mathemagical clinical neurology

MATHEMAGICAL CLINICAL MATHEMAGICAL CLINICAL NEUROLOGYNEUROLOGY

Prof.A.V.SRINIVASAN

M.D.D.M. Ph.D.F.I.A.N. F.A.A.N.

Additional Prof.of Neurology

Madras Institute of Neurology

TO TEACH IS AN HONOUR THAT IS SACRED

MIN - MOTTO

Mathemagical Clinical Neurology ABSTRACTOBJECTIVE: To construct a teaching model for easier clinical neurological examination to help

the medical students and paramedical personal to understand the neuroanatomy and etiopathological disorders of the nervous system.

BACKGROUND: Neurophobia is a fear of neural sciences and clinical neurology and half of the medical students and paramedical personal experience this disorder during their training. We have evolved an easy, faster ten step approach in clinical neurological examination using mathematical numbers.

METHODS: One characterizes consciousness / mind, Two represents the two cerebral hemispheres and Three, the major functions of the brain namely cognition, conation and affect. Four represents the four lobes and four ventricles. Five represents five special senses. Six explains the six major functional systems of the brain, basal ganglia (programmer), cerebellum (computer), cerebral and its efferents (output), sensory systems (input), autonomic nervous system (emergency situations) and the limbic system (integrator of all). Seven characterizes the LMN (anterior horn cells anterior nerve root posterior nerve root peripheral nerve neuromuscular junction muscle intracellular organelles. Eight represents eight language disorders, four with normal repetition and four with abnormal repetition. The Nine etiologies in fingertips Thumb (Tumour, Toxin, Trauma), Index Finger (Infection), Middle finger (Metabolic), Diamond finger (Demyelination), Little finger (vascular) and Hand (Hereditary and nutritional disorders). Ten represents the ten pairs of cranial nerves with olfactory and optic nerves, which are extensions of brain.

CONCLUSION: This faster and easier method of neurological examination will help the epidemiological field workers. Ten step approach of clinical neurology teaching will replace Neurophobia with Neurophilia, and will effectively integrate the basic sciences with clinical neurology.

ALBERT EINSTEINALBERT EINSTEIN

EVERY THING SHOULD BE MADE

SIMPLE, BUT NOT SIMPLER

-

AIMS AND OBJECTIVESAIMS AND OBJECTIVES

To Evolve a teaching model for easier, faster clinical neurological examination to help the Neuroscientists including medical students and paramedical personal to

understand the Neuroanatomy, Neurophysiology and Etiopathological approach of the nervous system.

BACKGROUNDBACKGROUND Neurophobia is a fear of Neuro sciences and clinical

neurology. Most of the medical students and paramedical personal experience this disorder during their training. Physical examination in the chapter of the nervous system in Hutchison’s Clinical methods 2002 W.B.Saunders,London, expanded more than 50% from 19,110 words to 29,632 words,while in Respiratory and Cardiovascular system decreased by 47% and 70% respectively when compared to the first edition of clinical methods-A guide to the practical study of medicine in 1897(Alisdair Mcneill-Practical neurology,2005,5,180-3).Clinical evaluation of the nervous system becoming too unwieldy for routine use and certainly for the modern medical student curriculum.We have evolved an easy, faster ten step approach in clinical neurological examination using mathematical numbers


ONE - CONSCIOUSNESS/MIND

TWO - CEREBRAL HEMISPHERES

THREE - FUNCTIONS OF BRAIN

COGNITION CONATION AFFECT

FOUR - LOBES OF BRAIN

FIVE - SPECIAL SENSES

SIX - UPPER FUNCTIONAL MOTOR

NEURON SYSTEMS OF BRAIN

SEVEN - LOWER FUNCTIONAL MOTOR

NEURON SYSTEMS OF BRAIN

EIGHT - LANGUAGE DISORDERS

NINE - ETIOLOGY

TEN - TEN CRANIAL NERVES WITH

OLFACTORY AND OPTIC NERVES – EXTENSIONS OF BRAIN

TEACHING METHODS-TEN STEPSTEACHING METHODS-TEN STEPS I AM HAPPY THAT PROF.A.V.SRINIVASAN HAS THOUGHT IT FIT TO

INTRODUCE A NEWER CONCEPT OF NEUROLOGICAL EXAMINATION WHICH IS BASED ON AREAS OF ANATOMY AND FUNCTION IN A STEP WISE FASHION STARTING AT THE CORTICAL LEVEL AND RIGHT DOWN TO THE NEUROMUSCULAR LEVEL AND INCURS THE ABILITY TO TRANSLATE THIS INTO A RESORTMENT PATTERN IN NEUROLOGICAL INTERPRETATION.THIS IS A NEW CONCEPT WHICH,HE HAS ENTERED, HAS DONE EXTREMELY WELL TO SHOW IT TO HIS COLLEAGUES.I AM SURE THAT THE ARDENT GROUP OF STUDENTS OF NEUROLOGY AND EVEN STUDENTS OF INTERNAL MEDICINE AND NEUROSURGEONS WILL BENEFIT WITH THIS NEW TECHNIQUE,METHOD OF A WAY OF EVALUATING NEUROLOGICAL DISEASES

Prof.K.V.THIRUVENGADAM

B.Sc,M.D.,D.Sc(hon).F.R.C.P(EDIN), FAMS,FCCP,FCAI FORMER DIRECTOR OF MEDICINEMADRAS MEDICAL COLLEGE AND GOVT.GENERAL HOSPITAL CHENNAI,TAMIL NADU, INDIA

.

CLINICAL DIAGNOSIS IN NEUROLOGY IS USUALLY ARRIVED AT BY DETECTING SIGNS WHICH INDICATE DISTURBANCE OF A FUNCTION IN THE CEREBRAL SPINAL AXIS.IN THE PRESENT SYSTEM OF DIAGNOSIS,BY VIRTUE OF COMBINING POSITIVE SIGNS TO FIND A MEANINGFUL LOCATION IN THE CENTRAL NERVOUS SYSTEM OR THE PERIPHERAL NERVOUS SYSTEM.THIS METHOD OF ARRIVING AT CLINICAL DIAGNOSIS HAS STOOD THE TEST OF TIME BUT HAS AN INHERENT DEFECT BEING TIME CONSUMING.

THE NEW SYSTEM BY VIRTUE OF DETECTING THE DEFECTS IN THE SYSTEM STRAIGHT WAY BY VIRTUE OF THE SIGNS PICKED UP AT THE TIME OF THE EXAMINATION HELPS IN THE BEDSIDE DIAGNOSIS EASIER AND QUICKER.ELECTROPHYSIOLOGICAL STUDIES AND IMAGING TECHNIQUES ARE USED ONLY TO CONFIRM THE CLINICAL IMPRESSION GIVING EASIER RECOGNITION OF ANATOMICAL LEVELS OF INVOLVEMENT.

DEMONSTRATION OF SOME OF THE CASES EXAMINED BOTH WAYS REVEAL THE ACCURACY OF DIAGNOSIS MORE IN THIS SYSTEM AS AGAINST THE CONVENTIONAL ONE.

THIS SYSTEM WILL HELP LEARNING AND DIAGNOSING NEUROLOGICAL AILMENTS.IT IS BOTH COMPLIMENTARY AND PRIMARY IN CLINICAL EXAMINATION AT THE BED SIDE PROBABLY GIVING A BETTER INSIGHT TO THE STUDENT REGARDING THE FUNCTIONAL DERANGEMENT CORRELATING WITH FUNCTIONAL ANATOMY AND WILL BE USEFUL IN EVALUATING NATURAL EVOLUTION OF MANY NEUROLOGICAL DISORDERS.

WITH THE REDUCTION OF TIME IN THE PRIMARY AND FOLLOW UP EXAMINATION,PATIENT CARE IMPROVES.THIS SYSTEM IS ALSO COMPUTER COMPATIBLE BY PROPER DATA COLLECTION AND ANALYSIS. THIS SYSTEM WILL BE A GREAT BOON IN HELPING QUICKER AND MORE SPECIFIC TREATMENT SCHEDULES.

Prof.K.JAGANNATHAN M.D.,D.T.M.,F.R.C.P.,F.A.M.S

Former Head and Prof. of Neurology

Madras Medical College and Govt.Gen.Hospital

Chennai,Tamilnadu, India

EXAMINATION OF EXAMINATION OF CONSCIOUSNESS(COMA)CONSCIOUSNESS(COMA)

GLASGOW COMA SCALEEYE OPENING SPONTANEOUS 4

TO LOUD VOICE 3 TO PAIN 2 NIL 1

VERBAL RESPONSE ORIENTED 5

CONFUSED,DISORIENTED 4 INAPPROPRIATE WORDS 3 INCOMPREHENSIBLE SOUNDS 2 NIL 1

MOTOR RESPONSE OBEYS 6 LOCALIZES 5 WITHDRAWS(FLEXION) 4 ABNORMAL FLEXIONPOSTURE 3 EXTENSION POSTURE 2 NIL 1

RANCHO LOS AMIGOS COGNITIVE SCALE

NO RESPONSE 1

GENERALIZED RESPONSE 2

LOCALIZED RESPONSE 3

CONFUSED/AGITATED 4

CONFUSED- NOT APPROPRIATE 5

CONFUSED-APPROPRIATE 6

AUTOMATIC-APPROPRIATE 7

PURPOSEFUL-APPROPRIATE 8

LEFT LEFT HEMISPHEREHEMISPHERE

(VERBAL)(VERBAL)

ANALYSISANALYSISDEDUCTIONDEDUCTION

FACTSFACTSLOGICALLOGICAL ORDER ORDER

MATHEMATICMATHEMATICPRACTICALPRACTICAL

RIGHT

HEMISPHERE

(VISUAL)

ARTISTIC

CREATIVE

HOLISTIC

INTUITION

IDEAS

IMAGINATION

SPATIAL

THREE FUNCTIONS

COGNITION -- Perception & Thinking

CONATION -- Movement

AFFECT -- Motor expression of Emotions

EXAMINATION OF COGNITIVE DECLINE-DEMENTIAEXAMINATION OF COGNITIVE DECLINE-DEMENTIA

IDEAL BED SIDE MMSE

RESEARCH ICD-10

DSM-IV

NINCDSADRDA

ADDTC-VASCULAR

DEMENTIA

CONATIONCONATION – –MOVEMENTMOVEMENTSECOND FUNCTION OF BRAINSECOND FUNCTION OF BRAIN

WHAT ARE THE MOVEMENTS?

IDENTIFY THE OVERALL SYNDROME.

DECIDE THE DISEASE.

AFFECT- MOTOR EXPRESSIONAFFECT- MOTOR EXPRESSION OF EMOTIONS OF EMOTIONS

THIRD FUNCTION OF BRAINTHIRD FUNCTION OF BRAIN

EXAMINATION

OBJECTIVE MEASUREMENT DIFFICULT, SUBJECTIVE SCALES ARE AVAILABLE

NORMAL EMOTION

EMOTIONAL LABILITY

EMOTIONAL INCONGRUITY

FOUR

LOBES OF CEREBRUM

AND

FOUR VENTRICLES

EXAMINATION OF HIGHER EXAMINATION OF HIGHER FUNCTIONS AND LOBAR FUNCTIONSFUNCTIONS AND LOBAR FUNCTIONS

HIGHER FUNCTIONS TRADITIONAL

FRONTAL LOBE EXECUTIVE FUNCTION

EMOTIONAL RESPONSE

SOCIAL BEHAVIOUR

PARIETAL LOBE CALCULATION

STEREOGNOSIS

SPATIAL ORIENTATION

TEMPORAL LOBE AUDITORY PERCEPTION

MUSIC TONE SEQUENCES

OLFACTION

SPEECH

OCCIPITAL LOBE VISION

FIVE SPECIAL SENSES

SMELL VISION

HEARING

TASTE

TOUCH

TRADITIONAL

1. Basal ganglia – Programmer

2. Cerebellum – Computer

3. Cerebral hemisphere &

connections - effector system

4. Sensory System

5. Autonomic nervous system – flight or fight

6. Limbic system - Holistic integrator of all

UPPER MOTOR NEURONUPPER MOTOR NEURONSIX FUNCTIONAL SYSTEMS OF THE SIX FUNCTIONAL SYSTEMS OF THE BRAIN (ABOVE FORAMEN MAGNUM)BRAIN (ABOVE FORAMEN MAGNUM)

TRADITIONALSPINOMOTOR SYSTEM

BASAL GANGLIA-INVOLUNTARY BASAL GANGLIA-INVOLUNTARY MOVEMENTSMOVEMENTS

PLENTY OF MOVEMENTS

A THETOSIS

B ALLISMUS

C HOREA

D YSTONIA

E SSENTIAL TREMOR

F ASCICULATIONS M YOCLONUS

PAUCITY OF MOVEMENTS

AKINETIC RIGID STATES

PARKINSONISM DRUG INDUCED IDIOPATHIC WILSONS DISEASE

PROGRESSIVE SUPRANUCLEAR PALSY

MULTIPLE SYSEM ATROPHY

CORTICOBASAL DEGENERATION

HUNTINGTONS -JUVENILE VARIANT

NIEMMAN-PICK DISEASE TYPE C

CEREBELLUM-(computer)CEREBELLUM-(computer)

FUNCTIONS-COORDINATION

GAIT ANTERIOR LOBE

TRUNCAL VERMIS

LIMBS AND LANGUAGE HEMISPHERE

EYE MOVEMENTS FLOCCULONODULAR LOBE

SIGNS OF CEREBELLAR SIGNS OF CEREBELLAR DYSFUNCTIONDYSFUNCTION

INCOORDINATION OF EYE- NYSTAGMUS HEAD-TITUBATION SPEECH-DYSARTHRIA TRUNK-ATAXIA LIMB-ATAXIA GAIT-ATAXIA WRITING-MACROGRAPHIA

CEREBRAL HEMISPHERESCEREBRAL HEMISPHERES(key board) (key board)

MOVEMENT - FRONTAL LOBE

SENSATION -PARIETAL LOBE

MEMORY

AND HEARING –TEMPORAL LOBE

VISION - OCCIPITAL LOBE

FUNCTIONS OF FUNCTIONS OF AUTONOMIC NERVOUS SYSTEMAUTONOMIC NERVOUS SYSTEM

SYMPATHETIC

HEART RATE INCREASED

BLOODPRESSURE INCREASED

INCREASED BLADDER SPHINCTER TONE

DECREASED BOWEL MOTILITY

BRONCHODILATATION

SWEATING

PUPIL DILATATION

PARASYMPATHETIC

HEART RATE DECREASED

BLOOD PRESSURE DECREASED

VOIDING (DECREASED TONE)

INCREASED BOWEL MOTILITY

BRONCHOCONSTRICTION

DECREASED SWEATING

PUPIL CONSTRICTION

SEVEN LOWER MOTOR NEURON SYSTEMSSEVEN LOWER MOTOR NEURON SYSTEMS

ANTERIORHORN CELL

ANTERIOR NERVE ROOT

POSTERIOR NERVE ROOT

PERIPHERAL NERVE

NEUROMUSCULAR JUNCTION

MUSCLE

INTRACELLULAR ORGANELLES

SPINAL CORD

SPASTICITY WEAKNESS FASCICULATIONS EARLY BLADDER AND BOWEL TROPHIC CHANGES

ANTERIOR NERVE ROOT SEGMENTAL WEAKNESS SEGMENTAL WASTING

POSTERIOR NERVE ROOT PAIN PARESTHESIA NUMBNESS

LOWER MOTOR NEURON SYSTEMS-CONTDLOWER MOTOR NEURON SYSTEMS-CONTD

4. PERIPHERAL NERVE

BILATERAL DISTAL SYMMETRICAL NUMBNESS AND

WEAKNESS WITH WASTING(NEUROPATHIC)

5. NEUROMUSCULAR JUNCTION DIURNAL VARIATION WITH FATIGABILITY OF

MUSCLES

6. MUSCLE

BILATERAL SYMMETRICAL PROXIMAL MUSCLE

WEAKNESS AND WASTING( MYOPATHIC)

7. INTRACELLULAR ORGANELLES

MITOCHONDRIA, SARCOGLYCANS

EIGHT-LANGUAGEEIGHT-LANGUAGE

DISORDERS OF LANGUAGEDISORDERS OF LANGUAGE

ABNORMAL REPITITION

BROCAS APHASIA

WERNICKES APHASIA

GLOBAL APHASIA

CONDUCTION APHASIA

DISORDERS OF LANGUAGEDISORDERS OF LANGUAGE

NORMAL REPITITION

TRANSCORTICAL SENSORY TRANSCORTICAL MOTOR ANOMIC ALEXIA

NINE –ETIOLOGIESNINE –ETIOLOGIES

THUMB - TUMOR, TOXIN, TRAUMA

INDEX FINGER - INFECTION

MIDDLE FINGER- METABOLIC

DIAMOND FINGER- DEMYELINATION,DEGENERATION

LITTLE FINGER - VASCULAR

(LITTLE FLOW/ABSENT FLOW)

HAND - HEREDITY AND NUTRITIONAL DISORDERS

TEN PAIRS OF CRANIAL NERVESTEN PAIRS OF CRANIAL NERVES

CRANIAL NERVES

III,IV,VI NERVES - OCULAR MOVEMENTS

V NERVE - FACIAL SENSATIONS

MUSCLES OF MASTICATION

VII NERVE - MUSCLES OF FACIAL

EXPRESSION

SECRETORY FUNCTIONS

IX AND X NERVE - PALATAL AND

PHARANGEAL MUSCLES

XI NERVE - STERNOMASTOID AND

TRAPEZIUS

XII NERVE - TONGUE MOVEMENTS


ONE - CONSCIOUSNESS/MIND

TWO - CEREBRAL HEMISPHERES

THREE - FUNCTIONS OF BRAIN COGNITION CONATION AFFECT

FOUR - LOBES OF BRAIN

FIVE - SPECIAL SENSES

SIX - UPPER MOTOR NEURONS SYSTEMS

OF BRAIN

SEVEN - LOWER MOTOR NEURONS

SYSTEMS OF BRAIN

EIGHT - LANGUAGE DISORDERS

NINE - GENERAL PRAESENS AND OTHER

SYSTEMS

TEN - ETIOLOGIES

ACKNOWELDGEMENTSACKNOWELDGEMENTS

OUR SINCERE THANKS TO THE HEAD OF THE DEPARTMENT OF NEUROLOGY, DIRECTOR OF INTERNAL MEDICINE OF MADRAS MEDICAL COLLEGE AND ALL THE FACULTY MEMBERS OF THE DEPARTMENT OF NEUROLOGY AND MEDICINE

mathemagical clinical neurology

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