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Neurologic Exam

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1. Core neurological examination items for neurology clerks: A modified Delphi study with a grass-roots approach. Full Text available with Trip Pro

Core neurological examination items for neurology clerks: A modified Delphi study with a grass-roots approach. With the evolution of treatments for neurological diseases, the contents of core neurological examinations (NEs) for medical students may need to be modified. We aimed to establish a consensus on the core NE items for neurology clerks and compare viewpoints between different groups of panelists.First, a pilot group proposed the core contents of NEs for neurology clerks. The proposed (...) viewpoints between different groups of panelists using the Mann-Whitney U test.Eighty-three items were used for the first round of the Delphi process. Of them, 18 without consensus of being a core NE item for the neurology clerks in the first round and another 14 items suggested by the panelists were further discussed in the second round. Finally, 75 items with different grades were included in the recommended NE items for neurology clerks.Our findings provide a reference regarding the core NE items

2018 PLoS ONE

2. Correlation of the self-reported Leeds assessment of neuropathic symptoms and signs score, clinical neurological examination and MR imaging in patients with lumbo-sacral radiculopathy. Full Text available with Trip Pro

Correlation of the self-reported Leeds assessment of neuropathic symptoms and signs score, clinical neurological examination and MR imaging in patients with lumbo-sacral radiculopathy. Lumbo-sacral radiculopathy (LSR) is a common musculoskeletal disorder for which patients seek medical care and referrals for advanced imaging. However, accurate diagnosis remains challenging. Neuropathic pain screening questionnaires, clinical neurological examination and magnetic resonance imaging (MRI) are used (...) in the initial diagnosis. The utility of these tools in diagnosing LSR varies and their correlation has not been reported.A cross-sectional, multicentre, blinded design was used in six physiotherapy departments in Kenya. Each participant was blindly examined by three independent clinicians using the Self-Reported Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) score, clinical neurological examination (CNE) and MRI. Spearman's rank coefficient (r) was used to examine the correlation between

2019 BMC Neurology

3. Trajectory of neurological examination abnormalities in antipsychotic-naïve first-episode psychosis population: a 1 year follow-up study. (Abstract)

Trajectory of neurological examination abnormalities in antipsychotic-naïve first-episode psychosis population: a 1 year follow-up study. Neurological Examination Abnormalities (NES) are quantified by measuring subtle, partially localizable (cerebello-thalamo-prefrontal cortical circuit) and heritable neurological signs comprising sensory integration, motor coordination and complex motor sequencing that are associated with first-episode psychosis (FEP). A few studies have evaluated NES (...) longitudinally and as a predictor for diagnostic and response classification, but these studies have been confounded, underpowered and divergent. We examined (1) baseline and longitudinal NES differences between diagnostic and year 1 response groups; (2) if NES predicts diagnostic and response groups and (3) relationships between clinical variables and NES measures in antipsychotic-naïve FEP.NES and clinical measures were obtained for FEP-schizophrenia (FEP-SZ, n = 232), FEP non-schizophrenia (FEP-NSZ, n

2019 Psychological Medicine

4. A Neurologic Examination for Anesthesiologists: Assessing Arousal Level during Induction, Maintenance, and Emergence. (Abstract)

A Neurologic Examination for Anesthesiologists: Assessing Arousal Level during Induction, Maintenance, and Emergence. Anesthetics have profound effects on the brain and central nervous system. Vital signs, along with the electroencephalogram and electroencephalogram-based indices, are commonly used to assess the brain states of patients receiving general anesthesia and sedation. Important information about the patient's arousal state during general anesthesia can also be obtained through use (...) of the neurologic examination. This article reviews the main components of the neurologic examination focusing primarily on the brainstem examination. It details the components of the brainstem examination that are most relevant for patient management during induction, maintenance, and emergence from general anesthesia. The examination is easy to apply and provides important complementary information about the patient's arousal level that cannot be discerned from vital signs and electroencephalogram measures.

2019 Anesthesiology

5. Pulse article: How do you do the international standards for neurological classification of SCI anorectal exam? Full Text available with Trip Pro

Pulse article: How do you do the international standards for neurological classification of SCI anorectal exam? Online survey of spinal cord injury (SCI) practitioners.Determine provider understanding and routine performance of International Standards for Neurologic Classification of Spinal Cord Injury (ISNCSCI) anorectal examination.International online questionnaire.A descriptive survey was developed to assess current performance of the ISNCSCI anorectal exam. Information about this survey (...) pressure against the rectal wall, and 87 placed firm pressure against the anal sphincter and rectal wall as part of the exam. On a routine basis, 74% tested sensation at the junction of the anal sphincter and skin, 82% had the patient attempt to squeeze their finger, and 50% performed the bulbocavernosus reflex.Marked inconsistency exists in the performance of the ISNCSCI anal examination. Researchers and clinicians need more education about the performance of the examination. Consideration should

2017 Spinal cord series and cases

6. Developing of Virtual Reality Based Neurologic Examination Teaching Tool(VRNET)

: standardized patients The medical students examine the standardized patients who have neurological deficits which presented by words or pictures. Other: standard patients In group of standard patients, those neurological deficits are presented only by words or pictures which are not realistic. Outcome Measures Go to Primary Outcome Measures : Neurologic physical exam(NPE) score [ Time Frame: after 2 weeks clinical clerkship rotation. ] NPE score is consist of 6 neurologic examination parts; cranial nerve (...) Developing of Virtual Reality Based Neurologic Examination Teaching Tool(VRNET) Developing of Virtual Reality Based Neurologic Examination Teaching Tool(VRNET) - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more

2018 Clinical Trials

7. NeurEx: digitalized neurological examination offers a novel high‐resolution disability scale Full Text available with Trip Pro

NeurEx: digitalized neurological examination offers a novel high‐resolution disability scale To develop a sensitive neurological disability scale for broad utilization in clinical practice.We employed advances of mobile computing to develop an iPad-based App for convenient documentation of the neurological examination into a secure, cloud-linked database. We included features present in four traditional neuroimmunological disability scales and codified their automatic computation (...) . By combining spatial distribution of the neurological deficit with quantitative or semiquantitative rating of its severity we developed a new summary score (called NeurEx; ranging from 0 to 1349 with minimal measurable change of 0.25) and compared its performance with clinician- and App-computed traditional clinical scales.In the cross-sectional comparison of 906 neurological examinations, the variance between App-computed and clinician-scored disability scales was comparable to the variance between rating

2018 Annals of clinical and translational neurology

8. The essential neurological examination of the unconscious patient in the emergency room Full Text available with Trip Pro

The essential neurological examination of the unconscious patient in the emergency room To determine whether neurologists with long-term experience in the emergency room are in general agreement about the essential components of the neurological examination (NE) used on unconscious patients in whom an obvious cause for coma is lacking.We surveyed 31 board-certified practicing neurologists who regularly examine unconscious patients in the emergency room and asked them to list the specific (...) components of the NE that they would normally choose to apply in at least 80% of cases.Twenty-seven neurologists rated 24 of 38 items as essential steps of the neurological examination of the unconscious patient, with a high level of agreement amongst survey participants.There was a high degree of consensus amongst the neurologists surveyed about which steps are essential for the NE of the unconscious patient. These findings provide an important source of validation for teaching this particular NE

2018 Brain and behavior

9. Yield of Computed Tomography (CT) Angiography in Patients with Acute Headache, Normal Neurological Examination, and Normal Non Contrast CT: A Meta-Analysis. (Abstract)

Yield of Computed Tomography (CT) Angiography in Patients with Acute Headache, Normal Neurological Examination, and Normal Non Contrast CT: A Meta-Analysis. Patients with acute severe headache, normal neurological examination, and a normal noncontrast head computed tomography (NCCT) may still have subarachnoid hemorrhage, cerebral venous thrombosis (CVT), cervical arterial dissection, or reversible cerebral vasoconstriction syndrome (RCVS). Computed tomography angiography (CTA) is used (...) increasingly in the emergency department for evaluating this, but its added value remains controversial.We retrospectively collected data on the diagnostic yield of CTA in patients with acute severe headache, normal neurological examination, and normal NCCT who received additional CTA in the acute phase in 2 secondary referral centers for vascular neurology. We combined data of our patients with those from the literature and performed a meta-analysis.We included 88 patients from our hospital files and 641

2018 Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association

10. Neuroimaging of headaches in patients with normal neurological examination: protocol for a systematic review. Full Text available with Trip Pro

Neuroimaging of headaches in patients with normal neurological examination: protocol for a systematic review. Headache disorders (HD) are among the most frequent neurological disorders seen in neurology practice. Because secondary HD are rare, patients' examination is most often unremarkable. However, the will to relieve patients' anxiety and the fear of prosecutions lead to overuse of neuroimaging thus resulting in the discovery of incidental findings (IF) or normal variants that can lead (...) to futile or harmful procedures. Knowing the probability of identifying a potentially clinically significant lesion in patients with isolated headache could facilitate decision-making and reduce health costs. This review aims to determine the prevalence of incidental findings and normal anatomic variants (NAV) on neuroimaging studies performed in patients presenting with headache and normal neurological examination.Studies reporting neuroimaging findings in patients with headache and normal neurological

2018 BMJ open

11. Letter to the Editor Regarding "Yield of Computed Tomography (CT) Angiography in Patients with Acute Headache, Normal Neurological Examination, and Normal Non Contrast CT: A Meta-Analysis". (Abstract)

Letter to the Editor Regarding "Yield of Computed Tomography (CT) Angiography in Patients with Acute Headache, Normal Neurological Examination, and Normal Non Contrast CT: A Meta-Analysis". 29571755 2019 09 27 2019 09 27 1532-8511 27 7 2018 07 Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association J Stroke Cerebrovasc Dis Letter to the Editor Regarding "Yield of Computed Tomography (CT) Angiography in Patients with Acute Headache, Normal (...) Neurological Examination, and Normal Non Contrast CT: A Meta-Analysis". 2043 S1052-3057(18)30111-3 10.1016/j.jstrokecerebrovasdis.2018.02.049 Malhotra Ajay A Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut. Electronic address: ajay.malhotra@yale.edu. Wu Xiao X Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut. Seifert Kimberly K Department of Radiology and Biomedical Imaging, Yale University

2018 Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association

12. Reliability of Hammersmith Examination in Prediction of Neurological Outcomes (REHAPENO)

Reliability of Hammersmith Examination in Prediction of Neurological Outcomes (REHAPENO) Reliability of Hammersmith Examination in Prediction of Neurological Outcomes (REHAPENO) - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies (...) before adding more. Reliability of Hammersmith Examination in Prediction of Neurological Outcomes (REHAPENO) (REHAPENO) The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our for details. ClinicalTrials.gov Identifier: NCT03580252 Recruitment Status : Completed First Posted : July 9, 2018 Last Update Posted : January 28, 2019 Sponsor: Abha International

2018 Clinical Trials

13. The sensitivity and specificity of the neurological examination in polyneuropathy patients with clinical and electrophysiological correlations. Full Text available with Trip Pro

The sensitivity and specificity of the neurological examination in polyneuropathy patients with clinical and electrophysiological correlations. Polyneuropathy is one of the most prevalent neurologic disorders. Although several studies explored the role of the neurological examination in polyneuropathy, they were mostly restricted to specific subgroups of patients and have not correlated examination findings with symptoms and electrophysiological results.To explore the sensitivity (...) and specificity of different neurological examination components in patients with diverse etiologies for polyneuropathy, find the most sensitive combination of examination components for polyneuropathy detection, and correlate examination findings with symptoms and electrophysiological results.Patients with polyneuropathy attending the neuromuscular clinic from 01/2013 to 09/2015 were evaluated. Inclusion criteria included symptomatic polyneuropathy, which was confirmed by electrophysiological studies. 47

2017 PLoS ONE

14. aEEG and neurologic exam findings correlate with hypoxic-ischemic brain damage severity in a piglet survival model. (Abstract)

aEEG and neurologic exam findings correlate with hypoxic-ischemic brain damage severity in a piglet survival model. Newborn pigs offer theoretical advantages for studying newborn hypoxic-ischemic (HI) brain damage because of a development and structure similar to the human brain. However, the correlation between functional features and actual HI brain damage has not been reported.Newborn pigs were examined daily for 3 days after a HI insult using amplitude-integrated EEG (aEEG (...) behavior were the best predictive items for histological and biochemical (lactate/N-acetylaspartate ratio) brain damage. Hyperexcitable response to stress correlated inversely with brain damage. Motionless time, which correlated with brain damage severity, was inversely related to brain concentration of dopamine and norepinephrine.Standard neurologic examination of brain activity and motor and behavioral performance of newborn pigs is a valuable tool to assess HI brain damage, thus offering a powerful

2019 Pediatric Research

15. Examining the Public Provision and Funding of PET-CT Imaging for Non-cancer Indications

• Financing of PET-CTs is included in global budgets of hospitals and is not limited to any types of diagnostics or indications Examining the Public Provision and Funding of PET-CT Imaging for Non-cancer Indications 10 Evidence >> Insight >> Action Jurisdiction For what non-cancer indications? How is it delivered? How is it paid for? Nova Scotia (7; 13; 23) • Inflammatory indication: o lympha-denopathy • Neurology indication: o refractory seizure • Other indications may be approved by Medical Services (...) viability assessment • Neurology indication: o preoperative assessment of refractory epilepsy • In 2009, the maximum number of PET-CT units allowed was set at 13 by law • However, based on the number of PET-CT exams that have been charged, it can be assumed that several others are operational in private facilities • An analysis conducted in 2017, suggests that there are now 25 PET-CT units in Belgium(30) • As of 2009, the reimbursement of PET-CT imaging is limited to pre-determined indications (e.g

2018 McMaster Health Forum

16. Exam Series: Guide to the Shoulder Exam

Musculocutaneous C5,6 Biceps: elbow flexion Lateral forearm Biceps Radial C6,7,8 Triceps: elbow extension Anatomic snuff box Triceps brachioradialis C7,8 Wrist extensors: wrist extension (thumbs up sign) ½ of the dorsal side of the radius towards the thumb Medial C6,7 Flexor pollicus longus: Thumb flexion (OK sign) Palmar side of 3 ½ fingers Ulnar C8, T1 Interossei: Finger abduction and adduction 5 th finger Suprascapular C5-C6 Supraspinatus and Infraspinatus Subscapularis Neurologic examination 4 Vascular (...) . Hermans J, Luime J, Meuffels D, Reijman M, Simel D, Bierma-Zeinstra S. Does this patient with shoulder pain have rotator cuff disease?: The Rational Clinical Examination systematic review. JAMA . 2013;310(8):837-847. [ ] 3. Luime J, Verhagen A, Miedema H, et al. Does this patient have an instability of the shoulder or a labrum lesion? JAMA . 2004;292(16):1989-1999. [ ] 4. Adiga S, Rebelo J, Lees C, Carmona R. Neurological Assessment. McMaster Musculoskeletal Clinical Skills. . Accessed 2018. 5

2018 CandiEM

17. Exam Series: Guide to the Back Exam

of the cervical spine. Assess for flexion, extension, and lateral flexion (fingers should touch the fibula) of the back, ensuring that the patient keeps their leg straight and recognizing that tight hamstrings may limit range of motion. Rotation is best assessed with the patient seated in order to isolate movement of the back from the hips. A power examination of the back is not necessary. GI/GU exam : A digital rectal exam is required to assess tone if there are any concerns for cauda equina. A post void (...) is indicative of SI joint pain. Neurovascular exam : It is essential to check for any neurologic weakness as a sign of serious back pathology. Power should be tested in the lower extremities to investigate any weakness. A gait exam can also be used to assess for weakness and instability. Exams should be repeated to monitor for any rapidly progressing symptoms. Nerve symptoms that are bilateral and span multiple levels are concerning for a spinal lesion that compresses multiple roots. Nerve Root Motor

2018 CandiEM

18. Exam Series: Guide to the Knee Exam

, Move” Throughout the physical examination compare the asymptomatic to the symptomatic knee. The knee exam should be conducted with the patient supine, examining a knee in a chair or wheelchair can significantly compromise your exam! Every patient will have a different laxity to their joints at baseline, use the asymptomatic knee to get a sense of the patients baseline laxity. Pain with provocative movements without associated laxity suggests a ligament strain rather than a tear. Remember to assess (...) pulses (posterior tibial and dorsalis pedis) using palpation, Doppler, or bedside ultrasound. Serial physical examinations are necessary, with the addition of an Ankle-Brachial Index (ABI <0.9 is abnormal) as popliteal injury still occurs in up to 15% of patients with palpable peripheral pulses 1 . CT angiography should be considered in all knee dislocations. Neurovascular exam should be documented before and after reduction of dislocations. Nerve Origin Motor function Sensory function Reflexes Deep

2018 CandiEM

19. Transcranial Doppler Ultrasound Examination in Dogs with Suspected Intracranial Hypertension Caused by Neurologic Diseases Full Text available with Trip Pro

Transcranial Doppler Ultrasound Examination in Dogs with Suspected Intracranial Hypertension Caused by Neurologic Diseases Transcranial Doppler ultrasound examination (TCD) is a rapid, noninvasive technique used to evaluate cerebral blood flow and is useful for the detection of intracranial hypertension in humans. However, the clinical usefulness of TCD in diagnosing intracranial hypertension has not been demonstrated for intracranial diseases in dogs.To determine the association between (...) the TCD variables and intracranial hypertension in dogs with intracranial diseases.Fifty client-owned dogs with neurologic signs.Cross-sectional study. All dogs underwent TCD of the basilar artery under isoflurane anesthesia after magnetic resonance imaging (MRI). Dogs were classified into 3 groups based on MRI findings: no structural diseases (group I), structural disease without MRI evidence of intracranial hypertension (group II), and structural disease with MRI evidence of intracranial

2017 Journal of Veterinary Internal Medicine

20. Direct withdrawal of a knife lodged in the thoracic spinal canal in a patient with normal neurologic examination: is it safe? Full Text available with Trip Pro

Direct withdrawal of a knife lodged in the thoracic spinal canal in a patient with normal neurologic examination: is it safe? Stab wound injuries to the spinal cord are rare, although they commonly cause complete or incomplete neurological deficits. Normal neurological examination with a knife traversing the spinal canal is extremely rare. Here we report on a patient with a knife lodged in the thoracic spine with normal neurological examination and describe direct withdrawal of the knife (...) with excellent results that have not been reported to date. A 50-year-old male patient was admitted to the emergency service because of his sustaining a stab wound to thoracic 3-4 level due to a knife traversing the spinal canal and still lodged in the vertebral bodies. His neurological examination was normal. The knife was withdrawn in the operating room under general anesthesia without bleeding or cerebrospinal fluid leakage. After withdrawal neurological examination was normal and control magnetic

2016 Spinal cord series and cases

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