The Outpatient Approach to Dizziness

2021 ◽  
Vol 41 (06) ◽  
pp. 771-780
Author(s):  
Anthony J. Brune ◽  
Eric R. Eggenberger

AbstractThe evaluation of the dizzy patient is complicated by many common pitfalls. The patient's description of symptoms and the standard neurologic examination are often nonspecific or unrevealing, and neuroimaging is most often normal. Over the past several years, research has demonstrated that a refocusing of history taking results in more reliable and diagnostically helpful information. This can guide a targeted expansion of the exam, often with an emphasis on eye movements.

2021 ◽  
Vol 67 (1) ◽  
Author(s):  
Prateek Kumar Panda ◽  
Indar Kumar Sharawat

Abstract Palmar erythema in children can be due to various reasons, such as chronic liver disease, rheumatological disorders, medications, irritant contact dermatitis and atopic dermatitis. Recently, there are few reports about contact dermatitis caused by frequent, daily use of hand sanitizers during this COVID-19 pandemic. A 3-year-old toddler brought with the concern of waxing-waning bilateral palmar erythema for the past 2 weeks. The parents revealed that the child liked the bright color of a recently bought hand sanitizer bottle so much he used to wash his hands every 20–30 min throughout the day. The atypical presentation of contact dermatitis might be because the child was using the sanitizer more frequently during the daytime. The dermatitis resolved with stopping excessive use of the hand sanitizer by the toddler. Clinicians should be aware of contact dermatitis during these pandemic times. Instead of investigating them extensively, careful history taking and merely advising them to judicially utilize the sanitizer can lead to complete reversal of symptoms.


1994 ◽  
Vol 15 (10) ◽  
pp. 391-393
Author(s):  
David M. Tejeda ◽  
Jessica Kaplan ◽  
John S. Andrews ◽  
Catherine DeAngelis ◽  
Neeru Sehgal

This section of Pediatrics in Review reminds clinicians of those conditions that can present in a misleading fashion and require suspicion for early diagnosis. Emphasis has been placed on conditions in which early diagnosis is important and that the general pediatrician might be expected to encounter, at least once in a while. The reader is encouraged to write possible diagnoses for each case before turning to the discussion, which is on the following page. We invite readers to contribute case presentations and discussions. Case 1 Presentation The parents of a 22-month-old boy complain that he has been increasingly clumsy and cranky for the past 7 days. He initially developed a stumbling gait and now prefers to crawl; he no longer can sit on his own. The child has been afebrile but has had a cough for several weeks. He has been on antibiotics for otitis media (with a presumed labyrinthitis) for 5 days. There have been no other recent illnesses, and he has not been ill in the past. On examination, the child appears irritable and has occasional jerking movements of his extremities. His temperature is 36.3°C, pulse is 128 beats/min, and blood pressure is 84/40 mm Hg. Chaotic, irregular eye movements are present.


2016 ◽  
Author(s):  
Luigi Lacchè

This volume gathers together 25 essays dedicated to the history of four important constitutional experiments (France, Belgium, Switzerland and Italy). While it considers these experiments and developments in the 19th and 20th centuries, comparative constitutional history, nevertheless, offers the possibility of obtaining a wider purview. It is in this sense that we can speak of the myth of the English constitution pervading the discourses and language of the French liberals, of Belgium being referred to as “Little England” in Italy, and the Modell Deutschland as increasingly becoming an object of fascination for Italian scholars of public law. In the 1830s Alexis de Tocqueville analysed the situation in Switzerland and compared the different kinds of federalism present in America and in Europe. A European comparative constitutional history, taking up a global perspective, can help us to better decipher two very important issues pertinent to our times: first, for assessing the identity and the constitutional substance of a living common core of the European constitutional traditions; and second, for considering constitutional history as a useful tool to address different levels of global constitutionalism and new trends of governance. History & Constitution offers not only insights into the past, but also provides some guidelines for the future.


Neurology ◽  
2018 ◽  
Vol 91 (13) ◽  
pp. e1255-e1261 ◽  
Author(s):  
Doniparthi V. Seshagiri ◽  
Pramod Kumar Pal ◽  
Sanjeev Jain ◽  
Ravi Yadav

ObjectiveTo characterize the clinical features in patients with spinocerebellar ataxia (SCA) type 1, SCA2, and SCA3 and to evaluate the oculomotor dysfunction by using optokinetic nystagmus (OKN) testing, which may be a sensitive marker.MethodsIn this prospective observational study, all patients underwent detailed neurologic examination with special emphasis on eye movements. OKN was evaluated with a tape. Disease severity was measured with the International Co-Operative Ataxia Rating Scale (ICARS).ResultsA total of 73 genetically confirmed patients were included, of whom 28, 30, and 15 patients were positive for SCA1, SCA2, and SCA3, respectively. Dystonia was more common in patients with SCA3 (46%), and absent ankle jerk was more common in those with SCA2 (21.4%). Brisk deep tendon reflexes were common in patients with SCA1 (46.6%), followed by patients with SCA3 (26.6%) and SCA2 (7.1%). Vertical OKN was impaired in all patients and absent in 86.6% of patients with SCA1, 96% of those with SCA2, and 80% of those with SCA3. Horizontal OKN was absent in 30% of patients with SCA1, 57% of patients with SCA2, and 33% of those with SCA3. Higher motor disability (posture and gait, kinetic functions [Motor Disability] subscore on the ICARS) was associated with higher oculomotor dysfunction measured by OKN-saccades impairment grading but not with the Ocular Disorder subscore of ICARS (ICARS-OD).ConclusionOKN-saccades are a better and sensitive bedside clinical tool to quantify oculomotor dysfunction in neurodegenerative ataxias. Its role needs to be tested further in presymptomatic carriers. The current ICARS-OD scale to grade oculomotor dysfunction in degenerative ataxias need to be modified.


1962 ◽  
Vol 108 (455) ◽  
pp. 457-465 ◽  
Author(s):  
Ralph J. Berger ◽  
Ian Oswald

In the course of the past few years, a series of related studies (Aserinsky and Kleitman, 1955; Goodenough et al., 1959; Wolpert and Trosman, 1958) has demonstrated beyond doubt the association of normal dreaming with the appearance of rapid, binocularly synchronous eye-movements. It has also been claimed that the rapid eye-movements (REMs) represent scanning movements made by the dreamer as he “watches” the visual events of the dream (Dement and Kleitman, 1957a; Dement and Wolpert, 1958). The REMs are absent during dreaming among those with life-long blindness, but are retained for some years by those whose blindness arises later than childhood (Berger et al., 1962a). In a study of undisturbed nocturnal sleep by Dement and Kleitman (1957b) periods of eye-movements were observed to occur fairly regularly at about 90-minute intervals throughout the night in association with the lightest phases of cyclic variation in depth of sleep, as indicated by the electroencephalogram (EEG). These REM periods had a mean duration of about 20 minutes, and 4–6 occurred per night.


2021 ◽  
Vol 15 ◽  
Author(s):  
Ziad M. Hafed ◽  
Masatoshi Yoshida ◽  
Xiaoguang Tian ◽  
Antimo Buonocore ◽  
Tatiana Malevich

Visual selection in primates is intricately linked to eye movements, which are generated by a network of cortical and subcortical neural circuits. When visual selection is performed covertly, without foveating eye movements toward the selected targets, a class of fixational eye movements, called microsaccades, is still involved. Microsaccades are small saccades that occur when maintaining precise gaze fixation on a stationary point, and they exhibit robust modulations in peripheral cueing paradigms used to investigate covert visual selection mechanisms. These modulations consist of changes in both microsaccade directions and frequencies after cue onsets. Over the past two decades, the properties and functional implications of these modulations have been heavily studied, revealing a potentially important role for microsaccades in mediating covert visual selection effects. However, the neural mechanisms underlying cueing effects on microsaccades are only beginning to be investigated. Here we review the available causal manipulation evidence for these effects’ cortical and subcortical substrates. In the superior colliculus (SC), activity representing peripheral visual cues strongly influences microsaccade direction, but not frequency, modulations. In the cortical frontal eye fields (FEF), activity only compensates for early reflexive effects of cues on microsaccades. Using evidence from behavior, theoretical modeling, and preliminary lesion data from the primary visual cortex and microstimulation data from the lower brainstem, we argue that the early reflexive microsaccade effects arise subcortically, downstream of the SC. Overall, studying cueing effects on microsaccades in primates represents an important opportunity to link perception, cognition, and action through unaddressed cortical-subcortical neural interactions. These interactions are also likely relevant in other sensory and motor modalities during other active behaviors.


2021 ◽  
Vol 5 (1) ◽  
pp. 114-126
Author(s):  
Adam B. Cohen ◽  
Brain V. Nahed

Digital health has been rapidly thrust into the forefront of care delivery. Poised to extend the clinician’s reach, a new set of examination tools will redefine neurologic and neurosurgical care, serving as the basis for the <i>digital neurologic examination</i>. We describe its components and review specific technologies, which move beyond traditional video-based telemedicine encounters and include separate digital tools. A future suite of these clinical assessment technologies will blur the lines between history taking, examination, and remote monitoring. Prior to full-scale implementation, however, much more investigation is needed. Because of the nascent state of the technologies, researchers, clinicians, and developers should establish digital neurologic examination requirements in order to maximize its impact.


Author(s):  
Patricia Sylla

History taking and physical examination 2 The significance of the past medical, social, and drug history in assessing emergencies and admissions 8 Assessment of patients undergoing surgery 12 Assessing the elderly 18 Physical examination 20 Differential diagnosis of 'the swollen face' by region 24 Preliminary assessment of multiple-injured patients—general points ...


Author(s):  
Donald W. Winnicott

Chapter 1 of Clinical Notes on Disorders of Childhood. In this chapter, Winnicott argues for the importance of history taking in child medicine: the past history of the child, the family history, and the history of onset of the illness. He gives several cases which illustrate the value to the physician of taking the time to hear a full history.


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