neurological symptoms د.محمد سلام

8/3/2019 Neurological symptoms .

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Headache (Migraine, Tension) :.Onset.Time.Character

.Severity

.Duration

.Frequency

.site

.associated feature as vomiting or visual disturbances

.aggravating factors

.Relieving factors.

Neurological symptoms


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Visual disorder :

. Impairment

.Diplopia

.Hallucination

.Illusion .Loss of consciousness :.Tongue pitting.Incontinence.Limb twitching.Alcohol& drugs

.head injury

.CVS & Respiratory symptoms.


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Speech disorder :.Difficult in forming words

.Difficult in expression.Difficult in understanding.Motor disorder :.Inco-ordination (balance)

.weakness

.Involuntary movement.Sensory disorder :.Pain

.Numbness

.Tingling

.Site.


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Sphincter disorder : (anal, bladder)

.Incontinence

.retention.Lower cranial nerves disorder:.Deafness

.Tinnitus

.Vertigo

.Balance

.Swallowing difficulty

.Voice change.


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Mental disorder:

.Memory disturbance

.Intelligence

.Personality

.Behavior


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Diagnosis of Nervous System disordersThe most common diseases or clinicalproblems encountered in a general

neurological outpatients clinic are:1-Headache and face pain2-Blackout and epilepsy3-Peripheral nerve and root disorders

4-Cerebrovascular disease5-Multiple sclerosis6-Parkinsonism and movement disorders7-Dementia8-Giddiness and vertigo10-Psychologically determined symptoms(headache, facial pain, spinal pain, tremor,blackouts)


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History taking-A.History taking is fundamental toneurological diagnosis (epilepsy,

migraine)..The history is usually much moreinformative than examination, whichgenerally is either reassuringly normal or

merely confirms features anticipated fromthe history.. No particular list of questions to ask..It is best to invite the patients to describetheir symptoms in the order in which theyoccurred, with approximate dates..Important detail can be clarified by specialquestioning during or after the patient'saccount.


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Time course

.Symptoms of abrupt or instantaneous onset

(epilepsy, CVA, ).Symptoms that deteriorate sub acutelyover hours, days, or even a few weeks aregenerally caused by inflammatory or

demyelinating disorders..Slowly deteriorating symptoms over someweeks, months, or years point to thegrowth of tumor, or neurodegenerative

process..Relapsing and remitting symptoms, whichcome and go over weeks, are typically ofMS.


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Negative symptoms

In which the normal neurological functionsare lost, e.g. hemi paresis, memory loss in

Alzheimer's disease, muscle weakness dueto motor neuron degeneration, or loss ofmicturition control due to quada equinatumor.


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Positive symptomsPositive symptoms are novel phenomenawhich often suggest specific diagnosis.

.A pill-rolling tremor of the fingers andthumb at rest is characteristic ofParkinson's disease..Flashing light (photopsia) or zigzag lines

preceding a headache are diagnostic ofclassic migraine..Repetitive twitching of the fingers or thecorner of the mouth occur in focal motorseizures..A hallucination of an odd smell, often likeburning rubber, is typical of an epilepticdischarge in the temporal lobe.


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Neuroanatomical localizationSometimes enquiry about other specific symptoms

is necessary to localize the disease processanatomically..Patient with suspected motor neuron diseaseshould be asked whether there are sensory orsphincter symptoms which might point to the

alternative diagnoses of generalized peripheralneuropathy or to spinal cord compression..A patient with sensory symptoms in the legsshould be asked whether their hands are alsoaffected; this would be a pointer to a

polyneuropathy or cervical myelopathy ratherthan a focal lesion of the cauda equina orthoracic spinal cord..Question a patients with gait unsteadiness aboutvertigo or double vision, which would implydamage to the brain stem rather than to thecerebellum or somatosensory pathways.


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Eye witness descriptionPatients with blackout are unaware of whatthey did while unconscious and may notrecollect the onset of the blackout.

.The eye witness description of a convulsionor automatic behavior is diagnostic ofepilepsy..Patients with motor neuron disease are

often unaware of their limb musclefasciculation, yet their spouse may havenotice their occurrence while in bed.


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Previous neurological history

This is vital for establishing the diagnosis MS, aneurological disorder which is disseminated inspace and time.

Familial disordersMany neurological disorders are genetic.Examination of the relatives of a patient withlongstanding muscle wasting and weakness

below the knees, and with high foot arches (pescavus), may reveal autosomal dominantinheritance of a similar disorder (Charcot-Marie-Tooth disease).


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Contributory general medical disorders

Progressively deteriorating neurologicalsymptoms should prompt questions abouta possible underlying cancer affecting thenervous system: smoking, weight loss,haemoptysis, bowel symptoms, and recent

breast and gynaecologic check-ups..In patient with stroke, a previous history ofischemic or valvular heart disease,hypertension, diabetes, oral contraceptive

usage, migraine, or cocaine abuse may berelevant.


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Typical courseOnsetDisorder

Recurrent attacks (minute)Acute (second)Epilepsy

Recovery in hours- daysAcute (sec.- min.)Vascular

Recurrent attacks (hrs)Acute (min)Migraine

Worsening- RecoverySub-acute (hrs-days)Infective

Varying severity, siteSub-acute (days- weeks)Demyelination

Gradual worseningSlow (weeks- months)Tumor

Gradual worseningSlow (months- years)Degenerative

Typical time course of neurological symptoms


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):HistoryWhat is the lesion (-I

Psychogenic (Hysterical)Organic

.Congenital & heredity diseases

.AcquiredTraumatic

Vascular

Inflammatory

Tumor


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):examinationWhere is the lesion (-IIA. In the nervous system1-C.N.S.(UMNL)-Brain

Cerebral hemisphereBrain stemCerebellum-Spinal CordcervicalThoracic

LumberSacrococcygeal2-Periphral N.S.(LMNL)B. In the neuromuscular junctionC. In the muscle


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Types of lesion as regard site:

Focal( infraction, tumors)

Systemic (diffuse): selects anatomically

& functionally related systems of cells &fibers as in M.N.D. (U.M.N. &L.M.N.)

Disseminated (Multifocal): The lesion

is scattered over affecting different sitesin the N.S. as M.S., meningovascular,cerebral atherosclerosis, metastasis.


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Evaluation + Association

Examination

Investigations

neurological symptoms د.محمد سلام

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