Patients presenting with headaches need to be screened for primary vs secondary etiologies. “Red flags” associated with secondary headaches are crucial to identify. Physical examination should be completed with careful assessment of clues obtained during the history. It should include blood pressure measurements, assessment of mental status, and cranial nerve (CN) examination including but not limited to fundoscopic examination, gait, and facial strength.
The CDR is a clinically based, semistructured interview, which rates impairment level in 6 cognitive domains: memory, orientation, judgment/problem solving, community affairs, home and hobbies, and personal care. Continue reading “Clinical Dementia Rating (CDR) Scale”
The posterior reversible encephalopathy syndrome (PRES) is a neurological disorder of (sub)acute onset characterized by varied neurological symptoms, which may include headache, impaired visual acuity or visual field deficits, disorders of consciousness, confusion, seizures, and focal neurological deficits. Continue reading “Diagnosis of Posterior Reversible Encephalopathy Syndrome (PRES)”
Cerebral venous thrombosis (CVT) is an important cause of stroke in young adults (mean age 33 years with a two-thirds female preponderance) caused by complete or partial occlusion of the cerebral major cerebral venous sinuses (cerebral venous sinus thrombosis) or the smaller feeding cortical veins (cortical vein thrombosis). Continue reading “Cerebral Venous Thrombosis (CVT) and Location of Probable Lesion”
The Confusion Assessment Method (CAM) is a widely used diagnostic tool for identifying delirium. It was developed by researchers at the Yale University School of Medicine and has become the gold standard for diagnosing delirium in clinical settings. The CAM helps healthcare professionals systematically evaluate and identify the presence of delirium based on four key features. Continue reading “Confusion Assessment Method (CAM) for Diagnosing Delirium”
The Global Deterioration Scale (GDS) provides caregivers an overview of the stages of cognitive function for those suffering from a primary degenerative dementia such as Alzheimer’s disease. It is broken down into 7 different stages. Stages 1-3 are the pre-dementia stages. Stages 4-7 are the dementia stages. Biginning in stage 5, an individual can no longer survive without assistance. Within the GDS, each stage is numbered (1-7), given a short title (i.e., Forgetfulness, Early Confusional, etc. followed by a brief listing of the characteristics for that stage. Caregivers can get a rough idea of where an individual is at in the disease process by observing that individual’s behavioral characteristics and comparing them to the GDS. For more specific assessments, use Brief Cognitive Rating Scale (BCRS) and the Functional Assessment Staging (FAST) measures.
Continue reading “The Global Deterioration Scale for Primary Degenerative Dementia”
Rasmussen’s encephalitis (RE) is a rare chronic inflammatory brain disorder resulting in progressive neurodegeneration in one cerebral hemisphere. The inflammatory process is accompanied by progressive loss of function of the affected hemisphere, associated with drug-resistant partial epilepsy. The diagnosis is based on a range of clinical, electroencephalographic, radiological and biochemical arguments, without any specific formal marker, which makes the diagnosis of the disease complex, especially in its initial phase. Seizures are refractory to anti-seizures medication (ASM) and to classical immunomodulatory treatments.
Continue reading “Clinical Criteria for Rasmussen´s Encephalitis”
The clinical diagnosis of an epileptic seizure requires a detailed history taking and, ideally, an eyewitness account of the seizure. Evaluation with 12-lead electrocardiography is essential in a patient who has had a first seizure or an unexplained blackout spell.
Patients who have had an epileptic seizure should be informed about factors that may provoke seizures (e.g., sleep deprivation and alcohol use), the risk of a seizure occurring while driving or engaging in solitary activities, and the risks of harm from further seizures. Continue reading “Common Types of Seizures in Adolescents and Adults”
The clinician must investigate and corroborate key features of the history that help to better characterize seizures while distinguishing epileptic seizures from nonepileptic events. The most common nonepileptic paroxysmal events during childhood and adolescence are syncope, psychogenic nonepileptic events (PNES), pallid and cyanotic breath holding spells, reflux/Sandifer syndrome, self-gratification disorders, and paroxysmal nonepileptic motor disorders of sleep among others. Continue reading “Clinical Aspects of the Diagnosis of Epileptic Seizures”
The Awaji recommendations for the use of electrodiagnostic studies in the diagnosis of amyotrophic lateral sclerosis (ALS) were proposed to enable earlier diagnosis of ALS to be achieved to meet an acknowledged need to obviate diagnostic delay. Continue reading “Awaji Criteria for Amyotrophic Lateral Sclerosis (ALS)”
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