Neuro%20DDx%202008%20-%20Student%20Lecture%20Notes

Neuro%20DDx%202008%20-%20Student%20Lecture%20Notes -...

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9/11/09 1 Neurological Differential Diagnosis Anthony D. Nicholson B.Sc. M.Chiro. D.A.C.N.B Wahroonga Specialist Centre 13/176 Fox Valley Road Wahroonga NSW 2076 What is Differential Diagnosis? The process of weighing the probability of one disease or cause versus others to account for a patient’s presenting signs and symptoms
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9/11/09 2 Longitudinal Level of Lesion Receptor / end organ Neuromuscular junction Peripheral nerve (single / multiple) Segmental distribution (nerve root) Spinal cord Brainstem Cerebellum Internal capsule Cortex First Principles Strong knowledge of the neuroanatomy and its blood supply is critical Neuroanatomical distribution Vascular distribution When multiple deficits that can’t be localised to a single lesion think: Demyelinating process Multiple vascular occlusions Multiple metastatic disease Systemic disease (metabolic, endocrine, toxic, autoimmune) Hereditary / genetic condition
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9/11/09 3 It’s all in the History…. The history indicates the parts of the examination that should be performed in detail A complete neurological examination on every single patient is prohibitive A short list of differential diagnoses should be made by the completion of the history A Systematic Approach Who is this patient? O.L.O.C.F.R.A.N. Previous history / Previous Rx F.A.M.I.T.O.N. F.R.E.O.S. Systems Review V.I.N.D.I.C.A.T.E.
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9/11/09 4 Receptor End Organ Peripheral Nerve Lower Motor Neuron Mechanisms of Injury Trauma Hypoxia Infection Metabolic Toxic Inherited / congenital
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9/11/09 5 Type of functions lost LMN functions vs. UMN functions Type of sensory modalities Distribution Peripheral nerve Dermatome / myotome Spinal cord, brainstem, IC, cortex For example… Differential Diagnosis of Weakness
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Neuro%20DDx%202008%20-%20Student%20Lecture%20Notes -...

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