Assessment of dizziness in neurology
Dizziness and vertigo are common symptoms. In acute vertigo, expert clinical assessment is critically important in discerning stroke from non-stroke causes because the results of stroke-protocol brain magnetic resonance imaging, including diffusion-weighted imaging, can be falsely negative in the first 24 hours. It follows that acute medical services must have access to clinicians expert in assessing acute vertigo. Expertise in clinical examination and interpretation of the findings requires appropriate training, but here we outline the basic diagnostic and therapeutic approach to patients with dizziness. (Source: Medicine)
Source: Medicine - June 27, 2023 Category: Internal Medicine Authors: Louisa Murdin, Barry M. Seemungal, Adolfo M. Bronstein Tags: Clinical assessment in neurology Source Type: research
How to perform a neurological examination
The neurological examination should be focused on the clinical history and seen as a means of testing the hypotheses generated while listening to the patient. However, pursuing the classically taught systematic interrogation of the neurological hierarchy is seldom necessary and sometimes impractical. A rapid screening neurological assessment should be used in all cases where it is possible, focusing on detecting high-yield clinical anomalies. (Source: Medicine)
Source: Medicine - June 27, 2023 Category: Internal Medicine Authors: Richard Rees, Kuven K. Moodley Tags: Clinical assessment in neurology Source Type: research
Taking a neurological history
A detailed neurological history is the foundation of the neurological diagnosis. In many cases, it is more valuable than the clinical examination in determining the location and nature of the underlying aetiology. Collateral information gathering is mandatory in some situations. The history-taking should be patient centred, and preconceived biases must be avoided. At the end of the history-taking, those features that heavily influence the clinician's formulation should be double-checked and can be referred to when explaining the diagnostic formulation and management plan to the patient. (Source: Medicine)
Source: Medicine - June 27, 2023 Category: Internal Medicine Authors: Richard Rees, Kuven K. Moodley Tags: Clinical assessment in neurology Source Type: research
Coma and brainstem death
The patient in a coma needs a rigorous clinical assessment that requires a meticulous approach to history-taking, and a systematic approach to the neurological examination. After immediate resuscitation and acute management, the clinician must establish the level of consciousness and seek evidence of meningism and localizing neurological signs. The prognosis depends on the underlying cause and the time taken to implement appropriate management. The diagnosis of brain death depends on establishing the aetiology of irreversible brain damage, excluding reversible causes, and establishing the absence of any brainstem reflexes. (Source: Medicine)
Source: Medicine - June 27, 2023 Category: Internal Medicine Authors: Robin S. Howard Tags: Clinical assessment in neurology Source Type: research
Visual disturbances in neurology
This article outlines the basic assessment of a person presenting with impaired vision, either as a primary complaint or as part of a more generalized neurological or systemic disorder. (Source: Medicine)
Source: Medicine - June 27, 2023 Category: Internal Medicine Authors: Gordon T. Plant Tags: Clinical assessment in neurology Source Type: research
Genetic testing in neurology
‘Neurogenetics’ spans almost every category of neurological disease (World Health Organization International Disease Classification: https://www.who.int/standards/classifications/classification-of-diseases), and genomic testing is increasingly important in the diagnosis and personalized manageme nt of these conditions. An understanding of the genetic basis of disease, genomic technologies and interpretation of increasingly complicated genomic data is essential for all clinicians. The likely disease aetiology and the utility of genomic testing must be considered as conditions might be caused by environmental adverse exp...
Source: Medicine - June 27, 2023 Category: Internal Medicine Authors: Mohamed Wafik, Nayana Lahiri Tags: Investigations in neurology Source Type: research
Self-assessment/CPD answers
Correct answer: C. Seizures, alongside memory deficits should make a clinician suspect autoimmune limbic encephalitis. The MRI brain scan shows T2-weighted hyperintensities, rather than atrophy (suggestive of a neurodegenerative dementia) therefore autoantibody testing for LGI-1 encephalitis is the correct answer. A and E may be used to support a clinical diagnosis of limbic encephalitis and B or D can rule out other conditions but they would not obtain the diagnosis. (Source: Medicine)
Source: Medicine - June 27, 2023 Category: Internal Medicine Tags: Self-assessment/CPD answers Source Type: research
Contents
(Source: Medicine)
Source: Medicine - May 31, 2023 Category: Internal Medicine Source Type: research
Editorial Board
(Source: Medicine)
Source: Medicine - May 31, 2023 Category: Internal Medicine Source Type: research
Refeeding syndrome
is a group of biochemical shifts resulting in clinical symptoms that can occur in malnourished or starved individuals when reintroducing nutrition. The lack of an agreed definition makes the incidence difficult to determine. Risk factors proposed by NICE in 2006 lack specificity and sensitivity but act as a framework to identify individuals potentially at risk. During starvation, there is a reduction in insulin secretion and an increase in glucagon to promote glycogenesis. The introduction of carbohydrate results in insulin secretion, stimulating the sodium –potassium pump that drives electrolytes into cells. (Source: Medicine)
Source: Medicine - May 31, 2023 Category: Internal Medicine Authors: Alison Culkin, Rhys White Tags: Nutrition Source Type: research
Oral nutrition support
Oral nutritional interventions to treat malnutrition in adults have been shown to improve mortality, morbidity, weight, anthropometry, dietary intake and quality of life. The National Institute for Health and Care Excellence recommends that malnutrition should be managed using oral nutrition support in individuals who can safely swallow and have a functioning gastrointestinal tract. Interventions comprise dietetic advice, dietary counselling, food fortification, texture-modified diets, altered meal patterns, assistance with feeding and the use of oral nutritional supplements when intake from food and drink alone is insuffi...
Source: Medicine - May 31, 2023 Category: Internal Medicine Authors: Anne Holdoway Tags: Nutrition Source Type: research
Nutritional support in palliative care
Making decisions to nutritional support in palliative care setting can be challenging. A multidisciplinary team approach is vital to deliver patient-centred care. The patient or their advocate should be involved when making decisions to instigate nutritional support, be it oral, enteral, via a tube or via the parenteral route. Oral nutrition plans (with oral nutritional supplements) are the mainstay of management and should be continued unless oral feeding becomes difficult, at which time enteral tube feeding can be considered. (Source: Medicine)
Source: Medicine - May 31, 2023 Category: Internal Medicine Authors: Kirstine Farrer, Antje Teubner Tags: Nutrition Source Type: research
Artificial nutrition support
Malnutrition remains common in the UK despite medical advances, with 40% of adult inpatients being at risk of malnutrition on admission to hospital and many weighing less on discharge than on admission. It is widely acknowledged that malnutrition leads to poorer clinical outcomes, longer length of stay, increased complications and increased morbidity and mortality compared with a well-nourished state. This emphasizes the importance of screening for malnutrition and implementing a comprehensive nutritional care plan to help mitigate the risk and manage the patient's nutritional status effectively. (Source: Medicine)
Source: Medicine - May 31, 2023 Category: Internal Medicine Authors: Nicola Burch Tags: Nutrition Source Type: research
The ethics of clinically assisted nutrition and hydration in adults
The provision of clinically assisted nutrition and hydration (CANH) often presents clinicians with an ethical challenge, which, in the context of changing health and social demographics, is set to increase. The subject is incredibly emotive for patients, relatives, carers and staff as food and water represent the most basic requirements for life. Modern society is an amalgam of different religious, ethnic and cultural backgrounds, and beliefs. Attitudes to end-of-life care and the sanctity of life vary widely between different groups. (Source: Medicine)
Source: Medicine - May 31, 2023 Category: Internal Medicine Authors: Dominic Crocombe, Andrew P. Rochford Tags: Nutrition Source Type: research
Obesity: medical management
Obesity is a chronic relapsing disease that is reaching pandemic levels. It is associated with excess morbidity and mortality by being directly associated with a number of mechanical and metabolic complications such as sleep apnoea, type 2 diabetes mellitus and coronary artery disease. The management of obesity with lifestyle intervention appears to be successful in the short term; however, the maintenance of reduced body weight is challenging because of complex physiological responses to energy restriction. (Source: Medicine)
Source: Medicine - May 31, 2023 Category: Internal Medicine Authors: Alex E. Henney, John PH. Wilding Tags: Nutrition Source Type: research
