Vancouver IM LMR

Dr. Dylan Meng (Neurology, PGY2) presented a very high yield and practical noon rounds on neurology topics for CTU, namely the mental status assessment and approach to localization for weakness.

See his didactic slide deck here.

Key takeaway points:

• Mental status exam:
  • Level of consciousness
  • If patient is conscious, next level to assess is attention and language
• Localization for weakness:
  • Time course of symptoms (hyperacute, acute, subacute, to chronic) helps guide differential diagnosis!
  • History should include: distribution, bulbar/ respiratory symptoms, pain/ sensory involvement, and associated features to help with localization of weakness
  • Localization patterns (see his slides for breakdown of how to localize to each):
    • Muscle
    • NMJ
    • Peripheral neuropathies
    • Plexus injury
    • Nerve root
    • Anterior horn cell
    • Spinal cord
    • Brainstem
      • Posterior circulation stroke (pontine specifically) should ALWAYS be on your differential for hyperacute loss of consciousness/ coma! Get a CT/CTA arch to vertex
    • Subcortex
    • Cortex
  • Three neurological emergencies that cause bilateral leg weakness:
    • Cauda equina syndrome
    • Spinal cord compression (myelopathy)
    • Guillain-Barre syndrome