The Fast Neurological Examination

2019 ◽  
pp. 385-388
Author(s):  
Christopher H. Hawkes ◽  
Kapil D. Sethi ◽  
Thomas R. Swift
Keyword(s):  
Neurological Examination ◽  
Cranial Nerves ◽  
Suggested Approach

The final chapter is a coalescence of material already detailed in earlier chapters but in a form that will save time in the clinic. The suggested approach is for the patient you wish to screen, having predicted from the history that there will be few physical signs. This would apply to most patients with nonspecific headache and dizziness for example. The cranial nerves are listed first followed by brief examination of limbs.

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.

scholarly journals Bromide toxicosis (bromism) secondary to a decreased chloride intake after dietary transition in a dog with idiopathic epilepsy: a case report

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Marco Fantinati ◽  
Nathalie Priymenko ◽  
Maud Debreuque
Keyword(s):  
Neurological Examination ◽  
Cranial Nerves ◽  
Chloride Content ◽  
Potassium Bromide ◽  
Idiopathic Epilepsy ◽  
Dietary Modification ◽  
Clinical Report ◽  
Dietary Changes ◽  
Dietary Transition

Abstract Background Bromide is a halide ion of the element bromine usually administered in the form of potassium salt as monotherapy or add-on treatment in epileptic dogs. It is excreted unchanged in the urine and undergoes tubular reabsorption in competition with chloride. Thus, dietary chloride content affects serum bromide concentrations. This is the first published clinical report of bromide toxicosis secondary to a dietary modification of chloride content in an epileptic dog treated with potassium bromide. Case presentation A 3-year-old 55-kg neutered male Tibetan Mastiff was evaluated because of a 1-month history of progressive signs including ataxia, lethargy and behaviour changes. The dog was successfully treated for idiopathic epilepsy since the age of 1-year-old with phenobarbital and potassium bromide. Two months prior to presentation, the owners decided to change the dog’s diet without veterinary advice. Physical examination was unremarkable. A 12-kg weight gain was recorded since last follow-up (8 months). Neurological examination revealed severe symmetric 4-limbs ataxia with altered vigilance and intermittent episodes of hyperactivity and aggressive behaviour without significant abnormality of cranial nerves. Serum bromide concentration was high and increased by 103 % since last follow-up. Nutritional evaluation revealed a 53 % decrease of chloride content in the diet before and after dietary transition. Bromide toxicosis was suspected, due to bromide reduced clearance secondary to the decreased dietary chloride content. Potassium bromide treatment was lowered by 15 % without further dietary changes. Neurologic signs progressively improved over the next month, without any seizure. After two months, the serum bromide concentration lowered to the same level measured before dietary modification. After four months, neurological examination was unremarkable. Conclusions Dietary chloride content can directly influence serum bromide concentrations, therefore affecting seizure control or contributing to unexpected adverse effects. In the present case, a reduction in chloride intake markedly increased serum bromide concentrations causing bromism. Dietary changes should be avoided in dogs treated with potassium bromide to maintain stable serum bromide levels.

The anatomical basis of the neurological examination

2010 ◽  
pp. 2-34
Author(s):  
George Samandouras
Keyword(s):  
Cerebral Cortex ◽  
Neurological Examination ◽  
Motor System ◽  
Cranial Nerves ◽  
Sensory System ◽  
Anatomical Basis

Chapter 1.1 cover the anatomical basis of the neurological examination, including the cerebral cortex, the cranial nerves, motor system examination, sensory system examination, reflexes, gait, and the cerebellum.

Clinical approach

2012 ◽  
Author(s):  
Rob Forsyth ◽  
Richard Newton
Keyword(s):  
Nervous System ◽  
Cognitive Function ◽  
Peripheral Nervous System ◽  
Neurological Examination ◽  
Real World ◽  
Cranial Nerves ◽  
Clinical Approach ◽  
History Taking

The consultation 2What, where, and when 4History taking 6Examination 8Higher cognitive function 13Cranial nerves 16Peripheral nervous system 25Neonatal neurological examination 41Real world examination sequences 45Synthesis 49‘I've learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.’ ...

Rarely Seen Poland–Moebius Syndrome: A Comprehensive View with Perspective of Pediatric Neurology

2019 ◽  
Vol 18 (03) ◽  
pp. 161-165
Author(s):  
Cengiz Havalı ◽  
Dilek Damla Saymazlar ◽  
Zeynep Öztürk
Keyword(s):  
Eye Movements ◽  
Neurological Examination ◽  
Pectoralis Major Muscle ◽  
Cranial Nerves ◽  
Rare Condition ◽  
Abdominal Ultrasound ◽  
Pectoralis Major ◽  
Poland Syndrome ◽  
Moebius Syndrome ◽  
Pediatric Neurology

Background Moebius syndrome is a rare congenital disorder characterized by a unilateral or bilateral congenital facial weakness with impairment of ocular movements. Poland syndrome is an occasional disease defined as the unilateral absence of pectoralis major muscle and ipsilateral syndactyly. As to, Poland–Moebius syndrome is a rare condition which consists of assembly components of Poland and Moebius syndromes. Patients and Methods Patient 1 is a 12-year-old male patient referred for evaluation of difficulties in eye movements to the hospital. On admission, facial, abducens, trochlear, and oculomotor cranial nerves involvement was determined in the neurological examination. His right pectoralis major muscle was hypoplastic in the examination. Patient 2 is a 4-month-old female patient who was admitted with restricted eye movements, weakness of crying, and difficulty in swallowing. Neurological examination indicated facial, abducens, trochlear, oculomotor, glossopharyngeal, and vagus cranial nerves involvement. Her physical examination demonstrated hypoplastic left pectoralis major muscle and hypoplastic left hand. Results The biochemical laboratory studies, creatinine kinase levels, and tests for inborn error of metabolism of both patients were normal. Chest X-ray studies revealed the lack of muscle tissue development in the left pectoral region. Cranial magnetic resonance imaging, echocardiography, and abdominal ultrasound were also normal. Conclusion This report highlights two cases of Poland–Moebius syndrome in two patients of varying age and clinical presentations, with a comprehensive review from the perspective of pediatric neurology.

scholarly journals Acute Trigeminal Nerve Neuritis in German Shepherd

2019 ◽  
Vol 48 ◽  
Author(s):  
Patrícia Negri Castro ◽  
Letícia Dominici Arroyo ◽  
Pâmela Rodrigues Reina Moreira ◽  
Victor José Vieira Rosseto ◽  
Giuliano Queiroz Mostachio ◽  
...  
Keyword(s):  
Trigeminal Nerve ◽  
Neurological Examination ◽  
Present Report ◽  
Systemic Disease ◽  
Cranial Nerves ◽  
Nerve Fibers ◽  
Spinal Reflexes ◽  
Unknown Etiology ◽  
German Shepherd ◽  
Temporal Muscle

Background: Trigeminal nerve is composed by ophthalmic, maxillary and mandibular portion, presenting sensory and motor functions. Its most common conditions include vascular, neoplastic, infectious and inflammatory causes. Neuritis is an inflammation caused by a primary nerve injury that can progress to demyelination and even degeneration of nerve fibers. The present report aims to describe an unusual case of a female dog, German Shepherd breed, with acute manifestation of trigeminal nerve neuritis whose etiology may be associated with erlichiosis, since infection with Ehrlichia spp. through serological test was verified.Case: A 3-year-old female German Shepherd , weighing 26.8 kg and not neutered, was attended at Veterinary Hospital Dr. Halim Atique - UNIRP, São José do Rio Preto, SP, Brazil presenting apathy, sialorrhea and polydipsia for seven days. The tutor reported an episode of foamy and yellowish vomit three days ago and ixodidiosis last week. Physical examination revealed flaccid open-mouthed posture, with mild bilateral masseter and moderate temporal muscle atrophy. Water was offered to the animal and it was observed that it could not properly seize, confirming a false polydipsia. The neurological examination revealed a slight decrease in head sensitivity, difficulty in chewing and seizure of food. It was not observed alterations in the other pairs of cranial nerves or other neurological parameters (postural reactions and spinal reflexes), and the diagnose of bilateral dysfunction of the trigeminal nerve was based on the affected neuroanatomic region. On neurological examination, other lesions of the nervous system were ruled out, suggesting an isolated manifestation of the trigeminal nerve. CBC revealed anemia, intense thrombocytopenia and leukocytosis by neutrophilia. Radiographic examination ruled out the possibility of trauma due to the absence of mandible fracture and also temporomandibular joint alterations. Masseter and temporal muscle biopsy were performed, and myositis or other masticatory muscle alterations were discarded among the diagnostic possibilities. Serological tests showed non-reactive results for toxoplasmosis and neosporosis, but reagent for Erlichia spp.Discussion: Idiopathic trigeminal neuritis (ITN) has an unknown etiology, but is not related to signs of systemic disease, and is usually not associated with deficits in other cranial nerves. The main clinical sign related to this condition is acute jaw paralysis, with inability to close the mouth, and in some cases is observed sensitivity deficits in face, as observed in the dog of this report during the neurological examination. In the patient of the present report, no justifiable causes were found for the presented symptoms, except the presence of erlichiosis. The treatment was based on the use of prednisone, doxycycline, antioxidants and vitamin complex. Response to treatment was satisfactory after seven days, and complete remission of clinical signs occurred nine days after its onset. Although cranial nerve neuritis is an uncommon clinical manifestation of erlichiosis, the patient in this study presented a good response to the treatment instituted, suggesting that erlichiosis is an important differential diagnosis for neuritis.

WP1-25 Improving neurological examination in acute admission: the INSPECT method

2019 ◽  
Vol 90 (3) ◽  
pp. e8.1-e8
Author(s):  
M Islam
Keyword(s):  
Retrospective Study ◽  
Hospital Stay ◽  
Eye Movement ◽  
Neurological Examination ◽  
Cranial Nerve ◽  
Cranial Nerves ◽  
Length Of Hospital Stay ◽  
Motor Power ◽  
General Survey ◽  
Time Of Admission

ObjectivesClerking proforma in the trust includes a detailed neurology examination which is mandatory to fill up according to the trust guideline. Incomplete neurological examination at the time of admission significantly increases length of hospital stay and hamper the overall prognosis.DesignA retrospective study was conducted for 2 weeks on 60 patients clerked in AMU. A general survey was conducted among 26 doctors to detect the possible reasons and suggestions.To ensure every patient gets a quick and accurate neurological examination during clerking, we suggested a new mnemonic method called ‘INSPECT’: I – Inspection ( GCS, GAIT), N- Neck Rigidity, S –Speech, sensory P- Pupil E- Eye movement, C –Cerebellar and Cranial Nerves, T- (Tone, Power, Reflexes).ResultsThe primary audit revealed that the neurology proforma completed in 18.3% notes, Partially completed – 43.2% Not completed – 38.5% and frequently missed examinations were Cranial Nerve examination: 68.3%, Sensory: 56.2% Cerebellar: 42.1%, Motor power: 21% Doctor’s survey revealed reasons behind examinations not being carried out: Time consuming: 46.1%, Not relevant: 23.07%. Not enough training 15.38%.ConclusionsResults showed that only 18.3% patients had complete neurological examination, mostly missed cranial nerves examination ( 68.3% ) Survey suggested time constraint is a major issue ( 46.1% ) and quicker assessment and concise proforma will help. The suggested method will be re-audited in 3 months time.

scholarly journals Neurological examination in the healthy term newborn

2003 ◽  
Vol 61 (2A) ◽  
pp. 165-169 ◽  
Author(s):  
Fleming S. Pedroso ◽  
Newra T. Rotta
Keyword(s):  
Neurological Examination ◽  
Cranial Nerves ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Primitive Reflexes ◽  
Term Newborns ◽  
Different Populations ◽  
Neurologically Normal ◽  
Tendon Reflexes

We carried out a cross-sectional study with a sample of 106 normal full-term newborns examined within 24 to 72 hours of birth. The following findings were evaluated: head and chest measurements, muscle strength, tone, tendon reflexes, superficial reflexes, primitive reflexes, and cranial nerves. All 106 newborns were considered neurologically normal. We found no differences in the neurological examination findings for newborns with different gestational ages. Primitive reflexes and appendicular tone in newborns examined at earlier postnatal ages tended to be less intense. We were able to determine the prevalence of certain neurological examination findings for the normal newborn and to discuss some differences between our results and those of other studies. Prevalence estimations for the different findings in our study may be valid for different populations as long as the same methodology is adopted.

scholarly journals Olfactory, trigeminal, facial, glossopharyngeal and vagus nerves: links with sars-cov-2 and neurosemiological prospects

2020 ◽  
pp. 20-25
Author(s):  
Jorge Duque Parra ◽  
Alex Pava Ripoll ◽  
José Fernando Marín Arias
Keyword(s):  
Nasal Mucosa ◽  
Neurological Examination ◽  
Cranial Nerves ◽  
Sensory Transduction ◽  
Vagus Nerves ◽  
Symptoms And Signs

A brief review of olfactory, facial, glossopharyngeal and vagus nerves is presented, the first one functionally related to odoriferous chemosensory innervation in the nasal mucosa, the following four cranial nerves to endocranial headache and oropharyngeal mucosa for purposes of gustatory sensory transduction. These nerves are associated with symptoms in Covid-19 positive patients, which dysosmia, anosmia, dysgeusia, ageusia manifestation, among other neurosemiological characteristics. It is concluded that these semiological characteristics may be due to neurotropic and transynaptic mechanisms, therefore a more rigorous neurological examination should be performed on symptoms and signs of Covid-19 patients.

Human Neurofibromas in Co-Culture with Mouse Neurons

1982 ◽  
Vol 40 ◽  
pp. 194-195
Author(s):  
R.L. Martuza ◽  
T. Liszczak ◽  
A. Okun ◽  
T-Y Wang
Keyword(s):  
Schwann Cell ◽  
Schwann Cells ◽  
Genetic Disorder ◽  
Cranial Nerves ◽  
Sympathetic Nerves ◽  
Acoustic Neuromas ◽  
Spinal Roots ◽  
Neural Crest Origin ◽  
Multiple Abnormalities ◽  
Other Neoplasms

Neurofibromatosis (NF) is an autosomal dominant genetic disorder with a prevalence of 1/3,000 births. The NF mutation causes multiple abnormalities of various cells of neural crest origin. Schwann cell tumors (neurofibromas, acoustic neuromas) are the most common feature of neurofibromatosis although meningiomas, gliomas, and other neoplasms may be seen. The schwann cell tumors commonly develop from the schwann cells associated with sensory or sympathetic nerves or their ganglia. Schwann cell tumors on ventral spinal roots or motor cranial nerves are much less common. Since the sensory neuron membrane is known to contain a mitogenic factor for schwann cells, we have postulated that neurofibromatosis may be due to an abnormal interaction between the nerve and the schwann cell and that this interaction may be hormonally modulated. To test this possibility a system has been developed in which an enriched schwannoma cell culture can be obtained and co-cultured with pure neurons.

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