hello
i have talked about my favourite neuro learning resources before
here is an update
do add your suggestions / opinions
_ _ _
1) neurological exam made easy by geraint fuller
great book - short, readable, nice pictures, clinical
2) neurological differential diagnosis by john patten
brilliant book - the best anatomical drawings of neurology (done by the author), clinical, practical
not so short, but all you will ever need to know about neurological examination (unless you become a neurologist)
3) neuroanatomy through clinical cases by hal blumenfeld
great book - very sensible way to learn neuroanatomy, lots of cases, good pictures, associated website
not short, but very readable
4) neuroanatomy: draw it to know it by adam fisch
great book - teaches anatomy by way of staged diagrams illustrating all the major neuro systems
good text too
not short, but nicely 'chunked'
5) neurologic examination website by university of utah
excellent website - videos of normal & abnormal findings for all major components of neuro exam, downloadable (with permission)
6) the neurological exam website by university of toronto
good site - not as comprehensive as utah site, but well laid out with nice tables
videos only with healthy volunteers
7 eyevideos.blogspot.com
good site made by a young ophthalmologist with videos detailing neuro-ophthalmology examination & investigations
Salaam
s
Tuesday, 14 December 2010
a 20-year-old woman with slurred speech and weakness
yesterday we briefly examined a very pleasant university student who has been unwell since earlier this year
she was alert - we did not test her higher order cognitive function
she had obvious slurring of her speech, which had been present for a month or so
we concentrated on examining her arms
we talked (again) about the importance of INSPECTION
fasciculations can be quite hard to see, especially if the light is poor and the muscles involved are small, so really have a good look - make sure you turn the lights on & adequately expose the patient (which can be done comfortably and with dignity)
_ _ _
as an aside, i wanted to mention motor neurone disease - i know very little about this condition; it results in upper and lower motor neurone signs; it must be one of the worst diseases and there are no treatments, riluzole, the only drug available increases life expectancy by a few months at best (miller et al, 2007);
here is link to a video of the historian tony judt talking about the disease
he died in august
_ _ _
we went on to test tone and then power
this is often done quite badly
my most useful tip (after practise a lot) would be to slow down & think about what you are doing
use the MRC grading scale
if a patient uses their muscles to move their arm (or leg) into the correct position against gravity, then they have already scored 3/5
_ _ _
here is a link to another website showing you how to do a neuro exam
i particularly like the muscle action & innervation chart in the motor section
_ _ _
we talked about the decreased utility of testing for inco-ordination in the context of muscle weakness
_ _ _
this lady has a diagnosis of multiple sclerosis
she has had several clinical events and has had a full diagnostic work up including MRIs, LP, VEP
the visual evoked potential involves being shown a visual stimulus, eg a pattern, and then measuring electrical responses primarily from the occipital lobe using EEG
[why the occipital lobe?]
she was alert - we did not test her higher order cognitive function
she had obvious slurring of her speech, which had been present for a month or so
we concentrated on examining her arms
we talked (again) about the importance of INSPECTION
fasciculations can be quite hard to see, especially if the light is poor and the muscles involved are small, so really have a good look - make sure you turn the lights on & adequately expose the patient (which can be done comfortably and with dignity)
_ _ _
as an aside, i wanted to mention motor neurone disease - i know very little about this condition; it results in upper and lower motor neurone signs; it must be one of the worst diseases and there are no treatments, riluzole, the only drug available increases life expectancy by a few months at best (miller et al, 2007);
here is link to a video of the historian tony judt talking about the disease
he died in august
_ _ _
we went on to test tone and then power
this is often done quite badly
my most useful tip (after practise a lot) would be to slow down & think about what you are doing
use the MRC grading scale
if a patient uses their muscles to move their arm (or leg) into the correct position against gravity, then they have already scored 3/5
_ _ _
here is a link to another website showing you how to do a neuro exam
i particularly like the muscle action & innervation chart in the motor section
we talked about the decreased utility of testing for inco-ordination in the context of muscle weakness
_ _ _
this lady has a diagnosis of multiple sclerosis
she has had several clinical events and has had a full diagnostic work up including MRIs, LP, VEP
the visual evoked potential involves being shown a visual stimulus, eg a pattern, and then measuring electrical responses primarily from the occipital lobe using EEG
[why the occipital lobe?]
_ _ _
she was actually admitted for episodes of loss of consciousness, the cause of which is not entirely clear
interestingly she is due to have a tilt table test - i mentioned my ignorance of the effects of MS on the autonomic nervous system
she is in the midst of a relapse affecting her speech, face, right arm & leg, and is due to start steroids this week
Salaam
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