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NERVOUS SYSTEM (neurological symptoms/syndromes due to drugs (PERIPHERAL…
NERVOUS SYSTEM
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DISORDERS OF MOVEMENT
LMN
weakness and wasting, reduced tone and reduced/absent reflexes
UMN
exagg RESPONSE TO STRETCH with inc tone (spasticity) and brisk reflexes. wasting not seen in acute setting. PRIMITIVE REFLEXES - such as plantar extensor response, recur
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hemplegic gait - UNILATERAL UMN LESION characterised by leg extension at the knee and ankle and circumduction at the hip
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cerebellar dysfunction => BROAD BASED UNSTEADY (aTAXIC) GAIT = tandem walking (heel to toe) IS IMPOSSIBLE
parkinsonism = INITIATING of walking delayed, short steps, shuffling, reduced/lose arm swing
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Bizarre gaits with no other neuro signs may be assoc with Huntington's disease but are usually due to non-organic disorders
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focal seizures can evolve into a secondary generalised seizure
FEATURES WHICH SUGGEST EPILEPTIC SEIZURE RATHER THAN SYNCOPE
neat, synchronised rhythmical jerking of limbs
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RF FOR FALLS
disability eg impaired balance, vision, gait, cognition
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disease eg cerebrovascular, AD, PD
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meningeal irritation
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raises the possibility of infection, blood or tumour within the subarachoid space BUT can also occur with non-neuro infections eg UTI
kernig's sign is not present in local causes of neck stiffness eg cervical spine disease or raised ICP
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COMMON CAUSES OF VERTIGO
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PERIPHERAL
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drugs eg gentamicin, anticonvulsants
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SYNCOPE
syncope during exercise suggests a cardiac cause, either LV outflow obstruction eg aortic stenosis or hypertrophic cardiomyopathy or an arrhythmia eg complete heart block
if considering a vascular cause for neurological symptoms, ask about important RF
eg other vascular disease, HTN, fam hx, smoking