0071643192.pdf

TREATMENT

■ Pharmacologic therapy should be initiated if patient presents within 1 week

of symptom onset.

■ Corticosteroids

■ Antiviral therapy

■ Eye protection

■ Eye patch for sleeping and artificial tears during the day

Acoustic Neuroma

Schwannoma of CN VIII that typically causes isolated CN VIII symptoms,

but if large may →mass effect on adjacent structures (CN VII, CN V,

4th ventricle)

SYMPTOMS/EXAM

■ Characteristic triad of sensorineural hearing loss, tinnitus, and disequi-

librium

DIAGNOSIS/TREATMENT

■ Audiogram to formally evaluate hearing loss

■ MRI can confirm diagnosis.

■ Treatment is surgical.

SPINAL CORD DISORDERS

Spinal cord anatomy:

■ Corticospinal tract:Motor pathway; fibers cross in medulla then descend

in cord.

■ Spinathalamic tract: Pain and temperature pathway; fibers first cross, then

ascend in cord.

■ Posterior (dorsal) columns: Vibration and proprioceptive pathway; fibers

ascend in ipsilateral posterior column to medulla, then cross.

■ Cauda equina: Lumbar and sacral nerve roots

CAUSES

Causes of spinal cord dysfunction include:

■ Trauma

■ Multiple sclerosis

■ Transverse myelitis

■ Spinal AVM or hemorrhage

■ Compression from tumor, disc, epidural abscess, or hematoma

■ Syringomyelia

■ Myelopathy (eg, HIV)

■ Infarction

SYMPTOMS/EXAM

■ Patients present with motor and sensory deficits depending on location of

injury.

■ Scoring motor function

■5 = Full strength

■4 = Able to resist, but weak

NEUROLOGY

Damage to single

corticospinal tract or posterior

column→ipsilateral motor

weakness or

vibration/position loss.

Damage to single

spinothalamic tract →

contralateral loss of pain and

temperature.