ETHOS Diencephalon!!!

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1/ Diencephalon location
- around the 3rd ventricle

The cavity of the diencephalon is ----- the 3rd ventricle
All of the structures of the diencephalon are around the 3rd ventricle, so the cavity of the diencephalon is the 3rd ventricle.

2/

The Examination in Coma

“the father of modern neurological surgery”

American neurosurgeon Harvey Williams Cushing (1869–1939)

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1/ Definition

“a state of unarousable unresponsiveness”

Parts
a. level of consciousness
b. vital signs (BP & breathing pattern)
c. cranial nerves (fundoscopy + vision + brainstem)
d. motor & sensory
e. reflex
f. meningeal signs

2/

Drifts!!!

French neurologist Jean Alexandre Barré (1880–1967)

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1/ The four types of drift

“pronator, cerebellar, parietal, and functional”

- pronator drift (pyramidal drift) was the 1st to be described
- Dr. Barre was the 1st to report it

2/

Brachial plexus!!!

“Erb-Duchenne palsy, Erb-Charcot paralysis, Erb's point, Erb-Westphal symptom, Erb's spot”

German neurologist Wilhelm Heinrich Erb (1840–1921)

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1/ Components

“Ready To Drink Cold Beer”

Root (5): C5-T1
Trunk (3): upper, middle, lower
Division (6): anterior & posterior from each of the trunks
Cord (3): lateral, posterior, medial
Branch (5)

2/

Signs of tetany!!!

“Trousseau sign of malignancy, Trousseau sign of latent tetany, Trousseau–Lallemand bodie”

French internist Armand Trousseau (1801–1867)

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1/ Definition

Tetanus
- it is different disease w/ different pathology

Tetanic contractions (physiologic tetanus)
- broad range of muscle contraction types

Tetany
- a type of tetanic contraction

2/

Meningeal signs

“Brudziński neck sign, Brudziński symphyseal sign, Brudziński cheek sign, Brudzinski's reflex”

Polish pediatrician Józef Polikarp Brudziński (1874–1917)

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1/ Definitions

Meningitis
-inflammation of leptomeninges & underlying subarachnoid CSF

Meningismus
-morbid state characterized by meningitic syndrome (triad: headache, photophobia, nuchal rigidity)

Meningism
-synonymous of meningismus
-neck stiffness w/o meningeal inflammation
2/

Autonomous Sensory Zones
(peripheral nerves)

Median nerve illustration by Guttmann (1939)

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1/ Definition

“regions where single nerve roots supply distinct and non-overlapping areas of skin”

- small portion of dermatome
- few nerve roots have such autonomous zones
- great variability

2/

Inverted & Perverted Reflexes

The first description of the paradoxical (inverted) triceps reflex

French neurologist Alexandre-Achille Souques (1860–1944)

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1/ Definition

“elicitation of the movement opposite to that normally seen when the reflex is elicited”

2/

Myotonic disorders!

“after a fright, or in an unexpected joyous movement, this convulsive constriction occurs in all limbs…the victim can not stand upright”

Prussian physician Asmus Julius Thomas Thomsen (1815–1896)

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1/ Definition

“difficulty in relaxation of a muscle after maximum voluntary contraction”

It can be specifically
- aggravated by conditions
- affecting regions of the body
- triggered

2/

Dermatome!!!

“Dermatomal man, early twentieth century”

University of Edinburgh Image Collections

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1/ History

“dermatomal charts are primarily derived from 3 sources”

Head & Campbell
-herpetic eruptions

Foerster
-rhizotomy in chronic pain
-dermatomal overlap

Keegan & Garrett
-various diseases
-exam & surgical correlate: 53%

American neurosurgeon John Jay Keegan(1889-1978)
2/

Hereditary Ataxias!!!
Spinocerebellar ataxias (SCA)

“SCA1 …. the unstable CAG trinucleotide repeat expansion”

American geneticist Harry T. Orr

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1/ SCA definition

“complex group of heterogeneous degenerative diseases of the cerebellum and its connections”

2/

Dancing larynx!!!

“a variant of palatal tremor?”

British neurologist Anette-Eleonore Schrag
1999, first description
@UCLIoN

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1/ Definition

“rhythmic vertical laryngeal cage movements of varying frequency with synchronous movements of the tongue, posterior pharynx, and the palatopharyngeal arch”

- not affecting uvula

2/

Rabbit syndrome!!!

“a peculiar extrapyramidal reaction”

Canadian psychiatrist André Villeneuve
1972, the first report

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1/ Definition

“stereotyped vertical, rhythmic movements, similar to the chewing movements of a rabbit”

5 Hz
Lips produce a popping sound
Not tardive dyskinesia!
- persist stage I sleep

2/

Belly Dancer's Dyskinesia!!!

“first described by Antonie van Leeuwenhoek in 1723 when he himself experienced the symptoms”

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1/ Definition

“rhythmic, involuntary contractions of the diaphragm resulting in undulating, rhythmic movements of the abdomen resembling a belly dance”

-bilateral, most freq
-limited to axial musculature
-sometimes painful
-no suppress on breath holding
-150 contraction/min

2/

Jack-in-the-box tongue!!!

“The English Hippocrates”

English physician Thomas Sydenham (1624 – 1689)
discovered Sydenham's chorea

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1/ Pathophysiology

“combination of chorea & motor impersistence”

https://twitter.com/theneurolander/status/1598156301728874496

2/

Milkmaid’s grip!!!

“motor impersistence of the hand”

Philippus Aureolus Theophrastus Paracelsus Bombastus von Hohenheim (1493–1541)
(Paracelsus)
first coined the term Chorea Sancti Viti

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1/ Pathophysiology

“combination of chorea & motor impersistence”

Motor impersistence
- inability to maintain tetanic muscle contraction
- positioning & compensatory repositioning
- independent of chorea
- linearly progressive (marker of disease severity?)
- frontal lobe

2/

Glabellar reflex (Myerson's sign)!!!

"the preliminary note on a new cranial reflex"

British doctor Walker Overend (1858–1926)

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1/ Glossary

Glabellar reflex
Habituation
Myerson’s sign
Primitive reflex

2/

Wing-beating tremor!!!

“pseudosclerotic, parkinsonism, and dystonic/choreic forms of Wilson’s disease”

American-born British neurologist Samuel Alexander Kinnier Wilson (1878–1937)

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1/ Pathophysiology

“lesion in the dentatorubrothalamic pathway”

- cerebellar outflow pathway

Complex phenomenology
- dystonic, myoclonic, rhythmic tremor?

https://twitter.com/theneurolander/status/1591933986753880067

2/

Nystagmus series – Part VII
(seesaw & hemi-seesaw nystagmus)

“Maddox rod, double prism Maddox, red glass Maddox, Maddox cross, and Maddox wing”

British ophthalmologist Ernest Edmund Maddox (1863–1933)
(first report)

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1/ Definition

“one half-cycle of elevation&intorsion of one eye
and
synchronous depression&extorsion of the other eye.
Next half-cycle,
vertical&torsional components are reversed”

- waveform: pendular (seesaw) & jerk (hemi-seesaw)
- hemi-seesaw: only one half-cycle

2/

Head retraction reflex!!!

“the great neurologist and neurosurgeon from Breslau (Wrocław)”

German neurologist and neurosurgeon Otfrid Foerster (1873–1941)

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1/ History

Head retraction reflex is a “triphasic cutaneomuscular reflex” related to the trigeminal system with some pyramidal control.

2/

Corneomandibular reflex!!!

“there is hardly a more valuable test than this to uncover a supranuclear lesion of the trigeminal nerve”

Russian neurologist Robert Wartenberg (1887–1956)

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1/ History

1902 by German doctor Von Sölder
- first description, normal patients

1918 by German neurologist Ernst Trömner
- rediscovered the reflex

1948 by Russian neurologist Robert Wartenberg
- complete description
- ‘jaw wincking phenomenon’

2/