CNS Clinical approach: Temporal profile: what the patient has suffered from the start Examination: HMF = higher mental function Pattern of neurological disease: shows severity Seizures/epilepsy = transient epileptic episode – starts all of a sudden and the severity is high – no other signs Disease comes suddenly within a matter of seconds/mins – may remain for some time and then depend ing on other factors gradually the patient may improve – some neurological disease is left after the gradual decrease – if disease comes back, meaning severity increases again then the patient may die = acute neurological disease stroke (vascular, sudden stoppage of blood flow to the neurological system); cerebrovascular disease Another disease, not as acute but similar to the stroke – sudden onset - paralysis and after a few days may be able to talk; onset is very quick but not so acute = SUB-ACUTE; the patient may or may not recover; evidence of infection, fever = infective neurological disease meningitis, cerebral abscess Degenerative neurological disease (demyelinating) = classic example is Alzheimer’s disease; very slow, gradual disease – at first patient may not realize that he/she has the disease Neoplastic (tumor): pattern of degeneration and neoplastic is the same but progression of this is faster with peaks in which may degenerate and then improve just a little bit; tumors compress structures which give rise to compression symptoms – disturbs CSF – causes increase in intracranial pressure; give drugs to bring it down a bit; in this case it does not improve (just as in degenerative diseases) and is faster than degenerative diseases Demyelinating disease: different type of demyelinating disease (compared to degenerative diseases); patient has problem then improves but problem keeps coming back and each time the problem is more severe; the disease will keep on increasing over time but improves in the beginning; example: multiple sclerosis Table that describes time course of neurological symptoms for the different types of disorders Neurological examination: Percussion hammer – elicits knee-jerk reflex Tongue depressor – for cranial nerve examination (9th, 10th, 11th) Tuning fork – tests acuity for hearing; examination of 8th cranial nerve; test for vibration (sensory system)
Cotton: touch sensation, corneal reflex, stereognosis Pin prick: pain sensation Test tube: temperature sensation Measuring tape: nutrition, muscle length, muscle mass Pen torch: light reflex, accommodation reflex CNS exam: HMF: consciousness, cooperation, memory, intelligent, judgement, speech, MMSE/MSQ (mini mental status examination/mental state questionnaire) – p. 41 MMSE: (Mini Mental State Examination) 1. 2. 3. 4. 5. 6. Orientation – time, place, person (10) Registration (3) Attention and calculation (5) Recall (3) Language – questionnaire (9) < 20-21 – significant, cognitive impairment (30)
Cranial Nerves I-XII: Anatomy, Function, Examination Methods Motor system (muscular system/movement) Nutrition Tone Power Abnormal movements Reflexes
Reflexes: response given by body - 10-15 1. 2. 3. 4. 5. Anatomy Types: superficial, deep, visceral Position: ideal Elicitation methods Interpretation
Sensory System: Cooperation of patient Anatomy – dermatome and tracts Types: superficial and deep
Others
Elicitation
Investigations DSA: digital angiogram PET: positron emission T Diagnosis