Neurology on the MAU. Geraint Fuller
|
|
- Aron O’Neal’
- 6 years ago
- Views:
Transcription
1 Neurology on the MAU Geraint Fuller
2 Conflicts of Interest Clinical neurologist No drug company links Past President of Association of British Neurologists Co-Editor of Practical Neurology Receive Royalties from Neurological examination made easy 5 th ed Neurology a colour illustrated text 3 rd ed Neurology and Neurosurgery illustrated 5 th ed
3 Common Neurological Emergencies Headache Weakness Blackouts Coma Confusion Dizziness Double vision Incoordination Stroke Epilepsy Subarachnoid Meningitis Encephalitis Myaesthenia Guillain-Barre Cord compression
4 Ms SA 34 year old woman normally fit and well Developed sudden and severe headache at work 1 hour before Vomited On citalopram 40mg/day; microgynon 155/90 In pain Normal neurological examination
5 Thunderclap Headache BMJ 2012;345:e8557 Instantaneous onset - 1 minute at most 43/100,000/year Single or recurrent Spontaneous or triggered
6 Thunderclap Headache BMJ 2012;345:e8557 Subarachnoid haemorrhage 11-25% CT Brain If CT negative LP (with spectrophotometry)
7 #asah
8 Quality of Care in Secondary Care Figure 3.6 8
9 Lumbar Puncture 5.4% Unable to perform LP 25% Unable to perform LP 24/7 75% had no guidance as to who should perform LP 9
10 Delayed or Overlooked Diagnosis (Advisors Form) Primary Care 17.6% of patients saw GP Delayed or overlooked in 32/75 Outcome affected in 23/32 Secondary Care Delay or overlooked in 12% Outcome affected in 10/49 Table
11 Quality of Care in Secondary Care Table % had NO neurological examination documented 11
12 Subarachnoid Haemorrhage Common problem Protocols Document examination Sort out LP Do simple things well
13 Thunderclap Headache BMJ 2012;345:e8557 Subarachnoid haemorrhage. CT Brain Other structural causes hydrocephalus; tumours If CT negative => LP (with spectrophotometry) meningitis If CT and CSF negative what then? Not SAH is NOT a diagnosis
14 Retake the history Really thunderclap? Prior history of headache? Thunderclap Headache Negative CT and CSF Previous investigations? Reexamine Horner s
15 Ms SA 34 year old woman normally fit and well Developed sudden and severe headache at work 1 hour before Vomited On citalopram 40mg/day; microgynon 155/90 In pain Normal neurological examination CT Brain normal CSF normal
16
17
18
19 You see what you are looking for
20 Thunderclap Headache Negative CT and CSF Cerebral venous sinus thrombosis Cervical artery dissection Spontaneous intracranial hypotension
21 Cerebral venous sinus thrombosis Up to 16% present with thunderclap headache CSF pressure may be elevated Post-partum Risk factors for thrombosis dehydration; COC; UC Alternative presentation Progressive headache with papilloedema Focal cortical deficits Seizures D-dimer negative in 25% with isolated headache Stroke. 2005;36: CT brain Treatment with anticoagulation
22 Hyperattenuation sign Sensitivity 65-95% Specificity 95% content/34/8/1568
23
24
25 Spontaneous Intracranial Hypotension Spontaneous leak of CSF similar to pneumothorax Develops into postural headache 15% have prominent onset CSF finds (if successful) low pressure, sometimes raised protein MRI venous engorgement (meningeal enhancement) Rx Blood patch
26
27
28 Ms SA 34 year old woman normally fit and well Developed sudden and severe headache at work 1 hour before Vomited On citalopram 40mg/day; microgynon 155/90 In pain Normal neurological examination CT brain normal CSF normal Called to see her Further severe headache when went to the toilet Screaming in pain BP surged to 160/110
29 Reversible Cerebral Vasoconstriction Syndrome Lancet Neurol 2012;11: Thunderclap headache Severe and recurrent Often triggered Sex; Valsalva Precipitants Vasoactive drugs Cannabis, cocaine, SSRIs, SRNIs, ephedrine, others ++ Post-partum
30 Reversible Cerebral Vasoconstriction Syndrome Lancet Neurol 2012;11: Surges of BP with pain in 30% Transient focal neurological deficits 10% Small convexity subarachnoid haemorrhage 10% Resolves after 4 weeks
31
32 What is reversible cerebral vasoconstriction syndrome? A clinical and radiological diagnosis: Diagnostic criteria for RCVS Acute/severe headache(s) Uniphasic course; no new symptoms >1/12 after onset Cerebral arterial vasoconstriction on angiography No evidence of aneurysmal SAH Normal/nearly normal CSF (prot <1g/L, WCC <15) Complete/substantial normalisation of arteries on angiography at 12/52 International Headache Society 2004 and Calabrese et al 2007
33 CT angiogram
34 CT angiogram
35 Follow up MRI angiogram
36 String and Beads Chen et al, 2010
37 RCVS Management Avoid triggers Stop precipitants (citalopram) Treat BP Analgesia Nimodipine, verapamil or Mg suggested Low risk of recurrence
38 Thunderclap Headache Think subarachnoid haemorrhage Remember not SAH is not a diagnosis Revisit the history Think about scan and CSF negative conditions Cerebral venous thrombosis Reversible cerebral vasoconstriction syndrome Cervical artery dissection Low CSF pressure headache
39
40 Mr AV 50 year old man with hypertension Developed vertigo with nausea and vomiting 10 hours earlier No hearing problem, pain or other symptoms Horizontal nystagmus to the left Very unsteady on walking
41 Differential Diagnosis Acute peripheral vestibular syndrome vestibular neuritis Acute central vestibular syndrome Cerebellar stroke Other brain stem strokes PICA AICA
42 Differential Diagnosis Acute peripheral vestibular syndrome vestibular neuritis Acute central vestibular syndrome Cerebellar stroke Other brain stem strokes PICA AICA
43 Does my dizzy patient have a stroke? CMAJ 2011;183: Gradual onset => neuritis (?) Sudden onset => stroke (?) Pain => stroke (+ve likelihood ratio 3) Diplopia & other symptoms => stroke (strong) < 50 => neuritis (weak) Vascular risk factors => stroke (weak)
44 Does my dizzy patient have a stroke? CMAJ 2011;183: Conventional neurological examination normal => neuritis (OR 0.36) Neurological signs present => stroke (probably strong) Normal head thrust test => stroke (positive likelihood ratio 18) No dangerous signs on HINTS bedside testing => Negative likelihood ratio 0.02)
45 HINTS to diagnose stroke in the acute vestibular syndrome: 3-step bedside test more sensitive than MRI Kattah et al Stroke 2009;40: Dangerous signs Head impulse test - Normal Nystagmus direction changing Skew deviation present Any one of these indicated stroke Sensitivity 100% Specificity 91%
46
47 Case 1 differential diagnosis Bronstein; Dizziness Cambridge Clinical Guides 2007
48 HINTS to diagnose stroke in the acute vestibular syndrome: 3-step bedside test more sensitive than MRI Kattah et al Stroke 2009;40: Dangerous signs Head impulse test - Normal Nystagmus direction changing Skew deviation present Any one of these indicated stroke Sensitivity 100% Specificity 91%
49 Mr AV: Treatment Vestibular neuritis Cerebellar stroke Short term vestibular sedatives Vestibular rehabilitation Admission Monitoring for complications
50 TOS Study Study Nicholl et al JRCPE 2012;42; Patients referred to neurology for opinion were asked if they recalled being examined using a: Stethoscope 96% Tendon hammer 67% Ophthalmoscope 52% Why?
51 A Patient 55 year old man presents to A&E Woke with blurred vision PERLA 6/5 bilaterally Fields normal Discs normal
52 Fields techniques Face Finger counting Red comparison Static finger wiggle Kinetic finger wiggle Kinetic 5 mm red pin Too much choice..
53 Diagnostic accuracy of confrontation visual field tests Neurology 2010;74: Sensitivity Specificity Face Finger counting Red comparison Static finger wiggle Kinetic finger wiggle Kinetic 5 mm red pin 91 96
54 Diagnostic accuracy of confrontation visual field tests Neurology 2010;74: Combination Static finger wiggle PLUS kinetic red pin => Sensitivity 79% => Specificity 90%
55
56
57
58 A Patient 55 year old man presents to A&E Woke with blurred vision PERLA 6/5 bilaterally Fields NOT normal Discs normal
59 Patient GH A 57 year old man got onto a plane feeling fine. During the 1 hour flight his legs became numb and on landing he could not get out of his seat. He taken to A and E. Cranial nerves and arms normal. Reduced tone both legs. HF 3 3; HE 3 3; KF 3 3; KE 3 3; FDF 4 4; PF 4 4 Knee reflex and right ankle reflex absent; left ankle reflex present. Plantars unresponsive. Loss of sensation to upper thigh Catheterised
60 Patient GH What is the diagnosis? A) Guillain Barre syndrome B) Multiple sclerosis C) Spinal cord compression D) Stroke
61 Wrong question!
62 Neurology and Detective Writing Kempster and Lees, Practical Neurology Dec 2013
63 Neurology and the Underground
64 Stopping at all the stations of the diagnostic process Weak legs Multiple sclerosis Symptoms and signs Synthesis Syndrome Diagnosis
65 Neurology and the Underground Missing stops Makes you Go too far
66 Stopping at all the stations of the diagnostic process Weak legs Localisation of lesion(s) + time course + tests Multiple sclerosis Symptoms and signs Synthesis Syndrome Diagnosis
67 Patient GH A 57 year old man got onto a plane feeling fine. During the 1 hour flight his legs became numb and on landing he could not get out of his seat. He taken to A and E. Cranial nerves and arms normal. Reduced tone both legs. HF 3 3; HE 3 3; KF 3 3; KE 3 3; FDF 4 4; PF 4 4 Knee reflex and right ankle reflex absent; left ankle reflex present. Plantars unresponsive. Loss of sensation to upper thigh Catheterised Type of weakness? Upper or lower motor? Distribution of weakness? Spinal cord? Cauda equina? Peripheral nerve? Distribution of sensory loss? Autonomic involvement? Spinal cord? Cauda equina?
68 MRCP and Cases all the information Real world Information correct? All information you need? What is missing?
69 Patient GH A 57 year old man got onto a plane feeling fine. During the 1 hour flight his legs became numb and on landing he could not get out of his seat. He taken to A and E. Cranial nerves and arms normal. Reduced tone both legs. HF 3 3; HE 3 3; KF 3 3; KE 3 3; FDF 4 4; PF 4 4 Knee reflex and right ankle reflex absent; left ankle reflex present. Plantars unresponsive. Loss of sensation to upper thigh Catheterised
70 Patient GH Is anything missing? Modalities of sensation: Vibration sense Joint position sense Temperature Pin prick Could there be a level?
71 Dissociated sensory loss Sensory level to umbilicus
72 Spinal Cord
73 Weakness and reflex loss above L1 Loss of spinothalamic sensation; preserved posterior column sensation Loss of bladder function => Where is the lesion? Anterior spinal cord syndrome at T12 or above => What is the lesion? Anterior spinal artery stroke Patient GH
74 Missing Information Uncritical examination of sensory system Failure to examine the sensation on the trunk
75 Sensory Examination Made Easy. Vibration Sense Temperature
76 Sensory Examination Made Easy Vibration Sense Temperature Joint position sense Pin prick (light touch..) Distal to proximal Abnormal to normal Delineate edge of normal Look for level if you think there might be one
77 Think about the sensory distribution in all 4 modalities Missing information Remember to look for a level on trunk Missing information Imagine you are shading in a drawing
78 Myotomes and Dermatomes
79 Common Neurological Emergencies Headache Weakness Blackouts Coma Confusion Dizziness Double vision Incoordination Stroke Epilepsy Subarachnoid Meningitis Encephalitis Myaesthenia Guillain-Barre Cord compression
80
81
82 Neurological Emergencies Thunderclap headaches Think SAH Not SAH is not a diagnosis Vertigo Clinical examination can distinguish central from peripheral lesions Weakness Think about missing data Critical and systematic sensory examination
83 Thank you
High Yield Neurological Examination
High Yield Neurological Examination Vanja Douglas, MD Sara & Evan Williams Foundation Endowed Neurohospitalist Chair Director, Neurohospitalist Division Associate Professor of Clinical Neurology UCSF Department
More informationCan I send this headache patient home? Dr Nicola Giffin Consultant Neurologist Bath, Nov 2017
Can I send this headache patient home? Dr Nicola Giffin Consultant Neurologist Bath, Nov 2017 SAH v benign thunderclap headaches Other pathologies not apparent on CT Severe primary headaches: management
More informationA Hypothesis Driven Approach to the Neurological Exam
A Hypothesis Driven Approach to the Neurological Exam Vanja Douglas, MD Assistant Clinical Professor UCSF Department of Neurology Disclosures None 1 Purpose of Neuro Exam Screen asymptomatic patients Screen
More informationSuspected neurological conditions: clinical questions
Suspected neurological clinical questions For questions on signs and symptoms, the committee wanted to consider any studies that determine whether a certain sign or symptom accompanying a main presenting
More informationAlan Barber. Professor of Clinical Neurology University of Auckland
Alan Barber Professor of Clinical Neurology University of Auckland Presented with L numbness & slurred speech 2 episodes; 10 mins & 2 hrs Hypertension Type II DM Examination P 80/min reg, BP 160/95, normal
More informationBrain and Central Nervous System Cancers
Brain and Central Nervous System Cancers NICE guidance link: https://www.nice.org.uk/guidance/ta121 Clinical presentation of brain tumours History and Examination Consider immediate referral Management
More informationBRAIN STEM CASE HISTORIES CASE HISTORY VII
463 Brain stem Case history BRAIN STEM CASE HISTORIES CASE HISTORY VII A 60 year old man with hypertension wakes one morning with trouble walking. He is feeling dizzy and is sick to his stomach. His wife
More informationHEADACHES THE RED FLAGS
HEADACHES THE RED FLAGS FAYYAZ AHMED CONSULTANT NEUROLOGIST HON. SENIOR LECTURER HULL YORK MEDICAL SCHOOL SECONDARY VS PRIMARY HEADACHES COMMON SECONDARY HEADACHES UNCOMMON BUT SERIOUS SECONDARY HEADACHES
More informationDiagnosis of Subarachnoid Hemorrhage (SAH) and Non- Aneurysmal Causes
Diagnosis of Subarachnoid Hemorrhage (SAH) and Non- Aneurysmal Causes By Sheila Smith, MD Swedish Medical Center 1 Disclosures I have no disclosures 2 Course Objectives Review significance and differential
More information/ / / / / / Hospital Abstraction: Stroke/TIA. Participant ID: Hospital Code: Multi-Ethnic Study of Atherosclerosis
Multi-Ethnic Study of Atherosclerosis Participant ID: Hospital Code: Hospital Abstraction: Stroke/TIA History and Hospital Record 1. Was the participant hospitalized as an immediate consequence of this
More informationWhat Do You Think of My Posterior?
What Do You Think of My Posterior? Posterior Stroke and Stroke Mimics Peter Panagos, MD, FACEP, FAHA Associate Professor Emergency Medicine and Neurology Washington University School of Medicine Disclosures
More informationAcute Neurological Problems
The International Convention Centre (ICC), Birmingham 11 12 September 2017 Acute Neurological Problems David Nicholl Consultant Neurologist, SWBH & UHB NHS Trusts, Birmingham; Hon Sec to the ABN @TOSStudyGroup
More informationOverview. Spinal Anatomy Spaces & Meninges Spinal Cord. Anatomy of the dura. Anatomy of the arachnoid. Anatomy of the spinal meninges
European Course in Neuroradiology Module 1 - Anatomy and Embryology Dubrovnik, October 2018 Spinal Anatomy Spaces & Meninges Spinal Cord Johan Van Goethem Overview spinal meninges & spaces spinal cord
More informationHow to Think like a Neurologist Review of Exam Process and Assessment Findings
Lehigh Valley Health Network LVHN Scholarly Works Neurology Update for the Non-Neurologist 2013 Neurology Update for the Non-Neurologist Feb 20th, 5:10 PM - 5:40 PM How to Think like a Neurologist Review
More informationLA CLINICA E LA DIAGNOSI DELLA VERTIGINE VASCOLARE
LA CLINICA E LA DIAGNOSI DELLA VERTIGINE VASCOLARE M. Mandalà Azienda Ospedaliera Universitaria Senese WHY ARE WE SCARED? NEED TO BETTER UNDERSTAND PATHOPHYSIOLOGY WHAT IS KNOWN WHAT IS EFFECTIVE and SIMPLE
More informationStroke in the ED. Dr. William Whiteley. Scottish Senior Clinical Fellow University of Edinburgh Consultant Neurologist NHS Lothian
Stroke in the ED Dr. William Whiteley Scottish Senior Clinical Fellow University of Edinburgh Consultant Neurologist NHS Lothian 2016 RCP Guideline for Stroke RCP guidelines for acute ischaemic stroke
More informationStroke Mimics. Paul Guyler
Stroke Mimics Paul Guyler Consultant Stroke Physician at Southend University Hospital Clinical Lead for Acute Stroke Essex Cardiac and Stroke Network Aims Why worry? Stroke Recognition Tools History, Examination
More informationAcute Dizziness: Is It a Stroke? Gordon Kelley MD November 2017
Acute Dizziness: Is It a Stroke? Gordon Kelley MD November 2017 No Disclosures Dizziness Occurs in nearly ¾ of cerebellar strokes 4 categories in classic teaching*: Vertigo Presyncope Imbalance Non-specific
More informationLesson. The most important aspect in the assessment of headache is a careful history
Lesson The most important aspect in the assessment of headache is a careful history Investigation of? SAH Summary A CT scan within 12 hours of presentation is 98% sensitive for SAH CSF >12 hours with spectrophotometric
More informationThe NIHSS score is 4 (considering 2 pts for the ataxia involving upper and lower limbs.
Neuroscience case 5 1. Speech comprehension, ability to speak, and word use were normal in Mr. Washburn, indicating that aphasia (cortical language problem) was not involved. However, he did have a problem
More informationP1: OTA/XYZ P2: ABC c01 BLBK231-Ginsberg December 23, :43 Printer Name: Yet to Come. Part 1. The Neurological Approach COPYRIGHTED MATERIAL
Part 1 The Neurological Approach COPYRIGHTED MATERIAL 1 2 Chapter 1 Neurological history-taking The diagnosis and management of diseases of the nervous system have been revolutionized in recent years by
More informationPause for thought. Dr Jane Anderson Consultant Neurologist
Pause for thought Dr Jane Anderson Consultant Neurologist Which is the top cause of years lived with disability worldwide? 1. COPD 2. Low Back pain 3. Diabetes 4. Migraine with medication overuse headache
More informationA synopsis of: Diagnosis and Management of Headaches in Adults: A national clinical guideline. Scottish intercollegiate Guidelines Network SIGN
A synopsis of: Diagnosis and Management of Headaches in Adults: A national clinical guideline Scottish intercollegiate Guidelines Network SIGN November 2008. PETER FRAMPTON MSc MCOptom BAppSc (Optom)(AUS)
More information3/3/2016. International Standards for the Neurologic Classification of Spinal Cord Injury (ISNCSCI)
International Standards for the Neurologic Classification of Spinal Cord Injury (ISNCSCI) American Spinal Injury Association International Spinal Cord Society Presented by Adam Stein, MD Chairman and Professor
More informationNon-Traumatic Neuro Emergencies
Department of Radiology University of California San Diego Non-Traumatic Neuro Emergencies John R. Hesselink, M.D. Nontraumatic Neuroemergencies 1. Acute focal neurological deficit 2. Worst headache of
More informationThe Big 3 of Vertigo
They feel it, you see it, few know it: Common vertigo conditions seen, but rarely diagnosed Peter Johns MD, FRCPC University of Ottawa pjohns@toh.ca Twitter @peterjohns84 The Big 3 of Vertigo BPPV Vestibular
More informationNeurological Examination
Neurological Examination Charles University in Prague 1st Medical Faculty and General University Hospital Neurological examination: Why important? clinical history taking and bedside examination: classical
More informationAcute Vestibular Syndrome (AVS) 12/5/2017
Sharon Hartman Polensek, MD, PhD Dept of Neurology, Emory University Atlanta VA Medical Center DIAGNOSTIC GROUPS FOR PATIENTS PRESENTING WITH DIZZINESS TO EMERGENCY DEPARTMENTS Infectious 2.9% Genitourinary
More informationCHRONIC RETROBULBAR AND CHIASMAL NEURITIS*t
Brit. J. Ophthal. (1967) 51, 698 CHRONIC RETROBULBAR AND CHIASMAL NEURITIS*t BY From the Department of Medicine, University of Bristol, and the United Bristol Hospitals AcuTE retrobulbar neuritis is a
More informationIntracranial hypotension secondary to spinal CSF leak: diagnosis
Intracranial hypotension secondary to spinal CSF leak: diagnosis Spinal cerebrospinal fluid (CSF) leak is an important and underdiagnosed cause of new onset headache that is treatable. Cerebrospinal fluid
More informationDISORDERS OF THE NERVOUS SYSTEM
DISORDERS OF THE NERVOUS SYSTEM Bell Work What s your reaction time? Go to this website and check it out: https://www.justpark.com/creative/reaction-timetest/ Read the following brief article and summarize
More informationTraumatic brain injuries are caused by external mechanical forces such as: - Falls - Transport-related accidents - Assault
PP2231 Brain injury Cerebrum consists of frontal, parietal, occipital and temporal lobes Diencephalon consists of thalamus, hypothalamus Cerbellum Brain stem consists of midbrain, pons, medulla Central
More informationIt s Always a Stroke; Except For When It s Not..
It s Always a Stroke; Except For When It s Not.. TREVOR PHINNEY, D.O. Disclosures No Relevant Disclosures 1 Objectives Discuss variables of differential diagnosis for stroke Review when to TPA and when
More informationNEUROLOGY CLERKSHIP CORE CURRICULUM GUIDELINES
NEUROLOGY CLERKSHIP CORE CURRICULUM GUIDELINES Endorsed by the following organizations - October 2000: American Academy of Neurology Association of University Professors of Neurology American Neurological
More informationThe Spinal Cord & Spinal Nerves
The Spinal Cord & Spinal Nerves Together with brain forms the CNS Functions spinal cord reflexes integration (summation of inhibitory and excitatory) nerve impulses highway for upward and downward travel
More informationNicolas Bianchi M.D. May 15th, 2012
Nicolas Bianchi M.D. May 15th, 2012 New concepts in TIA Differential Diagnosis Stroke Syndromes To learn the new definitions and concepts on TIA as a condition of high risk for stroke. To recognize the
More informationAcute Vestibular Syndrome (VS or Stroke?) Three-step H.I.N.T.S. eye examination
Acute Vestibular Syndrome (VS or Stroke?) Three-step H.I.N.T.S. eye examination Head Impulse (right- and leftward) Nystagmus type Test of Skew (cover test for skew deviation) Stroke findings: I.N.F.A.R.C.T.
More informationStroke School for Internists Part 1
Stroke School for Internists Part 1 November 4, 2017 Dr. Albert Jin Dr. Gurpreet Jaswal Disclosures I receive a stipend for my role as Medical Director of the Stroke Network of SEO I have no commercial
More informationPregnancy and Neurological Disorders
Pregnancy and Neurological Disorders Myles Connor NHS Borders and University of Edinburgh, United Kingdom Outline Why is it important? Specific conditions Eclampsia Cerebrovascular disease Epilepsy Idiopathic
More informationVague Neurological Conditions
Vague Neurological Conditions Dr. John Lefebre, MD, FRCPC Chief Regional Medical Director Europe, India, South Africa, Middle East and Turkey Canada 2014 2 3 4 Agenda Dr. John Lefebre, M.D., FRCPC 1. TIA
More informationNeurologic Examination
John W. Engstrom, MD October 16, 2015 Neurologic Examination Overview The Neurologic Examination Neurologic Examination John W. Engstrom, M.D. Dept. of Neurology University of California, San Francisco
More informationNeuroanatomy of a Stroke. Joni Clark, MD Professor of Neurology Barrow Neurologic Institute
Neuroanatomy of a Stroke Joni Clark, MD Professor of Neurology Barrow Neurologic Institute No disclosures Stroke case presentations Review signs and symptoms Review pertinent exam findings Identify the
More informationNeurological Dilemmas in Primary Care
Neurological Dilemmas in Primary Care David Clark, DO dclark@oregonneurology.com When to test? How to test? Pitfalls in testing? When to treat? How to treat? How long to treat? Neurological Dilemmas Seizure
More informationTutorials. By Dr Sharon Truter
Tutorials By Dr Sharon Truter To the Tutorials By Dr Sharon Truter What to expect from the Tutorials What to expect from these tutorials Outlines, structure, guided reading, explanations, mnemonics Begin
More informationSubarachnoid Haemorrhage and Thunderclap Headache. Tom Heaps Consultant Acute Physician
Subarachnoid Haemorrhage and Thunderclap Headache Tom Heaps Consultant Acute Physician Lesson Outline Clinical Case Why is this topic important? Thunderclap Headache (TCH): definition SAH: diagnosis, management
More informationChapter 13. The Spinal Cord & Spinal Nerves. Spinal Cord. Spinal Cord Protection. Meninges. Together with brain forms the CNS Functions
Spinal Cord Chapter 13 The Spinal Cord & Spinal Nerves Together with brain forms the CNS Functions spinal cord reflexes integration (summation of inhibitory and excitatory) nerve impulses highway for upward
More informationFORM ID. Patient's Personal Details. SECTION A : Medical Record of the Patient. Name. Policy Number. NRIC/Old IC/Passport/Birth Cert/Others
CRITICAL ILLNESS CLAIM - DOCTOR'S STATEMENT Brain and Nerve Related Conditions Note: This form is to be completed at the Patient s expense by the Attending Physician/ Surgeon who treated the patient. Patient's
More informationHIGH LEVEL - Science
Learning Outcomes HIGH LEVEL - Science Describe the structure and function of the back and spine (8a) Outline the functional anatomy and physiology of the spinal cord and peripheral nerves (8a) Describe
More informationWhat could be reffered to as dizziness by the patient?
What could be reffered to as dizziness by the patient? Rotational vertigo Sense of instability Ataxia of gait Disturbance of vision Loss of contact with surroundings Nausea Loss of memory Loss of confidence
More informationThe Neurologic Examination: High-Yield Strategies
The Neurologic Examination: High-Yield Strategies S. Andrew Josephson, MD Examination Approach Two types of neurologic examinations 1. Screening Examination 2. Testing Hypotheses Select high-yield tests
More informationManagement of TIA. Dr Ali Ali Consultant Stroke and Geriatrics Royal Hallamshire Hospital
Management of TIA Dr Ali Ali Consultant Stroke and Geriatrics Royal Hallamshire Hospital Objectives Definition TIA and stroke TIA: Diagnosis & mimics Risk assessment Referral and emergency management Secondary
More informationSpontaneous Intracranial Hypotension Diagnosis and Treatment
Spontaneous Intracranial Hypotension Diagnosis and Treatment John W. Engstrom MD, Philip R. Weinstein MD, and William P. Dillon M.D. University of California, San Francisco Spontaneous Intracranial Hypotension
More informationApproach to a Neurologic Diagnosis
Approach to a Neurologic Diagnosis Neurologic Diagnosis History Physical & Neurological Examination Ancillary Procedures 3 Questions Asked Focal neurologic deficits Increased intracranial pressure Signs
More informationSymptoms of a brain tumour in adults
Symptoms of a brain tumour in adults A tumour is an abnormal growth caused by cells dividing in an uncontrolled manner. Approximately 9,300 people are diagnosed with a primary brain tumour each year. (Primary
More informationThe University of Arizona Pediatric Residency Program. Primary Goals for Rotation. Neurology
The University of Arizona Pediatric Residency Program Primary Goals for Rotation Neurology 1. GOAL: Understand the role of the pediatrician in preventing neurological diseases, and in counseling and screening
More informationWHITE PAPER: A GUIDE TO UNDERSTANDING SUBARACHNOID HEMORRHAGE
WHITE PAPER: A GUIDE TO UNDERSTANDING SUBARACHNOID HEMORRHAGE Subarachnoid Hemorrhage is a serious, life-threatening type of hemorrhagic stroke caused by bleeding into the space surrounding the brain,
More informationThe Neurologic Examination: High-Yield Strategies
The Neurologic Examination: High-Yield Strategies S. Andrew Josephson, MD Assistant Professor, Department of Neurology Divisions of Neurovascular and Behavioral Neurology University of California San Francisco
More informationStroke - Intracranial hemorrhage. Dr. Amitesh Aggarwal Associate Professor Department of Medicine
Stroke - Intracranial hemorrhage Dr. Amitesh Aggarwal Associate Professor Department of Medicine Etiology and pathogenesis ICH accounts for ~10% of all strokes 30 day mortality - 35 45% Incidence rates
More informationThe High-Yield Neurologic Examination
The High-Yield Neurologic Examination S. Andrew Josephson MD Carmen Castro Franceschi and Gladyne K. Mitchell Neurohospitalist Distinguished Professor Chair, Department of Neurology Director, Neurohospitalist
More informationObjectives. Emergency Department: Rapid Fire Diagnosis 10/4/16. Why emergency medicine is unique. Approach to the emergent patient
Emergency Department: Rapid Fire Diagnosis Julie Beard DO St. Luke s Hospital Emergency Department October 4 th, 2016 Objectives Why emergency medicine is unique Approach to the emergent patient Discuss
More informationThe central nervous system
Sectc.qxd 29/06/99 09:42 Page 81 Section C The central nervous system CNS haemorrhage Subarachnoid haemorrhage Cerebral infarction Brain atrophy Ring enhancing lesions MRI of the pituitary Multiple sclerosis
More informationSpinal cord. We have extension of the pia mater below L1-L2 called filum terminale
Spinal cord Part of the CNS extend from foramen magnum to the level of L1-L2 (it is shorter than the vertebral column) it is covered by spinal meninges. It is cylindrical in shape. It s lower end become
More informationVertigo. Tunde Magyar MD, PhD
Vertigo Tunde Magyar MD, PhD What could be reffered to as dizziness by the patient? Rotational vertigo Sense of instability Ataxia of gait Disturbance of vision Loss of contact with surroundings Nausea
More informationAcoustic neuroma s/p removal BPPV (Crystals)- 50% of people over 65 y/ o with dizziness will have this as main reason for dizziness
Dizziness and the Heart Mended Hearts Inservice Karen Hansen, PT, DPT, Cert Vestibular Rehab, CEAS Tennessee Therapy & Balance Center, LLC July 21, 2016 Balance We maintain balance with input from our
More informationThe Neurologic Examination. John W. Engstrom, M.D. University of California San Francisco School of Medicine
The Neurologic Examination John W. Engstrom, M.D. University of California San Francisco School of Medicine Overview The Neurologic Examination Mental status demonstration/questions Cranial nerves demonstration/questions
More informationOltre la terapia medica nelle dissezioni carotidee
Oltre la terapia medica nelle dissezioni carotidee Rodolfo Pini Chirurgia Vascolare Università di bologna Alma Mater Studiorum Carotid and Vertebral Artery Dissection What we know from the literature Epidemiology
More informationNeurology Clerkship Learning Objectives
Neurology Clerkship Learning Objectives Clinical skills Perform a neurological screening examination of the cranial nerves, motor system, reflexes, and sensory system under the observation and guidance
More informationSpinal Cord Protection. Chapter 13 The Spinal Cord & Spinal Nerves. External Anatomy of Spinal Cord. Structures Covering the Spinal Cord
Spinal Cord Protection Chapter 13 The Spinal Cord & Spinal Nerves We are only going to cover Pages 420-434 and 447 Together with brain forms the CNS Functions spinal cord reflexes integration (summation
More informationStroke Workshop. Pre-Workshop Handout. With Walter Himmel, Meeta Patel & Anton Helman
2018 Stroke Workshop Pre-Workshop Handout With Walter Himmel, Meeta Patel & Anton Helman Instructions for Getting the Most Out of The EMU Stroke Workshop Handout This workshop has been designed around
More informationAnatomy of the Spinal Cord
Spinal Cord Anatomy of the Spinal Cord Anatomy of the Spinal Cord Posterior spinal arteries Lateral corticospinal tract Dorsal column Spinothalamic tract Anterior spinal artery Anterior white commissure
More informationChiari Malformation: Diagnosis
Chiari Malformation: Diagnosis SYMPTOMS DIAGNOSIS LIVING WITH CHIARI TREATMENT Rick Labuda, Executive Director director@conquerchiari.org 724-940-0116 Disclaimer: This presentation is intended for informational
More informationSpinal Cord: Clinical Applications. Dr. Stuart Inglis
Spinal Cord: Clinical Applications Dr. Stuart Inglis Tabes dorsalis, also known as syphilitic myelopathy, is a slow degeneration (specifically, demyelination) of the nerves in the dorsal funiculus of the
More informationSudden Headache and visual disturbances in a young woman
Sudden Headache and visual disturbances in a young woman A. Soupart, MD, PhD Department of Internal Medicine BSIM, December 12, 2014 48 years old woman with Sudden Headache 7/2014 * Admitted for Headache
More informationGuideline scope Subarachnoid haemorrhage caused by a ruptured aneurysm: diagnosis and management
0 0 NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE Guideline scope Subarachnoid haemorrhage caused by a ruptured aneurysm: diagnosis and management The Department of Health and Social Care in England
More informationTHE CERVICAL SPINE: WHAT GUIDES CURRENT 'BEST PRACTICE' IN OSTEOPATHY?
THE CERVICAL SPINE: WHAT GUIDES CURRENT 'BEST PRACTICE' IN OSTEOPATHY? LOS 20th May 2008 Laurence Butler BA(hons); DO(hons); MSc/D.Ost My thanks go to: Barry Jacobs (slides on cervical rotation) Steve
More informationOverview INTRODUCTION 3/15/2018. Headache Emergencies. Other way to differentiate between them? Is there an easy way to differentiate between them?
Overview Headache Emergencies Primary versus Secondary headache disorder Red flags 4 cases of unusual headache emergencies Disclaimer: we will not talk about brain bleed as patients usually go the ED.
More informationFILED: NEW YORK COUNTY CLERK 04/12/ :57 PM INDEX NO /2011 NYSCEF DOC. NO RECEIVED NYSCEF: 04/12/2018
' NYNeurological.- 't Associates, P.C. e 3He e a David Dc vld Snyder, M.D. Emilio Oribe, M.D., F.A.C.P Tonya FOtiml, M.D. Yvonne Zoharckis, M,b. www.nynapc.com July 3, 2017 Sabatini 4 Associates 237 West
More informationAssessing the Stroke Patient. Arlene Boudreaux, MSN, RN, CCRN, CNRN
Assessing the Stroke Patient Arlene Boudreaux, MSN, RN, CCRN, CNRN Cincinnati Pre-Hospital Stroke Scale May be done by EMS o One of many o F facial droop on one side o A arm drift (hold a pizza box, close
More informationBleeding in the brain: haemorrhagic stroke
Call the Stroke Helpline: 0303 3033 100 or email: info@stroke.org.uk Bleeding in the brain: haemorrhagic stroke Some strokes are due to bleeding in or around the brain, and are known as haemorrhagic strokes.
More informationSuspected spinal cord compression form
Suspected spinal cord compression form Enter this form into the notes at the appropriate date in the Progress / Evaluation sheets. Please copy this form to Lisa Lewis, Medical PA (ext 4551), for audit
More informationVERTEBRAL COLUMN ANATOMY IN CNS COURSE
VERTEBRAL COLUMN ANATOMY IN CNS COURSE Vertebral body Sections of the spine Atlas (C1) Axis (C2) What type of joint is formed between atlas and axis? Pivot joint What name is given to a fracture of both
More informationDizziness: Neurological Aspect
Dizziness: Neurological Aspect..! E-mail: somtia@kku.ac.th http://epilepsy.kku.ac.th Features between peripheral and central vertigo 1. Peripheral Central 2.! " # $ " Imbalance Mild-moderate Severe 3.!
More informationProvide specific counseling to parents and patients with neurological disorders, addressing:
Neurology Description: The Pediatric Neurology elective will give the resident the opportunity to learn how to obtain an appropriate history and perform a complete neurologic exam. Four to five half days
More informationEMU 2017 DIZZINESS AND VERTIGO Walter Himmel MD
EMU 2017 DIZZINESS AND VERTIGO Walter Himmel MD There is only one essential challenge in the world of dizziness and vertigo: Don t miss a posterior circulation stroke (vertebral/basilar artery) or TIA.
More informationUF NEUROLOGY HISTORY AND PHYSICAL GUIDELINES
UF NEUROLOGY HISTORY AND PHYSICAL GUIDELINES HISTORY Chief Complaint A maximally succinct statement of the patient age, handedness, gender, main problem, and its duration (e.g. 56 year old right-handed
More informationHerniated Disk in the Lower Back
Herniated Disk in the Lower Back This article is also available in Spanish: Hernia de disco en la columna lumbar (topic.cfm?topic=a00730). Sometimes called a slipped or ruptured disk, a herniated disk
More informationInside Your Patient s Brain Michelle Peterson, APRN, CNP Centracare Stroke and Vascular Neurology
Inside Your Patient s Brain Michelle Peterson, APRN, CNP Centracare Stroke and Vascular Neurology Activity Everyone stand up, raise your right hand, tell your neighbors your name 1 What part of the brain
More informationTIAs and posterior circulation problems
TIAs and posterior circulation problems A/Professor Helen Dewey Head, Stroke Service Austin Health Austin Health How many strokes and TIAs are out there? depends on the definition! ~60,000 strokes in
More informationE X P L A I N I N G STROKE
EXPLAINING STROKE Introduction Explaining Stroke is a practical step-by-step booklet that explains how a stroke happens, different types of stroke and how to prevent a stroke. Many people think a stroke
More informationPRACTICE EXAM QUESTIONS
PRACTICE EXAM QUESTIONS 1. A patient presents with muscle weakness. To assess his condition, you test his knee-jerk reflex by tapping his patella tendon with your hammer. Next you examine the jaw-jerk
More informationMethod Hannah Shotton
#asah Method Hannah Shotton 2 Introduction SAH Rupturing aneurysm Poor outlook Intervention Secure the aneurysm: clipping or coiling Recommended 48 hours Regional Specialist NSC Conservative management
More informationSlide 1. Slide 2. Slide 3. Intro to Physical Therapy for Neuromuscular Conditions. PT Evaluation. PT Evaluation
Slide 1 Intro to Physical Therapy for Neuromuscular Conditions PTA 103 Introduction to Clinical Practice 2 Slide 2 Mental status: consciousness, attention, orientation, cognition Communication: speech
More informationCarotid Artery Dissection Causing an Isolated Hypoglossal. Nerve Palsy
Archives of Clinical and Medical Case Reports doi: 10.26502/acmcr.96550035 Volume 2, Issue 5 Case Report Carotid Artery Dissection Causing an Isolated Hypoglossal Muzzammil Ali*, Yatin Sardana Nerve Palsy
More informationDaniel A Capen MD Downey Orthopedic Group COMPLICATIONS IN CERVICAL AND LUMBAR SPINAL SURGERY
Daniel A Capen MD Downey Orthopedic Group COMPLICATIONS IN CERVICAL AND LUMBAR SPINAL SURGERY Complications in Spinal Surgery Positioning Complications Approach Complications Procedure Complications Post-surgical
More informationCEREBRO VASCULAR ACCIDENTS
CEREBRO VASCULAR S MICHAEL OPONG-KUSI, DO MBA MORTON CLINIC, TULSA, OK, USA 8/9/2012 1 Cerebrovascular Accident Third Leading cause of deaths (USA) 750,000 strokes in USA per year. 150,000 deaths in USA
More informationCLINICAL PRESENTATION AND RADIOLOGY QUIZ QUESTION
Donald L. Renfrew, MD Radiology Associates of the Fox Valley, 333 N. Commercial Street, Suite 100, Neenah, WI 54956 04/26/2014 Radiology Quiz of the Week # 108 Page 1 CLINICAL PRESENTATION AND RADIOLOGY
More informationWORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 1053/08
WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 1053/08 BEFORE: B.L. Cook : Vice-Chair M. Christie : Member Representative of Employers A. Grande : Member Representative of Workers HEARING:
More informationNMH happens when there is an abnormal reflex interaction between the heart and the brain, although both are structurally normal.
Neurally mediated hypotension: is also known as: the fainting reflex, neurocardiogenic syncope, vasodepressor syncope, the vaso-vagal reflex, and autonomic dysfunction. (Hypotension= low blood pressure,
More informationTUMOURS IN THE REGION OF FORAMEN MAGNUM
TUMOURS IN THE REGION OF FORAMEN MAGNUM Abstract Pages with reference to book, From 119 To 122 Naim-ur-Rahman ( Department of Neurosurgery, Rawalpindi Medical College, Rawalpindi. ) A very unusual case
More information