Examining the Sensory System
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This cranial MRI is from a young woman who presented with low-grade fever, confusion, visual hallucinations and status epilepticus. Significant orofacial dyskinesias and autonomic dysfunction was also noted. Lumbar puncture was performed and cerebrospinal fluid (CSF) revealed mild lymphocytic predominant leukocytosis and slightly elevated protein. CSF glucose was within normal range and CSF for microbiological…
Subdural Haematomas
Subdural haematomas are far more common than epidural haematomas and acute subdural haematomas are one of the leading causes of death and disability in patients with severe traumatic brain injury. Subdural haematomas are due to an accumulation of blood between the dura and arachnoid. This is most often due to head injury resulting in a…
Areflexia
The knee-jerk, ankle-jerk and plantar reflexes are being examined in this patient. There is a slight down-going plantar reflex on the right side. Otherwise, all other reflexes are absent. Discussion of the sign Areflexia may indicate deficits in the reflex loop. This may be due to a lesion involving the sensory neuron or the lower motor…
Contraindications of a Lumbar Puncture
A lumbar puncture (LP) is contraindicated in the following scenarios: Patients with bleeding diathesis, e.g. severe coagulopathy (INR >1.4) and thrombocytopenia (platelet <50 x 109/L). If coagulopathy or thrombocytopenia is not corrected prior to the procedure, spinal hematomas resulting in spinal cord compromise may result. Patients with increased intracranial pressure due to an intracranial lesion…
Performing the Lumbar Puncture (Part 2)
By palpating onto the iliac crest and spinal processes of the back, the site of needle puncture for lumbar puncture (LP) is identified. As the spinal cord ends at the level of L2 in adults, the spinal needle can be inserted safely between the L3/4 or L4/5 levels. The highest point of the iliac crest…
Upper Limbs
Subtitles in English for this video can be displayed by clicking on (first button on the bottom right hand corner of the video). Inspection of the Upper Limbs After adequate exposure, one should then lay the patient’s arms out comfortably. The examiner should stand at the end of the bed / facing the patient if the patient is…
