NEURO - B PE 1 Distal weakness usually worse in legs than arms and worse in extensors than flexors 2 Superficial reflexes usually lost 6 BRAINSTEM

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NEUROLOGY: APPROACH TO THE PATIENT 1. MYOPATHIES A. HX.: 1. Proximal leg weakness 2. Proximal arm weakness 3. Symmetric weakness 4. No sensory loss B. PE 1. Proximal symmetric weakness without sensory loss 2. NEUROMUSCULAR JUNCTION DISEASE A. HX. 1. Fatigability: weakness worsens with use and recovers with rest 2. Extremely proximal: ptosis, diplopia, facial weakness B. PE 3. PERIPHERAL NEUROPATHIES A. HX. 1. Distal weakness in legs 2. Distal weakness in hands 3. Asymmetric weakness 4. Denervation changes: atrophy, fasciculations 5. Sensory changes: paresthesias 4. NERVE ROOT (RADICULOPATHIES) A. HX 1. Pain: radiates down arm/leg 2. Same as peripheral neuropathy B. PE 1. Myotome weakness 2. Dermatome sensory loss 5. SPINAL CORD LESIONS A. HX 1. Sensory level 2. Distal, usualy symmetric weakness, spasticity 3. Bowel and bladder changes (sphincter dysfunction)
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Unformatted text preview: B. PE 1. Distal weakness usually worse in legs than arms, and worse in extensors than flexors 2. Superficial reflexes usually lost 6. BRAINSTEM DISEASE A. HX. 1. Cranial nerve abnormalities (Big “D’s”) a. Diplopia b. Decreased facial sensation c. Decreased facial strength d. Dizziness e. Deafness f. Dysarthria & Dysphagia 2. Long tract findings 3. Crossed symptoms a. cranial nerve ipsilateral, long tract contralateral side of body 7. CEREBELLAR DISEASE A. HX 1. Legs: ataxia, drunken walk 2. Arms: dysmetria, dysdiadochokinesia, intention tremor 8. SUBCORTICAL vs. CORTICAL Aphasia, Visuospatial deficits Face, arm and leg Face and arm only Pain, temp., touch, position, vibration Astereognosis, Agraphesthesia Loss of two point discrimination Parkinsonism, chorea, dystonia, hemiballismus Seizures...
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This note was uploaded on 02/17/2012 for the course MPAS PA 602 taught by Professor Dr.laird during the Fall '10 term at Chatham University.

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NEURO - B PE 1 Distal weakness usually worse in legs than arms and worse in extensors than flexors 2 Superficial reflexes usually lost 6 BRAINSTEM

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