Basic Neurological Examination Research Articles

Is pruritus in chronic uremic patients related to peripheral somatic and autonomic neuropathy?: Study by R-R interval variation test (RRIV) and by sympathetic skin response (SSR)

The problem of pruritus in uremic dialysed patients remains unsolved. The etiology of pruritus has not been precisely explained, and sometimes no efficient treatment is available. The aim of this study was to analyse the relationship between somatic neuropathy and pruritus as well as the relationship between pruritus and dysautonomia. Fifty-one patients with end-stage renal failure underwent basic neurological examination, nerve conduction velocity studies, and pruritus assessment by means of a questionnaire. Two tests were used to assess the autonomic nervous system, namely the R-R interval variation test in basal and profound breath conditions (RRIV) and the sympathetic skin response (SSR). Pruritus was found in 63% patients of the sample. Most of them had clinical symptoms and signs of peripheral sensorimotor neuropathy and dysautonomia. About 59% of uremic patients revealed abnormally reduced RRIV. About 45% of patients had abnormal (delayed or absent) SSR. The pruritus in uremic patients occurred significantly more frequently ( P < 0.01) in patients with paresthesia. A nonsignificant but sizeable trend towards a relationship of pruritus with hypohidrosis and pathological SSR results was also observed. There was no relationship between the pruritus presence and RRIV results. According to our results the activity of the nervous system might play an important role in the mechanism of uremic pruritus, but paradoxically this latter appeared more tightly related to somatic neuropathy than to autonomic dysfunction. Our results also suggest that SSR may become a useful technique for the assessment of autonomic dysfunction in uremic patients.

Good practice in attention deficit hyperactivity disorder

AbstractMajor advances have been made in ADHD over the years, both in terms of diagnostic validity, different subtypes, comorbidities and treatment options. A comprehensive assessment needs to include medical, developmental and educational history using multiple sources of information and across different settings. In certain cases, additional investigations and neuropsychological testing may need to complement basic physical and neurological examination. The focus of treatment must include not only the core ADHD symptoms but also additional comorbid problems, family and peer relationships, and academic achievement. Treatment should therefore be multi-modal with simultaneous medication, behavioural and educational management. Both diagnosis and treatment response needs to be reviewed regularly to ensure optimal response with minimal adverse side effects.The increased awareness of ADHD by both clinicians and other professionals has resulted in a huge increase of referrals for assessment, diagnosis and treatment. In particular, families are becoming increasingly knowledgeable about the disorder and are rightly requesting adequate assessment and treatment of their children. It is therefore essential that all clinicians are equally knowledgeable about the advances in this area and offer a service to families which represents good clinical practice. This article reviews what constitutes good clinical practice in ADHD.

Neurology for Non-Neurologists, 3rd ed.

Back to table of contents Previous article Next article Book Forum: TEXTBOOKSFull AccessNeurology for Non-Neurologists, 3rd ed.Robert Cancro, M.D., Robert CancroSearch for more papers by this author, M.D., New York, N.Y.Published Online:1 Apr 1998https://doi.org/10.1176/ajp.155.4.569aAboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Following World War II, in the bloom of dynamic psychiatry, merged departments of psychiatry and neurology separated into individual components. As our understanding of the fundamental role of the nervous system in psychiatry has developed, it would seem that this divorce was premature and in error. Nevertheless, a reconciliation is possible only at a modest level. For the sake of the patients, it is necessary for practicing psychiatrists to develop a reasonable level of sophistication concerning the operation of the nervous system. Textbooks of neurology are essential in this regard because residency training programs, until recently, have emphasized interpersonal and dynamic theory rather than integrating neuroanatomy and neurophysiology into the curriculum.This small volume is designed for nonneurologists and is also designed to be carried in a jacket pocket. It is a clear, concise, and useful summary of clinical neurology for physicians, particularly for house officers. It is an excellent source for nonpsychiatric physicians but, unfortunately, does not meet the needs of psychiatric practitioners. As is to be expected from its intended audience, the book emphasizes the recognition and treatment of the usual neurological conditions, ranging from vascular to degenerative to neoplastic. This is not the daily fare of psychiatrists. There is virtually no recognition of behavioral disorders. Nevertheless, the chapters on neuroanatomy and the basic neurological examination are good reviews. It is almost sad to see how much better many aspects of the mental status examination are described in this book than the examination is conducted by many candidates on board examinations. The inadequacy of performance on mental status examinations reflects the inadequacy of the teaching in many residency programs. The proper teaching of the examination requires not only time and effort but the involvement of senior faculty. It should not be taught by the senior resident or inexperienced faculty. The mental status examination remains a sensitive diagnostic tool when used properly, and many psychiatrists would benefit from reading the few pages on this subject in Neurology for Non-Neurologists.Despite the depredations of managed care, psychiatrists still have the luxury of spending more time with their patients than most clinicians. For this reason we are able to serve as surrogate primary care physicians for many patients. The recognition and differential diagnosis of a variety of neurological conditions, including early dementia and transient ischemic attack, can be recognized in the psychiatrist's office and confirmed elsewhere. The recognition by the psychiatrist of medical illness is not restricted to neurological conditions. Many endocrine, cardiac, respiratory, and allergic disorders can be recognized and referred appropriately. If psychiatrists perform this function, they will strengthen the necessity of the field in the face of the economic “experts” who believe—or at least pretend to believe—that nonphysician mental health practitioners are equal in quality to psychiatric physicians as well as lower in cost for patients other than themselves.by Wigbert C. Wiederholt, M.D. Philadelphia, W.B. Saunders Co., 1995, 357 pp., $41.00 (paper). FiguresReferencesCited byDetailsCited ByNone Volume 155Issue 4 April 1998Pages 569a-570 Metrics History Published online 1 April 1998 Published in print 1 April 1998

Hand function in subjects with spina bifida.

The aim of our study was to assess the influence of the Arnold-Chiari malformation, cervical cord dysraphism and hydrocephalus on hand function in subjects with meningomyelocele, but without many of the other confounding factors commonly found in this group e.g low IQ and cerebral palsy, which in themselves cause poor hand function. Three groups of subjects who attended main stream schools underwent a basic neurological examination of the upper limbs and a battery of hand function tests. Group 1 consisted of subjects with meningomyelocele and shunted hydrocephalus (n = 21), Group 2 subjects had isolated shunted hydrocephalus (n = 13) and Group 3 were normal controls (n = 18). The results show that subjects with meningomyelocele had weaker power in the small muscles of the hand as compared to the controls and those with isolated hydrocephalus (p = 0.01) and poorer fine motor control and co-ordination. The meningomyelocele group scored significantly poorer in all of the tests as compared to the control group using the dominant hand (overall, p = 0.0003), and all of the tests but one using the non-dominant hand (overall, p = 0.0005). Our study has demonstrated that children with meningomyelocele have poorer hand function than healthy controls, which is due to causes other than hydrocephalus, poor IQ or cerebral hemisphere pathology. Instead, cerebellar and cervical cord abnormalities appear to be exerting a significant deleterious influence on the function of the upper limbs.

Clinical approach to erectile dysfunction in spinal cord injured men. A review of clinical and experimental data.

Despite the many developments in the area of sexual dysfunction, rehabilitation settings seldom investigate the remaining sexual function following spinal cord injury, or offer differential diagnoses of sexual dysfunction in spinal cord injured men. This article attempts to show how sexual rehabilitation should begin with a thorough assessment of the sexual function of paraplegic and tetraplegic men. Assessment includes a basic neurological examination of the perineal area and an extended clinical interview on sexual function and visceral function. The interpretation of patient evaluation is discussed in terms of a classification system adapted to sexual purposes and in terms of the differential diagnoses between sexual dysfunctions of organic, and those of predominantly psychogenic origin in the spinal cord injured patient. The organic or psychogenic contribution is discussed in terms of sophisticated procedures, where assessment of nocturnal penile tumescence (NPT) is critically evaluated and where alternatives such as urodynamic findings and skin potentials are discussed. Treatment strategies, such as intracavernous injections and cognitive-behavioural strategies adapted to different lesion types, are discussed.

Penetrating head injury.

Penetrating head injuries are a significant public health problem in the United States, with an estimated 33,000 gun-related deaths and many more nonfatal shootings per year. Initial treatment for a penetrating head injury is similar to that of a closed head injury. That is, all efforts must be made to prevent any secondary insults, hypoxia, or ischemia. This translates into the standard methodology of care of the trauma patient. The basic neurologic examination consists of using the Glasgow Coma Score and estimation of pupillary function and some estimation of brain stem function and motor power. The radiologic test of choice for a penetrating head injury is the computed tomography scan. There are several indications for surgery: the patient's condition will be improved or significant neurologic sequelae will be averted; the patient is sufficiently stabilized from any other injuries such that he or she can tolerate surgery; the condition of the patient is not so poor that surgery will have no effect; and the area of penetration is reasonably accessible to surgical intervention. Three main goals of medical management of a penetrating head injury include (1) control of hypertension, (2) maintenance of adequate cerebral circulation oxygenation, and (3) prevention of secondary complications. Outcome after a penetrating head injury is related to the extent of brain tissue damage caused either directly or indirectly by the missile as well as any indirect insults. The most significant indicator, particularly in terms of survival versus death, has consistently been the patient's presenting neurologic status. Some investigators have recommended that a patient presenting with a Glasgow Coma Scale Score of > 5 should not be treated. Others have said that patients with a low coma score and transventricular gunshot wounds should not be treated because of the high mortality. If the patient survives a penetrating head injury, he or she generally goes on to experience a relatively good functional outcome. Only if all components of a good treatment regimen are in place will patients and their families obtain the best possible outcome.

The neurologic examination in geriatric psychiatry.

The need to distinguish functional mental disorders from organic brain dysfunction has become increasingly important with the growing number of elderly patients who present with behavioral disturbances. As part of the evaluation of these patients, the psychiatrist or other physician should perform a basic neurologic examination. The author describes an examination for geriatric patients that includes methods for taking a neurologic history, for clinically measuring psychological functions, for evaluating primitive reflexes, and for interpreting peripheral neurologic responses.