Manual Oxford American Handbook of Pulmonary Medicine

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There are 1 items available. Please enter a number less than or equal to 1. Persistent hypertension and tachycardia in association with pure motor weakness occurs in porphyria. Differential diagnosis See Table 3. Disorder Clinical features Investigations Vasculitic Patchy motor and NCS may reveal clinically neuropathy sensory loss; pain asymptomatic lesions. EMG bulbar, respiratory studies show decrement. Ocular, channel antibodies. Rhabdomyolysis Hypokalemic periodic Autosomal dominant.

Disorder Clinical features Investigations Hyperkalemic Autosomal dominant. Sphincter oligoclonal bands; PCR involvement, sensory level. MRI imaging may or may not reveal infarction. Spastic paraparesis Bilateral upper motor neuron signs in the legs. A common presentation caused by a variety of disorders hereditary and acquired. Etiology See Table 3. In cases of undiagnosed spastic paraparesis, consider a trial of L-dopa for dopa-responsive dystonia.

May be more apparent when turning or stopping suddenly. When mild, only tandem gait may be impaired. Postural static tremors may also occur. Ataxia in combination with any of the following—pyramidal, peripheral nerve, ophthalmoplegia, dementia. Absence of a family history does not exclude the possibility of diagnosis.

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Aprataxin, oculomotor apraxia Oculomotor apraxia, chorea, chr 9p No cardiomyopathy tocopherol or decreased GTT. Vitamin E protein, chr decreased 8q Sensory ataxia Clinical features Any marked loss of proprioception will result in sensory ataxia.

Other features include deafness, retinitis pigmentosa. A rarer defect of pristanate metabolism presents in a similar fashion Massion Vernier disease. Described as a curtain being pulled downwards in front of the eye. Loss may be quadrantic or total and may be accompanied by contralateral limb signs due to ipsilateral hemispheric ischemia. Field defects may be altitudinal, quadrantic, or total.

A cherry red spot at the macula is pathognomonic. Neuromyelitis optica Relapse on steroid withdrawal. A hemorrhagic retinopathy results in a dense central scotoma with preserved peripheral vision. Fluorescein angiography is necessary for diagnosis. Visual loss of sudden onset with progression unilateral Usually due to acute optic neuritis. Most common cause is demyelination.

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Note if facial injuries or tracheostomy, verbal response unassessable. Head moved side to side—normally eyes deviate to opposite side. First check that tympanic membrane intact. Reprinted from Bates, D []. Coma and brain stem death. Medicine 32 10 — Copyright , with permission from Elsevier. Coma prognosis Neurologists are often asked to prognosticate on comatose patients in ICU so that decisions about further active treatment can be made.

The prognosis can be affected by etiology, as well as depth and duration of coma.