Benign Intracranial hypertension [Pseudolumor cerebri) -Condition of RIP not due to expandng mass lesion or obstruction TD CSF How Mechanism unknown P

paroxysmal, later constant with inlense exacerbations, cranial nerve palsies common CT scan shows enormous dilatation of The ventricular system IV. Benign Intracranial hypertension [Pseudolumor cerebri) -Condition of RIP not due to expandng mass lesion or obstruction td CSF How Mechanism unknown Possible causes - (I) Diet - obesity, hyper/hypovitarrtnosis A (II) Endocrine - Hypoparathyrodism, Cushing's syncfrome. Addlson's desease, menopause (iii) Hemaiological - Iran deficiency anemia, polycythemia vera (iv ) Drugs -Oral coniraceptlves. nalidixic acid, letracycline, sieroid administration or with drawal (v) Chronic respiraiory insufficiency Clinical features - Age - Predominantty between 10-15 years Headache, vomiting, Impaired visual acuity from papilloedema, diplopia from VI n. palsy Investigations - (i) Visual Meld charting - enlarged blind spot, peripheral field constriction (b) Lurrbar puncture - and pressure measurement CT scan - Negative, small ventricles. V. Gysls - Arachnoid orhydalid - may presenl as inlracraniaf mass. CTscan -shows a low density. well demarcated lesion In cerebral cysticercosis - Epileptic fits, palpable subculticular cysts In muscles or subcutaneous tissues, aoslnophllla. B. Disorders causing progressive or recurrent symptoms - 1 CerebraJ atherorna - Carotid artery sienosis may present as a slowly progressive lesion, symptoms and signs developing over weeks or months. Progressive menial deterioration, hemiplegia and headache simulate cerebral neoplasm. Unilateral or bilaleral papilloedema may be present Carotid bruit often heard Angiography and other investigations confirm dagnosis 2 Epifepsy - Convulsions starling after age of 25 should suggest possibility of tumour In doubtful cases investigations must be done to determine if epilepsy is due to tumour Management - Surgical removal easier with meningiomas and acoustic neuromas. For invasive growth or growlh in difficult situation partial removal, decompression or radiotherapy, immunolherapy and chemotherapy 17 DISORDERS OF THE SPINAL CORD Paraplegia DEFINITION - Paralysis confined to the lower limbs Classification of causes: I Due to upper motor neurone lesion - A Iniracranial causes - (a) Tumour of falx cerebri (parasagitta menlngioma). (b) Thrombosis of superior sagittal sinus (c) Cerebral idplegia (d) Internal hydrocephalus (e) Thrombosis of unpaired anterior cerebral artery. B Spinal causes SYSTEMIC DEGENERATION OF TRACTS - Subacute combined degeneration, multiple sclerosis, amyotrophic lateral scferosis, syringomyelia, Friedreich's ataxia (b) SECONDARY AFFECTIONS OF WHITE MATTER 1 Trauma - Fracture dsiocation. Kummel's dsease 2 Infection - Acute transverse myelitis, epklural abscess, syphilis 3 Vascular -(i) Haemorrhage - (a) Intrathecal (haematomyelia) (b) Intramedullary (spinal epidural haematoma) (ii) Thrombosis (myelomalacia) (Hi) A-V malformations 4 Compression Acute - Common Melastalic tumour Rare Infection, spontaneous hemaloma. cervcal or thoracic disc, intrinsic tumour. Chronic - Comrnon Cervical spondylosis. Rare Neurofibroma. mentngloma. Intrinsic tumour, congenital cysts, thoracic disc. syringomyelia, inflammatory dsease. arachnoicflls 5 Chronic malnutrition - Pellagra 6. Toxins - Lathyrism. fluorosis 7 Radiation myelopathy Common causes of spastic paraplegia are - (i) Transverse myelitis, (u) Spinal cord compreaaion including tuberculosis of spine (iii) Anterior spinal artery occlusion (iv) Trauma to spine II Due to lower motor neurone lesion - 1 Anterior horn cell -Acute anterior poliomyelitis, spinal muscular