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Thursday, October 29, 2009
Wednesday, October 28, 2009
Thursday, October 22, 2009
Monday, October 19, 2009
Re: Yumin
Hi yumin, you could check out the Natural Guideline Clearinghouse at www.guideline.gov/summary/summary.aspx?ss=15&doc_id=5946&nbr=3915, or you can simply just download the file from http://www.journals.uchicago.edu/doi/pdf/10.1086/425368?cookieSet=1. Its from IDSA website at http://www.idsociety.org/content.aspx?id=4430.
Tuesday, October 6, 2009
False localising sign & 3rd cranial nerve palsy
The false localising sigh
• Neurological signs that indicates a pathology far-away from the expected anatomical site.
• Commonest examples are 6th cranial nerve palsy (unilateral or bilateral) and papilloedema secondary to raised intracranial pressure (e.g. chronic meningitis and tumour)
• The reason for false localizing sign in the 6th CNP is due to its’ long intracranial course.
Surgical and medical 3rd nerve palsy
• As the name suggest, the causes of surgical 3rd CNP are compressive lesions (such as aneurysm or tumours)and medical 3rd CNP are those that you’ll see in the medical wards that may involve the course of 3rd cranial nerve.(such as diabetes = most common)
• So, to learn more about the causes of 3rd CNP, you’ll have to cover a wide range of diseases from surgical causes to medical causes that may injure or affect the 3rd nerve anywhere along its’ course. But the important points you’ll need to know are in the ptosis flow chart.
• Pupillary involvement (dilated pupil that does not react to light shone in either eye) is an important sign differentiating "surgical," including traumatic, from "medical" causes of isolated third nerve palsy. (as shown in my previous flow chart on ptosis)
• Surgical 3rd nerve / Compressive lesions of the 3rd nerve—eg, aneurysm of the posterior communicating artery and uncal herniation due to a supratentorial mass lesion—characteristically have pupillary involvement. Patients with painful acute isolated third nerve palsy and pupillary involvement are assumed to have a posterior communicating artery aneurysm until this has been excluded. Pituitary apoplexy is a rarer cause.
• Medical causes of isolated third nerve palsy include diabetes, hypertension, and giant cell arteritis.
• Neurological signs that indicates a pathology far-away from the expected anatomical site.
• Commonest examples are 6th cranial nerve palsy (unilateral or bilateral) and papilloedema secondary to raised intracranial pressure (e.g. chronic meningitis and tumour)
• The reason for false localizing sign in the 6th CNP is due to its’ long intracranial course.
Surgical and medical 3rd nerve palsy
• As the name suggest, the causes of surgical 3rd CNP are compressive lesions (such as aneurysm or tumours)and medical 3rd CNP are those that you’ll see in the medical wards that may involve the course of 3rd cranial nerve.(such as diabetes = most common)
• So, to learn more about the causes of 3rd CNP, you’ll have to cover a wide range of diseases from surgical causes to medical causes that may injure or affect the 3rd nerve anywhere along its’ course. But the important points you’ll need to know are in the ptosis flow chart.
• Pupillary involvement (dilated pupil that does not react to light shone in either eye) is an important sign differentiating "surgical," including traumatic, from "medical" causes of isolated third nerve palsy. (as shown in my previous flow chart on ptosis)
• Surgical 3rd nerve / Compressive lesions of the 3rd nerve—eg, aneurysm of the posterior communicating artery and uncal herniation due to a supratentorial mass lesion—characteristically have pupillary involvement. Patients with painful acute isolated third nerve palsy and pupillary involvement are assumed to have a posterior communicating artery aneurysm until this has been excluded. Pituitary apoplexy is a rarer cause.
• Medical causes of isolated third nerve palsy include diabetes, hypertension, and giant cell arteritis.
Monday, October 5, 2009
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