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    Approach To Body Weakness - Stroke

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    Hynne Jhea Echavez
    - The neurological problem presented is right-sided body weakness. - The key questions are: what is causing the lesion, where is the lesion located, and what treatment plan should be devised. - Possible causes include stroke, space-occupying lesions, spinal cord lesions, peripheral nerve lesions, and various diseases like multiple sclerosis. A left-brain stroke would cause weakness on the right side of the body. Early diagnosis through imaging and clinical exams is important for treatment and recovery.

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    Approach To Body Weakness - Stroke

    Uploaded by

    Hynne Jhea Echavez
    53 views13 pages
    - The neurological problem presented is right-sided body weakness. - The key questions are: what is causing the lesion, where is the lesion located, and what treatment plan should be devised. - Possible causes include stroke, space-occupying lesions, spinal cord lesions, peripheral nerve lesions, and various diseases like multiple sclerosis. A left-brain stroke would cause weakness on the right side of the body. Early diagnosis through imaging and clinical exams is important for treatment and recovery.

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    Approach to Body Weakness.Stroke

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    - The neurological problem presented is right-sided body weakness. - The key questions are: what is causing the lesion, where is the lesion located, and what treatment plan should be devised. - Possible causes include stroke, space-occupying lesions, spinal cord lesions, peripheral nerve lesions, and various diseases like multiple sclerosis. A left-brain stroke would cause weakness on the right side of the body. Early diagnosis through imaging and clinical exams is important for treatment and recovery.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    53 views13 pages

    Approach To Body Weakness - Stroke

    Uploaded by

    Hynne Jhea Echavez
    - The neurological problem presented is right-sided body weakness. - The key questions are: what is causing the lesion, where is the lesion located, and what treatment plan should be devised. - Possible causes include stroke, space-occupying lesions, spinal cord lesions, peripheral nerve lesions, and various diseases like multiple sclerosis. A left-brain stroke would cause weakness on the right side of the body. Early diagnosis through imaging and clinical exams is important for treatment and recovery.

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    APPROACH TO RIGHT

    SIDED BODY WEAKNESS


    EAY , KATRINA ANDREA C
    ECHAVEZ, HYNNE JHEA O.
    ECIJA, CLYDE JOSHUA A.
    NEUROLOGIST SUMMARIZE THIS PROCESS BY THE
    MOST IMPORTANT QUESTIONS THAT ARE
    ANSWERED IN SUCCESSION:

    • What is the neurological problem/presentation? establish that the presentation


    represents a focal motor deficit rather than another issue.
    • Where is the lesion? determine the localization within the nervous system of
    the lesion.
    • What caused the lesion? determine the etiology of the lesion; i.e. likely
    vascular, infective or neoplastic.
    • What are we going to do about it? devise an investigation and treatment plan.
    CLASSIFICATION BY CLINICAL PRESENTATION APPROACH:

    First of all keep in your mind the following helping questions:

    •Mode of Onset & Duration:

     Acute: vascular, toxic & metabolic.


     Chronic: neoplastic, infective, inflammatory, endocrine, degenerative diseases.
    • Course:
     Worse at onset then get regress later on: neurogenic cause: vascular.
     Progressive: neurogenic cause: neoplasm, degenerative & infective diseases.
     Episodic: neurogenic cause: vascular.
     Activity dependent: NMJ cause: MG & muscular cause: myopathies.
    • Co-morbidity: cardiopulmonary diseases, anaemia, infection, malignancy & psychiatric illness. (as causes
    & risk factors of true weakness & as a causes of functional weakness).
    • Associated symptoms & signs:
     Symptoms of etiologies & risk factors (cardiovascular, infections, endocrine, malignancy, metabolic…etc).
     Symptoms help to differentiate between true & functional weakness (constitutional, anemia, endocrine &
    positive drugs/ alcohol history).
     Cortical dysfunction symptoms.
     Spinal lesion symptoms.
     Sensory symptoms (distribution pattern of sensory loss help in localization site of lesion).
     Cranial nerves palsy & Bulbar symptoms (indicate brainstem involvement).
     Autonomic symptoms (bowel, bladder dysfunction & impotence): indicate spinal cord/ nerves
    involvement below level of T1.
     Increase intracranial pressure symptoms & signs.
     UMNL or LMNL signs.
    CLASSIFICATIO
    N BY
    ALGORITHM
    APPROACH:
    STROKE:

    • Most common cause of unilateral weakness.


    • Patients typically present with sudden onset of the
    complains.
    •If persist < 3 hours , then it will resolve (TIA), while if persist
    > 3 hours, then it will not resolve (true stroke).
    •It can be cortical or spinal. Cortical is the common, so
    “stroke” term alone usually refer to cortical one.
    HEMIPARESIS
    Hemiparesis occurs when one side of the body is weakened, and it typically impacts
    your limbs and facial muscles. It affects about 8 out of every 10 stroke survivors.
    Patients may experience limited movement in their arms, hands, legs, or facial
    muscles, which can lead to increased difficulty performing everyday activities.
    Experiencing a one-sided weakness in your arms, hands, face, chest, legs, or feet
    can cause the following in patients:
    • Loss of balance
    • Difficulty walking
    • Difficulty grasping objects
    • Loss of spatial recognition and a decrease in movement precision
    • Muscle fatigue
    • Lack of coordination
    DIAGNOSIS OF HEMIPARESIS

    • Early diagnosis helps to treat and get recovery as early as possible for
    all the diseases and same goes for hemiparesis as well.
    • A proper clinical diagnosis with CT scan and MRI (Magnetic Resonance
    Imaging) helps to understand the brain injury with the affected areas
    or lobes and even injuries in spinal cord.
    • Where patients with hemiparesis come with partial paralysis, patients
    of hemiplegia show complete paralysis. Early diagnosis and treatment
    may help hemiparesis patient before the condition becomes more
    severe and turns into hemiplegia.
    LEFT-BRAIN STROKE →
    AFFECTS THE RIGHT SIDE OF THE BODY

    The left half


    (hemisphere) of
    the brain controls
    the right side of
    the body. A person
    with a left-brain
    stroke may be
    weak or not able
    to move the right
    side of the body.
    OTHER PROBABLE CAUSES OF WEAKNESS

    • Space-occupying lesions • Peripheral nerve lesions


    • Spinal cord lesions • Guillain-barre Syndrome
    • Multiple Sclerosis • NMJ lesions; Myasthenia
    • Motor Neuron Diseases Gravis
    • Muscle Lesions;
    Myopathies
    REFERENCES:

    • Harrison’s Principles of Internal Medicine 20th ed (2018)


    • Macleod's Clinical Diagnosis 2nd Ed (2013)
    • Approach to Internal Medicine 4th Ed (2015)
    • Algorithmic Diagnosis of Symptoms and Signs 4th Ed
    (2017)
    • Toronto Notes 34th Ed (2018)
    • Ain-Shams University Internal Medicine curriculum (2014)
    • Decision Making in Medicine 3rd Ed (2010)

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