Urinary retention
Loss of awareness of bladder control
Frequency, urgency, urge and overflow maintenance.
MENINGEAL SIGNS
Headache
Projectile vomiting
Photophobia
Neck pain
OTHERS
Dizziness, vertigo, blackouts, and fatigue
Dizziness: It covers many complaints, from a vague feeling of unsteadiness to severe, acute
vertigo. It is frequently used to describe lightheadedness felt in panic and anxiety, during
palpitations, and in syncope or chronic ill-health. The real nature of this symptom must be
determined.
Vertigo: An illusion of movement—is more definite. It is a sensation of rotation, or tipping. The
patient feels that the surroundings are spinning or moving. It is distinctly unpleasant and often
accompanied by nausea or vomiting.
Blackout like dizziness, is a descriptive term implying either altered consciousness, visual
disturbance or falling. Epilepsy, syncope, hypoglycemia, anemia must be considered. However,
commonly no sinister cause is found. A careful history from an eyewitness is essential.
Fatigue is another common symptom of neurological disorders.
Table 6C.3: Various causes of neurogenic bladder.
Type Uninhibited
bladder/detrusor
hyperreflexia
Automatic
bladder/detrusor
sphincteric
dyssynergia
Autonomous
bladder/detrusor
areflexia
Sensory
atonic
bladder
Motor atonic bladder
Site of lesion Suprapontine
neurologic
disorder, mostly
frontal lobe
UMN disorder of
the suprasacral
spinal cord
LMN lesion at the
sacral cord
LMN lesion—peripheral nerve
Causes Frontal tumors,
parasagittal meningioma, ACA
aneurysm, NPH
Spinal cord
trauma,
compressive myelopathy, myelitis
Cauda equina
syndrome, conus medullaris lesion,
spinal shock
Diabetes mellitus,
amyloidosis,
tabes
dorsalis
Lumbosacral meningomyelocele,
tethered cord
syndrome, lumbar
canal stenosis
Bladder sensation Preserved Interrupted Absent Absent Intact
Size of bladder Normal Small Large Large Large
Ability to initiate
voiding
Present Absent Absent Present Lost
Type of incontinence Urge/social
disinhibition
Urge Overflow Overflow Overflow
Residual urine Nil Small Large amount Large Large
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Anal sphincter tone Normal Normal Lost Normal Lost
Perianal sensation Normal Normal Absent Absent Preserved
Bulbocavernous/anal
reflex
Normal Normal Absent Absent Preserved
Treatment Anticholinergic medication
Self-intermittent
catheterization
Continuous catheterization
NECK PAIN
Deformities:
Infantile torticollis
Infections of bone:
TB of cervical spine. Pyogenic
infection of cervical spine
Tumors:
Benign and malignant tumors in relation to
cervical spine and nerve roots
Arthritis of spinal joints:
Rheumatoid arthritis-ankylosing
spondylitis (RA-AS)
Cervical spondylosis
Mechanical derangement:
Prolapsed cervical disc
Cervical spondylolisthesis
Whiplash injury
Cervical spine fracture
Neck muscle strain
Neck sprain
Referred pain:
Ear
Throat
Brachial plexus
Angina (pain extends to neck)
Aortic aneurysm
Meningismus
BACKACHE
Musculoskeletal Infectious
Nonspecific musculoskeletal backpain
Spondylolysis/spondylolisthesis
Scoliosis
Scheuermann disease
Disc degeneration and/or prolapsed
Discitis
Vertebral osteomyelitis including tuberculosis (Pott disease)
Epidural abscess
Sacroiliac joint infection
Others Nonspinal infection
Intervertebral disc calcification
Congenital absence of pedicle
Vertebral apophyseal fracture
Aneurysmal bone cyst
Sacroiliac joint stress reaction
Idiopathic juvenile osteoporosis
Paraspinous muscle abscess
Pyelonephritis
Pneumonia
Pelvic inflammatory disease
Endocarditis
Viral myalgias
Inflammatory Neoplastic
Ankylosing spondylitis
Psoriatic arthritis
Inflammatory bowel disease-associated arthritis
Reactive arthritis
Osteoid osteoma
Leukemia or lymphoma
Solid malignancy, primary or metastatic
Other benign tumor: Neurofibroma, vascular malformation
Others
Appendicitis
Sickle cell pain crisis
Syringomyelia
Cholecystitis
Pancreatitis
Chronic recurrent multifocal osteomyelitis
Psychosomatic illness
Nephrolithiasis
Ureteropelvic junction obstruction
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
RED FLAGS FOR ACUTE LOW BACK PAIN
History
Cancer
Unexplained weight loss
Immunosuppression
Prolonged use of steroids
Intravenous drug use
Urinary tract infection
Pain worse at night or when supine
Fever
Significant trauma related to age
Bladder or bowel incontinence
Urinary retention (with overflow incontinence)
Physical examination
Saddle anesthesia
Loss of anal sphincter tone
Major motor weakness in lower extremities
Fever
Vertebral tenderness
Limited spinal range of motion
Neurologic findings persisting beyond 1 month
NOTES
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
D(i). GENERAL EXAMINATION IN NEUROLOGY
GENERAL PHYSICAL EXAMINATION IN NERVOUS SYSTEM
Pulse
Decreased pulse rate—increased intracranial pressure (ICP)—Cushing reflex
Resting tachycardia autonomic dysfunction
Irregularly irregular—atrial fibrillation (AF)
Feeble pulse, carotid bruit–atherosclerosis.
Blood pressure
Increased BP—intracranial (IC) bleed—reactionary hypertension
Cushing’s reflex.
Orthostatic hypotension
Jugular Venous Pressure
Increased in high output states.
Fever
Meningitis
Encephalitis
CVA
Brain abscess
Epidural abscess
Vasculitis
ADEM
Complex partial seizures
Normal pressure hydrocephalus
Myotonic dystrophy
Hypothalamic dysfunction.
Pallor
Vitamin B12 deficiency
Pica, restless leg syndrome—iron deficiency
Chronic liver disease (CLD), chronic kidney disease (CKD)—encephalopathy.
Icterus
Hepatic encephalopathy
Kernicterus.
Clubbing
Syringomyelia
Chronic hemiplegia
Median nerve injury.
•
•
–
–
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Lymphadenopathy
Lymphoma—neuropathy, cerebellar ataxia, intracranial metastasis
Paraneoplastic syndrome:
Lung carcinoma—Lambert–Eaton Myasthenic syndrome
Lymphoma.
Drug induced—phenytoin.
Pedal Edema
Chronic liver disease
Chronic kidney disease
Autonomic dysfunction.
Signs of Nutritional Deficiency
Discussed earlier.
NEUROCUTANEOUS SYNDROMES/PHAKOMATOSES
The neurocutaneous syndromes include a heterogeneous group of disorders characterized by
abnormalities of both the integument and central nervous system (CNS).
Most disorders are familial and believed to arise from a defect in differentiation of the primitive
ectoderm.
Common neurocutaneous syndromes
Neurofibromatosis I and II
Tuberous sclerosis
Von Hippel–Lindau disease
Sturge–Weber syndrome
Klippel–Trenaunay–Weber
syndrome
Osler–Weber–Rendu syndrome
PHACE syndrome
Wyburn–Mason syndrome
Linear nevus sebaceous
syndrome
Neurocutaneous melanosis
Waardenburg syndrome type 1
and 2
Fabry’s disease
Lentiginosis, deafness, cardiopathy syndrome
Hypomelanosis of Ito
Ataxia-telangiectasia (Louis–Bar syndrome)
Xeroderma pigmentosum
Cockayne’s syndrome
Rothmund-Thomson syndrome
Sjögren-Larsson syndrome
Neuroichthyosis
Werner syndrome and progeria
Incontinentia pigmenti
Neurocutaneous melanosis
Retinal—neurocutaneous cavernous hemangioma syndrome (Weskamp-Cotlier
syndrome)
NEUROFIBROMATOSIS [FIG. 6D(I).1]
Two types of neurofibromatosis (type 1 and type 2).
•
•
1.
2.
3.
4.
5.
6.
7.
•
•
•
•
•
Fig. 6D(i).1: Neurofibromas.
Neurofibromatosis 1
Synonyms: von Recklinghausen disease and Watson disease.
Most prevalent neurocutaneous syndrome.
Autosomal dominant
The NF1 gene on chromosome region 17q11.2 encodes a protein also known as neurofibromin.
Neurofibromin acts as an inhibitor of the oncogene Ras.
Diagnostic Criteria
Two out of the following seven signs
Six or more café-au-lait macules over 5 mm in greatest diameter in prepubertal individuals and over 15 mm in greatest
diameter in postpubertal individuals.
Axillary or inguinal freckling.
Two or more Iris Lisch nodules [Fig. 6D(i).2].
Two or more neurofibromas or one plexiform neurofibroma.
A distinctive osseous lesion, such as sphenoid dysplasia (which may cause pulsating exophthalmos) Or cortical thinning
of long bones with or without pseudarthrosis.
Optic gliomas.
A first-degree relative with NF1 whose diagnosis was based on aforementioned criteria.
Conditions with Café-au-lait Macules [Fig. 6D(i).3]
Neurofibromatosis type 1 and 2
McCune–Albright syndrome
Ataxia telangiectasia
Bloom’s syndrome
Familial Café-au-lait macules.
1.
2.
3.
•
•
Fig. 6D(i).2: Iris nodules (Lisch nodules).
Fig. 6D(i).3: Café-au-lait macules (CALM).
Neurofibromatosis 2
The NF2 gene (also known as merlin or schwannomin) is located on chromosome 22q1.11.
Diagnostic Criteria for Neurofibromatosis 2
One of the following three features is present
Bilateral vestibular schwannomas
A parent, sibling, or child with NF2 and either unilateral vestibular schwannoma or any two of the following: meningioma,
schwannoma, glioma, neurofibroma, or posterior subcapsular lenticular opacities
Multiple meningiomas (two or more) and unilateral vestibular schwannoma or any two of the following: schwannoma,
glioma, neurofibroma, or cataract.
TUBEROUS SCLEROSIS [TABLE 6D.(I).1)]
Also called Bourneville disease
Autosomal dominant
–
–
»
»
»
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
No comments:
Post a Comment
اكتب تعليق حول الموضوع