New PDF release: Practicing Neurology: What You Need to Know 2nd Edition

By Rahman Pourmand

ISBN-10: 1588296091

ISBN-13: 9781588296092

ISBN-10: 1597452971

ISBN-13: 9781597452977

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Extra info for Practicing Neurology: What You Need to Know 2nd Edition (Current Clinical Neurology)

Example text

Gaze palsy. Nystagmus. Dysarthria. Alteration of mental status and coma at the onset in of an acute severe brain stem lesion. 8. Extra-axial versus intra-axial brainstem lesion. Suspect extra-axial lesion (without compressing brainstem) when multiple cranial nerve dysfunction is not associated with motor sensory deficit or altered mental status. Acoustic neuroma, meningioma, epidermoid cyst, and aneurysm are few causes of extra-axial brainstem lesion. 9. Pseudobulbar palsy. Lesions involving bilateral corticobulbar tracts manifest as dysarthria, dysphagia, drooling of the mouth, and a labile affect (inappropriate laughing or crying).

Conditions which plexopathies are associated with: • Unilateral motor and sensory deficits in the distribution of more than one root and nerve. Common Neurological Constructs 45 • Muscle atrophy (later stages). • Hypo- or areflexia. 21. Conditions that could cause weakness and atrophy of the hand muscles could be due to: • C8–-T1 radiculopathy. • Lower trunk brachial plexopathy. • Median and ulnar mononeuropathies (carpal and cubital tunnel syndromes). For the first two conditions, always look for the presence of Horner’s syndrome and sensory deficit in the medial aspect of the forearm; for the latter condition, the strength of flexor pollicis longus muscles is intact (innervated by anterior interosseus nerve).

Hands in the elderly (senile hands) may appear to have intrinsic muscles wasting, but strength (grip) is good when tested. Clinical Hints Subtle unilateral weakness because of an UMN lesion can be detected by the following testing: • Pronator drift sign: Ask the patient to hold the arms out in front with the palms up and fingers open, and close the eyes. Downward drifting of the arms with pronation of the hand indicates weakness because of UMN. 22 Practicing Neurology • Test strength of the wrist extensors.

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Practicing Neurology: What You Need to Know 2nd Edition (Current Clinical Neurology) by Rahman Pourmand


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