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The Neurological Exam: Evaluating the Master Organ
How does a mind contemplate itself? That's a philosophical question I'll leave to minds smarter than mine, but what I can tell you is how to examine the brain and other parts of the nervous system. Most people are familiar with how doctors examine a heart or set of lungs. The physical exam of these organs consists mainly of using a stethoscope to listen to them in action. But when it comes to examining components of the nervous system-consisting of the brain, spinal cord, peripheral nerves and muscles-a stethoscope is pretty useless. The nervous system doesn't make sounds that the doctor can listen to (though the arteries in the neck that deliver blood to the brain can be usefully listened to). But because people can have medical disorders that damage the nervous system, it is every bit as important to have a method for evaluating this organ as for any other. The method is called the neurological exam. Because different parts of the nervous system do different things, the basic idea of the neurological exam is to put the patient through a number of mini-exams, each evaluating the function of a different component. And what a variety of functions there are! In fact, apart from exposure to an inspiring teacher, this is what drew me into the study of neurology in the first place-the sheer diversity of the neurological exam. This is an organ responsible for jobs as diverse as thinking, remembering, smelling, tasting, seeing, hearing, speaking, moving, walking, balancing, feeling and, yes, even contemplating itself-though I confess that my neurological exam doesn't include an assessment of self-contemplation. Moreover, the nervous system handles many infrastructure tasks like controlling body-temperature, pulse, blood-pressure, breathing and enabling a person to urinate at a time and place of their choosing. What's not to admire about an organ system that can do so many things! The many mini-tests of the neurological exam are bundled together in the following sub-groupings: mental status exam, cranial nerve exam, motor exam, sensory exam and evaluation of stance and walking. I'll provide a brief overview of each. The mental status exam focuses on the cerebrum which has a wrinkly, gray, outer surface usually shown in pictures of the brain. The cerebrum is divided into eight lobes which includes pairs of frontal lobes, parietal lobes, temporal lobes and-bringing up the rear-the occipital lobes. Each handles different mental tasks. In fact, even within a lobe, many different jobs are handled. So the usual mental status exam consists of observing the patient's behavior in the exam room and using a variety of standard tests to check the patient's orientation to time and place, attention, memory, speech, comprehension of language, memory, calculation and ability to track the relative positions of objects in space. The next grouping of mini-tests, the cranial nerve exam, also assesses the functioning of parts of the cerebrum, but additionally focuses on the brainstem. The brainstem is located at the base of the brain and connects the cerebrum above to the spinal cord below. The cranial nerve exam includes tests of smelling, vision, constriction of the pupils, eye-movement, facial sensation, facial movement, hearing, and action of certain muscles in the throat, tongue, neck and shoulders. I'll single out one item on the cranial nerve exam as deserving special mention, and that is the visual field exam. The visual fields are evaluated one eye at a time. While the patient stares at an unmoving object, the doctor asks if the patient can see objects (like the doctor's fingers) appearing in different locations of the patient's peripheral vision. In order to detect objects in the four corners of each eye's vision, the patient must have proper functioning of each of six lobes of the brain-both parietal lobes, both temporal lobes and both occipital lobes. In fact, this is the only portion of the entire neurological exam that checks the right temporal lobe. Despite its importance, the visual field exam sometimes gets skipped by medical students (in which case the ones under this author's supervision must endure hearing an earful). The motor exam includes some pretty obvious things like checking the strength of different muscles in the arms and legs, but also includes less obvious components like muscle tone, coordination, and the presence of involuntary movements. It also includes an inspection of muscles for loss of size or the presence of spontaneous twitches. Additionally, this is the part of the exam in which the doctor pulls out his or her rubber hammer and checks reflexes in the arms and legs. The motor exam also includes a briefly painful maneuver-called the Babinski test-in which the bottom of the foot is scraped with a metal object while the doctor observes for a reflexive response in certain foot-muscles. The sensory exam focuses on the processing of inputs from sensory nerve-endings in the patient's skin and joints. It can include awareness of light touch, pain, warmth, coldness and vibration. In addition, the doctor examines position-sense by moving the patient's toes and fingers up or down and asking the patient to say, without looking, which way they moved. Finally, we have those portions of the exam related to stance and walking, but also including the patients' ability to transfer in and out of their chair. While on their feet, patients are asked to walk in their usual fashion, as well as on tiptoes. They are also observed while doing a "tandem gait," known more commonly as the "state trooper test," in which they walk flat-footed in a straight line with the heel of the leading foot touching the toes of the trailing foot. Last, the doctor checks the patients' ability to remain standing after closing their eyes. This is called the Romberg test. That's about it. In the hands of experienced clinicians the neurological exam doesn't take much longer to perform than to describe, and yet provides a wealth of information about the functioning of the patient's nervous system. In this age of high-tech imaging devices the neurological exam might seem archaic or old-fashioned, but it is still indispensable, and provides diagnostic information that even a battery of CT or MRI scans might miss. (C) 2005 by Gary Cordingley Gary Cordingley, MD, PhD, is a clinical neurologist, teacher and researcher who works in Athens, Ohio. For more health-related articles, see his website at: http://www.cordingleyneurology.com
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Alternative Medicine Get Rid of Tendonitis Now! Advice From An Expert? Tendons are ropes of fibrous tissue that connect muscles to bones. It is this connection that permits joint motion. When muscles contract, they pull on the tendons which cause the bones to move. In order for tendons to glide they move inside a lubricated sheath of tissue that is lined with synovial tissue. This synovial tissue is the same type of tissue that lines the inside of joints. Tendonitis refers to a condition where the sheath through which a tendon glides becomes inflamed. This leads to severe pain. The pain usually gets worse with use of the affected joint. However, when tendonitis becomes severe, there may be pain at rest. A Compelling Look at Pain Relief If your back aches when you are loading groceries in the car or your hands cramp up with arthritis when you sit down at the computer, you are not alone. Although the nature, cause, and complaints vary, over one-half of Americans experience chronic or recurrent pain, a recent survey conducted by the Stanford University Medical Center found. Antibiotics 101- What You Absolutely Need to Know Introduction Bextra Withdrawal Could Be Just the Beginning for Pfizer The pharmaceutical industry is a tremendously profitable one, as anyone who reads the business pages of their newspaper can see. Although it can take years to develop a new drug and bring it to market, the profits obtained from a breakthrough drug can be staggering. Last year Merck sold about $2.5 billion worth of Vioxx, and Pfizer sold about $1.3 billion worth of Bextra. The profits are huge, but so are the losses if a problem should develop with a pharmaceutical product. Pfizer voluntarily withdrew the popular anti-inflammatory drug Bextra from the market last month, and their stock has suffered from both the loss of sales and the potential for a large number of product liability lawsuits. Pfizer may have to endure a double whammy this year as the FDA announced that they are investigating reports that the impotence drug Viagra may be linked to cases of blindness in male users. Cialis and Levitra were also mentioned in the report, although most of the cases involved the use of Viagra.The FDA reports shouldn't cause alarm; the agency says that it is investigating fewer than 50 incidents of blindness in patients who use a drug that has been used by more than twenty million people since its introduction seven years ago. The FDA investigation says less about the likelihood of blindness in patients than it does about the agency's own concerns about its reputation. The FDA rightly insists upon rigorous testing of drugs before they reach the market in the name of public safety. But that coin has two sides, and there are those who say that the agency is too quick to approve potentially dangerous drugs and others who say that the agency's testing isn't thorough enough. Adding fuel to the fire are the recent memos obtained from Merck employees that suggest that the company was aggressively marketing Vioxx even though their sales staff knew the drug was potentially dangerous.There may be no link between Viagra and blindness at all, as the form of sudden blindness alleged to have been caused by Viagra use is common to the sorts of patients who have erectile disfunction. The FDA is just being cautious, as they should be. Further tests will determine if there is an actual link. The party likely to suffer immediately is Pfizer, as stockholders, already concerned about Bextra lawsuits, drove the stock price lower immediately upon the release of the Viagra news. Sales will probably decrease, too, as patients who are now accustomed to reading about drugs being withdrawn from the market may shy away from the product until further tests are done. That could present a huge income for Pfizer, as they currently sell about $2 billion worth of Viagra each year. The drug business is a profitable one, but like any business, comes with risks. This year, it would seem that Pfizer is getting a double dose of bad medicine. Zyprexa Side Effects are Deadly: Effects Include NMS Zyprexa is a prescription drug that treats schizophrenia, acute mania and bipolar disorder. It is a psychotropic drug that treats the psychotic disorders of the mind but unlike other drugs for psychotic disorders, Zyprexa is an atypical antipsychotic. Eli Lily, the manufacturer of the drug Zyprexa, has been accused of promoting off-label prescriptions of Zyprexa, many to children, knowing that the FDA would force them to include risk information on the label and that the FDA has not approved the drug for use with children. Risks and side effects of Zyprexa include diabetes, hyperglycemia, pancreatitis, weight gain, tardive dyskinesia, neuroleptic malignant syndrome. The FDA has stated the Zyprexa should not be used if a patient is a child or has ADD, depression, addictions, treating aggressive behavior, or mood elevation, but it continues to be given to these people. New Company Helps Another Medical Condition Become: Acceptable Dinner Conversation Recently once taboo subjects like plastic surgery have become acceptable dinner conversation. Medical conditions are no longer whispered to friends, but have instead become part of the dinner table conversation with full blown discussions on Botox, erectile dysfunction and the feared colonoscopy. However recently there is a new kid on the block, well maybe not so new, it's actually plain old heel pain. You might ask why is this happening? Why is it so important now? After all heel pain for the most part won't kill you. 10 Steps To Detoxification Technology. We live in a grand time of technological development. Computers, the Internet, cell phones, digital cameras and DVDs. But the human body has not 'kept up' with technology. Human beings certainly shouldn't eat technology! But that is happening today as a result of the onslaught of chemicals in our foods and environments, and with the impending threat of chemical warfare. Rogue Online Pharmacies: The Internet War Of 2005 Online Pharmacy owners who haven't been working within moral and governmental regulations are in for the ride of their lives. In past months, many of these so called "rogue pharmacies" have either voluntarily shut down or been closed by the powers that be. However, the major illegitimate players have been unable to cover their tracks, and some have been outright irresponsible. Cut Your Prescription Drug Costs Without Having to Buy Foreign Drugs Save Up to 93% by Asking for a Generic - Use generics whenever they are available. Both brand name and generic drugs contain the same active ingredients, are the same in strength and dosage and meet the same government quality control standards. An Introduction to Acid Reflux Disease Acid reflux disease, also known as Gastroesophageal Reflux Disease or GERD, afflicts millions of people. Many suffer from an occasional bout with heartburn, but acid reflux disease, as a diagnosis, should only be made if the heartburn causes impediments to your lifestyle due to severe, chronic discomfort over prolonged periods of time. Usually, if you suffer from heartburn 2 or more times per week for at least 12 weeks, there's a good chance that your diagnosis would be GERD. Unfortunately, no one knows exactly what causes acid reflux disease, but there is an ample amount of information available at your doctor's office and on the Internet. Lunesta For Insomnia: A Guide To Compare Generic Lunesta ( Eszopiclone ) We all know that there's no such thing as cheap Lunesta, but if you would like to save money without sacrificing quality, you may want to buy Eszopiclone instead. Eszopiclone is the generic version of Lunesta, the only prescription sleep aid approved for long term use. Bee Propolis: Synergisitc Health Care for the 21st Centruy For well over a century modern science has progressed at a startling rate. With this increase in knowledge has come medicinal and healthcare benefits that have seen ages peak and diseases eradicated. These medical advances were based around the paradigm of the "magic bullet", isolating the active ingredient and using it to alter the chemistry of a single molecule/protein to elicit a change of state in the patient. Success however has turned to obsession as cracks appear in the armoury of disease fighting drugs at our disposal. MRSA is rifling through our hospitals as antibiotics become ineffective and severe side effects of modern drugs are becoming common place now years after their introduction. A direct consequence of a one dimensional strategy, it is maybe the time to acknowledge the synergistic health benefits of natural medicine. Propolis is a unique natural medicine because of its breadth of action. It has antibacterial, antiviral, antifungal, anti-inflammatory, anti-cancer and immunomodulatory effects, it could help treat asthma, allergies, arthritis and joint disorders, eczema and dermatitis, ME, viral infections including HIV and even cancer. This medicine could help treat an illness or keep you fit and healthy. Propolis: Defender of the City Propolis is a mainly resinous substance that bees collect from trees and plants. Being made up of waxes, resins, fatty acids and even amino acids. Aristotle reputedly coined the name Propolis meaning "defender of the city". This is exactly what Propolis is for the hive, it acts as a bee population's external immune system keeping the hive sterile and free of microbial invaders Evidence Based Medicine In the following paragraphs I will describe to you the pharmacological properties of Propolis. Before I do so I must explain where this evidence comes from. All the properties and actions of Propolis have been witnessed and detailed in scientific studies which have subsequently been published in journals. The bulk of these scientific studies have been performed in vitro (i.e. in a test tube) or in vivo (i.e. in a host animal for example rats), a much smaller proportion of these studies are clinical trials tested on humans. The abstracts of these papers can be found on the Medline and pubmed databases on the Internet. Propolis: A natural antibiotic Propolis is probably best known for its antibiotic properties. Even as early as 1960 French1 research demonstrated the bacteriostatic action on Bacillus subtilis, Proteus vulgaris and Bacillus alvei. The results have been replicated many times and Propolis has even been shown to be effective to MRSA2, the same antibiotic resistant bacteria that has infected up to 70% of our hospitals. A 1997 study by Calder et al. at the University of Oxford concurred with these results and found that the cinnaminic acids and flavanoids present in Propolis in particular show bacteriocidal action. This action believed to be as a consequence of Propolis uncoupling the bacterial energy respiratory chain. Interestingly this action may be involved in a synergistic action with antibiotics when used together, boosting the effectiveness of the drugs. Anti-Viral and immuno-stimulatory Viruses present a unique dilemma in the quest for good health, they are not affected by antibiotics and mutate so frequently that vaccines are hard to produce. They also cause illness by hijacking cells and using the cells machinery to replicate. Modern drugs aim to slow or stop the virus from the replicating and subsequently because they are attacking host cell machinery they have certain side effects. Viruses perhaps pose the greatest threat to humans' health, we are currently in the middle of a HIV pandemic with "39.4 million" people infected world wide. With a Flu pandemic overdue and certainly on its way and predictions of world wide casualties and chaos, a solution is needed. The bioflavanoids in propolis have a unique approach to combating Viruses, instead of trying to combat them once they have infected a cell, they lock the virus in its protein coat. This means that the dangerous machinery and DNA/RNA of the virus is nullified and the infection stopped. Propolis has been shown to be more effective than the pharmaceutical anti-viral acyclovir in treating genital Herpes in a clinical trial conducted in the Ukraine4 and there is growing evidence that Propolis could help treat people with HIV5. Propolis also works hard as an immunomodulator which is of interest for all of us. It does this by altering the way cytokine production and release is managed. Cytokines are the chemical messengers that allow immune system cells to communicate. By altering the cytokine system, it primes the immune system to be ready to react to antigens quickly and effectively. As well as this, bioflavanoids within Propolis stimulate the production of interferon which can help people recover from ME, stimulating their immune system. This alteration of the cytokine and interferon systems means that your body is ready to fight off infection and keep you healthy, making a case for using propolis as a supplement for good health, like vitamins. Prevention is better than the cure. Anti-inflammatory and anti-allergen A survey of Propolis consumers showed that arthritis was the health problem that Propolis was used to treat the most. This is because of the potent anti-inflammatory properties of the propolis constituents in particular CAPE (Caffeic acid Phenyl ester), CAPE has been shown to suppress T cell activation. A paper by Marquez et al in 20046 evaluated this to mean that since T-cells play a key role in the onset of several inflammatory diseases, CAPE is important because the this phenolic compound is a potent inhibitor of early and late events in T-cell receptor-mediated T-cell activation. Results like this have led other researchers to propose that CAPE is a worthwhile agent for reducing the severity of conditions associated with inflammation. Many of the experiments performed on CAPE were done so in vitro, however the anti-inflammatory properties of Propolis have been documented in rats when treating rat adjuvant arthritis. A paper by Park et al in 19997 concluding that the ethanolic extract of propolis had profound anti-inflammatory effects on both chronic and acute arthritic inflammations. These anti-inflammation properties extend to other illness and disorders such as asthma and allergies reducing both smooth muscle airway contraction8 and allergic responses. Any disorder or illness related to inflammation could be helped by Propolis. Anti-tumour/cancer Propolis and CAPE have been shown to reduce the size of tumours and to selectively destroy and to curb the proliferation of malignant cells of many different types of cancer. As recently as June 10th 2005 Cancer researchers have been given a grant of a million dollars to investigate the therapeutic value of Propolis for cancer. Costas Koumenis the lead investigator for the study was quoted as saying, "a very interesting property of these compounds is that they have been shown to cause cell death in tumor cells but not in normal cells." This study along with other current studies promises to propel Propolis into the limelight in the field of cancer treatment. Current Propolis Research in the UK BVR (BeeVital Research) recently won a major government Research and Development Award, part of a Ł250,000 research programme looking at the chemical, biological and clinical properties of propolis. These studies will focus on the: 1. Documenting the regional variances in chemical and biological properties, by HPLS, GC-MS and NMR. (Taking place at Univeristy of Strathclyde) 2. Futher investigating the role of Propolis in the Hive (University of Gloucester) 3. Dental trials looking at effectiveness of Propolis for Mouth Ulcers, Pericorinitis, Gingivitis and Sensitive Teeth. (Manchester University Dental school) 4. HIV/AIDS trials looking at the effectiveness of Propolis with anti-virals in Zambia and Tanzania 5. The effects of standardised propolis on mood, stress, fatigue and cognition at the Human Cognitive Neuroscience Unit at University of Newcastle. 6. To evaluate the use of local and non local propolis for wound healing and the treatment of skin and other dermatological problems. ( The Regional Teaching Hospital for University of Dar es Salaam) Increasing Patient Care and Reducing Liability in Seven Simple Steps When an unconscious patient arrives in the ED, every hospital agrees that timely next of kin notification is vital. Not only is it important to have a family member present to comfort the patient, but to make informed decisions for his care and provide the medical history that can make the difference between life and death. From a liability standpoint, as we know all too well, having a family member making medical decisions, often means that if complications do arise, the family will be much less likely to sue, than if they hadn't been in attendance. 4 Reasons Why You Should Use Canadian Pharmacies Let's face it: purchasing prescription drugs in the U.S. can be a costly undertaking. By filling your prescriptions online through Canadian pharmacies, your savings can be substantial. Here's why you should consider having your drugs shipped to your home from Canada: Blood Pressure Treatment: High and Low Blood Pressure Tips and Medication! High blood pressure is on the rise worldwide. But, doctors believe that small lifestyle changes can go a long way in preventing this silent killer. Medical Billing Software Takes the Stage Medical Billing Software Toenail Fungus: Treatment and Prevention A thick, yellowish nail with splotchy white areas is a classic presentation for a fungal toenail. In the early stages the toenail is only slightly discolored, or slightly thickened. In the late stages the nail can become very thick and has a tendency to "grow up" more than in grows out. The nail will be very discolored, typically dark yellow-brown and will start to change shape and crumble. In some cases the nail becomes very loose and many will lose the nail, only for it to regrow with the fungus. Contact Lenses and Eye Glasses, How is Your Vision? Notice friends getting contact lenses and pulling out eye glasses? Strong Pain Relief - Powerful & Effective Natural Pain Management Alternative The recent removal of several high profile and popular prescription pain medications of the same pharmaceutical family, nonsteroidal anti-inflammatories, from the buyer's market has left many people searching for a safer alternative for powerful, fast and effective pain relief. The most recent removal was Pfizer's pulling of Bextra, citing serious skin reactions, sometimes fatal, and two others, Vioxx and Celebrex have been linked to heart related risks. The dangerous side effects of this particular family of medications is definitely cause for alarm, and has many seeking alternatives that will manage their pain effectively, without the serious risks of several pharmaceutical pain killers. 10 Home Remedies For Arthritis Pain Relief Your Remedy No. 1 ==============
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