There is a sensory deficit for both light touch and pain on the left side of the face for all divisions of the 5th nerve. Note that the deficit is first recognized just to the left of the midline and not exactly at the midline. Patients with psychogenic sensory loss often identify the sensory change as beginning right at the midline. The first principle of neurologic diagnosis is regional or anatomical localization. In order to become skillful the student must understand how structure relates to function of the nervous system. The neurologic examination permits "dissection" of the nervous system and localizes the disease when present. Instead of simply memorizing the components of the exam, a logical and systematic approach to problem solving evolves from repeatedly asking, "Where is the lesion?"
Patient's speech is difficult to understand; loss of balance (fell off a truck); occasional choking spells, especially if he eats fast; bladder urgency; and slight impairment of memory. The patient returns for a follow-up with his wife. Since the last visit, he reports no significant changes. His speech is unchanged. Balance is the same with occasional falling. He has occasional choking spells, especially if he eats fast. He continues to have bladder urgency and an occasional accident, but he and his wife are fairly comfortable and have a urinal close at hand, at all times. There is no erectile dysfunction and no orthostatic dizziness. His mood is good. He has slight impairment of his memory. He functions well in daily life. He denies any visual problems.
Ed is a 57-year-old Caucasian male with a 15-year history of neurological disability that was diagnosed after his initial attack as multiple sclerosis. Lumbar puncture demonstrated the presence of numerous oligoclonal bands and MRI later showed multiple white matter plaques. He suffers from a significant dysarthria, as well as tremor and ataxia.
Stroking the lateral aspect of the plantar surface of the foot still elicits a strong 'Babinski sign' which is an up-going great toe and fanning of the other toes. A neuroscience tutorial focusing on those aspects of the pediatric neurological examination that are unique to the child's nervous system, with an emphasis on important neurodevelopmental milestones.
The strength and tone of the neck extensors can be tested by having the baby in sitting position and neck flexed so the baby's chin is on the chest. The baby should be able to bring the head to the upright position. The neck flexors can be tested by having the head in extension while in the sitting position. The baby should be able to bring the head to the upright position. These tests are an extension of the test for head lag and are done at the same time. A neuroscience tutorial focusing on those aspects of the pediatric neurological examination that are unique to the child's nervous system, with an emphasis on important neurodevelopmental milestones.
The tone of the neck can be assessed by passively rotating the head towards the shoulder. The chin should be able to rotate to the shoulder but not beyond the shoulder. If the chin goes beyond the shoulder then there is hypotonia of the neck muscles, which is associated with poor head control. A neuroscience tutorial focusing on those aspects of the pediatric neurological examination that are unique to the child's nervous system, with an emphasis on important neurodevelopmental milestones.
This video features a 54-year-old white male with a history of spastic paraplegia (diagnosed in 1994) and no previous history of heart disease or cardiac workup. He presented to the Emergency Room complaining of three days on-and-off retrosternal chest pain. Clinical history: Patient presented to the ER complaining of three days on-and-off retrosternal chest pain, rated 3/10, lasting approximately 30 minutes, occurring multiple times daily at rest or during activity. The first episode occurred three days before admission while the patient was working on his computer. The pain starts in his left neck and goes down to the left arm to the elbow and retrosternally. No shortness of breath, cough, nausea, vomiting, abdominal pain, fever or diaphoresis with this pain.
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