Neuro

Question 1

Seizure

Answer 1

• Epileptic
  
  • Epilepsy (≥2 unprovoked seizures)
  • < 50% have identifiable cause (ex. trauma, stroke, mass, infection, errors of metabolism)
• Provoked: Alcohol withdrawal, alcohol/drug intoxication, ↑/↓ Na+, ↓ Mg2+, ↓ Ca2+, ↓ glucose, nonketotic hyperosmolar state (NKHS), hyperthyroidism, and others
• Non-Epileptic Seizures

Question 2

Tremors

Answer 2

• Rest: Patient is recumbent on a bed or seated on a couch with the body part supported. Tremor is often enhanced by the performance of cognitive tasks or motor tasks with other body parts, and it is often suppressed, at least temporarily, by voluntary muscle contraction.
• Postural: Extending the upper limbs horizontally, pointing at objects, sitting erect without support for the upper body, protruding the tongue.
• Action: Finger-to-nose testing, heel-to-shin testing, reaching, writing, drawing, pouring water into a cup, eating with utensils, speaking. With isometric tremor: pushing against a wall, flexing the wrist against a table, making a fist
• Essential: MOST COMMON (POSTURAL/ACTION) TREMOR IN PATIENT’S WITH NEUROLOGIC PROBLEM. (5% OF WORLD)
  
  • Bimodal: 2nd and 6th decades

Question 3

Nystagmus

Answer 3

• Physiological nystagmus
• Pendular nystagmus: assoc w MS
• Jerk nystagmus
  
  • incr w movement of eye in direction of fast phase
  • may be normal at extremes of gaze or w caloric testing