Sites of Locked in syndrome (deefferantation)

Sites of Locked in syndrome (deefferantation)

1. Basilar artery occlusion
2. B/L ventral pontine lesion
3. Polyneuritis
4. Myasthenia gravis
5. Polio
6. GB Syndrome

Sites causing Ataxic Hemiparesis

Sites causing Ataxic Hemiparesis

1. C/L thalamocapsular
2. C/L posterior limb of internal capsule
3. C/L red nucleus
4. C/L basis pontis- juntion of upper third and lower two thirds
5. Superficial ACA supplying paracentral area

Sites of Dysarthria- Clumsy Hand Syndrome

Sites of Dysarthria- Clumsy Hand Syndrome

1. Genu of internal capsule
2. Small deep cerebellar hemorrhage
3. Basis pontis at junction of upper third and lower two third

Sites of Pure Motor Hemiparesis

Sites of Pure Motor Hemiparesis

A. Intracranial-
1. Posterior limb of Internal Capsule
2. Cerebral Peduncle
3. Medullary pyramid.
4. Basis pontis 

House-Brackmann scale

The House-Brackmann scale is a facial nerve grading system, at one end of the scale there is normal facial nerve function and at the other there is complete paralysis.

Grade	FunctionLevel	Symmetry at Rest	Eye(s)	Mouth	Forehead
I	Normal	Normal	Normal	Normal	Normal
II	Mild	Normal	Easy and complete closure	Slightly asymmetrical	Reasonable function
III	Moderate	Normal	With effort, complete closure	Slightly affected with effort	Slight to Moderate movement
IV	Moderately Severe	Normal	Incomplete closure	Asymmetrical with maximum effort	None
V	Severe	Asymmetry	Incomplete closure	Minimal Movement	None
VI	Total Paralysis	Total Paralysis

Complications of IvIg infusion

Nephrotic syndrome
Aseptic meningitis
Serum sickness
Thrombotic venous/arterial occlusion
Stroke
Hypotension

Wernicke's Encephalopathy- non alcoholic causes

prolonged intravenous feeding,

hyperemesis gravidarum, 

anorexia nervosa, 

refeeding after starvation, 

thyrotoxicosis, 

regional enteritis, 

malabsorption syndromes, 

hemodialysis, 

peritoneal dialysis,

uremia, 

HIV,

malignancy, and 
gastroplasty with postoperative vomiting

Hughes GBS Disability Scale

Guillain-Barré Syndrome Disability Scale (Hughes)

0	Healthy
1	Minor symptoms or signs of neuropathy but capable of manual work/capable of running
2	Able to walk without support of a stick (5m across an open space) but incapable of manual work/running
3	Able to walk with a stick, appliance or support (5m across an open space)
4	Confined to bed or chair bound
5	Requiring assisted ventilation (for any part of the day or night)
6	Death

Asbury Criteria for GBS

Diagnostic criteria
Assessment of current diagnostic criteria for Guillain-Barre syndrome

Required features

• Progressive weakness in both arms and legs
• Areflexia (or hyporeflexia).

Features supportive of diagnosis

• Progression of symptoms over days to 4 weeks
• Relative symmetry
• Mild sensory signs or symptoms
• Cranial nerve involvement, especially bilateral facial weakness
• Recovery beginning 2 to 4 weeks after progression ceases
• Autonomic dysfunction
• Absence of fever at onset
• Typical CSF (albuminocytologic dissociation)
• EMG/nerve conduction studies (characteristic signs of a demyelinating process in the peripheral nerves)

Features casting doubt on the diagnosis

• Asymmetrical weakness
• Persistent bladder and bowel dysfunction
• Bladder or bowel dysfunction at onset
• >50 mononuclear leukocytes/mm³ or presence of polymorphonuclear leukocytes in CSF
• Distinct sensory level.

Features that rule out the diagnosis

• Hexacarbon abuse
• Abnormal porphyrin metabolism
• Recent diphtheria infection
• Lead intoxication
• Other similar conditions: poliomyelitis, botulism, hysterical paralysis, toxic neuropathy.