Examining the Sensory System
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Artificial Eye
This patient did not have any recent ocular symptoms but was noted to have significant right eye ophthalmoplegia during examination, whilst the left eye movements were completely normal. There was no double vision upon testing. Whilst one would need to consider a combined third, fourth and sixth nerve palsy in a patient with unilateral opthalmoplegia,…
Cerebral Abscess
The scans shown are from two immunocompromised patients who presented with high fever and recurrent seizures. The contrast cranial CT of the first patient shows that the patient had a rim-enhancing lesion at the left basal ganglia (Figure 1). A set of cranial MRIs of the second patient also showed multiple contrast enhancing lesions in the…
Spontaneous Parenchymal Haemorrhage
There are a number of causes of spontaneous parenchymal haemorrhages. These include: hypertension, vascular malformations and aneurysms, neoplasm (primary or metastatic), cerebral amyloid angiopathy, use of antiplatelet agents or anti-coagulants, blood dyscrasias and drug abuse (e.g. amphetamine and cocaine use). Parenchymal haemorrhages could also be subdivided into deep versus lobar haemorrhages, where deep haemorrhages (basal ganglia, thalamus,…
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…
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…
Sixth Nerve Palsy
In this patient, there is a mild esotropia on neutral gaze as the left eye is slightly deviated medially. There is impaired left eye abduction resulting in diplopia when the patient is instructed to look towards the left. Discussion of the sign Abduction of the eye is controlled by the lateral rectus muscle, which is…