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OBJECTIVE: A review of current foundations for the medical diagnosis of vasospam and delayed cerebral ischaemia due to spontaneous subarachnoid haemorrhage. DEVELOPMENT: A review of available tests for the investigation of vasospasm (transcraneal Doppler, angiographic methods) and delayed cerebral ischaemia (clinical exam, computerised tomography by X rays, magnetic resonance, emission computerised tomography, electroencephalography, microdialysis) based on type and quality of information, advantages and limitations. Grading and trends for application were also considered for differential diagnosis. CONCLUSIONS: In current clinical practice the most advisable guideline for screening and diagnosis monitoring of vasospasm and delayed cerebral ischaemia is in the first place, based on clinical examination and transcraneal Doppler. The electroencephalographic monitoring, computerised tomography techniques and multi-modal magnetic resonance are justified in specific situations. Digital subtraction angiography is the current gold standard for diagnosis of cerebral vasospasm. There is a need for more and higher quality articles about the utility of diagnostic tests in this context.

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AIMS: The purpose of this work is to focus on the main practical aspects of the techniques used for the neurological physical examination of the sensory functions and to present an approach for the practice of this study. DEVELOPMENT: Despite the difficulty often involved in interpreting its results, today the formal examination of sensation is still an important part of a complete neurological evaluation and remains valid in the search for a correct diagnosis and suitable treatment. We recommend clinicians to carry out a brief but consistent and effective exploration in a systematic, flexible and orderly manner to check for abnormalities in the sensory functions. Should any anomalies be detected, then a more detailed and thorough neurological exploration must be performed selectively. We present a detailed review of the practical aspects of the main techniques used in the physical examination of this neurological category. In addition to the tests used to examine the peripheral and cortical sensory systems, we also describe other techniques designed to trigger pain or other sensory symptoms due to radicular lesions or injury to the median nerve. CONCLUSIONS: We present a detailed description of the main clinical techniques used in the neurological physical examination of the sensory functions, as well as an approach that allows them to be performed on adult patients. In addition, we underline the importance of physically examining the sensory functions in contemporary medicine and the need to continually perfect the way these techniques are performed in order to achieve an efficient clinical practice.

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Objetivos. Centrarnos en los principales aspectos prácticos de las técnicas para el examen físico neurológico de la función motora y refleja. Desarrollo. Se recomienda que los médicos apliquen de forma sistemática, flexible y ordenada una exploración breve, pero consistente y eficiente, para detectar alteraciones de las funciones motoras y reflejas del sistema nervioso. En caso de presentarse anormalidades, se indica la ejecución selectiva de una exploración neurológica más detallada e integral. Se revisan detalladamente los aspectos prácticos de las principales técnicas del examen físico de estas categorías neurológicas. Dentro de la función motora, se consideran las técnicas para explorar el tono muscular, la fuerza muscular, la fatigabilidad muscular, la hipocinesia, el temblor, la coordinación y la marcha. Por último, en esta categoría se abordan varias maniobras útiles en las parálisis histéricas o por simulación. Los reflejos a examinar usualmente se dividen en: a) Reflejos miotáticos; b) Reflejos cutaneomucosos; c) Reflejos de automatismo medular o de defensa, y d) Reflejos de postura y actitud. A éstos se añade el estudio de los reflejos patológicos primitivos, los reflejos a distancia, las sincinesias y los signos de irritación meníngea. Conclusiones. Se detallan las principales técnicas clínicas del examen físico neurológico de la motilidad y los reflejos, y se presenta un enfoque para su ejecución en el paciente adulto. Además, se subraya el valor que posee el examen físico del sistema nervioso en la medicina contemporánea y la necesidad de un perfeccionamiento continuo en la ejecución de sus técnicas para lograr una práctica clínica eficiente(AU)

Summary. Aims. The aim of this study is to highlight the chief practical aspects of the techniques used in the neurologicalphysical examination of the motor and reflex functions. Development. We recommend clinicians to carry out a brief but consistent and effective exploration in a systematic, flexible and orderly manner to check for abnormalities in the motor andreflex functions of the nervous system. Should any anomalies be detected, then a more detailed and thorough neurological exploration must be performed selectively. We present a detailed review of the practical aspects of the main techniques used inthe physical examination of these neurological categories. The motor function is explored using techniques that examine muscle tone, muscle strength, muscle fatigability, hypokinesia, tremor, coordination and gait. Lastly, in this category severalmanoeuvres that are useful in hysterical or mimicking paralyses are also dealt with. Reflexes to examination are usually divided into: 1. Myotatic reflexes; 2. Cutaneomucous reflexes; 3. Spinal cord or defence automatism reflexes; 4. Posture and attitudereflexes. We also add the study of primitive pathological reflexes, remote reflexes, synkinesias and signs of meningeal irritation. Conclusions. We present a detailed description of the main clinical techniques used in the neurological physical examination ofmotility and reflexes, as well as an approach that allows them to be performed on adult patients. In addition, we underline the importance of physically examining the nervous system in contemporary medicine and the need to continually perfect the waythese techniques are performed in order to achieve an efficient clinical practice(AU)

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Objetivo. Poner énfasis en los principales aspectos prácticos de las técnicas para el examen físico neurológico de la función sensitiva y presentar un enfoque para la práctica de este estudio. Desarrollo. A pesar de lo difícil que puede resultar su interpretación, el examen formal de la sensación es todavía una parte importante de la evaluación neurológica completa y mantiene su vigencia para el diagnóstico y el tratamiento apropiado. Se recomienda que los médicos apliquen, de forma sistemática, flexible y ordenada, una exploración breve, pero consistente y eficiente, a fin de detectar alteraciones de la función sensitiva. En caso de presentarse anormalidades se indica la ejecución selectiva de una exploración neurológica más detallada e integral. Se revisan detalladamente los aspectos prácticos de las principales técnicas del examen físico de esta categoría neurológica. Además de las pruebas para el examen del sistema sensitivo periférico y cortical, se describen otras técnicas diseñadas para desencadenar dolor u otros síntomas sensitivos por lesión radicular o del nervio mediano. Conclusiones. Se detallan las principales técnicas clínicas del examen físico neurológico de la función sensitiva y se presenta un enfoque para su ejecución en el paciente adulto. Además, se subraya el valor que posee el examen físico de la función sensitiva en la medicina contemporánea y la necesidad de un perfeccionamiento continuo en la ejecución de sus técnicas para lograr una práctica clínica eficiente(AU)

AIMS: The purpose of this work is to focus on the main practical aspects of the techniques used for the neurological physical examination of the sensory functions and to present an approach for the practice of this study. DEVELOPMENT: Despite the difficulty often involved in interpreting its results, today the formal examination of sensation is still an important part of a complete neurological evaluation and remains valid in the search for a correct diagnosis and suitable treatment. We recommend clinicians to carry out a brief but consistent and effective exploration in a systematic, flexible and orderly manner to check for abnormalities in the sensory functions. Should any anomalies be detected, then a more detailed and thorough neurological exploration must be performed selectively. We present a detailed review of the practical aspects of the main techniques used in the physical examination of this neurological category. In addition to the tests used to examine the peripheral and cortical sensory systems, we also describe other techniques designed to trigger pain or other sensory symptoms due to radicular lesions or injury to the median nerve. CONCLUSIONS: We present a detailed description of the main clinical techniques used in the neurological physical examination of the sensory functions, as well as an approach that allows them to be performed on adult patients. In addition, we underline the importance of physically examining the sensory functions in contemporary medicine and the need to continually perfect the way these techniques are performed in order to achieve an efficient clinical practice(AU)

Assuntos

RESUMO

AIMS: The aim of this study is to highlight the chief practical aspects of the techniques used in the neurological physical examination of the motor and reflex functions. DEVELOPMENT: We recommend clinicians to carry out a brief but consistent and effective exploration in a systematic, flexible and orderly manner to check for abnormalities in the motor and reflex functions of the nervous system. Should any anomalies be detected, then a more detailed and thorough neurological exploration must be performed selectively. We present a detailed review of the practical aspects of the main techniques used in the physical examination of these neurological categories. The motor function is explored using techniques that examine muscle tone, muscle strength, muscle fatigability, hypokinesia, tremor, coordination and gait. Lastly, in this category several manoeuvres that are useful in hysterical or mimicking paralyses are also dealt with. Reflexes to examination are usually divided into: 1. Myotatic reflexes; 2. Cutaneomucous reflexes; 3. Spinal cord or defence automatism reflexes; 4. Posture and attitude reflexes. We also add the study of primitive pathological reflexes, remote reflexes, synkinesias and signs of meningeal irritation. CONCLUSIONS: We present a detailed description of the main clinical techniques used in the neurological physical examination of motility and reflexes, as well as an approach that allows them to be performed on adult patients. In addition, we underline the importance of physically examining the nervous system in contemporary medicine and the need to continually perfect the way these techniques are performed in order to achieve an efficient clinical practice.

Assuntos

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Objetivo. Centrarnos en los principales aspectos prácticos de las técnicas para el examen físico del sistema nervioso y presentar un enfoque para la práctica de este estudio en el paciente adulto. Desarrollo. Se recomienda que los médicos apliquen de forma sistemática, flexible y ordenada una exploración breve, pero consistente y eficiente, para detectar alteraciones de las funciones del sistema nervioso. En caso de hallar anormalidades, se indica la ejecución selectiva de una exploración neurológica más detallada e integral. Las técnicas y los datos de este examen se organizan dentro de cinco grandes categorías: estado mental, nervios craneales, función motora, función refleja y función sensitiva. A continuación, se revisan detalladamente los aspectos prácticos de las principales técnicas del examen físico de los nervios craneales y se añade la descripción de la técnica para la palpación de los principales nervios periféricos. Conclusiones. Se detallan las principales técnicas clínicas del examen físico de los nervios craneales y de la palpación de los nervios periféricos y se presenta un enfoque para la ejecución del examen neurológico. Además, se subraya el valor que posee el examen físico del sistema nervioso en la medicina contemporánea y la necesidad de un perfeccionamiento continuo en la ejecución de sus técnicas para lograr una práctica clínica eficiente(AU)

AIMS: The purpose of this work is to focus on the main practical aspects of the techniques used for the physical examination of the nervous system and to present an approach for the practice of this study in adult patients. DEVELOPMENT: We recommend clinicians to carry out a brief but consistent and effective exploration in a systematic, flexible and orderly manner to check for alterations in the functioning of the nervous system. Should any anomalies be detected, then a more detailed and thorough neurological exploration must be performed selectively. The techniques and data from this examination are organised into five broad categories: mental status, cranial nerves, motor function, reflex function and sensory function. The practical aspects of the main techniques used in the physical exploration are reviewed and we also describe the technique to be employed for palpating the main peripheral nerves. CONCLUSIONS: The study offers a detailed description of the chief clinical techniques used in the physical exploration of the cranial nerves and for the palpation of the peripheral nerves; we also present an approach to performing the neurological examination. Furthermore, we highlight the importance of physically examining the nervous system in contemporary medicine and the need to continually perfect the way these techniques are performed in order to achieve an efficient clinical practice(AU)

Assuntos

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AIMS: The purpose of this work is to focus on the main practical aspects of the techniques used for the physical examination of the nervous system and to present an approach for the practice of this study in adult patients. DEVELOPMENT: We recommend clinicians to carry out a brief but consistent and effective exploration in a systematic, flexible and orderly manner to check for alterations in the functioning of the nervous system. Should any anomalies be detected, then a more detailed and thorough neurological exploration must be performed selectively. The techniques and data from this examination are organised into five broad categories: mental status, cranial nerves, motor function, reflex function and sensory function. The practical aspects of the main techniques used in the physical exploration are reviewed and we also describe the technique to be employed for palpating the main peripheral nerves. CONCLUSIONS: The study offers a detailed description of the chief clinical techniques used in the physical exploration of the cranial nerves and for the palpation of the peripheral nerves; we also present an approach to performing the neurological examination. Furthermore, we highlight the importance of physically examining the nervous system in contemporary medicine and the need to continually perfect the way these techniques are performed in order to achieve an efficient clinical practice.

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