in the CSF may be diagnostic in carcinomatous meningitis. CSF cultures along with analysis of genetic material by polymerase...

Evaluation Guidelines Table 182

Laboratory evaluation of patients with gait and balance abnormalities is largely determined by the findings derived from the history and physical examination that point to dysfunction in specific neural structures, and these tests are covered in other chapters. For example, a gait disturbance associated with proprioceptive sensory loss should trigger a workup for peripheral neuropathy or spinal cord (posterior column) disease depending on the accompanying signs. General guidelines pertaining specifically to gait and balance disturbances are indicated here. Neuroimaging. Magnetic resonance imaging (MRI) of the head is indicated for patients in whom the cause of a gait disturbance is not apparent from the history and neurological examination or in whom start hesitation or disequilibrium is evident. Hydrocephalus, frontal lesions, subcortical gray and white matter lesions, and brain stem lesions may be found that were not suspected from the history or physical examination. Computed...

Druginduced And Iatrogenic Neurological Disordersneuroleptics sedativehypnotics55

The motor neurons, producing weakness or paralysis, and would also disrupt the ascending and descending tracts, producing other neurological dysfunction. However, release of locomotor synergies can be seen in patients with damage to the central nervous system. Automatic or spinal stepping can be elicited in humans with clinically complete cervical or thoracic cord transection by having the patients partially supported on a moving treadmill. W Automatic stepping, probably due to stimulation of the brain stem locomotor regions, also occasionally occurs in patients with brain stem lesions and with coma, such as occurs with central herniation. y Freezing gait, or difficulty in initiating and maintaining locomotion, may represent an interruption of voluntary access to the brain stem locomotor regions or spinal central pattern generators. The feet of a patient with freezing seem to stick to the floor, and the patient may be at a loss as to how to start walking. This gait pattern has been...

Sensory Gait Syndrome

The adaptation of spinal and brain stem synergies to an individual's goals and limitations (i.e., context) requires a knowledge of the relations of the body segments to each other, the situation of the body in space and the gravitational field, and the presence of environmental hazards and aids to balance and locomotion. This information is largely derived from the somatosensory, vestibular, and visual senses. Generally, one sensory system is adequate to orient a person and permit normal balance and gait. Balance and gait difficulties arise if environmental information is inadequate because of reduced sensory input or if a mismatch between the sensory information provided by the three sensory systems occurs because the environmental clues are ambiguous or the information is distorted by diseased sensory systems. are focused on the feet and the ground immediately in front of them. Diverting the eyes away from the feet may cause the patient to fall. Reactive or protective postural...

Etiological Risk Factors

Primary dysregulation of specific neurochemicals and neuropeptides is also theorized, supported by abnormalities in platelets, spinal fluid, and postmortem brain samples (Bauer and Frazer, 1994) (see discussion of biochemical biomarkers later in this chapter). Definitive links, however, have not been made to disease pathogenesis, nor are there clear preclinical biochemical markers identifying individuals at risk.

Directed Neurological Examination

Examination of the optic and oculomotor nerves allows for the localization of lesions that produce asymmetrical pupils or absent pupillary responses to light. Because the pupilloconstrictor fibers are located peripherally in the oculomotor nerve, compressive (extrinsic) lesions such as aneurysms or an uncal herniation elicit unilateral mydriasis before extraocular motor paralysis. Intrinsic (vascular) lesions, such as the neuropathy resulting from diabetes, affect the central fascicles of the nerve and produce a pupil-sparing oculomotor palsy. There are some exceptions to this classic distinction. Examination of the function of the trochlear and abducens nerves and of facial sensation in the ophthalmic and maxillary distribution of the trigeminal nerve helps to localize lesions at the level of the cavernous sinus and orbit. A facial nerve palsy may be associated with absence of lacrimation. Nystagmus, vertigo, and paralysis of the glossopharyngeal, vagus, and spinal...

TABLE 303 Tumors Causing Mainly Increased Intracranial Pressure and Hydrocephalus Focal or Lateralizing Signs Less

Clinical syndrome similar to medulloblastoma but more protracted two-thirds of patients present with increased ICP, others with vomiting, dysphagia, paresthesias of extremities, vertigo, head tilt Dominant inheritance retinal angioma and polycythemia often conjoined may develop multiple spinal cord lesions and syringomyelia

TABLE 321 Diseases Simulating Viral Encephalitis Bacterial

Pathologically, there is an intense inflammation in two or three dorsal root or cranial nerve ganglia and in corresponding posterior and anterior roots, adjacent meninges, and gray matter of the spinal cord on one side. The latter lesion is a veritable poliomyelitis, but the neuronal destruction is more in the posterior than in the anterior horn. Myelitis and encephalitis are rare complications.

Vestibuloocular Pathways

One of the most important tasks of the vestibular system is its role in influencing the conjugate (i.e., coupled) movements of the eyes. These conjugate movements are controlled by inputs from many sources (e.g., from areas 8, 18, and 19 of the cerebral cortex) and by means of inputs to the vestibular system. The paramedian pontine reticular formation (PPRF also called pontine gaze center), located medially in the reticular formation, and its rostral continuation in the midbrain is a critical staging region in the central control of eye movements. It acts as a nuclear processing complex and contains a variety of cell types whose activity determines the form of many eye movements. Input to neuronal pools within the PPRF is derived from the cerebral cortex, superior colliculus, cerebellum, auditory and vestibular systems, and the spinal cord. Output from the PPRF is conveyed by circuits utilizing the MLF and the reticular formation and terminating in the motor nuclei of cranial nerves...

Posterolateral Medulla

Failure of the posterior inferior cerebellar artery (PICA), a long circumferential artery, can cause a lesion resulting in the lateral medullary syndrome (Wallenberg's syndrome) (see Fig. 17.2B). Damage to the following structures produces the symptoms spinothalamic tract spinal trigeminal tract and nucleus fibers and possibly nuclei associated with the glossopharyngeal nerve, vagus nerve, spinal portion of the accessory nerve (including the nucleus ambiguus, dorsal vagal nucleus, tractus, and nucleus soli-tarius), and portions of the reticular formation, vestibular nuclei, and the inferior cerebellar peduncle. Symptoms include the following 2. Loss of pain and temperature on the same side of the face and nasal and oral cavities in all three trigeminal divisions (uncrossed spinal trigeminal tract and nucleus). The

Primary immune response 393

Primary central nervous system lymphoma (PCNSL) A cancer of the central nervous system occurring most often as a complication of late-stage AIDS. It takes the form of B-cell tumor growth. b cells' normal task is to produce antibodies selectively when stimulated by CD4+ helper t cells. Factors that may contribute to their unrestrained proliferation in HIV infection include chronic stimulation, loss of T-cell control mechanisms, and infection by epstein-barr virus, which is closely associated with the development of PCNSL. Historically, this lymphoma was thought to affect only a few percent of people with AIDS, but in the multicenter aids cohort study (MACS) survey, it was increasing at a rate faster than HIV-sensory neuropathy, toxoplasmosis, CRYPTOCOCOCCAL MENINGITIS, and PROGRESSIVE MULTIFOCAL LEUKOENCEPHALOPATHY. Symptoms include focal neurologic signs such as hemiparesis, aphasia, seizures, loss of cranial nerve function, lethargy, confusion, and memory loss. Presumptive diagnosis...

Subjective Experience of the

Being drawn to a cliff edge in height phobics, a sense of falling in space phobics, disgust in those who fear worms, spiders and snakes. Nausea with actual fainting is almost unique to blood phobia, though a feeling of faintness without actually fainting is frequent in agoraphobia. Nausea with disgust is usual in food aversions. Disgust with fear is common in many kinds of phobia. Actual vomiting occurs, rarely, in intense agoraphobia or social phobia. An urge to urinate or defecate occasionally troubles intense phobics of diverse kinds, though actual incontinence is seldom seen. A sense of contamination or of impending doom is common in obsessive-compulsive disorder (OCD). Tingling in the fingers and shivers down the spine (''scroopy'' feelings) are typical of touch and sound aversions.

The answers are 480 c 481 a 482 b 483 d 484 e

(McPhee, 2 e, p. 140 Fauci, 14 e, pp 2460-2468.) Numerous localized disorders and many systemic diseases can damage the spinal cord or the peripheral nerves. The pattern of pain, sensory loss, and sometimes weakness can help classify the disorder. A mononeuropathy involves pain temperature and vibratory joint position abnormalities, along the

Small Intestinal Motility

Vomiting is reflexively controlled by the vomiting center located in the medulla. Electrical stimulation of this area results in immediate vomiting without retching. Stimulation of another medullary area can result in retching without vomiting. In the normal situation, however, the areas interact with each other and their activities are closely correlated. The vomiting center is activated by afferent impulses triggered by diverse stimuli from many parts of the body. These include tickling the back of the throat, distension of the stomach or duodenum, dizziness, unequal vestibular stimulation (seasickness), pain from the urogenital system, and other painful injuries. Various chemicals stimulate vomiting by acting on either central or peripheral receptors. A group of receptors located in the floor of the fourth ventricle of the brain constitutes a ''chemoreceptor trigger zone,'' which is activated by emetics in the blood or cerebrospinal fluid. Stimulation of this zone also

Indications for Canal WallDown Mastoidectomy

This is another important reason for removing the canal wall. In a sclerotic mastoid, the middle fossa tegmen is always low and the surgeon's ability to remove cholestea-toma from any part of the epitympanum (particularly anteriorly in the sinodural angle) will result in two common problems injury to the tegmen and or dura with cerebrospinal fluid (CSF) leak and bleeding, or thinning and eventual penetration of the superior part of the bony canal wall. A second site where disease is difficult or impossible to remove is in the facial recess. Even with removal of the incus and

Pharmacological Effects

PHARMACOKINETIC PROPERTIES Carbamazepine is absorbed slowly and erratically after oral administration. Peak concentrations in plasma usually occur 4-8 hours after oral ingestion but may be delayed by up to 24 hours, especially following the administration of a large dose. The drug distributes rapidly into all tissues. Approximately 75 of carbamazepine binds to plasma proteins, and the drug concentration in the cerebrospinal fluid (CSF) corresponds to the concentration of free drug in plasma.

Other pharmacotherapies

Of interleukin-8 in the cerebrospinal fluid halved during the treatment and this change correlated with pain relief. No complications were reported and MRI taken at the end of the intrathecal injections and a year later showed no change in the spinal cord. There has been little enthusiasm in the pain community to take up this practice and a corroborative study with a focus on safety measurement is very much in demand.

Autism Is A Genetic Syndrome

The fragile X syndrome (FXS) is the most common form of inherited mental retardation. People affected with FXS are mainly males with combination of mild to severe cognitive impairment, attention deficit, anxiety, communicative disorders and stereotypic behaviours. Adult males have also machroorchidism, large ears and prominent jaw (Bardoni and Mandel, 2002). In 25 to 40 of cases, affected individuals have also autistic behaviours, doing this syndrome one of the most frequently associated to autism. Moreover, we estimate more than 2 of autistic individuals have mutations in the FMR1 gene (Wassink et al., 2001a). The fragile X syndrome results from the absence of functional Fragile X Mental Retardation Protein (FMRP), encoding by the FMR1 gene. This protein binds other partners to form a RNA-binding complex, regulating the translation of at least 80 different target proteins (Miyashiro et al., 2003). The main mutation in this syndrome is an over-amplification of a CGG triplet in the...

Studies in MS and Other Conditions

The basic ideas that underlie craniosacral therapy are not consistent with the conventional understanding of skeletal anatomy or nervous-system functioning. There is no evidence that demonstrates that impaired cerebral spinal fluid flow is a common cause of disease or that craniosacral massage significantly alters cerebral spinal fluid flow. Also, it is not clear that craniosacral therapy rhythm is a meaningful measurement or that it can be reliably detected. Beneficial effects are claimed for many disorders, including brain injury, spinal cord injury, pain, and seizures. However, these claims usually are based on the experiences of individuals (anecdotes) rather than on formal clinical trials.

Clinical Features of Infection

In contrast, NiV infection in humans is usually associated with severe acute encephalitis and although a proportion of cases presented with respiratory disease, particularly in Bangladesh, the majority displayed fever, headache, drowsiness, dizziness, myalgia, vomiting, and a reduced level of consciousness. Clinical signs such as the absence of reflexes and the irregular twitching of muscles or parts of muscles and an abnormal doll's eye reflex are indicative of brainstem and upper cervical spinal cord dysfunction. In the Malaysian outbreak, 105 of 256 patients died, a mortality rate of 41 . However, this figure reduces to c. 30 when individuals who experienced either a mild or asymptomatic infection are taken into account. In Bangladesh, 66 of 90 patients died in outbreaks in 2001, 2003, and 2004, giving a combined case-fatality rate of approximately 70 . Whereas HeV or NiV infection of cats presents a model of respiratory

Surgery for Traumatic Middle Ear Conditions

Trauma to the middle ear can present as an isolated injury or may be associated with severe trauma to the skull base with resultant neurologic sequelae. The cause of injury varies from motor vehicle collisions and industrial accidents to recreationally related mishaps, falls, and assault. In all cases the structures embedded in the temporal bone are at risk for significant injury. Temporal bone injuries can present with facial paralysis, conductive hearing loss, sensorineural hearing loss, vertigo, and or cerebrospinal fluid (CSF) leak (otorrhea or rhinor-rhea).

Chiari malformation

Cervical spine note increased canal width or fusion of vertebrae (especially C2,3) - Klippel-Feil syndrome. Lumbosacral spine note any associated spina bifida. CT scan difficult to interpret at the cervico-medullary junction, but shows soft tissue filling the spinal canal at this level.

Therapy of Zoster Pain Postherpetic Neuralgia and Other Neurological Complications

Tricyclic antidepressants (TCAs) are effective in the treatment of postherpetic pain 16-18 . These compounds are inhibitors of the reuptake of monoaminergic transmitters. They are believed to potentiate the effects of bio-genic amines in CNS pain modulating, in particular pain-inhibiting pathways projecting from the brain stem to the spinal cord. In addition, they block voltage dependent Na-channels and alpha adrenergic receptors. However, it may be that the effectiveness of TCAs in neuropathic pain has to do with their broad range of pharmacological actions. Pregabalin, the successor drug of gabapentin was shown to be efficacious in PHN, DPN and spinal cord injury (until now 7 published studies) 22, 23 . Its mechanism of action has now been solved a modulating action on the a28-subunit of central Ca-channels located presynaptically at the nociceptive terminal in the dorsal horn spinal cord. Pregabalin has a low potential for drug-drug interactions, and no negative impact on cardiac...

Case Report 21 Clinical Features

Laboratory examinations showed high creatine phosphokinase (CK) levels of 640 U L (normal 38-109) and mildly low P-lipoprotein levels of 232 mg dl-1 (normal 250-500). Other normal or negative laboratory investigations included erythrocyte sedimentation rate, routine hematologic measures, urine sediment, serum electrolytes (K, Na, Cl, Ca, P), renal and hepatic functions, serum Cu and coerulo-plasmin, thyroid and pituitary hormones and serum immunoglobulins (IgA, IgG, IgE, IgM). Investigation of red blood cell morphology in the peripheral blood revealed acanthocytosis of over 10 . The electroencephalogram was normal. X-rays of the skull, chest and spine were normal. Magnetic resonance imaging (MRI) studies of brain showed slight atrophy of cortex and caudate. Electromyography (EMG) showed reduced interference patterns and giant complex motor units of the interossei muscles bilaterally. Motor and sensory conduction velocities were low normal in median, tibial, sural and peroneal nerves....

Symptoms And Management Of Autonomic Dysfunction In Parkinsons Disease Orthostatic Hypotension

Pathologically, studies have shown cell loss in the intermediolateral nucleus of the spinal cord in PD with Lewy bodies being found in the hypothalamus, sympathetic ganglia, sacral parasympathetic nuclei, and the GI tract. This widespread distribution of cell loss in structures important for autonomic function indicated that the dysau-tonomia seen in PD is due to both central and peripheral autonomic nervous system involvement (23,24).

Closure and Postoperative Management

The most common complications occurring after cochlear implantation are wound and flap related.7 Wound breakdown is most often associated with placement of the internal device too close to the pinna or at the site of the skin incision. Injury to the intratemporal internal carotid artery is extremely rare however, as discussed earlier in this chapter, in young children in whom the round window niche is not clearly seen, it is possible to follow the hypo-tympanic air cell tract to the carotid artery.8 In such clinical scenarios, it is therefore important to maintain a high index of suspicion so as to identify the carotid artery prior to injury. Other risks of the cochlear implant procedure are similar to, and as rare as, those seen in chronic ear surgery infection, facial paralysis, vertigo, cerebrospinal fluid (CSF) leakage, meningitis, and anesthesia-related risks.9 12 Of these, the risk of meningitis most warrants further comment due to the recent heightened awareness of this...

244 Acupuncture and acupressure

Numerous explanations have been proposed to explain the antiemetic influence of acupuncture and acupressure. The acupuncture needle presumably affects the diffuse noxious inhibitory controls of the spinal cord, causing secretion of -endorphins (analgesic effect) and ACTH from the hypothalamus. The surge of ACTH causes an elevation of blood Cortisol levels, influencing Lhc brain stem emetic ccnter (Strcitbergcr 1998, Foster 1987, Malizia 1979). The acupuncture directly affects the upper GI tract by enhancing gastric myoelectrical activity and vagal tone (Li 1992).

Classification Of Cerebral Edema

Hydrocephalic cerebral edema is characterized by increased brain water due to cerebrospinal fluid blockage. The blood-brain barrier is intact. The cerebral edema is confined to the extracellular interstitial space and is of the same composition as the cerebrospinal fluid. Treatment involves relief of the intraventricular obstruction. niai pressure has been variable but ranged from 5 to 12 Torr with the peak drop seen at 30-90 min. Combination therapy with furosemide and mannitol has consistently led to a significantly greater reduction of intracranial pressure than either agent alone 15,16 , The effect of furosemide in the treatment of cerebral edema is thought to be mediated by multiple mechanisms, direct inhibition of Na+-Cl transport into the brain, removal of salt and water from both normal and edematous brain tissue, and reduction in cerebrospinal fluid production by the choroid plexus. Most of the studies with furosemide have been done in experimental animals, and there are few...

Parinaud Syndrome Artery

Lateral Inferior Pontine Syndrome

Medial medullary syndrome (anterior spinal artery syndrome). Affected structures Figure 14-1. Vascular lesions of the caudal pons at the level of the hypoglossal nucleus of cranial nerve (CN) XII and the dorsal motor nucleus of CN X. (A) Medial medullary syndrome (arterial spinal artery). (J3) Lateral medullary posterior inferior cerebellar artery (PICA)) syndrome. Figure 14-1. Vascular lesions of the caudal pons at the level of the hypoglossal nucleus of cranial nerve (CN) XII and the dorsal motor nucleus of CN X. (A) Medial medullary syndrome (arterial spinal artery). (J3) Lateral medullary posterior inferior cerebellar artery (PICA)) syndrome. 6. The spinothalamic tracts (spinal lemniscus). Lesions result in contralateral loss of pain and temperature sensation from the trunk and extremities. 7. The spinal trigeminal nucleus and tract. Lesions result in ipsilateral loss of pain and temperature sensation from the face (facial hemianesthesia). Spinal trigeminal nucleus and tract...

Tympanomastoid Operation

Exercises For The Inner Ear

The mastoid is exenterated, under the microscope, using a drill with various-sized round cutting burs. Continuous suction-irrigation during drilling is used to cool the bone, to keep the field clean at all times, and to prevent clogging of the bur by bone dust. The initial bur cut is made along the linea temporalis. This marks the lowest point of the middle fossa dura in most cases. The second bur cut is along a line perpendicular to the one just described and tangential to the posterior margin of the ear canal. These two bur cuts outline a triangular area, the apex of which is at the spine of Henle. projected into the mastoid, parallel to the direction of the ear canal, the apex of this triangle is directly over the lateral semicircular canal. The only structure of importance lying within this triangle as one proceeds with the exenteration is the sigmoid sinus. The deepest mastoid penetration is always at the apex of this triangle. This ensures that the antrum is

Middle Cranial Fossa MCF Approach to the IAC and Petrous Apex

Cranial Fossa

The middle cranial fossa approach is often combined with the transmastoid approach for complete facial nerve decompression in cases of traumatic or viral paralysis. Some indications dictate more limited MCF exposure and less bone work. These include the repair of tegmen cerebrospinal fluid fistulas, meningoceles, and dehiscent superior canals. Facial paralysis is an uncommon complication of middle cranial fossa surgery. If an injury does occur, complete decompression, rerouting, or grafting are facilitated through the available exposure. Resection of facial nerve neuromas frequently requires end-to-end anastomosis with or without a cable graft.18 Cerebrospinal fluid leak can occur following the middle cranial fossa approach. Any exposed mas-toid air cells must be thoroughly sealed with bone wax. Large tegmen defects may require bone grafts. I normally use a large sheet of autologous temporalis fascia supplemented with free or pedicled tempor-alis muscle held in place with fibrin glue....

Side Effects Of Epidural Opioids

Spinal Cord Lamina Where Opioids Work

Peridurally applied morphine where only the free base diffuses through the dura mater and into spinal cord tissue (lamina I and II) Figure III-72. Peridurally applied morphine where only the free base diffuses through the dura mater and into spinal cord tissue (lamina I and II) The late respiratory depression is a common and most dangerous side effect, which occurs with a neuraxial opioid. It is often observed after morphine use, because after epidural injection this agent slowly spreads to the respiratory center, located at the floor of the IVth cerebral ventricle. This delay in onset of respiratory impairment is due to the cephalic migration of the opioid within the cerebrospinal fluid, which needs about 6-10 h in order to reach the IVth cerebral ventricle following intrathecal application 217 218 . Due to the greater hydrophilic characteristic of morphine, a greater portion of the agent remains in the cerebrospinal fluid, migrating rostrally to the respiratory...

Vertebrobasilar Stroke Syndromes

The AICA syndrome causes a ventral cerebellar infarction that has a characteristic clinical picture y , y (see Table, , . - ). The signs and symptoms that are seen include vertigo, nausea, vomiting, and nystagmus due to involvement of the vestibular nuclei. There may be ipsilateral facial hypalgesia and thermoanesthesia and corneal hypesthesia due to involvement of the trigeminal spinal nucleus and tract. There is ipsilateral deafness and facial paralysis due to involvement of the lateral pontomedullary tegmentum. Ipsilateral Horner's syndrome is present due to compromise of the descending oculosympathetic fibers. There is contralateral trunk and extremity hypalgesia and thermoanesthesia due to involvement of the lateral spinothalamic tract. Finally, there is ipsilateral ataxia and asynergia due to involvement of the cerebellar peduncle and cerebellum.

From pharmacogenetics to pharmacogenomics of psychotropic drug response

Been confounded by methodological issues (e.g., selection bias, retrospective assessments of response) and have been limited in their applicability to clinical practice. As the understanding of the biological basis of psychiatric disorders has improved, efforts to identify biological predictors of individual drug response have intensified (Malhotra and Pickar, 1996). Plasma and cerebrospinal fluid levels of neurotransmitter metabolites, neurohormone levels, and brain imaging measures, amongst others, have been hypothesized to provide informative correlates of drug response (Bowers et al., 1984 Pickar et al., 1984 Buchsbaum et al., 1992 Kahn et al., 1993 Szymanski et al., 1995). Despite some initially promising results, consistent data in this regard have remained elusive.

Nonvestibular Dizziness

Balance and spatial orientation depend on three main systems the vestibular apparatus, vision, and proprioception (position sense from the spine and pressure sensors of the extremities). Dizziness may result from problems involving any one, or more, of these systems. Furthermore, disease processes of other bodily systems, such as circulation, respiration, cerebration (including anxiety), and endocrine function, may cause dizziness by affecting the former ones Numerous types of nonvertiginous dizziness may occur, and the more notable types will be discussed briefly. Again, emphasis should be placed on eliciting an accurate descriptive history from the patient.

Posterior Fossa Anomalies

Cervical spinal cord (see Fig, 2.8.-2 ). The Chiari I malformation is occasionally equated with herniation syndromes involving pressure coning and necrosis of the Epidemiology and Risk Factors. Given the diverse group of anomalies that afflict the posterior fossa, it is impossible to give a concise estimate for the incidence or prevalence of this group of disorders. Some of the anomalies are found in almost constant association with other malformations. For example, the Chiari II malformation (discussed earlier with myelomeningoceles), is almost uniformly associated with lumbosacral spinal neural tube closure defects and thus the incidence parallels the incidence of myelomeningoceles. Other anomalies, like the Dandy- Walker malformation, may be found either as an isolated malformation, in conjunction with other malformations (e.g., cardiovascular), or as part of a syndrome (e.g., Meckel-Gruber syndrome and WWS). Risk factors also vary depending on the malformation in question. Mobius'...

Dizziness In The Cerebral Cortex

Vertigo Exercises Pictures

Following a lesion of a portion of the spinal cord, there was damage to the pathway conveying muscle spindle afferents to the cerebellum. Which of the structures shown in this diagram contains the axons that are now damaged as a result of lesion in the spinal cord a. First-order descending sensory fibers contained in the ipsilateral spinal tract of cranial nerve V c. Anterior spinal artery e. Anterior spinal artery

Celebral Cortex And Vertigo

A young boy was admitted to the emergency room after having experienced severe nausea, headache, and fever. The neurologist concluded that he was suffering from a form of bacterial meningitis. His cerebrospinal fluid (CSF) would most likely indicate which of the following

Pain Intervention 101 Techniques

Thoracic, lumbar, and sacral approaches to the epidural space have been described (111). The thoracic approach via the caudal space is possible in the infant and young child because the loose areolar fat and connective tissue yield little resistance. Success in obtaining the desired level via distal entry is enhanced with nerve stimulation guidance (112). The actualization of epidural anesthesia is often performed under general anesthesia. The risks of undetected nerve root trauma or spinal cord insult in the anesthetized patient is a theoretical concern. However, actualization under general anesthesia has proven to be a safe practice (113). Further advances in the use of epidural and other regional techniques in children has proven to be safe and desirable for medical, perioperative, and trauma-related pain management in children.

Approved Anticonvulsant Drugs

Vigabatrin (Figure 2) is an irreversible inhibitor of the enzyme GABA transaminase. It is structurally related to GABA and dose-dependently increases GABA levels, the major inhibitory neurotransmitter, in brain and cerebrospinal fluid. It is effective in the treatment of partial seizures, Lennox-Gastaut syndrome, and infantile spasms. Its use is limited by the development of a visual field loss in 14-92 of patients.

Clinical Features of Beriberi

Mortality from infantile beriberi mainly affected breast-fed infants between the second and fifth months of life, when solid foods were often first introduced. The introduction of white rice porridges, poor in thiamin, to a rapidly growing child and or the increased exposure to infections when solids are introduced may both have contributed to infantile beriberi. The onset of the disease was rare in the first month and early signs could be mild and somewhat subjective (e.g., vomiting, restlessness, anorexia, and insomnia). Early signs could progress to subacute infantile beriberi, the acute and usually fatal condition, or a chronic form. Features of acute infantile beriberi are presented in Table 5. The subacute form was characterized by slight oedema in the form of puffiness, vomiting, abdominal pain, oliguria, dysphagia, and convulsions. In addition, aphonia (soundless cry) was often a feature of subacute infantile beriberi and may have been due to nerve paralysis or oedema of vocal...

Morphine And Related Opioid Agonists

Those with the greatest lipid solubility also can be absorbed transdermally. Opioids are absorbed readily after subcutaneous or intramuscular injection and can penetrate the spinal cord adequately after epidural or intrathecal administration. Small amounts of morphine introduced epidurally or intrathecally into the spinal canal can produce profound analgesia that may last 12-24 hours. However, because of the hydrophilic nature of morphine, there is rostral spread of the drug in cerebrospinal fluid (CSF), and side effects, especially respiratory depression, can emerge up to 24 hours later as the opioid reaches supraspinal respiratory control centers. With highly lipophilic agents such as hydromorphone or fentanyl, rapid absorption by spinal neural tissues produces very localized effects and segmental analgesia. The duration of action is shorter because of distribution of the drug in the systemic circulation, and the severity of respiratory depression may be more directly...

Cervical Spondylopathy

Clinically, symptoms of cervical spondylopathy are miscellaneous however, those such as pain or numbing pain in the neck, shoulders (including their periphery, upper part of the back and chest and upper extremities due to irritation or compression of cervical nerve roots are common.Cervical overstrain or exopathic cold may serve as factors inducing this disease or worsening its symptoms. If the spinal cord is irritated or compressed, symptoms of numbness and weakness of the lower extremities, and staggering gait may appear while if vertebral artery is irritated or compressed, vertigo and dizziness may appear.

Amyotrophic Lateral Sclerosis

Amyotrophic lateral sclerosis (ALS), which is also called motor neuron disease, Charcot's disease, or Lou Gehrig's disease, is an age-dependent fatal paralytic disorder caused by the degeneration of motor neurons in the motor cortex, brain stem, and spinal cord. About 10 percent of cases are familial (FALS) and the rest are sporadic (SALS). Pathogenesis and Pathophysiology. ALS is a combined gray and white matter disease, affecting motor cells and motor fiber tracts. The hallmark of ALS is atrophy, degeneration, and loss of anterior horn neurons, followed by glial replacement. There is loss of pyramidal cells from the precentral cortex and large myelinated fibers of the anterior and lateral columns of the spinal cord, the brain stem, and the cerebrum. The posterior columns are usually spared in sporadic ALS. Lower brain stem Figure 36-1 Spinal cord section from J-M Charcot's original presentations on amyotrophic lateral sclerosis, showing the combined anterior horn cell degeneration...

Cervical Soft Tissue Injuries

Hyperflexion-hyperextension injuries to the cervical spine result in stretching of soft tissues, intervertebral joints, nerve roots, and adjacent peripheral nerves. The most common precipitating events are motor vehicle accidents, falls, and sport injuries. Staged automobile accidents using cadavers have demonstrated injuries ranging from petechial hemorrhage and edema, muscle and ligament distraction, vertebral dislocations and fractures, to herniations of the intervertebral disk. The forces applied during motor vehicle crashes are multiple and depend on the position of the head and neck as well as the type of accident. Forces applied include flexion, extension, rotation, and vertical compression. A rear-end collision propels the trunk forward on the pelvis, throwing the head into hyperextension and stretching the anterior structures of the neck. Hyperextension injuries include hyperextension dislocation atlas fractures including avulsions of the anterior arch, extension teardrop...

Associated Neurological Findings

Lesions of the ninth or tenth cranial nerve nuclei usually affect adjacent brain stem structures, producing ipsilateral sensory disturbance of the face from involvement of the fibers of the descending tract and nucleus of cranial nerve V, vertigo from vestibular nuclei, contralateral limb sensory changes from the lateral spinothalamic, and ipsilateral limb ataxia caused by involvement of the inferior cerebellar peduncle. The ninth and tenth cranial nerves travel closely together between the brain stem and the jugular foramen and consequently are rarely affected independently of one another in their intracranial locations. More peripherally, a lesion at the jugular foramen also affects the spinal accessory nerve, which passes through this opening with the glossopharyngeal and vagus nerves. In addition to disturbance of speech, swallow, and gag, the patient demonstrates weakness of the sternocleidomastoid and trapezius muscles. The twelfth cranial nerve may be involved...

Causes of respiratory alkalosis

Another medical intervention aimed at altering the acid-base status may cause dangerous alkalemia. In metabolic acidosis, the normal compensatory response of the body, mediated by the central nervous system, is to increase minute ventilation in order to lower PaCO2 and to increase the pH of body fluids. Because body fluid compartments equilibrate rapidly for CO2, hypocapnia is also present in the cerebrospinal fluid whose pH is restored in a new steady state, characterized simultanously by low local PCO2 and bicarbonate concentration. When exogenous bicarbonate is given rapidly in order to correct metabolic acidosis, CO 2 will be produced in the blood by the buffering of H + by HCO3-. Because CO2 diffuses rapidly into the cerebrospinal fluid, whereas bicarbonate does not (there is a slow transport mechanism for this anion accross the cisternal epithelium), there may be a transient disequilibrium in pH, which may also decrease in regions of the brain close to the respiratory centers....

Central Skeletal Muscle Relaxants

Relieving the signs and symptoms of local muscle spasm. None has been shown to be superior to analgesic-antiinflammatory agents for the relief of acute or chronic muscle spasm, although all are superior to placebo. Most of these drugs have mild sedative properties, and their muscle relaxant activity may be a direct result of sedation. Experimentally, all centrally active skeletal muscle relaxants preferentially depress spinal polysynaptic reflexes over monosynaptic reflexes.

Subarachnoid Hemorrhage SAH

When an aneurysm ruptures, blood is released under arterial pressure into the subarachnoid space and quickly spreads through the CSF around the brain and spinal cord. Aneurysms are less often caused by arterial dissection through the adventitia of arterial walls, embolism of infected or myxomatous material to the vasa vasorum of distal cerebral arteries (mycotic aneurysms), and degenerative elongation and tortuosity of arteries (dolichoectasia).

The adult neurological examination

The spinal accessory nerve (nerve XI) supplies motor function to the ipsilateral sternocleidomastoid and trapezius muscles. Only rarely is this nerve injured in traumatic brain injury, and that usually is in association with a basilar skull fracture. On examination, the spinal accessory nerve function is assessed by testing neck rotation. One must remember the rule of opposites here. When the right sternocleidomastoid muscle (R. SCM) is activated, the head turns to the left, and of course, the opposite holds for activating the left sternocleidomastoid muscle (L. SCM). Thus, if you ask the patient to rotate his head to the right and push upon your fist, you are testing the left sternocleido-mastoid muscle. On the other hand, weakness of the trapezius muscle will be demonstrated if the patient has difficulty shrugging his shoulder on the ipsilateral side of the lesion.

Lesion Left Brachium Pontic Vomiting Nausea Vertigo

The terms vestibulocerebellum, spinocerebellum, and pontocerebellum originate from termination sides of cerebellar afferent projections. These subdivisions match well with the subdivisions based on phylogenetic studies. The flocculonodular lobe (archicerebellum) has been named vestibulocerebellum because of heavily projecting vestibular afferents the vermis and paravermal parts of the cerebellar hemispheres (paleocerebellum) were called spinocerebellum because of its spinal

Medications to Decrease Outlet Resistance

Benzodiazepines (diazepam), dantrolene, and baclofen have been tried to treat voiding dysfunction owing to the striated sphincter. All of these drugs are considered antispasmotics. Dantrolene works directly on the skeletal muscle, and the other two medications affect the central nervous system through their interactions with inhibitory neurotransmitters. Benzodiazepines influence the neurotransmitter gamma-aminobu-tyric acid (GABA) at both the presynaptic and postsynaptic sites in the brain and spinal cord. The side effects are central nervous system

Classification of Temporal Bone Fractures

Despite the myriad mechanisms leading to middle ear injury, generally four clinical presentations may require surgical intervention facial paralysis, conductive hearing loss, CSF otorrhea or rhinorrhea, and (rarely) persistent vertigo. In all cases, prior to addressing issues dealing with the temporal bone, patients should be assessed for cervical spine, hemodynamic, and neurologic stability.

The Role Of Tau In Neurodegeneration

Expression of the gene encoding tau is highly regulated both at the developmental and tissue-specific levels and particularly at the mRNA splicing stage. This regulation differs between rodents and humans. Human MAPT has fifteen exons spanning a genomic distance of 133.9Kb (which includes 3' and 5' UTR sequences), and six of fourteen coding exons undergo alternative splicing 3,59,60 . In the fetal CNS, a single tau isoform lacking all alternatively spliced exons is produced. In the adult human CNS, six splice variants are produced by inclusion of alternative exons 2, 3, and 10 40 . In the adult human brain, the 3R 4R ratio is approximately one 62,72 . In contrast, in the adult rodent brain, three isoforms are present where all forms contain E10 and only E2 and E3 are alternatively spliced 19,72 . Tau mRNA encodes microtubule-binding domains that are imperfect eighteen amino acid repeats separated by thirteen to fourteen amino acid inter-repeat regions that are dissimilar E10 encodes...

Stimulation Techniques

3rd Generation Genogram

Spinal drug delivery Spinal cord stimulation an effect also on below-level neuropathic pain.92 V Spinal cord stimulation may also provide relief, although greater effect is obtained in those with at-level neuropathic pain and incomplete lesions.93 V Other available treatments are very invasive with limited evidence of efficacy. These include deep brain stimulation and motor cortex stimulation. Deep brain stimulation seems not to provide long-term pain relief in SCI pain.90 V Transcranial or epidural motor cortex stimulation94 has been tested in a few SCI pain patients with varying results. A recent study using transcranial direct current stimulation (tDCS) demonstrated short-term reduction in pain following a five-day treatment trial.95 II Figure 29.2 Proposed algorithm for the assessment and treatment of nociceptive pain following spinal cord injury (from Ref. 107). Figure 29.2 Proposed algorithm for the assessment and treatment of nociceptive pain following spinal cord injury (from...

Comparative studies

Granisetron and ondansetron were also effective in controlling nausea and vomiting related to emetogenic chemotherapy in a crossover study in 40 oriental patients (16). Adverse effects were similar to those reported in Western studies, constipation and headache being the commonest. In another placebo-controlled study of the efficacy and safety of granisetron (3 mg), droperidol (1.25 mg), and metoclopramide (10 mg) intravenously for the prevention of nausea and vomiting in 120 parturients undergoing cesarean section under spinal anesthesia, granisetron was the most effective antiemetic (17). The adverse events profiles of all three drugs were similar to that of placebo.

Other Examples Of Paroxysmal Dyskinesias

With clonazepam the drug of choice, which dramatically diminishes exaggerated startle response 44 . However, it does not reduce infantile hypertonicity to the same degree. Patients usually require high doses (0.1 to 0.2 mg kg day) of clonazepam and tolerate it very well without loss of effectiveness over time 44 . With regard to genetics, the hyper-ekplexia gene was initially linked to the long arm of chromosome 5 (5q33-35) by a linkage study in a large kindred study subsequently, the alpha 1 subunit of the inhibitory glycine receptor (GLRA1) gene was found to be the defective gene in hyperekplexia 45-49 . The inhibitory glycine receptor is a member of the neurotransmitter-gated ion channel superfamily that includes GABA, glutamate, and nicotinic acetylcholine receptors. It is a ligand-gated chloride channel provoking postsynaptic hyperpolarization, which mediates synaptic inhibition in brainstem and spinal cord, where it is primarily expressed. Several missense mutations of GLRA1...

Antinuclear antibody

PHENYLBUTA-ZONE is an NSAID that has a reputation among older rheumatologists for being particularly effective in controlling the symptoms of AS. Because it occasionally causes serious bone marrow damage, phenylbutazone is no longer available in many countries. In surveys of patients with AS, INDO-METHACIN was the preferred NSAID but it has a relatively high frequency of side effects, including central nervous system effects such as dizziness. NAPROXEN was the next preferred NSAID. However, it is likely that most of these drugs can improve symptoms, although individual patients may have preferences for a particular NSAID. Some evidence indicates that treatment with phenylbutazone and indomethacin may slow or prevent fusion of joints, but NSAIDs are used primarily to control symptoms rather than to slow progression of disease. Among the drugs that are prescribed to control inflammation if NSAIDs alone are insufficient, SUL-FASALAZINE is safe and...

Yohimbe And Yohimbine

Effects Yohimbe is said to produce a tingling feeling along the spine, followed by a mild, pleasant, and euphoric high lasting four to six hours. In high enough doses, it can produce mild hallucinogenic-like effects. It contains a number of psychoactive alkaloids, including yohimbine, and has shown positive results in treating both psychological and physiological impotence it even increases the sex drive of men with normal libido. It may have the same effects on women, with the added benefit of helping them lose weight. According to Ward Dean, M.D., it is the only substance with a specific FDA-approved indication as an aphrodisiac. The active compound, called yohimbine or yohimbine hydrochloride, is isolated and sold as a prescription medication, and is much safer.

Medications to Decrease Bladder Contractility

Capsaicin is a new compound that is obtained from hot peppers and is highly selective for the sensory neurons in mammals (96,97). Thus, repeated administration of capsaicin, either systemically or topically, induces desensitization and inactivation of the sensory nerves by creating reversible antinociceptive and anti-inflammatory action. The action of topical or local capsaicin is owing to the blockade of the C-fiber conduction and inactivation of the neuropeptides released from the peripheral nerve endings. By using systemic capsaicin, antinociception is produced by activating specific receptors on the afferent nerve terminals in the spinal cord, which results in blockade of spinal neurotransmission by the prolonged inactivation of sensory neurotransmitter release. Topical use prevents systemic side effects and acts primarily on the small diameter nociceptor receptors, which, in turn, prevents loss of sensation to touch and pressure as well as loss of motor function, which are owing...

Acute Mountain Sickness

Lineares Wachstum

Nervous system, namely headache, dizziness, gastrointestinal upset (nausea, vomiting, and anorexia), and sleep disturbance. AMS HACE-like syndromes in a sheep model are associated with brain swelling and raised intracranial pressure. Neuroimaging studies in humans have also demonstrated brain swelling in AMS, although this also occurs on ascent to high altitude in the absence of AMS. An interesting hypothesis is that susceptibility to AMS may relate to the 'tightness' of the brain within the cranial vault (Hackett, 1999). Variations in cranial anatomy may make some people less able to accommodate brain swelling through cerebrospinal fluid (CSF) dynamics, and thus more susceptible to AMS.

Evaluation Guidelines

If infectious, neoplastic (especially meningeal carcinomatosis), or inflammatory (sarcoidosis) etiologies are suspected, cerebrospinal fluid (CSF) evaluation is warranted. CSF glucose level, protein level, differential white and red blood cell counts, and cytology tests are compulsory, whereas other studies to isolate mycobacterial, fungal, rickettsial, parasitic, and viral pathogens should be addressed on an individual basis. In the immunocompromised person (e.g., one with cancer, acquired immunodeficiency syndrome AIDS , and organ transplant), opportunistic pathogens causing infections such as cryptococcosis, candidiasis, mucormycosis, toxoplasmosis, and cytomegalovirus need to be seriously considered in the setting of any acute or subacute neurological presentation.

Clinical Manifestations

Rarely the disease occurs in asymptomatic form, the lesions being found accidentally by MRI. The first attack comes without warning and may be mono- or polysymptomatic. In one-fifth of the cases, the onset is acute i.e., the deficit attains its maximum severity in minutes or hours. Weakness or numbness of a limb, monocular visual loss, diplo-pia, vertigo, facial weakness or numbness, ataxia, and nystagmus are the most common presenting symptoms, and they occur in various combinations. Remission after the first attack is to be expected. Recurrences represent a recrudescence of earlier lesions or the effects of new ones, predominantly the former. Over a variable period, usually measured in years, the patient becomes increasingly handicapped, with an asymmetric paraparesis and obvious signs of corticospinal tract disease, sensory and cerebellar ataxia, urinary incontinence, optic atrophy, nystagmus, internuclear ophthalmoparesis, and dysarthria. Seizures occur in 3 to 4 percent of...

Antidepressants Without United States FDA Approval

Recent studies have examined compounds that inhibit substance P (SP)-neurokinin-1 (NKj) receptor pathways as potential antidepressants (226). SP and NKj receptors are located in brain regions that regulate mood and are associated with neurotransmitter pathways thought to play a role in depression. In one postmortem study, higher concentrations of SP were found in the cerebrospinal fluid of depressed patients compared to controls (227). Aprepitant and compound A, SP-NK1 antagonists, have a high affinity and selectivity for the NKj receptor, but have not been shown to inhibit other depression-related neurotransmitters. Both compounds have been studied for the treatment of depression with disappointing results.

Answers and Explanations

The patient has lateral medullary syndrome affecting the spinodialamic tract and descending hypothalamic fibers providing long tract signs. The spinal nucleus of V has also been lesioned, giving rise to the pain and temperature loss in the face but no other trigeminal signs. The vagus nerve has been lesioned along with the cochlear and vestibular nuclei on the left. The posterior inferior cerebellar artery supplies the lateral medulla. 21. Answer C. The solitary nucleus is found throughout the length of the medulla the only choice also found in the medulla is the spinal nucleus of V. Spinal cord

Risks and Complications of Endolymphatic Sac Surgery

Cerebrospinal Fluid Leak Endolymphatic sac surgery carries a risk of dural fenestration, resulting in a cerebrospinal fluid leak. This may occur when arachnoid granulations are uncovered during drilling or through tears in congenital or age-related dural defects. Leaks through arachnoid granulations can be easily controlled by Infection is extremely uncommon and usually responds to medical therapy. If infection occurs in the presence of a cerebrospinal fluid leak, meningitis may develop.

Chemical Dependence Disorders

Hippocampus, locus coeruleus, amygdala, caudate, putamen, and the dorsal portion of the spinal cord. This receptor is involved in the production of both analgesic and euphoric states. g receptors are distributed similarly to m receptors, but more restrictively. Their primary locations are in the neocortex, striatum, and substantia nigra, with the expected involvement in cognitive processes and motor integration. The k receptor binds ketocyclazocine, an opiate analog molecule that produces hallucinations and dysphoric mood states thus, it is thought to have a possible role in psychiatric disorders, but presently this is far from clear. Opiate interactions with k receptors are involved in GI motility, food and water intake, thermoregulation, and pain perception. Opioid effects in the nervous system are highly complex and involve interactions with other neuro-transmitter systems. For example, opioid interactions with m receptors in the brain stem result in the stimulation of GABA...

Organophosphate Insecticides

Organophosphates inhibit acetylcholinesterase and pseudocholinesterase. Insecticides that are cholinesterase inhibitors include chlorpyrifos (Dursban), diazinon, malathion, ethyl and methyl parathion, and trichlorofon. y The neurotoxicity of these compounds is related to their ability to inhibit acetylcholinesterase, which occurs in the brain, spinal cord, myoneural junctions, pre- and postganglionic parasympathetic synapses, and preganglionic and some postganglionic sympathetic nerve endings. The resulting increase in acetylcholine overstimulates the postsynaptic receptors in the cholinergic system, thus differentially stimulating nicotinic receptors (skeletal muscle and autonomic ganglia) and muscarinic receptors (secretory glands and postganglionic fibers in the parasympathetic nervous system).


Magnetic resonance imaging (MRI) and CT scanning have additionally indicated that at least some of these children have cerebral thrombosis and infarction in addition to cerebral edema (26,31). In adults, monitoring by indwelling intrathecal catheters indicates that there is a rise in cerebrospinal fluid pressure in all patients during fluid and insulin therapy for DKA (26). In children, subclinical cerebral edema may be present in the majority, as suggested by narrowing of the cerebral ventricles detected by CT scanning during treatment and restoration to normal ventricular size after recovery (18). The cause of this syndrome is believed by some to be a rapid correction of osmotic disequilibrium between brain cells and extracellular fluid brought about by hypotonic fluids and by a precipitous lowering of the blood glucose concentration (20-29). This hypothesis is based on the tenet that in response to the hyperosmolar state of hyperglycemia, brain cells generate idiogenic osmoles,...