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Hi to our second session, neuro speed run. We're just gonna speed run this motherfucker, you know. Um, uh, my name is Coin. I'm third year medical student. Um, yeah. So, um, yeah, it, it's brought to you by AMSA. So today we're just gonna go through like the major, major topics. So, headache, stroke, head trauma, throat, co pathology. There's no point for me reading out. Oh, I'm pretty sure you guys can read. Um, and then at the end we, we're gonna have like a little quiz for you guys. So, yup. Hopefully you guys will, um, enjoy that, right? So, headache. So first one, tension headache is the most, most common headache. Ok. So usually it's related to stress. Um, and it usually presented as like, you know, patient described as tight band around the head and there are also no official changes. Ok. Unlike other, um, headaches like, um, you know, that, that I'm going to talk about. Um, so, you know, this is, uh, this is one of the key word. If the question says, oh, tight band around head, just go straight to tension headache. Ok? You don't even have to read. Um, you know other options, you just have to go straight to, um, tension headache, tight band around head. It's like that. Ok. Um, and first line treatment, paracetamol Nsaids. Um, that's it really, to be honest. I, I don't really think you need to learn the prophylactic. Um, I think acute is just fine. Um, paracetamol NSAID S ok. That's it for a first line treatment, right? Second migraine, migraine is also a kinda common headache. Um So as you can see for this one, tension headaches, like tight bound, tight band around the head, the forehead region at the back of the head. Migraine is kind of like unilateral, ok. It's like one side of the head. Ok. So it's unilateral pounding, throbbing headache, ok? And usually discomfort with lights and loud noises. So these are things called aura. Um when you see like these like these, these two combinations, unilateral headache and also like discomfort with like lights and not loud noises. Um these like this called aura, you just like uh again, go straight to migraine. I don't even care what the options are. Um and also migraine can further progress into nausea and vomiting if it is not um being treated. Um you know, there are some causes um stress but like, you know, we don't really need to know that um for treatment wise um for if it's like acute migraine, um aspirin and NSAIDS and then Triptans as well. So, yeah, um Triptan is something to do with the serotonin, ok? In the, in the, in the, in the blood vessels. So it's basically just like prevent um the blood vessel from um vasodilating. Um So it's kind of like vaso constraint, ok? In the, in the, in the, in the head, in the brain. So, aspirin nsaids and triptans. Ok. So, you know, it's a little bit different to um uh tension, headache, um tension, we don't use Triptan. And for migraine, you use Triptan and um aspirin and NSAIDS as well. Prophylactic, you know, beta blocker. So, and um and can tan can, if you guys can remember from first year, it is uh A RB. Um So again, like migraine is strongly linked to like the facial um dilation in the brain. So these two kind of like controlling the um the BP. So, you know, this is like prophylactic. Again, you don't really need to like kind of know that it's just to give you an idea. But like the main thing you need to know is these two. and also um the drugs, OK. And also um treatment in women like, you know, you, we do not, we do not do not give anti Hyc patients in women in childbearing age. OK. We do not do that. And also because it's um uh teratogenic OK, right? Trigeminal neuralgia. So it's something to do to do with the, the trigeminal nerve. Um again, you know, it, there are like, you know, ophthalmic maxillary and mandibular branch usually, you know, it's usually um unilateral maxillary or mandibular deficient pain. Um you know, oph ophthalmic, you know, can happen. But like maxillary and mandibular pain are most common against unilateral. Ok. And the patient usually describe it as stabbing pain, stabbing less um yeah, stabbing pain. Ok. So each stab around like, you know, just uh kind of like short bursts, like uh really kind of like short um duration and there are some triggers as well. So trigger, you know, it can be, yeah, this kind of trigger cold and wind blah, blah. Ok. And the main treatment is um carBAMazepine. So it's kind of like carBAMazepine is kind of like um uh kinda like a antiepileptic. Ok. So yeah, so basically like that. So um again, trigeminal neuralgia like uh I think about it as like, you know, it's like it's a, it's actually a pain caused by is a neuropathic pain. Ok. So no painkillers is not gonna work for trigem trigeminal neuralgia. My apologies. So we're gonna give something that's like, you know, some it is like, you know, stronger drugs. So like antiepileptic, um we don't give um carBAMazepine to migraine and tension headache. You know, those are like typical headache, they can be treated with nsaids. Um you know, uh aspirin and as I mentioned, ok, paracetamol and this one we give carBAMazepine. Ok. Again, always remember, you know, these like, you know, these key words, you see these two not n not necessarily stabbing pain but like, you know this one like the, the branch pain. OK. Right. And there are different types there on the major black branch of um headaches is called the trigeminal um autonomic um logs the tax. Um I'm just gonna give like the main one you have to learn is cluster headache. But like there are these two like these other types of small subtypes. Um The subtypes uh I would like you guys to like keep something like to know something about them as well. But like, you know, I'm not gonna go through um them too deeply because like it is extremely difficult to differentiate between them. You are not going to be asked to differentiate between these, these four, this five headaches. OK. They have very, very similar symptoms. Ok? Like the main one is cluster headache that I like you guys. I would like you guys to learn. OK. So for cluster headaches, OK. So we can see it is kind of Unna un uh like unilateral again, it's, but this time is kind of like orbital and temporal. So the eye region and the side region as well. OK. But this time is rapid on set and cluster headache usually described as the extreme headache or the suicidal headache. Ok. Um A lot of people actually kill themselves with this headache cause it's the like, you know, the pain is extreme it's beyond 10 out of 10 and treatment. Um you know, again, we're not gonna give like simple pain killer, it's not gonna work. Um, this time we're gonna give IV Triptan as well like, you know, um Sumatriptan is a type of Triptan. Ok. So this time we're gonna give IV and also high flow O2. OK? If it, if it, if they get admitted to the hospital, OK? We give them high flow 100% O2 um if they are like, you know, like um and also, yeah, also we can go um for um oral prednisoLONE as well. OK. And uh or like um the uh the uh the the the Graci nerve block as well. Um prophylaxis when you know this the uh the acute uh attack has been subsided. We can, we can give um you know, um some uh fer uh fil and lithium again, calcium channel blocker and then also some kind of lithium to kind of like, you know, it because it's uh I believe it's uh um BP related um condition as well. So, but the main one if triptan high flow oxygen, OK. And also extreme pain and orbital temporal pain, like these are the four things I hope you guys um remember, OK. Right, oxy hemicrania and um hemicrania continua, they're very similar. However, like, again, it's like unilateral, again, rapid onset um very, very short duration of birth. OK. And extremely, again, severe headache and like, you know, hemi parax, he um, hemicrania. Um, and, and then, and then the continua, the difference is that's the severity you see, like, you know, it's, it's so for, um, para, um, peral hemicrania, like a pain is like, you know, like, you know, there's a headache and then a massive sudden head of like, you know, really, really spike wave of like pain and then, and then, um, um, and then not as painful again, you know, and then, so it's kind of like, you know, this one is like level three, level two pain and then suddenly goes to 10, 1 2nd, goes to 10 and then another second stop and then in another seconds, it, it hits to like, you know, level 10 pain again for having a cranial conti, you know, there's has been like, you know, a constant level five pain and then it goes to level 10 and then like, you know, goes back down to level five again, like the thing again, please don't learn how to differentiate that. There's no way even like, you know, neurologist cannot differentiate that. But the only thing I want you guys to know about these two conditions. Um, and that, um, Indo Inamine are the only only treatment drugs we give for these two. Ok. That's the only thing I want you guys to remember. Ok. Indomethacin, OK. That's the only nsaids that works. No one knows why we just do. Ok? We just give them um uh Indocin, OK? Only for these two conditions. OK. Right. Um For these two again. Um uh So again, I, I don't, I don't want you guys to learn um these um conditions like um too deeply um like, you know, I just want you guys to have an idea of what they are. Um And treatment is for these two, these two latrine and um carBAMazepine. Um but I really doubt um they're gonna ask these two conditions. Um But, you know, again, just in case they do cause you have no idea what they're gonna do to us. Um Yeah, just like, you know, keep them in mind um in the, on the back of your head. But like, you know, II I really doubt they're gonna ask you to, we'll ask you guys about the drugs and here's a summary for you guys to like, you know, um uh if you guys have to study it um in the future, right? And also for high, like, you know, um and then uh intracranial hypertension and the m the major flag, you know, the major sign for intracranial hypertension is um headache when it's like upright posture. OK? But it, it's better when it's lying down. OK? When you see this. Yeah. OK. You just go again, go straight to hypotension, OK? Headache when you stand upright and it goes away, not, it goes away. But yeah, it goes away or it gets better when you lie down. Ok? And a lot of time it can actually be um after, right after, you know, a lumbar puncture, ok? Because like, you know, after lumbar puncture, it is like a, a collection of CS F and then there's like sudden drop of CS F and then causing, you know, um uh the hypertension. Ok? Um Right. So for treatment um IV caffeine or just caffeine or, you know, a can of Red Bull that's fine. Um fluids, bed rest. Um Yeah, it's like really like normal, just normal treatment that just like, you know, bring it back up. Um the intracranial hypertension again. OK. And this and like um for high intracranial hypertension, um the definition is above um 200 mg and um you know, um mercury of intracranial pressure. The normal in cranial pressure is 5 to 15. I need you guys to learn that this is like the some of the most important thing you guys have to learn. They're going to go, going to ask you that. I like, I, I like, I swear they will ask you that. What is no, which of the following is the normal IC P OK. It's 5 to 15. You guys have to learn that I don't care if you have any disability, you have to learn that OK, presentations um progressive uh episode like and also, you know, persistent um headache and also um fissure changes as well. And then um pap edema. Um So it's basically um you can see it like with um Fios um finos copy, you can see like the, the eye is kind of like a little bit bulging. Um It's like enlargement of the blind spot. OK. And, well, a again, the second thing I, what I need you guys to learn like you, you just have to know this, like this is the thing, I just have to link it instantly with um intracranial hypertension is um the complication it can cause coning herniation. So you see this one, usually it, it's called coning. So, right here in the Foramen magnum. Um uh So basically the cerebellar tonsil. So around here, this region it just goes downwards, push downwards because of the increase of the hypertension. OK? It pushes down and then it's gonna cause the uh the blockage of the blood vessels in that's supplying to the herniated to the, sorry to the um cerebellar tonsil or like the brain stem and then it's gonna loss of function and then that person is just gonna go, you know, um somewhere else. Um they're gonna die. And yeah, at, at this animation just to make sure you guys learn that. Um OK. Yeah. Right. So um there are different, you know, kind of causes of um a lot of different causes of um uh uh increased intracranial hypertension. Again, the thing is like this, like for your own interest only you don't have to learn like differentiate between, oh I'm, they're not gonna give you AC T scan and then tell you and they ask you like, oh what's it? What's the diagnosis? These are like the, the, the different types? Um the causes of the, you know, in increased intracranial hypertension and intracranial pressure. And this is what you see in the fundoscopy, um uh in the fundoscopy. Um you know, it's good the pap edema, it is like inside the eye. You can see that the blind spot is is enlarged and yeah, that's it. This will only interest only you don't have to learn this right? John cell arteritis, right? Please forgive me guys. I know I had all of them because they are all of them are like the flags that points directly towards John cell arteritis, um headache, nonspecific and then um scalp tenderness, jaw claudication, vision disturbance. Like to be honest, if we see these free description, you just link straight to giant cell arteritis, OK? Just go straight to that and also these as well like enlarged temporal arteries and you just go straight to giant cell. Um Yeah, systemically unwell. Well, yeah, I'm sorry, I shouldn't have highlighted that but like, you know, if they, these are combinations I need you guys to go, you know GC A OK? And the ma and one of the major one, the blood test result is raised ESRCRP platelet count. OK? So again, like this points straight towards um inflammation. Ok. And the gold standard um diagnostic um investigation is temporal bi uh artery biopsy, you know, just biopsy. Ok. We straight to biopsy and um we just have to and then like, you know, we have to give high dose um predniSONE as as soon as possible. Actually, even before we are, we are establishing the um investigations like, you know, like if we're unsure if it's show arteritis, we just give like, you know, sometimes we don't have to wait for the result, we give principal straight away um because it's kind of emergency. Um Yeah, so there you go, there you go. So right now um to head trauma and hemorrhage, right? G CS is a mus they love asking you about GC ss love asking you like, you know, oh patient um present to the uh A with um you know, um with spontaneous eye opening but with like, you know, in but they speak inappropriate words. Um and they also have like, you know, abnormal flexion. OK? What is the, what is, what is the G CS of the patient? Um They love asking that. So the way I remember it, so eyes, mouth and then limbs. Ok. So 456, OK, 456 eyes, mouth limbs. Um So four there, 44 max criteria and for these like, you know, four criteria, you know, oh, it's quite a lot but no, actually not. It's actually two OK. Each, each category you can actually just like, you know, subtract by two because like the, the top and the, and the top and the bottom one, the top is spontaneous normal, the bottom one is going to be none. Ok. You can see that all of them, the top one is normal. The bottom one is none. So technically for I you only need to like, you know, learn two of them lo explain, respond to loud voice or to pain. That's it. Verbal again to one only. We have to remember. Free confuse um for inappropriate words free. Um Inco inco hand sounds um too. OK. So only free and this one, you know, we have to learn for it's kind of, I don't know, it's, it's kind of easy like, you know, the bo so, so you know, localized is kind of localized to pain and then it's like, you know, um withdrawn um to pain and then, you know, um abnormal flexion and abnormal extension, the bone too. OK. Just abnormal. OK. Right. So 456 eyes mouth lips. OK. There you go. Um Please learn that. Um Yeah, they love asking you that and for G CS as well, please learn it um like, yeah, it's good to learn it as well. So between so 15 is normal, OK, 15 is normal but like usually like um 13 to 15 is considered mild, OK? 9 to 12, um moderate and less than eight is just gonna be severe. OK. Right. And, um, so before getting into medicine, um, I'd like you guys to like, kind of quickly go through about, um, a little bit of anatomy. So skin and then aponeurosis that you do have another and then the skull, the bone, OK. The main one I need you guys to learn is like meninges. OK? The meninges is considered is, um, um, made of, um, Jura Mata, the toughest layer, out layer, it's, it actually sticks like it actually like, you know, um it's uh it's like, it's, it's just like, you know, stick with the, the scalp, the with the skull, the bone, OK? You have to actually peel it off. Um If you actually want to separate your matter, you have to peel it off from the skull. OK? It's actually stick on the skull with the skull and then the bottom one arachnoid matter, it's kind of like transparent, transparent, not as like um kind of kind of kind of um matter. And then the PM matter pr matter just like, you know, you just stick with the, with the brain. It's like inseparable, you can't separate it. OK. Right. So hemorrhage, it is one of the most commonly asked stuffs. Um These, the like the slides, please remember, it's like one of the, some of the most important slide. So ju hemorrhage, OK. So Ural is um is outside of the Jura matter. OK? So it's between the Jura and the bone of the skull. Ok. So, between ju and the skull um is mainly main vessel, is a middle meningeal artery. Um Usually um there's like a, is something called the uh I think it's like, it's like uh the um uh uh it's like uh the little joint fissure. It's like the weakest point in scopes right here around the temporal region, usually like head trauma or like direct blow of the side of the head and it causes um is uh the um um breakage or damage of this middle meningeal artery? Ok. Um So, um yes, thank you so much. You have carry on. Yup. Thank you so much. Um So, yeah, and, and also um so yeah, middle meningeal artery, um when it they love ask you that which of the following vessels are most likely to be responsible for the extra dual hemorrhage, you just go straight to middle meningeal. OK? And there's something really interesting um for extra dual hemorrhage. So there's something called lucid interval. So uh let's say something, someone got uh something got strike in the head and then the their um middle meningeal artery broke and then the blood started leaking into the draw, the draw and the, you know, the the space extra jur space and then there's something called loose intervals. So the symptoms hasn't appeared yet, the patients still, you know, really alert and nothing. And then, you know, they, that's like, you know, that's uh like around like the first, like, you know, um, 30 minutes or, you know, it can be even an hour. I'm, I'm not sure. Yeah. I think it's around that kind of time. Um, they can be luci and completely normal but suddenly they just, like, you know, deteriorate and it just like, sudden lost consciousness. Um Yes. So it's called lucid interval. Ok. And for sub sub uh subdural um hemorrhage, well, they can kinda have loose interval but like loose interval is a much, much, much more common in extra dual hemorrhage. OK. Um Yeah, a subdural hemorrhage um between um the dual mata and the arno matter. So these two layer, OK. So um yes, uh the main vessels caused um to uh causing the uh subdural hemorrhage is the bridging vein. OK. Right. So, yeah, so the bridging vein and um it's often uh without um a skull fracture and also the smaller the brain, the higher the risk. OK? Because like they are more um prone to like, you know, there are more spaces in, in the, in the, in the skull inside the skull. So like, you know, if there's like um hit on the head, um it's gonna be, it has a much more um uh impact to it because it's smaller. It's not as compact as tight. So, yeah, it's high the risk again. Yeah. So, drill bridging fein. OK. I need you guys learn that. All right, subarachnoid hemorrhage. So it's inside of the arachnoid matter. So it's like, you know, this kind of region, ok? Between the Arachnoid and the brain. There's something called the thunderclap headache. It's like insane. Really pai really, really painful, sudden waves of pain of headache. Ok. It's called thunderclap. Um It's more commonly on if it's like on the occipital side, it's just called thunder clap headache. If it is, if the question again, it says thunder clap headache, you just go straight to subarachnoid, ok. Hemorrhage. All right. And the main um cause reason for this bleed for some retinal hemorrhage is because of the aneurysm rupture. Ok? And sometimes it, it's just like it's the, the, the aneurysm. So it's kind of like um it's, it's not really, it's just like, you know, sometimes um it's uh the, the, the blood vessels around here, this kind of region. Um usually, uh most particularly, it's kind of like um uh the angle in the, in the, in the um uh the ring on the circle of Willis. Um I hope you guys know that um it's like that sometimes the, the circle of Willis can have weak points and in making the aneurysm and the aneurysm can burst and the blood is gonna leak or like inside the brain spaces. Ok. So it's like, you know, causing the subarachnoid hemorrhage. All right. And um the symptoms, main symptoms are rapid co cola ra rapid um collapse, it just drops down very, very quickly. So, like, unlike ural hemorrhage, it doesn't really have lucid interval. Ok. And that's just, just like, you know, comes very quickly and um um maybe try to diagnose it before um the death, ok. Try to, yeah, diagnose it before the, the death of the patient. And also um a lot sometimes um they can give you a CT scan um like that and then ask you what is the likely diagnosis for extra dural hemorrhage? You can see it is more circular. OK? Um uh Unlike this one, subdural is more flat. The reason is that is um dual matter. Again, as I said, the ju matter, it sticks really hard um to the skull, to the bone, OK? You have to peel it off, you have to actually peel it off hard to actually separate between the dura matter and the skull bone. OK? So that's why, you know, it's like, you know, the layer is really tough, it's really hard to separate. So, you know, it's just gonna be, it's gonna be this shape, OK? And like this, it's a subdural, the subdural, the sub, you know, like around the draw and the Arno Jura and the arachnoid matter are not, they're not sticking together. So like, you know, they can just be easily separated. So we can see it's a lot more widespread like the the blood clot, the collection of the blood. OK? So please learn that. So please please please again, um it is just like um uh uh a comparison comparison. And also, you know, um they are um a lot of the time they don't actually need the questions. They don't give you the CT picture. They just describe it to you. Oh, CT scan is a crescent shape. Uh So basically you just go straight to a subdural. If it's like an egg shape, you just go straight to epidural. OK. I don't care. OK. You just go straight to it. And the major, major thing I also want you guys to know is whenever there's a head trauma, you al it doesn't really matter if the patient is experiencing any symptoms. Um You know, it's uh of course, now, if, if the patient experience any symptoms, of course, like, you know, make it more obvious you always ct head first, always, always, I don't care. You always ct head first. That's the first thing you need to do when a um head trauma patient comes in. We have to exclude and confirm that there is no or there is um you know, um head trauma or hemorrhage. Ok? And if we actually confirm um subarachnoid hemorrhage, um we need to do ac T angiogram to confirm exactly where it is because like, you know, unlike um um it subdural extra dual, we can see exactly where it is subarachnoid hemorrhage is inside the blood vessels inside the brain. It is i inside the brain that's causing damage. So we have to make Sure. Exactly. No, where, where exactly the, the bleeding is. Ok. So we have to the CT angiogram. Um, I mean, there isn't any treatment for, you know, like in the essence, there is no medical treatment for hemorrhage. You're not gonna give paracetamol for patient with hemorrhage, obviously. Um, and usually, um, it's like something called calling or clipping. Ok. And, or usually, um, or like, you know, co treaties, you know, it's like, like burning the, the, the um the wall of the vessel, hopefully, you know, it just like, um you know, it's a like a hole and it just like, you know, kind of close um the, the um vessels together, ok? And if it's like Subhi hemorrhage, we also like to give um um mon to kind of prescribe uh the facial spasm as well only for Subhi hemorrhage, ok? We don't give um monin for um um E DH and S DH. All right. And there's like, usually um these that there are two types of impact as well there. Cube and then the counter group. So count group is like, you know, the um you know, the head is like go forward and then it's like the, the rebound, the recall when the brain is like, you know, going backwards, that's the count and counter coup. So I just, you know, want you guys to have that in mind for and there's something called a diffuse external injury. The reason why I put a bracket because like, it's not necessarily caused by trauma, but it can also caused by trauma as well. You know, it's quite common. So, um, uh, you know, uh, diffuse external injury, it's a widespread, ok, widespread, um, external injury. It's not like a pinpoint, like, unlike, um, this kind of, um, injuries where it's like exactly the pinpoint, um, of the site location of the injury in the brain. It's widespread all around the brain, ok. So it can cause by trauma, hypoxia ischemia, hypoglycemia, hypoglycemia as well. And we can only only diagnose it. We're using micros microscopy. Ok? That's like only diagnose like um only investigation to diagnose the it like to confirm the diagnose um diagnosis. Ok? Um For the most common cause for the traumatic um diffused exon injury, the road traffic accident um fall from height and then usually like, yeah, so usually you see like rotational fall from height, a road traffic accident. Um It's kind of common now that it's gonna be diffuse, diffuse external injury if there's no um any bleeding like in the CT score. Um uh yes, so basically just anything that's like causing the sharing of exon. Ok. Basically just exon it just kind of like got it. Um and unfortunately, it's kind of sad because like um victim with like diu diffuse um external injury. If it's like been established, it's very likely that they unconscious. Um So yeah. Um so these are like the common site for um, diffused external injury. I don't need you guys to learn that. I highly, highly doubt they're gonna ask you that. All right, for stroke, stroke is also a massive one of you guys to pay a little bit more attention as well. It's quite important. They love asking you strokes. OK. Right. For stroke. Um, so basically, yeah, sudden onset of ischemia lasting more, more than 24 hours. OK. Less than 24 hours is transient ischemic stroke, ti A ok. Um Right. So um 55% majority of a stroke are actually ischemic. OK. Ischemic. So something like, you know, there's like a blood clot um inside the blood vessel, there's like a blockage inside blood vessel, hemorrhage. A stroke is actually not as much as common, you know, hemorrhagic is like, you know, s DH like these kind of strokes like traumatic ischemic, it's just like something blocking their vessels, ok? For ischemic stroke. Um the most common one is um um carotid artery um and uh hemorrhage stroke. Yeah, just trauma. And I, yeah, don't learn these by details. I just want you guys to give an idea. The main thing I need want you guys to learn is transient ischemic stroke and like majority of the stroke are ischemic. And also it's like, you know, um strokes like sudden or focal um you know, more than 20 it's more, more than 24 hours, ok? Less than it 24 hours. Is transient, it's ti a right here is just like a brief, really brief summary, summary. Um uh not summary but like de and uh and and an anatomical description before I get into detail. So, anterior circulation um is uh uh is um you know um and is in, I know how I say it like, you know, internal carotid artery apologies. Um They're responsible for their um internal circulation. OK. And also um anterior cerebral artery, middle, cerebral as well. And for the posterior circulation of the brain, um vertebral arteries, you know, and then basilar vertebral artery, um these two and then um the three pairs of cerebellar artery and then posterior cerebellar artery as well. Ok. So the main one, you know, uh uh anterior, internal carotid, anterior middle, that's it, you know, the rest basically just posterior and these are like, you know, um so um city angio I just want, I just want to show you, you know what, what it's like, right? They also love ask you about physiology. I'm, yeah, my apologies guys because like these um lectures are only gonna mostly include like um medicine. Um They're also gonna ask you quite a lot on physiology as well. So please don't forget about it um to study physiology. Um for frontal lobes. Um I want you guys to just remember mainly motor memory and higher connective function. That's it just mainly motor and a high content function. Ok. Um For parietal lobe is sensory. OK? Just sensory. OK. And also like you just anything to do with sensory um majority of the things do is sensory, my apologies, majority. Um Yeah, most things that do are like sensory, temporal. Um um Yeah, something to do with like auditory. Um Yeah. So uh and also like, you know, uh this is that's the main thing and there's like the other stuff as well. Speech. Yeah, as well. Um wordings. Um um but like the main one, auditory, OK. Um For function occipital lobe, um fissure is the major major one. OK. This fissure is the major one. And also they kind of like in true smooth eye uh movement. So it's kind of like, you know, like correcting eyesight, OK, cerebellum uh balance um and uh kind of like involuntary postural control as well, like your posture and anything and your coordinations as well. OK. For breaks down, it's just basic functions like breathing, heartbeat, swallowing, conscious consciousness, um something like that eye movement, just like the basic um human stuff. OK. Right. For the location of stroke, if it's an anterior sey. Um and it's very likely that um you know, the, you know, there's gonna be a, the leg weakness is gonna be greater than arm weakness. So, again, like, you know, I want you guys like, kind of like, um uh know, like um have an idea, have a good idea of like, you know what these are like you don't have to learn like, you know, these like I want you guys to have an idea and I kinda explain the reason why and the stroke occurs in the middle of artery. Um It's most likely it's gonna be face and arm and the the weakness on face and arm is gonna be greater than um the leg weakness. The reason why it says is because like you see here around here, this region is middle cerebral artery and this top and the middle region, this anterior cerebral artery. OK. So middle cerebral artery is just on the lateral side and middle of the, of the brain. OK. So again, you can see, so this here is around is supplied by the middle cerebral artery. So right here, yeah, OK. Cerebral artery. So it's gonna be um responsible face and arm and then for the top part and the middle part. So right here it's gonna be responsible for the leg and arms, you know. So, so, but, but uh obviously like, you know, yeah, so like that, I, I hope you guys, I I kind of doubt they're gonna ask you that but like I, I want you guys to keep that in mind. OK. And poster artery responsible for this um area. OK. Right. So there are um four main classifications for strokes. OK? It's kinda like the, the also classifications um 00 CS P. Um So they love asking you that please learn it as well, please, please, please. Um So um for the total anterior circulation syndrome, so tax it is all free, all of the free. Ok. So hemiparesis. So basically just like one sided um uh uh weakness. OK. And also one higher cortical function. So something like difficulty speaking or dysplasia, um you know, speech in, in uh deform, like uh impairment and also um facial spatial neglect as well. So like, you know, um if there's like, you know, um there are two things uh right on, on, in front of the left and right, you know, um I will neglect uh I, I will not be able to see one side of the thing depending on, you know, which stroke um you know, um which side of the stroke occurs up. Ok? Um So, and also um uh so basically, uh yeah, homonymous hemianopia. So, basically, again, um it's kind of similar to neglect but like, you know, it's basically the official field, one side of the fi field is completely gone, ok? That's kind of the reason why it's like, it's kind of neglect reason why for neglect. And uh um and then the, the cost of the, the um the reason for the um the blood vessel, I don't think you guys can learn it, but it's also very important to like, you know, so important. Yeah, but like, you know, I hope you guys can like, you know, um that in mind as well. Like the most important of these for like, you know, the, the clinical features. OK. Right. For the partial partial is like um uh higher critical function for these two or any of these two. OK. So like it's not all free, it's not all free, all free is tax, OK? If it's like just two, it's just gonna be like, and any of the, you know, um if this patient that with like high co co dysfunction or um hemiparesis or just like, you know, um uh dysfunction, hem um that's gonna be um pa just just two symptoms. Ok. If it's all free, it's gonna be tax. Um like again. Yeah, and then uh post circulation isolated just like just one of like, you know, just just one. and then Lacuna syndrome. So it's kind of like, it's like really, really, really small vessels, really like this tiny, like small blood vessels that um you know, um supply to like certain area of the brain. Um it's just have like either pure motor or pure sensory or just any of these pure atta um ataxic um hemiparesis. Just one. Ok. Right. And the main two just like these two, please like, you know, like please learn these two, please like inside out um Right. Ok. For stroke. Um so there are something called the positive and negative symptoms and stroke only has the negative symptoms. Ok. Negative symptoms are like loss of function. Ok. Posy, positive symptoms. Are like the extra, like, you know, the overexaggerated because like, you know, something that's causing the overactive, the something that's causing neuron to be too active. Ok? Something like migraines. Ok? And seizure that's, they have positive symptoms because like they're neurons just like keep over firing too much. Ok? For strokes because like the neurons are dying. So there can be negative symptoms because they're losing functions. Ok. So if there's like something like, you know, oh jerking, um, you know, it's, it's very unlikely that it's gonna be stroke. Um, basically it's like, oh loss of sensation, loss of vision loss, sensation, like a reduction in uh, blah, blah, blah. Um, it's gonna be stroke, ok? Like migraine is very unlike, it's, it's, they're not gonna have that. Ok? Se as well. Ok. And also fun facts only like 60% of the patient with stroke symptoms have stroke. So like, you know, a lot of the time patient comes in with like stroke symptoms, you know, it's not like, you know, we, we just like, like discharge them but like we still have to treat them, you know, but like, yeah, it's just a fun fact. It just, it shouldn't change your, you know, um, your, um, priorities. Ok. Right. Investigations. Um, CT is not, of course, it's a mu is the first one and then some, uh ro routine blood, uh, blah, blah, blah. Like, you know, it's just like that and the most, most important one, you know, aspirin, heparin and then something called A TP A, you know, it's kind of like thrombolysis. It just breaks the clot and aspirin heparin, they're antiplatelets. They don't, I, I don't, I don't think, I really don't think they break the clot like thrombolysis. They actually, they have Aspirin heparin, they prevent the clotting TP A is just like they actually breaks the clot. So it is very, very, you have to be very careful and gain all the consent before you use thrombolytic. The TP A because it's kind of dangerous. Ok. Um So there are criterias like you like, you know, um for using TP A, it's like that. Um it's also good to have it in mind like I don't, I'm not sure if you have to know it exactly. Like also you have best to keep it in mind. And also, um I also don't think you can need to know this for too, too deeply. Um Just like, you know, if there's like a recent surgery or recent blood um blood um blood loss or like recent hemorrhage, please please don't use thrombolytic because, you know, um recent, let's say like, you know, recent surgery or recent um uh hemorrhage, the blood vessels, you know, is, is clotted, you know, the the the wound, the damage of the blood vessels is clotted with the blood clot, you know, there's this wound. So if that's like if you add thrombolytic to the patient's body, you know, they're going to break the wound inside, you know, the the surgical site or the recent hemorrhagic site, it's going to bleed again. So please don't. So please please be careful with this. Ok. And again, please don't learn all of these. Um, and I don't think you have to learn the severity as well, but I just need you guys to know if we have to assess stroke severity. There's a system called NIHSS. OK. Please please don't learn it but know it like please learn that the assessment is called hinnihss for stroke severity. Ok. Yes. Um for spinal cord um pathologies uh right. So myopathy, myopathy is le like, you know, there's lesions, it's at, at the spinal cord um retinopathy, um re sorry. Um radic radiculopathy when lesions is at the spinal root. Ok. So the root is different. Ok. Yeah. The way I remember is, yeah. Um radiculopathy, you know, are are ro right? Most a sign for spinal damage if it's a upper motor um lesion. Ok. Upper motor neuron lesion. Um uh it's gonna have everything is just increased, ok? Increased muscle tone, increased reflex. The muscle mass is is not increased but like it's retain like, you know, there's no atrophy. Ok? Uh and the main cause is stroke, lower motor neuron lesions. Ok. So um everything is dropped, it's lower, it's dropped. Um like there's decrease, absent, decreased um muscle tone, decreased reflex and then there's a decrease in muscle mass, like, you know, atrophy and also you have Babinski sign. So it's like, um, it's very common. They'd like to ask you that as well. So, basically the normal, if like, there's like a stick, they run, you run at the, at the bottom of your feet, um, you know, the run and the, and the, you know, the bump up, you know, they good usually, uh, that's like, it should be like um toe flexion, but if it's like ba sign, ok, that's like a toes like AAA normal big toe dorsiflexion. Ok. Right. So, um yeah, again, retic opathy or myopathy, the gold standard is MRI CT or x-ray is extremely difficult to spot um spinal damage. Ok? We have to go for MRI. MRI is the only way for diagnostic um investigation and also um have some, it's good to keep in mind. Um uh B 12 deficiency is most is ca it's very common cause of myopathy. It's not the most common, it's very common and um you know, to treat it just um intra intramuscular injection for B 12, right spinal stroke. Um I just want you guys to know the most common is anterior, anterior is the most commonly involved. Ok. That's it. That's all I need you guys to learn. OK. This is the juicy part. Um I dislike something uh that is uh when I was second year, it's not easy for me to grasp. Um So you understand. Um right before yeah, so I'm just gonna go for it. So, lateral spinal thalamic right here um is for pain and temperature, OK. Dorsal colon, dorsal column. Um it's just like uh it's just sensory, other sensory and um descending track. OK. So corticospinal or pyramidal um is for just, just motor. OK. And again, um you know, to understand why the name as well, the reason why it's called spinal thalamic is because it's, it, it, it travels from the spine to the thalamic. So it's going to the brain. So spine to the brain. OK. So it's ascending, ok. Spinal from spine to the thalamus of the brain. So spine to brain, OK. Go up and, and uh the corticospinal from the cor from the from, from the the cortical layer of the brain to the spine, from the brain to the spine. So it's going down, OK. So it's descending. So it's gonna be MTA because it's going from the brain to the body. So it's gonna be motor, OK? Right? Traveling pathway. They love asking you that as well. The site of um um the ation like um it, it some also called like, you know, um the crossing over. Ok. So um for corticospinal tract, um they because they cross over at the pyramid. OK. Please learn it. Please. I beg uh if you don't learn it, I will come to your place personally. I know where you live. Um Those are column um, if they cross at the medulla, ok. And the lateral sp um spinal thalamic, they're very different. They, they just like once they get into the spinal, the, the, the spine, they instantly cross over, they at the cross over at the same level. Ok. That's, please learn that they cross over as the same level. Once the natural spinal th tract gets into the spine, they instantly cross unlike these two. Ok, like these two, you know, they kind of like, you know, they just like, you know, they only cross at the um uh this one is for the pyramid and this one is like, you know, uh the medulla, it's kind of around like the brainstem region. OK. Right. So the right side and the left side, OK. So this is a picture. So let's say there's a lesion occurring here, OK. The lesion is occurring here. So, because it is before it's above, OK, above the decussation above the crossing over point. So it is like before, like, you know, kind of before the crossover. So, um if the lesion occurs in here, this is like, you know, the left side and this is the right side. Um So this is gonna have a contralateral, a contralateral because it's above the um ation. OK. So we like left-sided lesion. So it's gonna have right-sided paralysis. OK? Because it's before the crossing over. However, if you go down, OK, it is after it's the cervical spine So it's below the, the pyramid. Ok. Below the pyramid. So it has already, it has crossed over, unlike this one. Unlike here, it still hasn't crossed over yet, but here they have crossed over. So it is after like it, it's below the decussation, it's after crossing over. So it's gonna be ipsilateral the same side, um, uh, lesion. Ok. So it's like if it's like left side here, um, you know, it's gonna cause, um, left-sided paralysis. Ok? And for this one, again, it's the exact same, it is below the crossing over. So it has crossed already, it's already on the same side. So it is, if there's like left-sided most lesion, so it's gonna cause a left-sided paralysis because it has already crossed. Ok. It has already crossed, it has already passed the point of the dec in the pyramid. Ok. This is below the pyramid. All right. So, again, for this one, um, this one is the, the, the, uh, the dorsal tract. Um, so dorsal tract again, um, if there's like um, the lesion that the crossing over is at the, uh the medulla, if the lesions occurs in here, it's above the excision, it's already crossed. It has crossed over. It has, or it is already on the other side. So it is going to be a contralateral. Ok. The contralateral, um, uh um, neural deficit. Ok. So, yeah, again, if it's like the left-sided lesion here, so it's gonna affect the right side, it's contract because it is after, is a, it is already crossed. OK. So it's after, um, after the decussation above the des OK? For this one, OK. After it's crossed. So like, you know, the, uh, you know, below the decussation, it is gonna be ipsilateral because it has crossed already. It crossed. OK. It's below the decussation point. So it has crossed. So they are gonna be on the same side again. for this one. They're not, they haven't, they hasn't, they haven't crossed yet. So they're gonna be on the opposite side. This one they have crossed over. So gonna be the opposite side. So it is contralateral. Yeah, ipsilateral, sorry. Um uh So yeah, it's just like left-sid lesion that kind of causing, you know, left-sided uh if natural sensory loss. OK. OK. This one's a little different because this um uh is a um this one is uh s uh spinothalamic, spinal thalamic um slash the spinal thalamic. It cross over right at the instant it gets into the spinal cord and like, you know, the other two is it, it, it cross um you know, on the brainstem, it doesn't like this one. Spinothalamic track. It cross at the same level. It cross at the same level. Please learn that. Um So, um this one uh uh is contralateral. So, um if, let's say the lesion is on the left side, OK. It is before the crossing because, you know, it's the, the crossing over is at the very, very bottom, you know, it's like, it's like, uh at the site of, um, you know, the, the enter, um, of the neuron. So, um, yeah, again, before it's gonna be contralateral because they have not crossed over yet, they have not crossed over, they are still on the opposite side and this one on the cervical spine. Um, again, it is unlike, um uh the, uh the other two that I just said, um the crossing over is not on the, the brainstem for spinal thalamic. So it is still still contralateral because it, we haven't reached um the location of the crossing over yet. OK. So this one, it is still contralateral. However, if the lesion occurs in here, OK. Um So after they have caught crossed over, it is going to be um uh the uh ipsilateral. OK. Right. Can you, can I go back to your previous slide? Um This one? Is that what you meant? Yeah. Or which, which side are you talking about? Um Right. We're, we're just gonna go for it. Um Right. So this is a summary, this is a summary for, for you guys to like uh for us uh for the revision. OK. Right. So this is the Brown Syndrome. So, um you know, uh 00 yeah, everything I just said is called the Browns Cross Syndrome. So, um you know, uh I um this like I, I this these, I like the explanations. Um Again, um uh Yeah, I'm, I'm not gonna go like, like, um uh into depth again cause like, you know, um because of the time, um I want you guys like kind of like, um uh test yourself um in your own time. Ok. Um If you guys have any under anything that you don't understand, please feel free to email me. Ok. Right. And there's something I'd like to go through something called a molecular mercury. So basically, what happened is that? Um so it uh for um um Gulen Guin uh Bari syndrome, uh I'm not sure how to pronounce it. I'm really sorry. So, basically what happened is that um uh that's the um the patient usually have like a, like a anti what like they have ingested some uh pathogen usually mainly can bacterin. So like something like raw meat or like some, I don't know. Um Taco Bell, I don't know. Um uh they created, you know, antibodies, you know, uh against this pathogen usually can bacter A OK. Um However, the anti antibodies that is like produced um you know, which is like, you know, acting or attacking the, the Campylobacter also attacks the nerve cells, the myelin sheath, um sheath, um specifically, OK. So they kind of have the same um the, the binding sites. OK? With the Kappa Veter. Um So, um you know, um they got confused and they attack the, the nerve and that's causing the neuro damage um and the two main, two main major um signs. OK? Is the um they're acute, OK. They're acute because the infection um you know, um sme is symmetrical as well, you know, um like usually, you know, if it i it's not really natural, symmetrical um because of the antibody, you know, like just all around the system has to be symmetrical. It's ascending as well ascending. So you come, it, it will um start at the bottom and then it goes up. OK. It affects both sensory and the motor. OK. Both sensory and the motor. All right. And, and also second point is um previous gastroenteritis. So let's say that previous uh patient came in with like, you know, um uh history of like sensory loss, gradual sensory loss and then they had previous um you know, stomachache or like, you know, vomiting um four weeks ago and you know, um if he says that just go straight to Guilin Barry Syndrome, just go straight to it. Um You don't even have to look at other options. Um uh And for treatment you give IV um immunoglobulins, then that's like, you know, that's like um um stopping the antibody. OK. Right. So muscles and nerve diseases. Um My ace graphics is kind of a big one. I don't need you guys to learn the entire pa uh pathophysiology. It's just to help you guys to understand. So, um basically, what happens is that the moon cells produce acetycholine receptor antibodies. So the antibodies that you just attacks the acetylcholine receptors. Ok. In the junction, like especially the post cytic neuromuscular junction, OK? Between the nerves and the muscles it's like. Um so it's basically uh on the, on the muscles. Um So postsynaptic neuromuscular junction, OK. So it's just gonna blocking the uh action potential to travel to the muscles. OK? And the major major one is fatigue, fa fatigue weakness, ok? So, you know, it gets tired in repetitive motion, ok? So like, you know, the more you do it, you know, the the more tired you're gonna get. Ok? And sometimes you're gonna get ocular and like, you know, these kind of symptoms as well, right? Um And uh for investigation, like again, like if it's like fatigue, fatigue weakness, it's very likely to, you can just go straight to my senior graphics. OK. Right. For investigation, there's like these two antibodies. I really hope you guys can remember that. And the, and then the, the third major thing is thymoma, myasthenia graphics is strongly, strongly linked to thymoma. OK. So yeah, so this is a ct chest. So like, you know, if something, some pa patients comes in with the my grafts, it's, it's likely that they're gonna have thymoma, high chance, high chance you're gonna have thymoma. Um Yeah, so um the treatment cholinesterase inhibitor, prednisoLONE. Ok? Um These are like the two main ones. Ok? Um I kinda, I don't know, uh, well, disease, disease modifying, um, you know, steroids, immunosuppressants, uh, immunoglobulins. Um, you know, just, it just kind of try to, like, suppress the imm immune system, but I don't need you guys to learn that. But, you know, just an idea. I mean, it kind of makes sense because it's caused by like, kind of autoimmune as well. Ok. But the main one, fatigue weakness, these two, anti M US K antibodies and uh um and the uh the uh the the antibodies as um the ach receptor antibodies as well and also thymoma. OK. Right. Number 18 syndrome. So um main thing I want you guys to learn is it related to small cell lung cancer? It's kind of similar to this one, but this one is related to small cell lung cancer patients. OK? And the antibodies, you know, um just kinda attack. So at these are like, you know, the lung cancer cells, they have these photos gated cal um these um um calcium channel on them, on these uh cancer cells. And you know, um the uh the our immune system recognized it um it to try to attack it but you know, these antibodies just, you know, they, they, they got a little bit confused, you know, they got the right spirit, they, they just a little bit confused, they attack our normal cells. Um um photog photog calcium channels. OK. Right. So, and the main difference is it improves with a repeated movement. Remember this one? Uh MG my graphic it it get worse, you know, fatigue will weakness like the more repetitive you do, the more fatigue you get. But this one is the opposite, the more you do it the improves. OK? Um For this one, I don't really need you guys to learn the drugs. Um I, I read out the, they're gonna teach you, they're gonna ask you about the drugs, but like, you know, I want you guys to keep that in mind as well, right? Um uh mo neuron disease um also also known as um A LS. Um you guys probably did that challenge without knowing that this, this condition. Um You know, when you guys, I know like, you know, 12, I don't know, I didn't get asked. So it's kind of sad. Um Right. OK. So um yeah, these, these are like um general symptoms um uh for the mone disease, it's just like muscular kind of like sensory like you ba no middle, like basically like um mota sorry, there's no sensory involvement. Please remember that. Um It's only as uh attacks um the the motor combinations, upper and lower motor neuron signs remem remember upper motor neuron signs. Um you know, the uh increase of uh you know, the the the um reflex and blah, blah, blah. And also want you guys learn um uh this one on the drug for motor neuron disease. Uh I don't think uh, it's unlikely they're gonna ask you. But like, you know, it's like, it's, it, it is really good to have that in mind as well. I mean, it's only one drug. I mean, come on guys, please. Um, just do that for me, please. Right. Degenerative disease in cns dementia. Ok. So dementia is just progressive and then, you know, impairment. Ok. And, um, the main, main major cause for dementia is Alzheimer's. Ok. Alzheimer's and the pathology, beta amyloid plaques. Ok. And the, uh, the neurofibrillary tales. Ok. And, and for investigations, you know, we do, um, a mini mental, uh, mental state or, or we can, we should, we also do MRI as well, kind of see like how, how the, uh, the sometimes, you know, the, for dementia, the brain is gonna get atrophy, you know, it's gonna just gonna shrink the brain actually shrunk. Ok. But however, like these are the screening tests we do, ok. Um, and, uh, the, um, uh, treatment for Alzheimer's, um, I mean, yeah, it's just trying to like, you know, stop the symptoms. I mean, there's nothing we can do. The brain is fried completely fried already. So that's the only thing the best we can do is just a cholinesterase inhibitor. So, you know, try to, um, prevent the, the, the acetic colon from, um, being, uh broken down. So just like maintain, like, try to keep as much, um, acetylcholine as possible to maintain, to like kind of improve symptoms and then uh an MD A antagonist as well. Ok. And for Parkinson's. Ok. Right. Parkinson's there are quite a lot of key words, pro progressive um so reduction of dopamine, that's the main pathophysiology, dopamine drops. Ok. Um ok. Just like that. Just patient just does not have enough dopamine and also like it's caused by something called the Lewy body. Um don't get confused with like, um you know, uh Alzheimer's, you know, space amyloid. This one is Lewy bodies, OK? At the basal ganglia. Ok? And the symptoms are asymmetrical. Ok? It's not on both sides, it's asymmetrical, it's only one sided. Um So only one side but like one side affected more and another a lot more and a classic triads. Please please remember this resting tremor rigidity and Brady kind. Please learn that. Please please remember that. And the main performing drugs. Um are these are these four? Um It is nice they can ask you that. Um you know, it's nice to like know these drugs as well. Levodopa, comma Hibi dopamine antagonist, uh agonist. Sorry, my apologies. And then um just know like, you know, um recognize like you don't have to learn like the name like the drugs, like just recognize these as well. And also they can also ask you like the side effects as well. Um Yeah, also, yeah, I'm sorry. Um The main, the the a main aim for Parkinson's treatment is just try to increase um the the dopamine function. Ok. And also um the main side effects for and um dopamine agonist uh is uh pulmonary fibrosis. Ok. Right. For the infection of nervous system. So we're gonna go through meningitis, um encephalitis and myelitis. Ok. Again, meningitis, inflammation of meninges, encephalitis, inflammation of the the brain substance and um and myelitis. Um you know, am so it's kind of related to spinal cord inflammation, infection of the spinal cord, right? Meninges, men uh sorry, the um meningitis, my apologies. Um Classic triad, please please learn it as well. Fever, stiff neck or mental state. If you see this free, just go straight to meningitis. Ok, please. And then um also something called the meningism. So uh it's like stiff neck photophobia, you know, there's sca of light, light. Um you know, they're just like um uh it can trigger symptoms um and nausea, nausea, vomiting as well. And then skin rash is very common in men meningitis. They always ask, they always say, oh it's usually in Children as well. Uh meningitis, ok, Children. And um if there's like meningitis um happening, it's very common, very likely that it's gonna be rash as well. Ok? And there are two signs. Um it is unlikely that they're gonna tell you guys about like ask you guys about the science, but like these are like mnemonics to, you know, for your um you know, further study purposes and the common uh you know, I want you guys to learn these as well for um the common um causative agents, uh agents. Um is uh Neer meningi meningitis and then strep pneumonia and also strep ayla. But strep ayla is more for neonate neonate. Ok? Like newborn baby. Ok? And for viral, um, it's an enteroviruses, ok? Like these are like the most common and to treat bacterial meningitis, um uh cefotaxime. Um and also you also need to add um amoxicillin as well. And you know, if they are like, you know, maybe like um if they're not uh uh sensitive, please um switch it to um vancomycin, right? Steroids. We give dexamethasone um for uh encephalitis. Um the symptoms is kind of similar but they don't really have like um uh uh you know, these three kind of like, you know, this kind of like we have, I don't think they have too much of a stiff neck and anything stiff neck is kind of big one in meningitis. Ence is just kind of like flu-like symptoms and then like some kind of neurological um symptoms as well. And usually anis are caused by viruses and the two main ones are herpes simplex virus and also um albo virus. Um and uh yeah, and for treatment, just antiviral CYO. Ok. And yeah, and there is also something called autoimmune encephalitis. It is a, it is as common as the viral encephalitis. Ok. And please uh there are two important antibodies. Um, you know, anti fun potassium channel and also anti N MD A receptors as well, right? So how do we differentiate that? Um So first, um you know, um bacterial meningitis, you know, um cell count neutrophil. Um obviously, because bacteria neutrophil, viral lymphocytes. Ok. And the CS F and glucose, um the way I remember it, you know, bacteria, they love glucose, you know, I mean, they have to use glucose for res um you know, uh respiration and so they're gonna be reduced. Ok. The viral, you know, it's just gonna be normal because they're not like actual organism. Bacteria is actual organism, protein, you know, and remember it kind of opposite to glucose if the glucose is low, you know, protein is gonna be high. So like bacterial, you know, low glucose is gonna have high protein and this one thyroid is gonna be slightly increased protein. It's gonna have high because like thyro is protein as well. It's gonna, obviously, it's gonna have like slightly increased protein as well in the CS F. That's how I remember it. But that's not a cause for like, you know, um that's how I remember it. And yeah, and um and uh lumbar puncture is like some of the major major investigations that we do to confirm the diagnosis. And however, there are some contraindications for lumbar puncture. But I really don't think you guys need to learn that. Uh but like, you know, just keep that in mind as Well, you know, if it's like focal lesion, like, you know, something like focal brain mass like tumor or the reduced consciousness may be causing, you know, a brain bleed or something that's, you know, um suggesting a raised intracranial pressure, we do not do um lumbar puncture, ok. However, like, they're not gonna like kinda like say this kind of contraindications, we just go main uh uh you know, investigation lumbar puncture, OK? For both uh meningitis and encephalitis, right? Multiple sclerosis is also kind of a big disease as well. They like to ask as well. So, um for the pathology, it's kind of, it's basically just like gradual demyelination, it's chronic. So it's not acute, it's, it's chronic and progressive demyelination of the demyelinated neurons in the CNS. This. Yeah. And then basically causing um so it's basically caused by um inflammatory process um by T cells. OK. So tt cells just like just, I don't know, just mess up the myelin um for no reason for fine. Uh you know, for fun, I guess. Um it's described as um um disseminated in times and space. It basically means that the lesion can differ in location over time. You know, the the the symptoms can changes over time usually, you know, I'm young women. Um Yeah. Um So the main, main presentation, a case optic neuritis with the optic neuritis, especially in second year exam. Neuro is very likely it's gonna be um multiple sclerosis. OK. So what optic neuritis, you know, large blind spot pain when you move your eyes, um and also impaired color vision as well. Um With see optic neuritis is second year exam, especially um multiple um sclerosis. Ok. And with like other neurological symptoms as well. Uh eye movement and again, yeah. Um and I ST something called a charco um neurological Triad. Um If you guys remember, I, we also mentioned the Charco triad yesterday, last night sessions. Um you know, it's a charco it a biliary obstruction, but this one is neurological. OK. So next time was um this intention. Tram blah, blah, blah. OK. Like the main one I want you guys to know is optic neuritis and other um you know, um uh neurological symptoms as well. Uh The gene, um the cause is usually um H I AD R two and then um the Epstein Barr virus, OK. Um This sign you don't, I don't think you need to know, like I don't think they are, they would, they require you to know this um sign but like, you know, in the future, if you are like goes into like 4th and 5th year, they're probably gonna show this. Oh, that's a shock. There's like, you know, this kind of sensation. Um you know, it's, they're very unlikely this is gonna show up in second year exam, right? So, um there are four patterns they love asking you that there has to be at least one question. Um, um, they're gonna, they're gonna describe the symptoms. So like, you know, uh, the most, um, common one, relapsing, remitting. Ok. So, yeah, it's just like, you know, um, for relapsing, remitting, um, it just like, suddenly get worse and it got better and it stops over time. Ok. And then after a while it is, the symptom flares again and they kind of like drops back down. It's not as serious again, but like there's still like her symptoms and then it just goes up again like that. OK. It's kind of relaxing but we meeting at the same time, but like they, it has a like in the general gradient of like, you know, symptoms get worsened but it goes up and down. OK? And for second, you progressive, you know, um it is similar, very similar to relax and remitting. But after a few time after a few uh few flares of the symptoms, it just goes straight up. That's no remitting at all. OK. So that's secondary progressive, primary progressive, easy, just go straight up. There's no evening. It doesn't give a yeah. Um it just keep going, it just keeps going, keep worsening, progressive relapsing, you know, um there's no like, you know, stabilization, it just like, you know, even though this can be like, you know, a little bit of stabilization, it just keeps flaring up again. So it's kinda like happening at the same time, you know, flare up and then it keeps worsening, flare up, keep worsening. Ok. It's just like the acceleration, not as fast treatment for MS. So it, you just use like disease, modifying drugs and biologic the therapy. The main one, you know, um subcutaneous or intramuscular injection of beta interferon. Um And this one, I, I have no idea how you answer. Uh like, you know, so I don't even know who made this name this man like anyway, yeah, just these two and um and then like oral treatment for these um I ple uh yeah, I don't need to know the second line. Um Yeah, like the beta interferon is the main one. OK? Like these three just have that in mind like beta interferon is the major major one. OK? Um If it, if it's like acute relapse like acute flares of, of uh MS like if it's uh for acute or very severe um you know, you give uh metha predniSONE like steroids, OK? Now, if it's like really, really severe or like oral fail, you give it to IV. OK. Again, prednisoLONE steroid steroid is gonna be im suppress your immune system. OK? Again, the reason why MS you know, autoimmune, OK. Just again during the rule of thumb, um autoimmune condition, we you, you just suppress their immune system by steroids or immunosuppressant epilepsy is another big one as well. And before I go to epilepsy, they like to ask syncopes as well. Syncope. So they are a general free type of syncope, first one reflex, OK, reflex kind, uh known as um neurocardiogenic. Again, usually kind of like, you know, coughing or like taking blood like something to do with like BP. Um you know, something like that also like, you know, um uh no, no something to do with BP. Sorry. So like, you know, taking blood, so like, you know, just sudden change, sudden change of BP, orthostatic. Ok. So, dehydration um and hypertension and endocrine and then cardiogenic um arrhythmia. So something like the heart cause of the the um the uh the um yeah, the causing symptoms, right. So epilepsy, epilepsy is not like uh just one single disease. It is umbrella term to describe like, you know, multiple like, you know, some kind of seizures. Ok. Different seizures and there are a lot of different seizures that I'm gonna go through. Um It's just like it's just kind of describe like abnormal activity on in the brain. Ok. Right. Classifications. The main one like, you know, like generalized seizures is just like, yeah, it's just like uh absence and generalized tonic clonic. These are the two main ones I want you guys to know um for the focal seizures, um you know, simple partial seizures, complex and then just like and localized as well. Frontal seizure like, you know, these are the 23 that you guys um I hope you guys know as well. And right, for general tonic clonic seizure. Ok. It is the most stereotypical that's like what we actually think about like what we imagine seizure is gonna be. It's just like the patient is gonna lost consciousness. It's just gonna start jerking, ok? Um Like muscle jerk. Ok. My apologies. Um So um the patient is gonna present with tongue bitting, biting um and also incontinence as well in the grinding as well growing as well. Um And yeah, they love to say they love to ask you like, oh patient present with like seizure like, you know, um there's the weakness. So the patient, you know, is like biting their tongue and it also has like um incontinence as well. You just go straight to like tonic clonic, OK? And for tonic clonic, you know, these like general seizures, we just give them sodium valpo for first line. OK? But that's one major major thing I want you guys to know is sodium valproate. We do not give it to pregnant ladies. OK. Sodium valpo is um teratogenic. OK? Um If it, if they don't, if they don't work, we give carBAMazepine. OK. Right. Complex seizures. OK. Um They're not like as like, you know, as generalized as generalized tonic. So we don't give sodium ate as first line. It's kind of like um carBAMazepine as as as first line. OK. Right. So for the presentation for the complex deja vu memory, fresh flashbacks and funny smells and taste, OK. Lip smacking is a big one as well. Um and lip smacking um repetitive pick of clothes, deja v like these are things like the love for in questions like, you know, you just, you just have to learn that I'm really sorry, absence seizure ab seizure usually in kids. Ok. Um in Children, young Children. So they're typically just like, you know, um just stare into space, they're just like, yeah, like they, they, they just stare into space and not doing anything. They're un unaware of their surroundings. It's kind of like short lasting as well. And for absence seizures again, it's kind of like, you know, the groups kinda like in general seizure. So we give them so they have fi rate and also this one as well. But um I'm not sure if you like to give them, but like usually sodium is the main one we learn, but like, you know, just have that in mind as well for after the seizure, frontal lobe seizure. I don't think you guys need to know too much, but it's more localized. OK? It's more localized. It's just like some kind of like multi jerk, just one hand, it just, just jerk, you know, you don't, you don't know what is what it is like you just like, oh shit, damn. Like my hand is shaking like one of the hands shaking. OK? Um And also something um statics status uh epilepticus. Um It's emergency. It's when last more than five minutes and, um, or more free, more, more than free seizures in an hour. I don't, I really, I don't think they're gonna ask you that but, um, just keep that in mind as well. I, we never know what they're gonna ask the first line for this emergency. Um, we get uh Mida or IV um, LORazepam. Um, if they don't work, um, we go, we go, ok. Right. Investigate is investigation for seizures like um eeg is the main one. And then uh MRI for, you know, under um 50. Right. And um yeah, again, um I'd like to ask you about side effects of antiepileptics. Sodium ate, please not give it to pregnant lady. I beg you please. Um If you do, I'm gonna GMC you um I'm just gonna do anything to you. Um uh pancreatitis as well is kind of big one for sodium fibrate. Um And these are the two main ones. I want you guys to learn sodium sodium fibrate, teratogenic and pancreatitis. CarBAMazepine. Ok. Um And a granulocytosis anemia. Um and also like kind of drowsiness kinda like, yeah, um neurological symptoms as well. Ok. Algin skin rash. OK. Um And yeah, iii I don't think you need to learn this one, but I I just put that just in case. OK? It's something called Steven Johnson syndrome or Dress Syndrome. You guys will learn in uh dermatology soon. So good luck with that. I hate dermatology, right? CRE nerves are almost there guys. So almost there, hang in there. OK. Right. Um For cranial nerves, um benign um peral um positional vertigo. So B PV um is the common, common, commonest cause for vertigo. OK. Um Investigation is called the, the Dexa Bikes Maneuver and the treatment is Apley maneuver. OK. Bell's palsy, just unilateral facial nerve, palsy, just like just one sided treatment, steroids. That's it. Um That's the only, that's all we need to know. Um So blood neuritis basically just like um the uh the inflammation of uh the the vestibular nerve um at the classic classic triad um is at first acute onset of vertigo and nausea, vomiting, ok? And the stus and also is a one off cause it will not happen again. I have no idea why but um and also treatment, it just gets better on its own. You don't have to do anything for um Oh no, Me Andie Disease. Uh please, sorry that I if I've butchered the name um Classic Triad, if you see vertical hearing loss again, like just um yeah, if you guys know what physical ver is kind of like spinning around, it feels like all this like really this is feels so it's the wall spinning hearing loss. Tinnitus, tinnitus is basically like, you know, feel like the fullness of the ear or ringing of the ear. If you see like these three, you, I don't even, you don't even have to think you just go straight to me, you decease, ok, just go straight to it. You don't have to think, do anything you don't need to look at other options. See, is free, go straight to it. Treatment bein is specific for prophylactic and this one for acute, I don't think you kinda need to know the treatment, but like you, ok, again, it's nice to know, keep that in mind, you know, to recognize that as well. Right. That's something I also want to go through. Um And uh yeah, uh so just like it kind of difficult topics for, for, for this one, firstly, cataract stimulations. So basically, we test for um the semicircular um uh the uh same circular the uh like in, in, in, in the ear, um the the the the canal um to alter ear. So basically what what we do is that um uh the outer ear is washed either with cold, warm water, OK. Cold warm and, and it can the confection current can affect the uh the end of lymph inside the ear. OK. Or semicircular canal. So, yeah, semicircular canal. And if it is warm fluid, you know, it's gonna um affect the NYUS like towards the NYX. So OK. So again, use the PICS cos you know, cold cold water, then this most um with uh moves like, you know, towards the opposite side and a warm, it's the same side. OK. Right. Counts. I love asking me that. So like, oh what would happen if like, you know, the and the to the nystatin, if there's like cold water on the side. So let's say like, you know, there's like, uh, the cold water on uh, the, uh, on the right ear. You know, we use cold water to wash the out white outer ear. So it's gonna cause so cold water opposite is gonna cause the NYS because like we're resting the, the right ear. So it's gonna um the NYUS is going towards the left side, the right side, OK? Because we're washing it with the left ear. However, like let's say like, oh we are washing with the right ear with warm water, right ear, warm water, the mass is going towards the right. OK. So cows cold opposite warm, same side, OK, right, red and weber and ready test. They love asking you that they are not easy to graft, OK? Like first Rana's test Rey test is um you know, the you know, you put the treating for, you know, um once like test the the air conduction and also the the bone conduction, OK? So like you know the ting and then next to your ear and then afterwards, you know, put it um beside you like, you know, um contact the bone normal normally, you know our ear is built for air condition. So air condition should be normally in normal condition, the air condition should be better than bone production, ok? However, in conductive hearing, no hearing loss, ok. The air condition is is not as strong um as um significant because conductive hearing loss. So something to do with like the canal, the air ear canal is blocked. So because of no conductive hearing loss, obviously, so ear canal is blocked. So air conduction is not gonna be, it's not gonna pass as effectively when comparing to um uh bone conduction, ok. However, in sensorineural loss, hearing loss, sensory neuro, so there's nothing wrong with the ear canal, it's just sensory nerve. OK? Um If there's something wrong with nerve, you know, it doesn't really matter because like, you know, it just can't hear it anyway, you know, it just cannot be received. OK? The sign the the sound signal cannot be received. It doesn't matter if it's bone, it doesn't matter if it's through bone or air, it just cannot be received because something wrong of the nerve. So they both can decrease. So that's it's just no, there's no change. OK? So something that the false positive as well, OK. Description is like called like really positive. OK. So when, yeah. Um so OK, for Weber, so we normally, you know, it's like killing fork again, vibration but you put in the midline of the head. OK. So usually normally, you know both he both um ear here at, at the exact same volume. OK? However, um for sensory neuro loss, hearing loss, you know, it is hurt in a good ear because obviously because like the bad ear, you know, um the ear that has the sensory neuro loss, they can't hear it anyway. So um yeah, so it's just, it's just that and for, for the, you know, um we, you know, it is hurt in a bad year. Um it is, I know it's confusing but, you know, um the way I remember it just like, you know, the opposite of sensory neuro, OK. So sensory neuro, obviously, you know, it's quite obvious because like, you know, they cannot hear anyway. So it's gonna only be here in a good year. Ok. It cannot be here in this, in the, in the, in the, in the affected ear because like sensory neuro, they're not gonna pick it up. So it's gonna opposite. Ok. So conductive is gonna hurt in bad year. So I search it up. Um Apparently it has something to do with like, you know, in the, if there's like conductive hearing loss, something like, you know, osteosclerosis, you know, something wrong with the, the, the maus or Stav. Um um there's like upregulation of the hearing or the second theory is that, you know, it like conductive hearing loss, it traps sounds because like, you know, the sound is an is harder to enter. Um It also means the sound is harder to escape. So um it is hurt. So like, you know, the sound is kind of amplified, so it's hurt in the bad ear. It's kind of theory but you know, that's how I remember it. OK? You guys favorite. It's test time. Are you guys ready? Ok. I just assume you guys are. Ok. Right. So two year old male, ok, came to the nane um with three day history of fever, skin rash and, and during the examinations, this shows um when there's like an active uh as it shows like active knees and hip flexion. Um, when the doctor is like, you know, um forcing your neck flexion on the, on the kid, what is the most likely diagnosis you guys put in the chat? Right? What's most, most like diagnosis? Very nice. I know. Nice, nice, nice. It is meningitis. Well done, well done, well done. Corner. Nay. Yeah, I, it is meningitis. Ok. 26 year old female present to the GP complaining left leg weakness. Ok. So she also experienced um, esa and then, um, uh, of the left leg and then she also had similar symptoms 66 months ago. Ok. She had six similar things six months ago, but they suddenly just like resolved and they had, she had a past medical history of an episode of I of uh, eye pain two years ago. What is the diagnosis? What do you guys think? Oh my God. Come on, let's go. Yes, it is, MS Right. Nice, good, good, good. Right. Anna is ST bit here. Come on, someone has to beat Anna. She's too good. It is MS very nice optic neuritis. It just goes, you know, obviously. And then so basically it's like a relapse. OK. Relapsing of MS which disease pattern is the most common, remember, primary progressive, progressive re meeting blah, blah, blah, which means the nice, let's go. Let's relax to thing. Oh my God. I'm so proud of you guys. I'm actually gonna cry. All right. This one which spinal artery is the most likely to be involved. Anterior spinal. Nice, good, good, good. It is. It is Antero spinal, right? Well done. It is OK. Right. So 23 year old male came in with a seizure. So when I saw his, he's like biting his tongue and also having incontinence as well. What is the diagnosis? I want, I want you guys to be specific with diagnosis. One is tough. Listen, catch up. Nice. Good job. Nice. OK. Oh Someone said already set the the treatment as well. OK. Nice. A done good shit, Aidan, nice. Um generalized anesthesia. First line sodium fa well done. OK. Right. 63 year old male presents a, a sudden onset of left sided weakness. Ok. And also inattention to left side and also unable to speak, right. What do you think? What of following of the classification? This so left-sided weakness and also left-sided in intention and also un nipple speech, dysphagia, hemiparesis and also facial ne neglect as well. It is well done. Good, good stuff guys. Oh, my God, you guys are so good. I'm gonna cry. Um Right. So, um, again, yeah, exactly. It is. And for, I'm just gonna, yeah, so for, for packs, you know, for, for partial anterior circulation, you know. So, uh, so sorry. So for total it's all free. It's ok. It's all, all of the free, um, for packs it's just like one, or the, uh, the other two. Ok. So just like 11 symptom. So it's just like basically just two symptoms. Ok. Um Lacuna just like, you know, um oops, sorry. Um just like pure sensory or pure motor. Ok. Right. So what is the first line investigation? Um Yeah, I mean, I kinda showed it already but I hope you guys didn't see it but so obviously it is a stroke. What's the, what's the first line investigation? Ct head. Nice. Whatever, whatever happens, it's just we just go CT head. Ok. CT head. First line for stroke, please again. Yep. So for, for tax all of the free, all of the above all free. Ok. For pa partial, you know, it's one higher cortical function or one of the two hemiparesis um or um you know, uh he or neglect or just another higher cortical function again, just two symptoms. Ok. Right. Ok. Patient came in. Yeah. And then what are we gonna do? Is there a he hea um Yes, I, yeah, I mean, yeah, I mean, for, for the previous one. Yeah. Yes. Middle men. Ural. Nice, nice, good, good, good to see here. Shape. Nice. Very nice guys. Oh my God. You guys are good, right? What blood vessel is more likely to cause? Urol? How about Urol? Subur what is it breathing fe nice. It is breathing fine. Oh my God. You get so smart. Mm. Uh OK. Right. Which hemorrhage is most likely to have a lucid interval? Lucid face. Extra. Sure, good, good, good, good, good, nice. Oh my God. You guys are Albert Einstein stuffs? OK. Right. 42 year old female go to a GP. OK. And there are headaches and also describe us like type ban around the neck. What's it gonna be? Nice, tension, headache. Nice nsaids. Nice nsaids or paracetamol. Ok. Good stuff guys. What is the treatment for viral encephalitis? What treatment do we get? What do we give? What's, what, what, what's the drug do we give the CEPT? Yeah. Do we, the, the what drug do we give? Acyl? Nice, nice, nice guys. So, too smart, man. Can't stop you guys, right? So two year old male came to GP. OK. Three day history, toes numbness and now it's extending to the knees as well. God damn. Right. So, um and uh she had a previous history of stomach ache um of eating raw chicken four weeks ago. What is the most like diagnosis? Nice, good, good, good. Oh my God. Oh my God. You guys still good. Y nice. It is. It is. Right. That's it guys. Um Thank you so much for um attending the session. Um Honestly. Um Yeah, thank you so much without you guys. Yeah, I won't be here today. Um Yeah, also please fill in the um um the uh feedback form cause um I really need to know what I'm gonna do to improve cause like, you know, I've, I've only just started kind of doing these sessions. Um So I'm still uh a kind of like a newbie, you know, I don't know, I need to know what I do, right? And what I do wrong. And also is there any questions that you guys would like to ask any questions? Um or you know, you guys want me to kind of go over? No worries guys. You're welcome buzzy. Um OK, nice. OK. Well, I'm just gonna say it's just a little bit longer just in case you guys have any questions. Um Yeah, please shoot in the feedback for me guys and thank you so much for coming as well. Honestly, thank you so much for coming. I hope you guys do all the best. Um All hope you guys do best with your, your exam. Good luck. Um Yeah, good luck with your exams. I'm sure you guys are gonna be fine. No worries guys. No worries. Thank you so much for coming as well. Thank you so much for spending your time. Yes. OK, I will go over the contract. No worries, no worries. Yeah. Would you, do you like me to go over all free tracks or do you just like just some specific tracks you want me to go over? Yeah. Ok. Ok. I'll just go over for it, right? Ok. Let me just um um Right. Yeah. Thank you so much guys. Thank you so much for coming honestly. Thank you so much. It actually means a lot to me. Right. Um Can you see the screen? OK. OK. Right. Um. Uh ophthalmology. Uh that's the thing. Um I don't think I kind of prepared for hi, head and neck. But um yeah, I'm really sorry, I'm really sorry. Um Right. And also they're not gonna ask too much on oph ophthalmology, I believe because it's kind of difficult topic and also it's not too big. So um yeah, don't worry too much about that. Yeah. Right. OK. So again, um so basically, so basics um natural spinal thalamic. Um So ascending tract is going towards the brain, OK? From the body to the brain. OK. So spinal thalamic. OK. So it's from the spine to the thalamus. OK. That's how you remember it. OK. Um Dorsal column, you know, dorsal, the remember the way I remember is dorsal is to the brain. So it's ascending, ventral column is from the brain. So it's going, it's descending. OK. Since I remember dorsal is to the brain. So dors touch textile and also have to remember. Lasic pain and temperature. Ok. Oh. What kind of things did they ask for? Do, um, they didn't ask too much for Derms? Um, yeah, I don't think they asked too much for Derms. Um, remember, like, they're kind of like, uh, the definitions for, like, macule or something like that, um, like, you know, kind of definition, like, you know, what are macules and like, you know, just something like that, I think. Um like the major, major stuffs. Yeah, I don't, I don't think. Yeah, for us. Yeah. Um And also what else? Um um if you run out of time for dermatology just go over the SB A that is made by, by our peers. So I think he already included the most important pathology that you need to know for the dermatology. So, but, but really focus on GG I and urology first and yeah. Um yeah, dermatology is tough but um I don't think they're gonna ask too much on dermatology. Um I can't remember. Yeah, I don't think they're gonna ask too much on dermatology. Yeah. Right. So descending track. OK. So from the brain to the body. OK. So, all right. I'm sorry. Let me just, I forgot. Right. Descending. OK. So corticospinal, yeah. Again, cold for the for the from the cortex to the spine. So descending. OK. So because it's from the brain, it's gonna be MTA OK. Again, um please remember. Yeah. Um Corticospinal is at the pyramid OK, dorsal column is at the medulla natural spin spinal thalamic. It crosses over at the same level, right at the end the level of entry. Ok. Right. Um No worries and I that I can help. Um Right. Ok. So um yeah, again, like please please remember that. Right? Ok. Juicy pop. So for um the cortical spinal, OK. They cross over, ok. They cross over um you know, at the pyramid once they cross over, it is going to be, you know, um uh uh it, it like if, if it's an actual, the, the way I remember it because like, you know, they have crossover. OK. So right now cause like they start off from like, you know, on the opposite side, this because like you see here they start here and then, and here they start with the opposite side. OK. So once they have crossed over, they're gonna be on the same side again. OK. So before or you know, like, like above the crossover, OK. Above the crossing over. So let's say this is like the left-sided lesion, OK. Left-sided Apha motor neuron lesion. OK. Right here because like it is before the crossing over they have not crossed over yet. So it is still not yet on the same side. OK. Because like, you know, because um this is how our brain works. Um You know, they just like going to the office side, you know, it's like right hand movement is, you know, innervated by the left side of the brain of the motor cortex. OK. So before the crossing over, it's gonna be the opposite side. So if there's like left side, upper mo uh the upper motor neuron lesion, um so um above or be before the crossing over the degas. So which in this case is at the pyramid because it's the cortical spinal tract. OK. So it is going to be contralateral lesion. ok? Because it is still on the opposite side, they have not crossed yet. But after they have crossed, after they have crossed, they are on the same side right now, which is at the pyramid. Ok. So after their ation, after they are crossing over after the pyramid, um because they have crossed over, so they are now on the same side, you know. Ok. Right. So after the cross over, they're on the same side. So it's gonna be ipsilateral on the same side of lesion. Ok. Um Because they have, they have, this is past the point of crossing over. They have crossed already. Ok. So they are good. They are already at the same side right now. Ok. So left, um, uh, the left-sided lesion. Ok. So, in this case, specifically the cervical spine. So like, um, you know, the neck, ok. Uh So below the crossing over, so, you know, for, um, below the um, uh pyramid below the crossing over. Ok. Right. Um Again, here it is after the crossing over as well, um, same as the cervical spine. So they have crossed over for this one, left, lower motor neuron lesion, they have crossed over. So, um, because they have crossed over. So the, it is gonna be ipsilateral, it's gonna be on the same side because they have crossed. Ok. So before the crossing over, ok, before they have crossed because they have not crossed yet because they are on, they start and end on the, on the opposite side and they have not crossed yet. It is gonna be contralateral because they have not crossed over to the same side yet. OK. But however, after they have crossed, OK, they've crossed over to the other side. So in this case, you know, like, you know, they have crossed to, to the, now they're on the same side because they have crossed over, OK. So it's gonna be ipsilateral. OK. Um Yeah, for this one, the crossing-over point is pyramid. Remember that. So below the pyramid, you know, after the crossing over, after the pyramid, below the pyramid, it's gonna be ipsilateral. OK? Before the pyramid, uh after the pyramid, it's gonna be ipsilateral and before the pyramid, it's gonna be contralateral. It because it's before, before the pyramid, before the crossing over after the pyramid. After the crossing over, it's gonna be ipsilateral because they have crossover, they're going to be on the same side, right? For this one dorsal tract, OK. Dorsal to the brain. Ok. Um, it doesn't really matter. Um, you know, that they are, um, the, the direction of truffle is the exact opposite. How like, you know, it doesn't really matter because like, all we look at is just like where the ends. Ok. So they also, again, they start on the opposite side and, and, you know, they start here and it ends at the opposite side. Ok? They start on the right side and end to the left side. OK. So um you know, sensor for sensory, you know, rightsided sensory, let's say, you know, like, like a like a touch sensory from the, from my right finger. OK. So they're gonna go up. So, you know, right here, um lower um motor neuron, no, no lower motor neuron. So like, you know, um up on the area but like, you know, it's kinda like um below the point of the decussation, OK? Below the point of decussation. So like c cervical spine again, remember dorsal track column, it crosses at the medulla, OK? Crosses at the medulla and so below the medulla, in other words, below the crossing over or be like before the crossing over, they have not crossed over yet. It is still on the opposite side because they start oppositely. OK. Um So before they cross over to the other side, to the same side, it is gonna be ipsilateral, OK? It's gonna be ipsilateral because like, you know, it's on is still on the same side because they have not crossed over yet. They have not crossed over. However, with this one, OK. For this one, let's say a lesion here, they have crossed over. OK. So they have crossed over. So it is gonna be um contralateral because like, you know, it's after the decussation, it's after the decussation. OK? Because like, you know, they, they have crossed over. So, yeah. So this one is right sided, a contralateral sensory loss because like, you know, crossover to the side. OK. Yeah. Again, the reason why it's a little bit different because um yeah, this one it just like kind of like um yeah, um the different direction just spread it in mind as well. But this one as well as standing track. OK. So the direction is here. OK. Um So this is the right side, this left side um Basically, you know, anywhere before, like after, you know, it's because like right when you enter, OK, right, when you enter it is already um the discussed OK? Because it's like later sp spinothalamic, OK. Again, spinal thalamic enter at the like they cross over at the same level. So, right when they cross over, they're gonna be on the same left, they, they, they go, they're on, they're on the um the other side already. OK. So when they cross over, so, you know, um basically, you know, um because like they have crossover rain, not crossing over at the brainstem. So it's already on the opposite side. So it's contralateral. Ok? Because it's gonna be because they are already on the opposite side. Ok. So, yeah, and for this one, look at that. So, so like here, um, they go in, you know, it gets like start from here and it ends from here. So they still not, it has not crossed over yet. So for this one, because like of the different direction of the travel, um this one leftsided. Um uh lesion is gonna have a, a contralateral side um effect because like, you know, um the the, the right side of the body is in, affected by the left side of the brain. They have not crossed over yet. So it's gonna be um uh contralateral. However, after their crossover, it is going to be ipsilateral because of the direction of travel. Remember? Ok. So, yeah, basically. Um just like that. So, um so, yeah, just after the crossing over, um it's gonna be um uh because they have cross over to the same side. However, this one um yeah, after the crossover, they, for this one, yeah, they, they're crossing over to the opposite. It's a little bit different. They're crossing over to the opposite side. So that's why it's a little bit different. So, yeah, again, like they cross because like, again, you have to think about the dorsal tract, you know, it's towards the brain. Ok. So um before deus conversation it is still the lateral side, like the like sorry, the opposite side of the brain, OK. This is how the brain works. Again, you know, the brain, you know, the left side of the brain um in the, the, you know, the right side of the, the body. OK. So before the, the, before the cross over, they are still on the same side because like, you know, left sided, it's gonna on the left side of the track. OK. So, and then until to the medulla, the crossing over of the dorsal column, it is only after the also column, it goes to the opposite side. OK. So after you know, it cross over to the opposite side, it's gonna have the contralateral effect. OK? And for this one, again, you know, um the only difference is that the, the, the location of the decussation for this one um because the level of ation is so, so, so low. Yeah, it's literally, yeah, it, it can't be any lower. It's literally on the same level. So, right, when you enter anything above that root level, OK? Is already contractual because it is already crossed to the opposite side. OK. So, yeah, so basically, again, it's like a nice diagram again. Um Yeah. Uh uh it's like general rules of firm. If it's like above the, above the taxation, it's a sign um you know, of a contralateral, OK? If it's below level is ipsilateral. OK. So again, like that's, um, that's why I said, like, you know, um, the direction, but if you think about it this way, you think of it this way, the direction doesn't really matter because we only look at the, the opposite end. Ok. Um So if we, if you think about above, you know, use the word above or below, OK. So above the, above the DEX, it's gonna be contralateral below the ci is gonna be ipsilateral. OK. So, yeah, these two could be IPSO is below the DEX again here as well. Yup. Um The definition is here, if it's like below the deci, it's gonna be ipsilateral above deci is gonna be contralateral. OK. Again, for this one again, you know, if it's like above the decussation, it's gonna be contra and contra because like the, if the, the, the crossing over point is so low, OK. So uh all of cause like, you know, all of these are already above the decussation already. So they're mostly gonna be contralateral unless there's like a, you know, there's like a lesion here like, you know, like before the nerve even goes in. So it is gonna be, it's a natural, I mean, I mean, I mean, obviously because like, you know, if there's like nerve damage here is obviously gonna be the right side, it's not gonna be the left side like that. Yeah. Um Yeah. Is that, is that, um is that, is that, is that good? I'm just going to go over this as well, right? So let's say there's a herniated disc, OK at a CF three fibra. So around this region, the neck, OK. So this below, below the pyramid and the medulla, OK? Below the pram and the medulla. So below the point of the decussation of both um the corticospinal and also the dorsal column, OK. So, um because like, you know, because it's below um the dedication is gonna be effect is gonna be if it's natural. So left-sided. So be it's gonna affect left-sided things that is innervated by the dorsal column and the, the cortical spinal as well because they, the cuts they, they cross over at here. OK? At the the level of the lesion. OK? Because and also the lesion is below the decussation. So below dec is gonna be ipsilateral. So it's gonna be left side. Yeah. OK. And left side um paralysis because those affect the do the column. Oh, sorry, sorry, sorry, affects the um um corticospinal and for here, left side loss of touch, sense, vibration, sense, it's gonna be um affects two, the dorsal column. OK. So it's gonna be, it's because it's below the point of both the deci of um corticospinal and dorsal column. OK. However, OK. However, for um lateral spinal thalamic, OK. Germ K is um above, above the decussation. OK? It's above the decussation and it's gonna be um contralateral. OK. Above it gonna be contralateral. OK? Because remember um sp uh spinothalamic is the only one that, um you know, um on, on the, on the, on the, on the same level. Actually, this line should be a little bit higher. I'm sorry, this, this is not safe. This is nowhere near C three. It should be around C three here. I'm sorry. But uh and anyway, yeah. Um again um oh actually, yeah, yeah. Anyway, yeah, it's just like it's just, yeah, just, just like that. Um So it's the um so sorry, it's the contralateral side that's innervated by this lateral spinal thalamic. So which is the sp uh spinal thalamic uh is responsible for temperature and pain. So the effect is gonna be ipsilateral from the spinal thalamic because it is below the herniated disc is C three and you know, anywhere that's like below the cree vertebrae it's gonna be and you know, it's gonna be um yeah. Uh it's, it's, it's just gonna be um not affected. Ok. No, anywhere, anywhere above the cree it might be affected it below the CRE it's gonna uh it's gonna be affected of the spinal thalamic natural spa aic I'm sorry. Is that, is that, does that make sense? Uh Yeah, it is, it is it is free difficult to, to understand the concept but um try to remember um of decussation means contralateral below decussation means ipsilateral and remember each um track of the ation point, lateral, thin spinal thalamic, same level of crossing over dexa corticospinal pyramid and also colum medulla. Ok. So yeah, is that, is that, is that, is that good or is that? Um and again, yeah, so for these like, you know, um you know, they would uh uh also added like, you know, because of upper motor neuron, upper motor neuron lesion, remember upper motor neuron. Ok. So tone increase in everything, increase uh reflex, increased tone and the mass is same. Ok? For lower motor neurone everything is drops, uh muscle atrophy, muscle mass, drop of muscle atrophy, um and absent of reflex, absent of muscle tone. OK? Just drop of muscle tone or anything. OK. So again, we can of like upper motor neuron lesion. OK? So it's gonna be hyperflex, hyperflex, increased tone, increased to lower motor neuron. OK. Spinal cord level. So anything kind of like below the uh the the brain stem is kinda like a uh lower motor neuron. Um again, after reflex, we get the flow motor neuron and then flac it OK. Just like that. And the same for here. The same here. So it's just that's the main thing you have to learn. I think if you can't remember if you can't understand, learn that above the level ation is gonna cause contralateral um symptoms. If it's like below the, the excision is gonna cause ipsilateral. OK? And also please learn the ci point because that's the most important part. OK. That can determine symptoms. All right, is that is that? Ok. Mhm. Right. Um I hope that is ok. Right. Are there any more questions because we will be closing the stream soon? So, if that, I think, I don't think there's anything else anymore. Right. Yeah. How, how, how is that? Is that, is that ok or is that uh Right. I am. Right. Um If there isn't any more question then yeah, it'll be great if you guys can please um fill in the the feedback form and um yeah, it would be great. It will, it will mean a lot to me. Um Yeah, best of luck with your exams and yeah, please feel free to email me if you have any problem. Um And also if you wanna slide, you know, you can join the member, you can become a member. Um Yeah. How much is that? How much to be a member again, Jane or Raymond Raymond? And please, how much do we, how much is it to be a to be a to be a member? Membership to join a membership thing? Yes. So you need to be an ma member to receive the slide. Yeah. Yeah, if you want the slides, yeah, please. I a member, I think it's like for two lb, I think. Uh Yeah, it's like, yeah, it's nice. It's good investment. Do we need malignancies? Yes, you do. Um I do not include, that's the thing. I don't include everything here. Um These are like the major, major topics. Um, but like, you know, um, don't just, like, rely on these slides, like, I'm just going through to, like, tie things, the major stuffs together if you want to score, you know, a s or like, you know, um, uh, get like 100% b, like, you know, solid B then, like, make sure you get a b, yeah, I like, if you learn all these, I'm pretty sure you can get a B as well. Um, uh, maybe not A s um, you know, uh, like malignancy. Yeah, you need malignancy. Main one. Probably like, uh, meningioma glioblastoma, multiforme. Um, yeah, just stuff like that. And then like, just like symptoms basically like seizure, weight loss, the classic ones, memory loss, personality change, stuff like that. Um, also increase, um, um, of the intracranial pressure as well. Ok. Rights. Is that anything if that's that? I hope, um, it helps it. They probably just, I don't know, they just like, opened it, left it open or something. Um, yeah. Right. I think we can, we can closely chat, I guess. I think, uh, we'll probably need to close this ring to stop the recording. So. Oh, ok. Ok. Yeah. So if there are any, any last question, so please feel free to type in. If not, I'll be closing the stream in, in a minute. Right. I don't think we have anyone. Right. So, thank you for coming. So we'll hope to see you next time. As well. Yes, thank you. So guys, thank you so much guys for coming. Anyway, that's only got a few left but yeah, good night guys. Good night. Bye.