The Neurologic Examination

2016 ◽  
Author(s):  
Nicholas J Beimer ◽  
Douglas J Gelb
Keyword(s):  
Neurodegenerative Disease ◽  
Neuromuscular Disease ◽  
Medical Specialty ◽  
Emergency Department Visits ◽  
Neurologic Disease ◽  
Neurologic Examination ◽  
Functional Disorders ◽  
Conceptual Approach ◽  
Neurologic Disorders ◽  
Suspected Stroke

All physicians, regardless of their medical specialty or the setting in which they treat patients, must be able to perform a neurologic examination. In the outpatient office, up to 9 to 10% of all symptoms suggest the possibility of neurologic disease and up to 5% of emergency department visits are due to primary neurologic disease. The neurologic examination is critical in triaging these patients, selecting diagnostic tests, and indicating management. This review covers how to think about the neurologic examination, the screening examination, and diagnosis-focused neurologic examinations with an emphasis on stroke, epilepsy, encephalopathy and coma, neurodegenerative diseases, neuromuscular disease, and functional disorders. The figure shows a conceptual approach to the neurologic examination. The tables list components of the screening neurologic examination, neurologic examination focus points for suspected stroke and suspected epilepsy, lateralization and localization of common seizure semiologies, and neurologic examination focus points for encephalopathy/coma, suspected neurodegenerative disease, suspected neuromuscular disease, and suspected functional neurologic disorders. This review contains 1 highly rendered figure, 8 tables, and 14 references. Key words: Neurologic examination, neurodegenerative disease, neuromuscular disease, neurologic screening

The Neurologic Examination

2017 ◽  
Author(s):  
Nicholas J Beimer ◽  
Douglas J Gelb
Keyword(s):  
Neurodegenerative Disease ◽  
Neuromuscular Disease ◽  
Medical Specialty ◽  
Emergency Department Visits ◽  
Neurologic Disease ◽  
Neurologic Examination ◽  
Functional Disorders ◽  
Conceptual Approach ◽  
Neurologic Disorders ◽  
Suspected Stroke

All physicians, regardless of their medical specialty or the setting in which they treat patients, must be able to perform a neurologic examination. In the outpatient office, up to 9 to 10% of all symptoms suggest the possibility of neurologic disease and up to 5% of emergency department visits are due to primary neurologic disease. The neurologic examination is critical in triaging these patients, selecting diagnostic tests, and indicating management. This review covers how to think about the neurologic examination, the screening examination, and diagnosis-focused neurologic examinations with an emphasis on stroke, epilepsy, encephalopathy and coma, neurodegenerative diseases, neuromuscular disease, and functional disorders. The figure shows a conceptual approach to the neurologic examination. The tables list components of the screening neurologic examination, neurologic examination focus points for suspected stroke and suspected epilepsy, lateralization and localization of common seizure semiologies, and neurologic examination focus points for encephalopathy/coma, suspected neurodegenerative disease, suspected neuromuscular disease, and suspected functional neurologic disorders. This review contains 1 highly rendered figure, 8 tables, and 14 references. Key words: Neurologic examination, neurodegenerative disease, neuromuscular disease, neurologic screening

The Neurologic Examination

2016 ◽  
Author(s):  
Nicholas J Beimer ◽  
Douglas J Gelb
Keyword(s):  
Neurodegenerative Disease ◽  
Neuromuscular Disease ◽  
Medical Specialty ◽  
Emergency Department Visits ◽  
Neurologic Disease ◽  
Neurologic Examination ◽  
Functional Disorders ◽  
Conceptual Approach ◽  
Neurologic Disorders ◽  
Suspected Stroke

All physicians, regardless of their medical specialty or the setting in which they treat patients, must be able to perform a neurologic examination. In the outpatient office, up to 9 to 10% of all symptoms suggest the possibility of neurologic disease and up to 5% of emergency department visits are due to primary neurologic disease. The neurologic examination is critical in triaging these patients, selecting diagnostic tests, and indicating management. This review covers how to think about the neurologic examination, the screening examination, and diagnosis-focused neurologic examinations with an emphasis on stroke, epilepsy, encephalopathy and coma, neurodegenerative diseases, neuromuscular disease, and functional disorders. The figure shows a conceptual approach to the neurologic examination. The tables list components of the screening neurologic examination, neurologic examination focus points for suspected stroke and suspected epilepsy, lateralization and localization of common seizure semiologies, and neurologic examination focus points for encephalopathy/coma, suspected neurodegenerative disease, suspected neuromuscular disease, and suspected functional neurologic disorders. This review contains 1 highly rendered figure, 8 tables, and 14 references. Key words: Neurologic examination, neurodegenerative disease, neuromuscular disease, neurologic screening

scholarly journals Patterns of healthcare utilisation for respiratory complications of adults with neuromuscular disease: a population study

2018 ◽  
Vol 52 (3) ◽  
pp. 1800754 ◽  
Author(s):  
Louise Rose ◽  
Douglas McKim ◽  
David Leasa ◽  
Mika Nonoyama ◽  
Anu Tandon ◽  
...  
Keyword(s):  
Emergency Department ◽  
Neuromuscular Disease ◽  
Healthcare Utilisation ◽  
Population Level ◽  
Emergency Department Visits ◽  
Service Utilisation ◽  
Substantial Variation ◽  
Specialist Care ◽  
Respiratory Complications ◽  
Respiratory Specialist

Our objective was to quantify health service utilisation including monitoring and treatment of respiratory complications for adults with neuromuscular disease (NMD), identifying practice variation and adherence to guideline recommendations at a population level.We conducted a population-based longitudinal cohort study (2003–2015) of adults with NMD using hospital diagnostic and health insurance billing codes within administrative health databases.We identified 185 586 adults with NMD. Mean age 52 years, 59% female. 41 173 (22%) went to an emergency department for respiratory complications on average 1.6 times every 3 years; 14 947 (8%) individuals were admitted to hospital 1.4 times every 3 years. Outpatient respiratory specialist visits occurred for 64 084 (35%) with four visits every 3 years, although substantial variation in visit frequency was found. 157 285 (85%) went to the emergency department (all-cause) almost 4 times every 3 years, 100 052 (54%) were admitted to hospital. Individuals with amyotrophic lateral sclerosis/motor neurone disease (ALS/MND) had more emergency department visits compared with other types of NMD (p<0.0001).One-third of adults with NMD received respiratory specialist care at a frequency recommended by professional guidelines, although substantial variation exists. Emergent healthcare utilisation was substantial, emphasising the burden of NMD on the healthcare system and urgent need to improve community and social supports, particularly for ALS/MND patients.

Acoustic Analysis of Voices of Patients with Neurologic Disease: Rationale and Preliminary Data

1988 ◽  
Vol 97 (2) ◽  
pp. 164-172 ◽  
Author(s):  
Lorraine A. Ramig ◽  
Ingo R. Titze ◽  
Ronald C. Scherer ◽  
Steven P. Ringel
Keyword(s):  
Amyotrophic Lateral Sclerosis ◽  
Huntington's Disease ◽  
Huntington’S Disease ◽  
Preliminary Data ◽  
Acoustic Analysis ◽  
Neurologic Disease ◽  
Clinical Value ◽  
Neurologic Disorders ◽  
Speech Pathologist ◽  
Lateral Sclerosis

This paper presents a rationale for acoustic analysis of voices of neurologically diseased patients, and reports preliminary data from patients with myotonic dystrophy, Huntington's disease, Parkinson's disease, and amyotrophic lateral sclerosis, as well as from individuals at risk for Huntington's disease. Noninvasive acoustic analysis may be of clinical value to the otolaryngologist, neurologist, and speech pathologist for early and differential diagnosis and for documenting disease progression in these various neurologic disorders.

Gluten, Inflammation, and Neurodegeneration

2022 ◽  
pp. 155982762110493
Author(s):  
Ashok Philip ◽  
Nicole D. White
Keyword(s):  
Neurodegenerative Disease ◽  
Observational Data ◽  
Study Data ◽  
Interventional Study ◽  
Neurologic Disorders ◽  
Potential Link ◽  
Underlying Mechanisms ◽  
Susceptible Populations

Growing evidence supports a potential link between dietary gluten intake and neurodegenerative disease in susceptible populations. Observational data supporting this link are described along with interventional study data evaluating the effects of restricting gluten from the diet in patients with neurologic disorders. Suggested underlying mechanisms between gluten intake and neurodegeneration are discussed.

scholarly journals Statistical Parametric Mapping Demonstrates Asymmetric Uptake with Tc-99m ECD and Tc-99m HMPAO SPECT in Normal Brain

2011 ◽  
Vol 32 (1) ◽  
pp. 190-198 ◽  
Author(s):  
Benjamin H Brinkmann ◽  
David T Jones ◽  
Matt Stead ◽  
Noojan Kazemi ◽  
Terence J O'Brien ◽  
...  
Keyword(s):  
Single Photon ◽  
Photon Emission ◽  
Statistical Parametric Mapping ◽  
Emission Computed Tomography ◽  
Normal Brain ◽  
Neurologic Disease ◽  
Parametric Mapping ◽  
Hmpao Spect ◽  
Neurologic Disorders ◽  
History Of

Tc-99m ethyl cysteinate diethylester (ECD) and Tc-99m hexamethyl propylene amine oxime (HMPAO) are commonly used for single-photon emission computed tomography (SPECT) studies of a variety of neurologic disorders. Although these tracers have been very helpful in diagnosing and guiding treatment of neurologic disease, data describing the distribution and laterality of these tracers in normal resting brain are limited. Advances in quantitative functional imaging have demonstrated the value of using resting studies from control populations as a baseline to account for physiologic fluctuations in cerebral perfusion. Here, we report results from 30 resting Tc-99m ECD SPECT scans and 14 resting Tc-99m HMPAO scans of normal volunteers with no history of neurologic disease. Scans were analyzed with regions of interest and with statistical parametric mapping, with comparisons performed laterally (left vs. right), as well as for age, gender, and handedness. The results show regions of significant asymmetry in the normal controls affecting widespread areas in the cerebral hemispheres, but most marked in superior parietotemporal region and frontal lobes. The results have important implications for the use of normal control SPECT images in the evaluation of patients with neurologic disease.

Differential Diagnostic Patterns of Dysarthria

1969 ◽  
Vol 12 (2) ◽  
pp. 246-269 ◽  
Author(s):  
Frederic L. Darley ◽  
Arnold E. Aronson ◽  
Joe R. Brown
Keyword(s):  
Amyotrophic Lateral Sclerosis ◽  
Diagnostic Group ◽  
Pseudobulbar Palsy ◽  
Neurologic Disease ◽  
Point Scale ◽  
Motor Functioning ◽  
Neurologic Disorders ◽  
Ataxic Dysarthria ◽  
Lateral Sclerosis ◽  
Cerebellar Disorders

Thirty-second speech samples were studied of at least 30 patients in each of 7 discrete neurologic groups, each patient unequivocally diagnosed as being a representative of his diagnostic group. Three judges independently rated each of these samples on each of 38 dimensions of speech and voice using a 7-point scale of severity. Computer analysis based on the means of the three ratings on each patient on each dimension yielded results leading to these conclusions: (1) Speech indeed follows neuroanatomy and neurophysiology. There are multiple types or patterns of dysarthria, each mirroring a different kind of abnormality of motor functioning. (2) These patterns of dysarthria can be differentiated; they sound different. They consist of definitive groupings of certain dimensions of speech and voice, deviant to distinctive degrees. (3) Five types of dysarthria were delineated: flaccid dysarthria (in bulbar palsy), spastic dysarthria (in pseudobulbar palsy), ataxic dysarthria (in cerebellar disorders), hypokinetic dysarthria (in parkinsonism), and hyperkinetic dysarthria (in dystonia and chorea). Also, a mixed dysarthria combining elements of flaccid and spastic dysarthrias was identified in amyotrophic lateral sclerosis. (4) Observed occurrence of a single dimension uniquely in a given neurologic disease and distinctive co-occurrence of several dimensions can aid diagnostically in identification of neurologic disorders.

Common Neurologic Disorders Affecting the Foot

2004 ◽  
Vol 94 (2) ◽  
pp. 104-117 ◽  
Author(s):  
Rochelle J. Woods ◽  
Richard L. Cervone ◽  
Hubert H. Fernandez
Keyword(s):  
Cerebral Palsy ◽  
Wide Spectrum ◽  
Clinical Manifestations ◽  
Disease Process ◽  
Neurologic Disease ◽  
Neurologic Disorders ◽  
The Common ◽  
Spectrum Of Patients ◽  
Disease Present

Podiatric physicians care for a wide spectrum of patients with neurologic illness. Often, patients with neurologic disease present to their podiatric physician with unrelated complaints that can be easily separated from their underlying neurologic condition. However, some neurologic conditions predictably lead to podiatric disease and, as such, are best treated in the context of the broader disease process. Neuropathies, spastic disorders, and cerebral palsy are examples of common neurologic disorders that can be associated with substantial podiatric manifestations; therefore, it is important for podiatric physicians to be familiar with these conditions. This article reviews the pathophysiology, clinical manifestations, and management of the common neurologic disorders affecting the foot. (J Am Podiatr Med Assoc 94(2): 104-117, 2004)

Mayo Clinic Essential Neurology

2018 ◽  
Author(s):  
Andrea C. Adams
Keyword(s):  
Internal Medicine ◽  
Medical Students ◽  
Mayo Clinic ◽  
Diagnostic Testing ◽  
Neurologic Disease ◽  
Neurologic Examination ◽  
Neurologic Diseases ◽  
Neurologic Symptoms ◽  
Paramedical Personnel ◽  
Source Of Information

Mayo Clinic Essential Neurology, Second Edition, is designed to provide clinicians the necessary neurologic information for the diagnosis and management of these common neurologic problems. This book will be useful to all clinicians who evaluate patients who have neurologic problems. It will also be useful to medical students and residents in neurology, internal medicine, and psychiatry. The book also will be helpful to paramedical personnel who need a concise source of information on outpatient neurologic practice. The book addresses 3 main areas: the neurologic examination and diagnostic testing, common neurologic symptoms, and common neurologic diseases. Neurology is a rapidly changing specialty, with an increasing number of therapeutic options available for managing neurologic disease. Neurologic symptoms such as headache, backache, and dizziness are frequent complaints that cause patients to seek medical care.

Neurologic Disorders Categorized by Mechanism

2012 ◽  
Author(s):  
Brian A. Crum ◽  
Eduardo E. Benarroch ◽  
Robert D. Brown
Keyword(s):  
Infectious Diseases ◽  
Vascular System ◽  
Cerebrovascular Disorders ◽  
Neurologic Disease ◽  
Action Tremor ◽  
Neurologic Disorders ◽  
Ischemic Attack ◽  
Rhythmic Movement Disorder ◽  
Arterial Blockage

Mechanisms of neurologic disease can be cerebrovascular, neoplastic, movement disorders, infectious diseases. The causes of ischemic cerebrovascular disorders can be classified on the basis of the site of the source for the arterial blockage within the vascular system, from most proximal to distal. The causes of ischemic cerebrovascular disorders, including transient ischemic attack and cerebral infarction, can be classified on the basis of the site of the source for the arterial blockage within the vascular system, from most proximal to distal. Tremor is an oscillatory rhythmic movement disorder. A simple classification of tremor is rest tremor and action tremor. Infectious diseases of the nervous system are manifested in various combinations of meningitis, encephalitis, brain abscess, granulomas, and vasculitis.

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