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NEUROLOGY

NEUROLOGY. THE Complete Neurologic Exam Screening Exam 1-for mental status 2- for cranial nerves 3- for motor and coordination 4- for sensation . Imaging Basics 1-Computed tomography 2-Magnetic resonance imaging 3-Contrast. Lumbar Puncture Results CSF profiles. Delirium and Dementia

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NEUROLOGY

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  1. NEUROLOGY

  2. THE Complete Neurologic ExamScreening Exam1-for mental status2- for cranial nerves3- for motor and coordination4- for sensation

  3. Imaging Basics 1-Computed tomography 2-Magnetic resonance imaging 3-Contrast

  4. Lumbar Puncture ResultsCSF profiles

  5. Delirium and Dementia • 1-Delirium vs dementia • 2- Common and treatable causes of delirium • 3- Wernicke’s encephalopathy • 4-Delirium tremens • 5-Alzheimer’s disease

  6. Headache • 1- Migraine • 2-Cluster • 3-Tension • 4-Subarachnoid hemorrhage • 5-Temporal arteritis • 6-Intracranial tumor • 7-Subdural hematoma

  7. Infections1-Meningitis :bacterial and viral2-HIV infection( both primary and opportunistic)3- Encephalitis and cerebral abscess4- Polio and postpolio syndrome

  8. Intracranial Hemorrhages1-Subarachnoid 2-Epidural hematoma3-Subdural4-Intraparenchymal

  9. Intracranial brain tumors1-Primary brain tumors2-Metastatic brain tumors3- Presentation of brain tumors4- Tumors in children and adults

  10. Low back pain , Spinal cord injuries1-Cord lesions, cord compression, and common myelopathies2-Differential diagnosis, workup and protocol3-Cervical spine injury

  11. Movement Disorders1-Parkinson’s disease2-Huntington’s disease3-Multiple sclerosis4- Wilson’s disease

  12. Seizures1-Partial2-Generalized3-Absence(petit mal)4 –Tonic-clonic (grand mal)5- Status epilepticus

  13. STROKE1- Clinical features2-Risk factors and preventive and management

  14. Weakness 1- upper motor neuron vs lower motor neuron weakness2- Carpal tunnel syndrome3- Guillain-Barre Syndrome4- Myasthenia gravis

  15. The Complete Neurologic ExamScreening exam for mental status:1- Level of consciousness :a- Alertnessb-orientationc-Response to voiced-Response to pain

  16. 2-Attention3- Languagea- comprehension of spoken wordb- comprehension of written wordc- Repetition of phrasesd-Fluency of speeche-Naming

  17. Concentration :ability to maintain focus

  18. Memory 1-Registration2-Short term3- Long term

  19. Higher cognitive functiona- fund of knowledgeb- calculationc- Abstractionsd- constructions

  20. Screening exam for cranial nerves12 Cranial nerves :I smellII Visual acuity,visual fiels and ocular fundiII,III pupillary reactionsIII,IV,VI Extraocular movementsV Corneal reflexes , facial sensation and jaw movementsVII Facial movementsVIII HearingIX,X Swallowing and rise of the palate,gag reflexV,VII,X,XII voice and neck movementsXI Shoulder and neck movementsXII Tongue symmetry and position

  21. Exam for motor • Muscle strength is graded on a 0 to 5 scale • 0 no muscular contraction detected • 1 a barely detectable flicker or trace of contraction • 3 Active movement of the body part with gravity eliminated • 4 Active movement against gravity some resistance • 5 Active movement against full resistance without evident fatigue .This is normal muscle strength

  22. Screen Exam for sensation • To evaluate the sensory system you will test several kinds of sensation. • Pain and temperature • Position and vibration • Light touch • Discriminative sensations

  23. D • Deep Tendon Reflexes • Reflexes are usually graded on a 0 to 4+: • 4+ Very brisk ,hyperactive ,with clonus • 3+Brisker than average • 2+ Average , normal • 1+ Somewhat diminished, low normal • 0 no response

  24. Imaging Basics • 2 Modalities used most in neurology • CT and MRI • Computed Tomography is far more useful than MRI in the following: • Suspected skull fractures • Suspected intracranial bleeds • Trauma • Monitoring hydrocephalus

  25. Delirium and Dementia • Delirium: • acute change in mental status affecting: • Attention, concentration ,orientation and perception • Course is waxing and waning

  26. Causes of delirium :MOVE STUPID • Metabolic • Oxygen • Vascular • Endrocrine/electrolytes • Seizures • Tumor/trauma/temperature • Uremia • Psychogenic • Infection/intoxication • Drugs

  27. Dementia Delirium • Memory loss Fluctuating orientation • Normal loa stupor or agitation • Slow course rapid course • Irreversible reversible

  28. Dementia • 5 A’s of dementia: • Amnesia, aphasia, agnosia, apraxia, abstract thought disturbances. • Causes of dementia:DEMENTIAS • Degenerative diseases(Parkinson’s Huntington’s , Lewy body) • Endocrine (thyroid, parathyroid, pituitary-adrenal axis) • Metabolic ( ETOH, B12, renal, wilson’s disease • Exogenous (heavy metals, CO • Neoplasm • Trauma (subdural hematoma) • Infections (meningitis, syphilis, HIV ,Lyme disease) • Affective disorders (pseudo-dementia ) • Strokes • ‘

  29. Alzheimer’s disease • Most common cause of dementia • Pathology :neurofibrillary tangles, neuritic plaques with amyloid deposition. • Amnesia is the first sign • Treatment :donepezil

  30. Headache • Characteristics • 3 categories (migraine,tension,and cluster)

  31. Migraine • Begin before age 30 • More common in women • Strong family component • Precipitated by some foods(chocolate,caffeine) stress, menses, oral contraceptive use, bright light

  32. Signs and symptoms • Throbbing • Unilateral • Nausea and vomiting • Photophobia • Noise sensitivity

  33. . • How to differentiate classic migraine from common migraine? • Classic migraine are preceded by a visual aura

  34. Work up : • CT with contrast or MRI

  35. Treatment : • Abortive and prophylactic • Abortive therapy includes: • Sumatriptan • 5HT1 agonist • NSAIDs

  36. Prophylaxis • Beta blocker (propranolol) • calcium-channel blockers(verapamil) • Amitriptyline • Valproic acid

  37. Cluster headache 1 more frequent in men 2 brief , severe,unilateral and periorbital 3 last 30 min to 3 hrs 4 affecting the same part of the head 5 associated sx : ipsilateral tearing of the eye and conjunctival injection

  38. o No workup is necessary Treatment 1 Sumatriptan 2 100% oxygen Prophylaxis

  39. Tension Headache • Dx of exclusion • Tight, bandlike pain exacerbated by noise stress,fatigue • Most intense in the occipital or neck region

  40. Treatment : Relaxation , massage, hot baths,exercise NSAIDs

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