out-patient management in neurology อ. ลักษนันท์...
TRANSCRIPT
Out-patient Management in Neurology
อ.ลั�กษนั�นัท์� ชี�วะเกรี�ยงไกรีแผนักปรีะสาท์ว�ท์ยา กองอาย�รีกรีรีม
โรีงพยาบาลัพรีะมงก�ฎเกลั�า
Common consultation• Headache
• Numbness
• Weakness
• Seizures
• Dizziness, vertigo
• Ataxia
• Ptosis
• Diplopia
• Visual failure
• Memory impairment
• Confusion
• Dysphagia
• Tremor, abnormal movement
Concepts of Neurology
• History: – CC, PI, PH– Onset, chronological progression– Underlying, associated symptoms– Systemic review
• Physical examination: – General medical examination– Neurological examination
Concepts of Neurology
•Anatomical localization– Where is(are) the lesion(s)?
•Etiology– What is(are) the etiology?
Concepts of Neurology
Concepts of Neurology
Concepts of Neurology
Concepts of Neurology
Concepts of Neurology
Overview in Common Symptoms in Neurology
For OPD practice
Headache
• Anatomical localization– Intracranial– Extracranial
• Etiology– Primary headache– Secondary headache
SNOOP
Numbness
• Anatomical localization– CNS– PNS
• Etiology– Congenital (inherited)– Trauma– Tumor, infection– Toxic, metabolic, endocrine– Inflammatory– Vascular – Degeneration – etc.
Weakness
• Anatomical localization– Upper motor neuron lesion– Lower motor neuron lesion
• Etiology– Congenital (inherited)– Trauma– Tumor, infection– Toxic, metabolic, endocrine– Inflammatory– Vascular – Degeneration – etc.
Seizures
• Anatomical localization– Cortical lesion– Subcortical lesion– Focal/ multifocal/diffuse (generalized)
• Etiology: provoked or unprovoked seizure– Genetics – Trauma– Tumor, infection– Toxic, metabolic, endocrine– Inflammatory– Vascular – Degeneration – etc.
Dizziness, vertigo
• Anatomical localization– Central vertigo– Peripheral vertigo
• Etiology– Trauma– Tumor, infection– Toxic, metabolic, endocrine– Inflammatory– Vascular – Degeneration – etc.
Ataxia
• Anatomical localization– Cerebellar ataxia– Sensory ataxia
• Etiology– Congenital (inherited)– Trauma– Tumor, infection– Toxic, metabolic, endocrine– Inflammatory– Vascular – Degeneration – etc.
Ptosis
• Anatomical localization– 3rd nerve nuclei or true nerve– NMJ– Muscle
• Etiology– Congenital (inherited)– Trauma– Tumor, infection– Toxic, metabolic, endocrine– Inflammatory– Vascular – Degeneration – etc.
Diplopia
• Anatomical localization– 3rd, 4th, 6th, cranial nuclei or nerve– NMJ, muscles
• Etiology– Congenital (inherited)– Trauma– Tumor, infection– Toxic, metabolic, endocrine– Inflammatory– Vascular – Degeneration – etc.
Visual failure
• Anatomical localization– Anterior visual pathway– Posterior visual pathway
• Etiology– Congenital (inherited)– Trauma– Tumor, infection– Toxic, metabolic, endocrine– Inflammatory– Vascular – Degeneration – etc.
Memory impairment
• Anatomical localization– Libic areas
• Etiology– Primary dementia
• Alzheimer’s disease
– Secondary dementia (treatable dementia)
Confusion
• Anatomical localization– Intracranial cause– Extracranial cause (delirium)
• Etiology– Trauma– Tumor, infection– Toxic, metabolic, endocrine– Inflammatory– Vascular – Degeneration – etc.
Dysphagia
• Anatomical localization– Balbar palsy– Pseudobulbar palsy
• Etiology– Congenital (inherited)– Trauma– Tumor, infection– Toxic, metabolic, endocrine– Inflammatory– Vascular – Degeneration – etc.
Tremor, abnormal movement
• Anatomical localization– Extrapyramidal pathway
• Parkinson or non-Parkinson
• Etiology:– Congenital (inherited)– Trauma– Tumor, infection– Toxic, metabolic, endocrine– Inflammatory– Vascular – Degeneration – etc.
Work up
• Lab:– General medicine
• CBC, UA, blood chemistry, septic work up, EKG
• Radiology
• Genetic testing
• Pathology
• Consultation
Neurological tests• Lumbar puncture
• Prostigmine test
• V-EEG: routine, long-term
• Polysomnography
• Carotid Doppler
• EMG, NCV
• Etc.
Imaging
• CT brain
• MRI brain, MRA, MRV
• Angiogram +/- intervention
Management
• Pharmacologic
• Non-pharmacologic
• Counselling
• OPD
• ER, observe
• Admission
Follow up plans
• Depending on diagnosis, underlying disease, severity of illnesses
Thank You