Cancer Treatment Today » Neurology

When nystagmus accompanies dizziness – pro

M Levin, MD — Wed, 25 Sep 2013 17:09:48 +0000

Dizziness accounts for an estimated 5 percent of primary care clinic visits. The physician who encounters this complaint should investgate only after classifying it into one of four categories: vertigo, disequilibrium, presyncope, or lightheadedness. Each one has a distinct differential diagnosis. The differential diagnosis of dizziness can be narrowed with easy-to-perform physical examination tests, including evaluation for nystagmus, the Dix-Hallpike maneuver, and orthostatic blood pressure testing. Laboratory testing and radiography play little role in diagnosis and, in fact, final diagnosis is not obtained in about 20 percent of cases. Romberg test and observation of gait can lead the physican to consider vestibular dysfunction. Ataxia is indicative of cerebellar dysfunction, and the patient’s gait is usually slow, wide-based, and irregular.

When nystagmus accompanies the complaint of dizziness, lesions of the labyrinth and cranial nerve VIII (vestibulocochlear) should be suspected. When nystagmus is not spontaneously present but is only provoked by maneuvers such as Dix-Hallpike maneuver, a vertebral apparatus cause is suspected.

The referenced article by Post et al is a good review of the issue.

ROBERT E. POST, MD, Virtua Family Medicine Residency, Voorhees, New Jersey
LORI M. DICKERSON, PharmD, Medical University of South Carolina, Charleston, South Carolina
Am Fam Physician. 2010 Aug 15;82(4):361-368.

Kevin A. Kerber, MD and A. Mark Fendrick, MD The Evidence Base for the Evaluation and Management of Dizziness. J Eval Clin Pract. 2010 February; 16(1): 186–191.

The Role of Physical Therapy in Musculor Dystrophies

M Levin, MD — Mon, 20 Aug 2012 18:18:25 +0000

Muscular dystrophy (MD)is a group of genetic diseases that affect muscle function. There are more than 30 genetic mutations that can cause muscular dystrophy. Based on the clinical features, including inheritance pattern, muscles affected, and muscle biopsy features, dystriophis are dvivided into: Duchenne, Becker, Myotonic dystrophy, Facioscapulohumeral, Limb-girdle, Ocullopharyngeal, Congenital and Distal.

Physical therapy, especially regular stretching, is important in helping to maintain the range of motion(ROM) for affected muscles and to prevent or delay contractures. Strengthening less affected muscles to compensate for weakness in the more affected muscles may improve the patient’s ability to engage in activities of daily living(ADL), especially in earlier stages of milder MD. Regular exercise is important in maintaining good overall health, but strenuous exercise should be avoided because it can damage muscles. Age of the patient and degree of dysfunction are not determining criteria of employing physical therapy, as long as an improvement in ROM and ADL can be expected.

Read the Professional version here.

MRI in the Diagnosis and Followup of Multiple Sclerosis

M Levin, MD — Tue, 17 Jul 2012 16:28:21 +0000

Magnetic Resonance Imaging (MRI) of the brain is useful in the diagnosis and treatment of multiple sclerosis (MS), because it is an inflammatory, demyelinating condition of the central nervous system (CNS) that MRI can visualize. Therefore, the activity of the disease can be quantified and tracked over time, with treatment. White matter tracts are affected, including those of the upper brain, lower brain, and spinal cord. MS lesions, known as plaques, may form in white matter in any location; thus, clinical symptoms may be diverse depending on where in the brain or spinal cord the disease is most active. MRI can identify the activity and explain the symptoms. MRI was widely used to in the diagnosis of multiple sclerosis (MS) and increasingly in follow-up. At the same time, it was not entirely clear how to use MRI. A consensus meeting was convened in 2008 to review and update the guidelines. The new guidelines incorporate new information and practice recommendations that will benefit patients and will be useful for physicians and care providers. This consensus recommends a for a baseline evaluation for patients with a Clinically Isolated Syndrome (CIS) and suspected MS. A Brain MRI with gadolinium, a Spinal Cord MRI if there is persisting uncertainty about the diagnosis and/or the findings on Brain MRI are equivocal should be performed, as well as a Spinal Cord MRI if presenting symptoms or signs are at the level of the spinal cord.

Read the Professional version here.

Neuropsychological Testing in Multiple Sclerosis: Importance of Brevity

M Levin, MD — Wed, 20 Jun 2012 17:49:18 +0000

Data shows a strong relationship of neuropsychological testing with neuropsychiatric features of the disease, brain imaging and vocational outcomes. Unfortunately, full neuropsychological testing is time consuming and expensive, which limits its usefulness as an ongoing assessment tool. One cannot easily frequently repeat testing that takes many hours to several days. The current tendency is to seek instruments for evaluation which combine diagnostic efficiency, clinical usefulness and brevity. There are tests available are found to be effective for evaluation of intellectual function in multiple sclerosis in the literature and yet are brief, so that they can be repeated often.

Read the Professional version here.

Transverse Myelitis

M Levin, MD — Wed, 20 Jun 2012 17:25:58 +0000

Transverse myelitis is an inflammatory condition of the spinal cord, which affects thel covering of the nerve cell fibers (myelin). Transverse myelitis causes diminished or absent sensation below the level of the injury injury.

The disrupted transmission of nerve signals due to transverse myelitis can cause pain or other sensory problems, weakness or paralysis of muscles, or bladder and bowel dysfunction. Transverse meylitis has been associated with infections outside the spine, with autoimmune disorders and multiple sclerosis. Treatment for transverse myelitis includes anti-inflammatory drugs, steroids, plasma exchange or immunosupressive drugs and medications to manage symptoms and rehabilitation therapy. Most people with transverse myelitis experience at least partial recovery, which can take as long as several years. Intensive rehab once recovery begins is fully warranted.

Read the Professional version here.