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Neuropsychiatric problems
Motor system
weakness
movement disorder
gait disorder
ataxia
Sensory system
numbness
Autonomic function
Episodic disorder
transient loss of
consciousness
pupils: 3 mm SRTL
no motor response
dolls eye-negative
case
case
The question of alter level of
conscious state
Localize lesion
C: state of consciousness
M: motor response
R: respiratory pattern
Hippus Greek hippos meaning horse
Hippus, also known as pupillary athetosis, is
spasmodic, rhythmic, but irregular dilating and
contracting pupillary movements between the
sphincter and dilator muscles
Unilateral/bilateral miosis,
retained light reaction
Bilateral unresponsive large pupils
Pupils remain xed in mid-position
Bilateral xed mid-position pupils
Hypothalamic/
diencephalon
Upper midbrain
Central midbrain
Lower brainstem/
medulla
Rostro-caudal brainstem compression secondary to
an expanding supratentorial process
O: Ocular movement
Resting position
Eye deviation
Resting position
Adventitious movements
Tonic clonic
myoclonus
Purposeful movement
Posture in coma
Decerebrate rigidity
Decerebrate cat
Decorticate posture
Apneustic breathing
Cluster breathing
Ataxic respiration
Localisation from respiratory
patterns
Structural
Non-structural
Exogenous:
drugs
Endogenous
Circumstance
Acute catatonia
Intoxication
Cholinergic (organophosphate)
Clinical symptoms
fever
memory loss
alteration of consciousness
neurological decit
Investigation:
Hours to day
Causes
Idiopathic
Prevalence
Donepezil(Aricept),
Rivastigmine(Exelon),
Galantamine(Reminyl)
Pharmacologic treatment
Donepezil(Aricept),
Rivastigmine(Exelon),
Galantamine(Reminyl)
Symptomatic treatment
Vascular dementia
Hypothyroidism
AID Dementia
Essential features
Subcortical dementia
Janssen et al. Neurology 1991. 41:778-785
White-matter abnormalities on CT and MRI
Left: CT scan showing ventricular enlargement and white-matter
hypodensity.
Right: FLAIR MRI showing both cortical and central atrophy,
and characteristic conuent signal abnormalities deep within the
white matter.
Operational denition of HIV-D and clinical
features of use for diagnosis
HIV-1 seropositivity
CSF biomarker: beta-2 microglobulin and HIV viral load are not
strongly correlated with ADC severity
Navia B, et al. Ann Neurol 1986, 19:517 524.
Dore GJ, et al. AIDS 2003, 17:15391545.
Cysique L, et al. XIVth International AIDS Conference. Spain 2002.
Treatment of HIV-D