Diagnostic Tests for Paraplegia
Paraplegia Tests: Book Excerpts
Home Diagnostic Testing
These home medical tests may be relevant to Paraplegia:
- Nerve Neuropathy: Related Home Testing:
Paraplegia Diagnosis: Book Excerpts
Diagnostic Tests for Paraplegia: Online Medical Books
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for more information about the diagnostic tests for Paraplegia.
FACIAL PARALYSIS:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
Immediate referral to a neurologist is indicated. One should do a complete examination of the ear, nose, and throat to determine if there is any rupture of the drum, discharge, evidence of otitis media, etc. Then x-rays of the mastoids and petrous bones should be done along with tomography. A CT scan of the brain with emphasis on the internal auditory foramina should be done if acoustic neuroma is suspected. Culture of the discharge from the ears and blood culture should be done if there are associated signs of an infectious process. Testing for Lyme disease may be indicated. Spinal fluid analysis should be done to look for Guillain-Barré syndrome. If myasthenia gravis is suspected, a Tensilon test may be done. Spinal fluid culture should be done in cases of brain abscess. Carotid scans and a workup for an embolic source should be done in cases of cerebral vascular accident. Of course, when there is a brain tumor or abscess or a cerebral vascular accident is suspected, CT scans of the brain should be done. If these are not helpful or are inconclusive, MRI of the brain can be done. Glucose tolerance testing should be done to rule out diabetic neuropathy. If lead poisoning is suspected, a blood level for lead should be done.
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Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
EXTREMITY PAIN, LOWER EXTREMITY:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
Often bursitis and myofascitis can be diagnosed by the dramatic relief obtained from a lidocaine injection. If there is clear-cut joint pathology, an x-ray of the joints, arthritis profile, and synovial fluid analysis will usually provide a diagnosis. MRI is useful in the diagnosis of a torn meniscus. If a deep-pain thrombophlebitis is suspected, venous Doppler ultrasound, impedance plethysmography, or a contrast venogram may be done. If an arterial embolism or chronic peripheral arterial disease is suspected, femoral angiography can be done. If a herniated disk or other pathology of the lumbar spine is suspected, plain films of the lumbar spine should be obtained. It might be wise at this point also to obtain a CBC, sedimentation rate, and chemistry panel to determine the alkaline phosphatase, calcium, and phosphorus. In older males, tests for acid phosphatase and PSA should be done.
If these tests are unrevealing, it is wise to refer the patient to a neurologic specialist before any more expensive tests are ordered. He will probably order a CT scan of the lumbar spine and may do nerve conduction velocity studies, EMG examinations, or dermatomal SSEP studies as indicated. In difficult neurologic problems, a combined myelography and CT scan is preferred over MRI. Bone scans will help diagnose obscure fractures and osteomyelitis, both of the lumbar spine and the lower extremities.
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Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
PARESTHESIAS OF THE LOWER EXTREMITY:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
The basic diagnostic workup includes a CBC, sedimentation rate, urinalysis, chemistry panel, arthritis panel, VDRL test, and x-ray of the lumbosacral spine. A serum B
12
and folic acid should be done if pernicious anemia is suspected. If these tests are negative, an orthopedic or neurologic specialist should be consulted. A CT scan of the lumbosacral spine, a nerve conduction velocity study, and an EMG may all be necessary in the workup. MRI is more expensive and often unnecessary.
Combined myelography and CT scan is often useful in evaluating the need for surgery. A bone scan may be helpful in diagnosing occult fractures, metastases, or osteomyelitis.
If multiple sclerosis, Guillain-Barré syndrome, or central nervous system lues are suspected, a spinal tap may be done. SSEP studies are useful in diagnosing multiple sclerosis.
A neuropathy workup may be necessary. This involves a glucose tolerance test to rule out diabetes; urine tests for porphyrins and porphobilinogen to rule out porphyria; quantitative urine niacin, thiamine, pyridoxine, and other B vitamins after loading, an ANA and anti-dsDNA test to rule out collagen disease; serum protein electrophoresis and immunoelectrophoresis to diagnose various collagen diseases and macroglobulinemia; a lymph node biopsy and Kveim test for sarcoidosis; nerve conduction velocity studies and EMG to establish the presence of a neuropathy; thyroid profile to rule out hypothyroidism or hyperthyroidism; HIV antibody titers; blood levels for heavy metals such as lead to rule out lead or arsenic neuropathy; and skin and muscle biopsies to rule out various collagen diseases. A trial of therapy is often necessary to rule out the nutritional neuropathies.
Lumbar puncture, as already mentioned, is useful in diagnosing Guillain-Barré syndrome. Nerve biopsy may be necessary when all the above procedures are negative.
RBC transketolase activity is decreased in beriberi and the serum pyruvate and lactate levels are elevated.
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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
Paralysis:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
If the patient is in no immediate danger, perform a complete neurologic assessment. Start with the history, relying on family members for information if necessary. Ask about the onset, duration, intensity, and progression of paralysis and about the events preceding its development. Focus medical history questions on the incidence of degenerative neurologic or neuromuscular disease, recent infectious illness, sexually transmitted disease, cancer, or recent injury. Explore related signs and symptoms, noting fevers, headaches, vision disturbances, dysphagia, nausea and vomiting, bowel or bladder dysfunction, muscle pain or weakness, and fatigue.
Next, perform a complete neurologic examination, testing cranial nerve (CN), motor, and sensory function and deep tendon reflexes (DTRs). Assess strength in all major muscle groups, and note muscle atrophy. (See Testing muscle strength, pages 418 and 419.) Document all findings to serve as a baseline.
» 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
Paralysis:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
If the patient is in no immediate danger, perform a complete neurologic assessment. Start with the history, relying on family members for information if necessary. Ask about the onset, duration, intensity, and progression of paralysis and about the events preceding its development. Focus medical history questions on the incidence of degenerative neurologic or neuromuscular disease, recent infectious illness, sexually transmitted disease, cancer, or recent injury. Explore related signs and symptoms, noting fever, headache, vision disturbances, dysphagia, nausea and vomiting, bowel or bladder dysfunction, muscle pain or weakness, and fatigue.
Next, perform a complete neurologic examination, testing cranial nerve, motor, and sensory function and deep tendon reflexes. Assess strength in all major muscle groups, and note any muscle atrophy. (See Testing muscle strength, pages 530 and 531.) Document all findings to serve as a baseline.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Paralysis:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Perform a complete neurologic examination, testing cranial nerve, motor, and sensory function and deep tendon reflexes. Assess strength in all major muscle groups, and note any muscle atrophy. Document all findings to serve as a baseline.
» 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
Paralysis:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
If the patient is in no immediate danger, perform a complete neurologic assessment. Start with the history, relying on family members for information if necessary. Ask about the onset, duration, intensity, and progression of paralysis and about the events preceding its development. Focus medical history questions on the incidence of degenerative neurologic or neuromuscular disease, recent infectious illness, sexually transmitted disease, cancer, or recent injury. Explore related signs and symptoms, noting fevers, headaches, vision distur-bances, dysphagia, nausea and vomiting, bowel or bladder dysfunction, muscle pain or weakness, and fatigue.
Next, perform a complete neurologic examination, testing cranial nerve (CN), motor, and sensory function and deep tendon reflexes (DTRs). Assess strength in all major muscle groups, and note muscle atrophy. (See Testing muscle strength, pages 410 and 411.) Document all findings to serve as a baseline.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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