Neonatal neurological examination, perinatal factors, subsequent development and evolution of a prognostic risk score.
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Child Development↗
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Results for “NEUROLOGIC EXAMINATION”
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Early extubation and neurologic examination following combined carotid endarterectomy and coronary artery bypass grafting using remifentanil.
Carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) as a combined procedure is occurring with increasing frequency. CEA-CABG incurs the morbidity of both procedures, and considerations for this procedure include anesthetic techniques that provide hemodynamic stability and prompt emergence from anesthesia. We present, to our knowledge, the first reported use in a combined CEA-CABG of the novel opioid remifentanil as a component of the anesthetic technique to achieve these goals. Remifentanil allows for early neurologic evaluation without sacrificing the hemodynamic stability of traditional, high-dose opioid techniques.
Analgesics, Opioid↗
[Myelography, CT scan, electromyography and neurologic examination in the diagnosis of herniated lumbar disk].
The research was carried out at the Clinical Hospital Osijek during a three-year period. Sixty-nine patients (34 men and 35 women) with the diagnosis of lumbar slipped disc who underwent surgery were followed up. The main inclusion criterion was the surgical finding of hernia. The aim of the study was to obtain a clearer insight into the values of the myelography and CT scan by observing a sufficiently large number of patients with surgically verified hernia of lumbar disc. The characteristics of neurological and EMG findings were surveyed, as well. Thirty-one patients were at the age of 40-49 years and 21 were at 30-39 years of age. Only 5 hernias were at the level L3L4, 28 at the level L4L5, and 46 at the level L5S1. Sensitivity, specificity and overall accuracy of the observed parameters were estimated for 41 leftwards and 30 rightwards located hernias. Myelographic finding, regardless of the observed level of slipped disc, showed excellent sensitivity, specificity and accuracy of diagnosis. CT finding was slightly less sensitive at the level L4L5, it was 0.93, and specific at the level L5S1, amounting to 0.90. Its accuracy was not substantially lower than that of myelography. The pathological EMG was 0.88 sensitive, 0.83 specific and 0.84 accurate. The accuracy was excellent at the level L3L4, it was 0.96, but only very good at the level L5S1, amounting to 0.76. A t-test of linked pairs was used to compare surgical reports and diagnostic findings. There was a great similarity between a CT finding and surgical one in all three levels (t-values 1.00, 0.21 and 0.36). Myeolography was more congruent with the surgical finding in the middle level (t-values 1.65, 0.93 and 1.52). An EMG finding was significantly different from that found by surgery (t-values 1.71, 1.76 and 2.71). The existence of Lasègue's sign for the diagnosis of hernia was 0.93 sensitive, 0.07 specific (remarkably low) and 0.36 accurate. It was particularly inaccurate at the level L3L4, moderately accurate at the level L4L5, and rather accurate at the lowest level L5S1. The weakened Achilles tendon reflex was less sensitive than Lasègue's sign, amounting to 0.80. Its specificity was 0.19 and accuracy 0.40. The highest accuracy was in hernias of the lower two levels L4L5 and L5S1. The existence of weakened sense was 0.91 sensitive, specificity was remarkably low, amounting to 0.08, and accuracy was 0.36. It was most inaccurate at the level L3L4 and slightly better at the levels L4L5 and L5S1. Disturbance of leg movements showed sensitivity of only 0.60, but specificity was 0.39 and accuracy 0.46. It was most precise at the level L4L5. Neurological symptoms and signs were insufficiently sensitive and specific for the diagnosis of lumbar disc hernia. On the basis of these parameters, the level of hernia could not be exactly determined.
Adult↗
Intracranial metastasis from cancer of the lung. A prospective study of the diagnostic validity of positive and negative findings in neurological examination, electroencephalography, 99m Tc brain scanning, and lumbar puncture before thoracotomy.
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Adenocarcinoma↗
An improved functional neurological examination for use in nonhuman primate studies of focal reperfused cerebral ischemia.
There is renewed interest in primate models of acute stroke for the evaluation of potential therapeutic agents prior to clinical trials. The development of more precise functional outcome measures would improve the pre-clinical assessment of neuroprotective strategies. We have constructed a grading scale that utilizes an increased number of goal-oriented tasks to assess both behavior and motor function. The new scoring system is designed to enhance precision and accuracy when compared to existing scales. Twenty-seven male baboons were subjected to 1 h of middle cerebral artery territory occlusion followed by reperfusion. Outcome was evaluated using both a standard neurological function scale and a new task-oriented scale. Each scoring system was assessed for reproducibility (inter-observer reliability) and for association with radiographic infarct volume. The task-oriented grading system was significantly less variable than the standard outcome measure (p < 0.0001). The task-oriented neurological scale demonstrated stronger correlation with radiographic infarct volume (p < 0.0001) than the standard scale (p < 0.01) and more accurately reflected infarct size in animals with small strokes. Compared to the accepted system for grading neurological function, the task-oriented scale demonstrates improved inter-observer variability and a better association with radiographic outcome measures. Incorporating this refined neurological evaluation into a baboon model of stroke may serve to increase the functional predictive value of pre-clinical studies.
Animals↗
[Characteristics of the clinical picture and neurological examination in combined craniocerebral injury against a background of shock].
The authors have performed an analysis of the clinical picture of the associated cranio-cerebral trauma accompanied by shock in 181 patients. It has been shown that of the greatest diagnostic significance in the period of shock is the assessment of the patient's consciousness, hemodynamics and respiration, the external symptoms of the injury of the brain and skull, investigation of the eye symptoms, motor disturbances, pathological pyramid symptoms.
Brain Concussion↗
Neurologic examination of the elderly patient. Signs of normal aging.
Once the signs of normal aging are recognized, findings that indicate aging alone can be separated from those that clearly suggest a focal neurologic lesion. Using the patient's history and other data, the physician can relate the findings to the complaints. However, it behooves the physician to explain all the findings on the examination and not merely blame the aging process for every neurologic sign.
Aged↗
[Neurologic examinations for facial nerve damage in surgically treated mandibular collum fractures].
Transcranial magnetic stimulation is a new method for objective evaluation of the facial nerve without constraints for the patient. By the first time, especially cortical lesions can be detected objectively. Using this method, a permanent disturbance of the ramus marginalis mandibularis after operative treatment of fractures of the mandibular condyle could be certainly excluded. Therefore, because of the clear presentation and the possibility of enlargement, the deep submandibular approach, using a correct operative technique, can be strictly recommended.
Electromagnetic Fields↗
[Neurological examination methods of the hand].
Handsurgeons are normally more interested in clinical tests evaluating sensory and movement disorders of hand. Since these are often unprecise and require a cooperative (and intelligent) patient, neurologists and neurosurgeons prefer precise diagnostic procedures. For this reason they use electrophysiological techniques to evaluate and localize peripheral nerve lesions, i.e. electromyography, sensory and motor nerve conduction velocity and somatosensory-evoked potentials (SEP), by which most nerves of the arm and hand (median, ulnar and radial nerves including their major branches) can be easily assessed. Insufficient technique (submaximal stimulation, no temperature control, stimulation of a neighbouring nerve) and mis- or overinterpretation are sources of error, which can best be avoided when the diagnosis is made in context with the clinical picture--especially when the surgeon is familiar with electrophysiological techniques.
Electromyography↗
The neurological examination in dementia.
The thesis of this chapter is that the neurological phenomena discussed and numerous others omitted or not yet recognized relate primarily to a release of primitive activity when diffuse brain damage erodes cerebral inhibition mechanisms. Anatomical correlations are always difficult when there are multiple lesions, and those that have been made have not completely explained these phenomena. A phylogenetic explanation is not completely adequate either but certainly does not bar further investigations. Indeed such a concept points out the necessity to continue to search for other fetal or developmental responses in dementia, to assess the interrelationships between these reflexes, and to quantify the stimulus as well as the response. The prognostic value of these reflexes is not emphasized, because it is not known. In the evaluation of dementia, one of the last obvious frontiers of neurological science, both specific observations and general principles await discovery.
Aged↗
[Some neurological examinations].
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Biopsy↗
Quantitative somatosensory testing of the penis: optimizing the clinical neurological examination.
PURPOSE: Quantitative somatosensory testing, including vibration, pressure, spatial perception and thermal thresholds of the penis, has demonstrated neuropathy in patients with a history of erectile dysfunction of all etiologies. We evaluated which measurement of neurological function of the penis was best at predicting erectile dysfunction and examined the impact of location on the penis for quantitative somatosensory testing measurements. MATERIALS AND METHODS: A total of 107 patients were evaluated. All patients were required to complete the erectile function domain of the International Index of Erectile Function (IIEF) questionnaire, of whom 24 had no complaints of erectile dysfunction and scored within the "normal" range on the IIEF. Patients were subsequently tested on ventral middle penile shaft, proximal dorsal midline penile shaft and glans penis (with foreskin retracted) for vibration, pressure, spatial perception, and warm and cold thermal thresholds. RESULTS: Mixed models repeated measures analysis of variance controlling for age, diabetes and hypertension revealed that method of measurement (quantitative somatosensory testing) was predictive of IIEF score (F = 209, df = 4,1315, p <0.001), while site of measurement on the penis was not. To determine the best method of measurement, we used hierarchical regression, which revealed that warm temperature was the best predictor of erectile dysfunction with pseudo R(2) = 0.19, p <0.0007. There was no significant improvement in predicting erectile dysfunction when another test was added. Using 37C and greater as the warm thermal threshold yielded a sensitivity of 88.5%, specificity 70.0% and positive predictive value 85.5%. CONCLUSIONS: Quantitative somatosensory testing using warm thermal threshold measurements taken at the glans penis can be used alone to assess the neurological status of the penis. Warm thermal thresholds alone offer a quick, noninvasive accurate method of evaluating penile neuropathy in an office setting.
Analysis of Variance↗
The effects of occupational exposure to chlorpyrifos on the neurologic examination of central nervous system function: a prospective cohort study.
Questions persist about adverse effects such as impaired cognition and attention, incoordination, spasticity, or parkinsonism from chronic, low-level exposures to organophosphate (OP) compounds. In a prospective cohort study, we evaluated chlorpyrifos-manufacturing workers and a referent group on 2 occasions, 1 year apart, to determine whether occupational exposure to chlorpyrifos produced clinically evident central nervous system (CNS) dysfunction. Chlorpyrifos subjects had significantly higher TCP excretion and lower average BuChE activity than referents in a range in which physiological effects on B-esterases exist. Few subjects had neurologic symptoms or signs, and there were no significant group differences in terms of signs at baseline or second examinations. Chronic chlorpyrifos exposure produced no clinical evidence of cortical, pyramidal tract, extrapyramidal, or other CNS dysfunction among chlorpyrifos subjects compared with referents, either at baseline or after 1 year of additional chlorpyrifos exposure.
Adult↗
[Etiological analysis of male diabetic erectile dysfunction with particular emphasis on findings of vascular and neurological examinations].
We studied the nocturnal penile tumescence (NPT) value obtained by simple method and the vascular and neurological findings closely related to the ability to achieve/maintain an erection in order to investigate the causative factors of organic erectile dysfunction seen in diabetes. Studies were carried out on 62 male diabetics (32-78 y.o.). The results were as follows. 1. There were no cases of a decrease in the nocturnal penile tumescence (NPT) value among eight subjects who showed no erectile dysfunction. However, a decrease in the NPT value was recorded in 28 (85%) of 34 subjects who showed complete failure to achieve/maintain an erection. It was, therefore, surmised that there is a large organic contribution to the erectile dysfunction seen in diabetes. 2. We determined the penile blood pressure index (PBPI), the reactions of papaverine tests, conduction velocity of the dorsal nerve of the penis and the latency of the bulbocavernosus reflex. 42 (67.7%) of the 62 subjects had penile vascular disorders and the cases with severe vascular disorders were skewed to the high age brackets. There were also many cases with neuropathy involved in the ability to achieve/maintain an erection: 38 (61.2%) of the 62 subjects. Moreover, many of the subjects were found to have damage to both the blood vessels and the nerves relating to an erection, and these forms of damage were surmised to be deeply involved in the decrease in the NPT value. 3. Multivariate analysis indicated that the most important factor involved in the decrease in the NPT value was vascular damage (contribution rate: 30.8%), followed by neuropathy (6.9%). These two factors represented the most important explanatory factors of the organic erectile dysfunction seen in diabetes. 4. The contribution rate of vascular damage to the decrease in the NPT value was 18.8% for diabetic subjects under the age of 60 years, but 45.1% for subjects aged 60 years or more. The contribution rate was thus higher in the elderly subject group. On the other hand, the contribution rate of neuropathy to the decrease in the NPT value was 7.7% for diabetic subjects under the age of 60 years, but the rate decreased to 4.7% for subjects aged 60 years or more.
Adult↗
Evoked fetal startle response: a possible intrauterine neurological examination.
The fetal startle reflex was studied in an attempt to provide an objective and quantitative estimate of the fetal neurological condition. This reflex is a normal response to a combined sound-vibratory stimulus in the healthy infant born after 30 weeks of gestation. It consists of a generalized paroxysmal motion that involves the whole body. Thirty women with uncomplicated pregnancies, who subsequently delivered healthy infants, were studied at term. Fetal movements were monitored by means of a real-time scanner. Placement of the transducer was such that it allowed for visualization of the long axis of the fetal forearm. A 3-second stimulus was delivered on the maternal abdomen over the fetal head with use of an artificial larynx. This device generates a mixed sound-vibratory output of 100 dB and 85 Hz. Sufficient visualization of the plane of forearm motion was possible 68% of the time, thus allowing for measurement of the duration of this motion. The results indicate that the mean duration of forearm motion in response to a 3-second sound-vibratory stimulus is 8.2 +/- 2.3 seconds (+/- SEM). Since an immediate forearm motion was detected each time that a stimulus was applied, we conclude that the startle reflex does indeed exist in the fetus. This simple means of assessing the neurological state of the fetus may provide a way to evaluate fetal tone as it applies to antenatal fetal assessment.
Acoustic Stimulation↗
Assessment of psychopharmacology on the American Board of Psychiatry and Neurology examinations.
OBJECTIVE: To report the assessment of psychopharmacology on the certification and recertification exams in general psychiatry and in the subspecialties administered by the American Board of Psychiatry and Neurology (ABPN). METHODS: The ABPN's core competencies for psychiatrists were reviewed. The number of items addressing psychopharmacology or neuropharmacology was determined for each examination. For the multiple-choice certification exams, item performance was reviewed. The grade cards of failing candidates were reviewed for the oral certification exam. RESULTS: A significant number of the core competencies involved psychopharmacology. The percent of items addressing the topic varied by examination but was substantial in general. Performance on these items on the multiple-choice certification exam was similar to performance in other areas. However, a majority of those who failed the patient section of the oral examination had inadequate performance in the area of drug treatment, indicating that trainees may need additional experience with applying psychopharmacological knowledge in the context of patient cases. CONCLUSION: This review indicated that knowledge of psychopharmacology was a significant component of the ABPN's core competencies and of its certification and recertification exams.
Certification↗
[Neurologic disorders in chronic brucellosis. II. Results of subjective neurologic examination].
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Brucellosis↗
[Neurological examinations of workers with chronic exposure to manganese dioxide during the production of piles and batteries].
The authors examined 118 workers making piles and batteries under conditions of exposure to toxic action of manganese dioxide dust. Neurological and EEG investigations showed presence of pyramidal tract lesion signs in 16.9% of workers, extrapyramidal syndromes in 6.8%, peripheral nervous system involvement in 13.5% and neurotic complaints in 42.4%. The frequency of neurological manifestations was directly proportional to the duration of work in exposure. The difference in the frequency of neurotic complaints and signs of peripheral and central nervous system damage was statistically significant between the group exposed to manganese dioxide and the control group. EEG investigations were performed in 51 workers and abnormalities were found in 21 cases.
Adult↗