Awesome .. Goose bumps all around my body on hearing this song.
Which is the first match of world cup football that u have watched and and can recall now? Well for me its way back to 1990 the semifinal match between England Vs Germany . All I remember is Gary Linekar , Klinsman and Lothar Mathhews and I think England lost the match . Germany eventually won the title that time . And yes Maradona who can forget him in that world cup . Everyone was talking about Maradona and his extraordinary brilliance and exuberant performance in 1986 who single handedly lead Argentina to win title in 1986. For a kid like me and and others it was the 1990 world cup to get a glimpse of brilliance of Maradona which we missed in '86.
And now its 2010 South Africa and and few days remaining for kick-off. I am not a heartthrob fan of any particular country but I do support England cause I follow EPL and I know most of the English players . So this time around I am eagerly waiting for the magic from boots of Rooney and left footed shoots of Gerrard . Well definitely England will miss the defensive wall of Rio Ferdinand . What I am missing is talented impressive Arsenal striker Walcott .
Well theres a bunch of players like Drogba , Arjen Robben , Ballack, Essien , and now Nani ....
Theyre all out of world cup . Billions of people are waiting to see the magical display of football from likes of Messi , Christian Ronaldo , Kaka , Rooney , Robinho , Xavi, David Villa and many more players . Spain is the most balanced side at present with Euro title already in bag they are more confident with impressive line up of class midfielders and strikers .Watch out for Inesta he is the sensational Barcelona midfielder. Brazil , Argentina and Holland are always favourites .
So its the month of brilliant football ...its the festival ... its the most awaited and the most watched game on the Earth . So lets celebrate . Lets enjoy ...
I am definitely in........
Tuesday, June 8, 2010
Monday, June 7, 2010
Clinical case discussion
30 yrs old female with Hx of headache occipital region for 10 yrs gradual progressive weakness of all four limbs and numbness below neck region for 4 yrs
O/E
General - WNL
CNS
HMF : normal
Cranial Nerves : lower cranial nerves ( IX, X, XI, XII ) intact
Motor : Bulk grossly maintained
Tone : Increased; spasticity
upper limbs : weakness all the way starting from shoulder abbdction ( C5)
weakness of flexors and extensors of elbow and wrist joints
small muscles of hand (T1)
boths sides involved
power 3 on MRC scale
lower limbs : similarly weakness of lower limbs Power 3 on MRC scale
weakness limited to knee joint
Reflexes : brisk Biceps
Triceps
Supinator
Knee
flexor plantar bilateral
Sensory :
Sensory level C4
bilateral Loss of Pain and temperature sensations from C4
dorsal column sensation intact
sacral sparing
Cerrebellar signs absent
Patient wheel chair bound
From history and clinical examination :
Quadriparesis with dissociative suspended sensory loss lesion at C4 cord segment due to Syrinx
MRI cervical spine with focus on craniocervical junction done
Discussion :
Clinically Syrinx is associated with typical dissociative suspended sensory loss
Detecting site of lesion is tricky but there are key points
In these case quadriparesis means lesion in cervical cord T1( small muscles of hand ) and above but can be lower brain stem medullary lesion .
So lower Cranial nerves examination is important and shouldnt be missed
Lower cranial nerves intact means lesion in the cervical cord clinically
Now this patient has weakness of shoulder abdduction so definitely deltoid is involved so
C5 cord is involved . Above C5 generally we use dermatome to localise lesion since testing of muscles above C5 is clinically insignificant.
Here sensory level is C4
Now the lower limit easy way is to check scral sensation first if it is spared it is called suspended sensory loss .
Lets review our knowledge og spinal cord and the arrangement of fibres which are topographivally arranged.
The fibres of spinothalamic tract are arranged with cervical fibres medially towards central canal and then thoracic then lumbar and most lateral are the sacral fibres .
O/E
General - WNL
CNS
HMF : normal
Cranial Nerves : lower cranial nerves ( IX, X, XI, XII ) intact
Motor : Bulk grossly maintained
Tone : Increased; spasticity
upper limbs : weakness all the way starting from shoulder abbdction ( C5)
weakness of flexors and extensors of elbow and wrist joints
small muscles of hand (T1)
boths sides involved
power 3 on MRC scale
lower limbs : similarly weakness of lower limbs Power 3 on MRC scale
weakness limited to knee joint
Reflexes : brisk Biceps
Triceps
Supinator
Knee
flexor plantar bilateral
Sensory :
Sensory level C4
bilateral Loss of Pain and temperature sensations from C4
dorsal column sensation intact
sacral sparing
Cerrebellar signs absent
Patient wheel chair bound
From history and clinical examination :
Quadriparesis with dissociative suspended sensory loss lesion at C4 cord segment due to Syrinx
MRI cervical spine with focus on craniocervical junction done
Discussion :
Clinically Syrinx is associated with typical dissociative suspended sensory loss
Detecting site of lesion is tricky but there are key points
In these case quadriparesis means lesion in cervical cord T1( small muscles of hand ) and above but can be lower brain stem medullary lesion .
So lower Cranial nerves examination is important and shouldnt be missed
Lower cranial nerves intact means lesion in the cervical cord clinically
Now this patient has weakness of shoulder abdduction so definitely deltoid is involved so
C5 cord is involved . Above C5 generally we use dermatome to localise lesion since testing of muscles above C5 is clinically insignificant.
Here sensory level is C4
Now the lower limit easy way is to check scral sensation first if it is spared it is called suspended sensory loss .
Lets review our knowledge og spinal cord and the arrangement of fibres which are topographivally arranged.
The fibres of spinothalamic tract are arranged with cervical fibres medially towards central canal and then thoracic then lumbar and most lateral are the sacral fibres .
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