2 John is a 57 year old man who developed gait difficulty which has worsened over the past months. He noticed that he needed to stand for apart to maintain.

Slides:

Advertisements

Similar presentations

All emergency transports are medically necessary, right? and other Myths about Compliance and Documentation.

Advertisements

MOTOR NEURON DISEASE The motor neuron diseases (or motor neuron diseases) (MND) are a group of neurological disorders that selectively affect motor neurons.

Ataxia Failure to produce smooth intentional movements (symptom of a variety of diseases & is not diagnoses)

Cerebellar dysfunction, syndromes, signs, examination doc. MUDr. Valja Kellerová, DrSc. Department of Neurology.

Cerebellum. Site: Posterior cranial fossa, behind pons & medulla oblongata. 2 Surfaces: Superior & Inferior. 3 Parts: * Vermis - Superior: indistinct.

Neurology 2 Part 3. Assessing Motor System Muscle Strength Tone – Tension pressure when the muscle is at rest Spasticity – Increase muscle tone Rigidity.

Gait disorders. Normal gait The Gait cycle – Comprised of swing and stance phases – A stride is one full gait cycle – Stance Starts with heel striking.

SPORTS MED 2 Head Evaluation Process. History Any loss of consciousness?  Note length of time unconscious for Determine level of consciousness (LOC)

ATAXIA Dr. Shamekh M. El-Shamy. THE CEREBELLUM ANATOMY: the cerebellum is formed of 2 main parts: ANATOMY: the cerebellum is formed of 2 main parts: 1.

A Red Flags: 1. Progressively declining level of consciousness 2. Progressive declining neurological exam 3. Pupillary asymmetry 4. Seizures 5. Repeated.

Principles of Neurological Diagnosis

Idara C.Eshiet. A 50 year old woman had a sudden onset of dizziness and vomiting. Her family noticed that her left eyelid appeared to be drooping.

Clinical assessment Aims (1) Is it a stroke? (2) What part of the brain is affected? (3) What caused this stroke? Is it a haemorrhage or an infarct? Can.

Head, Face, Eyes, Ears, Nose and Throat Dekaney High School Houston, Texas.

First Lesion Localization Problem Solving Assignment February 14, 2008 Place completion date in this box February 14, 2008 Place completion date in this.

Practical Management of MS in the Primary Care Office Setting Case Study 2.

Osteology and Articulations of the Back 2008 Gray’s Pages

Bed side examination of the dizzy patient Herman Kingma, ORL-HNS department.

Dizziness, Disequilibrium and Vertigo  There are three symptoms that are often refered to as dizziness by patients: dizziness, disequilibrium and vertigo.

Headaches Continued. Examination 3 minute neurological test.

Alcoholic Cerebellar Degeneration Clinical Syndrome The clinical syndrome of alcoholic cerebellar degeneration is remarkably stereotyped. The usual.

Unsteadiness Year 2 Michaelmas Term The case.. A 56 year old man presented to his GP with a persistent right-sided headache in the occipital-parietal.

4 patients falling over. Mrs April Aged 62 Complains of tripping up when she walks on uneven surfaces Falls over and comes to hospital PMH COPD Vegan.

 A traumatically induced alteration in mental status not necessarily with a loss of consciousness ◦ A change in your brain’s ability to function normally.

A 22-year-old woman has noticed blurry vision

Ed Hutchison and Paul Swift

Midbrain syndromes Idara Eshiet C..

931-4 Convergence Insufficiency. History A 73-year old man with known PD for 10 years, complained of horizontal double vision for 18 months. He could.

The Motor System and the Cerebellar Function

Ataxia and Gait Disturbances Presented by A. Hillier, D.O. EM Resident St. John West Shore Hospital.

By: Nathan & James. Our Patient (Totally breaking HIPPA) Name: Helen Weezy F Baby Age: 28 Symptoms: Strange pricks in her hands and feet, fatigue, impaired.

Pyramidal and extrapyramidal tracts

By Dr. Zahoor 1. 2 A 65 year old woman is brought to the emergency room after coughing up several table spoons of bright red blood. For the last 3-4.

Idara C.E.. Mrs. sauna was rushed to the ER after a motor vehicle accident in which she sustained severe injuries with spinal.

Lumber Spine Assessment Ahmed alhowimel,MSc.PT. Screening…  Red Flags. Means serious underlying condition that require more medical investigation like.

Sensory system.

Multiple Sclerosis A chronic, progressive central nervous system disease with a disseminating demyelination of the nerve fibers of the brain and spinal.

A 30 year old man with sub-acute ataxia Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy of Neurology.

Practical Management of MS in the Primary Care Office Setting Case Study 1.

Nursing Assistant Monthly Copyright © 2014 Cengage Learning. All rights reserved. What and when to report Medication adverse effects.

 Anterior View  Posterior View Adducent 7 & 8 th 12 9,10, Facial colliculus Striae Medullare.

Cases Neuroscience. Case 4 A 45 year old woman with a history of hypertension experienced a brief "blackout". She had complained of severe headaches,

Stroke. Definition Cerebrovascular accident (CVA) The rapidly developing loss of brain functions due to disturbance in the blood supply to the brain.

Clinical reasoning By Dr. Walid I. Wadi Jan,5 th 2010.

Morning Report Acute Ataxia 8/31/09 Lorena Muñiz, MD.

2 John is a 57 year old man who developed gait difficulty which has worsened over the past months. He noticed that he needed to stand for apart to maintain.

Clinic 5 Practicum Assignment Go see your staff doctor this week –Schedule your hours 2 Hours per week –Activate your patient file.

Baseline ImPact Testing. Concussion: Scope Each year, U.S. emergency departments treat an estimated 135,000 sports- and recreation related concussions.

Case Discussion. A 24-year-old university student presents to the Student Health Service with a 3-day history of a dry cough that was initially non-productive.

UNDERSTANDING THE CHILD WITH ATAXIA Robyn Smith Department of Physiotherapy University of Free State 2012.

Brain stem Anterior view

Cases Neuroscience. 1. Which of the following structures is located at the irregularity indicated by the black arrow in the fissure shown in the image.

Clinical Cases.

Neurological Exam: Still Important After All These Years Eric Kraus, MD Neurology.

Case 1….. A patient delays initiation of movement, displays an uneven trajectory in moving her hand from above her head to touch her nose, and is uneven.

PARKINSON’S DISEASE.

Multiple Sclerosis Christine Martin A. Background Information Helen, a 28-year-old woman, has noticed strange “pins and needles” feelings in.

Localising the lesion – where in the nervous system?

First Aid/CPR Chapter 13 Notes Injuries to the Head, Neck, and Back.

Cases Neuroscience. 1. Which of the following structures is located at the irregularity indicated by the black arrow in the fissure shown in the image.

Neurological/Sensory Assessment

STROKE DEFINITION Stroke is defined as

Neurological Examination Dr Andrew Gale 23 Feb 2010.

Cerebellar Ataxia Jose S. Santiago M.D..

Cerebellar Examination

THE NEUROLOGICAL EXAMINATION

Neurology Examination (cerebellar and gait examination)

Case 3 Headache & Slurred Speech Case Presentation

Cerebellum Lec 12.

Presentation transcript:

2 John is a 57 year old man who developed gait difficulty which has worsened over the past months. He noticed that he needed to stand for apart to maintain his balance and that he waddled when he walked. When tested by the neurologist, there was no sensory loss nor speech deficits. When asked to touch the doctor’s fingers then his nose, John missed his nose slightly. When asked to slide his right heel down his left shin, his heel slid sideways and clumsily across. The doctor ordered an MRI of Johns’s head.

1. What term could be used for John’s gait a. Stiff b. Fesinating c. Ataxia d. Spastic 2. Where is the lesion a. Posterior columns only b. Cerebellar tracts only c. Cerebellum d. Spinothalamic tract

3. Where in the brain would the neurologist expect to visualize it on MRI? a. Red nucleus b. Cerebellar vermis c. Cerebellar cortex d. Internal capsule

Case 1 Mr X, a 66-year-old gentleman, presented to the emergency department with progressively worsening unsteadiness on his feet, double vision, nausea and vomiting. Two months previously the patient noticed he was becoming unsteady on his feet. This progressed such that he was now struggling to walk unaided. Four days prior to his admission the patient developed persistent nausea and vomiting and noticed double vision. It was this that brought him to the emergency department. The patient denied any headaches, vertigo, weakness, confusion, bowel or bladder dysfunction and the unsteadiness was independent of position. Bowel movements were normal and he reported no other symptoms of abdominal pathology. The patient drank on average 10 units of alcohol a week and reported no recent increase in consumption.

His blood pressure was 120/94mmHg, pulse rate 107bpm, respiratory rate 14 and temperature 37.4C. He was able to sit upright in the bed unsupported. Of note there was no clubbing of the fingernails, no signs of malnutrition and no slurring of speech. In depth neurological examination revealed a wide-based gait with inability to walk in tandem gait. Tone and power were normal; intention tremor with past pointing was present bilaterally. The patient reported diplopia at all eye positions with images displaced horizontally, there was no noticeable nystagmus.