Critical Matters The Neuro Exam
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Jun 27, 2024 In this engaging discussion, Dr. Adam Rizvi, a neurologist specializing in critical care and tele-neurology, shares insights on performing neurological assessments in the ICU. He emphasizes key factors for non-neurologists to recognize signs of strokes and other conditions in sedated patients. The conversation highlights innovative exam techniques, including assessing brainstem reflexes and alternative methods for increased safety. Dr. Rizvi also discusses the profound impact of kindness and empathy in critical care settings, reflecting on the teachings of Marcus Aurelius.
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Localize Along The Neural Axis
- Neurological diagnosis asks "where along the neural axis" explains symptoms rather than which organ is involved.
- Apply Occam's razor to localize a single point that accounts for all neuro findings.
Equal Weakness Points To Subcortex
- Equal weakness of face, arm, and leg suggests a subcortical lesion like internal capsule involvement.
- Unequal weakness favor cortical territory patterns from lobar somatotopy.
Use HAND To Spot Cortical Signs
- Use the mnemonic HAND to spot cortical signs: Homonymous hemianopsia, Aphasia, Neglect, Deviation.
- Recognize cortical signs quickly to suspect large vessel occlusion and possible seizures.