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+--- Thread: CCS neuro - svenska101 (/showthread.php?tid=413096)
CCS neuro - svenska101 - ArchivalUser - 05-23-2009
Is the following list sufficient for possible CCS cases from neuro
TIA
Migraine
Parkinson
Dementia
Seizures
Headache
Myasthenia Gravis
Multiple Sclerosis
any input appreciated
0 - ArchivalUser - 05-23-2009
) I think you have listed everything
0 - ArchivalUser - 05-23-2009
I think we need to add spinal cord problems like trauma, though it could be in the trauma section.
0 - ArchivalUser - 05-23-2009
gullian burrie syndrome
meningitis
subdural hematoma
0 - ArchivalUser - 05-23-2009
oh yes I forgot to mention few more
Low Back Pain
Spinal cord compression (very important one)
Subarachnoid hemorrhage
Subdural hemorrhage
Vertigo
AMS (Altered mental status changes)
zkadhem what about like some other
neurological dx like ALS etc
0 - ArchivalUser - 05-23-2009
yeh, everything is possible and I think in neurology cases the approach is not much complicated.
0 - ArchivalUser - 05-23-2009
ok svenska101,
How will you manage a patient who is 50 years old male came to your office complaining of tremor? vital signs are normal. No Hx of DM or HTN.
0 - ArchivalUser - 05-23-2009
(zkadhem 2 scenarios)
HPI no current medications
Vitals normal (no orthostasis)
Complete physical exam
results show (s/s suggestive of parkinson dis)
(bradykinesia, rigidity,micrographia etc)
mental status normal no hallucinations
order these tests as routine and schedule the pt to return in 7 days
BMP
UA
TSH
CT head
seum ceruloplasmin
24 hr urine copper
on follow up visit
interval history
vitals
results are normal
order bromocriptine po (although one can also order ropinirole po)
send the pt home
counsell
medication compliance
diet low protein
exercise
if pt smokes or drinks (then smoking cessation etc)
dx parkinson dis
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Consider hospitalizing patients with Parkinson's disease who have any of the following conditions
Hallucinations
Delirium
Profound fluctuations in mobility
Mania
Depression
Frequent or serious falls
Infection (e.g., urinary tract infection, aspiration pneumonia)
------------------------------------------------------------------------------------------------------------
Second scenario
same pt more than 50 years with some tremor involving hands but spares legs
in office vitals stable, no DM, no HTN
but drinks and reports that his tremor improves when he is drinking
complete physical exam
results normal except only tremor
order routine
BMP
UA
propanolol po
send the patient home re schedule after 15 days
Pt returns after 2 weeks
interval hx
pt reports improvement in his tremor
continue the beta blocker
case ends
dx benign essential tremor
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0 - ArchivalUser - 05-23-2009
good