BEST NEUROLOGY LEARNING

TUBERCULOMA VERSUS NEUROCYSTICERCOSIS BRAIN Solitary granulomatous lesions are common causes of seizures and headache in India and elsewhere. The two most common causes are: 1. Tuberculoma (caused by Mycobacterium tuberculosis), 2. Neurocysticercosis-NCC (caused by tapeworm, Taenia solium). Treatment involves 1. Use of antiepileptic drugs for seizure control, 2. Specific anti-infective treatment for for TB or NCC. Anti-tuberculous treatment is long and may be needed for 18 months or longer. For tapeworm infection (NCC), 1-2 week treatment may be enough. Appropriate treatment depends on confirmation of diagnosis. The gold standard for confirming the diagnosis is biopsy of the lesion, which requires surgery in brain. Therefore, practically diagnosis depends on MRI and CT scan features. MRI features favoring a diagnosis of tuberculoma are: 1. Size> 2 cm, 2. Severe perilesional edema, 3. Conglomerate lesions. Presence of focal neurological deficits also favor a diagno...

PSYCHOGENIC MOTOR WEAKNESS Motor weakness is a common symptom presenting in neurology out-patient department or in an emergency room. It is important to determine whether it is of psychogenic or neurological origin. A few clinical signs can help in this matter. 1. Hoover's sign- Place the palm of your hand under the heel of foot on the side with "normal" power and ask the patient to lift the "affected" side. In a person with neurologic (genuine) weakness, you would feel the heel (of the normal foot) pressing against your palm. The affected leg would be weaker. On the other hand, in a person with psychogenic weakness, no pressure would be felt on the palm. 2. Raise the affected arm and let it drop. In a person with neurologic weakness, it falls on the body part if allowed to drop there. On the other hand, in a person with psychogenic weakness, the falling hand avoids any body part in order to avoid getting hurt. Please ensure that while testing, the hand ...