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Cardinal Signs
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List six signs of severe CNS compromise that would cause you to return the patient to the physician for further investigation.
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List six symptoms of severe CNS compromise that would cause you to return the patient to the physician for further investigation.
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A patient presents with posttraumatic non-vertiginous dizziness including lightheadedness, giddiness and mild nausea. Give five possible differential diagnoses.
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What is the pathological difference between Rhomberg's and Hautant's (Hautard, Hautarth) tests
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List six signs of severe CNS compromise that would cause you to return the patient to the physician for further investigation.
Any undiagnosed cranial nerve sign specifically:
- Anosmia or paraosmia (CN 1)
- Hemianopia/quadranopia/scotoma (CN 2)
- Aniscoria (CN 3 or sympathetic paralysis)
- Reduced, absent or oscillating pupillary light reflex (CN 3 or sympathetic paralysis)
- Nystagmus (CN 3,4,6,8)
- Ocular paralysis or paresis (CN 3,4,6)
- Ptosis (CN 3 or sympathetic paralysis)
- Strabismus (CN 3,4,6)
- Facial anesthesia/hypoesthesia (CN 5)
- Jaw hyperreflexia (CN 5)
- Jaw clonus (CN 5)
- Lower facial muscles paralysis or paresis (CN 7)
- Posttraumatic or recent sensorineural hypoacusia (CN 8)
- Dysarthria (CN 9,12)
- Dysphonia (CN 10,11)
- Sternomastoid and/or trapezius paralysis or paresis (CN11)
- Sternomastoid and/or trapezius atrophy (CN11)
- Trapezius hyperreflexia (CN 11)
- Trapezius clonus (CN11)
- Uvula deviation (CN 10,11)
- Tongue deviation and/or atrophy (CN 12)
Any undiagnosed long tract or other sign, specifically:
- Babinski response
- Arm or leg clonus
- Hyperreflexia
- Bilateral, quadrilateral, hemilateral light touch and/or pain sensation decrease
- Spasticity
- Bilateral, quadrilateral, hemilateral paralysis or paresis
- Bilateral, quadrilateral, hemilateral proprioception or mechanoreception sensation decrease
- Bilateral, quadrilateral, hemilateral dysmetria, ballismus, tremor
- Ataxia
- Dysphasia
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List six symptoms of severe CNS compromise that would cause you to return the patient to the physician for further investigation.
Any undiagnosed cranial nerve symptom, specifically:
- Anosmia or paraosmia (CN 1)
- Hemianopia/quadranopia/scotoma (CN 2)
- Diplopia (CN 3,4,6)
- Facial paresthesia (CN 5)
- Taste disturbance (unprovoked metallic or bitter taste) (CN 5,7,9)
- Posttraumatic or recent high frequency tinnitus (CN 8)
- Posttraumatic vertigo or oscillopsia (CN 8)
- Dysphagia (CN 9,10,12)
- Nausea or vomiting (CN 10)
Long tract or other symptoms, specifically:
- Bilateral, quadrilateral or hemilateral paresthesia
- Posttraumatic or recent pulsatile tinnitus (carotid bruit or arteriovenous fistula)
- Drop attacks
- Recurrent syncope
- Horner's syndrome
- Wallenberg's, Weber's, Parinaud's, Benidikt's or other brain stem syndromes
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A patient presents with posttraumatic non-vertiginous dizziness including lightheadedness, giddiness and mild nausea. Give five possible differential diagnoses.
- Vertebrobasilar compromise
- Labyrinthine concussion (although this usually produces vertigo)
- Posttraumatic shock
- Cervical joint dysfunction
- Medication adverse effect
- Concussion or post-concussion syndrome
- Posttraumatic stress disorder
- Chronic pain type syndrome
- Coincidental neurological disease
- TMJ dysfunction
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What is the pathological difference between Rhomberg's and Hautant's (Hautard, Hautarth) tests?
Hautant's test is dependent on it being positive when the head and neck are moved into potentially occlusive positions whereas Rhomberg's involves only very minimal (15 degrees) of neck extension. Consequently, Hautant's test is for posterior circulation ischemia while Rhomberg's mainly tests for non-vascular cerebellar or vestibular disease.
Disclaimer:
The assessment and treatment techniques depicted or described in this site are not intended to replace formal instruction in orthopedic manual or any other type of physical therapy. They are intended to review, augment and facilitate the knowledge and skills previously gained on manual therapy or other course and to stimulate the untrained or trainee physical therapist to increase the bounds of his or her knowledge and skill base.
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