Syndrome

<p>Acute Colonic Pseudoobstruction (ACPO) is commonly called Ogilvies Syndrome. &nbsp;ACPO presents massive dilation in critically ill patients, and might result in invasive procedures to avoid ischemia or perforation of the colon.</p>  

In this podcast, Drs. Andrew Cutler and Stephen M. Stahl examine the current treatment options available to treat the myriad symptoms of fibromyalgia. New treatment options are also reviewed in light of recent findings regarding chronic pain.  

In this podcast, Drs. Andrew Cutler and Stephen M. Stahl discuss the myriad comorbidities associated with the syndrome of fibromyalgia. Patients often present complaining of fatigue as well as pain. Recent research suggests a link between pain, depression and sleep, which is discussed in this podcast.  

In this podcast, Drs. Andrew Cutler and Stephen M. Stahl discuss the syndrome of fibromyalgia at the neurobiological level. Current diagnostic guidelines are addressed, as well as providing recent information regarding the underlying causes of this painful syndrome. Gender differences in presentation are also discussed.  

Sample audio file from <a href="../Products.html">Ophthalmology Buzzwords™</a> Audio Book.  

Orientation, Memor This patient has difficulty with orientation questions. The day of the week is correct but he misses the month and date. He is oriented to place. Orientation mistakes are not localizing but can be due to problems with memory, language, judgement, attention or concentration. The patient has good recent memory (declarative memory) as evidenced by the recall of three objects but has difficulty with long term memory as evidenced by the difficulty recalling the current and past presidents. Attention-working memor The patient has difficulty with digit span backwards, spelling backwards and giving the names of the months in reverse order. This indicates a problem with working memory and maintaining attention, both of which are frontal lobe functions. Judgement-abstract reasoning The patient gives the correct answer for a house on fire and his answers for similarities are also good. He has problems with proverb interpretation. His answers are concrete and consist of rephrasing the proverb or giving a simple consequence of the action in the proverb. Problems with judgement, abstract reasoning, and executive function can be seen in patients with frontal lobe dysfunction. Set generatio Set generation tests word fluency and frontal lobe function. The patient starts well but abruptly stops after only four words. Most individuals can give more then 10 words in one minute. Receptive languag Patients with a receptive aphasia (Wernicke’s) cannot comprehend language. Their speech output is fluent but is devoid of meaning and contains nonsense syllables or words (neologisms). Their sentences are usually lacking nouns and there are paraphasias (one word substituted for another). The patient is usually unaware of their language deficit and prognosis for recovery is poor. This patient’s speech is fluent and some of her sentences even make sense but she also has nonsense sentences, made up of words and parts of words. She can’t name objects (anomia). She doesn’t have a pure or complete receptive aphasia but pure receptive aphasias are rare. Expressive languag This patient with expressive aphasia has normal comprehension but her expression of language is impaired. Her speech output is nonfluent and often limited to just a few words or phases. Grammatical words such as prepositions are left out and her speech is telegraphic. She has trouble saying “no ifs , ands or buts”. Her ability to write is also effected Patients with expressive aphasia are aware of their language deficit and are often frustrated by it. Recovery can occur but is often incomplete with their speech consisting of short phrases or sentences containing mainly nouns and verbs. Praxi The patient does well on most of the tests of praxis. At the very end when he is asked to show how to cut with scissors he uses his fingers as the blades of the scissors instead of acting like he is holding onto the handles of the scissors and cutting. This can be an early finding of inferior parietal lobe dysfunction. Gnosi With his right hand the patient has more difficulty identifying objects then with his left hand. One must be careful in interpreting the results of this test because of the patient’s motor deficits but there does seem to be astereognosis on the right, which would indicate left parietal lobe dysfunction. This is confirmed with graphesthesia where he definitely has more problems identifying numbers written on the right hand then the left (agraphesthesia of the right hand). Dominant parietal lobe functio This patient has right-left confusion and difficulty with simple arithmetic. These are elements of the Gertsmann syndrome, which is seen in lesions of the dominant parietal lobe. The full syndrome consists of right-left confusion, finger agnosia, agraphia and acalculia.  

Cranial Nerve 1- Olfaction This patient has difficulty identifying the smells presented. Loss of smell is anosmia. The most common cause is a cold (as in this patient) or nasal allergies. Other causes include trauma or a meningioma affecting the olfactory tracts. Anosmia is also seen in Kallman syndrome because of agenesis of the olfactory bulbs. Cranial Nerve 2- Visual acuity This patientâs visual acuity is being tested with a Rosenbaum chart. First the left eye is tested, then the right eye. He is tested with his glasses on so this represents corrected visual acuity. He has 20/70 vision in the left eye and 20/40 in the right. His decreased visual acuity is from optic nerve damage. Cranial Nerve II- Visual field The patient's visual fields are being tested with gross confrontation. A right sided visual field deficit for both eyes is shown. This is a right hemianopia from a lesion behind the optic chiasm involving the left optic tract, radiation or striate cortex. Cranial Nerve II- Fundoscopy The first photograph is of a fundus showing papilledema. The findings of papilledema include 1. Loss of venous pulsation 2. Swelling of the optic nerve head so there is loss of the disc margin 3. Venous engorgement 4. Disc hyperemi 5. Loss of the physiologic cup an 6. Flame shaped hemorrhages. This photograph shows all the signs except the hemorrhages and loss of venous pulsations. The second photograph shows optic atrophy, which is pallor of the optic disc resulting form damage to the optic nerve from pressure, ischemia, or demyelination. Images Courtesy Dr. Kathleen Digre, University of Uta Cranial Nerves 2 & 3- Pupillary Light Refle The swinging flashlight test is used to show a relative afferent pupillary defect or a Marcus Gunn pupil of the left eye. The left eye has perceived less light stimulus (a defect in the sensory or afferent pathway) then the opposite eye so the pupil dilates with the same light stimulus that caused constriction when the normal eye was stimulated. Video Courtesy of Dr.Daniel Jacobson, Marshfield Clini and Dr. Kathleen Digre, University of Uta Cranial Nerves 3, 4 & 6- Inspection & Ocular Alignmen This patient with ocular myasthenia gravis has bilateral ptosis, left greater than right. There is also ocular misalignment because of weakness of the eye muscles especially of the left eye. Note the reflection of the light source doesn't fall on the same location of each eyeball. Video Courtesy of Dr.Daniel Jacobson, Marshfield Clini and Dr. Kathleen Digre, University of Uta Cranial Nerves 3, 4 & 6- Versions • The first patient shown has incomplete abduction of her left eye from a 6th nerve palsy. • The second patient has a left 3rd nerve palsy resulting in ptosis, dilated pupil, limited adduction, elevation, and depression of the left eye. Second Video Courtesy of Dr.Daniel Jacobson, Marshfield Clini and Dr. Kathleen Digre, University of Uta Cranial Nerves 3, 4 & 6- Duction Each eye is examined with the other covered (this is called ductions). The patient is unable to adduct either the left or the right eye. If you watch closely you can see nystagmus upon abduction of each eye. When both eyes are tested together (testing versions) you can see the bilateral adduction defect with nystagmus of the abducting eye. This is bilateral internuclear ophthalmoplegia often caused by a demyelinating lesion effecting the MLF bilaterally. The adduction defect occurs because there is disruption of the MLF (internuclear) connections between the abducens nucleus and the lower motor neurons in the oculomotor nucleus that innervate the medial rectus muscle. Saccades Smooth Pursui The patient shown has progressive supranuclear palsy. As part of this disease there is disruption of fixation by square wave jerks and impairment of smooth pursuit movements. Saccadic eye movements are also impaired. Although not shown in this video, vertical saccadic eye movements are usually the initial deficit in this disorder. Video Courtesy of Dr.Daniel Jacobson, Marshfield Clini and Dr. Kathleen Digre, University of Utah Optokinetic Nystagmu This patient has poor optokinetic nystagmus when the tape is moved to the right or left. The patient lacks the input from the parietal-occipital gaze centers to initiate smooth pursuit movements therefore her visual tracking of the objects on the tape is inconsistent and erratic. Patients who have a lesion of the parietal-occipital gaze center will have absent optokinetic nystagmus when the tape is moved toward the side of the lesion. Vestibulo-ocular refle The vestibulo-ocular reflex should be present in a comatose patient with intact brainstem function. This is called intact "Doll’s eyes" because in the old fashion dolls the eyes were weighted with lead so when the head was turned one way the eyes turned in the opposite direction. Absent "Doll’s eyes" or vestibulo-ocular reflex indicates brainstem dysfunction at the midbrain-pontine level. Vergenc Light-near dissociation occurs when the pupils don't react to light but constrict with convergence as part of the near reflex. This is what happens in the Argyll-Robertson pupil (usually seen with neurosyphilis) where there is a pretectal lesion affecting the retinomesencephalic afferents controlling the light reflex but sparing the occipitomesencephalic pathways for the near reflex. Video Courtesy of Dr.Daniel Jacobson, Marshfield Clini and Dr. Kathleen Digre, University of Uta Cranial Nerve 5- Sensor There is a sensory deficit for both light touch and pain on the left side of the face for all divisions of the 5th nerve. Note that the deficit is first recognized just to the left of the midline and not exactly at the midline. Patients with psychogenic sensory loss often identify the sensory change as beginning right at the midline. Cranial Nerves 5 & 7 - Corneal refle A patient with an absent corneal reflex either has a CN 5 sensory deficit or a CN 7 motor deficit. The corneal reflex is particularly helpful in assessing brainstem function in the unconscious patient. An absent corneal reflex in this setting would indicate brainstem dysfunction. Cranial Nerve 5- Motor • The first patient shown has weakness of the pterygoids and the jaw deviates towards the side of the weakness. • The second patient shown has a positive jaw jerk which indicates an upper motor lesion affecting the 5th cranial nerve. First Video Courtesy of Alejandro Stern, Stern Foundation Cranial Nerve 7- Motor • The first patient has weakness of all the muscles of facial expression on the right side of the face indicating a lesion of the facial nucleus or the peripheral 7th nerve. • The second patient has weakness of the lower half of his left face including the orbicularis oculi muscle but sparing the forehead. This is consistent with a central 7th or upper motor neuron lesion. Video Courtesy of Alejandro Stern, Stern Foundatio Cranial Nerve 7- Sensory, Tast The patient has difficulty correctly identifying taste on the right side of the tongue indicating a lesion of the sensory limb of the 7th nerve. Cranial Nerve 8- Auditory Acuity, Weber & Rinne Test This patient has decreased hearing acuity of the right ear. The Weber test lateralizes to the right ear and bone conduction is greater than air conduction on the right. He has a conductive hearing loss. Cranial Nerve 8- Vestibula Patients with vestibular disease typically complain of vertigo – the illusion of a spinning movement. Nystagmus is the principle finding in vestibular disease. It is horizontal and torsional with the slow phase of the nystagmus toward the abnormal side in peripheral vestibular nerve disease. Visual fixation can suppress the nystagmus. In central causes of vertigo (located in the brainstem) the nystagmus can be horizontal, upbeat, downbeat, or torsional and is not suppressed by visual fixation. Cranial Nerve 9 & 10- Moto When the patient says "ah" there is excessive nasal air escape. The palate elevates more on the left side and the uvula deviates toward the left side because the right side is weak. This patient has a deficit of the right 9th & 10th cranial nerves. Video Courtesy of Alejandro Stern, Stern Foundatio Cranial Nerve 9 & 10- Sensory and Motor: Gag Refle Using a tongue blade, the left side of the patient's palate is touched which results in a gag reflex with the left side of the palate elevating more then the right and the uvula deviating to the left consistent with a right CN 9 & 10 deficit. Video Courtesy of Alejandro Stern, Stern Foundation Cranial Nerve 11- Moto When the patient contracts the muscles of the neck the left sternocleidomastoid muscle is easily seen but the right is absent. Looking at the back of the patient, the left trapezius muscle is outlined and present but the right is atrophic and hard to identify. These findings indicate a lesion of the right 11th cranial nerve. Video Courtesy of Alejandro Stern, Stern Foundation Cranial Nerve 12- Moto Notice the atrophy and fasciculation of the right side of this patient's tongue. The tongue deviates to the right as well because of weakness of the right intrinsic tongue muscles. These findings are present because of a lesion of the right 12th cranial nerve.  

The presentation given to my tutorial group for my second year dissertation on types of stroke and the interesting resulting effects on visual perception.  

A video tutorial on fluid balance. This tutorial includes basic biochemistry and physiology of electrolytes followed by an outline of clinical conditions such as hypovolaemia, hypervolaemia, hypocalcaemia, hypercalcaemia and syndrome of inappropriate antidiuretic hormone hypersecretion (SIADH).  

Metabolic syndrome and obesity are attaining epidemic proportions worldwide. This PPT shows the link between the two, their aetiology, the pathophysiology and what simple measures could be used in managing the conditions.  

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A short animation representing a major cause for TMJ deviation. This animation is created by me using 3DS Max, and Maya.  

This is a syndrome that results from swelling of a muscle. The muscle is retained in its fixed volume fascia, however, and thus the swelling of the muscle causes occlusion of the blood supply. this can result in infarction, and can cause an ischaemic contraction known as Volkmann’s Ischaemic Contracture.   It typically occurs in the forearm and calf, but can also occur in the thigh and foot.    

Introduction Marfan Syndrome (sometime Marfan’s Syndrome) is an autosomal dominant connective tissue disorder.   Epidemiology and Aeitiology 25% of cases occur without family history Reduced life expectancy – average is around 60   Pathology  

Systemic sclerosis is an autoimmune connective tissue disorder. Other similar diseases include SLE, RA, Sjogren’s syndrome and mixed connective tissue disease. There is a lot of overlap in the symptoms of these diseases. Many will require immunosuppressive therapy.