MICRO
CNS (1).pptx

37 a 15 year old boy with epilepsy on treatment with

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A 15 year old boy with epilepsy on treatment with combination of valproate and phenytoin has good control of seizures. Levels of both drugs are in the therapeutic range. All of the following adverse effects can be attributed to valproate except - (AI04) a) Weight gain of 5 kg b) Serum alanine aminotransaminase 150IU/L c) Rise in serum ammonia level by 20 g/dl d) Lymphadenopathy 38
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A 15 year old boy with epilepsy on treatment with combination of valproate and phenytoin has good control of seizures. Levels of both drugs are in the therapeutic range. All of the following adverse effects can be attributed to valproate except - (AI04) a) Weight gain of 5 kg b) Serum alanine aminotransaminase 150IU/L c) Rise in serum ammonia level by 20 g/dl d) Lymphadenopathy Ans. is ‘d’ i.e., Lymphadenopathy [Ref: Harrison 18u'/ep.3263 t. (369.9); K.D.T. 5th/ep. 375] Drugs causing lymphadenopathy :- Phenytoin Primidone 40
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Upper motor neuron vs. lower motor neuron lesion UMN lesion is characterised by - (AI 99) a) Weakness & spasticity b) Fasciculations c) Rigidity d) Localised muscle atrophy 41
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The spinal cord contains central grey matter and the peripheral white matter. The grey matter contains many neuronal cell bodies and synapses. The white matter contains ascending and decending pathways. 42
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The ascending pathways relay sensory information to the brain. The descending pathways  relay motor instructions down from the brain. These pathways synapse at various points in their tracts but the number of synapses is not very important to know clinically. 43
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Ascending Pathways (Sensory pathways) There are several ascending pathways in the spinal cord, but we will limit the discussion to only three clinically main important pathways, which are :- i) Spinothalamic tract (Anterolateral pathway) ii) Posterior column (Dorsal column) iii) Spinocerebellar tract. 45
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Anterolateral pathways (spinothalamic tract) Antero lateral pathway carries following sensations : Pain Thermal including both warm and cold Crude touch. 46
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Their course in the spinal cord: The spinothalamic tract enters the spinal cord, crosses over to the opposite half of the cord almost immediately, ascends upto the thalamus on the opposite side and then moves on to the cerebral cortex. Thus any lesion in the spinothalamic tract will result in loss of pain, temperature and crude touch, contralaterally below the level of the lesion. 47
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Dorsal column-Medial lemniscal system (Posterior column) These convey:- Touch sensations requiring a high degree of localisation of the stimulus and fine gradation of intensity. Vibratory sensations. Position sensations from the joints.
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  • Winter '16
  • jean grey

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