Ebook Neurological clinical examination: Part
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Ebook Neurological clinical examination: Part
Inspection 48Distribution of weakness 49Drooping of the eyelids is common in the elderly, and results from dehiscence of the levator aponeurosis. Othe Ebook Neurological clinical examination: Parterwise, it usually results from weakness of the levator palpebrae $11 periods muscle. This is innervated by the oculomotor (Hird) nerve. The under-surface of the levator muscles is connected to the tarsus by smooth muscle fibres, Midler’s muscle, which is innervated by cervical sympathetic nerves. P Ebook Neurological clinical examination: Parttosis results from damage to these nerves or to disorders of muscle or neuromuscular junction.InspectionGive yourself a moment to take in the overallEbook Neurological clinical examination: Part
appearance of the patient. There are some ch a rac ter i s t i c presen t a I i on s:•One eye closed, the other normal (oculomotor palsy or myastheniaInspection 48Distribution of weakness 49Drooping of the eyelids is common in the elderly, and results from dehiscence of the levator aponeurosis. Othe Ebook Neurological clinical examination: Partotor palsy; l ig. 8.1).See Video 35: Third nerve palsyDistribution of weaknessNormalHorner's syndromeOculomotor palsyFigure 8.1 The eyes in the primary position: (a) normal, (b) Horner's syndrome, (c) oculomotor nerve palsy.•Bilateral ptosis (myopathy, such as dystrophia myotonica [drooping mouth, t Ebook Neurological clinical examination: Parthin neck and frontal balding] or Kearns-Sayre1 syndrome; or myasthenia gravis).•Proptosis and ptosis in one eye (orbital tumour or vascular anomaly).Ebook Neurological clinical examination: Part
Listen for a bruit over the eye.Distribution of weaknessIn the first place, you need to:•test visual acuity;•examine the lens and fundi;•test pupillarInspection 48Distribution of weakness 49Drooping of the eyelids is common in the elderly, and results from dehiscence of the levator aponeurosis. Othe Ebook Neurological clinical examination: Partoculi).What you find will then lead you to other aspects of the examination. Certain patterns of weakness are characteristic:• Unilateral ptosis:•With the patient attempting to look straight ahead, the eye is ‘down and out’ (see Fig. 8.1c). There is weakness of adduction and vertical eye movements; Ebook Neurological clinical examination: Partthe pupil is fixed and dilated. The patient has an oculomotor (Hird) nerve palsy (see Chapter 9).•As for the previous case, but with pupillary sparingEbook Neurological clinical examination: Part
. Consider small-vessel disease due to diabetes mellitus and/or hypertension as a cause.• With the pupil smaller on the same side but normally reactivInspection 48Distribution of weakness 49Drooping of the eyelids is common in the elderly, and results from dehiscence of the levator aponeurosis. Othe Ebook Neurological clinical examination: Partvated on the a flee Led side. Brush the back of your hand across the forehead. The skin may feel moist and sticky on the normal side, but smooth on the anhidrotic side. Horners syndrome is a good lateralizing but a poor localizing sign as the cervical sympathetic fibres run such a tortuous course. T Ebook Neurological clinical examination: Parthe following associated signs should be particularly looked for:•Loss of the corneal reflex in the same eye (orbital or retro-orbital lesion);•WeaknesEbook Neurological clinical examination: Part
s and loss of reflexes in the ipsilateral arm (avulsion injury to the brachial plexus; Pancoast2 tumour of the lung apex);•Ipsilateral loss of facial Inspection 48Distribution of weakness 49Drooping of the eyelids is common in the elderly, and results from dehiscence of the levator aponeurosis. Othe Ebook Neurological clinical examination: Partweakness of extra-ocular muscles and orbicularis oculi consider myasthenia gravis. Ask the patient to look up at the ceiling for about 2 minutes. The ptosis may worsen. After a brief rest, the eyelid will resume its original position. Look for evidence of weakness and fatigability in the limbs. Fati Ebook Neurological clinical examination: Partgability is most conveniently tested in the deltoid muscles. Sit the patient in a chair and ask them to abduct the arms at the shoulder, Hex the elbowEbook Neurological clinical examination: Part
s and to resist your attempts to pressDistribution of weaknessonce per second) rather than continuously. Within a minute or so, it becomes progressiveInspection 48Distribution of weakness 49Drooping of the eyelids is common in the elderly, and results from dehiscence of the levator aponeurosis. Othe Ebook Neurological clinical examination: Partn myasthenia gravis.See Video 37: Unilateral ptosisInspection 48Distribution of weakness 49Drooping of the eyelids is common in the elderly, and results from dehiscence of the levator aponeurosis. OtheGọi ngay
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