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Is it acute or gradual onset? If it is acute onset, Bell's palsy, diabetic neuropathy, and cerebral vascular accident must be considered. If it is gradual onset, one must consider an acoustic neuroma, advancing petrositis, or a brain tumor or abscess. ... DIAGNOSTIC WORKUP
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A subjective sensory phenomenon that may involve any of the five senses, such as visual auras (often described as flashing lights), sensory auras (paresthesias), or auditory auras. Other auras may be described as dreamlike or déjà vu sensations, or odd odors.... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Chorea (Greek for “dance”) refers to continuous, rapid, and abrupt jerking movements, which are involuntary and often possess a writhing quality. These movements often interfere with the ability to complete daily activities. A characteristic feature is an... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Seizures are a symptom of some identifiable underlying cause or are idiopathic. Epilepsy is recurrent unprovoked seizures. Seizures may or may not be associated with convulsive activity. Correct classification of the seizure type helps to suggest etiology and treatment.
... Workup and Diagnosis ... Treatment
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Differentiate supranuclear facial palsy from peripheral (nuclear) facial palsy. Supranuclear palsy involves predominantly the lower part of the face. Emotional responses may be intact (e.g., the patient may not be able to show you his teeth but will smile in response to a joke).... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Chorea consists of brief, irregular, nonrhythmic, unsustained involuntary movements that flow from one part of the body to another. Chorea is often accompanied by athetosis, which are slow, writhing, involuntary movements. These movement disorders are thought to result from... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Although Bell palsy is the most frequent etiology, it is a diagnosis of exclusion; one must thoroughly rule out infections, congenital, developmental, and other causes. Serial electrical testing provides objective monitoring of nerve function and... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Febrile seizures occur in 3–4% of all children; they often do not require long-term treatment. Each year, between 25,000 and 40,000 children in the U.S. have a first unprovoked afebrile seizure. Most of these children will not have a second seizure and do not... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Seizures in the newborn are often difficult to diagnose, because there may only be subtle manifestations. Any insult that affects the brain in this age group can present with seizures, thus the differential diagnosis is quite extensive. One also has to rule out several mimics such... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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... The causes of this symptom lend themselves easily to recall. Simply remember the word VINDICATE. There are usually just one or two diseases for each letter.
V—Vascular suggests an infarct of the subthalamic nucleus, which produces hemiballism.
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... The differential diagnosis of this sign is similar to the differential diagnosis of tremors (see page 521), but a few additional possibilities should be kept in mind. Idiopathic myoclonus epilepsy, petit mal epilepsy (with the petit mal triad),
... READ EXCERPTS »
... Anatomy can assist one greatly in formulating a differential diagnosis of tremor of hepatic coma, Wilson disease, and alcoholism. The thyroid brings to mind the tremor of Graves disease. The kidneys signify the tremor of uremia and electrolyte
... READ EXCERPTS »
... A facial palsy is usually considered to be Bell palsy and it frequently is. Nevertheless, the clinician who begins treatment without ruling out other possibilities will eventually get burned. Anatomy is the key to recalling these possibilities
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... This symptom, as opposed to generalized weakness and fatigue (see page 541), is almost invariably due to a neurologic disorder. Consequently, a comprehensive list of causes is developed using neuroanatomy. Muscle weakness or paralysis may be due to disease of the muscle, myoneural junction,
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... Many of the conditions that cause splenomegaly also cause generalized lymphadenopathy. They are best recalled with the use of the mnemonic MINT.
LYMPHADENOPATHY, GENERALIZED
M&
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... The analysis of the causes of weakness depends on a knowledge of both anatomy and biochemistry. Strength depends on an intact healthy muscle, peripheral nerve, and lower and upper motor neuron pathways and a functioning myoneural junction. Thus, general
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... An aura is a sensory or motor phenomenon, idea, or emotion that marks the initial stage of a seizure or the approach of a classic migraine headache. Auras may be classified as cognitive, affective, psychosensory, or psychomotor. (See Recognizing types of auras.)
... Emergency interventions ... History and physical examination ... Medical causes ... Special considerations ... Pictures
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... Carpopedal spasm is the violent, painful contraction of the muscles in the hands and feet. (See Recognizing carpopedal spasm, page 126.) It's an important sign of tetany, a potentially life-threatening condition characterized by increased neuromuscular... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pictures
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... A decrease in the level of consciousness (LOC), from lethargy to stupor to coma, usually results from a neurologic disorder and may signal a life-threatening complication, such as hemorrhage, trauma, or cerebral edema. However, this sign can also result from a metabolic, GI, musculoskeletal,... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Pictures
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... Myoclonus — sudden, shocklike contractions of a single muscle or muscle group — occurs with various neurologic disorders and may herald the onset of a seizure. These contractions may be isolated or repetitive, rhythmic or arrhythmic,... Emergency Interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers
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... Paralysis, the total loss of voluntary motor function, results from severe cortical or pyramidal tract damage. It can occur with a cerebrovascular disorder, degenerative neuromuscular disease, trauma, tumor, or central nervous system infection. Acute paralysis... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Pictures
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... A complex partial seizure occurs when a focal seizure begins in the temporal lobe and causes a partial alteration of consciousness — usually confusion. Psychomotor seizures can occur at any age, but their incidence usually increases during adolescence and adulthood. Two... History ... Medical causes ... Special considerations ... Pediatric pointers
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... Like other types of seizures, generalized tonic-clonic seizures are caused by the paroxysmal, uncontrolled discharge of central nervous system neurons, leading to neurologic dysfunction. Unlike most other types of seizures, however, this cerebral hyperactivity isn’t confined to... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Pictures
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... Resulting from an irritable focus in the cerebral cortex, simple partial seizures typically last about 30 seconds and don’t alter the patient’s level of consciousness (LOC). The type and pattern reflect the location of the irritable... History and physical examination ... Medical causes ... Special considerations ... Pediatric pointers ... Pictures
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... Absence seizures are benign, generalized seizures thought to originate subcortically. These brief episodes of unconsciousness usually last 3 to 20 seconds and can occur 100 or more times per day, causing periods of inattention. Absence seizures usually... History and physical examination ... Medical causes
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... Central Nervous System and Vascular Causes
Cerebrovascular disease
Thrombosis
Embolism
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... Acute (Developing in Hours)
Spinal cord injury
Spinal cord hemorrhage (secondary to vascular malformation, coagulopathy, anticoagulant therapy, trauma)
Spinal cord infarct
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... Acne vulgaris
Acne rosacea
Pyogenic infection (especially disseminated gonococcal, Pseudomonas, meningococcal)
Viral infection (especially vaccinia, variola)
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... Physical agents
Radiation
Burns
Chemicals
Cosmetics
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... Vocal cord paralysis results from disease of or injury to the superior or, most commonly, the recurrent laryngeal nerve. It may also be congenital.
Causes
Vocal cord paralysis commonly results from the accidental... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... An aura is a sensory or motor phenomenon, idea, or emotion that marks the initial stage of a seizure or the approach of a classic migraine headache. Auras may be classified as cognitive, affective, psychosensory, or psychomotor. (See Recognizing... Emergency interventions ... History and physical examination ... Medical causes ... Special considerations ... Pediatric pointers ... Pictures
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... Carpopedal spasm is the violent, painful contraction of the muscles in the hands and feet. (See Recognizing carpopedal spasm.) It’s an important sign of tetany, a potentially life-threatening condition that is commonly associated with... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... A decrease in level of consciousness (LOC), from lethargy to stupor to coma, usually results from a neurologic disorder and may signal a life-threatening complication, such as hemorrhage, trauma, or cerebral edema. However, this sign can also result... Emergency Interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Pictures
... READ EXCERPTS »
... Myoclonus—sudden, shocklike contractions of a single muscle or muscle group—occurs with various neurologic disorders and may herald onset of a seizure. These contractions may be isolated or repetitive, rhythmic or arrhythmic, symmetrical or... Emergency Interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers
... READ EXCERPTS »
... Paralysis, the total loss of voluntary motor function, results from severe cortical or pyramidal tract damage. It can occur with a cerebrovascular disorder, degenerative neuromuscular disease, trauma, tumor, or central nervous system infection.... Emergency Interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Pictures
... READ EXCERPTS »
... A complex partial seizure occurs when a focal seizure begins in the temporal lobe and causes a partial alteration of consciousness—usually confusion. Psychomotor seizures can occur at any age, but incidence usually increases during adolescence and... History and physical examination ... Medical causes ... Special considerations ... Pediatric pointers
... READ EXCERPTS »
... Like other types of seizures, generalized tonic-clonic seizures are caused by the paroxysmal, uncontrolled discharge of central nervous system (CNS) neurons, leading to neurologic dysfunction. Unlike most other types of seizures, however, this... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... Resulting from an irritable focus in the cerebral cortex, simple partial seizures typically last about 30 seconds and don’t alter the patient’s level of consciousness (LOC). The type and pattern reflect the location of the irritable focus. Simple partial seizures may be... History and physical examination ... Medical causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... Chorea—brief, unpredictable bursts of rapid, jerky motion that interrupt normal coordinated movement—indicates dysfunction of the extrapyramidal system. Unlike tics, choreiform movements are seldom repetitive but tend to appear purposeful despite their involuntary nature.... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers
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... Absence seizures are benign, generalized seizures thought to originate subcortically. These brief episodes of unconsciousness usually last 3 to 20 seconds and can occur 100 or more times a day, causing periods of inattention. Absence seizures usually begin... History and physical examination ... Medical causes ... Patient counseling
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... Linda M. Savory
Seizures are a common serious neurologic disorder in the outpatient setting. In the United States, approximately 4 million patients suffer at least one seizure and 2 million have suffered two or more. Approximately 10% of these suffer more... Approach. ... History. ... Physical examination (PE) ... Testing ... Diagnostic assessment.
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... Jeffrey D. Harrison
Lymph nodes of abnormal size, consistency, or number define lymphadenopathy. Generalized lymphadenopathy refers to these abnormal nodes when they are found in two or more noncontiguous sites. Generalized... Approach ... History ... Physical examination ... Testing ... Diagnostic assessment
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... Differential Overview
❑ Generalized (grand mal)
❑ Partial (focal)
❑ Complex partial (temporal lobe)
❑ Absence (petit mal) ... Diagnostic Approach ... Clinical Findings ... Pictures
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... Paralysis of the vocal cords results from disease of or injury to the superior or, most often, the recurrent laryngeal nerve.
Causes
Vocal cord paralysis commonly results from the accidental severing of the recurrent... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... Carpopedal spasm is the violent, painful contraction of the muscles in the hands and feet. (See Recognizing carpopedal spasm, page 70.) It’s an important sign of tetany, a potentially life-threatening condition characterized by increased... Assessment ... History ... Physical examination ... Pediatric pointers ... Geriatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... A decrease in level of consciousness (LOC), from lethargy to stupor to coma, usually results from a neurologic disorder and may signal a life-threatening complication, such as hemorrhage, trauma, or cerebral edema. However, this sign can also result from a... Assessment ... History ... Physical examination ... Pediatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... Myoclonus — sudden, shocklike contractions of a single muscle or muscle group — occurs with various neurologic disorders and may herald onset of a seizure. These contractions may be isolated or repetitive, rhythmic or arrhythmic, symmetrical or asymmetrical,... Assessment ... History ... Physical examination ... Pediatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching
... READ EXCERPTS »
... Paralysis, the total loss of voluntary motor function, results from severe cortical or pyramidal tract damage. It can occur with a cerebrovascular disorder, degenerative neuromuscular disease, trauma, tumor, or central nervous system infection. ... Assessment ... History ... Physical examination ... Pediatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... Like other types of seizures, generalized tonic-clonic seizures are caused by the paroxysmal, uncontrolled discharge of central nervous system (CNS) neurons, leading to neurologic dysfunction. Unlike most other types of seizures, however, this cerebral... Assessment ... History ... Physical examination ... Pediatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... An aura is a sensory or motor phenomenon, idea, or emotion that marks the initial stage of a seizure or the approach of a classic migraine headache. Auras may be classified as cognitive, affective, psychosensory, or psychomotor. (See ... Emergency Actions ... History ... Physical assessment ... Medical causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... Carpopedal spasm is the violent, painful contraction of the muscles in the hands and feet. (See Recognizing carpopedal spasm.) It’s an important sign of tetany, a potentially life-threatening condition characterized by increased neuromuscular excitation and... Emergency Actions ... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... Chorea — brief, unpredictable bursts of rapid, jerky motion that interrupt normal coordinated movement — indicates dysfunction of the extrapyramidal system. Unlike tics, choreiform movements are seldom repetitive but tend to appear... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... A decrease in level of consciousness (LOC), which can range from lethargy to stupor to coma, usually results from a neurologic disorder and may signal a life-threatening complication, such as hemorrhage, trauma, or cerebral edema. However, this sign can also result from metabolic,... Emergency Actions ... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... Myoclonus — sudden, shocklike contractions of a single muscle or muscle group — occurs with various neurologic disorders and may herald onset of a seizure. These contractions may be isolated or repetitive, rhythmic or arrhythmic, symmetrical or asymmetrical,... Emergency Actions ... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... Paralysis, the total loss of voluntary motor function, results from severe cortical or pyramidal tract damage. It can occur with a cerebrovascular disorder, degenerative neuromuscular disease, trauma, tumor, or central nervous system infection. Acute paralysis may be an early... Emergency Actions ... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... A complex partial seizure occurs when a focal seizure begins in the temporal lobe and causes a partial alteration of consciousness — usually confusion. Psychomotor seizures can occur at any age, but incidence usually increases during... History ... Physical assessment ... Medical causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... Like other types of seizures, generalized tonic-clonic seizures are caused by the paroxysmal, uncontrolled discharge of central nervous system (CNS) neurons, leading to neurologic dysfunction. Unlike most other types of seizures, however, this... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... Resulting from an irritable focus in the cerebral cortex, simple partial seizures typically last about 30 seconds and don’t alter the patient’s level of consciousness (LOC). The type and pattern reflect the location of the irritable focus. Simple partial seizures may be... History ... Physical assessment ... Medical causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... A seizureis a sudden paroxysmal discharge of neurons that causes a transientalteration in neurologic function. This alteration can include changesin level of alertness, sensation, motor activity, and autonomicfunction. Commission on... Classification of Seizure Types ... Principal Causes of Seizures ... Clinical Features and Diagnosis ... Diagnostic Approach ... References
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... An aura is a sensory or motor phenomenon, idea, or emotion that marks the initial stage of a seizure or the approach of a classic migraine headache. Auras may be classified as cognitive, affective, psychosensory, or psychomotor. (See Recognizing types of auras.)... History and physical examination ... Medical causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... Carpopedal spasm is the violent, painful contraction of the muscles in the hands and feet. (See Recognizing carpopedal spasm.)
It's an important sign of tetany, a potentially life-threatening condition characterized by increased neuromuscular excitation and sustained... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... A decrease in the level of consciousness (LOC), from lethargy to stupor to coma, usually results from a neurologic disorder and may signal a life-threatening complication, such as hemorrhage, trauma, or cerebral edema. However, this sign can also result from a... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... Myoclonus—sudden, shocklike contractions of a single muscle or muscle group—occurs with various neurologic disorders and may herald the onset of a seizure. These contractions may be isolated or repetitive, rhythmic or arrhythmic, symmetrical or asymmetrical,... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching
... READ EXCERPTS »
... Paralysis, the total loss of voluntary motor function, results from severe cortical or pyramidal tract damage. It can occur with a cerebrovascular disorder, degenerative neuromuscular disease, trauma, tumor, or central nervous system infection. Acute paralysis... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... A complex partial seizure occurs when a focal seizure begins in the temporal lobe and causes a partial alteration of consciousness—usually confusion. Psychomotor seizures can occur at any age, but their incidence usually increases during adolescence... History and physical examination ... Medical causes ... Nursing considerations ... Patient teaching
... READ EXCERPTS »
... Like other types of seizures, generalized tonic-clonic seizures are caused by the paroxysmal, uncontrolled discharge of central nervous system neurons, leading to neurologic dysfunction. Unlike most other types of seizures, however, this cerebral hyperactivity... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... Resulting from an irritable focus in the cerebral cortex, simple partial seizures typically last about 30 seconds and don't alter the patient's level of consciousness (LOC). The type and pattern reflect the location of the irritable focus. Simple partial seizures may be classified... History and physical examination ... Medical causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... Absence seizures are benign, generalized seizures thought to originate subcortically. These brief episodes of unconsciousness usually last 3 to 20 seconds and can occur 100 or more times per day, causing periods of inattention. Absence seizures usually... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching
... READ EXCERPTS »
...
The causes of this symptom lend themselves easily to recall. Simply
remember the word VINDICATE. There are usually just one or two
diseases for each letter.
V—Vascular suggests an infarction of the subthalamic nucleus, which
... READ EXCERPTS »
...
The differential diagnosis of this sign is similar to that of tremors
, but a few additional
possibilities should be kept in mind. Idiopathic myoclonus epilepsy, petit
mal epilepsy (with the petit mal triad), grand mal
... READ EXCERPTS »
...
Anatomy can assist one greatly in formulating a differential
diagnosis of tremor of hepatic coma, Wilson disease, and alcoholism. The
thyroid brings to mind the tremor of Graves disease. The
kidneys... Pictures
... READ EXCERPTS »
...
A facial palsy is usually considered to be Bell palsy and it frequently
is. Nevertheless, the clinician who begins treatment without ruling out
other possibilities will eventually get burned. Anatomy is the key to
recalling these... Pictures
... READ EXCERPTS »
...
This symptom, as opposed to generalized weakness and fatigue , is almost invariably due to a
neurologic disorder. Consequently, a comprehensive list of causes is
developed using neuroanatomy. Muscle weakness or paralysis may be
due to disease... Pictures
... READ EXCERPTS »
...
Many of the conditions that cause splenomegaly also cause generalized
lymphadenopathy. They are best recalled with the use of the mnemonic
MINT.
M—Malformations include sickle cell anemia and other... Pictures
... READ EXCERPTS »
...
The analysis of the causes of weakness depends on a knowledge of both
anatomy and biochemistry. Strength depends on an intact
healthy muscle, peripheral nerve, and lower and upper motor neuron pathways
and a functioning myoneural... Pictures
... READ EXCERPTS »
... Samir S. Shah
Approach to the Patient with Seizures
I. Definition of the Complaint
Seizures, a common neurologic ... Pictures
... READ EXCERPTS »
... I. History of Present Illness
An 8-month-old boy was well until 1 week before admission, when he was found by
his mother having a
“seizure.” He had shaking and jerking of all extremities that did not stop when
... READ EXCERPTS »
Deciding on treatment for the seizure disorder epilepsy involves balancing several factors, including the kinds of seizures being treated and...
New devices may help some epilepsy patients who are not seizure-free after taking medications.
Join our panel of experts as they discuss various standard treatment strategies for epilepsy and the factors doctors and patients should consider as...
In the past, treating kids with epilepsy might have meant using a combination of drugs that had unwanted side effects. Now it's possible for kids...