Documentos de Académico
Documentos de Profesional
Documentos de Cultura
• Cerebrovascular diseases
• Trauma
• Neoplastic diseases
• Epilepsy
• Headache
• Infectious diseases
• Inflammatory diseases
• Degenerative neurological diseases
• Developmental diseases
• Spinal cord diseases
• Peripheral nerve diseases
• Muscle & neuromuscular diseases
6% of the
population had
a neurological
disorder
sometimes
during the life:
3.6 million in
Italy
625
neurological
disorders were
observed per
100,000
population
annually:
375,000 in Italy
MacDonald et al , Brain 2000
Initial approach to neurological patients
1. Watch the patient as he enter the ambulatory or ER
2. Watch the age and the apparent general condition
3. Watch if he is alone or accompanied by someone
4. Watch how he is wakeful, alert and move
5. Watch if he has any unusual movement or posture
6. Ask for the problem leading the patient to the visit
7. Ask for the duration and progression of symptoms
8. Ask for symptoms that may be associated to patient’s disturbance
9. Ask for antecedent diseases or surgery
10. Ask for currently used therapy
11. Ask for the use of potentially toxic agents or drugs
12. Ask for the sexual attitude of the patient
13. Ask for his work
14. Ask for his mood
15. Ask for previously performed tests, visit or diagnosis
16. Ask for neurological and non-neurological disease in the relatives
Instruments for neurological examination
Electrophysiological abnormalities
Slowing of nerve conduction
Denervation
Reinnervation
Lumbar puncture
Genetic tests
Cerebral angiography
Nuclear Magnetic Resonance
PET for Amyloid in Alzheimer’s disease:
11-C Pittsburgh compound B
Brain tractography
Examination of Cranial Nerves
Smell: olfactory nerve (I° cranial nerve)
Symptoms:
1. anosmia
2. hyposmia
3. dysosmia
4. cacosmia
Testing:
coffee with closed eyes
Causes of lesions:
head injury
chronic basilar meningitis
brain tumor (frontal menin-
gioma, Foster-Kennedy S.)
Other causes of loss of
smell: cold, allergic rhinitis,
aging, smoking, cockayne
Vision disturbances
Left amaurosis
Bitemporal
hemianopia
Right homonymous
hemianopia
Right homonymous
superior
quadrantanopia
Right homonymous
hemianopia with
macular sparing
Scotoma
Category of
causes of optic
neuropathy
Papilledema Normal
4° Nerve
6° Nerve
Internuclear
Ophtalmoplegia
A lesion in right mlf would take place
here and cause right INO,
Which would be present as righ eye
Most common causes:
not being capable of adduction
And left eye jerk nystagmus
Multiple Scleoris
Brainsten infarct
Trauma, Infection, vasculitis
Intrinsic Ocular Movement
3° Nerve Palsy
+ Corneal Reflex
Trigeninal Neuralgia
Definition of the International Association for
the Study of Pain:
a sudden, usually unilateral, severe brief
stabbing recurrent pain in the distribution of
one or more branches of the fifth cranial nerve
551 pazienti
Hearing: 8th nerve: cochleovestibular nerve
Symptoms & Signs
1. Hypoacusia (reduced
hearing)
2. Anacusia (deafness)
3. Tinnitus (disturbing noise
like whistle, buzzing,
pulsing)
Hearing 8th nerve: cochleovestibular nerve
Test
1. Test of Rinne (mast-meato)
2. Test of Weber (vertex)
3. Audiogram
Equilibrium: 8th nerve: cochleovestibular nerve
Symptoms and Signs
1. Vertigo (rotation sense)
2. Nausea & vomit
3. Nystagmus
4. Loss of equilibrium
5. Trunc deviation
6. Gait (& tandem) deviation
7. Lateralized Romberg
8. Index deviation
9. Otovestibular test
Nystagmus:
Involuntary to-and-fro oscillations of the eyes with
a slow (pathological) and a fast (recovery) phase
(jerky nystagmus), or pendular
Orizzontal Rotatory
Vertical
Pyramidal system
Motor Examination:
Symptoms:
1. Weakness
2. Fatigue & and fatigability
3. Wasting
4. Cramps
5. Tremor
6. Muscle twitching
7. Involuntary movement
Inspection:
1. Patient’s posture (head & arms)
2. Walking and standing
3. Trophy: hypo/hypertrophy
4. Involuntary movements: Tremor,
fasciculation, cramps, clones, chorea,
athetosis, hemiballism, tics, dystonia &
dyskinesia
Motor Examination:
Testing:
1. Strength: anti-gravity and
segmental strength: paresis,
paralysis/ plegia
2. Muscle tone: hypo tonus,
hyper tonus/ spasticity;
3. Deep tendon reflexes (DTR):
hypo-hyper- areflexia
4. Pyramidal signs: Babinski,
Rossolimo, Hoffmann,
clonus, abdominal reflexes
Distribution:
1. Emi-, para-, diparesis/plegia,
2. stock and glove weakness
3. Proximal weakness
Movement disorders:
Involuntary Movements:
• Tremor: voluntary, resting,
. action/intentional
• Fasciculation, cramps,
(fibrillation)
• Clones
• Chorea
• Athetosis
• Hemiballism
• Tics
• Dystonia e dyskinesia
Bradi-, a-, hyper-kinesia
Ataxia: disturbance of
coordination and equilibrium
Vestibular, cerebellar, sensory ataxia
Standing ataxia Walking ataxia
Dismetry
Romberg sign
Sensory pathways
Temperature
touch in movement
Vibration/touch fast
pain/Temp. Stable pressure
Slow deformation/touch
prolonged
Sensory disturbances
Positive symptoms: Paraesthesias (tingling, burning,
pressure, coldness, tightening…), pain,
dysesthesia, painful hyperesthesia,
allodynia, numbness
Negative symptoms: Hypo-/anesthesia (superficial, deep,
pain, temperature, ataxia)
Symptoms and signs of
meningeal involvement
Symptoms:
• Acute headache frontoccipital,
fotofobia, nausea, vomit, impaired
consciousness -> coma
Signs: Rigor
• Nucal rigidity, Brudzinski and Kernig
signs
Brudzinski Kernig
Disturbance of high cognitive functions:
memory -> amnesia
ST orientation -> disoriented
judgment -> hypo -a criticism
language -> aphasia
use of movement -> apraxia
identification -> agnosia
calculation -> acalculia
writing -> agraphia
lecture -> alexia
Mechanism of speech
Types of Amnesia