Diagnosis of Brown-Sequard Syndrome
Brown-Sequard Syndrome Diagnosis: Book Excerpts
Diagnostic Tests for Brown-Sequard Syndrome: Online Medical Books
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MONOPLEGIA:
Ask the Following Questions:
(Algorithmic Diagnosis of Symptoms and Signs)
- Are there hyperactive or pathologic reflexes of the involved extremity? These findings suggest spinal cord tumor, parasagittal tumor, amyotrophic lateral sclerosis, anterior cerebral artery occlusion, spinal cord injury, transverse myelitis, and multiple sclerosis.
- Are there decreased or absent reflexes of the involved extremity? These findings suggest a herniated disk, a cauda equina tumor or early cervical cord tumor, progressive muscular atrophy, brachial plexus neuropathy, sciatic neuritis, or peripheral neuropathy.
- Is the onset acute or gradual? An acute onset would suggest a vascular lesion such as anterior cerebral artery occlusion, a spinal cord injury, transverse myelitis, and multiple sclerosis. A gradual onset suggests a space-occupying lesion such as spinal cord tumor, parasagittal tumor, and degenerative diseases such as amyotrophic lateral sclerosis.
- Are there exacerbations or remissions? The presence of exacerbations or remissions should suggest multiple sclerosis, transient ischemic attack, and migraine.
DIAGNOSTIC WORKUP
Monoplegia of the upper extremities with hyperactive reflexes should suggest the need to order a CT scan or MRI of the brain and/or MRI of the cervical spine.
Monoplegia of the lower extremities with hyperactive reflexes or pathologic reflexes would suggest the need to order MRI of the thoracic spine. However, because an anterior cerebral artery occlusion or parasagittal tumor may cause similar findings, a CT scan of the brain may be necessary. Rather than make this difficult choice yourself, a neurologist should be consulted. He may want to do a spinal fluid analysis or evoked potential studies as well. If he believes a vascular lesion is possible, then he may want to do a four-vessel angiography or simply a carotid scan.
The findings of monoplegia with hypoactive reflexes, especially of gradual onset, would suggest a radiculopathy, peripheral neuropathy, or plexopathy. In the lower extremities, these findings would indicate the need for a CT scan or MRI of the lumbosacral spine. In the upper extremities, these findings would suggest the need for MRI of the cervical spine.
A neuropathy workup is also indicated in monoplegia of the upper or lower extremity. Nerve conduction velocity studies and EMG studies of the involved extremities are extremely valuable also. The most cost-effective approach is to refer the patient to a neurologist at the outset.
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Analgesia:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
After you’re satisfied that the patient’s spine and respiratory status are stabilized — or if the analgesia isn’t severe and isn’t accompanied by signs of spinal cord injury — perform a physical examination and baseline neurologic evaluation. First, take the patient’s vital signs and assess his level of consciousness. Then test pupillary, corneal, cough, and gag reflexes to rule out brain stem and cranial nerve involvement. If the patient is conscious, evaluate his speech, gag reflex, and ability to swallow.
If possible, observe the patient’s gait and posture and assess his balance and coordination. Evaluate muscle tone and strength in all extremities. Test for other sensory deficits over all dermatomes (individual skin segments innervated by a specific spinal nerve) by applying light tactile stimulation with a tongue depressor or cotton swab. Perform a more thorough check of pain sensitivity, if necessary, using a pin. (See Testing for analgesia, pages 38 and 39.) Also, test temperature sensation over all dermatomes, using two test tubes — one filled with hot water, the other with cold water. In each arm and leg, test vibration sense (using a tuning fork), proprioception, and superficial and deep tendon reflexes. Check for increased muscle tone by extending and flexing the patient’s elbows and knees as he tries to relax.
Focus your history taking on the onset of analgesia (sudden or gradual) and on any recent trauma — a fall, sports injury, or automobile accident. Obtain a complete medical history, noting especially any incidence of cancer in the patient or his family.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Muscle spasticity [Muscle hypertonicity]:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
When you detect spasticity, ask the patient about its onset, duration, and progression. What, if any, events precipitate its onset? Has he experienced other muscular changes or related symptoms? Does his medical history reveal an incidence of trauma or a degenerative or vascular disease?
Take the patient’s vital signs, and perform a complete neurologic examination. Test reflexes and evaluate motor and sensory function in all limbs. Evaluate muscles for wasting and contractures.
During your examination, keep in mind that generalized spasticity and trismus in a patient with a recent skin puncture or laceration indicates tetanus. If you suspect this rare disorder, look for signs of respiratory distress. Provide ventilatory support, if necessary, and monitor the patient closely.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Gait, spastic [Hemiplegic gait]:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
Find out when the patient first noticed the gait impairment and whether it developed suddenly or gradually. Ask him if it waxes and wanes, or if it has worsened progressively. Does fatigue, hot weather, or warm baths or showers worsen the gait? Such exacerbation typically occurs in multiple sclerosis. Focus your medical history questions on neurologic disorders, recent head trauma, and degenerative diseases.
During the physical examination, test and compare strength, range of motion (ROM), and sensory function in all limbs. Also, observe and palpate for muscle flaccidity or atrophy.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Analgesia:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Once you’re satisfied that the patient’s spine and respiratory status are stabilized—or if the analgesia isn’t severe and isn’t accompanied by signs of spinal cord injury—perform a physical examination and baseline neurologic evaluation. First, take the patient’s vital signs and assess his level of consciousness. Then test pupillary, corneal, cough, and gag reflexes to rule out brain stem and cranial nerve involvement. If the patient is conscious, evaluate his speech and ability to swallow.
If possible, observe the patient’s gait and posture and assess his balance and coordination. Evaluate muscle tone and strength in all extremities. Test for other sensory deficits over all dermatomes (individual skin segments innervated by a specific spinal nerve) by applying light tactile stimulation with a tongue depressor or cotton swab. Perform a more thorough check of pain sensitivity, if necessary, using a pin. (See Testing for analgesia, pages 48 and 49.) Also, test temperature sensation over all dermatomes, using two test tubes—one filled with hot water, the other with cold water. In each arm and leg, test vibration sense (using a tuning fork), proprioception, and superficial and deep tendon reflexes (DTRs). Check for increased muscle tone by extending and flexing the patient’s elbows and knees as he tries to relax.
Focus your history taking on the onset of analgesia (sudden or gradual) and on any recent trauma, such as a fall, a sports injury, or an automobile accident. Obtain a complete medical history, noting especially any incidence of cancer in the patient or his family.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Muscle spasticity [Muscle hypertonicity]:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Once you detect spasticity, ask the patient about its onset, duration, and progression. What, if any, events precipitate onset? Has he experienced other muscular changes or related symptoms? Does his medical history reveal any incidence of trauma or degenerative or vascular disease?
Take the patient’s vital signs, and perform a complete neurologic examination. Test reflexes and evaluate motor and sensory function in all limbs. Evaluate muscles for wasting and contractures.
During your examination, keep in mind that generalized spasticity and trismus in a patient with a recent skin puncture or laceration indicates tetanus. If you suspect this rare disorder, look for signs of respiratory distress. Provide ventilatory support, if necessary, and monitor the patient closely.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Gait, spastic [Hemiplegic gait]:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Find out when the patient first noticed the gait impairment and whether it developed suddenly or gradually. Ask him if it waxes and wanes or if it has worsened progressively. Does fatigue, hot weather, or warm baths or showers worsen the gait? Such exacerbation typically occurs in multiple sclerosis. Focus your medical history questions on neurologic disorders, recent head trauma, and degenerative diseases.
During the physical examination, test and compare strength, range of motion, and sensory function in all limbs. Also, observe and palpate for muscle flaccidity or atrophy.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Analgesia:
History
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
After assuring spinal cord stabilization, proceed with assessing the patient. Establish the onset of analgesia (sudden or gradual). Did the patient suffer recent trauma, such as a fall, sports injury, or automobile accident? Obtain a complete medical history, noting incidence of cancer in the patient or his family.
Physical examination
Assess the patient’s vital signs, including the pattern of respirations. Determine his level of consciousness. Assist to test pupillary, corneal, cough, and gag reflexes to rule out brain stem and cranial nerve involvement. If the patient is conscious, evaluate his ability to swallow.
Assist to perform a full neurologic assessment, including orientation to person, place, and time. Assess the patient’s ability to speak clearly, pupil size and reaction to light, ability to follow commands, ability to wiggle extremities, and awareness of touch. Test for other sensory deficits over all dermatomes (individual skin segments innervated by a specific spinal nerve) by applying light tactile stimulation with a tongue depressor or cotton swab. Perform a more thorough assessment of pain sensitivity, if necessary, using a pin. (See Testing for analgesia, pages 18 and 19.) Assess the patient’s temperature sensation over all dermatomes, using two test tubes — one filled with warm water, the other with cold water. In each arm and leg, test vibration sense (using a tuning fork), proprioception, and superficial and deep tendon reflexes (DTRs). Check for increased muscle tone by extending and flexing the patient’s elbows and knees as he tries to relax.
After a spinal cord injury is ruled out, observe the patient’s gait and posture and assess his balance and coordination. Evaluate muscle tone and strength in all extremities.
» READ BOOK EXCERPT ONLINE »
Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Muscle spasticity:
History
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
If you detect spasticity, ask the patient about its onset, duration, and progression. What, if any, events precipitate onset? Has he experienced other muscular changes or related symptoms? Does his medical history reveal any incidence of trauma or degenerative or vascular disease?
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Analgesia:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
After you're satisfied that the patient's spine and respiratory status are stabilized—or if the analgesia isn't severe and isn't accompanied by signs of spinal cord injury—perform a physical examination and baseline neurologic evaluation. First, take the patient's vital signs and assess his level of consciousness. Then test pupillary, corneal, cough, and gag reflexes to rule out brain stem and cranial nerve involvement. If the patient is conscious, evaluate his speech, gag reflex, and ability to swallow.
If possible, observe the patient's gait and posture and assess his balance and coordination. Evaluate muscle tone and strength in all extremities. Test for other sensory deficits over all dermatomes (individual skin segments innervated by a specific spinal nerve) by applying light tactile stimulation with a tongue depressor or cotton swab. Perform a more thorough check of pain sensitivity, if necessary, using a pin. (See Testing for analgesia, pages 32 and 33.)
Test temperature sensation over all dermatomes, using two test tubes—one filled with hot water, the other with cold water. In each arm and leg, test vibration sense (using a tuning fork), proprioception, and superficial and deep tendon reflexes. Check for increased muscle tone by extending and flexing the patient's elbows and knees as he tries to relax. Focus your history taking on the onset of analgesia (sudden or gradual) and on any recent trauma—a fall, sports injury, or automobile accident. Obtain a complete medical history, noting especially any incidence of cancer in the patient or his family. Obtain a complete drug history.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Muscle spasticity [Muscle hypertonicity]:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
When you detect muscle spasticity, ask the patient about its onset, duration, and progression. What, if any, events precipitate its onset? Has he experienced other muscular changes or related symptoms? Does his medical history reveal an incidence of trauma or a degenerative or vascular disease?
Take the patient's vital signs, and perform a complete neurologic and musculoskeletal examination. Test reflexes and evaluate motor and sensory function in all limbs. Evaluate muscles for wasting and contractures.
Alert
During your examination, keep in mind that generalized spasticity and trismus in a patient with a recent skin puncture or laceration indicates tetanus. If you suspect this rare disorder, look for signs of respiratory distress. Provide ventilatory support, if necessary, and monitor the patient closely.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Gait, spastic [Hemiplegic gait]:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Find out when the patient first noticed the gait impairment and whether it developed suddenly or gradually. Ask him if it waxes and wanes, or if it has worsened progressively. Does fatigue, hot weather, or warm baths or showers worsen the gait? Such exacerbation typically occurs in multiple sclerosis. Focus your medical history questions on neurologic disorders, recent head trauma, and degenerative diseases.
During the physical examination, test and compare strength, range of motion (ROM), and sensory function in all limbs. Also, observe and palpate for muscle flaccidity or atrophy.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
MONOPLEGIA:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
The neurologic examination will help determine the site of the lesion
and thus the likely etiology. If there are hyperactive reflexes in the
involved extremity, the lesion is probably in the upper spinal cord or
cerebral cortex. If there is associated facial palsy or other cranial nerve
signs, the lesion is probably in the brain or brainstem.
Hypoactive reflexes in the involved extremity indicate a lesion in the nerve
roots, nerve plexus, or peripheral nerves. However, acute cerebral
thrombosis, hemorrhage, or embolism may present with hypoactive reflexes in
the involved extremity. Before proceeding with an expensive workup, a
neurologist needs to be consulted.
Monoplegia of the upper extremities with hyperactive reflexes would indicate
the need for an MRI or CT scan of the brain or cervical spinal cord.
Monoplegia of the lower extremities with hyperactive reflexes would suggest
the need for an MRI of the thoracic spine. However, a CT scan or MRI of the
brain may still be required to rule out a parasagittal lesion.
Monoplegia with hypoactive reflexes may require an MRI or CT scan of the
spine, electromyogram (EMG), and nerve conduction velocity (NCV) studies.
Blood lead levels, glucose tolerance tests, and other studies indicated in a
neuropathy workup (page 345) may be
required. Muscle biopsy and acetylcholine receptor antibody titers may be
necessary.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
SPASTICITY:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
After the level of the
lesion is established, an MRI or CT scan of that area can be ordered. A
neurologist should be consulted first. A spinal tap will be useful in
establishing the diagnosis of multiple sclerosis, encephalitis, and
neurosyphilis if a space-occupying lesion has been ruled out.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
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