Neurology examination (basic fundamental)

Student, house officer, medical officer hates the most ! neurology system. Coz, no particular song lyrics to sing ! all other system got same chores to sing.-Inspection, palpation, percussion and auscultation.

To me, neurology famous song would be look and proceed + investigator.
The rule no 1- when ask to look at the face, please do look for upper and lower limb grossly also ! This is what i called LOOK thoroughtLY !

Rule no 2-Pretend yourself as a wireman,
rule of thumb - for neuro, first ,level of lesion-brain, cerebellum, brain stem, spinal cord, anterior horn , peripheral nerve or muscle.
After that second question- left or right brain or level of lesion
lAST-cause of the lesion
Then bingo- You are PASSED.

rule no 3- don't panic- apply for all

Rule no 4- common thing come first-apply for ALL physical examination.

Rule no 5- use your rule no2 rule then give the diagnosis with statement like this is a 40 year old (middle-aged) gentleman with left hemiparesis which is due to right cerebral infarct. etc..
Bingo, you are passed then just answer all the question.......to get better marks.


Good luck, the next will be cranial nerve. If you like the blog, pls do CLICK on google ads on top or side to show APPreciation! Your appreciation is my best inspiration!

cognition after carotid endarterectomy or stenting

A neurology 77 published a interesting report regarding the topic above.
divided in 2 arms -one for CEA ( carotid endarterectomy) , another CAS (carotid artery stenting)
the NIHSS (NIH stroke scale) assessed at baseline and 1 daY postprocedure. Modifie RANKIN SCALE at baseline, 1 and 6 month. Cognition assessed in the week before procedure and 6 months later.Pt also assessed for mood using Beck depression inventory II.
MRI with DWI performed 1 to 3 days before and 3 days thereafter to assessnew ischemic lesion.]

Result:significant decrease in cogntion sumscore after CAS from baseline to 6 month
NO significant decrease score after CEA.
The mean difference between changes was not statistically significant.
the worst cogntion functioning inpt treated with CAS consistent with higher rate NEW ischemic DWI lesion after CAS

Peripheral neuropathy

Peripheral neuropathy or polyneuropathy-diffuse peripheral lesion, often symmetrical
Onset-
Childhood-CMT
Adult-diabetes
Older adult- paraproteinemia
Acute onset-AIDP, porphyria, toxic, vasculitis,tick paralysis, diphtheria
Chronic-B 12 def, paraproteinemia, diabetes.
Symptom-
Motor-distal weakness predominates.
Sensory-tingling (positive), numbness (negative)
Autonomic-orthostatic lightheadedness, gastroparesis, sweating abnormalities
Diff diagnosis by pattern
Pattern 1 : symmetrical ,prox and distal weakness + sensory loss
CIDP, vasculitis
Pattern 2 : symmetrical distal weakness +sensory loss
DM, drug and toxin, hereditary neuropathies, amyloidosis , paraproteinemia
Pattern 3: Asymmertical distal weakness and numbness
Infectious neurpathy, multifocal trauma, entrapment, vasculitic
Pattern 4: asymmetrical distal or prox weakness without sensory loss
Multifocal motor neuropathy, motor neuron disease, inclusion body myolitis
Pattern 5: asymmetric prox and distal weakness with sensory loss
Malignant infiltration, polyradiculopathy, HNPP
Pattern 6: symmetric small fibre sensory neuropathy without weakness
DM, amyloid, HIV
Pattern 7 marked proprioception loss
HIV, B6 toxicity, sjogren, paraneoplastic
Pattern 8: Neuropathywith cranial nerve involve
HIV,lyme, AIDP, sarcoidosis, malignant infiltration,antiGd1b neuropathy
Acute neuropathies
Guillain barre
Vasculitic neuropathic
Acute intermittent porphyria
Diphteria
Heavy metal
Tick paralysis
Chronic:
Mononeuropathic –trauma entrapment’
Multiple mononeuropathic- vasculitic
Polyarteritis nodosa
Sjogren
Wegener grnulomatosis
HNPP
Multifocal motor neuropathic
Polyneuropathic
DM,
Nutritional eg B12, B6, B1 def ,
Alcoholic
CIDP
Paraneoplstic
Paraproteinemia
Infectious-HIV, CMV, lyme, leprosy
Sarcoid
Metabolic- renal, hepatic or hypothyroid
Heavy metal- arsenic, lead, mercury
Drug- vincristine, flagyl, sisplatin , amiodarone,

Guillain Barre syndrome

Guillain Barre syndrome Also called as acute infective demyeliting polyradiculoneuropathy (AIDP)
Got few variant Include AIDP, AMAN (acute motor axonal neuropathy) ,AMSAN(acute motor sensory axonal neuropathy) ,acute ataxia and opthalnmoplagia (Fischer syndrome)
Presentation: acute onset paresthesia in distal upper and lower limb
Afebrile
After recovering from viral attack (such as diarrhea or URTI)
Absence of reflex
May got vent failure (1/3 pts)
Diagnosis:L electrodiagnostic, AIDP-demyelinating picture
CSF-albuminocytologic dissociation (increased protein without pleocytosis)
Management: Vent support if vital capacity < 15ml/kg
IV immunoglobulin or plasmaphresis