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Data and Picture Interpretation Stations: Cases 1–45
Published in Peter Kullar, Joseph Manjaly, Livy Kenyon, Joseph Manjaly, Peter Kullar, Joseph Manjaly, Peter Kullar, ENT OSCEs, 2023
Peter Kullar, Joseph Manjaly, Livy Kenyon, Joseph Manjaly, Peter Kullar, Joseph Manjaly, Peter Kullar
With regards to facial palsy, establishing the onset and severity is an important distinction. An immediate grade VI lower motor neuron palsy may require surgical exploration and repair/decompression by a skull base surgeon. Incomplete and delayed palsies should be treated with steroids.
Motor Neurological Examination of the Hand and Upper Limb
Published in J. Terrence Jose Jerome, Clinical Examination of the Hand, 2022
This ability of the muscles to function, based on their neurological supply, can be compromised in two situations: Upper motor neuron lesions and the lower motor neuron lesions. The upper motor neuron lesion involves any part of the upper motor neuronal pathway and the lower motor neuron lesion involves any part of the lower motor neuronal pathway.
Progressive Neurological Diseases
Published in Amy J. Litterini, Christopher M. Wilson, Physical Activity and Rehabilitation in Life-threatening Illness, 2021
Christopher M. Wilson, Amy J. Litterini
ALS is initially a diagnosis of exclusion, where other possible neurological causes of symptomatology are ruled out by the absence of electromyographic and neuroimaging proof of other diagnoses. According to the El Escorial criteria, after ruling out other neurologic conditions, the specific diagnosis is made with evidence of: lower motor neuron degeneration by clinical, electrophysiological, and or neuropathological examination; evidence of upper motor neuron degeneration by clinical examination; and progressive spread of signs and symptoms within a region, or throughout another region of the body, by history and examination.31
Transcranial Direct Current Stimulation of Motor Cortex Enhances Spike Performances of Professional Female Volleyball Players
Published in Journal of Motor Behavior, 2023
Seung-Bo Park, Doug Hyun Han, Junggi Hong, Jea-Woog Lee
In another aspect, although electrical stimulation was applied to the specific cortical area of M1 induced by tDCS in the present study, it might have affected adjacent areas, resulting in a somewhat more widespread area of target stimulation. This means that the premotor cortex, complex system of interconnected frontal lobe areas anterior to the primary motor cortex, s mainly responsible for motor functions. The upper motor neurons in the premotor cortex regulates motor behavior via extensive reciprocal connections with the primary motor cortex and axons projecting through the corticobulbar and corticospinal pathways that affect local circuit and lower motor neurons of the spinal cord and brainstem (Purves et al., 2001). In particular, the left dorsal premotor cortex activity is associated with complex motor coordination performance, meaning that tDCS has potential to improve visuomotor coordination (Pavlova et al., 2014). According to Tzvi et al. (2022), the cerebellum plays an essential role in the process of visuomotor adaptation. They noted that interaction with cortical structures, especially the premotor cortex, contributed mainly to this process. The cerebellum plays a central role in coordinating voluntary movements and motor skills including balance, coordination, and posture (Manto et al., 2012). These relationships suggest that activation of the premotor cortex and its interactions with the cerebellum could enhance the process of motor coordination by tDCS (Kwon et al., 2015; Tzvi et al., 2022).
Complete Horizontal Gaze Paresis Due to Medial Pontine Haemorrhage
Published in Neuro-Ophthalmology, 2023
Joan Pei Yun Sim, Jackie Jia Lin Sim, Sameer Saleem, Dennis Cordato
On physical examination, she was afebrile with a blood pressure of 146/60 and a heart rate 69 beats per minute with a normal rhythm. She had a skew deviation with relative hypertropia of the right eye, bilateral horizontal gaze palsies, and impairment of vertical gaze (see online Supplemental Video). Her pupils were equal and reactive, with normal visual fields and no visual neglect or nystagmus. A right lower motor neuron facial paresis, dysarthria, and impaired swallowing were also evident. Her power was significantly reduced in both arms and both legs, worse on the left and sensation was also reduced in her left arm and leg. There was right arm and leg ataxia. She had brisk reflexes on the left with a left upgoing plantar response. All other physical examination findings were unremarkable.
Amyotrophic lateral sclerosis in Antalya, Turkey. A prospective study, 2016–2018
Published in Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration, 2021
Hilmi Uysal, Parvin Taghiyeva, Mehtap Türkay, Fırat Köse, Mehmet Aktekin
The site of onset was spinal in 81.7% of patients and bulbar in 18.3% of patients. Bulbar onset was 18.2% for males and 18.5% for females (p > 0.05). The mean age of onset was 60.8 ± 10.5 in patients with bulbar onset, and 57.6 ± 14.7 in patients with spinal onset (p > 0.05). The initial finding of the disease was consistent with upper motor neuron involvement in 29.3% of patients, lower motor neuron involvement in 61.0% and both in 9.8%. There was no difference between upper or lower motor neuron involvement in terms of gender, age of diagnosis, and delay in diagnosis (p > 0.05). In patients with upper motor neuron involvement at onset, survival was 24.7 ± 14.2 months after diagnosis, whereas in patients with lower motor neuron involvement, survival was 73.1 ± 52.1 months (p < 0.05). In patients whose disease begins with both motor neuron involvement, the survival after diagnosis was the lowest (14.2 ± 5.8 months).