Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy of Neurology A 67 year-old man with progressive facial diplegia and.

Slides:

Advertisements

Similar presentations

Advertisements

Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy of Neurology A 74 year-old woman with cerebral edema after myelography.

A 15 YEAR OLD BOY WITH AN ASCENDING SPASTIC PARALYSIS Teaching Video NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology.

63 year-old woman with subacute parkinsonism Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy of Neurology.

Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology Neonatal Parechovirus Encephalitis: Typical MRI findings.

Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology A 68 year old woman with transient ptosis on awakening.

Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology Intracranial mass presenting with hemorrhage and respiratory.

A 56-year-old man with intense facial pain Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy of Neurology.

A 41 year old African patient with „multifocal neurology“ Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology.

A 52-year old man with recently diagnosed HIV infection with irregular shaking of his hand Teaching NeuroImages Neurology Resident and Fellow Section ©

A 62-year-old man presented with mild left hemiparesis, headache and blurred vision of his right eye Teaching NeuroImages Neurology Resident and Fellow.

A TWO YEAR OLD GIRL WITH PROGRESSIVE WEAKNESS Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy of Neurology.

A 62-year-old man with progressive action tremor and a 74-year-old man with progressive ataxia Teaching NeuroImages Neurology Resident and Fellow Section.

Teaching NeuroImages Neurology Resident and Fellow Section A 57-year-old woman with blurred vision © 2014 American Academy of Neurology.

Acute neck pain and quadriparesis An 82 year old man with acute neck pain Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy.

48-year-old man with ascending sensory deficits Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy of Neurology.

A 48-year-old man with ptosis and limitation of elevation in the left eye © 2014 American Academy of Neurology Teaching NeuroImages Neurology Resident.

A 68 year old woman with a troublesome chin tremor Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology.

Muscle cramps and a raised creatine kinase. Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology.

Teaching NeuroImages An 83-year-old woman with phonatory breaks and left hand rest tremor Neurology Resident and Fellow Section © 2013 American Academy.

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

Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology A 3-year-old boy with silvery gray hair and leukodystrophy.

Teaching NeuroImages: A 38-year-old woman with chronic progressive dysarthria, and gait disturbance. by Keon-Joo Lee, Jangsup Moon, Soon-Tae Lee © 2014.

Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy of Neurology 46 year-old women with acute headache, post seizure confusion.

A 43-year-old man with decreased consciousness Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy of Neurology.

Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology A 35-year-old woman with headache and diplopia.

A 17-year-old girl with encephalomyelitis Teaching NeuroImages Neurology Resident and Fellow Section © 2015 American Academy of Neurology.

A 50 year old man with progressive tetraparesis and blindness Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology.

A 38-year-old patient with partial seizures Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy of Neurology.

A 53-year-old man with abrupt hearing loss Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology.

Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology A dangerous case of orthostatic headache.

47-year-old with progressive upper limb weakness Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy of Neurology.

Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology An unusual cause of conus medullaris syndrome.

A 21-year-old man with rapidly deteriorating somnolence Neurology Resident and Fellow Section © 2013 American Academy of Neurology.

A 30-year male with cognitive decline and unsteady gait Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology.

Teaching NeuroImages 50 year old woman underwent therapeutic hypothermia after a witnessed cardiac arrest Teaching NeuroImages Neurology Resident and Fellow.

A 39-year old man with facial diplegia Teaching NeuroImages Neurology Resident and Fellow Section Campbell J, et al © 2013 American Academy of Neurology.

© 2013 American Academy of Neurology Teaching NeuroImages Neurology Resident and Fellow Section A 61-year-old patient with subacute blindness on the left.

68 year old man with aphasia and facial droop © 2014 American Academy of Neurology Teaching NeuroImages Neurology Resident and Fellow Section.

Teaching NeuroImages A 54-year-old man with progressive muscle weakness, hand tremor, tongue and perioral fasciculation Neurology Resident and Fellow Section.

21 YEAR OLD FEMALE WITH PROGRESSIVE WEAKNESS Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology.

Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology A 32-year-old man with a neuroendocrine disorder.

A 22 years old man with slow movements and mounding phenomenon © 2013 American Academy of Neurology Teaching NeuroImages Neurology Resident and Fellow.

A 26 year old woman with headache, diplopia, and pulsatile tinnitus Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy.

67-old man with 45-min onset left hemiparesis Teaching NeuroImages Neurology Resident and Fellow Section © 2015 American Academy of Neurology.

Teaching NeuroImages Neurology Resident and Fellow Section A 32-year-old woman presented with headaches, ataxia, diplopia © 2015 American Academy of Neurology.

A 21-year-old male with rapidly- progressive cortical visual loss Teaching NeuroImages Neurology Resident and Fellow Section © 2015 American Academy of.

A 4 Year Old Boy With Proptosis of Left Eye Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy of Neurology.

6-year-old boy with progressive neurologic decline Teaching NeuroImages Neurology Resident and Fellow Section © 2015 American Academy of Neurology.

A 16-year-old girl with acute- onset flaccid quadriparesis Teaching NeuroImages Neurology Resident & Fellow Section © 2015 American Academy of Neurology.

23 yo man with left buttock pain Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology.

Teaching NeuroImages Neurology Resident and Fellow Section A 77 year-old woman with Parkinson’s disease exhibits re- emergent jaw tremor. © 2015 American.

Teaching NeuroImages Neurology Resident and Fellow Section © 2015 American Academy of Neurology A two month old male infant presented with macrocephaly.

57 year-old man with confusion Teaching NeuroImages Neurology Resident and Fellow Section © 2015 American Academy of Neurology.

Teaching NeuroImages Neurology Resident and Fellow Section Spherules in Spine: Vertebral Coccidioidomycosis © 2014 American Academy of Neurology.

Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy of Neurology MRI-visible Virchow-Robin Perivascular Spaces in Cerebral.

Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology Two sisters with scapular winging.

A 36 year old woman with diplopia Teaching NeuroImages Neurology Resident and Fellow Section © 2015 American Academy of Neurology.

A 35-year-old patient with motor aphasia Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology.

Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy of Neurology 57-year-old man with a painful tumoral mass in the leg.

Teaching Video NeuroImages Neurology Resident and Fellow Section

A 55 year-old with lung cancer and leg numbness

A 41-year-old man with progressive quadriparesis

A 58-year-old man with progressive stiffness

Progressive jerky movements in a 58 year old man

30 YEAR OLD MALE WITH PROGRESSIVE COGNITIVE DECLINE AND ATAXIA

68-year-old patient with memory impairment

Neurology Resident and Fellow Section

Current Practice in Pulmonary Function Testing

Meta-analysis of the Effect of a Pulmonary Rehabilitation Program on Respiratory Muscle Strength in Patients with Chronic Obstructive Pulmonary Disease

Presentation transcript:

Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy of Neurology A 67 year-old man with progressive facial diplegia and gait imbalance

Vignette A 67-year-old man presents with progressive diplopia, dysarthria, dysphagia, and gait imbalance. Neurological examination revealed ophthalmoplegia, facial diplegia, and areflexia without signs of respiratory failure. CSF showed albuminocytologic dissociation. Initial spirometry yielded falsely low values due to air leakage and resulted in ICU admission, which may have been avoided with a better test. Kramer et al. © 2014 American Academy of Neurology

Kramer et al. Video © 2014 American Academy of Neurology

Kramer et al. Imaging © 2014 American Academy of Neurology

Table: Pulmonary Function Tests In Patient With Facial Diplegia Using Traditional Mouthpiece And With Facemask Forced Vital Capacity (mL) Maximal Inspiratory Pressure (mmH 2 O) Maximal Expiratory Pressure (mmH 2 O) Tidal Volume (mL) Using Spirometry With Traditional Mouthpiece Trial Trial Trial Using Spirometry With Facemask Trial 12, Trial 22, Trial 32, Kramer et al. © 2014 American Academy of Neurology

How to Unmask Respiratory Strength Confounded by Facial Diplegia Spirometry measures diaphragmatic strength in acute neuromuscular disorders and often directs patient triage. Facial weakness can confound readings with a conventional mouthpiece due to poor seal. Facemask spirometry in patients with motor neuron disease 1 and normals 2 improves values by reducing leak. We demonstrate unequivocally that mask spirometry surmounts spurious readings in acute facial diplegia. Kramer et al. © 2014 American Academy of Neurology