פרק 1 Chapter 1 Approach to the Patient With Neurologic Disease

Question 1

בן 60 מתלונן על חולשה מתקדמת ב 4- גפיים במהלך של 4 שבועות . בבדיקתו הנוירולוגית , עצבים קרניאלים תקינים, בהרמת ידיים צניחה ופרונציה של הגפיים העליונות ובמנוחה במיטה שתי רגליו
בתנוחה של external rotation .
מה האבחנה הסבירה ביותר ?
א. Myasthenia Gravis
ב. Polymyositis
ג. Polyneuropathy
ד. Spinal cord disease

Answer 1

תשובה: ד

Testing of Motor Function
In the assessment of motor function,
maintenance of the supinated arms against gravity (“pronator drift”).
additional sign of subtle weakness of one side is the asymmetric “orbiting” of one forearm around the other when the patient is asked to rotate the fists or index fingers around the other.
The strength of the legs knees flexed and observing downward drift of the weakened leg.
In the supine position at rest, weakness due to an upper motor neuron lesion causes external rotation of the hip.
. Estimates of the strength of leg muscles with the patient in bed may be unreliable; there may seem to be little or no weakness even though the patient cannot arise from a chair or from a kneeling position without help. Running the heel down the front of the shin, alternately touching the examiner’s finger with the toe and the opposite knee with the heel, and rhythmically tapping the heel on the shin are the only tests of coordination that need be carried out in bed.

Question 2

Table 1-1
NEUROLOGICAL SUBSPECIALTY

Answer 2

Question 3

Table 1-2
THE MAJOR CATEGORIES OF NEUROLOGIC DISEASE

Answer 3

Question 4

Figure 1-1. Contribution of neurologic conditions to the global burden of neurologic disease. The analysis, from WHO, includes communicable and noncommunicable diseases, but does not include traumatic brain injury or spine disease.

Answer 4

Question 5

Table 1-3
PREVALENCE OF THE MAJOR NEUROLOGIC DISORDERS IN
THE UNITED STATES

Answer 5

Question 6

Table 1-4
BRIEF NEUROLOGIC EXAMINATION IN THE GENERAL
MEDICAL OR SURGICAL PATIENT

Answer 6