This document discusses refining the neurological history. It emphasizes that the neurological history should answer where in the nervous system the lesion is located, the pathological process, and if it is purely neurological or a manifestation of systemic disease. A detailed history remains important as it is the safest, most cost-effective diagnostic tool, helps establish trust in the doctor-patient relationship, and can provide a diagnosis when tests are negative. Key elements to address in the history, like dizziness, slurred speech, blurred vision and numbness are discussed.
This document provides guidance on performing a neurological examination. It discusses the history of neurological examinations and emphasizes localization of lesions and differential diagnosis. The summary is:
1. Neurological examinations have evolved over decades to develop techniques for detecting subtle signs.
2. The document provides guidance for medical students and new physicians on performing comprehensive neurological examinations to make tentative diagnoses in half of cases.
3. It stresses the importance of localization of lesions through examination followed by differential diagnosis, despite advances in diagnostic testing.
A neurological examination involves assessing the nervous system through physical examination and medical history review. It evaluates sensory and motor functions like reflexes to determine if the nervous system is impaired. The exam includes tests of cranial nerves, motor skills, coordination, strength, reflexes, and sensory functions. It is used as both a screening and investigative tool to diagnose neurological conditions and plan treatment.
The document discusses the neurologic exam. It covers neuroanatomy, central vs peripheral lesions, upper motor neuron vs lower motor neuron deficits. It then discusses the different components of the neurologic exam including mental status, cranial nerves, motor exam, sensory exam, coordination, and reflexes. It provides examples of different clinical scenarios and focuses on localizing lesions based on exam findings.
This document provides lecture notes on performing a neurological examination. It outlines the objectives and components of the exam, including assessing the cranial nerves, motor system, reflexes, sensory system, coordination, and gait. It describes the techniques for testing each part of the exam and provides examples of normal findings and abnormalities. The goals are to demonstrate the proper techniques for performing a full neurological exam and to understand what constitutes normal variability versus pathological findings.
1. The document discusses examination of the cranial nerves and neurological system. Key tests described include evaluation of gait, stance, speech, mental status and cranial nerves I-XII.
2. Specific disorders are discussed such as types of dysarthria and dysphasia, optic nerve conditions seen on fundoscopy, and lesions affecting cranial nerves.
3. Examination techniques are provided for assessing conditions of the cranial nerves including testing of smell, hearing, eye movements, facial strength, and vestibular function.
This document provides guidance on neurological assessment techniques. It outlines objectives such as describing how to take a neurological history and examine the nervous system. Assessment areas covered include cerebral and cerebellar function, cranial nerves, motor and sensory systems, and reflexes. Specific examination techniques are described for testing things like vision, hearing, sensation, and coordination. Common neurological symptoms are also listed. The goal is to equip health professionals with the skills to properly evaluate patients for potential neurological conditions.
The document discusses an approach to evaluating and managing a patient presenting with altered sensorium, which can be caused by a wide range of reversible and non-reversible medical conditions. It outlines performing an initial ABCDE assessment to identify life-threatening issues and potentially reversible causes. A detailed history, physical exam, and assessment of level of consciousness using the Glasgow Coma Scale are recommended to help classify the altered sensorium and develop a differential diagnosis.
This document discusses refining the neurological history. It emphasizes that the neurological history should answer where in the nervous system the lesion is located, the pathological process, and if it is purely neurological or a manifestation of systemic disease. A detailed history remains important as it is the safest, most cost-effective diagnostic tool, helps establish trust in the doctor-patient relationship, and can provide a diagnosis when tests are negative. Key elements to address in the history, like dizziness, slurred speech, blurred vision and numbness are discussed.
This document provides guidance on performing a neurological examination. It discusses the history of neurological examinations and emphasizes localization of lesions and differential diagnosis. The summary is:
1. Neurological examinations have evolved over decades to develop techniques for detecting subtle signs.
2. The document provides guidance for medical students and new physicians on performing comprehensive neurological examinations to make tentative diagnoses in half of cases.
3. It stresses the importance of localization of lesions through examination followed by differential diagnosis, despite advances in diagnostic testing.
A neurological examination involves assessing the nervous system through physical examination and medical history review. It evaluates sensory and motor functions like reflexes to determine if the nervous system is impaired. The exam includes tests of cranial nerves, motor skills, coordination, strength, reflexes, and sensory functions. It is used as both a screening and investigative tool to diagnose neurological conditions and plan treatment.
The document discusses the neurologic exam. It covers neuroanatomy, central vs peripheral lesions, upper motor neuron vs lower motor neuron deficits. It then discusses the different components of the neurologic exam including mental status, cranial nerves, motor exam, sensory exam, coordination, and reflexes. It provides examples of different clinical scenarios and focuses on localizing lesions based on exam findings.
This document provides lecture notes on performing a neurological examination. It outlines the objectives and components of the exam, including assessing the cranial nerves, motor system, reflexes, sensory system, coordination, and gait. It describes the techniques for testing each part of the exam and provides examples of normal findings and abnormalities. The goals are to demonstrate the proper techniques for performing a full neurological exam and to understand what constitutes normal variability versus pathological findings.
1. The document discusses examination of the cranial nerves and neurological system. Key tests described include evaluation of gait, stance, speech, mental status and cranial nerves I-XII.
2. Specific disorders are discussed such as types of dysarthria and dysphasia, optic nerve conditions seen on fundoscopy, and lesions affecting cranial nerves.
3. Examination techniques are provided for assessing conditions of the cranial nerves including testing of smell, hearing, eye movements, facial strength, and vestibular function.
This document provides guidance on neurological assessment techniques. It outlines objectives such as describing how to take a neurological history and examine the nervous system. Assessment areas covered include cerebral and cerebellar function, cranial nerves, motor and sensory systems, and reflexes. Specific examination techniques are described for testing things like vision, hearing, sensation, and coordination. Common neurological symptoms are also listed. The goal is to equip health professionals with the skills to properly evaluate patients for potential neurological conditions.
The document discusses an approach to evaluating and managing a patient presenting with altered sensorium, which can be caused by a wide range of reversible and non-reversible medical conditions. It outlines performing an initial ABCDE assessment to identify life-threatening issues and potentially reversible causes. A detailed history, physical exam, and assessment of level of consciousness using the Glasgow Coma Scale are recommended to help classify the altered sensorium and develop a differential diagnosis.
A neurological examination is the assessment of sensory neuron and motor responses, especially reflexes, to determine whether the nervous system is impaired. This typically includes a physical examination and a review of the patient's medical history, but not deeper investigation such as neuroimaging.
An altered mental status or level of consciousness requires determining the underlying cause. The initial approach involves assessing the ABCs, giving supplemental oxygen, checking glucose, and looking for signs of infection, trauma, or drugs. Further evaluation includes detailed history, physical exam focusing on vital signs and neurological status, and diagnostic testing of blood and imaging based on suspected etiologies like metabolic derangements, medications/toxins, infections, and structural brain issues. Treatment is directed at reversing or controlling the specific cause, such as treating seizures, lowering blood pressure in hypertensive encephalopathy, or giving antibiotics for infections.
This document contains guidelines for performing a neurological examination. It begins with an overview of the developmental, psychosocial and cultural factors to consider. It then provides details on assessing various aspects of the neurological exam including mental status, cranial nerves, motor function, sensation and reflexes. Questions are provided to gather relevant history. The document comprehensively covers the steps and
A neurological examination assesses the functioning of the nervous system through physical examination and review of medical history. It involves evaluating levels of consciousness, cranial nerve function, motor skills, sensation, coordination, and reflexes. Abnormal findings may indicate neurological disorders requiring further investigation.
The document provides information on performing a neurologic examination, including:
1) Obtaining a health history to understand the onset and progression of symptoms.
2) Assessing mental status, cranial nerves, motor function, sensory function, and reflexes.
3) Common clinical manifestations of neurologic diseases include pain, seizures, dizziness, visual disturbances, weakness, and abnormal sensation.
The document provides information on evaluating patients presenting with dizziness. It discusses the different types of dizziness including vertigo, presyncope, and dysequilibrium. For evaluation, the history should explore the type of dizziness, onset, triggers, and age of the patient. Examination focuses on eye movements, nystagmus, gait, and the HINTS exam. The TiTrATE approach categorizes dizziness syndromes as acute episodic vestibular syndrome, spontaneous acute vestibular syndrome, or chronic vestibular syndrome based on timing and triggers. This helps distinguish dangerous mimics like stroke from more benign causes like BPPV or vestibular migraine.
Neuro examination, pediatric neurologist, dr. amit vatkarDr Amit Vatkar
This document contains information about Dr. Amit Vatkar's credentials and specialization in pediatric neurology. It then provides an overview of topics related to clinical neurology examinations, including the cranial nerves, motor and sensory systems, cerebellar function, gait, and signs of meningism. The document outlines examination techniques and disorders for each topic area. It concludes by thanking the reader and providing Dr. Vatkar's contact information.
This document provides guidance on approaching a pediatric patient with cerebral palsy by outlining what to inspect including positioning, movements, and abnormalities, defines cerebral palsy as a non-progressive brain lesion causing movement and posture disorders, and discusses the types, causes, and multidisciplinary management of cerebral palsy including physiotherapy, medications, and psychosocial support.
This document summarizes guidelines and techniques for examining the upper and lower limbs and cranial nerves during a neurology teaching session. For the upper limb, it describes how to observe patients, inspect for signs, and test tone, power, and reflexes at major joints. It distinguishes between central and peripheral signs. For the lower limb, it outlines how to observe gait and test for upper and lower motor neuron signs. It also describes mixed signs. For cerebellar examination, it details tests for the upper limbs and distinguishes intention tremors from other tremors. For tremor and Parkinson's disease, it describes how to observe and test for tremors, bradykinesia, and rigidity. Finally,
This document discusses consciousness and altered consciousness. It defines consciousness as awareness of thoughts, feelings, perceptions, and surroundings at any given moment in time, which creates our sense of reality. Altered consciousness can be caused by drugs, trauma, sleep, illness, disease, or anesthesia. The document outlines different levels of consciousness like awake, sleep, and dream states. It also discusses tools for assessing consciousness, like the Glasgow Coma Scale, and neurotransmitters that are involved in consciousness like serotonin, norepinephrine, and dopamine.
This document provides information about seizures and epilepsy. It defines what a seizure is, the different types of seizures including absence, tonic-clonic, simple partial and complex partial seizures. It discusses epilepsy as a neurological disorder characterized by recurrent seizures and covers common causes, prevalence, myths and facts. The document outlines appropriate first aid for different seizure types and signs that indicate a medical emergency. It also discusses potential learning impacts and provides tips for supporting students with epilepsy.
Approach to internship (mbbs in bangladesh perspective)Pritom Das
Some slides are taken from different textbooks of medicine like Davidson, Kumar and Clark and Oxford, and some from other presentations made by respected tutors. These resources are free for use, and I do not claim any copyright. Hoping knowledge remains free for all, forever.
This document discusses various types of visual hallucinations and their potential causes. It begins by describing visual hallucinations that can occur in normal people due to perception and expectation. It then discusses differential diagnoses for recurrent complex visual hallucinations, including medications, medical conditions, and neurological disorders. Specific disorders covered in more detail include peduncular hallucinosis, migraine aura, persistent migraine aura, visual snow, occipital lobe epilepsy, posterior cerebral artery ischemia, and Charles Bonnet syndrome.
The diagnostic criteria for schizophrenia have evolved over time to be more clear and reliable for diagnosing the disorder. Originally, there were subtypes described like paranoid, catatonic, and disorganized schizophrenia. The course and prognosis varies, with some having only acute episodes and others experiencing progressive impairment. The etiology of schizophrenia involves both genetic and neurobiological factors. There is evidence that it involves abnormal dopamine and inhibitory interneuron function in the brain. Genetic findings also indicate there is a significant heritable component, though it is not monogenic and involves multiple genetic loci.
This document outlines the components and procedures for performing a neurological examination. It discusses the 7 categories examined which include mental status, cranial nerves, motor system, reflexes, sensory system, coordination, and gait. For each category, it provides details on the specific tests, procedures, and what is evaluated. It examines each of the 12 cranial nerves in-depth, outlining the relevant anatomy and functions tested. It also describes how to evaluate the motor system, reflexes, coordination, gait, and sensory systems. The neurological exam is a comprehensive assessment of the central and peripheral nervous systems.
This document presents a case study of a 35-year-old female complaining of seeing shapes, colors, and partially formed images. Her medical history includes migraines, pituitary tumors, and other conditions. On examination, she has mild disc pallor in both eyes. The document lists potential etiologies for her visual hallucinations including migraine, psychosis, and Charles Bonnet Syndrome. It provides details on visual hallucinations and Charles Bonnet Syndrome. The assessment is that she is experiencing visual deprivation hallucinations due to Charles Bonnet Syndrome. The plan is to consult psychiatry and start her on olanzapine.
The neuroanatomical explanation for schizophreniaRobDan93
The document discusses the neuroanatomical explanation for schizophrenia which suggests that enlarged ventricles in the brain may be linked to the disorder. Several studies have found that schizophrenic patients tend to have larger ventricles compared to non-schizophrenic patients. However, the relationship between enlarged ventricles and schizophrenia is unclear as it is unknown whether enlarged ventricles cause schizophrenia or vice versa. There are also difficulties in determining what truly constitutes ventricle enlargement.
This document provides an overview of the approach to evaluating a patient presenting with headache. It discusses classifying headaches as primary or secondary and identifying red flags that suggest an underlying condition. The evaluation involves taking a thorough history including description of pain, associated symptoms, aggravating/relieving factors, medications, and performing a neurological exam to identify potential causes and guide further investigation or treatment.
Neurological Assessment for nursing students pptblessyjannu21
Prepared by Prof. BLESSY THOMAS, MSc NURSING (NEUROSCIENCE NURSING) Neurological assessment helps us to identify any abnormalities in the nervous system. it includes several assessment techniques. NEUROLOGICAL ASSESSMENT IS A SYSTEM PROCESS THAT INCLUDES A VARIETY OF CLINICAL TESTS, OBSERVATION ANS ASSESSMWNT DESIGNED TO EVALUATE THE COMPLEX SYSTEM. NEUROLOGICAL ASSESSMENT HELPS TO IDENTIFY MAY COMPLES DISEASES EARLY AND ALSO HELPS TO PROVIDE THE TREATMENT WITHOUT DELAY.
This document provides an overview of evaluating and managing a patient presenting with altered sensorium (AS). It defines sensorium and AS, noting that AS has many potential reversible and irreversible causes. The document outlines an approach including initial ABCDE assessment, detailed history, physical exam focusing on neurological assessment using Glasgow Coma Scale, and diagnostic testing to identify structural, metabolic, toxic, infectious, or other causes. Common differential diagnoses are listed. The goal is to recognize immediately life-threatening issues and rapidly reversible causes, and to systematically work through potential causes of AS.
A neurological examination is the assessment of sensory neuron and motor responses, especially reflexes, to determine whether the nervous system is impaired. This typically includes a physical examination and a review of the patient's medical history, but not deeper investigation such as neuroimaging.
An altered mental status or level of consciousness requires determining the underlying cause. The initial approach involves assessing the ABCs, giving supplemental oxygen, checking glucose, and looking for signs of infection, trauma, or drugs. Further evaluation includes detailed history, physical exam focusing on vital signs and neurological status, and diagnostic testing of blood and imaging based on suspected etiologies like metabolic derangements, medications/toxins, infections, and structural brain issues. Treatment is directed at reversing or controlling the specific cause, such as treating seizures, lowering blood pressure in hypertensive encephalopathy, or giving antibiotics for infections.
This document contains guidelines for performing a neurological examination. It begins with an overview of the developmental, psychosocial and cultural factors to consider. It then provides details on assessing various aspects of the neurological exam including mental status, cranial nerves, motor function, sensation and reflexes. Questions are provided to gather relevant history. The document comprehensively covers the steps and
A neurological examination assesses the functioning of the nervous system through physical examination and review of medical history. It involves evaluating levels of consciousness, cranial nerve function, motor skills, sensation, coordination, and reflexes. Abnormal findings may indicate neurological disorders requiring further investigation.
The document provides information on performing a neurologic examination, including:
1) Obtaining a health history to understand the onset and progression of symptoms.
2) Assessing mental status, cranial nerves, motor function, sensory function, and reflexes.
3) Common clinical manifestations of neurologic diseases include pain, seizures, dizziness, visual disturbances, weakness, and abnormal sensation.
The document provides information on evaluating patients presenting with dizziness. It discusses the different types of dizziness including vertigo, presyncope, and dysequilibrium. For evaluation, the history should explore the type of dizziness, onset, triggers, and age of the patient. Examination focuses on eye movements, nystagmus, gait, and the HINTS exam. The TiTrATE approach categorizes dizziness syndromes as acute episodic vestibular syndrome, spontaneous acute vestibular syndrome, or chronic vestibular syndrome based on timing and triggers. This helps distinguish dangerous mimics like stroke from more benign causes like BPPV or vestibular migraine.
Neuro examination, pediatric neurologist, dr. amit vatkarDr Amit Vatkar
This document contains information about Dr. Amit Vatkar's credentials and specialization in pediatric neurology. It then provides an overview of topics related to clinical neurology examinations, including the cranial nerves, motor and sensory systems, cerebellar function, gait, and signs of meningism. The document outlines examination techniques and disorders for each topic area. It concludes by thanking the reader and providing Dr. Vatkar's contact information.
This document provides guidance on approaching a pediatric patient with cerebral palsy by outlining what to inspect including positioning, movements, and abnormalities, defines cerebral palsy as a non-progressive brain lesion causing movement and posture disorders, and discusses the types, causes, and multidisciplinary management of cerebral palsy including physiotherapy, medications, and psychosocial support.
This document summarizes guidelines and techniques for examining the upper and lower limbs and cranial nerves during a neurology teaching session. For the upper limb, it describes how to observe patients, inspect for signs, and test tone, power, and reflexes at major joints. It distinguishes between central and peripheral signs. For the lower limb, it outlines how to observe gait and test for upper and lower motor neuron signs. It also describes mixed signs. For cerebellar examination, it details tests for the upper limbs and distinguishes intention tremors from other tremors. For tremor and Parkinson's disease, it describes how to observe and test for tremors, bradykinesia, and rigidity. Finally,
This document discusses consciousness and altered consciousness. It defines consciousness as awareness of thoughts, feelings, perceptions, and surroundings at any given moment in time, which creates our sense of reality. Altered consciousness can be caused by drugs, trauma, sleep, illness, disease, or anesthesia. The document outlines different levels of consciousness like awake, sleep, and dream states. It also discusses tools for assessing consciousness, like the Glasgow Coma Scale, and neurotransmitters that are involved in consciousness like serotonin, norepinephrine, and dopamine.
This document provides information about seizures and epilepsy. It defines what a seizure is, the different types of seizures including absence, tonic-clonic, simple partial and complex partial seizures. It discusses epilepsy as a neurological disorder characterized by recurrent seizures and covers common causes, prevalence, myths and facts. The document outlines appropriate first aid for different seizure types and signs that indicate a medical emergency. It also discusses potential learning impacts and provides tips for supporting students with epilepsy.
Approach to internship (mbbs in bangladesh perspective)Pritom Das
Some slides are taken from different textbooks of medicine like Davidson, Kumar and Clark and Oxford, and some from other presentations made by respected tutors. These resources are free for use, and I do not claim any copyright. Hoping knowledge remains free for all, forever.
This document discusses various types of visual hallucinations and their potential causes. It begins by describing visual hallucinations that can occur in normal people due to perception and expectation. It then discusses differential diagnoses for recurrent complex visual hallucinations, including medications, medical conditions, and neurological disorders. Specific disorders covered in more detail include peduncular hallucinosis, migraine aura, persistent migraine aura, visual snow, occipital lobe epilepsy, posterior cerebral artery ischemia, and Charles Bonnet syndrome.
The diagnostic criteria for schizophrenia have evolved over time to be more clear and reliable for diagnosing the disorder. Originally, there were subtypes described like paranoid, catatonic, and disorganized schizophrenia. The course and prognosis varies, with some having only acute episodes and others experiencing progressive impairment. The etiology of schizophrenia involves both genetic and neurobiological factors. There is evidence that it involves abnormal dopamine and inhibitory interneuron function in the brain. Genetic findings also indicate there is a significant heritable component, though it is not monogenic and involves multiple genetic loci.
This document outlines the components and procedures for performing a neurological examination. It discusses the 7 categories examined which include mental status, cranial nerves, motor system, reflexes, sensory system, coordination, and gait. For each category, it provides details on the specific tests, procedures, and what is evaluated. It examines each of the 12 cranial nerves in-depth, outlining the relevant anatomy and functions tested. It also describes how to evaluate the motor system, reflexes, coordination, gait, and sensory systems. The neurological exam is a comprehensive assessment of the central and peripheral nervous systems.
This document presents a case study of a 35-year-old female complaining of seeing shapes, colors, and partially formed images. Her medical history includes migraines, pituitary tumors, and other conditions. On examination, she has mild disc pallor in both eyes. The document lists potential etiologies for her visual hallucinations including migraine, psychosis, and Charles Bonnet Syndrome. It provides details on visual hallucinations and Charles Bonnet Syndrome. The assessment is that she is experiencing visual deprivation hallucinations due to Charles Bonnet Syndrome. The plan is to consult psychiatry and start her on olanzapine.
The neuroanatomical explanation for schizophreniaRobDan93
The document discusses the neuroanatomical explanation for schizophrenia which suggests that enlarged ventricles in the brain may be linked to the disorder. Several studies have found that schizophrenic patients tend to have larger ventricles compared to non-schizophrenic patients. However, the relationship between enlarged ventricles and schizophrenia is unclear as it is unknown whether enlarged ventricles cause schizophrenia or vice versa. There are also difficulties in determining what truly constitutes ventricle enlargement.
This document provides an overview of the approach to evaluating a patient presenting with headache. It discusses classifying headaches as primary or secondary and identifying red flags that suggest an underlying condition. The evaluation involves taking a thorough history including description of pain, associated symptoms, aggravating/relieving factors, medications, and performing a neurological exam to identify potential causes and guide further investigation or treatment.
Neurological Assessment for nursing students pptblessyjannu21
Prepared by Prof. BLESSY THOMAS, MSc NURSING (NEUROSCIENCE NURSING) Neurological assessment helps us to identify any abnormalities in the nervous system. it includes several assessment techniques. NEUROLOGICAL ASSESSMENT IS A SYSTEM PROCESS THAT INCLUDES A VARIETY OF CLINICAL TESTS, OBSERVATION ANS ASSESSMWNT DESIGNED TO EVALUATE THE COMPLEX SYSTEM. NEUROLOGICAL ASSESSMENT HELPS TO IDENTIFY MAY COMPLES DISEASES EARLY AND ALSO HELPS TO PROVIDE THE TREATMENT WITHOUT DELAY.
This document provides an overview of evaluating and managing a patient presenting with altered sensorium (AS). It defines sensorium and AS, noting that AS has many potential reversible and irreversible causes. The document outlines an approach including initial ABCDE assessment, detailed history, physical exam focusing on neurological assessment using Glasgow Coma Scale, and diagnostic testing to identify structural, metabolic, toxic, infectious, or other causes. Common differential diagnoses are listed. The goal is to recognize immediately life-threatening issues and rapidly reversible causes, and to systematically work through potential causes of AS.
Mistakes in Epilepsy Care - Orrin Devinsky, MDNYU FACES
The document discusses common mistakes made in epilepsy care, including diagnostic bias, failure to consider mood disorders or how disorders may evolve over time, overreliance on prior diagnoses, and failure to consider quality of life from the patient's perspective rather than just medical factors. It also notes how doctors and patients can be influenced by anecdotes rather than statistics and the importance of humility, open-mindedness, and reassessing risks and benefits over time based on new evidence rather than established viewpoints.
Diagnosis and Management of Special Populations 2010Dominick Maino
Diagnosis and Management of Special Populations presents the latest in the assessment and treatment of those with physical, cognitive, and behavioral abnormalities. Up to date information concerning the etiology, prevalence/incidence and physical/cognitive findings of individuals with developmental/acauired disabilities (Cerebral palsy, Down syndrome, Fragile X syndrome, autism, acquired/traumatic brain injury) will be discussed. New diagnostic and treatment techniques are reviewed. The eye care practitioner will be able to confidently provide eye and vision care for those with disability at the end of this presentation.
Delirium is a disturbance in attention, awareness and cognition that develops over a short period of time and tends to fluctuate. It is common in terminally ill patients, affecting up to 85%. Delirium causes distress for patients and families and conflicts with patient goals of cognitive awareness. It is important to assess for delirium using tools like the Confusion Assessment Method. The first step in managing delirium is to treat any underlying causes, such as infection, dehydration, or medication side effects. Non-pharmacological interventions include reorienting the patient, maintaining their sleep-wake cycle, and engaging family. As a last resort, antipsychotics may be used but they increase the risk of death.
The document provides guidance on evaluating and managing a patient presenting with altered sensorium (AS). It defines sensorium and levels of consciousness. Common causes of AS include metabolic disturbances, infections, trauma, medications, and neurological conditions. The approach involves assessing ABCDE, obtaining history, performing a full physical exam including Glasgow Coma Scale, running diagnostic tests, considering various differential diagnoses, and treating reversible causes. The prognosis depends on the underlying etiology, with metabolic/toxic causes having a better outlook than structural injuries or hypoxia.
This document discusses the evaluation and diagnosis of sensory disturbances. It begins by outlining the basics of neuroanatomy and differentiating between upper and lower motor neuron lesions. Common causes of peripheral neuropathy like diabetes, alcohol use, toxins and vitamins deficiencies are reviewed. Case examples are provided and approaches to investigating further outlined, including blood tests, imaging and electrodiagnostic studies. Specific peripheral neuropathies involving common nerves like median, ulnar and radial are reviewed in terms of typical presentations, locations of injury and treatment approaches.
This document provides guidance on performing a neurological history and examination. It begins with an introduction on the importance of the history and building rapport with the patient. The document then outlines the key components of a neurological history, including personal history, chief complaint, history of present illness, past medical history, and family history. It provides examples of questions to ask within each component. For the physical examination, it describes how to analyze symptoms related to motor function, sensation, coordination, and other neurological domains. It also reviews models for localizing neurological lesions based on their cause, location in the central or peripheral nervous system, and other characteristics. The overall document serves as a reference for neurology trainees on obtaining a thorough neurological history and focused physical examination
The document discusses palliative care and end-of-life management for cancer patients in the terminal phase. It covers key topics like prognosis, communication with patients, common symptoms in the terminal phase, palliative care emergencies and their management, preferred places of care, specific issues related to spinal cord compression and superior vena cava obstruction, and therapeutic interventions in the last days of life. The overall aim is to help patients die with dignity while relieving suffering through careful symptom control and support.
The document discusses palliative care and end-of-life management for cancer patients in the terminal phase. It covers key topics like prognosis, communication with patients, common symptoms in the terminal phase, palliative care emergencies and their management, preferred places of care, specific issues related to different cancers, medication management, and transitioning from specialist to generalist care. The overall aim is to help patients die with dignity while alleviating suffering.
1) The document summarizes dental management considerations for patients with Down syndrome, fetal alcohol syndrome, and cerebral palsy. It describes the characteristic oral findings, clinical features, and etiology of each condition.
2) It provides guidance for treating such patients in dental offices, including moving at a slower pace, using sedation if needed, and prescribing adequate analgesia since patients may not express pain clearly.
3) The document also outlines specific oral health challenges faced by patients with each condition and suggestions for home care, such as using the smallest toothbrush for those with misaligned teeth.
This document discusses various sleep disorders from pediatrics to geriatrics. It provides statistics on common sleep disorders like insomnia, sleep apnea, and narcolepsy. It describes risk factors, symptoms, and potential health consequences of obstructive sleep apnea, including increased risks of diabetes, heart disease, and stroke. The document also discusses screening questionnaires, medical conditions that can contribute to sleep disorders, and various treatment options like tonsillectomy, uvulopalatopharyngoplasty, and somnoplasty procedures.
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.
Delirium is a common and serious condition experienced by up to 85% of terminally ill cancer patients. It causes cognitive impairment, increased hospital stays and costs, worse patient and caregiver outcomes, and conflicts with patient goals of cognitive awareness at the end of life. Delirium has multiple potential causes including medications, metabolic imbalances, infections, and environmental changes. It is reversible in about 50% of cases with treatment of underlying causes and both pharmacological and non-pharmacological interventions. Early recognition and treatment are important for managing delirium and its impacts.
Mr. K, a 71-year-old man, was admitted to the hospital for cellulitis and has become confused, agitated, and somnolent over the past 24 hours. Precipitating factors for his delirium include his recent surgery, medications including antibiotics and painkillers, and his underlying medical conditions of asthma, hypertension, and prostate issues. Delirium is a transient organic mental syndrome characterized by impaired cognition and consciousness that can be caused by multiple predisposing and precipitating medical and environmental factors interacting in complex ways.
History Taking and MMSE 2024.pphghhghghtxSriRam071
The document provides information on history taking and assessments for cognitive impairment. It discusses the process of history taking, including obtaining consent and documenting key personal details. It also describes performing a full history, reviewing systems, and using tools like the MMSE and MoCA to evaluate cognition. The MMSE assesses orientation, registration, attention, recall, language, and copying. Dementia is defined as cognitive decline interfering with daily life. Alzheimer's is the most common cause, and symptoms include memory loss, confusion, and impaired functioning. Diagnosis involves cognitive testing, exams, and brain imaging. Nursing assessments for Alzheimer's patients cover areas like orientation, mood, behaviors, mobility, and continence.
Lively nontechnical discussion of how the gift of music can have positive effects on health and disease. Music as a part of the health care culture is discussed from the prehistoric era to present day
Bell's Palsy is an acute unilateral facial nerve paralysis that presents with weakness or paralysis of the muscles of facial expression. The most common cause is believed to be Herpes simplex virus infection of the facial nerve. Treatment involves oral corticosteroids combined with antiviral therapy if HSV or VZV infection is suspected. Prognosis is generally good, with most patients recovering, but complications can include synkinesis, hemifacial spasm, and gustatory lacrimation.
This document discusses various abnormal facial movements and neurological conditions:
1) Tardive dyskinesia, tics, Tourette's syndrome, hemifacial spasm, craniofacial tremor, oromandibular dystonia, and facial myokymia are summarized along with their characteristic presentations and treatments.
2) Oculomasticatory myorhythmia, a rare symptom of Whipple's disease characterized by eye and jaw muscle contractions, is described in one patient.
3) Faciobrachial dystonic seizures associated with LGI1 encephalitis and "chapeau de gendarme" seen in frontal lobe seizures are also summarized.
Music has been used medicinally for thousands of years across many ancient cultures. The Chinese character for medicine is derived from the character for music. Neurological music therapy is the therapeutic application of music to treat cognitive, sensory, and motor dysfunctions caused by nervous system diseases and injuries. It utilizes techniques grounded in neuroscience research to target non-musical goals. Studies show music can reduce pain, boost learning and memory, benefit brain injury recovery, and improve symptoms of conditions like Alzheimer's, autism, schizophrenia, and depression by influencing brain chemistry and structure.
This document discusses disorders of the hypoglossal nerve, which innervates the tongue muscles. It describes the anatomy of the nerve and its motor function. Lesions of the hypoglossal nerve cause the tongue to deviate to the opposite side due to the dominance of the genioglossus muscle. Various pathologies that can affect the hypoglossal nerve are presented, including medial medullary syndrome, which involves tongue deviation along with other neurological deficits. Tongue fasciculations are also discussed as they can indicate lower motor neuron diseases like ALS. The differential diagnosis and proper technique for recording fasciculations on EMG are outlined.
The document discusses differential diagnosis for Parkinson's disease and similar conditions, noting that Parkinson's is asymmetrical and improves with dopamine replacement, while conditions like multiple system atrophy and progressive supranuclear palsy present with symptoms like early falls, ataxia, and eye movement abnormalities. Imaging tests like DaT scans and MRI can help distinguish between these conditions based on patterns of radiotracer uptake or signs of atrophy in specific brain regions.
A discussion of the neurological and pathophysiological basis of auditory hallucinations including musical hallucinations, tinnitus and psychotic hallucinations.
This document discusses the neurological aspects of music and musicians. It begins by defining musical elements like rhythm, pitch, harmony, and timbre. It then discusses topics like hearing loss in musicians, musician's dystonia, musical hallucinations, synesthesia, amusia, and the benefits of music therapy for conditions like Alzheimer's, Parkinson's, and dementia. It also provides brief biographies of musicians like George Gershwin, Maurice Ravel, Bud Powell, and Charles Mingus who experienced neurological conditions. Finally, it discusses the cognitive and health benefits of music for people in general.
This document discusses eye alignment and extraocular muscles. It describes how telecanthus is associated with several genetic disorders. It then defines the six extraocular muscles and their functions, including the medial and lateral rectus muscles that control adduction and abduction. Mnemonics like "SIN" and "RAD" are presented to help remember the functions of the superior, inferior, and rectus muscles. Convergence is defined as bilateral contraction of the medial rectus muscles along with pupillary constriction and lens accommodation.
1. There are many types of neurological gait disorders that can arise from damage or dysfunction in different parts of the brain or nervous system.
2. Hemiplegic gait results from weakness on one side of the body, like after a stroke, causing the affected leg to drag and circumduct during walking.
3. Parkinsonian gait is slow, stiff, and shuffling, with loss of arm swing and difficulty initiating movement.
This document discusses several forgotten reflex tests including:
- The ciliospinal reflex which evaluates C8-T2 nerve roots and sympathetic outflow.
- The pectoral reflex which assesses C5/6 and C7/8 nerve roots via percussion of the deltopectoral groove. Hyperactivity correlates with cord lesions at C2/C3 and C3/C4.
- The Hoffman reflex which assesses the C8-T1 reflex arc and is an upper motor neuron sign.
- The superficial abdominal cutaneous reflex which evaluates T8-T12 nerve roots with loss indicating a loss of reflex arc.
- The mesial hamstring reflex which
This document discusses various types of central nystagmus and vertigo, including their distinguishing characteristics and potential causes. Central positional vertigo can be caused by lesions in the cerebellum. Direction changing nystagmus suggests a problem holding gaze due to cerebellar or brainstem issues. Upbeating or downbeating vertical nystagmus localize to specific areas of the cerebellum or brainstem. Internuclear ophthalmoplegia is associated with multiple sclerosis. Rebound nystagmus indicates brainstem or cerebellar disease.
This document discusses Tolosa-Hunt syndrome, which causes painful ophthalmoparesis. It presents the typical symptoms, which include severe retro-orbital or periorbital pain of acute onset followed by diplopia from ophthalmoparesis. MRI with contrast and labs are used to diagnose, while steroids are the primary treatment, often providing substantial pain relief within 72 hours. The document outlines criteria to distinguish Tolosa-Hunt syndrome from other potential causes of painful ophthalmoparesis and when steroid treatment is not effective.
This document discusses Tolosa-Hunt syndrome, which causes painful ophthalmoparesis. It presents the typical symptoms, which include severe retro-orbital or periorbital pain of acute onset followed by diplopia from ophthalmoparesis. MRI with contrast and labs are used to diagnose, while steroids are the primary treatment, with pain relief usually within 72 hours. The document outlines criteria to distinguish Tolosa-Hunt syndrome from other causes of painful ophthalmoparesis and conditions that should raise concern if not responding to steroids.
Nutritional deficiency Disorder are problems in india.
It is very important to learn about Indian child's nutritional parameters as well the Disease related to alteration in their Nutrition.
- Video recording of this lecture in English language: https://youtu.be/RvdYsTzgQq8
- Video recording of this lecture in Arabic language: https://youtu.be/ECILGWtgZko
- 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
Discover the benefits of homeopathic medicine for irregular periods with our guide on 5 common remedies. Learn how these natural treatments can help regulate menstrual cycles and improve overall menstrual health.
Visit Us: https://drdeepikashomeopathy.com/service/irregular-periods-treatment/
Allopurinol, a uric acid synthesis inhibitor acts by inhibiting Xanthine oxidase competitively as well as non- competitively, Whereas Oxypurinol is a non-competitive inhibitor of xanthine oxidase.
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
“Environmental sanitation means the art and science of applying sanitary, biological and physical science principles and knowledge to improve and control the environment therein for the protection of the health and welfare of the public”.The overall importance of sanitation are to provide a healthy living environment for everyone, to protect the natural resources (such as surface water, groundwater, soil ), and to provide safety, security and dignity for people when they defecate or urinate .Sanitation refers to public health conditions such as drinking clean water, sewage treatment, etc. All the effective tools and actions that help in keeping the environment clean come under sanitation. Sanitation refers to public health conditions such as drinking clean water, sewage treatment. All the effective tools and actions that help in keeping the environment clean and promotes public health is the necessary in todays life.
Storyboard on Skin- Innovative Learning (M-pharm) 2nd sem. (Cosmetics)MuskanShingari
Skin is the largest organ of the human body, serving crucial functions that include protection, sensation, regulation, and synthesis. Structurally, it consists of three main layers: the epidermis, dermis, and hypodermis (subcutaneous layer).
1. **Epidermis**: The outermost layer primarily composed of epithelial cells called keratinocytes. It provides a protective barrier against environmental factors, pathogens, and UV radiation.
2. **Dermis**: Located beneath the epidermis, the dermis contains connective tissue, blood vessels, hair follicles, and sweat glands. It plays a vital role in supporting and nourishing the epidermis, regulating body temperature, and housing sensory receptors for touch, pressure, temperature, and pain.
3. **Hypodermis**: Also known as the subcutaneous layer, it consists of fat and connective tissue that anchors the skin to underlying structures like muscles and bones. It provides insulation, cushioning, and energy storage.
Skin performs essential functions such as regulating body temperature through sweat production and blood flow control, synthesizing vitamin D when exposed to sunlight, and serving as a sensory interface with the external environment.
Maintaining skin health is crucial for overall well-being, involving proper hygiene, hydration, protection from sun exposure, and avoiding harmful substances. Skin conditions and diseases range from minor irritations to chronic disorders, emphasizing the importance of regular care and medical attention when needed.
Giloy in Ayurveda - Classical Categorization and SynonymsPlanet Ayurveda
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.
This presentation gives information on the pharmacology of Prostaglandins, Thromboxanes and Leukotrienes i.e. Eicosanoids. Eicosanoids are signaling molecules derived from polyunsaturated fatty acids like arachidonic acid. They are involved in complex control over inflammation, immunity, and the central nervous system. Eicosanoids are synthesized through the enzymatic oxidation of fatty acids by cyclooxygenase and lipoxygenase enzymes. They have short half-lives and act locally through autocrine and paracrine signaling.
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
1. REFINING THE NEUROLOGICAL
HISTORY
There is still much GLORY in the STORY
Randy M. Rosenberg, MD FAAN FACP
Clinical Assistant Professor of Neurology
Temple University School of Medicine
Randy M. Rosenberg, MD FAAN FACP
Clinical Assistant Professor of Neurology
Temple University School of Medicine
2. Sir William Osler
1849-1919
1872 MD Degree from
Magill and later Professor
of Medicine
1884 Chairman of Clinical
Medicine University of
Pennsylvania
1888 Professor and Chief
of Medicine Johns Hopkins
1905 Regius Chair of
Medicine Oxford University
3. Quotable Sir William Osler
"If you listen carefully to the patient they will tell you the
diagnosis“
"Variability is the law of life, and as no two faces are the
same, so no two bodies are alike, and no two individuals
react alike and behave alike under the abnormal
conditions which we know as disease.“
“Observe, record, tabulate, communicate. Use your five
senses. Learn to see, learn to hear, learn to feel, learn
to smell, and know that by practice alone you can
become expert.”
6. What Is The Inherant Distinction Of The
Neurological History?
The neurological history should be a focused, goal
directed exercise that answers the following questions:
Where in the nervous system is the lesion?
What is the pathological process (e.g. inflammatory,
vascular, infectious)?
Is this a purely neurological problem or a neurological
manifestation of a systemic disease?
7. Why Is the Neurological History Still Relevant?
• Safest and most cost effective
DIAGNOSTIC MODALITY available
• The most direct method to cultivate trust
and a sound doctor-patient relationship
• For some people there is a very thin line
between the laying of hands and assault and
battery.
• False negative MRI or “When all else
fails take a history!”
• Safest and most cost effective
DIAGNOSTIC MODALITY available
• The most direct method to cultivate trust
and a sound doctor-patient relationship
• For some people there is a very thin line
between the laying of hands and assault and
battery.
• False negative MRI or “When all else
fails take a history!”
9. NONSENSE DIAGNOSIS (MOST OF THE TIME)
Change in Mental Status
Drowsiness, hunger and rage are all changes in
mental status too!
10. NONSENSE DIAGNOSIS (MOST OF THE TIME)
Change in Mental Status
Syncope
Temporary loss of consciousness with interruption of awareness of
oneself and one’s surroundings
OFTEN INCORRECT HALF BECAUSE OF FAILURE TO TAKE A
HISTORY.
Rarely a justification for CT in the ER
Less than 4% of studies provide new information
Age greater than 65, anticoagulation, significant head trauma, accompanying
symptoms of headache or other focal neurological complaints change the
paradigm
If someone has fallen, this does NOT mean that they have lost
consciousness
11. NONSENSE DIAGNOSIS (MOST OF THE TIME)
Change in Mental Status
Syncope
TIA R/O CVA
Confuses the history (conclusion vs impression)
Are we talking about a clinical, radiological or patholophysiological diagnosis of
ischemia?
50% of TIAs are acute strokes on MRI
False negative MRI scans
In patient with lacunes or small brainstem strokes, initial MRI DWI will be negative in 25% of
cases especially with NIH score < 4 and stroke age <3 days
In an age of observational units, the honest consultant is deprived an appropriate payment
for service
12. KILLER WORDS
DIZZINESS
SLURRED SPEECH
BLURRED VISION
NUMBNESS
All of these symptoms are invisible BUT just like love, loyalty
and patriotism, they all exist.
The patient knows exactly what they are talking about
(even if you may not)
13. DIZZINESS
Spinning
Fast or Slow rotation
Fast-usually labyrinthian or vestibular
Slower-may be central
Often with a sense of “rocking boat”
Positional
Lightheaded or fainting
Orthostatic?
Hyperventilation?
Hypotension?
“Are you dizzy in your head or in your feet?”
14. Three Most Common Causes Of Dizziness
Hemodynamic
Hyperventilation may =
sighing
Positional Vertigo
15. NUMBNESS
Often used interchangeably by the patient for
weakness
Paresthesias = pins and needles
Dysthesias=unpleasant or unnatural sensation
Anesthesia=no feeling
Remember to get the zip code right
(anatomical localization)
Diagrams of radicular and cutaneous innvervation
Load on jump drive
17. “SLURRED SPEECH”: DEFINITIONS
Problem with articulation or pronouciation (dysarthria)
Problem with language or word finding (aphasia)
Problem with vocal quality (dysphonia or hypophonia)
Problem of fluency (stutters, stammers, bradyphrenia
tachyphemia)
Mumbled speech is not an expressive aphasia
Patient with profound facial weakness with dense
hemiplegia may have lost the capacity to articulate
but is not aphasic
18. Slurred Speech: Hints to Localization
Slow speech
?Aphasia == Dominant hemisphere?
?Bradyphrenia == Global, diffuse subcortical,
extrapyramidal or psychiatric disease
Difficult putting words together
Impaired attention == Global dysfunction
Lesions in the prefrontal cortex
Parietal lesions
Psychiatric disease
19. Slurred Speech: Hints To Localization
Conversational repetition
Impaired attention=short term memory
impairment
Mesial temporal, thalamic or mammillary body
pathology
Abnormalities in articulation or pronunciation
Lesions of the corticobulbar tract
Brainstem motor nuclei, cranial nerves,
cerebellum, basal ganglion or vocal cords
Disorders of arousal and/or wakefulness
20. BLURRED VISION
Most difficult aspect of the history
Ask instead:
Double vision?
See something that shouldn’t be there?
Typically of migraine such as scotoma
Is something missing in your vision?
Field cut
Remember that a field cut is usually sensed by the patient
as being in one eye
Speed of onset
Stroke is sudden and dark
Migraine is wavelike in onset and resolution and
usually bright
21. FIRST AND LAST WORD ABOUT TPA
“When was the patient last seen in their normal state?”
Most important piece of history
Must be documented, especially if the decision is made
NOT to give thrombolytics
Just to have TPA brought up increases the risk of litigation
Victory for the plaintiff in such cases is almost always for
FAILURE to give TPA
Defendants (ER/neurology/hospital) still prevail the majority
of the time
22. Helpful Hints To Avoid Polarizing The Interview
“Brute force approach”
How much do you drink, Mr.
Brown?
Do you know where you are,
Mr. Brown?
Do you know why they
brought you here?
“Blame it on the otherguy”
approach
Is a cocktail or a beer
something you enjoy
regularly, Mr. Brown?
Did anyone have a chance to
tell you the name of this
place? Well, anyone can get
mixed up in here.
Are they treating you well
here? What are they doing for
you?
23. In Conclusion…
There are no coincidences in
neurology….EVER! Multiple events
in a single patient occur for a
reason. If you can figure out the
relationships, you can make the
diagnosis.
Randy M Rosenberg, MD
There are no coincidences in
neurology….EVER! Multiple events
in a single patient occur for a
reason. If you can figure out the
relationships, you can make the
diagnosis.
Randy M Rosenberg, MD
Neurologists only have to worry about two
things…what the patient really has and what
will kill the patient tonight.
Arnold Bank, MD
Neurologists only have to worry about two
things…what the patient really has and what
will kill the patient tonight.
Arnold Bank, MD
Every patient you see is a lesson in much
more than the malady from which he
suffers.
The good physician treats the disease; the
great physician treats the patient who has
the disease
William Osler MD
Every patient you see is a lesson in much
more than the malady from which he
suffers.
The good physician treats the disease; the
great physician treats the patient who has
the disease
William Osler MD