Conditions of the nervous system – Seizures

- Seizures
o Attacks of altered consciousness, motor or sensory function, behavior or emotion.
 Simple Partial Seizure
• Consciousness is never impaired
 Complex Partial Seizure “Focal Cortical”
• Followed by loss of consciousness
 Absence Seizure
• Occurs in people younger then 20
• Loss of awareness (but not consciousness)
• Abrupt daydreaming
 Tonic-Clonic Seizure “Grand Mal”
• Tonic muscle contraction is followed by clonic contractions: lasting 2-3 min with
loss of consciousness
 Secondary Seizure
• These occur secondary to organic causes like tumor, meningitis, encephalitis etc
 Status Epilepticus
• Recurrent seizures with lack of consciousness (30 min +)
 Febrile Convulsions
• Brief (< 15 min) and generalized

Peripheral Neuropathies
- Mononeuropathy
o Peripheral nerves affected by trauma (particular pressure) or damage to their blood supply
 Carpal Tunnel Syndrome
• Wasting of thenar eminence muscles
• Tingling in median nerve area
• Pain upon pressing on carpal tunnel
 Nerve Palsy
• Ulnar Neuropathy
o Claw hand deformity in chronic lesions
o Tingling in ulnar boarder of hand
• Radial Palsy
o Saturday night palsy
o Loss of extension of hand leads to wrist drop
• Peroneal Palsy (aka Lateral Popliteal Palsy)
o Weakness in dorsiflexion and eversion of foot
o Foot drop
 Brachial Plexus Lesions
• Pancoast Tumor
o Ulnar pain, digital wasting, weakness, sensory loss (C7, C8, T1)
o Ptosis (dropping eye lid)
o Meiosis and anhydrosis (failure to sweat)
o Usually see presentation of Horner’s Syndrome with this condition which
manifests as ptosis and meiosis and anhydrosis
• Brachial Neuritis
 o Severe pain in the shoulder and arm, weakness in shoulder
o Follows immunization or operation usually

Peripheral Neuropathies
- Polyneuropathy
o Peripheral nerves are affected in diffuse bilateral and symmetric patterns, can be caused by
infection, inflammation, neoplastic tumors, metabolic conditions, vitamin deficiency, and drugs
 Metabolic Encephalopathy
• Myoclonic jerking seen in renal failure and respiratory alkalosis, and asterixis
which is repeated wrist and finger flexion (seen in hepatic encephalopathy and or
renal and respiratory failure
 Hepatic Encephalopathy
• Personality changes
• Brisk tendon reflexes
• Coma with hyperventilation

Neurodegenerative Diseases
- Myasthenia Gravis
o Loss of motor function (impaired), generalized, without sensory function loss
o General weakness after steady or continued use
o Ptosis
o Positive Tensilon test (meaning injection of edrophonium improves presenting muscle weakness)
o Progressive
- Guillain-Barre Syndrome
o Distal weakness or paralysis of the feet and legs with loss of deep tendon reflexes
o Ascending loss of motor function (legs then arms) without significant sensory impairment
o Occurs 1 wk after certain viral infections (mainly respiratory) or immunization
o Spinal pain, and 80% recovery rate
- Amyotrophic Lateral Sclerosis (aka Lou Gehrig’s Disease)
o Loss of all motor function without dementia or sensory deficits
o Progressive paralysis, UMNL + LMNL
o UMNL (spacticity and hyperreflexia)
o LMNL (fasiculations which are rapid muscle twitches without the limb moving and atrophy)
- Parkinson’s Disease
o Nigrostriate dopaminergic neurons are lost
o Imbalance in the extrapyramidal system
o Bradykinesia (Slow movement)
o Rigidity, tremor (pill rolling), family history, age and shuffling steps
- Multiple Sclerosis
o Autoimmune demyelinating disease of the CNS that is characterized by symmetric muscle
weakness more in the legs then arms
o Clumsiness (gait disturbances, trips a lot)
o Sudden radiating pain especially after exposure to heat
o Visual disturbances, speech uncoordinated, excessive variation in pitch and volume of speech
o Numbness in legs or arms
o Cardinal lesions: a plaque on CT or MRI and Oligoclonal band in CSF in 80-90% of MS px’s!