NEUROLOGY

THE Complete Neurologic ExamScreening Exam

1-for mental status2- for cranial nerves

3- for motor and coordination4- for sensation

Imaging Basics1-Computed tomography

2-Magnetic resonance imaging3-Contrast

Lumbar Puncture ResultsCSF profiles

• 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

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

Infections1-Meningitis :bacterial and viral

2-HIV infection( both primary and opportunistic)

3- Encephalitis and cerebral abscess

4- Polio and postpolio syndrome

Intracranial Hemorrhages1-Subarachnoid

2-Epidural hematoma3-Subdural

4-Intraparenchymal

Intracranial brain tumors1-Primary brain tumors

2-Metastatic brain tumors3- Presentation of brain tumors4- Tumors in children and adults

Low back pain , Spinal cord injuries

1-Cord lesions, cord compression, and common

myelopathies2-Differential diagnosis, workup

and protocol3-Cervical spine injury

Movement Disorders1-Parkinson’s disease2-Huntington’s disease

3-Multiple sclerosis4- Wilson’s disease

Seizures1-Partial

2-Generalized3-Absence(petit mal)

4 –Tonic-clonic (grand mal)5- Status epilepticus

STROKE1- Clinical features

2-Risk factors and preventive and management

Weakness 1- upper motor neuron vs lower

motor neuron weakness2- Carpal tunnel syndrome3- Guillain-Barre Syndrome

4- Myasthenia gravis

The Complete Neurologic ExamScreening exam for mental

status:1- Level of consciousness :

a- Alertnessb-orientation

c-Response to voiced-Response to pain

2-Attention3- Language

a- comprehension of spoken word

b- comprehension of written wordc- Repetition of phrases

d-Fluency of speeche-Naming

Concentration :ability to maintain focus

Memory 1-Registration2-Short term3- Long term

Higher cognitive functiona- fund of knowledge

b- calculationc- Abstractionsd- constructions

Screening exam for cranial nerves

12 Cranial nerves :I smell

II Visual acuity,visual fiels and ocular fundi

II,III pupillary reactions

III,IV,VI Extraocular movementsV Corneal reflexes , facial

sensation and jaw movementsVII Facial movements

VIII 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

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

• 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

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

• 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

• Delirium and Dementia• Delirium:• acute change in mental status affecting:• Attention, concentration ,orientation and

perception• Course is waxing and waning

•

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

• Dementia Delirium

• Memory loss Fluctuating orientation

• Normal loa stupor or agitation

• Slow course rapid course

• Irreversible reversible

• 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

• ‘

• Alzheimer’s disease

• Most common cause of dementia

• Pathology :neurofibrillary tangles, neuritic plaques with amyloid deposition.

• Amnesia is the first sign

• Treatment :donepezil

• Headache

• Characteristics

• 3 categories (migraine,tension,and cluster)

• 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

• Signs and symptoms

• Throbbing

• Unilateral

• Nausea and vomiting

• Photophobia

• Noise sensitivity

.

• How to differentiate classic migraine from common migraine?

• Classic migraine are preceded by a visual aura

• Work up :

• CT with contrast or MRI

• Treatment :

• Abortive and prophylactic

• Abortive therapy includes:

• Sumatriptan

• 5HT1 agonist

• NSAIDs

• Prophylaxis

• Beta blocker (propranolol)

• calcium-channel blockers(verapamil)

• Amitriptyline

• Valproic acid

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

o

No workup is necessaryTreatment

1 Sumatriptan2 100% oxygen

Prophylaxis

• Tension Headache

• Dx of exclusion

• Tight, bandlike pain exacerbated by noise stress,fatigue

• Most intense in the occipital or neck region

• Treatment :

• Relaxation , massage, hot baths,exercise

• NSAIDs