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Evaluación neurológica
- 1. Evaluación neurológica Dr. José Manuel Pérez Córdova Msc. Neurólogo pediatra Profesor Postgrado Neurología Pediátrica HGSJDD/USAC
- 2. Evaluación Neurológica • La evaluación incluye oInterrogatorio oAntecedentes oExamen físico oEstudios o evaluaciones especiales
- 3. Propósitos de la evaluación • Establecer un diagnóstico rápido de un determinado déficit o síndrome • Desarrollar un diagnóstico diferencial que los laboratorios o el tiempo puedan clarificar • Establecer la condición de base que permita la continua evaluación
- 4. Ambiente
- 5. Observación
- 6. Exploración de la función motora general
- 7. Romberg
- 8. ROT
- 11. Pares craneales
- 12. Pares craneales
- 13. Visión
- 15. Agudeza visual
- 16. Agudeza visual
- 17. Campimetría
- 18. Campimetría
- 24. Acomodación
- 27. Abducens
- 30. • Movimientos oculares oManiobra de ojos de muñeca oRespuesta calórica oReflejo opto cinético
- 33. Fondo de ojo
- 34. Fondo de ojo
- 35. Papiledema
- 37. Papilítis
- 38. Atrofia óptica
- 40. Micro-aneurismas
- 41. Neo-vasos
- 42. Exudados duros
- 44. Hemorragias
- 46. Sensibilidad de la cara
- 49. Anatomía de la audición
- 50. Audición
- 52. Vértigo
- 54. Glosofaringeo
- 56. Vago
- 58. Hipogloso
- 59. Hipogloso
- 61. En el síndrome de Horner la vía simpática esta lesionada.
- 63. Tono muscular
- 64. Arco Reflejo • Huso neuro- muscular o Fibra intra fusal • Fibra aferente Ia. • Alfa motoneurona • Unión neuro muscular • Fibra muscular
- 65. Anatomía del tono muscular • Neurona motora superior • Sistema extra- piramidal • Células de Renshaw • Cerebelo • Ganglios basales
- 67. EEG
- 68. RMN
- 69. RMN
- 70. RMN
- 71. SPECT
- 72. PET
- 75. Clasificación Internacional de las Crisis Epilépticas de 1981 Crisis epilépticas Parciales (focales, locales) Generalizadas No clasificables Comisión 1981, ILAE
- 77. Migraña: Una sucesión de síntomas Cady R et al. Headache. 2002;42:204–216. Linde M. Acta Neurol Scand. 2006;114:71–83. Linde M. Cephalgia. 2006; 26; 712–721. Cefalea Post cefalea Tiempo Pre cefalea ModeradoLeve Severo Premonición Cambios de humor Fatiga Cambios cognitivos Dolor muscular Rechazo a comidas Reversible Cambios neurológicos: Visual-somatosensoriales Aura Cefalea incremento Congestión nasal Dolor muscular Dolor inicial Pulsátil unilateral Nausea Fotofobia Fonofobia Osmofobia Dolor avanzado Fatiga Cambios cognitivos Dolor muscular Post dolor
- 78. Neuralgias
Notas del editor
- Key point: Migraine is manifested clinically as a constellation of symptoms that evolve through the various phases of a migraine attack; clinical experience indicates that symptoms typically associated with each phase of an attack often recur during other phases of the attack, resulting in a continuum of symptoms, rather than a succession of distinct phases. CLINICAL PHASES OF MIGRAINE1 A migraine attack can take days to develop and resolve; headache is only 1 of several symptoms associated with migraine.1 Although the symptoms of migraine often overlap, the classic view is to separate an attack into phases.1 The Premonitory Phase1 Seventy percent of patients suffering from migraine with or without aura experience premonitory symptoms.1 Premonitory symptoms are often seen as predictors of the headache attack. 1 Mood alterations, muscle pain, food cravings, cognitive changes, fluid retention, and yawning are common premonitory symptoms.1 Eighty-three percent of subjects with premonitory symptoms could predict over 50% of their attacks.1 The Aura Phase 1 An aura involves focal, reversible neurologic symptoms that often precede the headache.1 Aura symptoms are believed to arise from an electrical disturbance called cortical spreading depression (CSD); it occurs in approximately was 15-32% of migraine attacks.1,2,3 Auras are not always followed by headache pain; such auras are called acephalgic migraine or migraine aura without headache.1 The Headache Phase1 The headache phase is subdivided according to headache pain intensity into an early phase and an advanced phase.1 Early headache: mild pain without the associated symptoms of migraine1 Advanced headache: moderate to severe pain with the associated symptoms of nausea, photophobia, phonophobia, or disability; used to confirm a migraine diagnosis1 Postdrome1 Phase of migraine-associated symptoms beyond the resolution of the headache; often entails significant disability that can last for 1 or 2 days.1