Localization Flashcards
Examination
1-Assess the function of each cranial nerve to identify potential pathology
2-Evaluate muscle strength, tone, reflexes, and coordination to determine if there are motor system abnormalities
3-Assess sensation to determine if there are specific areas of sensory impairment
4-Determine if there are difficulties with urinary or fecal continence for sphincter control assessment
5-Look for symptoms related to temperature regulation, sleep-wake cycle disturbances, appetite changes, and hormonal abnormalities if there are any manifestations of hypothalamic dysfunction.
6-Assess for additional symptoms that might indicate systemic disease or multi-system involvement
Why is it important to obtain a detailed history of the present illness?
To define the affected structure in terms of physiology
To determine the localization of the affected structure in terms of anatomy
To understand the specific pathology affecting the structure
Why past illnesses should be explored in the patient’s history?
Past illnesses are important to identify potential pathophysiologic risk factors and co-morbidities that may contribute to the current neurological condition.
What specific aspects of the patient’s past history should be considered?
History of similar conditions
Fever or trauma of neurological significance
Relevant medical illnesses
Relevant surgeries
Drug history
Recent vaccination, blood transfusion, contraceptive pill use
How can the history of the present illness be analyzed to determine localization?
Analyze the patient’s complaints and ask leading questions to identify the affected structure and its localization.
Determine the duration and course of each symptom to reach the underlying pathology.
Arrange the symptoms in chronological order to formulate a comprehensive history.
What is the provisional diagnosis based on the patient’s history?
The provisional diagnosis helps to narrow down the possible conditions that could be causing the neurological symptoms, guiding further investigations and management
What areas should be covered during the analysis of complaints and leading questions?
Headache, disturbed consciousness, seizures, and speech
Cranial nerves
Motor system
Sensory system
Sphincter control
Hypothalamic manifestations
Symptoms of other systems affected
How can weakness be analyzed to determine the localization of the neurological complaint?
Weakness is a common neurological complaint and indicates motor system disturbance.
Other motor system symptoms such as impaired tone, muscle state, abnormal involuntary movements, and incoordination should also be assessed.
Weakness can result from lesions in various structures, including the cortex, subcortex, internal capsule, para-thalamic region, brainstem, spinal cord, roots, peripheral nerves, neuromuscular junctions, and skeletal muscles
What are the clinical features of weakness due to muscular diseases?
Isolated muscle diseases like sarcomas cause localized symptoms and surgical mass, but they are not neurological diseases.
Hereditary and metabolic muscular diseases cause bilateral, almost symmetrical weakness, more proximal (bulky muscles).
Weakness is associated with hypotonia, late atrophy (bulky), no abnormal involuntary movements, and no incoordination.
There are no other non-motoric symptoms.
On examination, late hypo-reflexia (bulky and nerve intact) may be observed
What are the clinical features of weakness due to neuromuscular junction diseases?
Weakness in neuromuscular junction diseases shows diurnal variation (significant fatigability) and specific marsh.
In primary myasthenia gravis (MG), cranial weakness is usually present first, while in secondary myasthenia, skeletal weakness is more prominent initially.
There is no constant weakness early in the disease, no change of tone and muscle state, no involuntary movements, and no incoordination.
There are no symptoms of other system affection.
On examination, there is usually hyper-reflexia (hyper-excitability).
What are the clinical features of weakness due to peripheral nerve diseases?
Isolated nerve lesions cause weakness and atrophy in the muscles supplied by the affected nerve, along with sensory deficits in its skin topographic distribution.
In peripheral neuropathy (hereditary and metabolic), weakness is bilateral and symmetrical, more distal, and associated with hypotonia and early atrophy.
There are no involuntary movements, but sensory incoordination may be present.
The weakness is associated with impairment of superficial sensation, deep sensation, and autonomic functions.
On examination, early hypo-reflexia is usually observed.
What are the clinical features of weakness due to radicular (roots) diseases?
Isolated root lesions cause weakness and atrophy in the muscles supplied by the affected root, along with sensory deficits in its skin topographic distribution (dermatomes).
In systemic radiculopathy like Guillain-Barre syndrome, weakness is bilateral and symmetrical, more proximal, and associated with hypotonia and atrophy.
There are no involuntary movements, but sensory incoordination may be present.
The weakness is associated with dermatomal sensory deficits and radicular pains, but no autonomic deficits.
On examination, early stretch signs and areflexia are usually evident
What are the clinical features of weakness due to AHC (anterior horn cell) diseases?
Focal AHC affection causes segmental weakness, atrophy, and fasciculation without segmental sensory affection.
Systemic AHC affection (Motor Neuron Disease) causes bilateral and symmetrical weakness, atrophy, and fasciculation.
Tongue fasciculation, hyper-reflexia, intact sensations, sphincters, and abdominal reflexes may be present.
For spinal cord affection, long tract deficits below the level and sphincter impairment may be evident
What are the clinical features of weakness due to pyramidal tract lesions?
Pyramidal tract lesions can be systemic or focal at different levels (spinal cord, brain-stem, para-thalamic, capsular, subcortical, cortical)
What are the clinical features of weakness due to systemic pyramidal tract lesions?
Systemic pyramidal tract lesions cause bilateral and symmetrical distal weakness, affecting more extensors of the upper limbs and flexors of the lower limbs.
There are no involuntary movements, incoordination, or sphincter affection.
There is usually bilateral hyperreflexia, and plantar reflexes may be extensor.
Abdominal reflexes are usually intact
