Positive Neurological Examination Research Articles

Dopamine-2 receptor antibody encephalitis presenting as pure tongue-biting in a tourette syndrome patient: a case report

BackgroundTourette syndrome (TS) is a neuropsychiatric disorder characterized by repetitive and patterned tics. Its onset correlates with dysfunctions in immunological activation and neurotransmitters. Autoimmune movement disorders such as dopamine-2 receptor antibody encephalitis (D2R encephalitis) may go undiagnosed in TS patients seeking medical help for tic symptoms only. Here, we present a clinical case of D2R encephalitis in a TS patient.Case presentationA 13-year-old boy with a history of TS presented with acute tongue-biting without positive neurologic examination or auxiliary examination results, except for a weakly positive finding for D2R antibodies in the serum sample. He was initially diagnosed with possible D2R encephalitis, but the influence of TS could not be ruled out. In addition to psychotropics, we administered immunotherapy early based on clinical characteristics, and his symptoms were ameliorated significantly. During the follow-up, he was diagnosed with definite D2R encephalitis, and the dosage of psychotropics was further adjusted for fluctuating symptoms.ConclusionsOur case suggests that clinicians should discern D2R encephalitis in TS patients when tics are the primary symptoms. Administering immunotherapy early, according to clinical characteristics, may benefit the patient. Moreover, the features of premonitory urges could help evaluate the state of TS.

Cervical Angina: A Literature Review on Its Diagnosis, Mechanism, and Management.

Cervical angina has been defined as chest pain that resembles true cardiac angina but originates from the disorders of the cervical spine. Thus, physicians and spine surgeons alike should raise awareness of this unusual condition for diagnosis and treatment. Particularly when neurologic signs and symptoms are present, there should be a strong suspicion for cervical angina in any patient with inadequately explained noncardiac chest pain. Cervical angina can be diagnosed according to negative cardiac workups, positive neurologic examination, and cervical radiographic findings (herniated disk, spinal cord compression, or foraminal encroachment). However, the mechanisms of pain production in cervical angina remain unclear. Previous studies attributed the pain to cervical nerve root compression, cervical sympathetic afferent fibers, referred pain, or lesions of the posterior horn of the spinal cord. Conservative treatments, which include neck collar fixation, head traction, and nonsteroidal anti-inflammatory drugs, have been determined to be successful in most patients with cervical angina. But when conservative treatment fails, anterior cervical surgery with complete decompression of the spinal cord and/or nerve root has been identified to effectively relieve cervical angina symptoms.

Case Report: Treating Cryptococcal Meningoencephalitis with Chinese Herbal Medicine Based on Macro Natural Law of Traditional Chinese Medicine

Background: Over the past few decades, Expansion, Cryptococcus infection. Has become a worldwide Common fungal infections. Cryptococcus prevention has many difficulties in clinical application. Survivors Neurological sequelae are also common Cryptococcal Meningoencephal, CM. In China, Traditional Chinese Medicine tends to been used for poor fungal treatment or sequelae. Case presentation: We present a 47-year-old patient with cryptococcal encephalitis who’s clinical manifestations are atypical, and it is easy to misdiagnose. The first symptom was headache after tooth extraction, followed by fever. The diagnosis was confirmed 6 months after the onset of the disease. After antifungal treatment for 18 days, Headache and fever not reduced and multiple adverse effects such as impaired internal organs. The use of antifungal therapy has serious adverse reactions and poor treatment effects. When the disease is in critical condition, the modern medical antifungal treatment is ineffective and resistant to help. Using traditional Chinese medicine theory, it acknowledges the harmonious unity between man and nature, instead of looking for better resistance Fungal drugs, but by changing the internal environmental stability of the body, after 5 days of initial treatment, the patient no longer had fever, headache, snore, appetite restored and normal bowel movements, the nervous system function gradually recovers. No fever or headache occurred within 5 months, neurological function gradually recovered, head MRI improved, and cerebrospinal fluid culture was negative. After 7 months, the patient still had no fever, headache, snore, he can take care of himself, normal language expression can be done, farm work at home, one person can do food shopping and cooking, etc., limb muscle strength is normal, muscle tension is not high, No positive neurological examination. Conclusion: Traditional Chinese medicine modalities may be considered for treatment When western medicine treatment of cryptococcal encephalitis is not effective, based on appropriate syndrome pattern assessment.

A case of spontaneous subarachnoid hemorrhage and intraventricular hemorrhage with negative computed tomography angiography findings

Brain computed tomography angiography (CTA) is a useful tool for detecting subarachnoid hemorrhage (SAH) and cerebral aneurysms, but less reliably when cerebral aneurysms which are smaller than 2 mm. We present a case of spontaneous SAH and intraventricular hemorrhage (IVH) with negative findings on brain CTA. Due to the clinical presentation and positive neurologic examination, lumbar puncture was performed and xanthochromia of cerebrospinal fluid (CSF) had been noted. Cerebral angiography was performed and showed a small unruptured saccular cerebral aneurysm (<2 mm).

Analysis of clinical predictors of intractable childhood epilepsy

Objective To identify clinical predictive factors in intractable childhood epilepsy, to provide some evidence for its early diagnosis. Methods Six hundred and twenty-four children with newly diagnosed epilepsy were retrospectively identified in Xinhua Hospital Affiliated to Shanghai Jiaotong University Medical School(1993-2009). The epileptic children were divided into a drug-responsive epilepsy group(n=584) and an intractable epilepsy group(n=40). Clinical data of patients were retrospectively analyzed, including the gender, age, pathogen, inducement, number of pre-treatment seizures, seizure type, seizure type change, seizure duration, family history, previous history, physical examination, brain CT and initial electroencephalogram(EEG) findings.Single factor analysis and Logistic regression analysis were made in 2 groups. Results Strong univariate associations suggested that some factors could increase the risks of intractable epilepsy: symptomatic or cryptogenic epilepsy, mental retardation, type of infantile spasm, positive neurological examination and large absolute number of pre-treatment seizures, and changes in seizure types in the course of the disease.With multiple Logistic regression, independent predictors of intractability were symptomatic or cryptogenic etiology(OR=3.61), large absolute number of pre-treatment seizures and changes in seizure types in the course of the disease(OR=4.76). Conclusions It's necessary to be wary of intractable epilepsy and to adjust therapy accordingly when seizures were uncontrollable and accompanied by one or more conditions such as symptomatic or cryptogenic epilepsy, large absolute number of pre-treatment seizures, changes in seizure types in the course of the disease. Key words: Child; Intractable epilepsy; Predictors

THE CHANGING FACE OF URGENT NEUROLOGY OUTPATIENT REFERRALS

IntroductionA recent report published jointly by the RCP and ABN found that neurological presentations accounted for a significant proportion of GP and emergency room time, but access to acute neurological...

Pain in the upper anterior-lateral part of the thigh in women affected by endometriosis: study of sensitive neuropathy

To assess whether pain in the anterior-lateral part of the thigh in women affected by endometriosis is due to femoral nerve invasion by endometriotic implants. Case-control study. Hospital. We enrolled 30 patients with endometriosis and leg pain in the anterior-lateral part of the thigh and 30 healthy women. Skin biopsy and neurologic examination for detection of neuropathy. Intraepidermal small fiber density reduction and positive neurologic examination agree with sensitive neuropathy. Biopsy results showed no statistically significant difference between the case group and the control group. At neurologic examination nine patients in the study group (30%) showed positive results, none in the control group showed signs. These nine patients had reduced intraepidermal small fiber density, compared to the lower cutoff values of the control group, suggesting a sensitive neuropathy. When there is leg pain in women with endometriosis it is important to distinguish neuropathic from referred pain. Skin biopsy and neurologic examination should be introduced in the management of leg pain in endometriosis, due to their low invasiveness to diagnose a sensitive neuropathy. As a result early detection of nerve injury and planning for a prompt specific treatment would be possible.

Symptomatic blunt head injury in children--a prospective, single-investigator study.

The goal of this study was to describe a single emergency physician's experience with symptomatic blunt head injury in children and prospectively assess the sensitivity and predictive value of the neurologic examination. The author utilized a prospective patient series comparing neurologic examination with computed tomography (CT) of the head. Nine of 42 patients had intracranial injury for a prevalence of 21%; two patients (5%) had intracranial injury with only subtle neurologic examination findings. Twenty-six patients had a negative neurologic examination, and all had normal-appearing CT scans. Sixteen patients had a positive neurologic examination, of whom nine had a positive CT scan. The properties of the neurologic examination as a diagnostic test, with CT as the gold standard, were as follows: sensitivity = 100%, specificity = 78%, positive predictive value = 56%, negative predictive value = 100%. Normal findings from neurologic examination can be used in some children with symptomatic blunt head injury to delay or eliminate the need for CT of the head.

Practical selection criteria for unenhanced cranial CT in patients with acute headache

We studied clinical predictors of cranial computed tomography (CT) abnormalities in patients with acute or acutely worsened headache. Data were collected from chart review of 333 consecutive patients presenting to an emergency department and who were clinically selected for cranial CT. Patients with a positive neurologic examination were at 10.7 times greater risk for a positive CT than the rest of the sample (p<1.5 – 10−10). Using only neurologic examination to select patients for CT would have missed 30.3% of the positive scans. The amnesia, depressed sensorium, and hypertension variables had CT yields approximating 10% or greater even in the presence of a negative neurologic examination. Together with a positive neurologic examination, these variables detected 87.9% of the patients in this sample with positive scans; their absence had a negative predictive value of 98.0%. Of the four patients with positive scans who would have been missed using this strategy, one was discharged directly from the emergency department anyway and the other three developed positive neurologic examinations within 24 hours. One died of causes unrelated to the intracranial pathology. Positive neurologic examination, hypertension, history of amnesia, or a depressed sensorium provide reasonable initial guidelines to select for CT patients with an acute headache.

Practical selection criteria for noncontrast cranial computed tomography in patients with head trauma

To study patients with acute trauma retrospectively for clinical predictors of positive cranial computed tomography. We reviewed the medical records and noncontrast computed tomography scans of 373 consecutive head trauma patients presenting to a trauma Level I emergency department. Potential criteria for patient selection were analyzed statistically, using both univariate and multivariate models. Our data suggest that relying on four variables--positive neurologic examination, intoxication, and a history of amnesia or focal neurologic deficit--as screening criteria for computed tomography would have saved 58.6% of the scans performed on these patients. Together, these criteria had a sensitivity of 90.1% and a negative predictive value of 98.1% for abnormal computed tomography. Four patients with positive scans would not have been detected using this strategy. None of these patients deteriorated clinically or required operative intervention. Our data suggest that it may be possible to effectively screen patients with head trauma for cranial computed tomography using clinical criteria and so reduce the current number of scans performed by more than half. However, a prospective study is required to confirm our results.