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It, it's loading so I will be patient. Ok. Um Hello. Uh Can you hear me? I'll check the chart. Um If you could put in the chart if you can hear on and see if that would be helpful. Um We're just gonna wait for a couple of minutes um for people to keep coming in. Um And then we'll get started maybe in 22 or three minutes. I ok. Yes. Yes. Thank you. Two. Yeah. Yeah. Ok. Hi for anyone joining, we're probably gonna start in um maybe one or two minutes. Um just to wait for more people to come in. Uh If anyone could put on the chart, if they can hear me, that would be lovely. Yeah, it's ok. Mhm. Yeah. Mhm. Yeah. I think, I think it's ok if we um start now if that's, if that's ok with you Shruti. Um So hello everyone. My name is Ayesha. I'm 1/4 year. I'm currently doing the Gastro BSE, but today I'm going to be doing the lecture on acute neurology. Um So basically what we'll go over is a stroke, tia um brain bleeds, epilepsy, GBS cord compression, ch quina radiculopathy and carpal tunnel syndrome. Um things to keep in mind while looking at the slides, these icons show different things. So like etiology, history, presentation, investigations, management, if you see a star that's usually gold standard and a lightning bolt will be high yield um information. Um So I want to start first with an SBA. Um and I uh for now, don't put it in the chart, just write it down next to you and then we can see afterwards um after we teach some of the content, um how you get on with the question. So I'll give you about 30 seconds um to read the question and maybe put an answer. Um And then we'll get on. OK. OK. So I'm gonna start now. So first condition we're gonna go over is stroke. Um So the definition is a focal neurological deficit and this is usually um a vascular origin um that will last more than 24 hours. So, the important part of this is that it's more than 24 hours. Um The etiology, it's usually either hemorrhagic um which is a rupture in your blood vessels in your brain or ischemic. Um and that can occur due to occlusion, stenosis for ischemia, that's just the reduction in the normal blood supply um to an area of your um body. But in this case, your brain, um in terms of the hemorrhagic strokes, um it's the rupture of the blood vessels. Um We've said that could be like a subarachnoid or an intracerebral hemorrhage. And then in terms of ischemia, it's usually either a thrombotic or embolic um origin. So thrombotic is within like in situ um plaque formation and that could be because of atherosclerosis. Um and embolic is coming from elsewhere. So a good way to remember that is embolic starts with em which is like emigrate. So moving from one place to another and that's gives you embolic um embolic um can be um caused by atrial fibrillation. Um So basically, the irregular heartbeat will cause blood to pool in the chambers of your heart. Um And that can lead to clot formation which will could lead um could go to your brain and then cause a stroke. Um I think the most common place for a clot to form when you have AFIB is in the left atrial appendage or I think it's called oracle sometimes. Um And that's just because of the shape of the heart and the anatomy of the heart. Um So the biggest risk factor is hypertension. Um And uh that's why it's really important that we manage for it. Other is um risk factors are diabetes, obesity, old age, high cholesterol and smoking amongst other things. Um Then the symptoms of the stroke, it's usually acute onset. Um you'll see limb weakness, facial drop, dizziness. Um This is amongst other things, but most importantly, um the presentation is dependent on what which area of the brain is being affected. Um And that's why it's quite a common exam question. Um This is just a public health um notice for face arm speech time. So, um people can recognize the symptoms of a stroke and then make sure that they um go into A&E as fast as they possibly can. Um So with strokes, it's important to look back at um the vasculature of the brain. So, if you remember from anatomy, this is the circle of Willis. Um And these perfusion diagrams are really useful when you're um answering stroke questions. Um So the blue is the anterior cerebral, whereas the orange is the middle and the yellow is the posterior cerebral artery. Um And when we look at an anterior cerebral artery stroke, um the associated signs are mostly uh contralateral hemiparesis and that's in the lower limbs more than the upper limbs. Um And that's how you sort of differentiate anterior cerebral strokes. Um Behavioral changes are also common and that's because it's affecting the frontal lobe um moving on to a middle cerebral artery stroke. Um The associated signs are contralateral hemiparesis and that's now your upper limbs more than your lower limbs. You can also see contralateral hemisensory loss. Um apraxia, apraxia is like difficulty coordinating movements, aphasia, we'll talk a bit about aphasias in a second and quadrantanopia. Um If you look on the right hand side, um we have the broker's and the Wernicke's area which is like on the left hand side of your brain. Um How I remember like which ones um like further to the front is like b before W in the alphabet. So broke is close to the front of your brain. Um The broker's area is responsible for like speech reduction and Wanaka is responsible for the comprehension of speech. So um a good way to tackle um questions about aphasia is actually looking at what's wrong with the patient. So sometimes they'll have fluent speech. Um Flu fluency is um the sentences they say they flow. Um But the content won't make sense. If a patient's comprehension is preserved, then that would be brokers. Um Aphasia also known as express as aphasia. Um And that was the inferior frontal gyrus, that's where the broker's area was. Um if um they have fluent speech, but their comprehension is impaired, then that would be Global Aphasia. Global Aphasia is the brokers area, Waka area and the part between them, those are all affected and that leads um to um fluent speech, but the content doesn't make sense and they um don't comprehend um in terms of non fluent speech. So that could be labored, um or halting sentences, um content could be preserved or may not be preserved. Um But if they have normal comprehension, then that's conduction aphasia and that's the place between brokers and Wernick. Um If their content comprehension is compared, then that's Wernick. Um