Approach To Neurological Disease
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- Pages: 27
Thinking
like
neurologist Is
it
difference? Dr.
Surat
Tanprawate,
MD,
FRCP(T) Northern
Neuroscience
Center Chiangmai
University
Thinking like a Neurologist Where ‘s the lesion? What’s the lesion?
Simply word Complex way
Series of steps to collect data Task Chief complaint
Goal Possible anatomical localiza
History
Neurological examina
Possible anatomical localiza
Differen
Complex brain processing
How to be Jedi… • Basic neuroanatomy • Basic neurophysiology
• Symptoms approach
Symptoms approach‐1 In your head
• Disorder of consciousness – Level of consciousness – Content of consciousness
• Mental disorder – – – – –
Memory Intelligence Personality Behavioral Demen
• Higher cor
– Apraxia, aphasia, agnosia, others
• Visual disorder – Visual loss – Diplopia
Symptoms approach‐2 • Language and speech disorder – Dysarthria – Dysphasia
• Lower cranial nerve disorder – – – – –
Deafness/
In your head
Symptoms approach‐3 In your head
• Sensory disorder – Pain disorder • Headache and facial pain • Others pain disorder
– Numbness/
• Motor disorder – Weakness – Movement disorder
• Sphincter disorder
Symptoms approach‐4 • Episodic disorder – Seizure/epilepsy – Syncope – TIA – Abnormal movement – Migraine
In your head
Skill to collect the data Chief complaint – Get the right data – First step to approach Consist of Group symptoms+ Mode of onset
Common misinterpret symptoms • Palalysis VS • Blur vision VS numbness Diplopia • Dizziness VS • Blackout: loss of weakness VS Fa
Present illness Symptoms Clarify symptom Onset, dura
Onset
Data from CC and PI: What’s and where ‘s the lesion?
If can not interpreted the data Recollect the data
Neurological examina
• Screening neurological examina
• Record neurological sign – – – –
Presence VS Absence Hard signs VS So_ signs Normal VS abnormal Lateralizing sign: • True VS false localizing sign • Normal varia
General neurological examina
• Limb – Voluntary movement – Muscle: bulk, tone, power – Coordina
• Gait and balance • Romberg test
Concept of “so_” neurological sign • “Hard sign”: – neurological sign result from a lesion at a known site or that affect a known pathway
• “So_ sign”: – any structural or func
Concept of “false” localizing sign • True sign that occurs secondary to a lesion elsewhere in the CNS. • The sign is not false, but is distant from the actual site of primary lesion • Cause: – Shi_ of brain: compress or displace structure (distant) or blood vessel (ACA, MCA) – Hydrocephalus: CN 6 palsy, Pretectal (sylvian) syndrome
Differen
List of problems
Integrate of History and PE • First: anatomical localiza
– – – – – – –
Tumor Infect/Inflamma
Thinking outside the box
Example • • • • •
Female, 35 Y.O: SLE pa<ents, on pred. 5 mg/d Presented with acute Rt. Hemiparesis 1 d PTA CT brain: acute Lt. MCA infarc
Organized your thought AF with CHF
Acute stroke
SLE
Acute stroke from AF Others problem is SLE Acute stroke from AF AF from cardiPs CardiPs from SLE
Acute stroke from other caused(non‐AF) SLE associated caused of stroke(vasculiPs, APL) SLE treatment associated caused of stroke(infecPon) AF can caused by stoke?
SLE can caused acute stroke: direct: vasculiPs, APL Ab Indirect: cardiPs, autoimmune endocardiPs AF : direct: cardiPs indirect: Associated autoimmune thyrotoxicosis
Exercise your thought process by Discussion bedside Case record(MGH)
Equipment Needed • Reflex Hammer • 128 and 512 (or 1024) Hz Tuning Forks • A Snellen’s Eye Chart or Pocket Vision Card • Pen Light or Otoscope • Wooden Handled Colon Swabs • Paper Clips
“Neurology tutorial program for medical resident”
Neurological symptomatology Emergency neurology Disease based oriented approach
Thinking like a Neurologist Where ‘s the lesion? What’s the lesion?
Simply word Complex way
Series of steps to collect data Task Chief complaint
Goal Possible anatomical localiza
History
Neurological examina
Possible anatomical localiza
Differen
Complex brain processing
How to be Jedi… • Basic neuroanatomy • Basic neurophysiology
• Symptoms approach
Symptoms approach‐1 In your head
• Disorder of consciousness – Level of consciousness – Content of consciousness
• Mental disorder – – – – –
Memory Intelligence Personality Behavioral Demen
• Higher cor
– Apraxia, aphasia, agnosia, others
• Visual disorder – Visual loss – Diplopia
Symptoms approach‐2 • Language and speech disorder – Dysarthria – Dysphasia
• Lower cranial nerve disorder – – – – –
Deafness/
In your head
Symptoms approach‐3 In your head
• Sensory disorder – Pain disorder • Headache and facial pain • Others pain disorder
– Numbness/
• Motor disorder – Weakness – Movement disorder
• Sphincter disorder
Symptoms approach‐4 • Episodic disorder – Seizure/epilepsy – Syncope – TIA – Abnormal movement – Migraine
In your head
Skill to collect the data Chief complaint – Get the right data – First step to approach Consist of Group symptoms+ Mode of onset
Common misinterpret symptoms • Palalysis VS • Blur vision VS numbness Diplopia • Dizziness VS • Blackout: loss of weakness VS Fa
Present illness Symptoms Clarify symptom Onset, dura
Onset
Data from CC and PI: What’s and where ‘s the lesion?
If can not interpreted the data Recollect the data
Neurological examina
• Screening neurological examina
• Record neurological sign – – – –
Presence VS Absence Hard signs VS So_ signs Normal VS abnormal Lateralizing sign: • True VS false localizing sign • Normal varia
General neurological examina
• Limb – Voluntary movement – Muscle: bulk, tone, power – Coordina
• Gait and balance • Romberg test
Concept of “so_” neurological sign • “Hard sign”: – neurological sign result from a lesion at a known site or that affect a known pathway
• “So_ sign”: – any structural or func
Concept of “false” localizing sign • True sign that occurs secondary to a lesion elsewhere in the CNS. • The sign is not false, but is distant from the actual site of primary lesion • Cause: – Shi_ of brain: compress or displace structure (distant) or blood vessel (ACA, MCA) – Hydrocephalus: CN 6 palsy, Pretectal (sylvian) syndrome
Differen
List of problems
Integrate of History and PE • First: anatomical localiza
– – – – – – –
Tumor Infect/Inflamma
Thinking outside the box
Example • • • • •
Female, 35 Y.O: SLE pa<ents, on pred. 5 mg/d Presented with acute Rt. Hemiparesis 1 d PTA CT brain: acute Lt. MCA infarc
Organized your thought AF with CHF
Acute stroke
SLE
Acute stroke from AF Others problem is SLE Acute stroke from AF AF from cardiPs CardiPs from SLE
Acute stroke from other caused(non‐AF) SLE associated caused of stroke(vasculiPs, APL) SLE treatment associated caused of stroke(infecPon) AF can caused by stoke?
SLE can caused acute stroke: direct: vasculiPs, APL Ab Indirect: cardiPs, autoimmune endocardiPs AF : direct: cardiPs indirect: Associated autoimmune thyrotoxicosis
Exercise your thought process by Discussion bedside Case record(MGH)
Equipment Needed • Reflex Hammer • 128 and 512 (or 1024) Hz Tuning Forks • A Snellen’s Eye Chart or Pocket Vision Card • Pen Light or Otoscope • Wooden Handled Colon Swabs • Paper Clips
“Neurology tutorial program for medical resident”
Neurological symptomatology Emergency neurology Disease based oriented approach
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