Clinical Decision Making

Question 1

Step 1

Answer 1

Are higher cognitive functions involved

Question 2

Are higher cognitive functions involved - if yes, if no

Answer 2

Yes - lean cortical

No - doesn’t mean you can rule cortical out

Question 3

Step 2

Answer 3

Pattern of sensory loss

Question 4

Pattern of sensory loss - what are you considering

Answer 4

Dissociated - brainstem or spinal cord lesions

Global - cortical or peripheral

Question 5

Dissociated sensory loss is what

Answer 5

A pattern of neuro damage cause by a lesion to a specific tract that results in selective loss of the touch and proprioception without loss of pain and temp (or vice versa)

Question 6

DCM includes what

Answer 6

Vibration, touch, proprioception

Question 7

Spinothalamic includes what

Answer 7

Pain, temp

Question 8

Step 3

Answer 8

Cranial nerve signs

Question 9

Cranial nerve signs - what are you asking yourself if yes

Answer 9

Are the signs the same side as long tract signs - cortical

Opposite - brainstem

Question 10

Step 4

Answer 10

Pattern of voluntary movement

Question 11

Pattern of voluntary movement - includes what

Answer 11

UMN syndrome - cortical, brainstem, SC
LMN syndrome - spinal cord, peripheral
No true primary weakness but loss of coord - cbm
No true primary weakness but loss of intention - bg

Question 12

UMN syndrome

Answer 12

Paresis, paralysis
Loss of fractionation
Hyperreflexia
Spasticity

Question 13

LMN syndrome

Answer 13

Loss of reflexes
Atrophy
Flaccid paralysis
Fibrillations

Question 14

Special considerations

Answer 14

Deficit of horizontal conjugate gaze: at rest eyes deviate away from body weakness (cortical)
deviate toward body weakness (brainstem)
Unilateral facial weakness - complete or segmental (LMN) or if lower face only/suprasegmental (UMN)