Signs and Symptoms in Neurology PDF

Signs and Symptoms in Neurology Amber Eker Bakkaloglu, MD., Assoc. Prof., FEBN Department of Neurology Evaluation in Neurology 1- Is there a problem related with neurology? (History of complain,symtomes) 2- Where is the lesion? (Neurologic exam for signs, neuroanatom...

Signs and Symptoms in Neurology Amber Eker Bakkaloglu, MD., Assoc. Prof., FEBN Department of Neurology Evaluation in Neurology 1- Is there a problem related with neurology? (History of complain,symtomes) 2- Where is the lesion? (Neurologic exam for signs, neuroanatomy knowledge) 3- What is the lesion/etiology? (History of patient, neuroimaging) Changes in Consiousness; Reasons, Symptoms and Causes Changes in Consiousness; Reasons, Symptoms and Causes which one of below defines a satate of consiousness in which Consious, Alert the person is only resposive to painful Somnolance: Sleepy but easily awake STIMULI? Letargy: Sleepy difficult to awake but can Stupor: Responsive only painfull stimulus Coma: Unresponsive to all stimulus Changes in Consiousness; Reasons, Symptoms and Causes Global cortical involvement Major stroke Infections, trauma Metabolic conditions (severe hypoglisemia, hypoxia, hypercarbi) Toxications … Reticular system involvement Stroke Tumor Trauma …  which one of the Brain Death satatments below is incorrect ? Irriversible Total circulatory arrest of brain and brain stem Criteria Coma Apnea Loss of brain stem reflexes  what are the symptoms of increased intracranial pressure? Meningeal Symptoms and Causes Intracranial pressure increase-related symptoms: Headache Double vision Vomiting Meningeal irritation signs  Meningeal Symptoms and Causes Meningeal Irritation Signs Neck stiffness: Resistense to neck flexion (A) Kernig sign: Positive when the leg is bent at the hip and knee at 90 degree angles, and subsequent extension in the knee is painful (B) Brudzinski’s sign: Involuntary lifting of the when lifting a patient's head off the examining couch, with the patient lying supine (C) Meningeal Symptoms and Causes This signs most freguently found in patients with meningitis or subaracnoid hemorrage. Cranial Nerves Realated Symptoms  COVID-19 CN 1 (Olfactory Nerve) Tumors of olfactory nerve Smell Neurodegenerative disorders, Anosmia, Hyposmia Parkinson disease  CN 2 (Optic Nerve) Visual Acuity Visual Fields Light Reflex (Aff. CN 2, eff. CN 3) Visual Field Defects  Papilledema: Optic disc swelling Optic neuritis Intracranial pressure increase  CN 3 (Oculomotor) Eye lid Eye movements Light reflex (Aff. CN 2, eff. CN 3) CN 3 (Oculomotor), 4 (Trochlear) and 6 (Abducens) Eye Movement Lateral Rectus Muscle: Abducens Nerve (CN 6) Superior Oblique Muscle: Trochlear Nerve (CN 4) Others are innervated by the Oculomotor Nerve (CN 3) LR6 , SO4, O3 Direct and Consensual Light reflexes Pupil changes Anisocoria Mydriasis Myosis Mydriasis Myosis Oculomotor palsy Horner Syndrome (sympathetic denervation) Medications Ptosis Ptosis Neurogenic: Oculomotor nerve palsy Horner Syndrome Myogenic: Muscle disorders, dystrophies Neuromyogenic: Neuromuscular junction disorders Other: Mechanical (tumors), trauma Horner Syndrome Ptosis Anhydosis Myosis CN 5 (Trigeminal Nerve)  CN 7 (Facial Nerve) Muscles of Facial Expression ; Facial Paralysis Taste to Anterior 2/3 of Tongue (Posterior 1/3 CN 9) Corneal Reflex (Aff CN 5, eff CN 7) Ageusia: Loss of the sense of taste  CN 8 (Vestibulocochlear Nerve) Hearing and Balance Hearing loss Vertigo  CN 10 (Vagus Nerve): which n are responsible for gag reflex ? Pharyngeal Muscles Gag Reflex (Aff. CN 9, Eff. CN 10) Dysphagia Nasonated speech Motor System Diagram of motor pathways Motor System Symptomes Paresis (Partial weekness) Hemiparesis Paraparesis Quadriparesis Monoparesis Plegia (Complete weekness) Hemiplegia Paraplegia Quadriplegia Monoplegia Atrophy Fasciculation  Reflexes Deep tendon reflex abnormalities Sensory neuron Areflexia pathologies; polyneuropaties Hyporeflexia Lower motor neuron patologies Hiperleflexia Upper motor neuron pathologies  Sensory System Modalities – Light touch – Pain – Temperature – Vibration – Proprioception – Cortical Hemihypoestesia Patterns of Sensory Loss Periferal Nervous System Related Symptoms Weakness Sensory problems Autonomic system related symptoms; Impotance , urinary incontinance, urinary retention, hypotention, bradycardia, tachicardia,diarea, constipation Cerebellar System Symptoms and Signs Cerebellar System Symptoms and Signs Nystagmus Diplopia Dysartria- scanning speech Vertigo Balance problems, ataxia Tremor (Intentional) Dysmetria Dysdiadochokinesia Movement Disorders Parkinsonism- Hypokinetic Hyperkinetic movement disorders-Chorea, tremor, dystonia) Tremor –action-intentional, rest, postural Parkinson Disease : – Hypomimia – Hypophonia – Bradimimia – Bradikinesia – Resting tremor – Rigidity – Postural ınstability Dystonia Speech Problems Aphasia Dysarthria Stuttering Hypophonia Nasonated speech Aphasia Receptive language (Wernicke’s aphasia) Expressive language (Broca’s aphasia) Gait and Balance Others Headache Cognitive problems Seizure Syncope Sleep problems Psychiatric symptoms; delirium, mood disorders, psychotic disorders