...
Are the episodes of loss of consciousness really seizures? Real seizures, especially grand mal, present with incontinence and/or tongue biting. Hysterical seizures with actual tonic or ... DIAGNOSTIC WORKUP
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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 ... 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... 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... 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... Differential Diagnosis ... 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... 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.... 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... 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... 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... 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
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... This sign is generally considered pathognomonic for anterior horn cell or root disease. It may occur, however, in certain cases of peripheral neuropathy, in electrolyte disturbances, and in myasthenia gravis,
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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
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... 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
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... To formulate a differential diagnosis of convulsions, one must use both physiology and anatomy. The anatomic causes are charted in Table 19 .
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... 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
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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
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Aura
(Handbook of Signs & Symptoms (Third Edition))
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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... 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... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pictures
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... Fasciculations are local muscle contractions representing the spontaneous discharge of a muscle fiber bundle innervated by a single motor nerve filament. These contractions cause visible dimpling or wavelike twitching of the skin, but they... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers
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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... 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... 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... Emergency interventions ... History and physical examination ... Medical causes ... Other 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... History and physical examination ... Medical causes
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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... 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... 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... History and physical examination ... Medical causes ... Special considerations ... Pediatric pointers ... Pictures
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... Central Nervous System and Vascular Causes
Cerebrovascular disease
Thrombosis
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... Acute (Developing in Hours)
Spinal cord injury
Spinal cord hemorrhage (secondary to vascular malformation, coagulopathy, anticoagulant therapy, trauma)
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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.
... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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Aura
(Professional Guide to Signs & Symptoms (Fifth Edition))
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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 ... 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... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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... Fasciculations are local muscle contractions representing the spontaneous discharge of a muscle fiber bundle innervated by a single motor nerve filament. These contractions cause visible dimpling or wavelike twitching of the skin, but they... Emergency Interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Patient counseling
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... 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,... Emergency Interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Pictures
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Myoclonus
(Professional Guide to Signs & Symptoms (Fifth Edition))
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... Myoclonus—sudden, shocklike contractions of a single muscle or muscle group—occurs with various neurologic disorders and may herald onset of a seizure. These... Emergency Interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers
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Paralysis
(Professional Guide to Signs & Symptoms (Fifth Edition))
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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... Emergency Interventions ... History and physical examination ... Medical causes ... Other 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... History and physical examination ... Medical causes ... Patient counseling
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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... History and physical examination ... 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 (CNS) neurons, leading to neurologic... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Patient counseling ... 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... History and physical examination ... Medical causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
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... 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... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers
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Seizures
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
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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... Approach. ... History. ... Physical examination (PE) ... Testing ... Diagnostic assessment.
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... Differential Overview
❑ Generalized (grand mal)
❑ Partial (focal)
❑ Complex partial (temporal lobe)
&... 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... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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Carpopedal spasm
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
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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... Assessment ... History ... Physical examination ... Pediatric pointers ... Geriatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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Fasciculations
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
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... Fasciculations are local muscle contractions representing the spontaneous discharge of a muscle fiber bundle innervated by a single motor nerve filament. These contractions cause visible dimpling or wavelike twitching of the skin,... Assessment ... History ... Physical examination ... Pediatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching
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... 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... Assessment ... History ... Physical examination ... Pediatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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Myoclonus
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
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... 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... Assessment ... History ... Physical examination ... Pediatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching
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Paralysis
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
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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... Assessment ... History ... Physical examination ... Pediatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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... 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... Assessment ... History ... Physical examination ... Pediatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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Aura
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
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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 ... Emergency Actions ... History ... Physical assessment ... Medical causes ... Special considerations ... Pediatric pointers ... Patient counseling ... 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... Emergency Actions ... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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Chorea
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
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... 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... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
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... 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,... Emergency Actions ... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
... READ MEDICAL BOOK EXCERPTS ONLINE » (free access, no registration)
... 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... Emergency Actions ... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
... READ MEDICAL BOOK EXCERPTS ONLINE » (free access, no registration)
... Paralysis, the total loss of voluntary motor function, results from severe cortical or pyramidal tract damage. It can occur with a cerebrovascular disorder, degenerative... Emergency Actions ... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Patient counseling ... 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 incidence... History ... Physical assessment ... Medical causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
... READ MEDICAL BOOK EXCERPTS ONLINE » (free access, no registration)
... 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... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
... READ MEDICAL BOOK EXCERPTS ONLINE » (free access, no registration)
... 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... History ... Physical assessment ... Medical causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
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Seizures
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
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... 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... 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... History and physical examination ... Medical causes ... Nursing considerations ... Patient teaching ... Pictures
... READ MEDICAL BOOK EXCERPTS ONLINE » (free access, no registration)
... 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... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... READ MEDICAL BOOK EXCERPTS ONLINE » (free access, no registration)
... Fasciculations, or muscle twitches, are local muscle contractions caused by the spontaneous discharge of a muscle fiber bundle supplied by a single motor nerve cell. These contractions cause visible dimpling or wavelike twitching of the... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching
... READ MEDICAL BOOK EXCERPTS ONLINE » (free access, no registration)
... 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,... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... READ MEDICAL BOOK EXCERPTS ONLINE » (free access, no registration)
... 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... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching
... READ MEDICAL BOOK EXCERPTS ONLINE » (free access, no registration)
... 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... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... READ MEDICAL BOOK EXCERPTS ONLINE » (free access, no registration)
... 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... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching
... READ MEDICAL BOOK EXCERPTS ONLINE » (free access, no registration)
... 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... History and physical examination ... Medical causes ... Nursing considerations ... Patient teaching
... READ MEDICAL BOOK EXCERPTS ONLINE » (free access, no registration)
... Like other types of seizures, generalized tonic-clonic seizures are caused by the paroxysmal, uncontrolled discharge of central nervous system neurons, leading to neurologic... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... READ MEDICAL BOOK EXCERPTS ONLINE » (free access, no registration)
... 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... History and physical examination ... Medical causes ... Nursing considerations ... Patient teaching ... Pictures
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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
... READ MEDICAL BOOK EXCERPTS ONLINE » (free access, no registration)
...
This sign is generally considered pathognomonic for anterior horn cell
or root disease. It may occur, however, in certain cases of peripheral
neuropathy, in electrolyte disturbances, and in myasthenia gravis,
especially
... READ MEDICAL BOOK EXCERPTS ONLINE » (free access, no registration)
...
The differential diagnosis of this sign is similar to that of tremors
, but a few additional
possibilities should be kept in mind. Idiopathic myoclonus
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...
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
... Pictures
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...
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... Pictures
... READ MEDICAL BOOK EXCERPTS ONLINE » (free access, no registration)
...
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 ... Pictures
... READ MEDICAL BOOK EXCERPTS ONLINE » (free access, no registration)
...
To formulate a differential diagnosis of convulsions, one must use both
physiology and anatomy.The anatomic causes are charted in Table
19.
... Pictures
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