'Y.wanna B , , , ,

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1 51-3 03-61 73-13 44-83 45-54 75-55 06-85 07-16 67-17 58-77 39-68 101-49 801-201 911-901 121-021 621-221 331-721 931-431 871-041 , , - , -CSF CNS "

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. : . , , . . : - Olfactory" . 1. ) ( . " - 04 , 2. - Optic ) (, . : - -2.1 - 1. . )( 03 ", - ; . ) 1 (J . - ) .(CF - COUNTING FINGERS - . - , . - ) NLP ( - .NO LIGHT PERCEPTION - ; 2. . , ) ( - OPTIC RADIATION , 3 . - . 3 - III . - EFFERENT . , , 2 -3 ) AFFERENT- EFFERENT(.

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-PERRLA , , . , , . LIGHT SWINGING TEST , . - , , - - RELATIVE AFFERENT PUPILLARY DEFECT RAPD " ; . , , " ' - PUPILLARY PLAY ) , , (. - . 3. , ) (. - , , " 2 , " ) (. . - , . - , ) - CONES (. - CENTRAL SCOTOMA - . - ) (. - ; . ) (. - ) ( - . : - , , - . )( . 4. , -, ) , (. - - OPTIC ATROPHY - , , ", , . , .

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-OPTIC .ATROPHY , ) (. , , . - , . RETRO BULBAR NEURITIS . , - . ) RAPD (. - - ; - ,COLLAPSE . -%58 . - ICP, - Oculomotor - 3. '. 3 5 7 )4 SUPERIOR OBLIQUE -6 .(LATERAL RECTUS 3 . , ) 6,4,3 ( - ; . - . , SCLERA . , . - . , ) ( - ) (FEF , " . Cochlear . 4 4. , -) superior oblique ( . Trigeminal . 3 - , 5. , . ) ( . ) " 2 (C . - , . - //, , ) " 3 .(C " 3-2 C " 5. " - , " - .Maseter " .V - afferent - . 5 0 (Jaw jerk http://www.youtube.com/watch?v=ctFvOasAKo ( , .

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- Abducens 6 - 6. PONTINE GAZE CENTER ) (MLF 3 - 2 . - ) (INO . INO ) INO"(, . - . Facial ; 7 7. , , - , ) (. : , , , , '. -7 - . 7 ) (. 7 - - . - BELLS PALSY 7 , , . ' ) (, . -Hemifacial spasm post Bells palsy , . Vestibulocochlear : 8. Vestibular ), ( 1. - , . , . - Cochlear . , 2. ) 0002-005 821(. . RINE- .VEBER , - . - RINE ) ( - ) (. In a normal patient, the sound is heard equally loud in both ears (no lateralization). Thus, there is diagnostic utility only in asymmetric hearing losses. In an abnormal patient, the sound is heard louder in one ear (lateralization). However, a patient with symmetrical hearing loss will hear the sound equally as well. A patient with a unilateral conductive hearing loss would hear the tuning fork loudest in the affected ear, This is because the conduction .problem masks the ambient noise of the room WEBER , . A patient with a unilateral ,sensorineural hearing loss would hear the sound louder in the unaffected ear because the affected ear is less effective at picking up sound even if it is .transmitted directly by conduction into the inner ear

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Conductive hearing loss is confirmed in the weaker ear if bone conduction is .greater than air conduction and the Weber test lateralizes to that sideWeber without lateralization Rinne both ears AC>BC Rinne left BC>AC Rinne right BC>AC Normal Weber lateralizes left Sensorineural loss in right Conductive loss in left Combined loss : conductive and sensorineural loss in right Weber lateralizes right Sensorineural loss in left Combined loss : conductive and sensorineural loss in left Conductive loss in right

Glossopharyngeal 9. )(, , )3 4 (, , . . " - ) (. - GAG REFLEX . ) (. . . - 9 . - . , . 9 . - Vagus . 01. - . , " . - Accessory -3-1 C 11. '. SCM. - ) , (. " - . - SCM " - . - Hypoglossal . 21. - . , , . " . . ) (. ) (

. : http://www.youtube.com/watch?v=Xd2PXvH-gAc

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http://www.youtube.com/watch?v=Dzaf9Auyef4&feature=related - UMN ; . " . - . : 1. - //, , , , , , ) - " (. - ) ( )) (MUP -.(LMN 2. - . . - . 2 - 1. )( - - LMN -) UMN (. - 5 T " ; " . 2. - : - - ,UMN , - ) (. )( - . -. : ) ( ) (. 3. - Pronation drift ; , . - 'Barre -09 ) (, . 4. . 5. . 6. : ?http://www.youtube.com/watch v=oYeqavQiZdg&feature=related

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* 1C5-T 6 : 0 . 1 - . 2 - . 3 - . 4 - , ; . 5 - . ? -(tibalis anterior (L4-5, deep peroneal 5,L )5 (sup. gluteal L -deep peroneal. 5-4 (tibalis posterior (tibial, L .peroneal - )4-2 ,L( ) 4-2 (L ) 4-2 L(. 2 - 4-2 ;L )4-2 L(. . . : - , ' . , . . ,LMN ) UMN (. : )?http://www.youtube.com/watch 1=(v=fymDY2q0FtE&NR 1. : 4 : 6-5 Biceps (C(, 8-7 Triceps (C(, 6-5 Brachioradialis (C(, ) C7-8, Median .(Ulnar 2. : 2 : ) , 4-2 L(, )2-1 S(. 3. : - )=(. )8-7" - (C ] . "[ , . 2 " - . - , - . " . - . , .UMN

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4. : - " . 1. - ; - , )(. - Confirmatory reflexes - ' 2. ) - Lat. maleolus ][(, ) ( ) 2 (. 5. : - . 1. : 2. - . . -UMN - . - . .UMN 6. : .PALMOMENTAL, GRASP, SNOUT, ROOTING , '. - Palmomental - .Mentalis- - Grasp . 0http://www.youtube.com/watch?v=4WPCOruYfU . : 2 : ) ( - ' ), ( . ) (, 2 - . , . ) (. ) (. . ) ( - . , ' . -dorsal root

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ganglion , , . )( )( . . -VPL . .

? ?http://www.youtube.com/watch v=Sfr2UTNF6EM - . 06 . . - . " - . " '. - 1,L 01 ,D 5 ,D 4-3 ,L 1 S'. -3 D- 4 C ; . 7C . - 6 .C - 5 C'.

'Y.wanna B

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. - . - ).(Occiput ) (. . - , . . , - ,Thenar . . , . , . ". - . . . 4 D . 01 D . .Inguinal . . , . , Medial maleolus . , . , . - . - ) 3 .(S - . ) 2 .(S . . -.

2C 3C 4C 5C 6C 7C 8C 1D 21D2-D 1L 2L 3L 4L 5L 1S 2S 3S 4S 5S

. : " . ) (. - . : 1. - ; ; , . . . " ) (. 2. - - -. 3. - . , - . 4. - . 5. ) ( , - . " .

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6. - . . , . 7. "" - 03 , " 03 - ) ( , 2 - )( "; "" . 8. - . 9. : Pursuit . o - . ) o (, -) Frontal eye field (. - Saccadic pursuit - Pursuit - Saccadic pursuit . Overshot . o 01. , , .Scanning speech

)(: 1. ,UMN - Clasp knife . Led ) pipe (, ) Cogwheel (. 2. - . ) .(Digiti minimi sign .

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3. , 4. ) 4 (. 5. . 6. : - -%69. - , . ' - . ' - Lat. maleolus . - . - %53. Spreading )( - . 7. - . 8. - ) (UMN , V afferent- .efferent - LMN . -: - , , , : - , Freezing ) (. , , . ) Gower sign ( ), ( ; . )" "(. )( . , ) (. , , . , ) Glabellar( - -%07. -. reflex It is elicited by repetitive tapping on the forehead. Normal subjects blink in response to the first several taps. If the blinking persists, this is known as Myerson's sign and is abnormal.The afferent sensory signals are transmitted by the trigeminal nerve, and the efferent signals come back to orbicularis oculi muscle via the facial .nerve , , , .

:

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1. Palmpomental . . . 2. Snout )( )" " (. . . 3. - Grasping . 4. - Boxer sign, Rooting . " - , . - Fastination " ". , Gait . praxia - - 5 , , )7-7-7-7-7-001( - . )( , . . : 1. )( (Gerstmann syndrome (angular gyrus 4 : , , - finger .agnosia . 2. )( , : - geometric apraxia / . .i - topotgraphic disorientation .ii . . .iii ) (denial )(neglact .iv 3. Two point discrimination . . . 4. . 5. . : 1. .scanning speach 2. - . 3. -.Saccadic pursuit 4. 5. . 6. . 7. -. 8. -. 9. )(. "". 01.

'Y.wanna B

61 - Tower of Saigon . 11.

- . -3 : . - 1. -, - ' - . , " - - . - Paramedian 2. ) , (. - - 3. , , , . - ) (Dentate , - .Paramedian . ; - , - . . - Tower of saigon ; . , - , - . -.Cerebello-spinal - , - ; ) ( , )( . - )( ; ;Alcohol induced - , - - . - ) , ( . - . . : : 1. - , , , . 2. , )(, ) , - (. )

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( . 3. - , ) (, ) - (. " . - VPL ) (. - , , . - - - VPL . . : 1. 2. - , , 7-7-7-7-7-001, .Digit span ) ( . 3. 3 . 4. ) (. . 5. . 6. , .

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, . -000,02 . , 56. . : 1. 2. " . 3. . 4. . 5. . 6. . 7. , . , . , , - , , , , , , , . , . , 42 , - ,CNS . : 1. - ; ) ( ) ( .

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) ( Stroke in evolution .Progressive stroke ) (, , . 2. , 42 . )" 03 (, Transient ischemic attack (TIA). TIA , . TIA , . ,TIA TIA 5 " . , -42 Minor stroke Reversible ischemic neurological deficit (RIND). TIA- ,RIND , . 3. . , , , ICP, , , . , ;stroke ) Global cerebral ischemia" ( - Subarachnoid .hemorrhage

;Stroke CVA . - %02 %08. -) ICH ( -) SAH (. ) (Hemorrhagic transformation - ; - . 5-3 . ) (. - CT" 84-42 ; . - - CT , CT . ;NIH " ) (. NIH : 1. )%04( - , " . - - MCA, ACA, PCA

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) , , (. - ) ( - Perforating arteries , . 2. )%02-51( - - - ) '(. 3. )%02-51( - ) , (; )( . " , , . - -4 . -21 ) (. : - Pure motor syndrome ) ( 1. . %05 , . - Pure sensory syndrome . 2. . Disarthria clumsiness . 3. - Hemiparesis hemiataxia syndrome - 4. . 3 - )(, )-( - - )(. - Peduncles. - -; , - . 4. )%5(. 5. .

** : 1. ,SLE, PAN, Granulomatous angiitis, Syphilitic arteritis .AIDS 2. Fibromuscular dysplasia . 3. /. 4. , , . 5. .Venous or Sinus thrombosis 6. , ) ,(AF, ) (ASD.

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7. , , , , ) .(APLA ) - :(Carotid 1. - -Internal carotid - PCA, Ophtalmic artery . - CT MCA - ACA ) , '(. - Internal carotid . , ) (. : 1. / . 2. -. 3. ) -.(Optic radiation 4. ) (. 5. . ** : . " , . . , ) (, . 2. - MCA- MCA ; )( ), (. ) (, ) ,Optic radiation . 3-2 - MCA 01 . MCA ), ( : ) " .(ACA 1. . 2. )( - . 3. ) .(SMA 4. . 5. - MCA )( : 7. . )( (Gerstmann syndrome (angular gyrus .a 4 : , , - .finger agnosia )( - . . )( , .b : 982

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- geometric apraxia .i / . - topotgraphic disorientation .ii . . .iii .iv 8. - - optic radiation . - , ) (. ) Lenticulostriate (Perforating ) MCA ( , , ) - .(Internal capsule , : . 1. . 2. . 3. ** - ) ( . , , . - , . MCA - ) (. ) ( . - SMA -, "" , - , - 2 . , . - SMA - - -; -3 , . ** - MCA ) (, - - MCA Lenticulostriate .

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: 1. . )(, )(, )( - . " - , ) (, ) (. , , . - , , ) (. . 2. - ; . - 2 - point discrimination . 3. - , , - Denial .Neglect - Denial" , , - ) - , (. - Neglect , , - Esteem - . , - ) , '( - .Alien hand 3. ACA - ACA ) MCA (. ACA - ) ( - ACA - . ,MCA . - ACA : 1. ; - ) -(. 2. - Urine incontinence - . 3. . , - , '.

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- - . - , '. - ) , - (. , ; - , . ** - NPH - CSF , , '. , - . , - , - .Normopressure hydrocephalus . - " )" " - (, . - ACA , ) ( . - 05 " - LP ) (. " , . . - Gait ataxia . ACA : - ACA - -%03 - ACA , - .ACA ) - (ACA : 1. ) (. 2. , - ,Abulia - . 3. . ) ( - , - . - ,UMN , CT - " . - , .

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- )(: : " - ).(Paramedian branches Pontine arteries - .pons, 3 - Circumferential - ,PICA .AICA, SCA - PICA . - PICA , - - PICA . 4 Perforating , - Choroid - , ), '(. - . ) - -,VPL (VPM - ) - (. - Dejarine Russy " - VPL . , . - PCA . : ) Reticular formation , '( - Paramedian core . . - ) ,(Afferent ; ) ( . " - Peduncles 3 . -. : 882

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I ; " .II 1. III - ,Midbrain .IV 2. - Pons VI- .VII 3. VIII -. - ,IX, X 4. .XI, XII - , . 9 , . ? 1. : 6,4,3 ; 1. . . 5 - , . 2. 7 - . 3. 8 - , / ) ( - 4. . 21,01,9 - :D, ) (, 5. )(. 2. ) - - (Reticular formation . 3. )( - )UMN ( -. 4. . - ) (. ) ( - .Alternating (crossing) symptoms -. : 1. 5 ) ( - ) ( . 2. - ) - UMN (, 3 ), , ( . 4 . 3. , -7,6 . 4. - ", ) / (. - , . : 1. PCA- PCA , , . PCA . PCA: - ,Macular sparing 1. . ) .(MCA

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, III, INO 2. - PCA . - ) ,(Anomic aphasia 3. . - Visual agnosia . PCA , ) (, ) ,(Prosopagnosia ) (.

2. 2 , .PCA , , , . : 1. " ) .(AICA , . 2 . " , -.Pons )( / ,VI ) - ,(PRPF ) (, , . , - Ventral

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.Locked in syndrome " . EEG . " " , 2. - .PCA ) - ,(Reticular formation / ,III ) ( Uncal .herniation : 1. ) - ( .III .Weber syndrome ) III ] [, ( : '. . ** "" - ;III , , : - - )( , . ) - ( - - . - %09 . , - ; - " Posterior communicating " . ; - - , ) (. - III , . III - , . 2. - ) ( - VI- VII .Millard-Gubler , VII .LMN - VII , ) - Bells palsy( - Bells palsy- DD - - VII , . 3. - -(Wallenberg syndrome (PICA syndrome: , , ,IX X.

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) PICA - ,(Inferior peduncle )(, , ) .(3D , , - .X , . - .VIII - . - - , -. , - V - , , . , V ) 5( - . 4. : ) (. - , , ].[three Z's ** - - D . ; . 1. : , onset ) TIA , ] [ ] [ ( ) , ( ) -%52 (. 2. : , . 3. : ; 1. ) CBC , , , (, ) ESR (, ) CRP (, , ) (, ) (. " MI AF 2. . CT MRI 3. , ), ( . " CT , . MRI " CT , . LP SAH . 4. . 5. . 6. :

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1. ,ICH /, SAH , . 2. . 3. . Asymptomatic carotid bruit or stenosis 1. ) " ( . , . ) (, ).(Endarterectomy 2. TIA TIA , : ) ( - TIA 1. ) (; , , . TIA ; 2. ) ,AF ( . , - Warfarin ) INR 4-3(. Carotid endarterectomy 3. TIA . - Endarterectomy . - TIA - -. , . 4. . Stroke in evolution . 3. , . - TPA . " . 4. -Completed stroke : IV TPA 1. , . TPA 3 . 9.0 " 09 ". %01 , . . - C/I ) - ,(100k ) -3 (, , " , ) (TIA . ,TPA , ), , ,CVP (. Prourokinase 2. ) ( IV, MCA 6-3 . - 84 ', - ,TIA 3. . 803

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, 4. . , . . 5. , " . 6. ** " / / ) (. . ) (. . ) , (. . . ) ;(SMA . . -. -. / . . Internal carotid MCA )( MCA

-. - -. .Macular sparing . - III , . :3D'S , , . ) (. )(.

- . ) (

. ) .(Abulia , , .Visual agnosia

) Perforating MCA ( ) ACA "( PCA

-.

Weber syndrome Millard-Gubler Wallenberg

. .

rebral rhage - ensive

Intr ace he mor

ICH Hy pert

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.hemorrhage - ICH , , /, , . " -) ICH " -(. " -ICH ICH " ) ( ) ( - .ICH - ICH " . ; penetrating - Caudate and putaminal branches %24( ,(MCA ) %61(, %51( , (PCA SCA Dentate nuclei )%21(. : , . -%05 . . " , " 05. , ICH . , . , . , . , , . , - CSF. ICH " . : 1. Deep cerebral hemorrhage , " ) , .(Optic radiation - . , , . , . , , - .Upward gaze " , . 2. Lobar hemorrhage . , , , , , . , . 3. Pontine hemorrhage , " 84 . , , , . . ", - RAS . 4. Cerebellar hemorrhage , , , , . , 42-21 . . LMN . , .

413

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:ICH 1. , .Lobar , . CT . 2. / . " , " . 3. , , - .gait ataxia , , " . : 1. : Cerebellar decompression 1. , . . , . Cerebral decompression 2. . . C/I Pontine , 3. . 2. : ) (. 1. Volume overload ". 2. . 3. Global Cerebral Ischemia . . ) ( , . , - Border zones , - Watershed region 3 . , " , . : 1. ; 21 . , . , . 2. : Focal cerebral dysfunction 21 , 1. , . , .

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-) (, 2 , . . Border zones , Persistent vegetative state .2 (. , Neocortical death) - . Spinal cord syndromes .3 , . , (. border zone ) .(' -anterior spinal shock- ) Spinal stroke , , Global Cerebral Ischemia - . (Cerebral venous sinus thrombosis (CVST is a rare form of stroke that results from thrombosis (a blood clot) of the dural venous sinuses, which drain blood from the brain. Symptoms may include headache, abnormal vision, any of the symptoms of stroke such as weakness of the face and limbs on one side of the body, and seizures. The intracranial pressure may rise causing: papilledema (optic disc swelling -> visual obscurations), consciousness is decreased, the blood pressure rises, the heart rate falls and the patient assumes an abnormal posture. The diagnosis is usually by computed tomography (CT/CAT scan) and preferably ormagnetic resonance imaging (MRI) venography employing radiocontrastto demonstrate obstruction of the venous sinuses by thrombus.

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: - ) (. . )UMN ( - , - , , )( . . - . . - . ) - 8 ,9(. - , " . - 4-2 L ) (. , -, ) ( - . : . ) ( - . , ; 1 ;C5-T - 1 L ) (. , . , , , , . 3-1 ; -

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. ) VPL - VPM (. , , . . ), , ( , - ; , ) - (. ) (. : -5) T ( - , , ) (. ) UMN , - , )( ( . 5 T - - , , - . - ) ( , . -4 : , , . , . , , . , . , 5 C . - 5 C , -1T . ,UMN . , . , , . , , .

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) (: ) , , ( , . )( ;Spinal shock - LMN , , ) ; = (. , . . , . ) (, . - LMN - UPN . - . ; .Overflow incontinence - - Mass reflexes , , . - . .Spastic paraplegia/quadriplegia ) ( " , .UTI , ) (. . , , . - .Urgency incontinence , ) (. " . ) 8 ( ) (. , , ) ,(GABA, ) 2 (. , . - ) , (. Cauda equina syndrome (CES) - After the conus (L1-2), the spinal canal contains a mass of nerves (the cauda equina) that branches off the lower end of the spinal cord and contains the nerve roots from L1-5 and S1-5. CES is an acute loss of function of the cauda equina wich causes: paraplegia and bilateral absence of ankle reflexes (LMN injurey), urinary retention, sexual dysfunction, saddle-anaesthesia, possibly fecal ,incontinence Diagnosis confirmed by MRI/CT. etiologey: Tumors and lesions .Trauma, Spinal stenosis, Inflammatory conditions " " - - , . - , , - " . . .

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, - , , . , , '. ) ( , ) (, ) ( -2 (. . The corticospinal lesion produces spastic paralysis on the same side of the body below the level of the lesion (due to loss of moderation by the UMN). At the level of the lesion, there will be flaccid paralysis of the muscles supplied by the nerve of that level .((since LMN are affected at the level of the lesion :Sub acute combined degeneration of cord 21 .B 21 B . -21 B )( - " )(. . Lhermitte sign (an electrical sensation that runs down the back and into the limbs. In many patients, it is ,(elicited by bending the head forward . , , . , Optic atrophy )(. " . , , . 21 B . 21 B IM , " , . : 1. -Poliomyelitis , . . - . 2 - , " . , , '. " )(, . . - LMN , , , , . - . LMN - . 2. Epidural abscess , , OM, ,IVDA , .LP AIDS . ' , , -, . , , , ; ,

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. ; MRI . ". 3. - , ) (. Tabes dorsalis is a slow degeneration of the spinal cord dorsal columns (proprioception), caused by demyelination secondary to an .untreated syphilis infection 4. TB , , - )(, " .Tuberculoma 5. AIDS ) Vacuolar myelopathy -%02 ( , . , ) " ,HIV (. 21 ,B , . " , , . , , , , . 6. " . , ) , (. . , NT, - GABA . . 3 , ) (, , ) .(Risus sardonicus ) -(. . , - EMG , CK . " . 01-5 . ) (, .Tetanus IG ", IG ) IM -(, ' . ; -. %06-01; , %59 . : 1. ) Infarction of the spinal cord '( .Anterior spinal artery , " , " . , , , ,PAN . , )" 11.(T10-T

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, , ) UMN - (. , . . - , . 2. Hematomyelia ; " , , -. - .CSF . 3. , , /, , .LP . )" ( LP . LP - . - 20k .LP ; . /, / CT/MRI . 4. AVM or Fistula SAH . . . . , UMN, LMN . " . , . , . " MRI " . - ; " , , . , . :Cervical Spondylosis " ) ( : ; , ; UMN. , , , . , , . " . , ; . . , . 6 C5-C ), / , , ( . , UMN ; . , - MRI/CT .

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- DD ,MS , 21 ,B, , . , . :Syringomyelia )( ; ) Communicating - Central canal - (CSF Non ) communicating -.(CSF , . . , . , . . / , , . 1 T . ) (Syringobulbia , , , , . Communicating 1 ) ; (. Non communicating , -, . -, , ; . , . :Spinocerebellar ataxia . , ) Anticipation ( . . , . . . GAA .Frataxin ) (, . , , , .

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) 4( ", , , . , , , . , ; 04. . :ALS . , " )-%01 (, , . - .Superoxide dismutase UMN- LMN", . ) Amyotrophic Lateral Sclerosis , (. . . , - . . - . - ; .Progressive bulbar palsy , . UMN-,LMN , , /. UMN- LMN , . . " .EMG ) .(MRI - , - . ) ( , ) (.

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2 , - Reticular activating system . , . 2 : 1. . 2. . . , : , Aura 1. ) , , , , ( . , , , . . 2. )( " , ) Jerking ( -51 . , . ) - (. - ) (. ) - (. EEG )(. " 3. . . " 4. ) ,AS, HOCM ( ) (. ), , ( 5. -. )(. ) (Prolonged postictal state , ) , , (. , . ) (Seizures , . - - EEG ) (. 2 . . -%5.0. -%3. )%01 (

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, 06. -02 06 . 2 ) ( - ) -(.

)%57( ; . . : 1. : )( 3 5 . " 52-5. %01 -%2 . %8 . . . HIV encephalopathy " - AIDS ..dementia c - Mesial temporal sclerosis , - .Complex partial seizures 2. : 03-02 "/" . 021 . ), ( 033. . . . . - Drug overdose ,, , , ,TCA, , , ) (sedatives. . ) (. . . . : -2 :

562

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1. ) (Generalized : 1. Petit mal / Absence . )01-5 ( . , . , . , ) (. - EEG 3/ s spike and wave . 2. Grand mal / Tonic-Clonic , " . 2 ; 03-01 , , , ) (; . , . " , "" . 06-03 . , . , . , - Jerking , . , . , . -03-01 . ) (Todd paralysis . 2. : Tonic . Clonic . Myoclonic , Juvenile myoclonic epilepsy. ; , . - Juvenile myoclonic epilepsy - . Atonic . .Lennox-Gastaut 3. ) (Partial . Simple- .Complex Simple Complex - - : Simple Partial . 03 ; 1. , ) (, , ) ( ' . , . , , , , , , . . Complex partial . 2. . , - ) (. , ) Video EEG

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( - - )(. CPS 3-1 . ) (Automatism-%57 ,Orobuccolingual ) , ( - . , , , , ) ( - . -. . ; , . . : , - EEG %06 . , , - -%01. - EEG - ) 31-8 ( ; ) ( - )(. ) ( , ) (. - EEG polyspike discharges,Abnormal spikes- ) spike-wave complexes -.(Absence ) ( , " . ,EEG ) (. 52 " .MRI

: : , , , . 2 - )( -%07 ; %03 - ) (, ) (. 2 : 1. " . 2. - . ,Mesial Temporal Sclerosis . - , GABA'. ; " , -

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) (, ;GI - , , . CBC , ), 1, 3 ,6 (.

) ( 5-2 . , -%52. Spikes-.EEG , , "

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6 . -%02 -%04 , . - ***Status Epilepticus ; . , 2 . Non convulsive Status - Epilepticus , - EEG - , . , -.EEG - SE : 1. , ) , , , (. 2. %05 )05 "( " -03 , - . ) ( - IV ) 01-5 " IV 2 (. - BD IV 02 " - ; ) 05 " ( - ". )01-5 "/( - = )02 "/"( 001 " . - " , . ) (. 3. ), , , , ,CBC (, , ) LP - LP- (, .ECG 4. SE ) 34-24 (, ) PH -7( ) .(60k , . .Curare . - ***SUDEP . , . : , ) (. , -%57 . , , . .

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Pseudoseizures ) ( ,Conversion disorder , ,Factitious .Malingering , . ,Factitious , . ,Malingering . Pseudoseizures " .EEG -, ; " , . . , ; " . . - EEG " .postictal slowing Cataplexy & narcolepsy Cataplexyis a sudden and transient episode of loss of muscle tone, often triggered by emotions. It is a rare disease, but frequently affects people who have narcolepsy, a ,disorder whose principal signs are EDS (Excessive Daytime Sleepiness), sleep attacks sleep paralysis, hypnagogic hallucinations and disturbed night-time sleep. Cataplexy is sometimes confused with epilepsy, in which a series of flashes or other stimuli can cause superficially similar seizures. Cataplexy can also be present as a side effect of SSRI Discontinuation Syndrome. Cataplexy .Symptoms: Arm weakness, Sagging jaw, Drooping head, Slumping of the shoulders Slurred speech, Generalized weakness, Knee buckling, vision is impaired (double (vision, inability to focus Syncope . . : ) Vasovagal syncope ( - . 1. , , , , , . " , . -. " . , , , , . . , . , , . , - ) (. . ) (, , , , , , .

972

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, ) (. " .Tilt test" . - Cardiovascular syncope 2. , , . CO - : 1. . 2. - , ) SVT 002 (, ,VT, MVP, Long QT syndrome. 3. .Cardiac inflow obstruction 4. .Cardiac outflow obstruction 5. . 6. . 7. PE. " , - 3. ) (. , ) ( ) (. - )" , CNS ( 2 ) Idiopathic Orthostatic Hypotension - ( -) Shy Drager Syndrome -; , , .(LMN , 03 " " 01 " " . .Tilt test - Micturition syncope , 4. . , . )( . " .

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) ( , . : 1. . , , , , , . 2. ; . - . ,Caudate, Putamen, Globus pallidus Subthalamic nucleus- .Substantia negra - GB .Lentiform nucleus Lentiform- Caudate .Corpus striatum : 1. Corticocortical loop , , . 2. .Nigrostriatal loop 3. .Striatopallidal loop ) ( "; ) (essential tremor . : 1. Tremor , , . . " . : Static/rest tremor . 1. ) (.

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" ", , , . Postural tremor ) 2. (. , . ) Physiologic tremor " (, ) (Benign essential tremor . , , , . . , /. , . ) (. , " . asteriaxis - ,Postural tremor . " . , , " ) ( , . . Intention tremor 3. . ) (Postural tremor .Action tremor " , , ) - .(Limb ataxia - ,Sup. Cerebellar peduncle . , ) ( . . 2. Chorea . , , . " . , , )" "(. , ) (. , . , Athetosis . . , - Caudate- ,Putamen " . , " )( . Huntington chorea . , . ", . 04-03 ", ) (.

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, . " - ; , " . ) GABA , - Caudate(. - Huntington chorea Caudate Balooning 2 - Caudate. . . - Huntington chorea . , -. . , , , , , ) - .(PEG - ) Uptake GABA( , '. . Hemiballismus , . ) ( , . -%09 ) ( - , . . , .Thalamotomy

3. Athetosis ) (. , Dystonia . ) (Generalized ) ,Segmental dystonia .(Focal dystonia - , " )( . - " , ) , (. . " " . , , . / , , 5 ". " , . %03. ) -7 8(, " . . ) (. . , .

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%59-09 . , . Torsion dystonia is a disease characterized by painful muscle contractions resulting in uncontrollable distortions. This specific type of dystonia is found in children, with symptoms starting around the ages of 11 or 12. It commonly begins with contractions in one general area such as an arm or a 5 leg that continue to progress throughout the rest of the body. It takes roughly .years for the symptoms to completely progress to a debilitating state : 1. - , . 2. - Mage syndrome ; . 3. - Hemifacial spasm post Bells palsy . . 4. . 4. Myoclonus " Generalized myoclonus , Focal/segmental myoclonus . , , )Action .(myoclonus ) ( , . , . Segmental myoclonus , , . , . 5. Tics ; . -%08 )(OCD, ADHD . - . 6. - Dyskinesia , , , . Tardive , 1 D-2 ,D) Metoclopramide ( , , , . ) (, ,Encephalitis lethargica, Drug/toxin induced . " ' , , , ;

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) (. , " ". " )9191(, . -9791 , - ) L-DOPA 3691(. - Thalamotomy " . . : %2-1 56. . 3-2 5 . -%52 . : 1. - 56 . 58 %01 ) 2 (. 2. - . , . 3. : , . )( 4. : , . 5. : , . : , - Substantia niegra , - GB. - . ) (Lewy bodies Alpha-sinuclein , , . - . , ; - ; - ) ( - . Diffused Lewy Bodies - Disease , ; ) (. 21 - " . - . . 2002 Braak - Staging " - , . ; , - - Dorsal vagal nucleus- - Olfactory bulb - . - Reticular formation

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; . , - . - . : ) (, , -. NT , ,NE . Output GABA ) (Caudate + putamen ACH Output; , , , - GABAnergic output. : 1. 6-4 , . . . " , )-(, /, / . . " , , . , . ; Akinetic rigid type ; , ) ( - , . )%43( )%42(. Equivalence type . 2. , . . , , " ". 3. ) ( ; . )" "(. )( . , ) (. , , . 4. , . , . . , . , . 5. - : , ) (, )

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(, )( , , ) (. , - ) (, ) ; (, . : 1. - . 2. / 2 . 3. . 4. - L-DOPA . 5. - L-DOPA On and off ;phenomenon . 6. . : - " ACH " . : 1. - , . " , , , , . . 2. Amantadine - . - Amantadine . , ) , , , , ( . , . ) IV , (. 3. Levodopa , ) (. , . , .Levodopa " , , ", )(, . . . - Levodopa Wearing-off effect ) ( On-off phenomenon ) , (. Levodopa - Carbidopa , Levodopa; - Levodopa -CNS ) ,(CNS - Levodopa . COMT Inhibitors , Levodopa .

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, Levodopa -4. . " On/off phenomenon - .( L-DOPA ) Sinement - .Levodopa , . MAO B Selegiline .5 . Levodopa - : ) ( Thalamotomy 1. " ) ( Pallidotomy . " . )%02(, .) -%5( Deep brain stimulation .2 - GP . . , . 3. , , . (Multiple system atrophy (MSA MSA is an idiopethic degenerative neurological disorder. MSA is associated with the .degeneration of nerve cells in specific brain areas. typical age of onset is 50-60 MSA is characterized by a combination of the following: autonomic dysfunction: orthostatic hypotension, urinary incontinence or urinary retention, impotence, constipation, dry mouth and skin, trouble regulating body temperature due to abnormal sweating, sleep apnea, REM Behavior Disorder and excessive daytime sleepiness parkinsonism (muscle rigidity + tremor and slow movement) ataxia (Poor coordination / unsteady walking) When autonomic failure predominates, the former term was Shy-Drager syndrome. Parkinson-plus syndromes (disorders of multiple system degeneration, atypical (parkinsonian are a group of neurodegenerative diseases featuring the classical features of Parkinson's disease (tremor, rigidity,akinesia/bradykinesia, postural instability) with additional features that distinguish them from simple idiopathic Parkinson's disease. Some consider Alzheimer's disease to be in this group. They include multiple system atrophy (MSA), progressive supranuclear palsy (PSP), and corticobasal degeneration (CBGD).and possibly Dementia with Lewy bodies (DLB). These disorders are currently lumped into two groups, the synucleinopathies and the tauopathies. Additional Parkinson-plus syndromes include Pick's disease and olivopontocerebellar atrophy(OPCA - ataxia and dysarthria,). Parkinson Plus syndromes are often difficult to differentiate from Parkinson's disease, Nuclear medicine SPECT procedure using 123I-IBZM, is an effective tool in the establishment of the differential diagnosis ditinguish between them.

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The Parkinson-plus syndromes are usually more rapidly progressive and less likely to respond to anti-parkinsonian medication than Parkinson's disease, However, the additional features of the diseasesmay respond to medications not used in Parkinson's .disease

)(Huntington disease . , 5 -000,001. " ) 05-03( . Huntingtin 4; , %05 . ) Anticipation ( - .Paternal descent , ) CAG 04 , -11 43 (. . CAG , . " , 51 . : 1. , , , , . 2. , . 3. Mutant Huntingtin is expressed throughout the body, some peripheral tissues abnormalities include: muscle atrophy, cardiac failure, impaired glucose .tolerance, weight loss, osteoporosis and testicular atrophy 4. ; , ,Westphal variant " . ) (. " . CT- MRI - .Caudate ; Benign hereditary chorea , , . , 02-01 . , " ) 2 D / (. SSRI . Wilson disease

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, . " 31. , , , , . . 11 , -91 , ) (. , 2 . , , , . : 1. . - ) (; , . , , . . 2. - ,Caudate, . 8 , , , , , , , . . , , ; , ; . 02, ; , , . , , " . " , -42 . " . - . " ) ( . , . " , , ,MG, , .SLE, . , . , . , . " , , . Gilles de la Tourette syndrome

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" ) (. , , . 12, . , ) (. . , .Cortico-striato-thalamo-cortical , " . : " 12-21. -%08 )-%02 (; . , , , , '; . ; " , , , ; ) (, , ) (, ) (. . -%05 ) , , '(. . , OCD- ADHD . " , .

: , , . ) -%05(, , ,Pimozide. OCD-.ADHD Restless legs syndrome , . , , . ) (. . , . . , , ,Levodopa, . .

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Multiple sclerosis " . , . . , ) (. - ) 04-02(. 05. , . .

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: ; . ; . , . , . 2 HLA DR . , . : - " " , . - BBB, - ,BBB" ) " " (. , . - , . , , . , , . " MS 2 T- Flair- .MRI -1 T" " - CSF ; , -1.T MS CSF-2) T(. ) - .(Periventricular - ,CNS - . , - -. : . , , . ) Optic neuritis (. , ", . ).(Red desaturation , , ) - " ; MS " (. INO Bilateral INO - .MS . , - . " , , . ) (, . , ) , (. ) (Relapse , 3 , ) (. , , , , , , , . , 4 : 561

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1. Relapsing and remitting )%58( . , . - Secondary progressive MS . 52 . 2. Primary progressive MS )%01(. , . 3. Progressive relapsing MS , . . 4. - Benign MS . : ,MS . MS 2 . ) MRI 2 (. . 2 . MS ) ( - - CSF - ) CSF IgG -%09 %001(. - - MS EDSS . 0 , 4 " , 7 - . ) Evoked potentials (. -:MS - DD , : 1. ), ,APLA(. 2. . 3. .Optic neuropathy 4. - ADEM " - , , .MS . -:MS , : 1. - , Optic neuritis - IV" .PO - IV ) (; , - . - BBB . . 2. - . . : - . 1. - ) ( . - E.coli . ;

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-%03 - .MRI " - " , , , . ) (Glatiramer acetate , " 2. . - Natalizumab ; ) 3. T (. IV . " PML .MRI - , - MS 4. . . :MS - . - ,MS ).(secondery progressive , 04, ) (, )Relapsing and remitting (, , , . - ) (, , ) Primary progressive MS (, -.MRI 01 , %05 . (Acute Disseminated Encephalomyelitis (ADEM , . , , . Perivascular , . , . , . , . , , . CSF , . , IVIG ) (. )%03-5(, .

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- , '. - , , / / , , ) (, , ) (, . )( . - - . - , . , . : 1. - Dysarthria ) (. : 1. - UMN - . , )( ) , (. 2. - Scanning speech ; , ; . . 3. - (LMN (Bulbar )(. ) (hot potato. - ,GBS , '.

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, - . )( - - . " 3 : , , 1. . - . 2. - Repetition 3. . 2. - (Motor Aphasia (Broka ) ( // .Non fluent Broka major- - Minor , - . ' - - ) 001-06 ; - 01 (. , . - ; . - , . " ? , - .Pre-central gyrus - MCA ) " ( , ; . 3. - (Sensory aphasia (Wernicke's ) - (Fluent aphasia , " . , " - MCA. , . , - ; - . - ) " " "( - ; . ) (, 3 : 1. ) (. 2. ) ) - (. 3. ) Overfunctioning - (. ' . - , . 4. - Conductive aphasia ), .(Supramarginal . . : " . . - . .

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5. - , ' - , , . - MCA . , - - Mixed MCA; - Mixed 2 . 6. - ) - (TCA . , - ,SMA - ; - . ; . - . 7. TCA - . . , . - . ) - , (. 8. - Pure word deafness - . 9. - , - . : 1. . - . 2. . , - , - . - , . - - ) (. - ', . :

'Y.wanna B . . . . . . .

96 . , . ; , . ; . . . . (Motor (Broka

. . . . .

(Sensory (Wernicke Conductive Global TCA TCA )(

- 1. )( - . , , . 2. ) ( - , ) , , '(. 3. - Space graphia visual - , . . , : 1. ) ? ( - . - , . . - , . 2. ) Ideational apraxia (- , - , . 3. / ) ( - . ) (. 4. ) Gait apraxia ( - . 5. ) Bucco-oral apraxia ( - , . .

'Y.wanna B

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, . ) (, , , , , , . , : S agalactiae E coli L monocytogenes N meningitides S pneumoniae H influenzae S pneumoniae N meningitides S pneumoniae L monocytogenes Gram-Negative Bacilli monocytogenes L Gram-Negative Bacilli Staphylococci Gram-Negative Bacilli S pneumoniae

/ - 3 3 8 81 05 05 CSF

: - CNS" " , , -. - : - . , ; - . , 1 IL- 6 ,IL TNF - ,BBB , - CBF . , " PMN . S pneumoniae- ) HI (, .

'Y.wanna B

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, , .

: 7-1 : 1. - - ) (. 2. - . , , . 3. . 4. - -%08 , , . , ' ) - 09 (. 5. - -%05 " N meningitides : 1. ) (PMN , . -%09-04 . 2. ), ( . 3. CT MRI , . 4. EEG" , , . 5. LP , : 1. CSF -%09 ) 081 "(. 2. . 3. 000,01-0001 ) PMN (. 4. 005-001 .mg/dL 5. -04 mg/dL-%08 . 6. -%08 . 7. CSF -%08 , ".

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8. PCR ) HI (, . : 1. SAH , CSF . 2. PMN , - LP 21-6 . : , C/I ) (CT . - CSF ". , , " CT - CT C/I . " , " . / ". LP 42 - CSF , 3 - WBC -.PMN )( " 4 6 , . " - . - ' 3, ) (. . - , ". . 4-2 )(. : , , , ,SIADH ) ,(VIII. " " ) -(. %02 , ), -( ),HI (. , , , Stupor , . : 1. :TB meningitis , TB, . TB" " , - .CNS . " " . . , .

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, /, . , , , , , . , . PPD . " CSF - CSF " , " . , -05 005 , PMN . - CSF 001, 005. , -02. Acid fast . " " .CSF -.PCR - DD , , . ) ( -) CSF (. , , " PO . ,Spinal subarachnoid block ICP ) - (. , . . 2. :Syphilitic meningitis . , , . - Treponema palidum - ,CNS " )= (. , , , , , , , , , ) (. , , , . ) ( ,VII VIII, III, V, VI- .II" . " CSF . )0001-001( . ) -002( . VDRL- CSF- FTA MHA-TP " . " ,self limiting . " G IV 01 . CSF . 3. :Lyme disease " " Borrelia .burgdorferi . ) ( " , . , , , , , , . -01 , /. , .

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Lyme meningitis" , " , , , . , " , , /. - CSF" 002-001 , , . .IgG " , " Elisa western blot - .PCR ,Lyme CNS IV 4-2 . 01 . , . / , . ,Enteric viruses ), , , (, " , )1.(HS : CNS : ) " (, ) , ( ), (. , " . , Microglia ; . : , , , , . . , , , , , , , . , , . , -. : .CSF , -000,1 ) (. PMN , . )002-08(. " , . , . " , ,PCR ') (. , . ; , . - EEG , .

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: 1. , .TB , , . 2. Immune mediated encephalomyelitis , , . : " , . - . , .REYE " . - . , . , . **:Herpes simplex Encephalitis 04. ) 1( ) 2(. , . ,HSV1 Encephalitis , . , 2 HSV ) (. , 2 HSV" . 1 HSV , , , " . , , , , , , , , . , . , . - CSF , 001-05 ) ,(PMN , . ,RBC . " .PCR- EEG , - CT MRI . . - DD , 2 " . CNS .HSV Encephalitis " , " . " IV 8 , 12-41 . , . 03 . , %52 -81 .

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CSF/:

21

-AIDS AIDS , , , . , - CNS" - ,HIV . : 1. HIV1 meningitis " , , , ) , (VII . " Seroconversion 1 .HIV- CSF 002 . " . 2. Cryptococcal meningitis -%01-5 . , , , , /, . - CSF -%02 , " -.CSF 3. HSV & VZ Encephalitis , 1 HS 2 HS ) " 1 .(HS - CSF , . VZ ) (. 4. CMV encephalitis . - CSF . " , .

13

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5. Cerebral Toxoplasmosis . PCP . )%03(, , ) , (, , , . . MRI , , , . .

6. Primary CNS Lymphoma . , , , , . . - CSF , . . MRI - ,CT , - 3 , . CNS . :AIDS Dementia Complex ; , . 1 HIV , , . HIV , , ,AIDS Dementia Complex )" (. , , , ", , . , , , . , , , , , , . - CSF , . CT- MRI - , . - HIV " . , " . " 9-1 . (Leptomeningeal metastases (carcinomatous meningitis - ,ALL 75

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,Non Hodgkin lymphoma, ,AML , ,Hodgkin lymphoma , ,GI . CNS . " 3 5 , , . , , . , , . )%64(, )%83(, . %87( ,(LMN )%06(, )%05(, )%05(, )%05(. ,LP )%05(, )%75(, )%18(, )%13(. " - CSF. , - CSF CEA, HCG-.AFP , , , . , . / " , Small cell . , - Leptomeningeal metastases , . , %2 -. , " , ) (; - ), OM, (; ; ; . , - ,Bacteroides Fusobacterium- .Prevotella' , - . , " . . )%55(, )%85(, , . - CT MRI . - CSF 002 -%57 , 005-52 , )-54 005( -%06 . CSF " . , LP . " ) (. , . G .IV Creutzfeldt-Jacob disease CNS , , , . 28-61, 06. . ) "

93

'Y.wanna B

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( . , , , , , , , -) CSF (. .Prion , , Prion protein " . , Prion protein , . , ) (PrPsc. " , . Prions )( : 1. Kuru ) " (. 2. Gerstmann-Strausller syndrome . 3. Fatal Familial Insomnia , . :Creutzfeldt-Jacob disease CNS . , , . . , , , , , , . , , ) EPS, , , , (, . , . )(Bovine Spongiform Encephalopathy . ) 03(, , , . :Creutzfeldt-Jacob disease EEG Spikes , . - CSF , 3-3-41 ) , HSV). MRI 2 .T " PrPsc , " . :Creutzfeldt-Jacob disease 1. -.EPS 2. , , progressive supranuclear palsy . 3. - . 4. . :Creutzfeldt-Jacob disease 25

'Y.wanna B

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. , , . , 7 . , , . : 1. / , ,SAH , , .ICP 2. / . 3. - . 4. ) CSF(. : 1. - SOL . 2. , . 3. , - .20k 4. - SOL LP , . : , . , . . . 4-3 L 5-4 ,L ) ( 2-1 L. 4-3 L - .Posterior iliac crests , "" - .Ligamentum flavum ,CSF ) (. , " 2-1 " -5 , , ,VDRL . . , ) 01 "(. - CSF, . : , 1. . / Spinal cord compression . , 2. . , . " ,

'Y.wanna B

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. NSAIDS . : 1. - CSF . 002 . 05, . )(, )( )(. 2. 002-081 " . , , SAH-.PTC 3. . . CSF 5 ) ( , ,PMN ) RBC (. . 4. CSF .CNS , RBC , Supernatant ) , , .(CNS ,SAH - CSF 6 . - ,CSF 0001 WBC 1mg/dL.

'Y.wanna B

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. - Input , , . " ) (, , . " : . 2 ": 1. : , . . -, " / . 1. ) , (. - TIA )" , (, BPPV ) Meniere " " (. ) ( ) 21 B (E . 2. ) 3. 21 ,B( ), , -(. " " ), , , , , (. 4. . ,Spinocerebellar ataxia , , . 2. : 1. .Tabes dorsalis , 2. 21.B . 3. . 4. 3. : 1. , - .Wernicke encephalopathy , -, , - -. 21 .B " . . 2. , . :

'Y.wanna B

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" . , . , . , . ) (. , . ) ( . . . . , .

: 3. Malalignment " . " " , .Gaze evoked nystagmus ) Pendular nystagmus ( ) Jerk nystagmus " ; " (. - Jerk nystagmus , " . / , .Gaze paresis , , , , ) Overshoot (. Pendular nystagmus " . Rinne- .Weber , Dix-Hallpike . , -54 . ; . , . " -.BPPV - . -03 , 04 , 5 . C/I . , 2 ,

'Y.wanna B

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. . ) ( , . : 4. . , , )(. . , CJD . - ,MS , - . ) (. ,B12, MS . : 5. . : 6. ; . , Tabes dorsalis . " ,MS 21 ,B , . 4. : 21 ,B, ) , (, ) IG ,(AFP ) - (. 5. :CSF - CSF - ) Cerebellopontine angle tumors (, , . , -, . LP . 6. : CT , , . MRI , .MS 7. :Evoked potentials , , .MS EP Cerebellopontine angle tumors CT. 8. : CXR , . , -. : 9.

'Y.wanna B

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, 1. ,Labyrinthine , . ENG , 2. . Auditory evoked response 3. . . , ) Impulsion (, ) Oscillopsia (, , .Gait ataxia ) (Dizziness , . ) ( ) (. , .CPS : , , . ) ( " . , . , , . , , , , , , . : 1. :BPPV ; " , ) (. BPPV , -%03 . , . Canalolithiasis " . " ) ( , . " . " , ; . .BPPV ) (Positional vertigo " - . - BPPV , , ' . , . , .

79

'Y.wanna B

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, , . , "" "". - BPPV " Repositioning maneuvers - ,Vestibule . ) , , ,BD(. 2. :Meniere disease , , " - . , ) Cochlin .(14q 05-02, . - ,labyrinth . , , . " , ; . , -%07-01 . , . ) ( . " , . . . " , . ) .(BPPV , , , . 3. :Acute Peripheral Vestibulopathy , , - .CNS Acute ,labyrinthitis ,Vestibular neuronitis . , , . , . , ) ( " . . . . ; , , / . " 41-01 )02 " (, " , " . - + BPPV Meniere disease Acute peripheral vestibolopathy

'Y.wanna B

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. , . , ) (, , , . : . , " . . , . , . : , - ,Peduncles, Red nucleus . , , , . , . ; , - . , Terminal dysmetria (Overshoot ( - Intention tremor . , , . , / / . , : 1. , Flocculonodular ) (Fastigial , , , . , ) ,(Titubation , - .Gait ataxia , ) (, ).(Gait ataxia 2. )(Cerebellar Hemispheres , ) (Gaze. , ) (. Paramedian , . 3. " , . .

'Y.wanna B

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: , , .Medial lemniscus . " , A . - fasciculus gracilis , - Fasciculus cuneatus . - Nucleus gracilis/cuneatus . - Medial lemniscus . - ventral posterior nucleus , . " ; . , . , . . , / . , . , :

'Y.wanna B

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, " " . , . - ,Fovea . , )(Rods and Cones , -)CN II (. , )( , )(, . , Optic tract . , prechiasmal , Retrochiasmal 2 . - Optic tracts - ,Lateral geniculate nuclei Optic radiation ) ,(Calcarine cortex . )( , - ,Calcarine fissure. . " Central ,retinal artery Ophtalmic artery - .Internal carotid - ,Superior and Inferior retinal branches .Altitudinal - Ophtalmic.a. - Optic radiations " .MCA - ,PCA ) -.(MCA " 6 . 6 - ) Primary position (. , ) (Ophtalmoplegia . , , , ).(Diplopia " III, VI- .VI 621

'Y.wanna B

09

. , " . (III (Oculomotor Medial rectus, Superior rectus, Inferior rectus- Inferior oblique - ) Levator palpebrae (. . III , , ; )( . (IV (Trochlear .Superior oblique . (VI (Abducens )(. ,Lateral rectus . III- IV , - Cerebral aqueduct .((of sylvius VI -.Pons III , - Superior rectus III, levator palpebrae Superior rectus , Superior rectus III . ,IV .IV VI ) VI (, Lateral rectus , Conjugate gaze, . VI- Facial nerve fasciculus, PPRF- .Ascending RAS - : - , (Version (Conjugate gaze .Vergence ) (Brainstem gaze centers - Pons- Pretectal region , , . ,Lateral gaze center - Paramedian pontine reticular (formation (PPRF ,VI VI III . - PPRF ) , (. - PPRF Input , )(, - , ) .(Persuits , ) (. , ), ( . 031

'Y.wanna B

19

: 1. . . , MS-.MG 2. . 3. , ,MS , ", , ) (, , , , . : 1. " , , ) 02/02, 04/02 002/02(. , ) ,(CF ) (HM . , .NLP - ) (. 2. 061 -531 . , 081 . , 5 - .Optic disc ) (Confrontation . : Central scotoma . 1. - (Optic disk (Optic neuritis ) .(Retrobulbar neuritis 2. . 3. " . Right nasal hemianopsia - 4. ) (. 5. - ) ,Optic tract .(Optic radiation 6. Optic radiation . 7. - Optic radiation . 8. Macular sparing .PCA : 3. 231

731

'Y.wanna B

29

1. ) - Pretectal nucleus(. , , - .Iris-%02 ) Anisocoria(, 1 ". )( 2. )( . , 3. . : 1. - ) Iris, ,Iritis(, ) III" , ( ).(Optic neuritis, MS Light-near dissociation 2. ; " , -, , , . Argyll Robertson , , 3. , . Light-near .dissociation -. Tonic pupil 4. . , , ).(Holmes adie syndrome Horner syndrome 5. ) (, ) ,(III ) (. 3 ) 1 ,(T - ) ( - ) Internal carotid 1.(V " . , " -1 " . ) (, , - .CNS , . , .

931

'Y.wanna B

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) RAPD -( , 6. . " ) - Afferent (. 4. )( - , -Optic disk - ICP. , )" ( . - Optic disk , . ) Optic disk swelling( ICP, Swelling - ICP )( - .Ischemic optic neuropathy " , ) ( . " , ICP ) (. , . , . . , .

5. ) (Ocular palsies )(Gaze palsies " " -6 . ) (, " ) ; ( ) ( , ; , . , , ) ( . : Ocular palsy , 1. - ) , NMJ (. , . III . , . . IV (superior oblique ( ; . . ) VI ( . .

'Y.wanna B

49

Gaze palsy ) 2. 2 ( . " - . ,Gaze palsy - ,Ocular palsy 2 " . - Upgaze . Internuclear ophthalmoplegia -MLF 3. ) VI .(III, 2 ) (, . INO ; III" . - INO " . One and a half syndrome - Pons - 4. MLF - PPRF INO , ) ( . , ) (. - pons, MS -.pons : , , - 6 . , . , ) (. : . , . , ) ( , ) ( ) (. Jerk :nystagmus Gaze-evoked nystagmus 1. . . " - Residual ocular palsy . " , .

'Y.wanna B

59

Vestibular nystagmus 2. " " . , , . , , ; " . ) (Positional " , . / ) ( / ) (. : Optokinetic nystagmus 1. ; . Levator palpebrae 2. , III , . ,III NMJ , . ) (Lid retraction - ) Parinaud syndrome - .(Pineal Exophthalmus " 3. . , , Cavernous ) sinus " (. 6.

:Monocular disorders Transient monocular blindness ,Amaurosis fugax 1. , 5-1 02-01 . , . ) -.(TIA - TIA. Optic neuritis ; 2. . " -. ), 1.

'Y.wanna B

69

(, , 21 .B , . , %09 ; " . ,Central scotoma ) - Retrobulbar neuritis (. .RAPD , 3-2 . . (Anterior ischemic optic neuropathy (AION 3. . 05. , , " . , ) Altitudinal (. . , . , .Optic atrophy Giant cell (temporal) arteritis 4. . , , , . . , . . , 08-07. ) ESR 05( - CRP. :Binocular disorders Papilledema 1. - ICP ) - CSF -(. , ICH SAH . 3-2 - .ICP ICP , , ) .(VI , ) (, . Pseudotumor cerebri Chiasmal lesions , 2. . , MS , .Berry , " . Retrochiasmal lesions 3. : Optic tract & lateral geniculate body . Optic radiations , . , 2.

'Y.wanna B

79

)" (. . Occipital cortex " , . %09 .PCA - AVM . " ; , ).(Tunnel vision 1. Gaze palsy III , : Hemispheric lesions , 2 1. ) (. , . . Midbrain lesions - Upward 2. gaze, . , ) (, , Midposition pupils- -Light .near dissociation Pontine lesions - PPRF . 3. , ) (, " . .VI 2. INO - INO " III . - ,INO " .MS , ". 2 %08 . INO ) MG (. Oculomotor nerve lesions III , 3. ) (, , , ) , ,Cavernous sinus (, . : 1. - . " . 2. " -) P. connecting. A III (. Cavernous sinus III 3. 1 IV, VI, V-2 .V III . Orbit III 4. , CT MRI .Cavernous sinus Trochlear nerve palsy , , 4. -%23( IV(. )%12(, )%92(.

841

'Y.wanna B

89

5. Abducens nerve palsy . VI - VI - ,ICP . , - VI . Diabetic ophthalmoplegias - III, IV 6. .VI III - ) Pupillary sparing , (. , )" ( Paranasal sinus, Cavernous sinus " .Mucormycosis Painful ophthalmoplegias 7. . CT MRI , , . 8. -%09 . ; , . Ocular myopathies 9. " ". . Progressive external ophthalmoplegias , . , .

'Y.wanna B

99 37

: " ; , , , . -%51 Aura . - %57-66 ; -%52 , %55 02, -%09 04. . %81; 54-52. , - . %25-82, . ,Aura ,Familial hemiplegic migraine ; Loci 31 19p .1q : - Aura . Ergotamine , Amyl nitrate - .Aura , , - .Aura . - Aura, - Aura . , , ) ,(Headache phase ) (Cingulate, Auditory, Visual - ) Raphe - Nucleus ceruleus(. ) (Sumatriptan, Ergotamine , . CBF . - Periaquaductal gray Raphe . , . , . " Reserpine ; - . : 1. ):(Classic migraine %51 . 2 . " )( , , ; ,

'Y.wanna B

001

, . -4 ) - ,TIA (. ) ( . , -%05 . 4-2 . , - . 27 . . , . - , . , ) - .(Tension headache , , , , , , . , , , . ; , , -. " . . 2. ) :(Common migraine , " -, . . , . , . . , " . : ) , , ( . , , , ) ( . : ), , (. ) Ergotamine , ( - " ) ( - . ) (. ; ". - . - 5 ; ) ( - , ), Substance P'( .

'Y.wanna B

101

) 4 ( - . )(, TCA )(, , ), (. ) ( . - TCA ) - Topamax (. . :Analgesic withdrawal headache ) ( . , , ) -.(OTC , , . , Superimposed . . . - Sumatriptan .Dihydroergotamine :Cluster headache , . , 52. . , , , . , " . " , , ) (, . , . . , . . %001 , Sumatriptan ,Dihtdroergotamine 08-04 " , ) (. , ) Cluster headache Ergotamine .(Dihydroergotamine ) ( - .Indomethacin , , . :Tension type headache .Cluster headache ; , , . , Tension headache 02. ) 19

'Y.wanna B

201

( , , , . . . , Tension headache ; - Tension headaches , , . , Tension headaches . - Tension headaches . , NSAIDS, , Ergotamine .Dihydroergotamine , , SSRI's . , . , . :Cervical spine disease . 2.C , . . .

:Sinusitis . , . " " . . " , . , . ; .Tension headaches :Dental disease - TMJ - -, , "" . , . , , .NSAIDS , , - . , . . :Subarachnoid hemorrhage

'Y.wanna B

301

)%57( ) AVM- %01(. 6 -000,001 , , . , . " , ) ( . . AVM 2 , . , . : ,Berry , . , %02 . ) (: ,MCA, ICA .AICA, BASILAR A., ACA, PICA, VERTEBRAL A- .PCA PKD . SBE ) - %3-2 (. . AVM ; MCA. : ICP . ICP , - %05 . ICP . , , - .MCA ,AVM .

: . , . . . ,AVM . . . 93 ' . . )- %02( . ,

67

'Y.wanna B

401

III PICA . " VI . AVM , . : CT , ; CT - %09 . . . - ,CT - CT ) ( AVM. MRI AVM . LP ) 000,001 " (. CSF . 84 . - 000,51. " T , PR U. . : ICH . " -.CSF ) ( " . " ) CSF (. 1. 2. 3. 4.

: 1. %02 -41-01 . AVM . 2. , AVM - ACA .MCA - 3. . . 4. CSF . 5. - - %01 . 6. .SIADH

/: ICP - , . . .

'Y.wanna B

501

. " NaCl %3 NS. )( ; . . : - . . , . , . AVM . . AVM . : - %02 ", - %52 - %02 . . . - AVM - %09 . /: . , . . , , ' .ICP . . . " CSF . :LP , , . 84-42 . - Traction . " . . " .

'Y.wanna B

601

:Trigeminal neuralgia . ) V - %5 (. . . , . , , , . ).(CT/MRI MS . " ) 42 (; ) ; IV (. . - .Posterior fossa microvascular decompressive suegery :(Pseudotumor Cerebri (Idiopathic intracranial hypertension ICP , , , - .Abducens nerve palsy - ICP ) (, . , ", . . ) ( . , . . Self limiting ' - CSF ; -%01 . ) ( " ) , (, , ,A, , , . - empty sella-%07 . II . - CSF , 04-02 ml CSF- LP . . . , . , , 2, -.CSF :Intracranial mass

'Y.wanna B

701

, - . %03 , - %08 . - . " , , . , ) ( , ), , (. . , , . ; . SOL " .CT/MRI

:Giant cell (Temporal) Arteritis - ,External carotid -superficial temporal artery .-vertebral artery . . " ) 2 ( 05 , , , . - ophthalmic artery -%05 ) "(. , . , . . . ) (jaw claudication giant cell arthritis . " . - ESR 001, . " PO , IV . - .ESR , . . .

'Y.wanna B

801

, , : 1. , - RAS . ) (. )(, , , . , , ), , ", , , (, ), (. 2. " . , )( . , 2 . , . , , . , ) (Mini mental , , ), ( . - Mini mental . , , )(,

'Y.wanna B

901

. , . , : 1. , , . , ; . 2. . . , " . " , . 7-5 . 3. . 4. , , , . . , , . 5. . , )( . . 6. 3 : , . , " . , . , , . , ", " ) (. - Mini mental , . , . , . ) ( . ) ( ) (. 7. " - , . : Astereognosis " . 1. Agraphestesia . 2. .Two point discrimination 3. Allesthesia " . 4. Extinction 5. , . Unilateral neglect and Anosognosia 6. " -, ) ,(Anosognosia .

'Y.wanna B

011

,Constructional apraxia 7. / - Neglect of external space . - Constructional apraxia , . 8. Apraxia , , . " " - - pre motor. , ,Gait apraxia . : 3. : , , / , 1. , , . /, /. 2. , /. 3. " , 21.B 4. , , , 5. , , . 4. / : , TB, ,Syphilitic meningitis , , ,AIDS , , .Leptomeningeal mets . 5. : , ,SAH -, , .SLE, DIC, TTP 6. : ) Concussion (, . 7. : -, .CPS 4 01

: , , - Limb and gait .ataxia , , ) ( . ) (. .

'Y.wanna B

111

, .Wernicke encephalopathy : 3 . - ,Wernicke encephalopathy , 001 " IV ,IM . 3 : 1. Tremulousness & Hallucinations self limiting ; - ) Tremulousness (, , , , , ". . , " , -%52 . , . 2. Seizures 84 , 42-7 . -%04 , -%09 6-1 . -%58 , 6 . , . , ) 21-6 (, 6 , , - . 21-6 , . ,Delirium tremens . 3. Delirium tremens ; 5-3 27 . , , , , , ", . , , . 02-01 " ,IV 5 " , , . 001 " . ) 001-05 " (. :Wernicke encephalopathy , . )1 (B , , - Gliosis . , ,Mamillary bodies, PAG, III, IV . , . , ,VI -. ) (. , . . . " . , . - MRI .Mamillary bodies 001 " ,IV , . .

'Y.wanna B

211

1 " " , . , / . , , . , -%04 . Wernicke encephalopathy .Korsakoff Syndrome :Korsakoff syndrome , . Wernicke ,encephalopathy . . - Wernicke encephalopathy 4/3 .Gait ataxia , . , . . , . ) (. " .Wernicke encephalopathy , , . , . )%02-5 56(, . , , . , , . ) (sulci - CT ,MRI . . ) ( . , . - ) (. , , -%01 . , . : 8.

'Y.wanna B

311

) 1. (. . 2. ) , , (. 3. . 4. . 5. . 6. 9. , ) 3-1(. 01. , ), '(. . - Minimental . 11. , , . . 21. 7-1. : ,CBC ,pH, , ,BUN , , , , , ,LP, CT ,MRI .EEG PH CSF : 21-11 . : ) 32-1( ) (AD . , ) AD ( . , ,Multiinfarct dementia . , , . ,NPH , 21 ,B, , . ) (, CJD- ) AIDS dementia complex (, - PML (Progressive multifocal leukoencephalopathy , - ,HIV, (. ) (. - -%51 . *** EPS , , CJD-:NPH :Alzheimer disease . %7-1 , %05-3 58-56. .

5

11

74

'Y.wanna B

411

, -amyloid . , neurofibrillary tangles- .Neuritic (senile) plaques neurofibrillary tangles Hyperphosphorylated tau ((Microtubule-associated protein- .Ubiquitin -, Presenilin 1, Presenilin 2, 1-, ,Apo lipoprotein E 2- - .Ubiquitin : 1. AD , -%5 . - (Amyloid precursor protein (APP 12; , 1 Presenilin - 41. , - 2 .Presenilin , . AD Apo E 91, ) Late onset -AD (. 12 ) (, AD . 2. - . 24-04 " .APP APP " - 04 ", . - ,AD APP" - 24 " ; , - - AD , ) (. 3. AD , Choline acetyltransferase . AD ,ACHE . : 1. AD . , . , . , . ) (Visuospatial, . . , , , , . 2. , , .

'Y.wanna B

511

. . , , , . 3. - , . " 01-5 . . CT MRI , . AD . : AD . , Multiinfarct ,dementia, CJD . : : 1. Memantine NMDA . 2. ACHE )%5( . " , , . .Donepezil (Aricept) is a centrally acting reversible acetylcholinesterase inhibitor .Used for mild to moderate dematia Rivastigmine (Exelon) is a parasympathomimetic or cholinergic agent for the .treatment of mild to moderate dementia 3. -. 4. - , . : , )(. . ; . " 01-5 . :Normal pressure hydrocephalus , , Gait apraxia . NPH - CSF .SAH , - .Incontinence " , " . , . :

'Y.wanna B

611

NPH Communicating ) Non obstructive -CSF (. CSF- Arachnoid granulations .SAH , ) Noncommunicating( - CSF , CSF, . : NPH . gait apraxia ) (. / / , . , . , . ) Motor perseveration ( Grasp . , . : LP . - CT- MRI , Sulci. , -03 05 " CSF -.Shunting :DD ) AD , - Sulci (, ) , - ,(NPH . : , ,SAH " .Shunting- NPH, ) ( .Shunting , subdural ,heamtoma . *** EPS ) AD), Corticobasal ganglionic ,degeneration - :Progressive supranuclear palsy :Dementia with lewy bodies . PM , - ) (Lewy bodies . ,-synuclein - ,PD- ) tau AD -(. ,AD .

'Y.wanna B

117

, " AD ,(fluctuating) . .( ) , " - ) / .( :(Frontotemporal dementia (FTD degeneration of the frontal lobe of the brain and may extend back to the temporal lobe. It is one of three syndromes caused by frontotemporal lobar degeneration, and the .second most common early-onset dementia afterAlzheimer's disease Symptoms can be classified into two groups which underlie the functions of the frontal lobe: behavioural symptoms (and/or personality change) and executive function. Frontal symptoms: Behavioural(Apathetic and aspontaneity or oppositely disinhibition). primitive reflexes(the first is palmomental reflex, palmar grasp reflex and rooting reflex appears late) Temporal symptoms: Executive function(the cognitive skill of planning and organizing), languge (semantic dementia- difficulty with naming and word comprehension, others present with progressive nonfluent aphasia- articulation difficulty, syntactic errors). diagnosis is mainly clinical(changes in behavior and language and, neuropsychological tests), MRI and FDG-PET imaging can also suport the diaginosis MRI . The treatment is Supportive care of behavioural symptoms (e.g. SSRIs for depression; atypical neuroleptics etc.). Median survival time is 7 years.

(NMJ) - :Myasthenia Gravis RA , , MG .SLE , . , .

'Y.wanna B

811

, , ,Facial . . , . -%08 , . , ) (MuSK ACH ) - NMJ(. : , " . . " , , , , , , , .MG - MG . , , , , . , Superimposed" . . , , CNS. %09 -, . . . , 2 , . , . -GBS , . : " ) Ache ( , . (Edrophonium (Tensilon IV 01 " 2 " ) ( -8 " 03 . ,MG , -5 . , -5.1 " ,IM . " CT . - )2 3 ( ; . EMG " . ACH - %09-08 ,Generalized MG .anti MUSK 481

'Y.wanna B

911

: MG : 1. . " 081-03 " ) 06( , 4 . " . - Cholinergic crisis ) MG (Edrophonium IV , , , , , . 2. 06, 06, -. , , . 3. -2 . , . , . 4. Azathioprine . , . 5. - ,Myasthenic crisis . 6. IVIG . 7. Mycophenolate mofetil B-T , " , , , , . MG , " . : " . - .Aspiration pneumonia :(Myasthenic syndrome (Lambert-Eaton syndrome " ;Pernicious anemia . -, Cross reaction ,ACH -.NMJ , . - ,MG - , . , , . " . - P/Q , . ) ( / IVIG . Guanidine hydrochloride ) " " (. . .

'Y.wanna B

021

:Botulism " ) ACH- NMJ (, " . 27-21 , , , , , . . , , paralytic ileus. . " - .EMG - . : 1. Muscular dystrophies . , , , . , . ; " . : Duchene dystrophy . 1. X-linked . 5, , . , . , . ) .(Gower - ) (. , . - CK . , 3 . " X ) (. Becker dystrophy X linked 2. - .Duchene ) 11 ( ) 24 ( . , CK . , . . Emery-Dreifuss Muscular Dystrophy X linked 3. . , , )

'Y.wanna B

121

, , (, , . - CK . Limb girdle dystrophy 4. ; , . Facioscapulohumeral dystrophy ' 5. " , , , Foot .drop .Winged scapula Distal myopathy ' 04, 6. , , . . Ocular dystrophy ' , 7. . " 03; , . . . Oculopharyngeal dystrophy ' , 8. 5-3. , , ) (, , . Paraspinal dystrophy - 9. 04. . CK . CT .Paraspinal 2. Congenital myopathies . , , , - CK ; . " , " . . : .Nemaline myopathy 1. .Central core disease 2. .Myotubular myopathy 3. Mitochondrial myopathies 4. , . " . Kearns-Sayre syndrome(ragged red fiber myopathy) is a sporadically occurring mitochondrial myopathy presenting in childhood, and causes: chronic progressive external ophthalmoplegia with associated cardiac conduction .defects, short stature, and hearing loss 3. Myotonic disorders )(

'Y.wanna B

221

; , . , , . - EMG Discharges ) (Wax and wane , . : 1. Polymyositis- :Dermatomyositis . , . , , . , , ,Malaise , . T . , . 2 ; " , . . 2 " , SLE, RA. - CK , , . - EMG , . , . - )(, IVIG, MTX. 2. :Inclusion body myositis , " 05, " . . , . -%58-04 . , T . " , - )DM ( . CK . . . : " , , , , , . CK . , --. " . , CK; ) CK 005 ( , CK .

'Y.wanna B

321

/: 1. , . ) ( ) (. 2. Periodic paralysis syndromes , " . . , , . , . , . 3. " . 4. /, /, /, . :Motor neuron disease in adults 03 -06, . , , /. " , -%01-5 - .(Superoxide dismutase (SOD . , " ,ROS SOD, " . 5 , : 1. Progressive Bulbar Palsy , ) (LMN . 2. Pseudobulbar palsy , UMN " -. Pseudobulbar palsy ", . 3. Progressive spinal muscular atrophy LMN, . .ALS 4. primary lateral sclerosis , UMN )( . .ALS 5. Amyotrophic lateral sclerosis UMN- LMN; UMN .LMN :ALS

'Y.wanna B

421

-%02 ALS , , , )(. -%04 , . , , , , , ; . , UMN-.LMN - ALS UMN - LMN 2 ), (, . , - . - CSF. :ALS ) Riluzole ( 001 " -3-2 . . , . , - , .PEG , , . , " 5-3 , ; . : , . -, 53-5 . , , ,Malaise URT ,GIT . , . , . , ; . , . . - CSF , CSF ' . " ) -.(CSF , . , , . Postpolio syndrome . . . " . . :(Spinal muscular atrophy (SMA . ; , .

'Y.wanna B

521

3 SMA ,SMA I,II,III ),SMN, NAIP 44 (BTF2p .5q 1. ) SMA I -( -3 . , . , . . , 3. , . 2. ) SMA II ( , " . ; . , . - ,SMA I . . 3. ) SMA III -( , )' ( . , . , . ,Muscular dystrophy CK, EMG . .

'Y.wanna B

621

, . . , . . , . : - RAS - midpons . : 1. : ABC- .C Spine 1. , , , , 2. . IV 52 ) (, 001 " 3. ) (, - 2.1-4-0 .IV 4. . . 5. 2. : , .LP 1. . 2. CT / .SAH 3. 3. : ". 1. /. 2. : - . 3. .CXR 4. ; .EEG 5. : 1. : : , 1. .SAH ), 2. ( ).(ICH , , , , 3. . , , 4. .

'Y.wanna B

721

2. : , ) Battle sign, Hemotympanum 1. (, /. . " ) - ICH (; 2. " 051/052 - .Hypertensive encephalopathy" ICH, SAH . " 3. , , , , . ,Heat stroke , ) (, , , . ,SAH 4. . , " 5. ICP. 3. : : : 1. 4-3 "; . " , . Fixed dilated pupils -7 " . " III , . -. Fixed midsized pupils 5 " , . ) (Pinpoint 5.1-1 " . , . , , . ) (Anisocoria 1 " -%02 , -. , " .III : 2.

'Y.wanna B

821

, " " )/Oculocephalic reflex / (vestibulo-ocular reflex " ) Oculovestibular reflex (. , 2 " " , ) (. . : III , . ) (. . : 3. " ,Supraorbital ridge , . : , " . , . ) , , ( , . ) , , ( . , . . . , " , ) (. 4. : ) ( ) , (

'Y.wanna B

921

. - )( . :Supratentorial structural lesion 1. ; , ) ( . ) ( , . Stupor , . , , , , ; - - . , ; , . - ) (Uncal herniation , , ) ( ; , . .

623

:Subtentorial structural lesions 2. - . , . , . Midsized . / . , INO . . ) Ataxic .(Grasping - - , . :Diffuse encephalopathies 3. ) ( ) ( , , SAH.

723

'Y.wanna B

031