Common Neurological Problems

1
Common Neurological Problems

• Utcharee Intusoma, MD.
• Department of Pediatrics
• 7 SEP 2008

2
Scope

• Syncope
• Motor weakness
• Ataxia

3
Syncope
4
Syncope

• Abrupt loss of consciousness, postural tone
• Causes
• Neurocardiogenic (vagovagal) 60
• Situation syncope (micturation, cough, combing)
• Cardiac cause (brady or tachyarrhythmia) 25
• arrhythmia/prolong QT/heart block/obstruction

5
DDx

• Seizures
• Cerebrovascular disease
• Hyperventilation syndrome
• Orthostatic hypotension
• Hysterical fainting
• Breath holding spell (infant, toddler)

6
Neurocardiogenic (vagovagal)

• Prodrome nausea, warmth, pallor,
  lightheadedness, and/or diaphoresis.
• frequently induced by prolonged standing,
  venipuncture , heat exposure, painful or noxious
  stimuli, fear of bodily injury, or exertion
• Dx by exclusion, upright tilt table ? pass out

7
History Taking

• Underlying heart disease
• No. of episodes
• Associated symptoms
• Prodrome
• Position
• Warning/preceding event
• Duration of symptoms
• Recovery

8
Distinguish from Seizures

• Seizure only 5 of syncope
• Dx EEG
• Supportive evidence tongue cut, abnormal
  behavior, post-ictal confusion, head turning

9
Motor Weakness
10
Motor Neuron

• Corticobulbar tract

• Corticospinal tract

• Cranial nucleus

• Anterior horn cell

Pons
Spinal cord
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Weakness
UMN
LMN
Brain
Cord
AHC
NMJ
Nerve
Muscle
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Exception

• Spinal cord lesion usually present with UMN, but
• some conditions may present with LMNs sign
• Acute spinal cord injury spinal shock (24-48
  hr)
• Multiple spinal cord segments involvement
• ????????????????????????? LMN (???????????
  involvement of AHC ???? ??????? areflexia ???
  nerve ??????????????? segment ????) ?????? PE
  ????? ????????????? lesion ???????????? UMNs
  sign

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UMN weakness

• Brain

• Spinal Cord

• Consciousness
• Cortical sign
• CN involvement
• Seizure
• Ipsilat. weakness numbness

• Sensory level
• Bowel bladder involvement
• Contralat. weak numb

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Locations in the Brain
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Location in the spinal cord

• Ipsilateral weakness /contralateral numbness
• Choose highest impairment (sensory or motor
  deficit)
• Level 1-2 segment(s) above impaired sensory
  level
• Intra or Extramedullary

16
(No Transcript)
17
Spinal cord lesion
ANS. bowel bladder involvement
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Guess by onset

• Sudden (second)
• vascular (ruptured, emboli)
• Acute (min-hr.)
• vascular (thrombosis, ischemic), inflammation,
  metastasis
• Chronic progressive
• tumor, degenerative disorder
• Recurrence
• inflammation (e.g. multiple sclerosis)

19
Ataxia
20
Ataxia

• Cerebellar connection
• Acute drug, acute cerebellar ataxia
• Chronic progressive degenerative, tumor
• Sensory
• Neuropathy Miller-Fisher syndrome
• Posterior column e.g. tabes dorsalis, spinal
  cord dz
• Frontal ataxia e.g. normal pressure hydrocephalus
• Toxic substances
• e.g. antihistamine, phenytoin

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Ataxia