Basic Neurological Examination Research Articles

Structured Manual Muscle Testing of the Lower Limbs

An accurate and reliable neurological examination is pivotal in diagnosing patients with neurological and neurosurgical conditions. Despite the advancement of neuroscientific knowledge and the ever-progressing technologies and modalities that are being adopted to help achieve the challenge of accurate diagnosis, the neurologic examination is still crucial in both ambulatory and emergency settings. It provides the physician a tool to recognise neurologic involvement in certain disease states, and thereby allow proper work-up and treatment for patients. A basic neurologic examination can be performed rapidly with practice. Manual muscle testing of the lower limbs was carried out in accordance with a bedside clinical examination involving a clinical personnel examiner and a patient. This testing was performed in a rostro-caudal manner, starting from the hip and progressing to the toes. The neurological exam can be intimidating to perform for a lot of physicians. Deficiencies in accurate muscle testing have always presented a challenge for medical students and clinicians. By referring to the examination methods mentioned in our text and with the help of related video, it is our aim to improve the quality of neurological examination among medical personnel so that diseases may be recognised and managed earlier in their course.

The clinical relevance assessment of ROSIER scale in emergency care

Stroke incidence and its consequences are nowadays a common cause of death, disability and financial burden for the health system. The scale of this phenomenon is estimated to increase in further years. To ensure the best patients care, therapy should be applied in a dedicated stroke unit as soon as possible. Nevertheless, even 2 out of 3 suspected patients visit the emergency department in the first place. The probable lack of knowledge and experience from the personnel indicates up to a 60% rate of misdiagnosis resulting in delays in treatment administration and consequently a reduction of chance for survival and full recovery. The Recognition of Stroke in the Emergency Room scale has been developed to improve the emergency physicians’ assessment. It evaluates the initial event history and physical examination, which translates into a score from –2 to 5 with a > 0 cut-off point anticipating a high probability of stroke. Simple construction assures easy use and evaluation quality by all emergency staff members. The scale shows satisfactory accuracy, which establishes its superiority over the basic neurological examination, Face Arm Speech Time Test (FAST), and Cincinnati Prehospital Stroke Scale (CPSS) proven in several studies. On the contrary, the application is considerably reduced in cases of hemorrhage stroke, transient ischemic attack (TIA) and posterior circulation infarct in both adult and pediatric patients. Despite those limitations, the Recognition of Stroke in the Emergency Room Scale (ROSIER) scale constitutes a valuable instrument that can improve the insufficient stroke recognition rate and following patients’ prognosis.

Feasibility of multidisciplinary telehealth evaluations in atypical dementia.

While cognitive assessment by videoconference has become possible over the past decade, the COVID-19 pandemic underscores the critical need for expansion and examination of these methods, their appropriateness for various patient populations, and their benefits and limitations. Validity and reliability studies of tele-neuropsychological testing have been conducted in MCI or mild AD dementia patients (e.g., MMSE=25+); few studies have assessed the feasibility of neurologic examination by video, and none in atypical dementias, assuming that patients with some types (e.g., language, comportment) or greater severity of cognitive-behavioral impairment would be unable to participate. Here we report the feasibility of telehealth services for a multi-disciplinary dementia subspecialty clinic that include cognitive-behavioral and neurologic assessment with patients with atypical neurodegenerative syndromes. 104 patient-carepartner (P-C) dyads met with providers in the MGH FTD Unit by videoconference (March-December, 2020) for routine clinical care. P-Cs completed validated questionnaires assessing cognition-mood/behavior/function on REDCap prior to video clinical interview and cognitive assessment, including the MoCA and Boston Cognitive Exam (BCE2.0), a newly revised brief cognitive assessment battery adapted for telehealth. P-Cs met with a neurologist for a basic neurologic examination (including eye-movement examination), review of assessment results, and discussion of care plan. P-Cs completed a satisfaction survey. The 104 P-Cs included a range of atypical neurodegenerative disorders (bvFTD, PCA, PPA, CBS, PSP, eoAD, Multidomain syndrome) mild-to-severe impairment (CDR range: 0-3). 76% completed the MoCA (25% had CDR=2). 36% also completed the BCEv2. Comparison of remote assessment data to previous in-person testing is ongoing. Of P-Cs who completed a satisfaction survey, all reported being "very satisfied" with the appointment, with 93% open to participating in a remote visit again. 87% found the telehealth visit comparable to an in-person visit. 66% preferred a future combination of remote and in-person visits. Multi-disciplinary telehealth visits appear to be feasible with patients with atypical cognitive-behavioral syndromes of across the severity spectrum. P-Cs report a high degree of satisfaction with the telehealth visit and an openness to ongoing telehealth visits. Results have implications for increasing accessibility of multidisciplinary medical services for patients and families living with complex forms of dementia.

Time is Brain - Preclinical Emergency Care for Acute Ischemic Stroke

Stroke is one of the most common neurological emergencies and requires rapid detection and treatment (time is brain). There is still insufficient knowledge about stroke warning signs. It is therefore of crucial importance that trained personnel in the preclinical setting recognize the relevant warning symptoms and collect the necessary information to quickly refer the patient to the appropriate additional care structure. For this purpose, training of the emergency medical services (EMS) and the correct triage are of particular importance. The on-site assessment of a patient with a suspected stroke by EMS should include airway, breathing, vital functions, a basic neurological examination, blood glucose testing and cardiac monitoring.Patients with suspected acute ischemic stroke should be brought to the nearest hospital with a stroke unit, ideally connected with a tertiary stroke centre. From there, once the primary diagnosis has been carried out and appropriate therapy initiated, the patient can be transferred to a thrombectomy center if necessary. To improve supply times, teleradiological networking plays a major role both between clinics of different levels of care and in communication between pre- and intra-hospital care providers. Also, the use of mobile stroke units can improve preclinical stroke care and reduce delays in access to intravenous thrombolytic therapy and mechanical thrombectomy. The identification of preclinical biomarkers could also save time.

Evaluating Acute Sport-related Concussion In The Primary Care Setting: Are We Dropping The Ball?

Concussed athletes are increasingly introduced into the medical care continuum via the primary care setting. As such, primary care physicians (PCPs) are expected to make more decisions regarding return-to-play, symptom management, and specialist referral than ever before. Concussion-specific history and physical examination is vital for this decision-making process. PURPOSE: To review clinic documentation and determine how PCPs are evaluating concussed athletes in clinic relative to published consensus and guidelines. METHODS: We conducted a retrospective records review for all patients evaluated by PCPs with no formal sports medicine training at a single large academic medical center. We restricted our review to pediatric patients (7-18 yrs) diagnosed with sport-related concussion between 2014-2017. RESULTS: We included 490 patients (age=14.7 ± 2.2 years; 184 females). Patients presented most frequently to pediatricians (60%) at a median of 3 days from injury (range 0-64 days, IQR 1-6). Most patients participated in football (25.9%), soccer (19.8%), and basketball (15.1%). Prior concussion history was documented in 28.8% of visits. Providers documented headache presence or absence in 94% of patients, compared with nausea (52.2%), dizziness (51.8%), vision changes (45.7%), cognitive complaints (45.7%), emotional changes (17.1%), sleep difficulties (15.8%) and neck pain (13.5%). Basic neurologic examination was documented in 95.5% of visits compared to detailed neurologic assessment including strength, sensation, cranial nerves, and cerebellar function (26.9%), clinical cognitive assessment (13.5%), balance testing (41%), and neck exam (45.7%). Return-to-play was frequently discussed (94.5% of visits) and 13.1% of PCPs referred the patient to a dedicated sports medicine provider. CONCLUSIONS: Symptom-based return-to-play algorithms cannot be effective if the signs and symptoms driving their decision-making aren’t being properly evaluated and documented. The PCPs caring for the patients in our retrospective study often omit important components of the history and physical examination for concussed athletes. New tools are needed to empower PCPs to more completely evaluate and manage these patients, and PCPs should be encouraged to thoroughly document the care provided.

Novel Algorithm to Help Identify Stroke Mimics

Stroke is a major cause of disability in the United States. A portion of patients presenting with stroke-like symptoms in the emergency room who receive tissue plasminogen activator (tPA) do not end up having a true stroke, leading to unnecessary health-care costs. The aim of our study is to identify those patients who have a high likelihood of experiencing a stroke mimic using a novel stroke mimic score and to identify a cutoff point with a high specificity of ruling in stroke mimics. We reviewed literature on stroke mimics and the various associated risk factors. We devised a 9-point scoring system and applied it retrospectively to patients who received tPA from 2010 to 2014 to calculate a score for each patient. The final sample size was 105 patients, out of which 25% turned out to be patients with stroke mimics. Patients with stroke mimic were significantly younger and more likely to have history of seizure, migraine, or prior psychiatric illness. History of atrial fibrillation had the highest correlation with true stroke. We found approximately 100% specificity in ruling in a stroke mimic if a patient scored more than 5 points. Our stroke mimic scoring system along with a basic neurologic examination could be a useful tool in the identification of stroke mimics with a high specificity in the emergency room setting. These patients may require further studies such as rapid magnetic resonance imaging, which would decrease unnecessary tPA administration and hospital admissions.

Multisite Single-Blinded Randomized Control Study of Transfer and Retention of Knowledge and Skill Between Nurses Using Simulation and Online Self-Study Module.

Obstetric (OB) nurses must be proficient in performing a basic neurologic examination to assess and detect changes in a patients' neurologic status. This study aimed to compare knowledge and skill acquisition for a basic neurologic examination between OB nurses who participated in simulation and those who participated in an online self-study module. Short- and long-term knowledge retention and skill transfer between groups were evaluated. Nurses were randomized to either simulation or online self-study module and assessed by direct observation and completion of a standardized instrument by the observer at 3 time points: baseline (time 1), within 7 days of baseline in the clinical setting (time 2), and at 2 months (time 3) using a validated12-item Neurologic Knowledge Assessment and a 14-item performance skill checklist. Among OB nurses, those in the simulation group demonstrated higher levels in both short-term (time 2) [mean (SD), 67.6 (20.2) vs. 29.6 (19.0); P < 0.001] and long-term (time 3) [mean (SD), 46.1 (17.6) vs. 27.5 (15.9); P < 0.001] skill performance compared with nurses in the online self-study module. Nurses in the simulation and online self-study module groups had similar mean levels on Neurologic Knowledge Assessment scores at time 2 (P = 0.86) and time 3 (P = 0.59), but these mean scores were not significant. The greater transfer of skills by nurses who received simulation education is an important finding because few studies have addressed this level of translation with practicing nurses. There was a lack of differences in short- and long-term knowledge acquisition between nurses in the simulation and online self-study module groups. More research is needed to determine the timing of simulation-based education repetition over time to aid in knowledge and skills retention.

Idiopathic Intervertebral Disc Calcification in a Child: An Atypical Case Involving Many Segments.

A seven-year-old girl presented to the emergency department with severe neck pain and restricted movement of sudden onset. A basic neurological examination supplemented by radiography showed calcification within the intervertebral disc at the C6-C7 level. Computed tomography and magnetic resonance imaging of the spine confirmed the diagnosis and revealed additional calcification within the spine at the C3-C4, C7-T1, T1-T2, T4-T5, and T5-T6 levels. Idiopathic intervertebral disc calcification is a rare condition in children, and its etiology remains unclear. In this report, we present a rare case of idiopathic intervertebral disc calcification at numerous levels in a seven-year-old girl. The clinical and radiographic findings, laboratory examination, and follow-up are discussed.

Neurology assessment by objective structured video examination.

The ability to carry out a neurological examination and make an appropriate differential diagnosis is one of the mainstays of our final Bachelor of Medicine (MB) exam; however, with the introduction of objective structured clinical examinations (OSCEs) it has become impossible to arrange for adequate numbers of suitable real patients to participate in the exam. It is vital that newly qualified doctors can perform a basic neurological examination, interpret the physical signs and formulate a differential diagnosis. It is vital that newly qualified doctors can perform a basic neurological examination Since 2010 we have introduced an objective structured video examination (OSVE) of a neurological examination of a real patient as part of our final MB OSCE exam. The students view clips of parts of the examination process. They answer questions on the signs that are demonstrated and formulate a differential diagnosis. This type of station is logistically a lot easier to organise than a large number of real patients at different examination sites. The featured patients have clearly demonstrated signs and, as every student sees the same patient, are perfectly standardised. It is highly acceptable to examiners and performed well as an assessment tool. There are, however, certain drawbacks in that we are not examining the student's examination technique or their interaction with the patient. Also, certain signs, in particular the assessment of muscle tone and power, are more difficult for a student to estimate in this situation.

English

Pupillary abnormalities are a common feature of general ophthalmic practice. It often causes confusion as they can be manifestations of local and/ or systemic diseases. These diseases may range from vision threatening to life endangering to innocuous ones. A keen observational and clinical skill can help the ophthalmologist in diagnosis & timely referral when necessary. We report 3 cases of acquired mydriasis, with cholinergic supersensitivity. The short history poses a diagnostic dilemma as to whether it is Adie’s Tonic pupil or a harbinger of a serious neurological problem. 2 of the patients with mydriasis were younger, 32 & 35 years of age, presenting with recent onset of blurring of Vision for distance and difficulty in reading. The 3rd patient was a 45 year old presbyope who presented with sudden drop in near vision in one eye. Our cases raise several important question regarding so-called “benign pupillary dilation of the young” and its relationship with Adie‘s tonic pupil. Demonstration of probable transient parasympathetic dysfunction suggests that pharmacologic testing with dilute pilocarpine should be considered in patients reporting with near vision problems with isolated unilateral recent onset mydriasis which is probably intermittent. Thorough history and basic clinical neurological examination are mandatory. The importance of timely referral to neurologist must be borne in mind always in such cases.

Intervertebral disc calcification in children: Case description and review of relevant literature

SummaryBackground:Intervertebral disc calcification is a rare condition in children; in most cases, it is asymptomatic and therefore not diagnosed.Case Reports:In our study, we present a case of idiopathic intervertebral disc calcification within the cervical segment, at the level of C2/C3 and C4/C5 vertebrae in a 5-year-old girl with torticollis. Basic neurological examination supplemented by X-ray examination was performed, showing calcification within the cervical segment at the level of C2/C3 and C4/C5 vertebrae.Conclusions:In order to complement the diagnostics, a CT scan of the cervical spine was performed; the scan confirmed the diagnosis and revealed additional calcification of the anterior longitudinal ligament at the level of C4/C5 vertebrae.

Twitch or no twitch? The cutaneous trunci reflex

The localisation of spinal cord lesions in dogs has always been a controversial topic creating agreement, disagreement and discussion amongst veterinary clinicians. The different causes of injury to the spinal cord and the time elapsing from the onset of injury influence both the neurological signs and reflex changes detected during a neurological examination. For many years, clinical examination and neurological examination have been the only means of localisation, supported by the changes detected in radiographs of the vertebral column with or without myelographic contrast imaging. Veterinary students (including myself ) learned the value of the cutaneous trunci reflex (or panniculus reflex as it was incorrectly named) and how it was interpreted to help diagnose the site of a spinal cord lesion. I read about the cutaneous trunci reflex in Palmer’s textbook Introduction to Small Animal Neurology, a small but powerful book of the time. I learned the reflex’s subtleties: the different ways to elicit the reflex with pinch, pin prick or light irritation and, with understanding of the sensory dermatomes, to interpret the response and determine the possible localisation of the lesion. Dehydration affected the response and there were other unexplainable responses in some patients. The discrepancies between my localisation and that of radiological findings could be explained but not substantiated by ‘cord oedema’ or ‘more than one lesion’ or some other reason. Nevertheless, I was mostly happy with my subjective localisations. The advent of advanced imaging techniques such as magnetic resonance imaging (MRI) and computed tomography (CT) has now provided clinicians with a new dimension in diagnosis of spinal cord lesions. Young clinicians and students seem now to recruit these imaging modalities as part of their investigation of a spinal cord problem soon after examination, but frequently the basic neurological examination of the patient has been, rightly or wrongly, superficial at best. The paper by Gutierrez-Quintana and others (2012), in this issue of JSAP, attempts to evaluate the accuracy of the cutaneous trunci reflex in localising spinal cord lesions, to grade the severity of thoracolumbar spinal cord injuries and to correlate the neurological findings with the cord lesion identified by MRI in 41 dogs. The authors correctly state that the value of this reflex has neither been subject to audit with respect to its accuracy in determining the site of spinal cord lesions, nor in relation to its contribution to evaluating the severity of cord lesions. This paper identifies the cutaneous trunci reflex as having particular merit for the localisation of lesions cranial to L1, with the level for ‘cut-off’ of the reflex from zero to four vertebral bodies caudal to the maximal spinal cord lesion as determined by MRI in 80% of the dogs, and two to three vertebral bodies caudal in 16%. The authors also determined that the presence or absence of a cutaneous trunci reflex ‘cut-off’ correlated significantly with the severity grading according to the systems of Sharp and Wheeler (2005) and Olby and others (2001). The loss of the cutaneous trunci reflex occurred at a severity grade lower that that associated with an inability to walk (I cannot bring myself to say ‘non ambulatory’!). The reflex helps to allocate dogs with paresis into a less and more severely affected category without additional gait analysis. Veterinary clinicians and surgeons who investigate dogs with spinal cord lesions, especially those dogs with intervertebral disc disease, might have their subjective opinions reinforced by the results of this study. If that is not the case, this paper does provide some welcome objective data regarding the cutaneous trunci reflex that should assist decision making in dogs with spinal cord disease: in lesion localisation and determining the degree of severity of the cord lesion. Furthermore, the improved clinical localisation helps to plan appropriate diagnostic imaging with confidence of the location of the cord lesion and the determination of severity might help in deciding whether advanced imaging is required at all. However, the cutaneous trunci reflex must be elicited with skill and the results interpreted as part of a full neurological examination in every patient. It is a simple reflex to elicit and to interpret and the results from the paper by Gutierrez-Quintana and others (2012) have expanded its usefulness. It is the clinician’s responsi

A New Simple Model for Prediction of Hospital Mortality in Patients with Intracerebral Hemorrhage

The current prognostic models for mortality and functional outcome after intracerebral hemorrhage (ICH) are not simple enough. To predict the outcome of ICH, a new simple model, ICH index (ICHI), was established and evaluated in this study. Medical records of all cases with ICH in our hospital from January 2008 to August 2009 were reviewed. Multiple linear regression analyses were used to assess the contributions of independent variables to hospital mortality after ICH. Age, serum glucose, white blood cell counts (WBC), and Glasgow Coma Scale (GCS) score were found to be greatly associated with mortality. A formula of ICH index [ICHI = age (years)/10 + glucose (mmol/L) + WBC (10(9) /L) - GCS score] was established. Furthermore, the receiver operating characteristic (ROC) analyses were performed to estimate the predictive value of the ICHI. The model showed an area under the ROC curve (AURC) of 0.923 (95% CI: 0.883-0.963, P < 0.001). The best cut-off value of ICHI for mortality was 18, which gave sensitivity, specificity, and Youden's index of 0.65, 0.95, and 0.60, respectively. The hospital mortality was extremely increased when 18 < ICHI < 28 (mortality 72.0%) and when ICHI ≥ 28 (mortality 100%), in contrast with overall mortality (21.6%). The ICHI can be a simple predictive model and complementary to other prognostic models.

Guía rápida de cefaleas. Consenso entre Neurología (SAN) y Atención Primaria (SEMERGEN Andalucía). Criterios de derivación

Headache is one of the most frequent reasons for consultation in our health centers, something which should not be surprising if we consider that is one of the most common symptoms experienced by the population.The main concern of the family physician and emergency physician is to reach a correct diagnosis by clinical history and a basic neurological examination and adapted to the time and means at its disposal.In case of diagnostic doubts or suspected secondary headache, the primary care physician or emergency medical have to refer the patient to be studied and/or treated for Neurology services, such referral shall be made with varying degrees of urgency depending on the presence, or not, of symptoms or signs of alarm.A working group consisting of Neurologists of Sociedad Andaluza de Neurología (SAN) to provide services in different hospitals in Andalucía and Family Physicians representatives of the Sociedad Andaluza de Medicina Familiar y Comunitaria (SAMFyC) and the Sociedad Española de Médicos de Atención Primaria (SEMERGEN Andalucía), has developed a Quick Guide headache, which addresses the more practical aspects for the diagnosis, treatment and monitoring of patients with headache.We show you in this paper, the chapter that deals the alarm criteria and referral.

Does Neurologic Examination During Inpatient Rehabilitation Help Predict Global Outcome After Nonpenetrating Traumatic Brain Injury?

To determine whether combining basic neurologic examination measurements with posttraumatic amnesia (PTA) duration can enhance prediction accuracy in moderate-to-severe traumatic brain injury (TBI). A descriptive between-subjects study. Multicenter: 4 Veterans Affairs Brain Injury Rehabilitation Centers within the Defense and Veterans Brain Injury Center network. A total of 210 patients (active duty, veteran, or military dependent) with moderate-to-severe nonpenetrating TBI who consented during acute rehabilitation for data collection and completed relevant baseline and 12-month follow-up evaluations. Multivariate analysis on neurologic examination predictor variables (upper extremity paresis, lower extremity paresis, Romberg test, and Kurtzke Expanded Disability Status Scale [EDSS]) was performed with block logistic regression modeling that controlled for duration of PTA. Glasgow Outcome Score at 1 year. Glasgow Outcome Score prediction accuracy by using PTA duration was modestly improved with the included neurologic examination measurements. The most influential predictor among them was EDSS, a composite measurement of neurologic impairment. When EDSS was excluded, the simple measurements of upper limb paresis and the Romberg test also provided independent prognostic value. This study demonstrated that simple clinical measurements of neurologic impairment (limb paresis, imbalance, other neurologic deficits) are of value in refining the prediction of long-term global outcome from TBI. These measurements may serve as markers of focal injury not captured by PTA duration, a severity marker weighted toward diffuse injury.

Predicting Prognosis Of Isolated Head Injury: Computer-based Models With Simple Variables

Objective: Over one hundred predictive models were defined in the past for head injury (HI) prognosis, but none of them have been widely used up to the present. The aim of this study is to predict the prognosis of isolated HI patients by simply using data from the first day after injury. Materials and Methods: Data of head injury patients in Trakya University Hospital between January 1996 and December 2006 were obtained from records. The age, gender, causes of HI, basic neurologic examination findings, radiologic findings and discharge status are examined. Results: Most of the data were simplified as absent (0) and present (1), and mortality rates for each groups were accepted weighted values. All data were processed statistically and two models were created. Model 1 with Glasgow Coma Scale (GCS) score predicted the mortality/vegetative event at a rate of 56.5%, and the conscious survival event at 98.7%. Model 2, without the GCS score, predicted the mortality/vegetative event at 55.1% rate and the conscious survival event at 99.2%. Conclusion: Both models could be used for informing the patient and relatives and helping them to understand the severity of HI in busy working conditions of emergency departments.

Evaluation of nonnociceptive sensation in patients with congenital insensitivity to pain with anhidrosis

Congenital insensitivity to pain with anhidrosis (CIPA) is a rare, autosomal recessive disorder characterized by lack of pain and thermal sensation, anhidrosis, thermodysregulation, and mental retardation. Although nonnociceptive sensation, which is mediated by large-caliber myelinated Abeta fibers, is reported to be normal in CIPA patients, precise clinical assessments of this type of sensation have yet to be performed. The aim of this study was to evaluate peripheral sensory nerve function, including senses of touch/pressure, vibration, joint position, and two-point discrimination, in patients with CIPA by basic clinical neurological examination. We examined touch/pressure sense, deep senses (vibration, joint proprioception), and two-point discrimination in 12 patients with CIPA (six males and six females aged 11-44) and 12 age- and sex-matched healthy controls. Touch/pressure sense was examined with Semmes-Weinstein monofilaments, vibration sense with a tuning fork, and two-point discrimination with a vernier caliper. Joint proprioception was assessed through subject recognition of passive movement of the great toe. Perception thresholds of touch/pressure, vibration, and two-point discrimination were significantly higher (p < 0.05), and proprioception sensitivity was significantly lower (p < 0.05) in CIPA patients than in the healthy controls. Our findings suggest that CIPA patients suffer from more widespread disturbances of sensation than has been previously recognized. Impairment may not be restricted to the types of sensation conducted by peripheral sensory Adelta and C fibers.

The Clinical Analysis of General Paresis With 5 Cases

The Clinical Analysis of General Paresis With 5 Cases

Motor impairment after severe traumatic brain injury: A longitudinal multicenter study

Neuromotor impairment is a common sequela of severe traumatic brain injury (TBI) but has been understudied relative to neurocognitive outcomes. This multicenter cohort study describes the longitudinal course of neurological examination-based motor abnormalities after severe TBI. Subjects were enrolled from the four lead Department of Veterans Affairs and Defense and Veterans Brain Injury Center sites. The study cohort consisted of 102 consecutive patients (active duty, veteran, or military dependent) with severe TBI who consented during acute rehabilitation for data collection and completed all follow-up evaluations. Paresis, ataxia, and postural instability measures showed a pattern of improvement over time, with the greatest improvement occurring between the inpatient (baseline) and 6-month follow-up assessments. Involuntary movement disorders were rare at all time points. Two years following acute rehabilitation, more than one-third of subjects continued to display a neuromotor abnormality on basic neurological examination. Persistence of tandem gait abnormality was particularly common.

Neurology for the Non-Neurologist, 5th ed.

Back to table of contents Previous article Next article Book Forum: Neurology and NeuropsychiatryFull AccessNeurology for the Non-Neurologist, 5th ed.FRANCINE M. BENES, M.D., Ph.D., FRANCINE M. BENESSearch for more papers by this author, M.D., Ph.D., Belmont, Mass.Published Online:1 Jul 2005https://doi.org/10.1176/appi.ajp.162.7.1394-aAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail This multiauthored book provides a practical overview of clinical neurology for physicians who work in other areas of medicine. It begins with a concise and well-focused discussion of the basic neurological examination, beginning with the cranial nerves and peripheral nervous system and moving systematically through basic diagnostic tests and the evaluation of coma. Each chapter is individually authored and covers a broad variety of neurological problems, including cerebrovascular disease, headache, epilepsy, multiple sclerosis, Parkinson’s disease, alcoholism, peripheral neuropathy, the dementias, traumatic brain injury, neuromuscular disorders, and neurological manifestations of cancer. There is also an entire chapter devoted to neurological complications of pregnancy. These topics are all dealt with in a straightforward way that is suitable for the average psychiatrist. NeuroAIDS and other conditions with relevance to psychiatry, such as low back pain and insomnia, are also dealt with in a clear and practical way.Most chapters provide a description of the correct ways to perform a neurological examination and enumerate the forms of treatment that are available for different neurological disorders. In the chapter on “eye signs,” detailed diagrams showing visual pathways are provided and visual field defects are depicted in simple diagrams. The final chapter includes a discussion of medical-legal issues involved in the care of patients with neurological disorders as well as a discussion of the problems associated with obtaining informed consent from patients who are not legally competent. This chapter also contains a fairly extensive discussion of brain death, including the use of electroencephalography and cerebral blood flow as part of the evaluation. For the psychiatrist who is seeking to learn more about behavioral neurology, there is a description of the Papez circuit and a fairly comprehensive discussion of temporal lobe epilepsy. Beyond this, however, there is very little information regarding psychiatric manifestations of neurological disorders. For those who treat the geriatric population, where behavioral manifestations of delirium and dementia are common, this book is probably not an appropriate resource. Overall, however, Neurology for the Non-Neurologist provides a well-illustrated and clearly written overview of basic clinical neurology.By William Weiner and Christopher Goetz. Philadelphia, Lippincott Williams & Wilkins, 2004, 528 pp., $59.95 (paper). FiguresReferencesCited byDetailsCited ByNone Volume 162Issue 7 July 2005Pages 1394-a-1395 Metrics PDF download History Published online 1 July 2005 Published in print 1 July 2005