Neurology and Neurosurgery Illustrated E-Book

Kenneth W. Lindsay, Ian Bone, Geraint Fuller

• Verlag: Churchill Livingstone
• Jahr: 2010
• ISBN:
  9780702049170
• Auflage: 5
• Thema: Medicina
• Thema: Neurologia

New edition of a highly successful illustrated guide to neurology and neurosurgery for medical students and junior doctors.•Comprehensive guide to neurology and neurosurgery for medical students and junior doctors – competing books do not cover both areas.
•Graphic approach to the subject – concise text is arranged around clear and memorable line diagrams. Readers find this approach accessible and easy to learn form.
•Clarifies a subject area which students tend to find difficult and forbidding.

Updated and revised in all areas where there have been developments in understanding of neurological disease and in neurological and neurosurgical management. This revision has also incorporated current guidelines, particularly recommendations from National Institute for Health and Clinical Excellence (NICE).

SECTION I GENERAL APPROACH TO HISTORY AND EXAMINATION

NERVOUS SYSTEM – HISTORY

An accurate description of the patient’s neurological symptoms is an important aid in establishing the diagnosis; but this must be taken in conjunction with information from other systems, previous medical history, family and social history and current medication. Often the patient’s history requires confirmation from a relative or friend.

The following outline indicates the relevant information to obtain for each symptom, although some may require further clarification.

NERVOUS SYSTEM – EXAMINATION

Neurological disease may produce systemic signs and systemic disease may affect the nervous system. A complete general examination must therefore accompany that of the central nervous system. In particular, note the following

CNS examination is described systematically from the head downwards and includes:

EXAMINATION – CONSCIOUS LEVEL ASSESSMENT

A wide variety of systemic and intracranial problems produce depression of conscious level. Accurate assessment and recording are essential to determine deterioration or improvement in a patient’s condition. In 1974 Teasdale and Jennett, in Glasgow, developed a system for conscious level assessment. They discarded vague terms such as stupor, semicoma and deep coma, and described conscious level in terms of EYE opening, VERBAL response and MOTOR response.

The Glasgow coma scale is now used widely throughout the world. Results are reproducible irrespective of the status of the observer and can be carried out just as reliably by paramedics as by clinicians

EYE OPENING – 4 categories

VERBAL RESPONSE – 5 categories

Orientated Confused Words Sounds None

– Knows place, e.g. Southern General Hospital and time, e.g. day, month and year – Talking in sentences but disorientated in time and place – Utters occasional words rather than sentences – Groans or grunts, but no words

MOTOR RESPONSE – 5 categories

Obeys commands

Localising to pain

Apply a painful stimulus to the supraorbital nerve, e.g. rub thumb nail in the supraorbital groove, increasing pressure until a response is ...