Chapter one
THE NEUROLOGICAL DIAGNOSIS
It is useful to think of the neurological diagnosis as a three step process. The first step is to make a topographical diagnosis, i.e. to locate the lesion that is responsible for the patient’s symptoms, because almost every neurological disorder has a tendency to occur in a specific part or parts of the nervous system. For example, the plaques of multiple sclerosis have a predilection for the visual pathways, cerebellum, brain stem and spinal cord. Therefore, localisation of a lesion to a specific part of the nervous system narrows down the number of possible diagnoses. However, since several diseases may affect the same part of the nervous system the second step involves a further diagnostic workup to differentiate between the various possible disorders. The final step is to confirm the provisional clinical diagnosis with laboratory tests.
The topographical diagnosis is made by
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Apart from few specific points, the format of taking a neurological history is similar to that of general medicine. But, in contrast to general medicine, it is often necessary to ask neurological patients, at the end of the consultation, to repeat parts of the history because inconsistencies usually suggest impairment of memory or attention. Inconsistencies in reporting the symptoms are also an important feature of functional (conversion) disorders. It is also equally important to establish what the patient exactly means when he uses ambiguous words or phrases, e.g. collapsed, felt dizzy, etc. In addition, the clinician should allow the patient to describe his symptoms without unnecessary interruptions and he should avoid asking leading questions. Enquiry should also be made about the onset, progression and course of the
○ Confirmation of diagnosis is made by radiographic examination of the skull (i.e., MRI of the head)
of the day. Whether the challenges are mental or purely physical. We have found more
Dzevdet Smajlovic, professor from the Department of Neurology at the University of Tuzla in Bosnia stated that
The patient is a 59-year-old right-handed white female who was admitted in June to Portsmouth Regional Hospital for what was determined to be either transient global amnesia or complicated migraine. I did review those notes. She was seen by Galina Simkin, MD. The symptomatology discussed in the H&P is consistent with transient global amnesia. She was having problems asking questions inappropriately, repeating sentences, repeating questions over and over again, and seeming somewhat confused. There were no other neurological symptoms at that time. No evidence for seizure activity. No evidence for stroke. She was brought to the emergency room, where she underwent a CAT scan, which was
For the pass this assignment will describe the investigations that are carried out to enable the diagnosis of these physiological disorders. For the merit this assignment will assess possible difficulties involved in the diagnosis from their signs and symptoms.
1. Review and analyze the laboratory data. What diagnosis is supported by these values? Give your rationale.
Doctors administer a variety of strategies to diagnose dementia (National Institute of Neurological Disorders and Stroke). It is extremely important that all treatable conditions first be ruled out, such as depression and Vitamin B12 deficiency, which can cause the same type of symptoms as dementia (National Institute of Neurological Disorders and Stroke). Timely and accurate diagnosis of dementia is extremely important for both the patient and their families because it allows early treatment of symptoms (National Institute of Neurological Disorders and Stroke). A variety of tests are used to aid in the diagnosis process, such as neurological evaluations, in which doctors look specifically at patients’ balance, sensory responses, reflexes, and various other functions (National
Write a brief description of the three slides (Neuron, Spinal Cord Smear and C.S of Myelinated Nerve Fibers) as though you were explaining it to someone who cannot see the slide.
Impaired memory R/T neurologic disturbances AEB patient unable to recall recent events. She was to take part in the nursing facilities exercise program more often; this was to promote her physical and psychological well-being (Cox, 2007). Upon visiting her the second time it was clear that she had followed my suggestions. She was able to walk around her room more freely with the aid of her walker, which she did not use as much before. She was also able to recall our last meet in some detail, verbalizing recall of some recent events. The patient is consistent in her routine of care, which aided in her ability to recall events (Cox, 2007). The sense of familiarity form a consistent routine assisted the patient in being able to recall events.
He is alert, attentive, oriented x3. Normal attention and concentration. Normal fund of knowledge. No language errors noted during this exam. Memory testing reveals some problems with short-term memory and amnesia for the event. Patient also was noted to have difficulty following simple and multi-step commands with a slowed comprehension speed.
This work coined the term neurology, and was not the result of his own personal and unaided exertions; he acknowledged his debt to Sir Christopher Wren, who provided drawings, Thomas Millington, and his fellow anatomist Richard Lower. It abounds in new information, and presents an enormous contrast with the vaguer efforts of his predecessors.
Patient 1 – Two individuals come to the emergency department with head injuries. One is a 25 years old, has just been in a motor vehicle accident (MVA) and has a temporal lobe injury. The other, 65 years old, has increasing confusion after a fall that happened earlier in the week.
• In same position (with the ventral surface downward), make a longitudinal cut along the longitudinal fissure using a scalpel all the way down, and separate the cerebral hemispheres. • Identify the corpus callosum, white and gray matters of the brain, thalamus, hypothalamus, lateral ventricle, and pineal gland. • After finishing
In the hospital, Auguste D. was a patient of Alois Alzheimer, a German neurologist who had a particular interest in the microscopic analysis of brain disorders. He describes the clinical features of Auguste D. condition and
Through a medical approach, we have discovered some symptoms that illustrate this fact in the case