Neurology Diagnostics

Posts Tagged ‘Neurological diseases’

One of the most frequent causes of consultation is the dizziness. Vertigo is the sensation of things spinning around each other (objective vertigo) or a tour around things (subjective vertigo).

Dizziness is a feeling of instability, as one walks on cotton, in high and low. These can occur separately or together, and the vast majority of cases are of benign origin, ie, not a brain problem, but on one condition at the ear or vestibular nerve, which is carrying the information from ear to the brain.

The most common causes of vertigo or dizziness of non-cerebral origin (peripheral vestibular syndrome or SVP) are of viral origin (vestibular neuronitis, a viral inflammation of the nerve), at the microscopic mechanical disorders of the ear (benign paroxysmal positional vertigo), by increasing pressure of the endolymph which is a liquid in the internal system of the ear (Meniere’s disease), trauma (vertigo post TEC), infectious (syphilis) and others.

The SVP is often accompanied by severe nausea, vomiting, sweating, cold and long malaise. Depending on the cause, can last a couple of days, or chronic. It is with rest, light food and drugs that decrease the dizziness / vertigo (antivertiginosos) and drugs that reduce nausea (antiemetic) and the prognosis is generally good. Read the rest of this entry »

The diagnosis of Parkinson’s disease should not be sure until it is known in detail all drugs that the patient, consciously or inadvertently, come take at the time of the query.

It is well known that neuroleptics (phenothiazines, butyrophenones) may trigger events and parkinsonian tremor by blocking postsynaptic dopamine receptors in the striatum. The same happens with the depleting dopamine (reserpine, tetrabenazine).

Selective blockers of calcium channels (cinnarizine, flunarizine), masked in various commercial preparations of routine administration can produce similar manifestations full or partial recovery in all patients after discontinuation of medication and within a variable.

Some authors argue that drug-induced parkinsonism may be a latent or subclinical parkinsonism revealed by antidopaminergic medication. It is noteworthy that late buccolingual dyskinesia caused by prolonged use of neuroleptics may be associated with parkinsonian manifestations but hardly reason for misdiagnosis is the presence of stereotyped slow and continuous movements that occur in the lower face (lips , jaw and tongue).

The distal parts of the body and trunk tend to show small movements of flexion and extension, while the proximal muscles are not compromised. When the patient is standing may have repetitive movements of the lower extremities (go hard). The patient often develops secondary akathisia. It is assumed that tardive dyskinesia was given to a hypersensitivity of postsynaptic receptors for dopamine and its increased secretion secondary to blockade of these receptors.

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Part of parkinsonian patients develops, over time, subcortical dementia.

Although the diagnosis of Parkinson’s disease is largely clinical, can take account of hyposmia (may precede up to 20 years to your appearance), positron emission tomography showing decrease of dopamine in the striatum, markers recently biological and electromyography to show subclinical tremor.

An important chapter of this issue is that of drug-induced parkinsonism, which generally refers to the interruption but not always. Drugs that can induce are neuroleptics (phenothiazines, butyrophenones), depleting dopamine (reserpine, tetrabenazine) and calcium channel blockers (cinnarizine, flunarizine).

The clinician, before diagnosing Parkinson’s disease, should take into account the possibility cited in the preceding paragraph as well as a number of neurological disorders that are targets of specialized study.

Fustinoni (in Semiology Nervous System [1997]) says the following signs and symptoms exclude the diagnosis of Parkinson’s disease:

Signs and Symptoms that exclude Parkinson

l buccolingual dyskinesia (parkinsonism drug)

l hyperreflexia not justified by previous stroke (Vascular parkinsonism)

l pseudobulbar syndrome (vascular parkinsonism)

l or intentional tremor predominant attitude (Essential tremor)

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Since the caudate nucleus and putamen, there is a path to the black substance secreted by the inhibitory neurotransmitter GABA (gamma aminobutyric acid). In turn, a series of fibers originating in the substantia nigra send axons to the caudate and putamen, secreting an inhibitory neurotransmitter from their terminals, dopamine. This pathway maintains a degree of mutual inhibition of the two areas and the injury causes a series of neurological syndromes, among which is Parkinson’s disease.

The fibers from the cerebral cortex secrete acetylcholine, an excitatory neurotransmitter, in the neostriatum. The causes of abnormal motor activities that make up Parkinson’s disease are related to the loss of the secretion of dopamine by nerve endings in the substantia nigra on the neostriatum (nigrostriatal tract) to the left of suppression.

Thus, neurons that secrete predominantly acetylcholine, excitatory signals broadcast to all basal ganglia, responsible in whole, motor planning and some cognitive functions. It requires a loss of approximately 80% of striatal dopamine to the symptoms.

Histologically, the disease is characterized by the presence of Lewy bodies in the substantia nigra and locus coeruleus, but can also appear in other locations of the extrapyramidal system. These intracytoplasmic inclusions composed of protein, free fatty acids, sphingomyelin, and polysaccharides.

The incidence of Parkinson’s disease, assessment difficult, is variable ranging from 4.5 to 21 cases per 100,000 population per year. It is the most accurate estimate of the disease and the extent of new cases in a period of time. Prevalence is the total number of cases in a population and at the same time.

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Although neurologists for the miokimia or eyelid twitching or MP (episodic involuntary contraction of the lower eyelid) does usually more serious, is a frequent cause of consultation.

Patients usually suffer from panic to see in the mirror and keeps your eyelid contract without being able to control is sometimes close to a patient that you mentioned this annoying condition. The patient will automatically think the worst diagnosis: brain tumors, epilepsy, the onset of facial paralysis, etc., But fortunately is very wrong.

For peace of patients by far the most common cause of PD is anxiety or stress. Most patients are tired, has not slept well for several days or had problems at work or home. Then the treatment is first of all try to relax, try to disconnect (it is that you can) the problems, sports, etc.

If the MP is very upset or ashamed to have her patient, anxiety may be indicated to lower your anxiety level. the problem with anxiety is that people are very sensitive to them and are permanently “dazed” after taking the drug. In addition, the MP does not disappear immediately after taking the anti-anxiety, it is usual to take several days before this contraction is reduced involuntary “nervous.”

As it is extremely rare to find an organic cause of the MP, it is rare that additional tests are needed to make the diagnosis.

So the advice is to relax and if they have at some point the MP, is a good time to take a break or decrease engine speed, is the easiest way to get better.

Neurology is the science of diseases affecting the nervous system. Neurologist is a physician who specializes in diagnosing and treating these diseases.

The nervous system consists of the central nervous system (brain and spinal cord), peripheral nervous system (nerve roots, nerves, union muscle and nerve and muscles) and autonomic nervous system (responsible for regulating blood pressure, heart rate, sweating, etc.).

Neurological diseases are many, some common (migraine, stress and depression, stroke and cerebral hemorrhage, etc.). And not so common (multiple sclerosis, Parkinson’s disease, Guillain Barre syndrome, etc.)..

The diagnosis of these diseases is first of all clinical, ie, based on history and patient history and physical examination. Then, when the neurologist sees fit, request more specific examinations such as computed tomography, MRI, EEG, EMG, transcranial Doppler, etc.

Once the diagnosis, the neurologist will find the most effective treatment for the patient. As every patient is different each other, the physician should indicate the drug that creates more appropriate for your patient.

Once the treatment, the patient must go to his neurologist checks prompted. Some diseases require a few checks (eg attacks of vertigo or dizziness) and others require more controls (epilepsy, cerebral vascular attacks, etc.)..

Finally, the main objective is to solve the problem the patient, and if there is no definitive treatment for their disease and find ways to best manage the symptoms the patient may have.

It was James Parkinson who described the disease in 1817 under the name of paralysis agitans. “The etiology is unknown but pathophysiologically related to a deficiency of dopamine in the striatum, resulting from neuronal degeneration that mainly affects the compact zone of the substantia nigra (locus niger), the locus coeruleus and other properties in catecholamine-containing which are eosinophilic inclusions known as Lewy bodies “(JC Fustinoni).

The extrapyramidal motor system is the set of motor pathways that exert a major influence on spinal motor circuits, brain stem, cerebellum and cortex. Has fibers from the motor cortex that connect with the basal ganglia, particularly the caudate and putamen, as well as bulbar nuclei (red nucleus, substantia nigra and reticular formation) or midbrain and terminate in the anterior horn of the spinal cord.

Several hypotheses attribute the disease to genetic factors (genes have been identified as responsible mutants), metabolic (oxidative stress) or environmental (pesticides, aluminum). 10% of patients exhibit genetic predisposition. One out of every thousand people with the disease is less common in blacks and Japanese.

The onset of the disease is insidious and, retrospectively, patients may report having suffered from hyposmia, pain erratic confused as arthritic origin, dysesthesias burning sensations, depression, mental or seborrheic dermatitis, which can not always be taken into account as a prodrome.

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Childhood neurological cause much anguish in the family. However, thanks to scientific advances, most young patients can enjoy a full life today.

What would be the most frequent pathologies in this specialty.

There are two groups of diseases which, by their frequency in childhood and adolescence, represent the main reasons for consultation in the neurological specialty: developmental disorders and so encompass the paroxysms.

A substantial proportion of children has a developmental disorder of sufficient magnitude to require a specialized evaluation. The reasons for consultation vary by age:

In infants: is manifested in the acquisition of maturational patterns, especially motor. In Pre-school stage in the development of language disorders. By school age and adolescence: for disorders of learning and behavior.

A similar or lower rate at some time, a transient paroxysmal episode. These are manifested as a change at the level of motor behavior (convulsions, tics, etc..) Perceptual (headache, dizziness) of impaired breathing (apneas, breath) or level of consciousness (syncope). Within the spectrum of seizures, which may have different ways of presenting stand-febrile seizures.

What other causes of consultations may be cited?

Although less common genetic and chromosomal diseases and central nervous system malformations (Down syndrome, myelomeningocele) and neuromuscular diseases (muscular dystrophy, neuropathies, spinal atrophy), neurodegenerative diseases, some with known metabolic error (phenylketonuria, galactosemia , etc.).
The importance of technological advances.

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Neurological diseases are those in which an injury or dysfunction of the nervous system, either central or peripheral.  If we make a comparison with computing, neurological diseases would be a hardware problem, machinery, and psychiatric would rather the software, the system program.

Neurologists often have patients with diseases which can detect lesions in the central nervous system, such as vascular brain, which is a dysfunction of neurotransmitters such as Parkinson Sea.

Perhaps one of the most prominent pathology is the stroke, also known as brain circulatory disease or cerebrovascular accident (CVA) before misnamed cerebral atherosclerosis.

This is a neurological disease that occurs most often disabling or fatal consequences, although many things you can do to avoid them.

Everyone knows what a heart attack, but what a brain infarction. Myocardial infarction or heart is a matter of urgent consultations everywhere and people know what it is.

Myocardial ischemia and brain are less known. Occurs anywhere in the body including the brain, where lack of circulation and oxygen can not reach.

Cerebral artery is covered and the most common failure is that the functioning of the body part that depends on the cerebral artery. The brain is organized as a map, so that failure of the movement in a particular area, that will speak with the failure of such a function linked to a body part.

What we know everyone is hemiplegia, which occurs when you flip one of the major cerebral arteries.  They are conditions that may be transient, with recovery and may even be reversed, so the patient must make a query quickly, because once installed it is more difficult to overcome.