tailieunhanh - Thieme Mumenthaler, Neurology - part 3

Một sự khác biệt huyết áp giữa hai cánh tay nên khơi dậy sự nghi ngờ của một phình động mạch chủ, Takayasu của bệnh viêm động mạch, hoặc đòn đánh cắp hội chứng. Sự hiện diện của ecchymoses, petechiae, và tổn thương da khác cho thấy rằng bất cứ điều gì quá trình cơ bản họ có ảnh hưởng đến não. | 186 2 Diseases Mainly Affecting the Brain and its Coverings farction in the basal ganglia internal capsule thalamus brainstem and rarely cerebral cortex. Arterioloscle-rosis is often directly visible by reti-noscopy. Clinical examination of the heart and its rhythm may suggest the possibility of cardiogenic embolism. A difference in blood pressure between the two arms should arouse suspicion of an aortic aneurysm Takayasu s arteritis or subclavian steal syndrome. The presence of ecchymoses pete-chiae and other cutaneous lesions suggests that whatever process is underlying them has affected the brain as well. Deep venous thrombosis in an extremity may lead to paradoxical cerebral embolism in the presence of an anatomical right-to-left shunt. If the physical findings yield no evidence of atherosclerosis or cardiac disease other types of vascular disease should be considered particularly arterial dissection. Carotid artery dissection should be suspected when there is a Table Initial ancillary studies for the patient with a focal neurologic deficit of acute onset Erythrocyte sedimentation rate Hemoglobin hematocrit Leukocyte count with differential count Platelet count Sodium potassium Glucose BUN creatinine Syphilis serology Prothrombin time Urinalysis Serum osmolality ECG Chest radiograph history of cervical facial temporal or orbital pain on one side accompanied by ipsilateral Horner syndrome and contralateral hemiparesis or hemi-sensory syndrome. Carotid artery dissection may rarely cause ipsilateral cranial nerve deficits and thus misleadingly arouse suspicion of a brainstem process. Vertebral artery dissection presents with ipsilateral cervical and occipital pain and as a rule with brainstem symptoms and signs p. 193 . Tenderness of the temporal arteries suggests the diagnosis of giant cell arteritis temporal arteritis polymyalgia rheumatica . Diagnostic Evaluation and Use of Ancillary Tests An acute focal neurologic deficit is usually due to a .