- Patient is lying down
- Flex the hip and knee
- Knee cannot be extended
- Due to stiff hamstrings
- Patient is lying down
- Flex their neck
- Their body is unaffected but their hips and knees flex
Facebook and Twitter! Two important procrastination tools of our time! Many a student has suffered gloriously from these distractions. Finally, they help us to learn medicine, just like you’ve always wanted.
“Cushing response?!” you cry. “Why is Cushing’s name everywhere and why should I care?! BAH!”
How astute! In fact, that disgruntled sound you make is quite appropriate.
A lumbar puncture is a procedure that involving drawing out cerebrospinal fluid, fondly known as CSF. For example, it can be used to check CSF for immune cells and glucose levels in suspected meningitis.
Lumbar puncture is considered an invasive procedure. But even with that aside, it’s not appropriate for everyone. That is, it does not suit all patients.
Contraindications to lumbar puncture are:
Muscles are a grand amalgamation of thin actin, thick myosin, calcium ions binding to troponin, tropomyosin and Z-lines. They require ATP to be relaxed and use ATP when they undergo contraction.
Stretching helps realign and lengthen muscles to prevent them from being tight and easily injured.
How are muscle contractions triggered in the first place?
Motor neurons use the neurotransmitter acetylcholine to send messages to muscles, prodding them into action. This causes the in-flow of sodium ions, propagating the action potential onward through the muscles. In turn, this invokes the release of calcium ions inside the cells.
The calcium binds to troponin and the obstructive bits move out of the way, allowing actin and myosin to meet for a sweet, brief moment. This is cross-bridge cycling
Time heals all wounds except relapsing-remitting MS.
And primary-progressive MS.
And secondary-progressive MS.
And whole bunch of other age-related illnesses, like glaucoma, age-related macular degeneration and malignancy.
At least time is good for adhesive capsulitis, alternatively known as frozen shoulder!
MS is a chronic disease involving immune-mediated attacks on the central nervous system. Demyelination causes mayhem.
As a parallel, Guillan-Barre acutely affects the peripheral nervous system. When it’s chronic, it’s called chronic inflammatory demyelinating polymyopathy.
Neurological symptoms ensue after the disease has passed a threshold.
Clinically isolated syndrome is a one-off presentation of demyelination that can progress to MS.
MRI can show brain lesions.
CSF analysis can show inflammation.
Evoke potential measurement can show demyelination.
Ongoing: immunotherapy agents.
Acute relapse: high-dose corticosteroids.
Paroxysmal symptoms: carbamazepine
Urinary symptoms: oxybutynin
The risk of MS relapse is lower during pregnancy and higher in the first 3 months after giving birth.
Central nervous system: clinically isolated syndrome (acute), MS (chronic)
Peripheral nervous system: Guillan-Barre (acute), CIDP (chronic)
Myelin is the fatty, insulating sheath that surrounds some neurons, specifically their axons. It allows electrical impulses to travel faster down nerves.
Here are the cells that make myelin.