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Category: Neurosurgery

LUMBAR SPINE NEUROLOGICAL EXAMINATION TEMPLATE

LUMBAR SPINE NEUROLOGICAL EXAMINATION TEMPLATE

The neurological examination is relative to the pathology you are investigating. This should not be used in a cut and paste fashion but rather for reference.   MOTOR Hip flexion “pull your knee to your chest” (L2/3) 5/5 Hip adduction “pull your knees into each other” (L2/3) 5/5 Hip abduction “pull your knees apart” (L4/5/S1) 5/5 Hip extension “pull your thigh back” (L4/5) 5/5 Knee extension “hold your knee straight” (L3/4) 5/5 Knee flexion “pull your heel to your bottom”…

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VERTEBRAL COMPRESSION FRACTURES: PERCUSSION AND SUPINE CHALLENGE

VERTEBRAL COMPRESSION FRACTURES: PERCUSSION AND SUPINE CHALLENGE

An elderly patient with a history of COPD presents with back pain radiating to the chest. After an extensive workup, a CT scan shows a vertebral compression fracture. You percuss the area and find that this reproduces the pain. Is this the cause of her pain?   Sometimes in emergency medicine we face the dilemma of a new vertebral compression fracture. Is it new or old? MRI can help, but is hard to obtain still. Until recently there was not…

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VENTRICULOPERITONEAL SHUNT COMPLICATIONS

VENTRICULOPERITONEAL SHUNT COMPLICATIONS

Does this patient with a ventriculoperitoneal shunt have a complication? Shunt failure is common, with half of patients experiencing this within the first two years of shunt placement (Livingston 2011). Obstruction is a much more common complication than infection (Piatt 2008). Headache, nausea, vomiting, depressed mental status are common symptoms but have poor specificity. Some have suggested bradycardia as a more specific sign, but it is not sensitive (Livingston 2011). The sensitivity of CT scan is as low as 61%…

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