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Cerebellar Neuroanatomy

Introduction Examination of the cranial nerves allows one to "view" the brainstem all the way from its rostral to caudal extent. The brainstem can be divided into three levels, the midbrain, the pons and the medulla. The cranial nerves for each of these are: 2 for the midbrain (CN 3 & 4), 4 for the pons (CN 5-8), and 4 for the medulla (CN 9-12). It is important to remember that cranial nerves never cross (except for one exception, the 4th CN) and clinical findings are always on the same side as the cranial nerve involved. Cranial nerve findings when combined with long tract findings (corticospinal and somatosensory) are powerful for localizing lesions in the brainstem. Cranial Nerve 1 Olfaction is the only sensory modality with direct access to cerebral cortex without going through the thalamus. The olfactory tracts project mainly to the uncus of the temporal lobes. Cranial Nerve 2 This cranial nerve has important localizing value because of its "x" axis course from the eye to the occipital cortex. The pattern of a visual field deficit indicates whether an anatomical lesion is pre- or postchiasmal, optic tract, optic radiation or calcarine cortex. Cranial Nerve 3 and 4 These cranial nerves give us a view of the midbrain. The 3rd nerve in particular can give important anatomical localization because it exits the midbrain just medial to the cerebral peduncle. The 3rd nerve controls eye adduction (medial rectus), elevation (superior rectus), depression (inferior rectus), elevation of the eyelid (levator palpebrae superioris), and parasympathetics for the pupil. The 4th CN supplies the superior oblique muscle, which is important to looking down and in (towards the midline). Pontine Level Cranial nerves 5, 6, 7, and 8 are located in the pons and give us a view of this level of the brainstem. Cranial Nerve 6 This cranial nerve innervates the lateral rectus for eye abduction. Remember that cranial nerves 3, 4 and 6 must work in concert for conjugate eye movements; if they don't then diplopia (double vision) results. The medial longitudinal fasciculus (MLF) connects the 6th nerve nucleus to the 3rd nerve nucleus for conjugate movement. Major Oculomotor Gaze Systems Eye movements are controlled by 4 major oculomotor gaze systems, which are tested for on the neurological exam. They are briefly outlined here: Saccadic (frontal gaze center to PPRF (paramedian pontine reticular formation) for rapid eye movements to bring new objects being viewed on to the fovea. Smooth Pursuit (parietal-occipital gaze center via cerebellar and vestibular pathways) for eye movements to keep a moving image centered on the fovea. Vestibulo-ocular (vestibular input) keeps image steady on fovea during head movements. Vergence (optic pathways to oculomotor nuclei) to keep image on fovea predominantly when the viewed object is moved near (near triad- convergence, accommodation and pupillary constriction) Cranial Nerve 5 The entry zone for this cranial nerve is at the mid pons with the motor and main sensory (discriminatory touch) nucleus located at the same level. The axons for the descending tract of the 5th nerve (pain and temperature) descend to the level of the upper cervical spinal cord before they synapse with neurons of the nucleus of the descending tract of the 5th nerve. Second order neurons then cross over and ascend to the VPM of the thalamus. Cranial Nerve 7 This cranial nerve has a motor component for muscles of facial expression (and, don't forget, the strapedius muscle which is important for the acoustic reflex), parasympathetics for tear and salivary glands, and sensory for taste (anterior two-thirds of the tongue). Central (upper motor neuron-UMN) versus Peripheral (lower motor neuron-LMN) 7th nerve weakness- with a peripheral 7th nerve lesion all of the muscles ipsilateral to the affected nerve will be weak whereas with a "central 7th ", only the muscles of the lower half of the face contralateral to the lesion will be weak because the portion of the 7th nerve nucleus that supplies the upper face receives bilateral corticobulbar (UMN) input. Cranial Nerve 8 This nerve is a sensory nerve with two divisions- acoustic and vestibular. The acoustic division is tested by checking auditory acuity and with the Rinne and Weber tests. The vestibular division of this nerve is important for balance. Clinically it be tested with the oculocephalic reflex (Doll's eye maneuver) and oculovestibular reflex (ice water calorics). Medullary Level Cranial nerves 9,10,11, and 12 are located in the medulla and have localizing value for lesions in this most caudal part of the brainstem. Cranial nerves 9 and 10 These two nerves are clinically lumped together. Motor wise, they innervate pharyngeal and laryngeal muscles. Their sensory component is sensation for the pharynx and taste for the posterior one-third of the tongue. Cranial Nerve 11 This nerve is a motor nerve for the sternocleidomastoid and trapezius muscles. The UMN control for the sternocleidomastoid (SCM) is an exception to the rule of the ipsilateral cerebral hemisphere controls the movement of the contralateral side of the body. Because of the crossing then recrossing of the corticobulbar tracts at the high cervical level, the ipsilateral cerebral hemisphere controls the ipsilateral SCM muscle. This makes sense as far as coordinating head movement with body movement if you think about it (remember that the SCM turns the head to the opposite side). So if I want to work with the left side of my body I would want to turn my head to the left so the right SCM would be activated. Cranial Nerve 12 The last of the cranial nerves, CN 12 supplies motor innervation for the tongue. Traps A 6th nerve palsy may be a "false localizing sign". The reason for this is that it has the longest intracranial route of the cranial nerves, therefore it is the most susceptible to pressure that can occur with any cause of increased intracranial pressure.  
Neurologic Exam
over 8 years ago
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No Title

EXPLANATION BASICS  ICE  Signpost,Summarise,ChunkandCheck,Invite Questions  OfferLeaflet WarfarinExplanation Intro: Introduce yourself.Elicitname,age,occupa…  
M Chughtai
over 7 years ago
Www.bmj
1
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An adolescent athlete with groin pain

A 14 year old boy felt a mild aching discomfort in his left groin while playing rugby but still continued to play. He subsequently tackled an opponent and developed a severe pain of sudden onset in the left upper thigh and groin. A “snapping” sound was heard and he fell to the ground. He was unable to bear weight on the left leg and appeared pale, clammy, and nauseated. His pitch-side vital observations were normal and he was offered combined gaseous nitrous oxide and oxygen for pain relief. Ice was applied to the area of maximum discomfort and he was accompanied to the emergency department in an ambulance. At the emergency department he was advised that he had probably “strained” a muscle and was given conservative advice. He was discharged with crutches and analgesia.  
bmj.com
over 5 years ago
Www.bmj
1
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An adolescent athlete with groin pain

A 14 year old boy felt a mild aching discomfort in his left groin while playing rugby but still continued to play. He subsequently tackled an opponent and developed a severe pain of sudden onset in the left upper thigh and groin. A “snapping” sound was heard and he fell to the ground. He was unable to bear weight on the left leg and appeared pale, clammy, and nauseated. His pitch-side vital observations were normal and he was offered combined gaseous nitrous oxide and oxygen for pain relief. Ice was applied to the area of maximum discomfort and he was accompanied to the emergency department in an ambulance. At the emergency department he was advised that he had probably “strained” a muscle and was given conservative advice. He was discharged with crutches and analgesia.  
bmj.com
over 5 years ago
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Why Is Ice Slippery? - The Naked Scientists

Naked Scientists - 22nd Oct 2011 - Why Is Ice Slippery?  
thenakedscientists.com
over 5 years ago
Foo20151013 2023 113s0nw?1444773969
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The Medical Book Warzone... Which book is best?

As the days are slowly getting longer, and spring looms in the near future, it can only be the deep inhale of the medical student ready to embrace the months of revision that lies ahead. Books are dusted off the shelves and Gray's anatomy wrenched open with an immense sigh of distain. But which book should we be pulling off the shelves? If you're anything like me then you're a medical book hoarder. Now let me "Google define" this geeky lexis lingo - a person who collects medical books (lots of medical books) and believes by having the book they will automatically do better!... I wish with a deep sigh! So when I do actually open the page of one, as they are usually thrown across the bed-room floor always closed, it is important to know which one really is the best to choose?!? These are all the crazy thoughts of the medical book hoarder, however, there is some sanity amongst the madness. That is to say, when you find a really good medical book and get into the topic you start to learn stuff thick and fast, and before you know it you’ll be drawing out neuronal pathways and cardiac myocyte action potentials. Yet, the trick is not picking up the shiniest and most expensive book, oh no, otherwise we would all be walking around with the 130 something pounds gray’s anatomy atlas. The trick is to pick a book that speaks to you, and one in which you can get your head around – It’s as if the books each have their own personality. Here are a list of books that I would highly recommend: Tortora – Principles of anatomy and physiology Tortora is a fantastic book for year 1 medical students, it is the only book I found that truly bridges the gap between A levels and medical students without going off on a ridiculous and confusing tangent. While it lacks subtle detail, it is impressive in how simplified it can make topics appear, and really helps build a foundation to anatomy and physiology knowledge The whole book is easy to follow and numerous pretty pictures and diagrams, which make learning a whole lot easier. Tortora scores a whopping 8/10 by the medical book hoarder Sherwood – From cells to systems Sherwood is the marmite of the medical book field, you either love this book or your hate it. For me, Sherwood used to be my bible in year two. It goes into intricate physiological detail in every area of the body. It has great explanations and really pushes your learning to a greater level than tortora in year one. The book doesn’t just regurgitate facts it really explores concepts. However: I cannot be bias, and I must say that I know a number of people who hate this book in every sense of the word. A lot of people think there is too much block text without distractions such as pictures or tables. They think the text is very waffly, not getting straight to the point and sometimes discusses very advanced concepts that do not appear relevant The truth be told, if you want to study from Sherwood you need to a very good attention span and be prepared to put in the long-hours of work so it’s not for everyone. Nonetheless, if you manage to put the effort in, you will reap the rewards! Sherwood scores a fair 5-6/10 by the medical book hoarder Moore & Dalley – Clinical anatomy At first glance Moore & Dalley can be an absolute mindfield with an array of pastel colours that all amalgamate into one! It’s also full of table after table of muscle and blood vessels with complicated diagrams mixed throughout. This is not a medical book for the faint hearted, and if your foundation of anatomy is a little shakey you’ll fall further down the rabbit hole than Alice ever did. That being said, for those who have mastered the simplistic anatomy of tortora and spent hours pondering anatomy flash cards, this may be the book for you. Moore & Dalley does not skimp on the detail and thus if you’re willing to learn the ins and out of the muscles of the neck then look no further. Its sections are actually broken down nicely into superficial and deep structures and then into muscles, vessels, nerves and lymph, with big sections on organs. This is a book for any budding surgeon! Moore & Dalley scores a 6/10 by the medical book hoarder Macleod’s clinical examination Clinical examination is something that involves practical skills and seeing patients, using your hands to manipulate the body in ways you never realised you could. Many people will argue that the day of the examination book is over, and it’s all about learning while on the job and leaving the theory on the book shelf. I would like to oppose this theory, with claims that a little understanding of theory can hugely improve your clinical practice. Macleod’s takes you through basic history and examination skills within each of the main specialties, discussing examination sequences and giving detailed explanations surrounding examination findings. It is a book that you can truly relate to what you have seen or what you will see on the wards. My personal opinion is that preparation is the key, and macleod’s is the ultimate book to give you that added confidence become you tackle clinical medicine on the wards Macleod’s clinical examination scores a 7/10 by the medical book hoarder Oxford textbook of clinical pathology When it comes to learning pathology there are a whole host of medical books on the market from underwood to robbins. Each book has its own price range and delves into varying degrees of complexity. Robbins is expensive and a complex of mix of cellular biology and pathophysiological mechanisms. Underwood is cheap, but lacking in certain areas and quite difficult to understand certain topics. The Oxford textbook of clinical pathology trumps them all. The book is fantastic for any second year or third year attempting to learn pathology and classify disease. It is the only book that I have found that neatly categories diseases in a way in which you can follow, helping you to understand complications of certain diseases, while providing you with an insight into pathology. After reading this book you’ll be sure to be able to classify all the glomerulonephritis’s while having at least some hang of the pink and purples of the histological slide. Oxford textbook of clinical pathology scores a 8/10 by the medical book hoarder Medical Pharmacology at glance Pharmacology is the arch nemesis of the Peninsula student (well maybe if we discount anatomy!!), hours of time is spent avoiding the topic followed immediately by hours of complaining we are never taught any of it. Truth be told, we are taught pharmacology, it just comes in drips and drabs. By the time we’ve learnt the whole of the clotting cascade and the intrinsic mechanisms of the P450 pathway, were back on to ICE’ing the hell out of patients and forget what we learned in less than a day. Medical pharmacology at a glance however, is the saviour of the day. I am not usually a fan of the at a glance books. I find that they are just a book of facts in a completely random order that don’t really help unless you’re an expert in the subject. The pharmacology version is different: It goes into just the right amount of detail without throwing you off the cliff with discussion about bioavailability and complex half-life curves relating to titration and renal function. This book has the essential drugs, it has the essential facts, and it is the essential length, meaning you don’t have to spend ours reading just to learn a few facts! In my opinion, this is one of those books that deserves the mantel piece! Medical Pharmacology at a glance scores a whopping 9/10 by the medical book hoarder. Anatomy colouring book This is the last book in our discussion, but by far the greatest. After the passing comments about this book by my housemates, limited to the sluggish boy description of “it’s terrible” or “its S**t”, I feel I need to hold my own and defend this books corner. If your description of a good book is one which is engaging, interesting, fun, interaction, and actually useful to your medical learning then this book has it all. While it may be a colouring book and allows your autistic side to run wild, the book actually covers a lot of in depth anatomy with some superb pictures that would rival any of the big anatomical textbooks. There is knowledge I have gained from this book that I still reel off during the question time onslaught of surgery. Without a doubt my one piece of advice to all 1st and 2nd years would be BUY THIS BOOK and you will not regret it! Anatomy colouring book scores a tremendous 10/10 by the medical book hoarder Let the inner GEEK run free and get buying:)!!  
Benjamin Norton
over 6 years ago
Foo20151013 2023 gvoh9v?1444774222
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311

Socks, Kiwis and Surgical Removal

I’m a klutz. Always have been. Probably always will be. I blame my clumsiness on the fact that I didn’t crawl. Apparently I was sitting around one day and toddling on two feet the next. Whatever the cause, it’s a well-tested fact that I’m not good on icy footpaths. Various parts of my anatomy have gotten up close and personal with frozen ground on many an occasion. Not usually an issue for a born-and-bred Australian, except when said Australian goes to visit her Canadian family during the northern winter. During one such visit, I found myself unceremoniously plopped onto slick ice while my two-year-old niece frolicked around me with sure-footed abandon. I thought, “There has to be an easier way.” As freezing water seeped through my jeans, providing a useful cold pack for my screaming coccyx, my memory was jogged. I recalled that a lateral-thinking group of New Zealand researchers had won the Ignoble Prize for Physics for demonstrating that wearing socks on the outsides of shoes reduces the incidence of falls on icy footpaths. To the amusement of my niece, I tried out the theory for myself on the walk home. I don’t know if I had a more secure foothold or not, but I did manage to get blisters from wearing sneakers without socks. I love socks. They cover my large, ungainly clod-hoppers and keep my toes toasty warm almost all year round. You know the song ‘You can leave your hat on.’? Well for me, it is more a case of ‘You can leave your socks on, especially in winter. There’s nothing unromantic about that… is there? I’m not, however, as attached to my socks as a patient I once treated. As an intern doing a psychiatry rotation, one of my tasks was to do physical examinations on all admissions. Being a dot-the-i’s kinda girl, when an old homeless man declined to remove his socks so that I could examine his feet, I didn’t let it slide. “I haven’t taken off my socks for thirty years,” he pronounced. “It can’t be that long. Your socks aren’t thirty years old. In fact, they look quite new,” I countered. “When the old ones wear out, I just slip a new pair over the top.” I didn’t believe him. From his odour, I would have believed that he hadn’t showered in thirty years, but the sock story didn’t add up. He eventually agreed to let me take them off. The top two sock layers weren’t a problem but then I ran into trouble. Black remains of what used to be socks clung firmly to his feet, and my gentle attempts at their removal resulted in screams of agony. I tried soaking his feet. Still no luck. His skin had grown up into the fibres, and it was impossible to extract the old sock remnants without ripping off skin. In retrospect I probably should have left the old man alone, but instead got the psych registrar to have a peek, who then involved the emergency registrar, who called the surgeon and soon enough the patient and his socks were off to theatre. The ‘surgical removal of socks’ was not a commonly performed procedure, and it provided much staff amusement. It wasn’t so funny for Mr. Sock Man, who required several skin grafts! From my perspective here in Canada, while I thoroughly commend the Kiwis for their ground-breaking sock research, I think I’ll stick to the more traditional socks-in-shoes approach, change my socks regularly and work a bit on my coordination skills. References: PHYSICS PRIZE: Lianne Parkin, Sheila Williams, and Patricia Priest of the University of Otago, New Zealand, for demonstrating that, on icy footpaths in wintertime, people slip and fall less often if they wear socks on the outside of their shoes. "Preventing Winter Falls: A Randomised Controlled Trial of a Novel Intervention," Lianne Parkin, Sheila Williams, and Patricia Priest, New Zealand Medical Journal. vol. 122, no, 1298, July 3, 2009, pp. 31-8. (This blog post has been adapted from a column first published in Australian Doctor http://www.australiandoctor.com.au/articles/58/0c06f058.asp) Dr Genevieve Yates is an Australian GP, medical educator, medico-legal presenter and writer. You can read more of her work at http://genevieveyates.com/  
Dr Genevieve Yates
over 5 years ago
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The Cold Reality That's Set In After Last Year's Ice Bucket Challenge

Like so many people this past summer, I did the ice bucket challenge for ALS. I imagine many of you read that and thought: "Oh yeah... that." I was chall...  
huffingtonpost.com
over 4 years ago
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How to Treat Muscle Strains and a bit on Measles

How to Treat Muscle Strains and a bit on Measles Heat or Ice? What is best to use on strained muscles? To begin this video, I cover the facts about measles a...  
youtube.com
over 4 years ago
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Ice baths for athletes: research questions any benefit

New research suggests that plunging into an ice-cold bath after a workout may not make any difference in strength or soreness, though it could marginally help with inflammation.  
medicalnewstoday.com
over 4 years ago
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New Post on the CE Notice Board!

New post on the CE Notice Board -  Learn more about the 2015 ICE Summits here.  
icenetblog.royalcollege.ca
over 4 years ago
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New Post on the CE Notice Board!

New post on the CE Notice Board -  If you are attending the AMEE 2015 Conference in Glasgow, Scotland, arrive a day early and attend the ICE Summit - Glasgow (Friday September 4, 2015) for a day of networking with your fellow CEs and to engage in provocative discussion. To learn more about the ICE Summit…  
icenetblog.royalcollege.ca
over 4 years ago
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Ice bucket challenge: What's happened since? - BBC News

Last summer, social media was dominated by videos of people being doused in cold water for charity. So how much difference did it make?  
bbc.co.uk
over 4 years ago
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ICEicle: Tips for Surviving Night Shifts

We’re starting a new feature here on the ICE blog - ICEicles.  These mini posts profile a resource we discovered on the “internets.” Today’s ICEicle provides tips on how to navigate your circadian rhythm pre/post a night shift.        
icenetblog.royalcollege.ca
about 4 years ago
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Addenbrooke's Hospital stops ice in patient water jugs - BBC News

A Cambridge hospital stops providing ice for patients' water jugs in a bid to save almost £40,000 per year.  
bbc.co.uk
about 4 years ago
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The ICE Blog Celebrates its Second Anniversary!

On September 23, 2013, the International Clinician Educators blog was launched. The blog helps to connect the Clinician Educators around the world.  Perhaps you feel connected.  Perhaps you’re still exploring.  Where ever you are, the editorial board is glad that you’re following. As we celebrate our second birthday, we’d like to look to the past…  
icenetblog.royalcollege.ca
about 4 years ago
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Personal learning networks: A hack to maintain competence

(From the EiC: The ICE blog welcomes guest author, Swami.  It seems appropriate that Felix follows his own advice and gets help from his network with this post - Jon) By: Felix Ankel and Anand Swaminathan “The measure of intelligence is the ability to change.” ― Albert Einstein You are a new #meded leader responsible…  
icenetblog.royalcollege.ca
about 4 years ago