This document presents 9 clinical cases involving various neurologic emergencies:
1. A man found unresponsive with rigidity is diagnosed with neuroleptic malignant syndrome based on elevated CK and the diagnostic triad of fever, altered mental status, and rigidity.
2. A woman withdrawing from an antidepressant exhibits features of serotonin syndrome including agitation and hyperthermia.
3. A woman with carotid artery dissection presents with headache, neck pain, and Horner's syndrome.
4. A man with "top of the basilar" syndrome has oculomotor deficits, behavioral changes, and visual field cuts consistent with a hyperdense basilar artery on CT.
5.
General approach and differential diagnosis of comaAn Chang
This document provides guidance on evaluating and managing comatose patients. It outlines the following key steps:
1. Ensure airway, breathing and circulation are stabilized. Treat any rapidly reversible causes of coma like hypoglycemia.
2. Use the Glasgow Coma Scale to assess the level of consciousness. Common causes of coma include head injuries, strokes, infections, tumors, and metabolic derangements.
3. Perform a full neurological exam including pupil size and response, motor function, and posture. Request diagnostic tests like bloodwork and CT or MRI as indicated.
4. Manage increased intracranial pressure with osmotic diuretics if present. Treat any identifiable structural or metabolic causes. Monitor
This document provides an overview of neuroleptic malignant syndrome (NMS). It begins with a case vignette of a 45-year-old woman who developed NMS after being prescribed haloperidol and fluphenazine. The document then covers the diagnostic criteria of NMS, risk factors, pathophysiology, laboratory findings, differential diagnosis, management including discontinuing antipsychotics and supportive care, prognosis which includes potential mortality, and conclusions regarding NMS.
The document discusses febrile seizures, which are the most common seizure disorder in children. It defines febrile seizures as seizures occurring in children between 6 months and 5 years of age when they have a fever over 38°C but no signs of central nervous system infection. The document outlines the typical presentation and classification of febrile seizures and discusses their causes, risk factors, investigations, treatment including anticonvulsant prophylaxis, and excellent prognosis.
This document provides clinical materials for self-learning in clinical medicine. It was prepared by Dr. Ajith Karawita and contains acknowledgements, instructions for use, and 12 case studies with associated radiological images and reports. The case studies cover a range of topics in clinical medicine and are intended to allow the reader to examine each case, analyze the findings, and suggest a diagnosis and treatment plan.
1) A 55-year-old woman suddenly developed left-sided weakness after stopping her warfarin, raising concern for hemorrhagic stroke. Rapid diagnosis with CT and attention to reversing any coagulopathy is important.
2) A 20-year-old male student experiencing prolonged seizure requires immediate treatment to stop the seizure and prevent future seizures, given risk of neuronal injury.
3) A 35-year-old woman presented with the worst headache of her life and symptoms concerning for aneurysmal subarachnoid hemorrhage, requiring urgent CT to rule out this neurological emergency.
This document discusses several topics related to neurology. It begins by describing upper and lower motor neuron lesions, including that pronator sign is an early sign of upper motor neuron lesion. It then discusses different types of headaches like tension-type headache and migraine, providing details on their symptoms. Raised intracranial pressure and space-occupying lesions as secondary causes of headache are also mentioned. Management strategies for various conditions like tension headaches, migraines, seizures and more are outlined. Neural tube defects, febrile seizures, and Duchenne muscular dystrophy are also summarized.
1) A 5-month-old male child presented with 5 days of fever followed by seizures and was intubated due to poor condition and raised intracranial pressure. Infectious etiologies like dengue and autoimmune encephalitis were considered.
2) Investigations like MRI, LP, and metabolic workup were normal or negative. The child had refractory seizures and raised ICP and died.
3) Causes of acute encephalopathy like infection, autoimmune, metabolic and epileptic encephalopathy were discussed. Management involves stabilization, empiric antibiotics, supportive care, preventing complications, and identifying specific causes.
This case involves an 18-year-old female who presented with protrusion of the eyes, headaches, visual blurring, and weakness of all four limbs. Examination found signs of Graves' disease including exophthalmos and an enlarged thyroid. Testing found elevated thyroid hormones consistent with Graves' disease. Imaging found lesions in the brainstem and spinal cord characteristic of neuromyelitis optica spectrum disorder (NMOSD). She tested positive for NMO-IgG antibodies. The final diagnosis was Graves' disease with NMOSD, possibly associated with systemic lupus erythematosus. NMOSD must be distinguished from multiple sclerosis as they have different treatments and prognoses. This case demonstrates the association
General approach and differential diagnosis of comaAn Chang
This document provides guidance on evaluating and managing comatose patients. It outlines the following key steps:
1. Ensure airway, breathing and circulation are stabilized. Treat any rapidly reversible causes of coma like hypoglycemia.
2. Use the Glasgow Coma Scale to assess the level of consciousness. Common causes of coma include head injuries, strokes, infections, tumors, and metabolic derangements.
3. Perform a full neurological exam including pupil size and response, motor function, and posture. Request diagnostic tests like bloodwork and CT or MRI as indicated.
4. Manage increased intracranial pressure with osmotic diuretics if present. Treat any identifiable structural or metabolic causes. Monitor
This document provides an overview of neuroleptic malignant syndrome (NMS). It begins with a case vignette of a 45-year-old woman who developed NMS after being prescribed haloperidol and fluphenazine. The document then covers the diagnostic criteria of NMS, risk factors, pathophysiology, laboratory findings, differential diagnosis, management including discontinuing antipsychotics and supportive care, prognosis which includes potential mortality, and conclusions regarding NMS.
The document discusses febrile seizures, which are the most common seizure disorder in children. It defines febrile seizures as seizures occurring in children between 6 months and 5 years of age when they have a fever over 38°C but no signs of central nervous system infection. The document outlines the typical presentation and classification of febrile seizures and discusses their causes, risk factors, investigations, treatment including anticonvulsant prophylaxis, and excellent prognosis.
This document provides clinical materials for self-learning in clinical medicine. It was prepared by Dr. Ajith Karawita and contains acknowledgements, instructions for use, and 12 case studies with associated radiological images and reports. The case studies cover a range of topics in clinical medicine and are intended to allow the reader to examine each case, analyze the findings, and suggest a diagnosis and treatment plan.
1) A 55-year-old woman suddenly developed left-sided weakness after stopping her warfarin, raising concern for hemorrhagic stroke. Rapid diagnosis with CT and attention to reversing any coagulopathy is important.
2) A 20-year-old male student experiencing prolonged seizure requires immediate treatment to stop the seizure and prevent future seizures, given risk of neuronal injury.
3) A 35-year-old woman presented with the worst headache of her life and symptoms concerning for aneurysmal subarachnoid hemorrhage, requiring urgent CT to rule out this neurological emergency.
This document discusses several topics related to neurology. It begins by describing upper and lower motor neuron lesions, including that pronator sign is an early sign of upper motor neuron lesion. It then discusses different types of headaches like tension-type headache and migraine, providing details on their symptoms. Raised intracranial pressure and space-occupying lesions as secondary causes of headache are also mentioned. Management strategies for various conditions like tension headaches, migraines, seizures and more are outlined. Neural tube defects, febrile seizures, and Duchenne muscular dystrophy are also summarized.
1) A 5-month-old male child presented with 5 days of fever followed by seizures and was intubated due to poor condition and raised intracranial pressure. Infectious etiologies like dengue and autoimmune encephalitis were considered.
2) Investigations like MRI, LP, and metabolic workup were normal or negative. The child had refractory seizures and raised ICP and died.
3) Causes of acute encephalopathy like infection, autoimmune, metabolic and epileptic encephalopathy were discussed. Management involves stabilization, empiric antibiotics, supportive care, preventing complications, and identifying specific causes.
This case involves an 18-year-old female who presented with protrusion of the eyes, headaches, visual blurring, and weakness of all four limbs. Examination found signs of Graves' disease including exophthalmos and an enlarged thyroid. Testing found elevated thyroid hormones consistent with Graves' disease. Imaging found lesions in the brainstem and spinal cord characteristic of neuromyelitis optica spectrum disorder (NMOSD). She tested positive for NMO-IgG antibodies. The final diagnosis was Graves' disease with NMOSD, possibly associated with systemic lupus erythematosus. NMOSD must be distinguished from multiple sclerosis as they have different treatments and prognoses. This case demonstrates the association
The next step is E) Continue to monitor patient and recheck thyroid function after illness resolve. This clinical presentation suggests Euthyroid Sick Syndrome/Non-thyroidal illness syndrome, which causes changes in thyroid function tests similar to hypothyroidism during acute illness but does not require thyroid hormone treatment. Thyroid function should be reassessed after recovery from the acute illness.
The document discusses shock, including the types (hypovolemic, distributive, cardiogenic, obstructive), stages, pathophysiology, and case study of a 72-year-old male found lethargic in bed who is assessed using the AMLS pathway and diagnosed with sepsis from an untreated foot infection.
This document provides tips for using a PowerPoint presentation (PPT) for active learning sessions:
1. Blank slides are included for topics to allow students to provide input before content is shown.
2. The presenter should show blank slides, ask students what they know, then show the content slide.
3. This process should be repeated for revisions to reinforce learning.
4. It can also be used for self-study by viewing content after providing own input for blank slides.
This document provides information on neurologic disorders and conducting a neurologic exam. It describes the anatomy and physiology of the brain and nervous system. It then presents two case studies of patients presenting with neurologic complaints. The first case involves a 66-year-old woman experiencing difficulty speaking, which upon assessment is determined to likely be an acute ischemic stroke. The second case involves a 68-year-old man who fell while walking and is complaining of a mild headache, with the differential diagnosis including intracranial hemorrhage or elevated intracranial pressure. The document stresses using the AMLS assessment pathway to evaluate patients with potential neurologic issues.
Our errors in diagnosing dizziness slidesBest Doctors
This document summarizes a webinar on diagnosing dizziness presented by Best Doctors. It includes:
1) Four case studies on misdiagnoses of dizziness presented by Drs. Samuels, Calkins, Megerian, and Derebery focusing on conditions like pheochromocytoma, postural orthostatic tachycardia syndrome, endolymphatic sac tumor, and migraine-associated vertigo.
2) A discussion by Dr. Derebery of the differential diagnosis of dizziness and approaches to diagnosis based on temporal patterns and urgency.
3) Details on ACCME accreditation and speaker disclosures for continuing education credits.
This document presents a case report of a 9-year-old female patient with craniopharyngioma who underwent partial tumor resection. It describes her history of headaches and vomiting, previous diagnosis of craniopharyngioma 8 months prior, and recent worsening of symptoms. Her examination, labs, CT and MRI findings are reported. She underwent partial tumor resection with external ventricular drain placement. Post-operatively she developed diabetes insipidus which was managed with vasopressin. The document also provides background on craniopharyngioma including embryology, clinical features, diagnosis, pre-operative evaluation and management, surgical approaches, and common post-operative complications.
This document provides an overview of multiple sclerosis (MS), including its epidemiology, pathophysiology, clinical presentation, diagnosis, and treatment. Some key points:
1. MS typically affects people between the ages of 15-45 and is more common in women. It has a variable geographic distribution and prevalence of around 0.1% in the US.
2. The pathophysiology involves chronic inflammation and demyelination in the central nervous system resulting in neurological deficits. MRI is an important tool for diagnosis and monitoring disease progression.
3. Clinical symptoms can include visual disturbances, motor and sensory problems, fatigue, and cognitive issues. Relapsing-remitting is the most common disease course.
This document provides an overview of the approach to evaluating and managing a patient presenting with headache. It begins by introducing headache as a common neurological problem and outlines pain-sensitive and pain-insensitive structures in the head. It then classifies common headache types such as migraines, tension-type headaches, and trigeminal autonomic cephalgias. The document details the pathogenesis, triggers, phases, and treatment of migraine headaches. It also discusses red flags, evaluation through history, physical exam, and investigations, and management of primary and secondary headache disorders. The take-home message is that a thorough history is most important for diagnosis and neuroimaging is not always needed, with judicious use of investigations.
This document provides guidance on evaluating and managing patients presenting to the emergency department (A&E) with headache. It outlines important aspects of history taking and examination for headache patients. Key causes of headache discussed include subarachnoid hemorrhage, space occupying lesions, migraine, and tension headache. The document also presents 4 case examples and concludes with take home messages emphasizing the need to rule out serious conditions like subarachnoid hemorrhage for severe or unusual headaches through CT scanning or lumbar puncture if indicated.
Medical clearance of the psychiatric patientSCGH ED CME
This presentation discusses medically clearing psychiatric patients. It defines what being "medically clear" means, including having no medical issues or having psychiatric issues dominate over any medical conditions. The presentation reviews how to declare a patient medically clear through history, exam, and observations. It discusses investigating patients based on being lower or higher risk. For lower risk young patients with no issues, further tests may not be needed. The presentation reviews evidence that "routine bloods" are often unnecessary. It presents a case of a patient whose altered mental state was ultimately found to be due to non-convulsive status epilepticus. The presentation concludes that clearly documenting medical clearance is important and requirements may differ by institution.
This patient presented with back pain, bilateral lower limb weakness and numbness, and bowel and bladder dysfunction. MRI revealed extensive spinal metastases resulting in malignant spinal cord compression. Emergent management was required to prevent permanent neurological injury, including high-dose steroids and consideration of radiotherapy or surgery. This case highlights the importance of promptly recognizing and treating malignant spinal cord compression.
A 67-year-old female presented with right upper quadrant abdominal pain following meals and diarrhea for two weeks. Imaging studies including CT, MRI, and MIBG scan revealed bilateral adrenal masses consistent with pheochromocytoma. Laboratory tests showed markedly elevated urine and plasma metanephrines levels confirming the diagnosis. Pheochromocytoma is a rare catecholamine-secreting tumor that arises from chromaffin cells of the adrenal medulla or extra-adrenal paraganglia. It is usually benign but can be malignant in 10% of cases.
This document provides an overview of epilepsy, including its pathogenesis, clinical features, diagnostic approach, and management. It discusses how epilepsy results from an imbalance between excitation and inhibition in the central nervous system. Seizures occur due to factors that lower the seizure threshold or precipitate an attack. Diagnosis involves obtaining a medical history, clinical examination, and tests like EEG and imaging. Treatment primarily involves antiepileptic drugs to control seizures, though surgery may be an option for refractory cases. Proper management of epilepsy requires long-term medical treatment as well as attention to any psychiatric comorbidities.
Differential diagnosis in a relapse clinicMS Trust
This document summarizes key points from a presentation on accurately diagnosing relapses in multiple sclerosis (MS) patients. It discusses the clinical definition of an MS relapse according to textbooks and reality, and highlights factors like pre-morbid function and medication that can influence relapse diagnosis. Several clinical scenarios are then presented where attendees must determine if new symptoms represent a relapse or have alternative causes like infection, autoimmune conditions from MS treatments, musculoskeletal issues, or functional neurological symptoms. Accurately diagnosing relapses is important for treatment decisions and understanding the natural disease course.
Febrile seizures are non-epileptic seizures triggered by fever between ages 6 months to 5 years. They are generally brief and self-limiting, resolving within 15 minutes. Febrile seizures are classified as simple or complex depending on duration and recurrence. While frightening, febrile seizures typically cause no long term issues and have a low risk of developing epilepsy. Proper management involves antipyretics, observation, and reassurance of parents on typical prognosis.
This 12-year old girl presents with progressive back pain and weakness. Her neuro exam shows diffuse reduced strength and absent reflexes. LP shows elevated protein. Of the treatment options, IVIg would be most beneficial as it is first-line treatment for Guillain-Barré syndrome, which presents with progressive weakness and albuminocytologic dissociation on LP. Steroids are not effective as monotherapy and the other options do not match the presentation or workup findings.
This document discusses toxicology, hazardous materials, and weapons of mass destruction. It begins by outlining the objectives of reviewing toxidromes, hazardous environments, and managing toxicologic emergencies using the AMLS Assessment Pathway. It then defines key terms like toxicology, toxidrome, and major toxidromes. The autonomic nervous system and its sympathetic and parasympathetic divisions are described. Initial approaches for hazardous scenes and weapons of mass destruction exposures are reviewed. Two case studies of potential toxic exposures are then presented and managed using the AMLS Assessment Pathway.
PMR and GCA: A GP Update - Dr Toby Helliwell pcsciences
Dr Toby Helliwell is a practising GP and Researcher at the Research Institute for Primary Care and Health Sciences. As part of the 2017 Musculoskeletal Education Day, he provides an update of the diagnosis on treatment of Polymyalgia Rheumatica and Giant cell Arteritis from a GP's perspective
This document presents 4 case studies to discuss barriers to correct diagnosis in neurology. Case 1 describes a woman misdiagnosed with back pain who later presented with spinal epidural abscesses. Case 2 involves a man diagnosed with labyrinthitis who later had a cerebellar infarct. Case 3 is about a woman discharged with headaches who returned with a cerebellar infarct. The document emphasizes considering alternative diagnoses and thorough neurological exams to avoid missed diagnoses.
The document describes several cases presenting with central nervous system infections. The first case is of a 32-year-old man with fever, headache and vomiting, found to have meningitis based on CSF analysis. The second case is a 23-year-old woman with sudden unconsciousness, fever and headache, diagnosed with meningitis. Subsequent cases describe presentations of meningitis, encephalitis, brain abscess and tuberculous meningitis. Management of various CNS infections including bacterial meningitis, viral meningitis and tuberculosis is discussed.
PGx Analysis in VarSeq: A User’s PerspectiveGolden Helix
Since our release of the PGx capabilities in VarSeq, we’ve had a few months to gather some insights from various use cases. Some users approach PGx workflows by means of array genotyping or what seems to be a growing trend of adding the star allele calling to the existing NGS pipeline for whole genome data. Luckily, both approaches are supported with the VarSeq software platform. The genotyping method being used will also dictate what the scope of the tertiary analysis will be. For example, are your PGx reports a standalone pipeline or would your lab’s goal be to handle a dual-purpose workflow and report on PGx + Diagnostic findings.
The purpose of this webcast is to:
Discuss and demonstrate the approaches with array and NGS genotyping methods for star allele calling to prep for downstream analysis.
Following genotyping, explore alternative tertiary workflow concepts in VarSeq to handle PGx reporting.
Moreover, we will include insights users will need to consider when validating their PGx workflow for all possible star alleles and options you have for automating your PGx analysis for large number of samples. Please join us for a session dedicated to the application of star allele genotyping and subsequent PGx workflows in our VarSeq software.
The biomechanics of running involves the study of the mechanical principles underlying running movements. It includes the analysis of the running gait cycle, which consists of the stance phase (foot contact to push-off) and the swing phase (foot lift-off to next contact). Key aspects include kinematics (joint angles and movements, stride length and frequency) and kinetics (forces involved in running, including ground reaction and muscle forces). Understanding these factors helps in improving running performance, optimizing technique, and preventing injuries.
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Similar to Neurologic Emergencies 9-4-09 Jacobi medicine residents.ppt
The next step is E) Continue to monitor patient and recheck thyroid function after illness resolve. This clinical presentation suggests Euthyroid Sick Syndrome/Non-thyroidal illness syndrome, which causes changes in thyroid function tests similar to hypothyroidism during acute illness but does not require thyroid hormone treatment. Thyroid function should be reassessed after recovery from the acute illness.
The document discusses shock, including the types (hypovolemic, distributive, cardiogenic, obstructive), stages, pathophysiology, and case study of a 72-year-old male found lethargic in bed who is assessed using the AMLS pathway and diagnosed with sepsis from an untreated foot infection.
This document provides tips for using a PowerPoint presentation (PPT) for active learning sessions:
1. Blank slides are included for topics to allow students to provide input before content is shown.
2. The presenter should show blank slides, ask students what they know, then show the content slide.
3. This process should be repeated for revisions to reinforce learning.
4. It can also be used for self-study by viewing content after providing own input for blank slides.
This document provides information on neurologic disorders and conducting a neurologic exam. It describes the anatomy and physiology of the brain and nervous system. It then presents two case studies of patients presenting with neurologic complaints. The first case involves a 66-year-old woman experiencing difficulty speaking, which upon assessment is determined to likely be an acute ischemic stroke. The second case involves a 68-year-old man who fell while walking and is complaining of a mild headache, with the differential diagnosis including intracranial hemorrhage or elevated intracranial pressure. The document stresses using the AMLS assessment pathway to evaluate patients with potential neurologic issues.
Our errors in diagnosing dizziness slidesBest Doctors
This document summarizes a webinar on diagnosing dizziness presented by Best Doctors. It includes:
1) Four case studies on misdiagnoses of dizziness presented by Drs. Samuels, Calkins, Megerian, and Derebery focusing on conditions like pheochromocytoma, postural orthostatic tachycardia syndrome, endolymphatic sac tumor, and migraine-associated vertigo.
2) A discussion by Dr. Derebery of the differential diagnosis of dizziness and approaches to diagnosis based on temporal patterns and urgency.
3) Details on ACCME accreditation and speaker disclosures for continuing education credits.
This document presents a case report of a 9-year-old female patient with craniopharyngioma who underwent partial tumor resection. It describes her history of headaches and vomiting, previous diagnosis of craniopharyngioma 8 months prior, and recent worsening of symptoms. Her examination, labs, CT and MRI findings are reported. She underwent partial tumor resection with external ventricular drain placement. Post-operatively she developed diabetes insipidus which was managed with vasopressin. The document also provides background on craniopharyngioma including embryology, clinical features, diagnosis, pre-operative evaluation and management, surgical approaches, and common post-operative complications.
This document provides an overview of multiple sclerosis (MS), including its epidemiology, pathophysiology, clinical presentation, diagnosis, and treatment. Some key points:
1. MS typically affects people between the ages of 15-45 and is more common in women. It has a variable geographic distribution and prevalence of around 0.1% in the US.
2. The pathophysiology involves chronic inflammation and demyelination in the central nervous system resulting in neurological deficits. MRI is an important tool for diagnosis and monitoring disease progression.
3. Clinical symptoms can include visual disturbances, motor and sensory problems, fatigue, and cognitive issues. Relapsing-remitting is the most common disease course.
This document provides an overview of the approach to evaluating and managing a patient presenting with headache. It begins by introducing headache as a common neurological problem and outlines pain-sensitive and pain-insensitive structures in the head. It then classifies common headache types such as migraines, tension-type headaches, and trigeminal autonomic cephalgias. The document details the pathogenesis, triggers, phases, and treatment of migraine headaches. It also discusses red flags, evaluation through history, physical exam, and investigations, and management of primary and secondary headache disorders. The take-home message is that a thorough history is most important for diagnosis and neuroimaging is not always needed, with judicious use of investigations.
This document provides guidance on evaluating and managing patients presenting to the emergency department (A&E) with headache. It outlines important aspects of history taking and examination for headache patients. Key causes of headache discussed include subarachnoid hemorrhage, space occupying lesions, migraine, and tension headache. The document also presents 4 case examples and concludes with take home messages emphasizing the need to rule out serious conditions like subarachnoid hemorrhage for severe or unusual headaches through CT scanning or lumbar puncture if indicated.
Medical clearance of the psychiatric patientSCGH ED CME
This presentation discusses medically clearing psychiatric patients. It defines what being "medically clear" means, including having no medical issues or having psychiatric issues dominate over any medical conditions. The presentation reviews how to declare a patient medically clear through history, exam, and observations. It discusses investigating patients based on being lower or higher risk. For lower risk young patients with no issues, further tests may not be needed. The presentation reviews evidence that "routine bloods" are often unnecessary. It presents a case of a patient whose altered mental state was ultimately found to be due to non-convulsive status epilepticus. The presentation concludes that clearly documenting medical clearance is important and requirements may differ by institution.
This patient presented with back pain, bilateral lower limb weakness and numbness, and bowel and bladder dysfunction. MRI revealed extensive spinal metastases resulting in malignant spinal cord compression. Emergent management was required to prevent permanent neurological injury, including high-dose steroids and consideration of radiotherapy or surgery. This case highlights the importance of promptly recognizing and treating malignant spinal cord compression.
A 67-year-old female presented with right upper quadrant abdominal pain following meals and diarrhea for two weeks. Imaging studies including CT, MRI, and MIBG scan revealed bilateral adrenal masses consistent with pheochromocytoma. Laboratory tests showed markedly elevated urine and plasma metanephrines levels confirming the diagnosis. Pheochromocytoma is a rare catecholamine-secreting tumor that arises from chromaffin cells of the adrenal medulla or extra-adrenal paraganglia. It is usually benign but can be malignant in 10% of cases.
This document provides an overview of epilepsy, including its pathogenesis, clinical features, diagnostic approach, and management. It discusses how epilepsy results from an imbalance between excitation and inhibition in the central nervous system. Seizures occur due to factors that lower the seizure threshold or precipitate an attack. Diagnosis involves obtaining a medical history, clinical examination, and tests like EEG and imaging. Treatment primarily involves antiepileptic drugs to control seizures, though surgery may be an option for refractory cases. Proper management of epilepsy requires long-term medical treatment as well as attention to any psychiatric comorbidities.
Differential diagnosis in a relapse clinicMS Trust
This document summarizes key points from a presentation on accurately diagnosing relapses in multiple sclerosis (MS) patients. It discusses the clinical definition of an MS relapse according to textbooks and reality, and highlights factors like pre-morbid function and medication that can influence relapse diagnosis. Several clinical scenarios are then presented where attendees must determine if new symptoms represent a relapse or have alternative causes like infection, autoimmune conditions from MS treatments, musculoskeletal issues, or functional neurological symptoms. Accurately diagnosing relapses is important for treatment decisions and understanding the natural disease course.
Febrile seizures are non-epileptic seizures triggered by fever between ages 6 months to 5 years. They are generally brief and self-limiting, resolving within 15 minutes. Febrile seizures are classified as simple or complex depending on duration and recurrence. While frightening, febrile seizures typically cause no long term issues and have a low risk of developing epilepsy. Proper management involves antipyretics, observation, and reassurance of parents on typical prognosis.
This 12-year old girl presents with progressive back pain and weakness. Her neuro exam shows diffuse reduced strength and absent reflexes. LP shows elevated protein. Of the treatment options, IVIg would be most beneficial as it is first-line treatment for Guillain-Barré syndrome, which presents with progressive weakness and albuminocytologic dissociation on LP. Steroids are not effective as monotherapy and the other options do not match the presentation or workup findings.
This document discusses toxicology, hazardous materials, and weapons of mass destruction. It begins by outlining the objectives of reviewing toxidromes, hazardous environments, and managing toxicologic emergencies using the AMLS Assessment Pathway. It then defines key terms like toxicology, toxidrome, and major toxidromes. The autonomic nervous system and its sympathetic and parasympathetic divisions are described. Initial approaches for hazardous scenes and weapons of mass destruction exposures are reviewed. Two case studies of potential toxic exposures are then presented and managed using the AMLS Assessment Pathway.
PMR and GCA: A GP Update - Dr Toby Helliwell pcsciences
Dr Toby Helliwell is a practising GP and Researcher at the Research Institute for Primary Care and Health Sciences. As part of the 2017 Musculoskeletal Education Day, he provides an update of the diagnosis on treatment of Polymyalgia Rheumatica and Giant cell Arteritis from a GP's perspective
This document presents 4 case studies to discuss barriers to correct diagnosis in neurology. Case 1 describes a woman misdiagnosed with back pain who later presented with spinal epidural abscesses. Case 2 involves a man diagnosed with labyrinthitis who later had a cerebellar infarct. Case 3 is about a woman discharged with headaches who returned with a cerebellar infarct. The document emphasizes considering alternative diagnoses and thorough neurological exams to avoid missed diagnoses.
The document describes several cases presenting with central nervous system infections. The first case is of a 32-year-old man with fever, headache and vomiting, found to have meningitis based on CSF analysis. The second case is a 23-year-old woman with sudden unconsciousness, fever and headache, diagnosed with meningitis. Subsequent cases describe presentations of meningitis, encephalitis, brain abscess and tuberculous meningitis. Management of various CNS infections including bacterial meningitis, viral meningitis and tuberculosis is discussed.
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PGx Analysis in VarSeq: A User’s PerspectiveGolden Helix
Since our release of the PGx capabilities in VarSeq, we’ve had a few months to gather some insights from various use cases. Some users approach PGx workflows by means of array genotyping or what seems to be a growing trend of adding the star allele calling to the existing NGS pipeline for whole genome data. Luckily, both approaches are supported with the VarSeq software platform. The genotyping method being used will also dictate what the scope of the tertiary analysis will be. For example, are your PGx reports a standalone pipeline or would your lab’s goal be to handle a dual-purpose workflow and report on PGx + Diagnostic findings.
The purpose of this webcast is to:
Discuss and demonstrate the approaches with array and NGS genotyping methods for star allele calling to prep for downstream analysis.
Following genotyping, explore alternative tertiary workflow concepts in VarSeq to handle PGx reporting.
Moreover, we will include insights users will need to consider when validating their PGx workflow for all possible star alleles and options you have for automating your PGx analysis for large number of samples. Please join us for a session dedicated to the application of star allele genotyping and subsequent PGx workflows in our VarSeq software.
The biomechanics of running involves the study of the mechanical principles underlying running movements. It includes the analysis of the running gait cycle, which consists of the stance phase (foot contact to push-off) and the swing phase (foot lift-off to next contact). Key aspects include kinematics (joint angles and movements, stride length and frequency) and kinetics (forces involved in running, including ground reaction and muscle forces). Understanding these factors helps in improving running performance, optimizing technique, and preventing injuries.
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Giloy, also known as Guduchi or Amrita in classical Ayurvedic texts, is a revered herb renowned for its myriad health benefits. It is categorized as a Rasayana, meaning it has rejuvenating properties that enhance vitality and longevity. Giloy is celebrated for its ability to boost the immune system, detoxify the body, and promote overall wellness. Its anti-inflammatory, antipyretic, and antioxidant properties make it a staple in managing conditions like fever, diabetes, and stress. The versatility and efficacy of Giloy in supporting health naturally highlight its importance in Ayurveda. At Planet Ayurveda, we provide a comprehensive range of health services and 100% herbal supplements that harness the power of natural ingredients like Giloy. Our products are globally available and affordable, ensuring that everyone can benefit from the ancient wisdom of Ayurveda. If you or your loved ones are dealing with health issues, contact Planet Ayurveda at 01725214040 to book an online video consultation with our professional doctors. Let us help you achieve optimal health and wellness naturally.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
How to Control Your Asthma Tips by gokuldas hospital.Gokuldas Hospital
Respiratory issues like asthma are the most sensitive issue that is affecting millions worldwide. It hampers the daily activities leaving the body tired and breathless.
The key to a good grip on asthma is proper knowledge and management strategies. Understanding the patient-specific symptoms and carving out an effective treatment likewise is the best way to keep asthma under control.
Are you looking for a long-lasting solution to your missing tooth?
Dental implants are the most common type of method for replacing the missing tooth. Unlike dentures or bridges, implants are surgically placed in the jawbone. In layman’s terms, a dental implant is similar to the natural root of the tooth. It offers a stable foundation for the artificial tooth giving it the look, feel, and function similar to the natural tooth.
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Visit Us: https://drdeepikashomeopathy.com/service/irregular-periods-treatment/
Summer is a time for fun in the sun, but the heat and humidity can also wreak havoc on your skin. From itchy rashes to unwanted pigmentation, several skin conditions become more prevalent during these warmer months.
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
The Children are very vulnerable to get affected with respiratory disease.
In our country, the respiratory Disease conditions are consider as major cause for mortality and Morbidity in Child.
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Neurologic Emergencies 9-4-09 Jacobi medicine residents.ppt
1. Neurologic Emergencies
September 4, 2009
Matthew Robbins, MD
Assistant Professor of Neurology
Montefiore Headache Center
Albert Einstein College of Medicine
2. Case #1
• History
– 49 year old man is found lying on the grounds outside
of Bronx Psychiatric Center. He is unresponsive to
staff members and 911 was called. The day prior he
was less talkative than usual.
– Meds: Haloperidol decanoate 100mg qMonth, Seroquel
25mg qhs
• Exam
– BP 145/92, HR 108, T 100.3F
– Awake, nonverbal, follows no requests.
– Axial and appendicular rigidity, no tremor, no
myoclonus
8. Neuroleptic Malignant Syndrome:
Management
• Withdraw (or reinstitute, if levodopa) the offending
agent
• IV hydration +/- urine alkalinization
• Look for underlying infection
• Bromocriptine 5mg TID, titrate up as needed
• Start Dantrolene 1 to 3mg/kg (div TID) if rigidity not
controlled
• Improvement over 10-13 days
• Rechallenge with neuroleptic at 2 weeks the earliest
9. Case #2
• History
– A 41 year old European woman with a history
of depression is brought to the ED by her
family “acting drunk” for the past 12 hours.
She stopped a medication given to her by her
psychiatrist back in France 1 week ago, and a
bottle of Venlafaxine was found in her purse.
• Exam
– Next slide
10. Boyer E and Shannon M. N Engl J Med 2005;352:1112-1120
Diagnosis?
11. Serotonin Syndrome vs. NMS
Pelonero AL, Levenson JL, Pandurangi AK. Neuroleptic malignant syndrome: a review. Psychiatr Serv 1998;49:1163-1172.
12. Boyer E and Shannon M. N Engl J Med 2005;352:1112-1120
Drugs and Drug Interactions Associated with the Serotonin Syndrome
13. Serotonin Syndrome
Management
• Remove offending agent(s)
• Control agitation with benzodiazepines
• 5-HT2A antagonists
– Cyproheptadine 12mg x1, 2mg q2PRN
– IV chlorpromazine or SL olanzapine
• Treat hypotension
• Treat hyperthermia
14. Case #3
• History
– 40 year old woman presents to the ED with
new-onset constant left frontal pain for 2 days.
• Exam
– Next slide
17. Carotid Artery Dissection:
Features
• Ipsilateral pain
– Headache 55-100%
• Can be thunderclap
– Neck pain 25%
• Horner’s syndrome <50%
– No anhidrosis
• Pulsatile tinnitus 25%
• Cranial nerve palsies 12%
– Most common: hypoglossal
• Ischemia 50-95%
– Retina
– Cerebral
18. Carotid Artery Dissection:
Who is at risk?
• Connective tissue disorders 1-5%
– Ehlers-Danlos
– Marfan’s
– Fibromuscular dysplasia
– Polycystic kidney disease
• Family history 5%
• Antecedent URI
• Minor precipitating event
– “beauty-parlor stroke”
– Chiropractic manipulation, yoga, Valsalva
• Vascular risk factors
• Migraine
19. Carotid Artery Dissection:
Evaluation and Management
• Tests
– Angiography gold standard
– MRA neck (fat-suppressed, T1 axial thin cuts)
– CTA neck
• Management
– Improvement is the rule (although 2% recurrence rate)
– Anticoagulation: IV heparin and warfarin
– Antiplatelets?
– Repeat MRA q3-6 months, assess for recanalization
20. Case #4
History
• 63 RHM awoke in the morning:
– Hallucinating (seeing his mother, who has been
dead for years)
– Worsening confusion
– Double vision upon looking up
– Ataxia
• PMH: smoker, DM, HTN, atrial fibrillation
21. Case #4
• Exam
– BP 189/100
– Drowsy but alert and oriented, fluent
– Left homonymous hemianopia
– Right ptosis, hypotropia, and exotropia
– Bilateral upgaze paresis
– Bilateral Babinski signs
– Marked gait ataxia
25. Case #5
History
– 56 yo RHM starting having pain in his upper
back 2 weeks ago, after lifting a heavy box in
his garage.
– Pain initially responded to ibuprofen.
– Since yesterday, pain intensified, sweating,
numbness of both legs.
– PMH: DM, asthma
26. Case #5
Exam
– BP 102/78 HR 91 T 99.4°F
– No focal tenderness
– MSE, CN normal
– Bilateral mild paraparesis
– DTRs 2+ throughout except absent L triceps and
B/L Babinski signs
– Absent vibration and diminshed pinprick in legs
– +Romberg
– Spastic gait
27. Intramedullary vs.
Extramedullary Cord Lesions
Adapted from Brazis PW, Masdeu JC, Biller J. Localization in Clinical Neurology, 5th ed, 2006.
Signs/Symptoms Intramedullary Extramedullary
28. Case #5
Tests
– WBC 17,000
– ESR 57 mm/hr
– MRI C-spine +/- gadolinium: next slide
30. Spinal epidural abscess
• Who is at risk?
– Diabetics
– Back trauma
– IV drug abusers
– Alcoholics
– Pregnancy
– Prior spinal surgery
– HIV
• Infections
– Staph aureus (50-90%)
– MRSA now common
– Strep. species (5-10%)
– Gram negative and
anaerobic species (13-17%)
– Accompanying infections
– Diskitis 80%
– Osteomyelitis 65%
31. Spinal Epidural Abscess
• Workup
– MRI spine +/- contrast (>CT)
– Blood cultures (+) 50%
– No LP or myelogram
• Management
– Call neurosurgery
• urgent open surgery
• if small: CT-guided drainage
– Antibiotics
• Vancomycin initially
• Ceftriaxone / Ceftazadime / Metronidazole if
other sp. considered
32. Other Causes of
Spinal Cord Compression
• Neoplasm
– Primary tumors
• breast, lung, prostate,
lymphoma, sarcoma,
kidney
– Management
• MRI +/- gadolinium
• Postvoid residual
• Steroids + XRT
• Surgery if XRT
unsuccessful or
instability
33. Other Causes of
Spinal Cord Compression
• Trauma
– Steroids
• Bolus: 10-100mg IV dexamethasone
• Maintenance: 4-25mg IV dexamethasone q4h
– Postvoid residual + catheterization
– Neurosurgical consult
• Other causes
– Vascular
– Inflammatory
– Other infections (e.g. TB)
36. Case #6
• History
– A 34 year old woman presented to the ED with
3 days of worsening holocephalic headache.
– 1 week ago, uncomplicated delivery of her 2nd
child after epidural anesthesia.
– In the ED, she had a brief convulsion.
37. Case #6
• Exam
– Normal mental status
– Edematous optic disks
– L inferior quadrantanopia
– flattened L nasolabial fold
– Clumsy L hand
– Extinction to double simultaneous stimuli on
the L
– Mildly L hemiparetic gait
42. Stam J. N Engl J Med 2005;352:1791-1798
Frequency of Thrombosis of the Major Cerebral Veins and Sinuses
43. Stam J. N Engl J Med 2005;352:1791-1798
Causes of and Risk
Factors Associated
with Cerebral Venous
Sinus Thrombosis
44. Venous Sinus Thrombosis:
Clinical Manifestations
• Headache >90%
– Rarely thunderclap headache
• Seizures 40%
• Hemorrhagic infarction 40%
• Focal hemispheric findings
• Other symptoms by way of:
– Cavernous sinus
– Deep venous drainage
45. Venous Sinus Thrombosis:
Management
• Acute anticoagulation
– IV heparin
• Chronic anticoagulation
– Warfarin
– Re-image to assess recanalization in 3-6 months
• Treat underlying cause
• Reduce intracranial pressure
– Avoid dehydrating treatments
46. Case #7
History
• 30 year old male (no PMH, on no meds) brought
to the ED by friends with shortness of breath
• First: sore throat for the past 6 days
• 3 days ago: increasing weakness in both the
upper and lower limbs
• 2 days ago: “breathy” voice and trouble chewing
• Today: progressive dyspnea on exertion and then
at rest
47. Case #7
Exam
• BP 110/80, HR 96, RR 26, afebrile
• Normal mental status
• Bilateral moderate ptosis
• Fluctuating diplopia on extreme horizontal gaze B/L
• Breathy speech
• Neck flexors, extensors 4/5
• Deltoids, triceps 4/5, quads 5-/5
• Normal sensation
• DTRs 1+
49. Clinical Features of Neuromuscular
Respiratory Failure
• Shortness of breath
• Staccato speech
• Inability to count past 20 in a single breath
• Tachypnea
• Accessory muscle use
• Paradoxical breathing
• Orthopnea
53. Myasthenic Crisis:
Pharmacological Management
• IVIg or plasmapharesis
– May be equally efficacious
• Acetylcholinesterase inhibitors
– Hold while respiratory compromise
• Corticosteroids
– NOT IV acutely, eventually can start PO for
maintenance
54. Case #8
History
• 40 year old woman comes to the ED with 5 days of
weakness of her legs
• Intermittent tingling of toes and finger tips
• Past day – arms feel somewhat weak
• 2 weeks prior to symptom onset – flu-like illness
55. Case #8
Examination
• Transverse smile
• 4/5 proximal and 3+/5 distal muscles
• Diminished light touch and pinprick distally
• DTRs:
– 1+ biceps, brachioradialis
– Remainder absent
57. AIDP: Tests
• CSF analysis
– WBCs
• Acellular in 90%
• Elevated in 10% (11-50 cells/mm3)
– Lyme, sarcoid, HIV, EBV, neoplastic
– Protein
• Often normal in 1st week
• Increased in 90% by end of the 2nd week
58. AIDP: Tests
• Electrodiagnostics
– Predominance of demyelinating features
• multifocal conduction block
• slowing of nerve conduction velocities
• prolonged distal and F-wave latencies
• various degrees of denervation
– Frequently normal early
*not an emergency
59. AIDP: Variants
• Acute motor-sensory axonal neuropathy
– severe, fulminant paralysis + sensory loss
– incomplete recovery
• Acute motor axonal neuropathy
– Most closely associated with C. jejuni
– Rapid progression
• Miller-Fisher Syndrome
– Ophthalmoplegia, ataxia, areflexia
– Associated with GQ1b or GT1a antibodies
– Limb weakness infrequent
62. Case #9
History
• 71 year old healthy woman brought to the
ED for 2 days of headache and confusion.
• When asked, she complained about a
diffuse headache, but could not answer
questions coherently.
Case 5-24 from Plum and Posner’s Diagnosis of Stupor and Coma, 4th ed.
63. Case #9
Exam
• Temp 98°F
• Mild left hemiparesis
• Mild left-sided inattention
64. Case #9
• A right hemisphere ischemic stroke was suspected,
but the CT did not disclose any abnormality, and
she was admitted to the stroke service.
• The following day, her temp spiked to 102°F.
• LP:
– 7 WBCs, 19 RBCs
– Protein 48, Glucose 103
– normal opening pressure
66. Case #9
• By this time, she lapsed into a stuporous
state, with small but reactive pupils, full
roving eye movements, and symmetrically
increased motor tone.
• She was started on acyclovir.
• Despite treatment she developed edema of
the right temporal lobe with uncal
herniation.
67. Herpes Encephalitis:
Clinical Features
• Fever near universal
• Headache >90%
• Focal neurological deficits
• Seizures
• Behavioral disturbances
• Time course
– Acute onset (days to 1 week)
– Immunosuppressed patients: days to weeks
(subacute)
Mortality
20-30%
(if untreated:70%)
68. Herpes Encephalitis:
Tests
• CSF
– Pleocytosis (100-500 WBCs)
– Increased RBCs common
– Mild high protein, normal glucose
– HSV PCR
• In brain biopsy specimens: 98% sens. 100% spec.
• Can be negative on day 1 or 2 of illness
• Stays (+) in >80% by 1 week of therapy
69. Herpes Encephalitis:
Tests
• MRI
– Inferomedial temporal lobe(s) high T2 signal
and enhancement
• EEG
– Focal findings in >80%
• Intermittent high amplitude slow waves
• PLEDs (periodic lateralized epileptiform discharges)
(not pathognomonic but very suggestive)
70. Herpes Encephalitis:
Management
• Antiviral agent: Acyclovir
– 10 mg/kg IV q8 hours
– Treat for 14 to 21 days
– Infusion should be slow
– Monitor renal function
• When to stop Acyclovir if PCR is (-)?
– Low clinical suspicion <1% still has HSV
– High clinical suspicion 5% still has HSV
71. Case #10
• A 47 year old hypertensive man awoke one
morning with the most severe, holocephalic,
pounding headache that he has ever had, and
felt quite nauseous. His family called 911.
• Physical and neurological exam was normal.
• A nonconstrast CT was unremarkable, and he
was discharged after feeling somewhat better.