Neurologic focality

Neurologic focality Symptomatic sensory or motor deficits that point to specific lesions or dysfunction in the brain. 

Ischemic stroke is the abrupt development of a focal neurologic deficit that occurs due to inadequate blood supply to an area of the brain. Most often, this is due to a thrombotic or embolic arterial occlusion leading to cerebral infarction. 

Ischemic stroke is the abrupt development of a focal neurologic deficit that occurs due to inadequate blood supply to an area of the brain. Most often, this is due to a thrombotic or embolic arterial occlusion leading to cerebral infarction. A thrombotic occlusion occurs when a thrombus forms inside an artery in the brain. An embolism refers to a clot originating outside of the brain in which a piece of the clot breaks loose and is carried to the brain. 

AG, a 20-year-old male college student, is seen by his physician 4 days after an apparent seizure during finals week. According to his roommate, he suddenly fell to the floor and had a generalized tonic-clonic seizure. This seizure lasted for 1 to 2 minutes. The patient was incontinent for urine during the seizure. He was sleepy and confused when the paramedics arrived 1 0 minutes later. Due to final examinations he reports being sleep-deprived. His physical exam is completely normal and no focal neurologic deficits were observed. 

Abdomen Benign, bowel sounds positive Neurologic Non-focal... 

Systemic signs (e.g., fever, weight loss, accelerated hypertension) Focal neurologic symptoms (i.e., other than typical visual or sensory aura)... 

H = Headaches. Headaches (particularly those associated with focal neurologic symptoms, such as blurred vision, speech impairment, and/or weakness) may represent strokelike symptoms. Headaches also may indicate poorly controlled blood pressure. 

Intracranial hemorrhage (spontaneous or following trauma), with headache, vomiting, change in mental status, and focal neurologic signs... 

Focal neurologic defects (including positive Brudzinski s sign and Kernig s sign) (33%)... 

Predictors of an unfavorable outcome seizures, focal neurologic findings, altered mental status, papilledema, hypotension, septic shock, and pneumococcal meningitis3... 

Immunocompromised, history of CNS disease, new onset seizure, papilledema, altered consciousness, or focal neurologic deficit or delay in performance of diagnostic lumbar puncture... 

Transient ischemic attack A focal neurologic deficit lasting less than 24 hours in which symptoms resolve completely. 

Stroke is a term used to describe an abrupt onset of focal neurologic deficit that lasts at least 24 hours and is presumed to be of vascular origin. Stroke can be either ischemic or hemorrhagic in origin. Transient ischemic attacks (TIAs) are focal ischemic neurologic deficits lasting less than 24 hours and usually less than 30 minutes. 

Fever and a history of headaches are the most common symptoms of cryptococcal meningitis, although altered mentation and evidence of focal neurologic deficits may be present. Diagnosis is based on the presence of a positive CSF, blood, sputum, or urine culture for Cryptococcus neoformans. 

Obtundation, hallucinations, grand mal seizures, and focal neurologic findings have also been associated with this illness. 

Migraine is a common, recurrent, primary headache of moderate to severe intensity that interferes with normal functioning and is associated with GI, neurologic, and autonomic symptoms. In migraine with aura, a complex of focal neurologic symptoms precedes or accompanies the attack. 

In the headache evaluation, diagnostic alarms should be identified. These include acute onset of the first or worst headache ever, accelerating pattern of headache following subacute onset, onset of headache after age 50 years, headache associated with systemic illness (e.g., fever, nausea, vomiting, stiff neck, and rash), headache with focal neurologic symptoms or papilledema, and new-onset headache in a patient with cancer or human immunodeficiency virus infection. 

CNS adverse experiences CNS adverse experiences have occurred with the IV formulation, especially when recommended dosages were exceeded. They are most common in patients with CNS disorders who also have compromised renal function and are rare when no underlying CNS disorder exists. (Continue anticonvulsants in patients with a known seizure disorder.) If focal tremors, myoclonus, or seizures occur, neurologically evaluate the patient, institute anticonvulsants, re-examine the dose, and determine whether to decrease dosage or discontinue the drug. If these effects occur with the IM formulation, discontinue the drug. 

All subjects should receive a complete physical examination, including a neurological exam. If focal signs are... 

Seizures ( rum fits ), which are generalized motor events that usually peak 12 to 48 hours after cessation of alcohol consumption. Partial seizures suggest a focal lesion and require careful neurological evaluation. 

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