Clinical Features of Neurological Diseases 25022013 Final
Post on 02-Apr-2018
225 Views
Preview:
Transcript
7/27/2019 Clinical Features of Neurological Diseases 25022013 Final
1/29
OVERVIEW OF CLINICAL PRESENTATIONOF NEUROLOGICAL DISEASES
Njideka U. Okubadejo, FMCPAssociate Professor & Consultant neurologist
Faculty of Clinical Sciences, CMUL & Lagos University Teaching Hospital
Idi Araba, Lagos State, Nigeria
NPMCN Radiology Update Course 2013
7/27/2019 Clinical Features of Neurological Diseases 25022013 Final
2/29
OUTLINE
Introduction Clinical features of neurological diseases
Headaches
Altered sensorium
Vertigo
Muscle weakness
Movement disorders
Higher cortical dysfunction
Gait disturbance / imbalance
Sensory abnormalities
Common clinical scenarios
NPMCN Radiology Update Course 2013
7/27/2019 Clinical Features of Neurological Diseases 25022013 Final
3/29
INTRODUCTION
Important guide to radiological evaluation ofneurologic disorders
Inadequate clinical information can greatly hamper accuracy/utility of radiological
investigations
result in inappropriate interventions increase mortality and morbidity
Adverse financial consequences
LitigationNPMCN Radiology Update Course 2013
7/27/2019 Clinical Features of Neurological Diseases 25022013 Final
4/29
NEUROLOGICAL DX AETIOLOGIES
Vascular
Infection /
Inflammatory
Trauma/Toxins
Autoimmune
Metabolic
Idiopathic
Neoplastic
Psychogenic/Seizures
Degenerative/Drugs
Endocrine
Congenital
(VITAMINS DEC)
NPMCN Radiology Update Course 2013
7/27/2019 Clinical Features of Neurological Diseases 25022013 Final
5/29
CLINICAL FEATURES OF NEURODX
Wide spectrum of features with localizing or non-
localizing value
Combination of clinical features and scenario improve
diagnosis
In evaluation: correct sequence of evaluation
Functional /anatomical localization
Aetiology (based on clinical scenario; age;
constitutional symptoms; geographic location;
associated non-neurologic features; mode of onset,
etc) NPMCN Radiology Update Course 2013
7/27/2019 Clinical Features of Neurological Diseases 25022013 Final
6/29
CLINICAL FEATURES OF NEURODX
Important factors regarding aetiology include:
Mode of onset (acute v. subacute/chronic)
Temporal profile: ?: monophasic, recurrent/episodic,
stepwise, progressive
Age at onset: paediatric, young adult, middle age,
elderly?
Constitutional/other systemic symptoms: fever,
endocrine abnormality, skin, etc Clinical scenario: antecedent trauma, malignancy
Risk factor profile: family history, CVD risk factors
NPMCN Radiology Update Course 2013
7/27/2019 Clinical Features of Neurological Diseases 25022013 Final
7/29
CLINICAL FEATURES OF NEURODX ii
Headaches
Altered consciousness
Seizures
Syncope
Vertigo
Muscle weakness
Higher cortical dysfunction
Language disturbance
Cranial neuropathies
Movement disorders
Gait disturbance
Sensory abnormalities
NPMCN Radiology Update Course 2013
7/27/2019 Clinical Features of Neurological Diseases 25022013 Final
8/29
HEADACHE
Headache = pain in the head.
Symptoms suggestive of serious underlying dx
Worst headache ever
First severe headache
Subacute worsening over days or weeks
Abnormal neurological examination
Fever or unexplained systemic signs
Vomiting preceding headache
HA induced by bending, lifting, cough
Disturbance of sleep or HA immediately on awakening
Known systemic illness e.g. malignancy
Onset after age 55 yearsNPMCN Radiology Update Course 2013
7/27/2019 Clinical Features of Neurological Diseases 25022013 Final
9/29
HEADACHE ii
NPMCN Radiology Update Course 2013
Features of serious underlying causes of headache
Meningitis Generalized headache; associated nuchal
rigidity; photophobia; may be febrile;
focal signs
Intracranial hemorrhage Severe headache; altered sensorium; seizures; nuchal rigidity in
subarachnoid/intraventricular hrrhage;
bloody tap or xanthochromia
Brain tumor / SOL Pounding severe HA; associated
nausea/vomiting/progressive altered
sensorium; focal deficits; seizures
Glaucoma Severe eye oain; nausea or vomiting;
painful red eye
7/27/2019 Clinical Features of Neurological Diseases 25022013 Final
10/29
ALTERED SENSORIUM
Coma (GCS
7/27/2019 Clinical Features of Neurological Diseases 25022013 Final
11/29
VERTIGO
An illusory or hallucinatory sense of movement
of the environment (sense of spinning)
Can be physiologic or pathologic
Pathologic causes:
Visual: new glasses; diplopia
Somatosensory: peripheral neuropathy; myelopathy
vestibular: labyrinthine dx; 8th nerve dx; central
connectionsNPMCN Radiology Update Course 2013
7/27/2019 Clinical Features of Neurological Diseases 25022013 Final
12/29
MUSCLE WEAKNESS
Reduction in normal power of one or more muscles
-plegia: complete weakness-paresis: mild or moderate weakness
Pattern
UMN: corticospinal tract involvement brain or spinal cord
LMN pattern: anterior horn cells, nerve roots, peripheralnerve
Myopathic: muscle or NMJ; proximal weakness typically
Distribution:
Hemi - one half of the body (corticospinal UMN)
Para both legs (spinal cord or cortex; flaccid or spastic)
Quadri all four limbs (UMN or LMN)
Mono one limb (UMN or LMN)
NPMCN Radiology Update Course 2013
7/27/2019 Clinical Features of Neurological Diseases 25022013 Final
13/29
MUSCLE WEAKNESS
NPMCN Radiology Update Course 2013
7/27/2019 Clinical Features of Neurological Diseases 25022013 Final
14/29
MUSCLE WEAKNESS
NPMCN Radiology Update Course 2013
7/27/2019 Clinical Features of Neurological Diseases 25022013 Final
15/29
MOVEMENT DISORDERS
Disturbance of fluent movt or unintended extra movement
Most have a biochemical rather than structural basal ganglia dx
Classified as: hyperkinetic or hypokinetic
Hemiballismus:
contralateral subthalamic nucleus lesion vascular, etc
Chorea:
acute/subacute toxins, drugs, pregnancy, hyperthyroidism,
antiphospholipid syndrome, rheumatic fever
Chronic; neurodegenerative dx e.g. Huntingtons disease
Myoclonus:
Metabolic and neurologic aetiologies
Structural causes: brainstem or spinal lesions causing palatal or
segmental myoclonusNPMCN Radiology Update Course 2013
7/27/2019 Clinical Features of Neurological Diseases 25022013 Final
16/29
MOVEMENT DISORDERS
Tremor
Rest tremor: maximal at rest (parkinsonian tremor)
Postural tremor (max. with limb postured against gravity; DD
acute: toxic/metabolic; insiduous: benign essential tremor
Intention tremor (max. during voluntary movt towards a
target; cause cerebellar disease)
Parkinsonism
Hypokinetic movt disorder
Tremor, bradykinesia (slowness), rigidity, postural
impairment)
DD: PD, multiple system atrophies, PSP, vascular,
drug/toxins, head trauma, etcNPMCN Radiology Update Course 2013
7/27/2019 Clinical Features of Neurological Diseases 25022013 Final
17/29
HIGHER CORTICAL DYSFUNCTION
APHASIA
Language dysfunction due to damage to neuralnetwork including Wernickes, Brocas perisylvian,
temporal, prefrontal, posterior parietal regions
Due to left hemispheric lesion in 90% of right
handed, 60% left handed; small % no language
dominance; right dominance in others (incl. small
minority of right handed)
Causes: stroke, tumors, trauma, degenerative
NPMCN Radiology Update Course 2013
7/27/2019 Clinical Features of Neurological Diseases 25022013 Final
18/29
HIGHER CORTICAL DYSFUNCTION ii
APRAXIA:
Motor deficit not due to pyramidal, extrapyramidal,
cerebellar, or sensory dysfunction
Causes: left hemispheric lesions, focal premotor cortex
lesions, cortico-basal ganglionic degeneration (with
parkinsonism)
GERSTMANNS SYNDROME:
Acalculia, dysgraphia, finger anomia, right-left confusion
In isolation, due to left inferior parietal lobe (angular
gyrus) lesion
NPMCN Radiology Update Course 2013
7/27/2019 Clinical Features of Neurological Diseases 25022013 Final
19/29
HIGHER CORTICAL DYSFUNCTION iii
HEMISPATIAL NEGLECT Loss of attention to left sided stimuli (feeding,
dressing, etc)
Due to right hemispheric lesions
AGNOSIAS
Recognition deficits
e.g. face (prosopagnosia), objects (visual object
agnosia occipito-temporal region) due to
bilateral posterior cerebral artery infarcts
NPMCN Radiology Update Course 2013
7/27/2019 Clinical Features of Neurological Diseases 25022013 Final
20/29
HIGHER CORTICAL DYSFUNCTION iv
AMNESIAS
Due to dysfunction of the limbic system for memory(hippocampus, amygdala, entorhinal cortex, ant/medial
thalamic nuclei, medial/basal striatum, hypothalamus)
Controls declarative memory for recent experiences +behaviour (emotion, motivation, endocrine fxn)
Retrograde (prior memories) or anterograde (new
knowledge)
Caused by bilateral lesions in limbic network: tumors,
infarctions, head trauma, encephalitis, Wernicke-Korsakoff,
degenerative dementias (Alzheimers, Picks)NPMCN Radiology Update Course 2013
7/27/2019 Clinical Features of Neurological Diseases 25022013 Final
21/29
HIGHER CORTICAL DYSFUNCTION iv
DEMENTIA:
acquired impairment in memory + impairment in one or
more cognitive domains, including: executive function;
language; praxis; gnosis
Causes:
NPMCN Radiology Update Course 2013
7/27/2019 Clinical Features of Neurological Diseases 25022013 Final
22/29
7/27/2019 Clinical Features of Neurological Diseases 25022013 Final
23/29
GAIT DISTURBANCE / IMBALANCE
NPMCN Radiology Update Course 2013
7/27/2019 Clinical Features of Neurological Diseases 25022013 Final
24/29
SENSORY ABNORMALITIES
Lesions at any level of neuraxis: parietal cortex, thalamus,
brainstem, spinal cord, spinal root, peripheral nerve, etc Distribution and nature important for localization
Parietal lobe:
Contralateral hemineglect; abnormal higher sensory fxn,
hemilateral loss of primary sensation (pseudothalamic)
Focal sensory seizures
Thalamus:
Hemisensory disturbance from head to toe (e.g. stroke)
Brainstem:
Harlequin pattern ipsilateral facial sensory loss and
contralateral body (lateral medulla)
Contralateral face/arm/leg pons and midbrainNPMCN Radiology Update Course 2013
7/27/2019 Clinical Features of Neurological Diseases 25022013 Final
25/29
SENSORY ABNORMALITIES ii
Spinal cord:
Distribution of the sensory abnormality and accompanying
tract dysfunction is important
Hemisection
Contralat loss pain and temp below; ipsilat loss of
proprioception and muscle power below
Transection:
sensory level on trunk
Central canal (syrinx): sensory dissociation with loss of pain and temperature.
Nerve and root: discrete boundaries of sensory abnormality
NPMCN Radiology Update Course 2013
VISUAL COMPLAINTS
7/27/2019 Clinical Features of Neurological Diseases 25022013 Final
26/29
VISUAL COMPLAINTS
Impaired visual acuity
Visual field loss Hemifield
Homonymous hemianopsia
Quadrantanopia
Upper quadrant
Lower quadrant
Bitemporal
Conjugate gaze Disconjugate gaze (diplopia): cranial neuropathy;
myopathy; neuromuscular junction; brainstem
NPMCN Radiology Update Course 2013
7/27/2019 Clinical Features of Neurological Diseases 25022013 Final
27/29
NPMCN Radiology Update Course 2013
7/27/2019 Clinical Features of Neurological Diseases 25022013 Final
28/29
COMMON CLINICAL SCENARIOS
Intracranial SOLs
Subacute/chronic onset typically Add-on signs and symptoms
Raised intracranial pressure
Stroke:
Abrupt onset
Stepwise deterioration if any
Subtype features: ischaemic; haemorrhagic (ICH v.
SAH)
Risk factor profileNPMCN Radiology Update Course 2013
7/27/2019 Clinical Features of Neurological Diseases 25022013 Final
29/29
COMMON CLINICAL SCENARIOS
CNS infections: fever, headache, neurologic signs and symptoms
Exceptions: occasionally no fever
Inflammatory disease MS, NMO, CNS vasculitis Abrupt onset; relapsing or remitting course; visual
pathway involvement
Seizures Idiopathic or due to structural intracranial
abnormalities
NPMCN Radiology Update Course 2013
top related