Chiangmai Neurology http://www.chiangmaineurology.com "Brain, Science and Ideas" Fri, 26 Feb 2010 23:13:02 +0000 http://wordpress.org/?v=2.9.2 en hourly 1 The history of reflex hammer http://www.chiangmaineurology.com/archives/797 http://www.chiangmaineurology.com/archives/797#comments Fri, 26 Feb 2010 01:20:15 +0000 admin http://www.chiangmaineurology.com/?p=797

History of the Reflex Hammer

The history of reflex hammers begins in 1875, when Erb and Westphal described the clinical utility of the muscle stretch reflex. At that time, it was realized that a tool would be required to test reflexes. Heinrich Erb recommended testing the patellar-tendon reflex (the knee-jerk reflex we all know and love) by striking the tendon with either a finger or a percussion hammer. Carl Friedrich Otto Westphal similarly recommended this reflex, by striking the patellar ligament “lightly but quickly with a finger — best when the index finger is put on top of the middle finger and the former is accelerated downward — or even more effectively with a percussion hammer.” [Author's note: after hours of twisting my fingers around, I have yet to figure out what he meant]

In the 1880’s, William Gowers coined the phrase “myotatic reflex” for this knee-jerk reflex, and he recommended eliciting this reflex by striking the patellar tendon with either the side of the hand or the rubber edge of the end of a stethoscope. I know that most physicians have experimented with these techniques, as it is very common (and disgraceful in my opinion) to be without a reflex hammer handy.

Over the next several decades, percussion hammers became the preferred tools for eliciting reflexes. Charcot even recommended the particular Skoda hammer for obtaining the knee-jerk reflex. Joseph Babinski (Charcot’s pupil) was an advocate of hammers. Rather than use the side of the hand, he felt “one would be better served to use a percussion hammer.” Bernhard Berliner (like myself) was an adamant advocate of hammers. He is quoted as having said “it is not very elegant to percuss the knee or achilles tendon with a paper weight, the edge of a large electrode, the foot of a laboratory stand, a table lamp, or similar devices.”

Because percussion hammers were not specifically designed for eliciting reflexes, it is to be expected that hammers would be developed specifically for this purpose. It was quickly realized that the percussion hammer had too small a head and was too light to securely strike the desired tendon. In addition to greater weight and larger stiking area, some hammer designers added a pointed tip to facilitate testing of cutaneous reflexes, a pin, a brush, and a ruler along the handle.

The first “reflex hammer” was probably designed by John Madison Taylor in Philadelphia in 1888. Krauss, Berliner , Dejerine, Stuempell, Troemner, Babinski, Ebstein, Wintle, and others developed reflex hammers which enjoyed popularity.

The most consistent new feature of these reflex hammers was their greater weight. The Taylor hammer, at approximately 60 – 70 grams, was considered heavy when it was introduced. The later hammers were even heavier, weighing between 80 and 140 grams. Some contemporary versions of the Troemner and Queen Square hammers weight over 200 grams! The added weight of the head, and in some cases a longer flexible handle, increased the hammer’s effectiveness. Berliner even claimed that his hammer “allows, in almost all instances, the elicitation of an existing achilles reflex through the patient’s boots.” Now that’s a reflex hammer.

]]> http://www.chiangmaineurology.com/archives/797/feed 0 Neurological examination: Family Practice Curriculum in Neurology © 2001 American Academy of Neurology http://www.chiangmaineurology.com/archives/775 http://www.chiangmaineurology.com/archives/775#comments Fri, 15 Jan 2010 20:00:26 +0000 admin http://www.chiangmaineurology.com/?p=775 This page will link to the Family Practice Curriculum in Neurology page from website

http://www.aan.com/familypractice/html/menu.htm

Purpose and Goals

Introduction

In Memory of Dr. Eun-Kyu Lee

Contents
Chapter 1 – The Neurologic Examination
Raymond A. Martin, MD, Eun-Kyu Lee, MD,
and Edward L. Langston, MD, RPh

Chapter 2 – Visual Problems
Leonard Hershkowitz, MD, J. Albert Hagy, MD

Chapter 3 – Numbness: A Practical Guide for Family Physicians
Jeffrey Rosenfeld, MD, Raymond A. Martin, MD, and David Bauer, MD

Chapter 4 – Weakness: Practical Guide for Family Physicians
Raymond A. Martin, MD, Jeffrey Rosenfeld, MD, and David Bauer, MD

Chapter 5 – The Dizzy Patient: A Clear-Headed Approach
Martin A. Samuels, MD, Jerri Harris, MPH

Chapter 6 – Headaches: Practical Management
Thomas N. Ward, MD, George H. Sands, MD, and J. Christopher Shank, MD

Chapter 7 – Episodic Disorders
Donna C. Bergen, MD, Thomas A. Madden, MD

Chapter 8 – Gait and Movement Disorders
Rosabel R. Young, MD, MS, Richard W. Homan, MD, and J. Thomas Hutton, MD, PhD

Chapter 9 – Neck and Back Pain
Lynne P. Taylor, MD, Sandi E. Lemming, MD

Chapter 10 – Common Neurologic Emergencies
Sidney Starkman, MD, Grant C. Fowler, MD

Chapter 11 – Changes in Behavior
Jeffrey Victoroff, MD, Michael Herbst, MD, Rosabel Young, MD

Chapter 12 – Sleep Disorders
Eun-Kyu Lee, MD, Jerri Harris, MPH

Chapter 13 – Common Problems in Pediatric Neurology
Bhuwan P. Garg, MB, BS, Hema U. Patel, MD, and Laurence E. Walsh, MD


Videotaped Segments of the Neurologic Examination

Brief Office Examination
Instruments
Cranial Nerve I – Olfactory Nerve
Cranial Nerve V – Trigeminal Nerve
Cranial Nerve VII – Facial Nerve
Cranial Nerve VIII – Acoustic Nerve
Cranial Nerves IX and X – The Glossopharyngeal and Vagus Nerves
Cranial Nerve XI – Accessory Nerve
Cranial Nerve XII – Hypoglossal Nerve
The Sensory System
The Extrapyramidal System
The Pyramidal System
The Cerebellum and Coordination
The Visual Exam
Gait

Evaluation

To complete and submit the evaluation form electronically:www.aan.com/familypractice

To print the evaluation and mail or fax the completed form: Family Practice Curriculum in Neurology Evaluation

Documents in PDF format for easier printing

Family Practice Curriculum in Neurology
Table of Contents
Introduction
In Memory of Dr. Eun-Kyu Lee
Acknowledgement
List of Authors
Chapter 1 – The Neurologic Examination
Chapter 2 – Visual Problems
Chapter 3 – Numbness: A Practical Guide for Family Physicians
Chapter 4 – Weakness: Practical Guide for Family Physicians
Chapter 5 – The Dizzy Patient: A Clear-headed Approach
Chapter 6 – Headaches: Practical Management
Chapter 7 – Episodic Disorders
Chapter 8 – Gait and Movement Disorders
Chapter 9 – Neck and Back Pain
Chapter 10 – Common Neurologic Emergencies
Chapter 11 – Changes in Behavior
Chapter 12 – Sleep Disorders
Chapter 13 – Pediatric Neurology

]]> http://www.chiangmaineurology.com/archives/775/feed 0 After WCN Thailand 2009 http://www.chiangmaineurology.com/archives/770 http://www.chiangmaineurology.com/archives/770#comments Mon, 04 Jan 2010 06:49:33 +0000 admin http://www.chiangmaineurology.com/archives/770 After smog

งาน World Congress of Neurology ก็ผ่านไปด้วยดีครับ ได้พบ Professor หลายท่าน

Lecture หลาย lecture ช่างมหัศจรรย์อะไรอย่างนี้ ถ้าถามว่า lecture อะไรที่ชอบที่สุด ก้อตอบยาก เพราะมีหลาย lecture เหลือเกิน

ได้ไปเข้า Progressive supranuclear palsy หรือ steele richardson olszewski syndrome – the history ก็เห็น slide นี้ ที่เป็น case report ของประเทศไทย

PSP First thai patient

ผู้ป่วยรายนี้ Report โดย John C Steel.  ผู้ที่เป็นหนึ่งในชื่อโรคหนะแหละครับ

ประวัติ Progressive supranuclear palsy โดย Whonameit.com

Steele-Richardson-Olszewski disease(Progressive supranuclear palsy)

Also known as:
Steele-Richardson-Olszewski syndrome
Associated persons:
Jerzy Olszewski
John Clifford Richardson
John C. Steele

Description:
A progressive neurologic disorder characterized by a supranuclear ophthalmoplegia, especially paralysis of vertical gaze; retraction of eyelids, psuedobulbar palsy, dyasarthria, dystonic rigidity of the neck and trunk, and dementia. Onset usually in the sixth decade.

Richardson first recognized the condition in 1955 in his private practice and began looking for other patients. The team of Richardson, Steele and Olszewski began working together in 1959.

งานปีนี้สำเร็จไปด้วยดีครับ  ถามอาจารย์อวุโสท่านนึง กล่าวว่า ไม่รู้ว่า ประเทศไทยจะมีโอกาสมาจัดงานใหญ่ ๆแบบนี้อีกเมื่อไหร่ ถ้าย้อนไปดู ประเทศใหญ่ ๆ อย่าง England จะเห็นว่า กว่าจะกับมาจัดครั้งที่ 2 หลังจากจัดครั้งแรกไปแล้วก็ปาเข้าไปตั้ง 50 ปีแนะ อืม เห็นที่ครั้งใหญ่ผมต้องรอช่ติหน้าแล้วมั้งครับเนี่ย

Dr. Surat

]]> http://www.chiangmaineurology.com/archives/770/feed 0 Cluster headache lecture: UCSF 2008 by P. J. Goadsby http://www.chiangmaineurology.com/archives/764 http://www.chiangmaineurology.com/archives/764#comments Tue, 29 Dec 2009 14:23:12 +0000 admin http://www.chiangmaineurology.com/?p=764

]]> http://www.chiangmaineurology.com/archives/764/feed 0 Vilayanur S. Ramachandran http://www.chiangmaineurology.com/archives/761 http://www.chiangmaineurology.com/archives/761#comments Thu, 03 Dec 2009 17:56:21 +0000 admin http://www.chiangmaineurology.com/?p=761 From official website of V.S. Ramachandran

http://cbc.ucsd.edu/ramalab.html

V.S. Ramachandran is Director of the Center for Brain and Cognition and Professor with the Psychology Department and Neurosciences Program at the University of California, San Diego, and Adjunct Professor of Biology at the Salk Institute. Ramachandran initially trained as a doctor and subsequently obtained a Ph.D. from Trinity College at the University of Cambridge. Ramachandran’s early work was on visual perception but he is best known for his experiments in behavioral neurology which, despite their apparent simplicity, have had a profound impact on the way we think about the brain. He has been called “The Marco Polo of neuroscience” by Richard Dawkins and “The modern Paul Broca” by Eric Kandel.

In 2005 he was awarded the Henry Dale Medal and elected to an honorary life fellowship by the Royal Instituion of Great Britain. His other honours and awards include fellowships from All Souls College, Oxford, and from Stanford University; the Presidential Lecture Award from the American Academy of Neurology, two honorary doctorates, the annual Ramon Y Cajal award from the International Neuropsychiatry Society, and the Ariens-Kappers medal from the Royal Netherlands Academy of Sciences. In 2003 he gave the annual BBC Reith lectures and was the first physician/psychologist to give the lectures since they were begun by Bertrand Russel in 1949. In 1995 he gave the Decade of the Brain lecture at the 25th annual (Silver Jubilee) meeting of the Society for Neuroscience. Most recently the President of India conferred on him the second highest civilian award and honorific title in India, the Padma Bhushan.

Ramachandran has published over 180 papers in scientific journals (including five invited review articles in the Scientific American). He is author of the acclaimed book “Phantoms in the Brain” that has been translated into nine languages and formed the basis for a two part series on Channel Four TV (UK) and a 1 hour PBS special in USA. NEWSWEEK magazine has named him a member of “The Century Club” – one of the “hundred most prominent people to watch in the next century.”

Recent Reviews

A Brief Tour of Human Consciousness; BBC Reith Lectures. New York: Pi Press, 2004

“Vintage Ramachandran, packed with ideas that are bold, irreverent, original, and ingenious. People who have never thought much about the brain will be intrigued, but so will those who, like me, have spent most of their lives thinking about the brain.”

-David Hubel, Nobel Laureate, Harvard University, author of Eye, Brain, and Vision

“An extraordinary book by a remarkable scientist! Ramachandran is … the modern Paul Broca, the great French neurologist who opened up the biological analysis of higher mental functions.”

-Eric R. Kandel, M.D., Nobel Laureate, Columbia University

“The Marco Polo of neuroscience.”

-Richard Dawkins, Oxford University, author of The Blind

Phantoms in the Brain. New York: William Morror, 1998.

“The patients he describes are fascinating and his experiments on them are both simple and ingenious. If you are at all interested in how your brain works, this is the book you must read.”

-Francis Crick, Nobel Laureate, Salk Institute

“…Enthralling not only for its clear and eloquent descriptions of neurological phenomena but also for its portrait of Dr. Ramachandran, a scientist in search of the secrets of the mind…and he is a splendid subject indeed.”

-Michael Goldberg, M.D., Chief of Neuropsychology NIH

]]> http://www.chiangmaineurology.com/archives/761/feed 0 European Federation of Neurological Societies Guideline http://www.chiangmaineurology.com/archives/757 http://www.chiangmaineurology.com/archives/757#comments Sun, 29 Nov 2009 13:42:46 +0000 admin http://www.chiangmaineurology.com/?p=757
Guideline papers from EFNS European Federation of Neurological Societies
Original website
http://www.efns.org/Guideline-Archive.389.0.html

J. Finsterer et al.; EJoN, Volume 16, 2009

M. Billiard et al.; EJoN, Volume 13, 2006

P. O. Lundberg et al.; EJoN, Volume 8, 2001

M. P. Barnes et al.; EJoN, Volume 4, 1997
]]> http://www.chiangmaineurology.com/archives/757/feed 0 Clinical Practice Guidelines published in CMAJ http://www.chiangmaineurology.com/archives/753 http://www.chiangmaineurology.com/archives/753#comments Sun, 29 Nov 2009 13:12:51 +0000 admin http://www.chiangmaineurology.com/?p=753 Clinical Practice Guidelines published in CMAJ

From original website

http://www.cmaj.ca/misc/service/guidelines.shtml

This is an archive of Clinical Practice Guidelines that have been published in CMAJ. More recent guidelines may be available elsewhere. We now encourage formal submissions of rigorous evidence-based guidelines. Click here to submit a guideline through our online submission system.

2008

Canadian best practice recommendations for stroke care (updated 2008)

2007

2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children [summary]

2005

Care and treatment of breast cancer

Fetal alcohol spectrum disorder: Canadian guidelines for diagnosis

Canadian Society of Transplantation: consensus guidelines on eligibility for kidney transplantation

2004

Summary of recommendations from the Canadian Asthma Consensus Guidelines, 2003 and Canadian Pediatric Asthma Consensus Guidelines, 2003 (updated to December 2004)

2003

Management of dyslipidemia and the prevention of cardiovascular disease (2003) SUMMARY | FULL TEXT

Care of HIV-positive pregnant women: putting recommendations into practice

2002

Management of pregnancy, labour and delivery and for postpartum care in HIV-positive pregnant women and their offspring (summary)

Diagnosis and management of osteoporosis in Canada

2001

Screening and management of developmental dysplasia of the hip in newborns

Canadian Society of Transplantation: consensus guidelines on eligibility for kidney transplantation

Screening mammography among women aged 40-49 years at average risk of breast cancer

2000

Prevention of child maltreatment

Screening and management of hyperhomocysteinemia for the prevention of coronary artery disease events (2000)

Management and treatment of dyslipidemia

Management of uninvestigated dyspepsia in the era of Helicobacter pylori

1999

Canadian asthma consensus report | Summary

The recognition, assessment and management of dementing disorders

Management of hypertension

Lifestyle modifications to prevent and control hypertension

Management of irritable bowel syndrome in family practice

Detection, prevention and treatment of obesity

Elevated levels of serum creatinine: recommendations for management and referral

Echocardiography for the detection of a cardiac source of embolus in patients with stroke

1998

Management of diabetes in Canada

Universal counselling and offering of HIV testing in pregnancy in Canada

Antiretroviral therapy for HIV infection

1997

Red blood cell and plasma transfusion for adults and children

Report of the Canadian Hypertension Society Consensus Conference: 
1. Definitions, evaluation and classification of hypertensive disorders in pregnancy
2. Nonpharmacologic management and prevention of hypertensive disorders in pregnancy
3. Pharmacologic treatment of hypertensive disorders in pregnancy

Diagnosis and management of migraine in clinical practice

Use of carotid endarterectomy

1996

Guidelines for the emergency management of asthma in adults

Prenatal screening for and diagnosis of Down syndrome

Recommendations for ensuring early thrombolytic therapy for acute myocardial infarction

Screening for chlamydial infections

1995

Guidelines for the use of allergen immunotherapy

Diagnosis, comprehensive care and assessment

Prevention of dental caries

Screening for human papillomavirus infection in asymptomatic women

Screening for visual problems among elderly patients

1994

Primary and secondary prevention of neural tube defects

Screening strategies for colorectal cancer

Secondary prevention of elder abuse and mistreatment

Obesity in childhood

Essentials of tuberculosis control for the practising physician

1993

Recommendations on the use of folic acid supplementation to prevent the recurrence of neural tube defects

Guidelines for the identification, investigation and treatment of individuals with concomitant tuberculosis and HIV infection

Periodontal diseases: classification, diagnosis, risk factors and prevention

Guidelines for the investigation of individuals who were place under surveillance for tuberculosis post-landing in Canada

1992

Assessment and management of chronic obstructive pulmonary disease

]]> http://www.chiangmaineurology.com/archives/753/feed 0 Functional blemphalospasm Following conjunctivitis (1931): wellcome film http://www.chiangmaineurology.com/archives/745 http://www.chiangmaineurology.com/archives/745#comments Thu, 26 Nov 2009 16:52:30 +0000 admin http://www.chiangmaineurology.com/?p=745

A brief clinical case from Germany showing blepharospasm and gait consequent upon it. Find out more

]]> http://www.chiangmaineurology.com/archives/745/feed 0 Galen of Pergamum(ca. 130-ca.200) http://www.chiangmaineurology.com/archives/731 http://www.chiangmaineurology.com/archives/731#comments Mon, 23 Nov 2009 09:57:31 +0000 admin http://www.chiangmaineurology.com/?p=731 photo-credits.html.jpg

Greek physician considered second only to Hippocrates of Cos in his importance to the development of medicine, Galen performed extensive dissections and vivisections on animals. Although human dissections had fallen into disrepute, he also performed and stressed to his students the importance of human dissections. He recommended that students practice dissection as often as possible. He studied the muscles, spinal cord, heart, urinary system, and proved that the arteries are full of blood. He believed that blood originated in the liver, and sloshed back and forth through the body, passing through the heart, where it was mixed with air, by pores in the septum. Galen also introduced the spirit system, consisting of natural spirit or “pneuma” (air he thought was found in the veins), vital spirit (blood mixed with air he believed to found in the arteries), and animal spirit (which he believed to be found in the nervous system). In On the Natural Facilities, Galen minutely described his experimentation on a living dog to investigate the bladder and flow of urine. It was Galen who first introduced the notion of experimentation to medicine.

Galen believed everything in nature has a purpose, and that nature uses a single object for more than one purpose whenever possible. He maintained that “the best doctor is also a philosopher,” and so advocated that medical students be well-versed in philosophy, logic, physics, and ethics. Galen and his work On the Natural Faculties remained the authority on medicine until Vesalius in the sixteenth century, even though many of his views about human anatomy were false since he had performed his dissections on pigs, Barbary apes, and dogs. Galen mistakenly maintained, for instance, that humans have a five-lobed liver (which dogs do) and that the heart had only two chambers (it has four).

]]> http://www.chiangmaineurology.com/archives/731/feed 1 When aura make creativity http://www.chiangmaineurology.com/archives/724 http://www.chiangmaineurology.com/archives/724#comments Fri, 20 Nov 2009 10:39:33 +0000 admin http://www.chiangmaineurology.com/?p=724 Visual auras ของไมเกรน ถือว่าเป็นปรากฎการณ์ที่น่าสนใจของ neurologist เป็นอย่างยิ่ง  โดย Oliver Sacks Neurologist นักประพันธ์ชชื่อดังได้มีการเขียนบรรยายปรากฎการณ์ไมเกรน aura ในหนังสือ  Migraine ของเขา โดย  Lewis Carroll ผู้ประพันธ์หนังสือนิยายแฟนตาซีเรื่อง “ALICE IN WONDERLAND” มีปัญหาปวดศีรษะไมเกรน และยิ่งกว่านั้น ยังเป็นไมเกรน visual aura อีกด้วย โดยมีลักษณะของ การมองเห็นภาพที่บิดเบี้ยว หรือ unusual visual distortions นำมาก่อนอาการปวดศีรษะ ซึ่งอาการมองเห็นภาพบิดเบี้ยว ในปัจจุบันเรียกตามลักษณะตัวละคร ในเรื่อง ALICE IN WONDERLAND ว่า  ”Alice in Wonderland syndrome”

ไม่ต้องเป็นที่กังขา Visual distortion ของ Caroll ทำให้งานเขียนเรื่อง Alice in the wonderland มีสีสันขนาดไหน เรียกได้ว่า Caroll อาจต้องขอบคุณอาการ aura ของ ไมเกรน ที่ทำให้หนังสือ เรื่อง Alice in the wonderland เป็นหนังสืออันน่าอัศจรรย์ติดอันดับขายดีตลอดการระดับโลกมาจนถึงปัจจุบัน

Term Alice in the wonderland syndrome(AIWS) ได้ถูกเรียกมาตั้งแต่ปี 1955 โดยการบรรยายถึงการที่มีการมองเห็น รูปภาพบิดเบี้ยว ในแง่ของรูปร่าง ขนาด ตำแหน่ง ซึ่งสามารถเรียกลักษณะการมองเห็นผิดปกตินี้ได้ว่า macro- and microsomatognosia

A migraine sufferer’s report of the Alice in Wonderland syndrome

“Throughout my early childhood I suffered from migraine headaches. My mom got migraines too so she just gave me children’s Tylenol and told me to tough it out. When I was 10 years old, I woke up one morning and I almost felt like I was still asleep and dreaming. I was still laying down in my bed and I held out my hands in front of me and they didn’t feel like my hands, they felt like long skinny dry twigs. If I concentrate hard enough I can ‘remember’ the feeling and my hands start to feel that way again. After a few minutes it all went away and I didn’t say anything to my parents about it. But for the next couple of weeks it happened more and more often, usually in the evening. Most of the time it was when I was sitting still, I would feel so incredibly heavy that I was sure I couldn’t move any part of my body and my depth perception felt like it was completely off. One time while I was walking down the hall I felt like the walls were rushing past me at 50 mph. One afternoon after school I was sitting on my bed, which was a day bed with a spiraly-cast iron design on the headboard and while I was looking at it it started to move and rotate, like it was turning like a wheel. When I tried to explain this to my parents I got frustrated because my eyes were telling me that my bed wasn’t moving, but my brain was telling me that it was moving. Every episode was accompanied with a strange feeling that at the time I didn’t understand, but in retrospect I would call it an extreme-version of light-headedness, kind of like you’re on laughing gas but highly uncomfortable and very scary. And every episode was followed by a killer migraine headache… An EKG, an MRI, and a couple of months later the diagnosis was I had an ‘abnormal brainwave’ which was ‘triggered’ when I had a migraine, causing hallucinatory side effects to my migraine. The doctor actually called it ‘Alice In Wonderland Syndrome’ saying that it was compared to how Alice felt while tumbling down the rabbit hole. At the time, we thought this could possibly be the delusions of a Southern California doctor who had spent a little too much time trying out ‘herbal’ remedies. But he had newspaper clippings and journal clippings to back up his theory.”

(Jen Smith, Alice In Wonderland Syndrome forum, March 12, 2005)

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