NEUROLOGICAL DIAGNOSIS

5.0(2)
studied byStudied by 3 people
learnLearn
examPractice Test
spaced repetitionSpaced Repetition
heart puzzleMatch
flashcardsFlashcards
Card Sorting

1/42

encourage image

There's no tags or description

Looks like no tags are added yet.

Study Analytics
Name
Mastery
Learn
Test
Matching
Spaced

No study sessions yet.

43 Terms

1
New cards

NEUROLOGICAL DIAGNOSIS

  • _______ (80%)

  • _________ (15%)

  • ________(5%)

    • For confirmation of neurologic diagnosis

History (80%)

Physical & Neurological Examination (15%)

Ancillary Procedure (5%)

2
New cards

DIAGNOSIS OF NEUROLOGIC DISORDERS

This comprise the most meaningful information of the initial (and often subsequent) steps of clinical diagnostic reasoning, informing the diagnostic workup, and treatment plans

history and physical examination

3
New cards

HISTORY TAKING IN NEUROLOGY

  • Chief Complaint

  • Present Illness

  • Past History

    • Prenatal

    • Perinatal

    • Neonatal

  • Medical History

    • Immunizations

  • After COVID vaccination, pt had stroke, myasthenia gravis, parkinson’s worsened, memory problems (worsened), etc

  • Illnesses

  • Operations

  • Injuries

  • Family History

  • Social History

  • Review of Systems

  • to determine if there are correlations with the present condition

  • Growth and Development

    • Psychomotor

    • Habits

    • Educational

  • Nutrition

  • Behavioral History

  • Habits 

4
New cards

3 QS TO ASK

  1. Is there a neurological problem?

    • may be one or all three questions are (+) 

    • Focal neurologic deficits

      • Are there s/sx?

      • Check based on history, subjective & objective data gathered

    • Increased intracranial pressure

      • Positive? Do we see any evidence?

    • Signs of meningeal irritation

  1. Where is the neurological problem?

    • Levelize

    • Lateralize

    • Localize

  2. What is the neurological problem?

5
New cards

COMMON SYMPTOMS OF NEUROLOGICAL LESIONS

  • Alteration in the level of consciousness

  • Aphasia, Apraxia, Agnosia

    • _______: language difficulty

    • _______: difficulty performing tasks

    • _______: loss of ability to recognize objects

  • Changes in memory, syncope, seizures

    • _______: transient loss of consciousness

    • ______: abnormal electrical change in the brain

  • Alteration in the level of consciousness

  • Aphasia, Apraxia, Agnosia

    • Aphasia: language difficulty

    • Apraxia: difficulty performing tasks

    • Agnosia: loss of ability to recognize objects

  • Changes in memory, syncope, seizures

    • Syncope: transient loss of consciousness

    • Seizures: abnormal electrical change in the brain

6
New cards

COMMON SYMPTOMS OF NEUROLOGICAL LESIONS

  • Sensory changes

  • Dizziness

  • Hearing loss

    • May be a problem with the temporal lobe (Heschl's gyrus) or tympanic membrane

  • Impaired vision

  • Headaches

  • Involuntary movements

  • Muscle weakness

  • Gait disorders

7
New cards

IS THERE A NEUROLOGICAL PROBLEM?

  • Meningeal irritation

    • The classic triad of meningitis is _____________

  • ______ intracranial pressure

  • Focal neurologic deficits 

  • fever, headache, and meningismus

  • Increased

8
New cards

I. MENINGEAL IRRITATION

  • Headache/vomiting with:

    • ______ : stiff neck, meningismus

    • _______: (+) when passive flexion of the neck results in spontaneous flexion of the hips and knees

    • ________: (+) Passive extension of the leg elicits pain

      • Thigh and knee flexed → (+) Passive extension of the leg elicits pain

  • Nuchal rigidity

  • Brudzinski sign

  • Kernig Sign

9
New cards

I. MENINGEAL IRRITATION

  • Patients with bacterial meningitis have either a fulminant illness that develops over a matter of hours or a subacute illness that progresses over 24 to 72 hours

  • The patient’s level of consciousness may become progressively worse over a short period of time

  • As the disease progresses, and the complications of seizures, increased intracranial pressure, and cerebral ischemia and intracerebral hemorrhage occur, the patient’s level of consciousness evolves from lethargy to stupor to obtundation

10
New cards

II. INCREASED INTRACRANIAL PRESSURE

  • 3 signs→ ___________ (HPV)

  • Crushing Triad is? ( IB DPR)

  • Headache ,Vomiting , Papilledema

  • INC BP, DEC PULSE,DEC RESPIRATION

11
New cards

II. INCREASED INTRACRANIAL PRESSURE

  • Headache/vomiting with

    • ___________

      • optic nerve is not well defined and optic disc is not delineated

      • typically bilateral, due to elevated intracranial pressure (ICP)

      • Can be a diagnostic clue to underlying secondary cause of high ICP such as brain tumor or venous sinus thrombosis

      • Can develop in the absence of subjective or objective vision loss and in the absence of other signs of high ICP such as headache.

Papilledema

<p>Papilledema</p>
12
New cards

II. INCREASED INTRACRANIAL PRESSURE

  • Headache/vomiting with

    • _______

      • Eye is medially deviated

      • Double vision (CN 4 & 6)

      • Diplopia d/t inc. ICP – CN 6 palsy

      • Lateral rectus palsy secondary to Abducens nerve lesion

      • Initial stage: _____ affected

      • Later stage: _____ affected

Diplopia with internal squint

  • initial → one eye affected

  • later → both eyes affected

13
New cards

II. INCREASED INTRACRANIAL PRESSURE

  • Headache/vomiting with

    • Deterioration in __________

      • Leads to comatose state of patient

      • Arousal system is compromised

      • Wakefulness and awareness of self and environment

      • CONSCIOUS COMA

Deterioration in the level of consciousness

14
New cards

II. INCREASED INTRACRANIAL PRESSURE

  • Headache/vomiting with

    • Bulging fontanel (tense), separation of sutures, rapid enlarging head size ( Pediatric)

      • ______ fontanelle – hungry

      • _____ fontanelle – INC. ICP

  • Depressed fontanelle

  • Bulging fontanelle

15
New cards

III. FOCAL NEUROLOGIC DEFICITS

  • Weakness

  • Sensory deficits

  • Cranial nerve deficits

  • Disturbance in higher intellectual functions eg: Memory impairment, Emotional & behavioral changes (organic), Language disturbance, & Seizure

  • Sensory impairment in trunk & extremities

CONT →

16
New cards

III. FOCAL NEUROLOGIC DEFICITS

  • Cranial nerve deficits eg: diplopia, dysphagia, dysarthria, facial numbness, & sensory impairment

    • _______ – Swallowing problems

    • _____ – Speech articulation

  • Weakness or paralysis of extremities

    • Weakness – _______ tract affected

    • 1st neuron: _____ 

    • 2nd neuron: Short interneuron w/ anterior horn cell

    • 3rd neuron: anterior horn cell, peripheral nerve, myoneural junction 

  • Cranial nerve deficits eg: diplopia, dysphagia, dysarthria, facial numbness, & sensory impairment

    • Dysphagia – Swallowing problems

    • Dysarthria – Speech articulation

  • Weakness or paralysis of extremities

    • Weakness – corticospinal tract affected

    • 1st neuron: UMN 

    • 2nd neuron: Short interneuron w/ anterior horn cell

    • 3rd neuron: anterior horn cell, peripheral nerve, myoneural junction 

17
New cards

III. FOCAL NEUROLOGIC DEFICITS

  • Incoordination, poor equilibrium

    • Cerebellar symptoms

    • 2 hemispheres: ___ control 

      • Problem with coordination 

      • Tests: _______

    • Vermis 

      • Controls ___ 

        • Truncal ataxia 

        • Gait ataxia 

        • Wide BOS

        • Leaning to the lesion

    • Intention tremor 

  • Reflex asymmetry, pathological reflexes (+ Babinski)

    • Always sensory and motor component 

  • limb control

  • finger to nose test 

  • trunk control

18
New cards

Neurologic Examination

  • Mental Status

  • Cranial nerves

  • Motor

  • Cerebellar

  • Reflexes

  • Sensory

  1. Where is the lesion?

    1. levelize

    2. lateralize

19
New cards

Muscle Disease

  • _____ & ____ weakness

    • what part usually?

  • atrophy of involved muscles

  • absent sensory sign except for? (PT)

  • proximal & symmetrical weakness

    • limb girdle usually

  • absent sensory signs except for pain & tenderness

20
New cards

READ & ANALYZE

knowt flashcard image
21
New cards

NMJ Lesion Site

  • Purely ____

  • cranially and spinally innervated muscles

  • ____ pattern

  • ____ reflexes

  • (+) response to ______

  • Myastenia Gravis

    • ____ muscles are affected

    • normal when rested but weakness progress as day ends

  • motor

  • diurnal

  • intact reflexes

  • anticholinesterase

  • eye muscles

22
New cards

NMJ Lesion Site

  • ____ or ____ muscle weakness without sensory symptoms

  • _______ and facilitation of strength with repeated activity suggest a neuromuscular junction disorder

  • ______ suggests myopathic disorders but also can be reported in motor neuron and basal ganglia disease

  • limb or cranial muscle weakness

  • fatigability

  • cramping

23
New cards

Peripheral Nerve Lesion

  • Distal ______ symptoms

  • weakness is likely to be more severe _____

  • symmetrical unless compression injury

  • atrophy with time

  • Caused by _____( 3)

  • distal sensory & motor

  • distally

  • symmetrical

  • DM, Chronic alcohol intake, Guillain–Barré syndrome

24
New cards

Spinal Cord Lesion

  • ______ often _____ deficit

  • Normal above lesion; below the level of lesion + symptoms

  • Prominent __________

    • Catheterization & manual evacuation of feces

  • _______ level

    • Extinction of sensory determination a few levels below the lesion in spinal cord traumas

  • Bilateral often symmetrical

  • Incontinence

  • Sensory

25
New cards

Spinal Cord Lesion

  • If there is neck or back pain → _______ suspected

  • no pain →______ is likely

  • The level of a spinal compressive lesion is indicated by cutaneous ____ loss than by ____ signs

  • Lesion that causes spastic paraparesis is anywhere above the lumbar segments

  • compressive lesion

  • multiple sclerosis

  • sensory loss »»»»»» motor signs

26
New cards

Brainstem/Cerebellum Lesion

  • _______ cranial nerve deficits

  • Ataxia

  • Altered ____

  • Usually ______ pyramidal tract signs

    • pathological reflexes on both side

  • ipsilateral

  • sensorium

  • bilateral

27
New cards

Brainstem Lesion

  • _______ cranial nerve deficits

    • Lesions in the right midbrain/pons/medulla will have same side deficits

    • ______ hemiparesis with Babinski

  • _____ limb ataxia

  • __________ - lesion at the median longitudinal fasciculus (MLF) syndrome

    • MLF connects cranial nerves 3,4,6,8

    • Problems in the movement of eye (one and a half syndrome)

  • Ipsilateral cranial nerve deficits

  • Contralateral

  • Ipsilateral limb ataxia

  • Internuclear ophthalmoplegia MLF

28
New cards

Cerebellum Lesion

  • Incoordination, poor equilibrium

    • Vermis → Truncal or gait ataxia, no limb ataxia

    • Hemispheres → ipsilateral limb ataxia

      • Intention tremor

      • _____ → finger to nose test, heel-knee-skin test

      • ________ → alternate pronation supination test

    • Hemisphere & vermis lesion can co-exist together

      • (+) Titubation

      • Extremity problems

  • vermis

  • ipsilateral

  • Dysmetria

  • Dysdiadochokinesia

29
New cards

Cerebrum Lesion

  • Disturbance in higher intellectual functions

  • _____ impairment

  • _____ and ____ changes (organic)

  • Discrete deficits

  • ____ disturbance

  • _____ impairment

  • Seizure, delirium and dementia

  • hemiplegia, aphasia or hemianopia

  • memory

  • emotional & behavior

  • language

  • intellectual

30
New cards

Neurologic Illness according to Onset

  • ________

    • vascular, acute demyelinating ,trauma

  • ________

    • mass lesions

    • Degenerative disease

  • __________

    • Infection, metabolic, intoxication, nutritional

  • Minutes to a day

  • Insidious ( weeks or months)

  • One day to several days

<ul><li><p>Minutes to a day</p></li><li><p>Insidious ( weeks or months)</p></li><li><p>One day to several days</p></li></ul><p></p>
31
New cards

CATEGORIES OF NEUROLOGICAL DISEASES

  • Congenital/Hereditary/Developmental

    • Craniostenosis, Spina bifida, Aneurysm (some are congenital but they also develop over time), AVM

    • _________ = premature closure of sutures of the skull

  • Craniostenosis

32
New cards

CATEGORIES OF NEUROLOGICAL DISEASES

  • Traumatic

    • Epidural & Subdural hematoma

    • Subarachnoid Hemorrhage

    • Cerebral contusion,concussion

  • Infection

    • Meningitis, Encephalitis, Brain abscess

33
New cards

CATEGORIES OF NEUROLOGICAL DISEASES

  • Degenerative

    • Alzhimer, Parkinson’s disease, Amyotrophic Lateral Sclerosis

  • Demyelinating

    • Post infectious/ post vaccinal: Encephalomyelitis,

    • Multiple Sclerosis

    • Landry Guillan Barre syndrome

  • Metabolic/Endocrine

    • Hypoglycemia, Hypoxia (chronic lung disease), Hyponatremia (low sodium), Hypercalcemia (high calcium)

    • Drug overdose

    • Hyponatremia

    • DM

34
New cards

CATEGORIES OF NEUROLOGICAL DISEASES

  • Nutritional deficiency

    • Vit B1, B6, B12 deficiency

  • Tumor

  • Immunologic

    • Polymyositis, Dermatomyositis, Guillain-barre, Myasthenia Gravis, Autoimmune encephalitis

    • Post infectious and postvaccinal encephalomyelitis

35
New cards
  • ________: destruction of matured myelin sheath

  • _________: destruction of myelin sheath while it is being formed

  • Demyelinating

  • Dysmyelinating

36
New cards

Diagnostic Tests

  • ________ → Mass lesions, strokes, head trauma, demyelinating disease, brain abscess

  • _______→ seizures

Computed Tomography (CT Scan)

Electroencephalogram (EEG)

37
New cards

Diagnostic Tests

  • _________ → Mass lesions, strokes, demyelinating disease, brain abscess

  • _________ → Myopathies (check for the level of muscle enzymes)

  • Magnetic resonance imaging (MRI)

  • Muscle Biopsy

38
New cards

Diagnostic Tests

  • ________ → Neuropathies, Myasthenia gravis, Guillain-Barre syndrome

  • ________ → CNS infections (Meningitis, encephalitis, subarachnoid hemorrhage)

  • Nerve stimulation studies (NSS)

  • Lumbar Puncture

39
New cards

Diagnostic Tests

  • ______ → Hypokalemic paralysis

  • ______ → Muscle disease, polymyositis, dermatomyositis

    • Total CPK level = very high

  • Serum Potassium

  • Total CPK (creatine phosphokinase)

40
New cards

Diagnostic Tests

  • ______ → Aneurysm, aterio-venous malformation

  • ______ → Stroke and hydrocephalus

  • Angiogram

  • Transcranial US

41
New cards

Diagnostic Tests

  • _____ → fx

  • ______ → Pott s Disease

  • Skull X-ray

  • Spine X-ray

42
New cards

Diagnostic Tests

  • _________ → Pt w/ CNS manifestation of HIV/AIDS, TB, viral encephalitis

Serologic test

43
New cards

Read Chapter of Meritts →

“Great minds think alike, but lovers think as one” ❤‍🔥