Describe approaches to diagnosis and treatment

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Describe approaches to diagnosis and treatment. Diagnosis – syringomyelia Neural structures affected in this disease – anterior horns of gray matter at cervical level of SC, lateral columns of white matter at cervical and thoracic levels of SC Diagnosis – spinal cord MRI (presence of cavities filled with fluid) Electromyography which measures muscle weakness Treatment – surgical decompression 16
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4 Patient, male, in age of 66 years, was admitted to the hospital with complaints of upper extremities’ wasting and weakness. This condition has been steadily progressing for last 2 years. His vital parameters: BP – 145/86 mm Hg, pulse – 78 beats/sec., breath rate – 14/sec. During neurological examination next signs were revealed – positive bilateral upper Rossolimo’s sign, loss of tendon reflexes from the arms, hands’ wasting, fibrilations of the biceps and deltoid muscles, slightly diminished gag reflex. No sensory, autonomic, cerebellar and cortical deficit was evident. Blood assay – normal. CSF assay – normal. Fundoscopy – age-related changes. What is your diagnosis? How to confirm it? How to treat the patient? Diagnosis: ALS How to confirm: diagnosis of ALS is primarily based on the symptoms and signs the physician observes in the patient and a series of tests to rule out other diseases, presence of upper and lower motor neuron signs in a single limb is strongly suggestive. electromyography (EMG), nerve conduction velocity (NCV), MRI Treatment: Slowing progression Riluzole (Rilutek). Riluzole is decreasing the release of glutamate via activation of glutamate transporters. Physical therapy 5 Patient, male, in age of 29 years, was admitted to the hospital with moderate weakness of lower extremities, urinary incontinence, evident disbalance during gait, visual decrease, which have been steadily aggravating during last 2 years. Patient very often suffered from sore throat in the past. His actual vital parameters: BP – 120/79 mm Hg, pulse – 66 beats/sec., breath rate – 17/sec. During visual examination nothing special was observed. During neurological examination next signs were revealed – very elevated tendon reflexes from legs with extended elicitation areas, accompanied with clonus, bilateral positive Babinski’s and Gordon’s sign, decreased deep and superficial sensation in lower extremities (below the knees), left-sided swaying in Romberg’s test, bilateral intention tremor during finger- to-nose test, scarce diplopia during contralateral gaze. Blood assay – normal. CSF assay – normal. Fundoscopy – clear discoloration of the optical discs’ lateral halves. What is your diagnosis? Describe algorithm of diagnosis and treatment. Diagnosis – MS, primary progressive type Affection of lateral and posterior white columns of white matter at the level of thoracic SC, affection of oculomotor nerve Algorithm of diagnosis: MRI, evoked potentials, immunological tests Treatment: Cytostatic to decrease progression- azathioprine
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  • Winter '18
  • Jane doe
  • Neurology, Seizure, Seizure types

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