Category Archives: Neurology

Ataxia: The Physical Examination

Ataxia is an extremely important clinical sign that has a broad and important differential diagnosis. Causes of ataxia include posterior circulation strokes and various toxic and metabolic insults to the cerebellum (and sometimes to the spinocerebellar tracts). Ataxia can be a very subtle physical finding, especially when you don’t know what to look for or when you are… Read More »

Physical Examination of Muscles in Systemic Disease

How to examine patients and report findings in patients with suspected muscle diseases: Abnormal movements Fasciculation → peripheral nerve injury Tremor Resting → Parkinsonism (with bradykinesia and rigidity) Intention → cerebellar issue → look for additional signs of cerebellar problems (e.g., ataxia) Myoclonus (involuntary purposeless jerks of limbs) → toxic metabolic issues (e.g., hypoxia, uremia, serotonin syndrome, opioid… Read More »

Central vs. Peripheral Vertigo Simplified

The first and most important step in evaluating a patient with vertigo is to attempt to distinguish vertigo of central origin from vertigo of peripheral origin because the management of central vertigo (brain imaging, hospital admission) is very different from the management of peripheral vertigo (symptomatic treatment, outpatient referral). Differences Between Central and Peripheral Vertigo Peripheral Vertigo Central Vertigo Percentage… Read More »

Stroke & TIA Mimics

Here are the important stroke and TIA mimics: Systemic and metabolic insults: especially hypoglycemia, but also a very wide variety of other systemic insults such as infections (urinary tract infections, pneumonia) and toxins, all of which can cause re-expression of symptoms of old strokes. Peripheral neuropathies such as idiopathic seventh cranial nerve (Bell’s) palsy, peripheral vestibulopathy, and even… Read More »

Headache: The Ominous Causes

Introduction Most headaches are benign and do not require a specific workup. Here are the ominous ones that require a specific workup and management. From the Patient History Sudden, severe, and maximal at onset, especially in an older patient without a prior history of headaches → subarachnoid hemorrhage → get a head CT without contrast → CT angiogram or cerebral angiogram. Systemic… Read More »

Vertigo: What You Need to Know for Clinical Practice and the Boards

Introduction Vertigo is a sensation of spinning, either of the patient or of his or her environment. There are four types of vertigo that you must consider in a patient who complains of a spinning sensation: Toxic vertigo Central nervous system vertigo Peripheral nervous system vertigo Hematologic vertigo (hyperviscosity syndrome) Toxic Vertigo Salicylates and anticonvulsants, particularly phenytoin, are… Read More »

Myasthenia Gravis: The Workup

Here’s a workup for suspected myasthenia gravis: Acetylcholine receptor antibody Muscle specific receptor tyrosine kinase (MuSK) antibody Chest CT (to look for thymoma) TSH (concomitant autoimmune thyroiditis is sometimes seen) Search for underlying infectious precipitants as guided by history (e.g., CBC, chest radiograph, urinalysis) Search for underlying concomitant metabolic derangements which may contribute to weakness (e.g., potassium, magnesium,… Read More »