B. Phenomenologic classification. 1. Rest tremor. Tremor that occurs in a body part that is not voluntarily activated and is completely supported against gravity. Rest tremor amplitude always diminishes during target-directed movements,…
(Video 29.1). Upper motor neuron signs (hyperreflexia and spasticity) are commonly found in patients with SCA1 and SCA3; cognitive impairment has been reported in association with SCA2, SCA12, SCA13, and…
B. Response to medications. Absence of benefit from adequate dosages of dopaminergic drugs, especially levodopa, casts doubt on the diagnosis of IPD and suggests a diagnosis of secondary causes of parkinsonism…
(2) Paresthesias and sensory loss. Paresthesias are spontaneous sensations originating from nerve fibers, which patients describe as “tingling” or “pins and needles.” Sensory loss indicates absence of normal sensation, which patients…
(Video 59.1). d. Treatment. (1) Activated charcoal. 1 g/kg by mouth if the patient is awake and is not at risk of aspiration and if ingestion is within 1 hour. (2) Benzodiazepines. Repeated…
Do you believe that the decision to treat Maria with IV morphine 6 months earlier was to hasten her death? Is this an “acceptable” outcome for someone who is 94…
(Video 19.1). Other findings include muscle weakness with greater than normal tone. Dysphagia may also occur. In addition to spastic dysarthria, the patient with pseudobulbar palsy may often exhibit emotional…
Video 51.1). Significant atrophy can occur in the affected muscles. The pain usually lessens within 3 to 6 weeks. Sensory loss and weakness improve over months, but long-term deficits may…
(see Video 31.1). Eventually, dysarthria, dysphagia, and respiratory distress may occur. Ocular myasthenia will present with asymmetric ptosis and diplopia. There is fatigability induced by repetitive exercise. Muscle tone, bulk,…
(Video 27.1). D. Brachial and lumbosacral plexus. Acute sensorimotor deficits indicating multiple nerve or nerve-root distributions in an arm or leg suggest plexopathy. E. Spinal cord. Most fibers conducting pain and temperature…
