Instant Neurological Diagnosis

2019 ◽  
Author(s):  
Christopher H. Hawkes ◽  
Kapil D. Sethi ◽  
Thomas R. Swift
Keyword(s):  
Cerebrospinal Fluid ◽  
Peripheral Neuropathy ◽  
Video Clip ◽  
Cranial Nerves ◽  
Red Flags ◽  
Spinal Lesions ◽  
Salient Points ◽  
The Right ◽  
Initial Impressions

Experienced neurologists work fast. They ask few questions, maybe perform a brief examination, and they come up with the right answer. Sometimes they do neither and their conclusions are accurate—but how do they do it? This book holds the answers. The book is divided into 14 chapters which, for the most part, focus on a particular neurologic condition, namely: demyelination, headache, epilepsy and sleep, myopathy and motor neuron disorders, movement disorders, stroke, peripheral neuropathy, cerebellar ataxia, and dementia. The remaining chapters are concerned with the clinician’s initial impressions (first encounters), cranial nerves, limbs and trunk, spinal lesions, and cerebrospinal fluid. At the end of each chapter is a summary of the salient points and a few key references. The final chapter relates to the fast neurological examination. Most diagnostic clues or “Handles” are illustrated by a table, figure, or video clip to reinforce a particular message, and the text is marked with Red Flags that the clinician must be alert for.

Instant Neurological Diagnosis

2016 ◽  
Author(s):  
Christopher H. Hawkes ◽  
Kapil D. Sethi ◽  
Thomas R. Swift
Keyword(s):  
Video Clip ◽  
Cranial Nerves ◽  
Diagnostic Process ◽  
Red Flags ◽  
Spinal Lesions ◽  
Salient Points ◽  
Red Flag ◽  
The Right ◽  
Initial Impressions ◽  
Grand Rounds

Experienced neurologists work fast. They ask few questions, maybe perform a brief examination, and come up with the right answer. Sometimes they do neither and their conclusions are accurate—but how do they do it? Traditionally, the diagnostic process includes pattern recognition and probabilistic, causal, or deterministic methods. The aeronautical expert uses so-called demons—which are essentially memorized diagnostic shortcuts that help to solve problems rapidly. In this text they are called Handles. Another complementary diagnostic process is the use of caveats, or Red Flags, which are negative Handles in the sense that if one encounters a Red Flag, then the diagnosis should be reconsidered. This book provides diagnostic shortcuts, collected by the authors through their own observations, with many others identified at grand rounds and conferences. Thus a diagnosis may be reached rapidly by applying a mixture of Handles and Flags. The Handles and Flags are grouped into regions based on standard neurological history and examination, and others in relation to specific diseases. The book contains thirteen chapters, which for the most part focus on a particular neurological condition, namely demyelination, headache, epilepsy and sleep, myopathy and motor neuron disorders, movement disorders, stroke, peripheral neuropathy, cerebellar ataxia, and dementia. The remaining chapters are concerned with the clinician’s initial impressions (first encounters), cranial nerves, limbs and trunk, spinal lesions, and cerebrospinal fluid. At the end of each chapter is a summary of the salient points and a few key references. Most Handles, are illustrated by a table, figure, or video clip to reinforce a particular message.

scholarly journals Gasperini Syndrome: A Case Report and Systematic Review and Proposing a New Definition

2020 ◽  
Vol 12 (3) ◽  
pp. 433-439
Author(s):  
Riwaj Bhagat ◽  
Siddharth Narayanan ◽  
Marwa Elnazeir ◽  
Thong Diep Pham ◽  
Robert Paul Friedland ◽  
...  
Keyword(s):  
Systematic Review ◽  
Brain Mri ◽  
Cranial Nerves ◽  
Clinical Manifestations ◽  
The Other ◽  
Neurological Deficits ◽  
Brainstem Stroke ◽  
Neurological Features ◽  
The Right ◽  
Core Features

Gasperini syndrome (GS), a rare brainstem syndrome, is featured by ipsilateral cranial nerves (CN) V–VIII dysfunction with contralateral hemibody hypoesthesia. While there have been 18 reported cases, the GS definition remains ambiguous. We report a new case and reviewed the clinical features of this syndrome from all published reports to propose a new definition. A 57-year-old man with acute brainstem stroke had right CN V–VIII and XII palsies, left body hypoesthesia and ataxia. Brain MRI showed an acute stroke in the right caudal pons and bilateral cerebellum. After a systematic review, we classified the clinical manifestations into core and associate features based on the frequencies of occurring neurological deficits. We propose that a definitive GS requires the presence of ipsilateral CN VI and VII palsies, plus one or more of the other three core features (ipsilateral CN V, VIII palsies and contralateral hemibody hemihypalgesia). Additionally, GS, similar to Wallenberg’s syndrome, represents a spectrum that can have other associated neurological features. The revised definition presented in this study may enlighten physicians with the immediate recognition of the syndrome and help improve clinical localization of the lesions and its management.

scholarly journals Crayon in the Orbit and Sinuses in a Pediatric Patient

2021 ◽  
pp. 014556132110185
Author(s):  
Michela Borrelli ◽  
Kristen A. Echanique ◽  
Jeffrey Koempel ◽  
Elisabeth H. Ference
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Pediatric Patient ◽  
Cerebrospinal Fluid Leak ◽  
Ethmoid Sinus ◽  
Rare Occurrence ◽  
Lamina Papyracea ◽  
The Right ◽  
Fluid Leak ◽  
Type Of Injury

Penetrating transorbital injury with skull base involvement is a rare occurrence from a crayon. We report a case of a 2-year-old male who sustained a penetrating crayon injury through the right orbit and lamina papyracea into the posterior ethmoid sinus complicated by cerebrospinal fluid leak. There have been no other reported cases of this type of injury by a crayon.

Unusual Transoral Penetrating Injury of the Foramen Magnum: Case Report

Neurosurgery ◽  
2003 ◽  
Vol 53 (4) ◽  
pp. 989-991 ◽  
Author(s):  
Bradley J. Bartholomew ◽  
Charla Poole ◽  
Emilio C. Tayag
Keyword(s):  
Cerebrospinal Fluid ◽  
Unusual Case ◽  
Spinal Injury ◽  
Foramen Magnum ◽  
Penetrating Injuries ◽  
Computed Tomographic ◽  
Foreign Objects ◽  
Computed Tomographic Scan ◽  
Posterior Pharynx ◽  
The Right

Abstract OBJECTIVE AND IMPORTANCE Penetrating injuries of the cranium and spine are frequent to the civilian neurosurgical practice. Although a variety of unusual objects have been reported, to our knowledge, there has never been a craniocerebral or spinal injury caused by a fish. An unusual case of transoral penetration of the foramen magnum by a billed fish is described. The history, radiographic studies, and treatment are presented. CLINICAL PRESENTATION A fisherman struck by a jumping fish initially presented with severe neck pain and stiffness, bleeding from the mouth, and a laceration in the right posterior pharynx. A computed tomographic scan of the cervical spine revealed a wedge-shaped, hyperdense object extending from the posterior pharynx into the spinal canal between the atlas and the occiput. Because of the time factor involved, the fisherman was brought directly to surgery for transoral removal of the object. INTERVENTION The patient was placed under general anesthesia, and with a tonsillar retractor, a kipner, and hand-held retractors, the object was visualized and identified as a fish bill. Further dissection above the anterior aspect of the atlas permitted removal of the object by means of a grabber from an arthroscopic set. No expression of cerebrospinal fluid was noted, and a Penrose drain was placed. CONCLUSION The patient was treated under the assumption that penetrating foreign objects in continuity with the cerebrospinal fluid space and the outside environment should be removed as soon as possible. The patient was provided appropriate antibiotics to treat potential infection of normal pharyngeal flora and organisms unique to the marine environment. The patient recovered and did not experience any residual neurological deficit.

Cerebrospinal Fluid Drainage to Reverse Paraplegia after Endovascular Thoracic Aortic Aneurysm Repair

2000 ◽  
Vol 7 (2) ◽  
pp. 132-135 ◽  
Author(s):  
Kurt Tiesenhausen ◽  
Wilfried Amann ◽  
Günter Koch ◽  
Klaus A. Hausegger ◽  
Peter Oberwalder ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Aortic Aneurysm ◽  
Neurological Deficit ◽  
Thoracic Aortic Aneurysm ◽  
Intrathecal Catheter ◽  
Descending Thoracic Aortic Aneurysm ◽  
Csf Drainage ◽  
Cord Injury ◽  
The Right ◽  
Aneurysm Repair

Purpose: To report a case of endovascular descending thoracic aortic aneurysm (TAA) repair in which delayed-onset paraplegia was reversed using cerebrospinal fluid (CSF) drainage. Methods and Results: A 74-year-old patient with a 6.0-cm TAA underwent endovascular stent-graft repair that involved overlapping placement of 3 Talent devices to cover the 31-cm-long defect. Twelve hours later, a neurological deficit occurred manifesting as left leg paralysis with paresis on the right. After urgent intrathecal catheter placement and drainage of cerebrospinal fluid for 48 hours, the neurological deficit resolved. The patient's clinical condition was normal and endoluminal exclusion of the TAA remained secure at 8-month follow-up. Conclusions: This case demonstrates the potential therapeutic role for CSF drainage to reduce the complications of spinal cord injury after endovascular thoracic aneurysm repair.

Pneumocephalus and CSF leak secondary to skull base fracture by pyrotechnical object: case report

2021 ◽  
Vol 3 (3) ◽  
Author(s):  
Marcos Vilca ◽  
◽  
Carlos Palacios ◽  
Sofía Rosas ◽  
Ermitaño Bautista ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Pressure ◽  
Skull Base ◽  
Rare Complication ◽  
Cerebrospinal Fluid Leak ◽  
Standing Position ◽  
Csf Leak ◽  
Skull Base Fracture ◽  
Timely Diagnosis ◽  
The Right

Introduction: Pneumocephalus is mainly associated with traumatic injuries, being a rare complication but with high mortality rates; it behaves like a space-occupying lesion and increases intracranial pressure. The symptoms are not specific, but in the event of trauma it is necessary to suspect this entity to carry out a timely diagnosis and treatment, since being the product of the skull base fracture it can cause communication with the outside, and the appearance of cerebrospinal fluid (CSF) leak. Clinical Case: a 38-year-old male patient who suffers trauma from a pyrotechnic explosion near his right ear, when handling a pyrotechnic object (whistle) during the New Year, presenting severe pain, slight bleeding in the right ear, feeling faint and holocranial headache that increased in a standing position; likewise, he presents high-flow aqueous secretion (CSF) from the right ear. Brain and skull base tomography (CT) showed air in the intracranial cavity, fracture of the skull base, and the ossicles of the right middle ear. Conservative management was performed using rest and lumbar drainage, presenting a satisfactory evolution. Conclusion: Pneumocephalus is a frequent and expected complication of trauma with a skull base fracture. Its early and timely diagnosis using skull base CT is essential to define therapeutic measures. Accidents due to the misuse of pyrotechnics continue to be a relevant problem in our country. Knowing and disseminating its consequences can help raise awareness in the population. Keywords: Pneumocephalus, Skull Base, Intracranial Pressure, Cerebrospinal Fluid Leak. (Source: MeSH NLM)

Termination for Breach of Contract

2020 ◽  
Author(s):  
Stannard John E ◽  
Capper David
Keyword(s):  
Final Section ◽  
Breach Of Contract ◽  
The Third ◽  
Specific Performance ◽  
The Subject ◽  
Key Topics ◽  
English Law ◽  
The Right ◽  
Legal Consequences

The aims of this book are to set out in detail the rules governing termination as a remedy for breach of contract in English law, to distil the very complex body of law on the subject to a clear set of principles, and to apply the law in a practical context. This book is divided into four parts. The first section sets out to analyse what is involved in termination and looks at some of the difficulties surrounding the topic, before going on to explain the evolution of the present law and its main principles. The second section provides a thorough analysis of the two key topics of breach and termination. The third section addresses the question when the right to terminate for breach arises. And the fourth and final section considers the consequences of the promisee's election whether to terminate or not. The final chapter examines the legal consequences of affirmation, once again both with regard to the promisee and the promisor, with particular emphasis on the extent of the promisee's right to enforce the performance of the contract by way of an action for an agreed sum or an action for specific performance.

scholarly journals Extreme Lateral Supracerebellar Infratentorial Approach to the Lateral Midbrain

2018 ◽  
Vol 79 (S 05) ◽  
pp. S415-S417
Author(s):  
M. Kalani ◽  
William Couldwell
Keyword(s):  
Cranial Nerves ◽  
Sudden Onset ◽  
Superior Cerebellar Artery ◽  
Entry Zone ◽  
Cerebellar Artery ◽  
Sensory Disturbances ◽  
History Of ◽  
Supracerebellar Infratentorial Approach ◽  
The Right ◽  
Piecemeal Resection

This video illustrates the case of a 52-year-old man with a history of multiple bleeds from a lateral midbrain cerebral cavernous malformation, who presented with sudden-onset headache, gait instability, and left-sided motor and sensory disturbances. This lesion was eccentric to the right side and was located in the dorsolateral brainstem. Therefore, the lesion was approached via a right-sided extreme lateral supracerebellar infratentorial (exSCIT) craniotomy with monitoring of the cranial nerves. This video demonstrates the utility of the exSCIT for resection of dorsolateral brainstem lesions and how this approach gives the surgeon ready access to the supracerebellar space, and cerebellopontine angle cistern. The lateral mesencephalic safe entry zone can be accessed from this approach; it is identified by the intersection of branches of the superior cerebellar artery and the fourth cranial nerve with the vein of the lateral mesencephalic sulcus. The technique of piecemeal resection of the lesion from the brainstem is presented. Careful patient selection and respect for normal anatomy are of paramount importance in obtaining excellent outcomes in operations within or adjacent to the brainstem.The link to the video can be found at: https://youtu.be/aIw-O2Ryleg.

Isolated Congenital Absence of Cranial Nerves: Report of Two Cases

2018 ◽  
Vol 49 (06) ◽  
pp. 405-407
Author(s):  
Vivek Agarwal ◽  
Sumeet Dhawan ◽  
Naveen Sankhyan ◽  
Sameer Vyas
Keyword(s):  
High Resolution ◽  
Mr Imaging ◽  
Cranial Nerve ◽  
Clinical Presentation ◽  
Cranial Nerves ◽  
Rare Condition ◽  
Congenital Absence ◽  
The Third ◽  
Seventh Cranial Nerve ◽  
The Right

AbstractIsolated cranial nerve absence is a rare condition that can be diagnosed using high-resolution cranial nerve magnetic resonance (MR) imaging. Thorough clinical examination with proper knowledge of the course of cranial nerves may help diagnose this rare condition. We describe two cases, one each of, isolated congenital absence of the third and seventh cranial nerve with their clinical presentation. High-resolution T2-weighted MR imaging was done in both patients which revealed absence of cisternal segment of the right-sided third nerve and cisternal with canalicular segment of the right-sided facial nerve.

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