Download Localizing Signs And Symptoms In Neurology

Localizing Signs And
Symptoms In Neurology
Dr. Suhail Al-Shammri FRCP (C)
Associate. Professor. Faculty of
Medicine,Kuwait University
Language :
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Aphasia- language disturbance
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fluency, comprehension,repitition,
naming,reading,writing and
handedness.
Dysarthria- abnormal speech
articulation
NON-APHASIA
Fluent aphasia
Cranial Nerves :
OLFACTORY
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Loss of smell: Anosmia
Diminished : Hyposmia
Distorted
:dysosmia
Causes Of Anosmia
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Local nasal disease:cold.rhinitis,polyps
Head injury: Fracture of frontal base
Degenerative:
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Alzheimer’s disease
Parkinson’s disease
Endocrine: Addison’s disease, diabetes
Cranial Nerve Function:
optic nerve
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Visual acuity: reduced in :
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refraction error
obstruction of light- catarct
retinal or optic nerve disease
Visual fields-confrontation
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hemianopia- loss of half of visual field
quadrantanopia- loss of quarter
Visual Fields
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Homonymous hemianopia- loss of same
half of visual field in each eye.
Bitemporal hemianopia- loss of temporal
fields in each eye.
Perimetry- to detect small spots of visual
loss(scotoma) or blind spot
Extinction or neglect- perception of one
stimulus on double stimulation
PAPILLEDEMA
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PATHOLOGICAL SWELLING WITH
ELEVATION OF THE OPTIC DISC CAUSED
BY RAISED INTRACRANIAL PRESSURE
Optic Nerve: Papilledema
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loss of venous pulsation
blurring of optic disc margins
venous engorgement
elevation of optic disc
retinal hemorrhage
visual acuity usually spared
Enlarged blind spot
PAPILLEDEMA
CAUSES OF
PAPILLEDEMA:Increased ICP
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Mass lesions:tumors,abscess, hematoma
Cerebral edema: trauma
Infections: meningitis, encephalitis
Venous sinus thrombosis
Idiopathic intracranial hypertension
CAUSES OF
PAPILLEDEMA:Medical disorders
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Severe anemia
Accelerated hypertension
Lead poisoning
Polcythemia rubra vera
Carbon dioxide retention
Drugs: tetracyclines, steroids,excess vit A
OPTIC NEURITIS
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Acute inflammation of the optic nerve
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Papillitis
Retrobulbar neuritis
Optic Nerve:Fundoscopy
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Papillitis- optic disc inflammation
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usually unilateral,painful
visual acuity is impaired
Causes:
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Demyelination: Multiple sclerosis
Viral
Post-infectious
OPTIC ATROPHY
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small pale sharply demarcated optic
disc
end-stage of various diseases
visual acuity is usually impaired
Afferant Pupillary Defect
Oculomotor Nerves
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Eye movements controlled by six
extraocular muscles:
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superior rectus, medial rectus,inferior
rectus and inferior oblique(oculomotor)
lateral rectus (abducens nerve)
superior oblique (trochlear nerve)
eyelid elevation,pupillary size,shape
and reactivity to light and
accommodation(oculomotor nerve)
Nystagmus
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Abnormal involuntary rhythmic eye
movement- at rest or induced
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slow deviation of one eye in one
direction and quick corrective
movement in opposite direction
“End- point” nystagmus: occurs
normally with gaze too far laterally
Asymmetric horizontal nystagmus:
indicate central or vestibular lesion
Nystagmus
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Up-beating or downbeating
nystagmus indicates brain-stem
disease.
Congenital nystagmus:
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present at birth
horizontal beating
reduced or disappears on convergence
usually associated with rduced visual
acuity
NYSTAGMUS
Oculomotor nerve palsy
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Eye is down and out
upper eyelid droops(ptosis)
pupil is dilated, unreactive to light
the concept of pupillary sparing
differentiates between diabetic and
compressive neuropathy.
Oculomotor nerve palsy
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Nuclear: result in contralateral superior
rectus palsy
Fascicular: Long tract signs
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Weber’s syndrome: contralateral hemiplegia
Benedikit’s syndrome: contralateral ataxia
and intention tremor
Peripheral: Partial or complete
Oculomotor nerve palsy:
CAUSES
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Diabetes
Compressive:
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Aneurysm
Cavernous sinus lesions:
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Affect oculomotor nerves
First and second divisions of trigeminal
Oculosympathetic fibers
Cavernous sinus lesions:
Causes
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Aneurysm
Caroticocavernous fistula or thrombosis
Expanding pituitary tumor
Granuloma: Sarcoidosis
Oculomotor nerve palsy
Abducens nerve palsy:
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eye is adducted and doesn’t cross
midline
Nuclear lesions cause Gaze palsy
CAUSES:
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Diabetes
Atherosclerosis
Multiple sclerosis
Raised intracranial pressure
Abducens nerve palsy
Internuclear
ophthalmoplegia
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Adducting eye does not move past
midline and the abducting eye develops
nystagmus
Adduction is spared during convergence
Result from lesion of the medial
longitudinal fasciculus(MLF)
Internuclear
ophthalmoplegia
Trochlear nerve palsy
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Vertical diplopia(double vision)
especially on looking downword
Head tilt toward side opposite paretic
superior oblique muscle
Isolated trochlear nerve palsy is often
due to HEAD TRAUMA
Argyll Robertson pupil-small irregular
pupil costricts to light not to
accommodation - neurosyphilis
Trochlear nerve palsy
Trigeminal Nerve
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Corneal Reflex: lightly touching cornea
normally causes brisk bilateral eye
closure.
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Blink will not occur on side of facial
nerve paralysis.
Touching cornea on the side of
ophthalmic division dysfunction will not
result in eye blink
Trigeminal Nerve
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Facial sensation - loss of sensation can
occur independantly in each trigeminal
nerve division.
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Muscles of mastication :
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atrophy of temporalis or masseter
muscles.
Jaw deviation toward weak side in
unilateral lesions.
Facial Nerve
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Lower motor neuron palsy :
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produces weakness of all facial muscles
including forehead on same side as
lesion.
Upper motor neuron palsy :
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Unilateral lower facial weakness
sparing the ability to wrinkle forehead
and partially close eyelids.
Horner’s Syndrome
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Damage to the sympathetic nerve supply
to eye
Characterized by :
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small pupil (miosis)
slight drooping of eyelid (ptosis)
impaired sweating (anhydrosis) on that
side of the face
Vestiulocochlear nerve
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Weber’s test:
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In sensorineural deafness sound is
heard better in the normal ear.
In conductive deafness sound is heard
better in diseased ear.
Rinne test :
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Air conduction is louder than bone
conduction in normal individuals and in
those with sensorineural deafness
Vestibulocochlear nerve
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Caloric test :
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unilateral vestibular stimulation is
accomplished by instillation of cold or
warm water into one external auditory
meatus .
It induces nystagmus
Warm water- towards stimulated ear
Cold water- away from stimulated ear
Glosopharyngeal and
Vagus nerve
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Unilateral vagal nerve lesion result in
palatal asymmetry with uvula deviating
towards normal side.
Palatal weakness results in nasal quality
to voice
Vocal cord weakness result in Horseness.
Hypoglossal Nerve
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Unilateral lesion : tongue deviates toward
weak side.
In long-standing lesion : atrophy of
affected side of tongue
Case 3
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A patient is found to have :
Reduced joint position sense in the left
foot.
Reduced pin prick sensation on the
palmar surface of the little finger of the
right hand
Case 4
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A patient is found to have :
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reduced joint position sense in the left
foot
reduced pin prick sensation on the
palmar surface of the little finger of the
right hand.
Weakness of left ankle dorsiflexion
Hperreflexia at left knee
Case 5
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A patient found to have:
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reduced joint position sense in the left
foot.
Reduced joint position sense in the
right foot.
Reduced joint position sense in the left
hand
reduced joint position sense in the right
hand
Case 6
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A patient is found to have:
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reduced joint position sense in the left
foot.
Reduced pin prick sensation on the
palmar surface of little finger of the
right hand
reduced visual acuity in the left eye