Thursday, September 30, 2010

74 - Vogt's triad

1. in tuberous sclerosis
- Facial nevus (adenoma sebaceum)
- Seizures
- Mental insufficiency

2. in congenital glaucoma/buphthalmos (BPL)
- Lacrimation
- Photophobia
- Blepharospasm

3. in congenital toxoplasmosis (3C)
- Congenital cataract
- Chorioretinitis
- Cerebral Calcification (diffuse)

4. in poscongestive glaucoma (GAP)
- Glaucomflekens (Ant cortical opacity)
- iris Atrophy (stromal)
- Pigment on the corneal endothelium

Saturday, June 12, 2010

73 - Glasgow coma scale

*Normal Score = 15

*Mild Head injury = 14-15

*Moderate Head injury = 9-13

*Severe Head injury = less than or equal to 8

Thursday, June 10, 2010

72 - Marcus Gunn Pupil

Marcus Gunn pupil (relative afferent pupillary defect) is a medical sign observed during the swinging-flashlight test[1] whereupon the patient's pupils constrict less (therefore appearing to dilate) when a bright light is swung from the unaffected eye to the affected eye. The affected eye still senses the light and produces pupillary sphincter constriction to some degree, albeit reduced.
The most common cause of Marcus Gunn pupil is a lesion of the optic nerve (distal to the optic chiasm) or severe retinal disease. It is named after Scottish ophthalmologist Robert Marcus Gunn.

The Marcus Gunn pupil is a relative afferent pupillary defect indicating a decreased pupillary response to light in the affected eye.
In the swinging flashlight test, a light is alternately shone into the left and right eyes. A normal response would be equal constriction of both pupils, regardless of which eye the light is directed at. This indicates an intact direct and consensual pupillary light reflex. When the test is performed in an eye with an afferent pupillary defect, light directed in the affected eye will cause only mild constriction of both pupils (due to decreased response to light from the afferent defect), while light in the unaffected eye will cause a normal constriction of both pupils (due to an intact afferent path, and an intact consensual pupillary reflex). Thus, light shone in the affected eye will produce less pupillary constriction than light shone in the unaffected eye.

A Marcus Gunn Pupil is distinguished from a total CN II lesion, in which the affected eye perceives no light. In that case, shining the light in the affected eye produces no effect.

Anisocoria is absent. A Marcus Gunn pupil is seen, among other conditions, in optic neuritis.

Thursday, February 25, 2010

71 - Onodi cell

*Posterior ethmoid cells can become pneumatized far laterally and to some degree superiorly to the sphenoid sinus, in which case they are called sphenoethmoid cells(cellulae sphenoethmoidales) or Onodi cells. Pneumatization of the clinoid process in those cases may originate from the posterior ethmoid cell, also.

*The optic nerve and carotid artery may be exposed in a sphenoethmoid(Onodi) cell. This is clinically significant because the sphenoid sinus is located medially and inferiorly to the most posterior cell of the posteriorethmoid complex. Consequently, attempts to use instrumentation to locate the sphenoid sinus directly behind the last cell of the posterior ethmoid complex may result in serious damage to the optic nerve or carotid artery.

*The most posterior ethmoid cell may becalled a sphenoethmoid cell(Onodi cell) when it pneumatizes laterally and superiorly to the sphenoid sinus and is intimately associated with the optic nerve. Prominence of the optic nerve tubercle or the internal carotid artery is not prerequisite, however. Moreover, the optic nerve tubercle may be prominent in other posterior ethmoid cells as well. Whether ethmoid complex components grow posteriorly alongside the sphenoid sinus or sphenoethmoid cells pneumatize directly into the sphenoid bone has not been resolved, but the answer does not bear on practical issues in diagnosis and sugery: the air space in question is clearly ethmoid.

70 - Vernet's syndrome

Monday, February 22, 2010

69 - Tennis Racquet spores

*The spores of clostridium tetani are in the shape of Tennis racquet and hence are called tennis racquet spores. Pictures are shown below :

Sunday, January 31, 2010

67 - En Coup de Sabre

En Coup de Sabre is a term used when linear scleroderma affects the forehead. It appears as an indented, vertical, colorless, line of skin on the forehead. The indentation looks as though the person may have been struck by a sword.

En coup de sabre is a type of linear scleroderma characterized by a linear band of atrophy and a furrow in the skin that occurs in the frontal or frontoparietal scalp. Multiple lesions of en coup de sabre may coexist in a single patient, with one report suggesting that the lesions followed Blaschko lines . Unlike skin in localized morphea, skin in linear scleroderma may be fixed to underlying tissue. Calcinosis may rarely occur. Cutaneous changes accompanying the facial hemiatrophy associated with the Parry-Romberg syndrome may be similar to those found in en coup de sabre . Serologic abnormalities may include anti-nuclear antibodies, anti-single-stranded DNA antibodies, and rheumatoid factor. Eosinophilia may be present and may correlate with disease activity. A polyclonal IgG and IgM hypergammaglobulinemia may also be present and is found more often with severe cases and with clinical progression .

On the basis of a retrospective analysis of patients who developed morphea between 1960 and 1993 in Olmsted County Minnesota, the incidence of en coup de sabre is 0.13 cases per 100,000 population . Of the 82 cases of morphea identified in that study, 16 patients had linear scleroderma, including 4 with en coup de sabre and 2 with Parry-Romberg syndrome. None of these patients developed systemic sclerosis, although progression from linear scleroderma to systemic disease has been reported. Skin softening or disease resolution occurred in 8 of 16 patients within 5 years of diagnosis.

As in other types of scleroderma, the etiology of en coup de sabre is unknown. Hypotheses include microchimerism, which leads to a chronic, low-grade graft-versus-host-like disease, or an alteration in antigens caused by ischemic damage . Borrelia burgdorferi DNA has been identified by polymerase chain reaction assays in tissue sections from some,  but not all,  patients with localized scleroderma.

Modalities used in the management of en coup de sabre have included topical, intralesional, or systemic glucocorticoids; vitamin E; vitamin D3; phenytoin; retinoids; penicillin; griseofulvin; interferon-(x), D-penicillamine; antimalarials; ultraviolet A phototherapy with or without psoralens; and surgery .

Thursday, January 14, 2010

66 - Spurling's test (Foraminal Compression test)

Spurling's test, or foraminal compression test, is a very specific, but not sensitive physical examination maneuver in diagnosing acute cervical (neck)radiculopathy.
Patients with a cervical radiculopathy (compression of a nerve ‘root’ in the neck) can present with a variety of symptoms, including pain, numbness and weakness. Many other disorders can produce similar symptoms. In addition to the clinical history, the neurological examination may show signs suggesting a cervical radiculopathy.
One such sign, ‘Spurling’s test’ is the reproduction of the patient's nerve symptoms by movements of the neck. It is performed by extending the neck, rotating the head, and then applying downward pressure on the head. The test is considered positive if pain radiates into the limb ipsilateral to the side that the head is rotated to.

Thursday, January 7, 2010

65 - Prehn's sign

- Prehn's sign is a medical diagnostic indicator that helps determine whether the presenting injured testicle is caused by acute epididymitis or from testicular torsion.

- According to Prehn's sign, the physical lifting of the testicles relieves the pain of epididymitis but not pain caused by testicular torsion.

* Negative Prehn's sign indicates no pain relief with lifting the affected testicle, which points towards testicular torsion which is a medical emergency and must be relieved within 6 hours.

* Positive Prehn's sign indicates there is pain relief with lifting the affected testicle, which points towards epididymitis.

1: Epididymis
2: Head of epididymis
3: Lobules of epididymis
4: Body of epididymis
5: Tail of epididymis
6: Duct of epididymis
7: Deferent duct (ductus deferens or vas deferens)

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