9. Movement Disorders
Authors Dawn DeWitt, MD In this module Optional activity Watch the movie Awakenings. Characterize as hypokinetic vs. hyperkinetic Speed, amplitude, and frequency of movement; fatigability, suppressibility; randomness, directionality. Detailed assessment of motor function and gait. Assess muscle tone for rigidity—increase in resistance to passive movement. Gait: Base, pace, stride, foot clearance, postural stability, arm swing. […]
References
Meagher, R.J., et.al. Which CT findings indicate chronic subdural hematomas (SDGs). Jul. 26, 2018. [Medscape.] Intracranial Hemorrhage. Visual aid. Loyola University Chicago Stritch School of Medicine. Payne WN, De Jesus O, Payne AN. Contrecoup Brain Injury. [Updated 2021 Aug 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Shashidhar, V.M. Pathology of Head […]
Knowledge Check
While this knowledge check is “open book,” the best way to learn is to practice spaced-repetition “free recall.” Try to answer these without looking at the answers. Check your answers CTE (Chronic traumatic encephalopathy) Epidural hematoma Subdural hematoma Subarachnoid hemorrhage Skull fracture Diffuse axonal injury Diffuse cerebral edema (second impact syndrome)
Case Study 4: Stopped by a Tree
Case study 4: Olivia—Stopped by a tree Tap the image to view the case. A 21-year-old student on the WSU ski team presents after popping out of her ski while practicing on the race course. Her fall into a ravine was “stopped by a tree.” She hit the back of her head. She’s not sure […]
Cerebral Vasospasm and Diffuse Axonal Injury (DAI)
Cerebral vasospasm Common phenomenon following brain bleeds (especially aneurysmal SAH), as blood is a CNS irritant. True incidence unknown, but estimated to occur in up to ~70% of TBI-related bleeds. Clinical presentation Prevention/Treatment Location Cause Imaging Most often presents 3–7 days after aSAH, but may occur up to 21 days after the bleed. S/sx: New […]
Case Study 3: Seeing Black Spots
Case study 3: Murray—Seeing black spots Tap the image to view the case. A 78 y/o male with a history of HTN presents to the ER a week after he was discharged following emergent neurosurgical management of a ruptured Berry aneurysm. He says he’s seeing “black spots” and has had a worsening headache for the […]
Subarachnoid Hemorrhage
Location Cause Clinical presentation Prognosis Imaging Between arachnoid and pia mater. May be traumatic or non-traumatic in origin. Most common causes: Aneurysmal/vascular malformation (esp. sacular or “berry” aneurysms) → sudden, un-attenuated increase in intravascular pressure leads to rupture. Carotid artery dissection. Skull base fracture (can lead to internal carotid aneurism). Amyloid angiopathy. Vasculitis. Cerebral vasospasm, […]
Epidural and Subdural Hematomas
Epidural hematoma Location Cause Demographics Clinical presentation Imaging Extra-axial; between dura and skull (often temporal bone), or dura and vertebrae if spinal. Most commonly traumatic; frequently involves skull fracture. Typically an arterial bleed (middle meningeal artery), but can also be venous. Arterial source → rapid bleed. More commonly seen in younger patients; attributed to traumatic […]
Case Study 2: Fall while Skiing
Case study 2: Martha—Fall while skiing Tap the image to view the case. A 55 y/o actress falls while skiing without a helmet. She hits her head but gets up and skis to the bottom. Two hours later, she decides to take a nap because she feels “very tired” and has a mild headache. An […]
Case Study 1: Unresponsive at a Bus Stop
Case study 1: Mitch—Unresponsive at a bus stop Tap the arrow to view the case. Image source. A 63 y/o male is brought into the ED after being found unresponsive at a bus stop. His pupils are slightly unequal in size, and he only responds to painful stimuli. He is identified presumptively by the wallet […]