LESSON № 6 (PRACTICAL – 6 HOURS)
Theme: 1. Intracranial Tumor and Tumor of the Spinal Cord.
2. Epilepsy and convulsive syndromes. Classification and diagnosis of epileptic attack and convulsive syndromes.
Aim: Students should be able to find out symptoms of intracranial tumor and tumor of the spinal cord, to set cure. To be able to make diagnosis and treatment the convulsive syndromes and epilepsy ieurological patients. To be able himself to make correct topical, clinical diagnosis and prescribe adequate treatment.
Professional orientation of students: Brain tumor and tumors of the spinal cord are very common at any age. They are characterized by severe changes of central nervous system. That’s why in time diagnosis of brain tumors and tumors of the spinal cord has very important meaning for the effective treatment of such patients. Lesion of the nervous system caused by different pathology of infection, vascular, endocrinal, traumatic, tumor and other character. All specialists of medicine must make a correct topical and clinical diagnosis for adequate pharmacotherapy. Knowledge of the clinical features, early diagnosis, prevention and treatment of the epilepsy and convulsive syndromes are necessary not only for neurologists but every other physicians, clinicians, laboratory assistants, electro physiologists.
Methodology of Practical Class (9:00-12:00).
Algorithm of students’ communication with patients with pathology in subject (communication skills):
Complaints and anamnesis taking in patients
1. Friendly facial expression and smile.
2. Gentle tone of speech.
3. Greeting and introducing
4. Find a contact with a patient, try to gain his/her confidence
5. Correct inquest, listening to the patient’s explanation.
6. Conversation accomplishment.
Physical methods of examination
1. Friendly facial expression and smile.
2. Gentle tone of speech.
3. Greeting and introducing
4. Find a contact with a patient, try to gain his/her confidence
5. Explain to the patient the nessessity of the examination and its aim, get his/her informed consent
6. Explain to the patient examination details, its safety and possible sensations
7. Prepare for the examination (clean, warm hands, ets.)
8. Explain to the patient results of his/her tests correctly and accesibly
9. Conversation accomplishment.
Informing about the results of examination
1. Friendly facial expression and smile.
2. Gentle tone of speech.
3. Greeting and introducing
4. Interpretation of test results
5. Calm a patient in the case of precense of pathological changes, inform about the following actions
6. Assure in positive changes and favourable prognosis at implementation of all of the medical recommendations
7.Conversation accomplishment
Work 1.
Intracranial Tumor and Tumor of the Spinal Cord.
Step II. Aim: To prescribe the treatment.
The treatment of the brain tumors is surgical extirpation, when possible, followed by radiation therapy when indicated. If the tumor cannot be removed in tote, partial removal followed by radiation therapy may appreciably lengthen the period of useful life.
Hypertonic solutions formerly given to alleviate the symptoms due to increased intracranial pressure have been replaced by the administration of corticosteroids, particularly dexamethazone. Prompt improvements of the symptoms due to increased and partial or occasionally almost complete remission of focal symptoms often result for a limited period of time.
Work 2.
Epilepsy and convulsive syndromes. Classification and diagnosis of epileptic attack and convulsive syndromes.
1. To examine the patient (history, somatic-neurological state).
2. To use the results of the laboratory investigation (general and biochemical blood and urine analyses, EEG, craniography, CT –scan tomography).
3. To make the differential diagnosis using the algorithm.
4. To make the clinical diagnosis.
Step II. Aim: To prescribe adequate treatment.
The treatment of patients with convulsive seizure can be divided into four parts:
1. Elimination of the factors of importance in the causation or precipitation of attacks
2. General mental and physical hygiene
3. Medical therapy directed toward elevation of the convulsive threshold and thus the prevention of the attacks
4. Surgical therapy in carefully selected patients with focal epilepsy
Step III. Aim: Preventive determination.
Prognostic examination is determined according the clinical diagnosis and effectiveness of the treatment. To make the prognosis to live, to recover, to work, make a complex of the preventive measures.
Individual Students Program.
You should be prepared for the practical class using the existing textbooks and lectures. Special attention should be paid to the following:
Theme 1. Intracranial Tumor and Tumor of the Spinal Cord.
1. Clinical features of brain tumors:
a) characteristic of hypertension syndrome;
b) local signs;
c) characteristic of cerebrospinal fluid.
2. Clinical features of spinal tumors:
a) classification of the spinal tumors;
b) compression of nerve roots;
c) Brown-Sequard syndrome
3. Methods of diagnosis of tumors:
a) laboratory;
b) roentgenologic;
c) electrophysiological,
d) roentgen contrasts.
4. Methods of treatment the tumor:
a) surgical;
b) radiological;
c) symptomatic.
Theme 2. Epilepsy and convulsive syndromes. Classification and diagnosis of epileptic attack and convulsive syndromes.
1. Etiology of the epilepsy and convulsive syndromes.
2. Pathogenesis of the epilepsy and convulsive syndromes.
3. Clinical features of the epileptic diseases:
a) classification of the epileptic attacks
b) clinical features of the general epileptic attacks:
4. Clinical features of the focal (partial) epilepsy.
5. Clinical features of the convulsive syndromes:
a) at cause of the tumors of the brain, strokes, neuroinfections (ekzo and endogenic)
b) differential diagnosis of the epileptic and paroxizmal attack
6. Treatment of the epilepsy and convulsive syndromes:
a) treatment of the epilepsy and Grand mal seazures
b) treatment of the convulsive syndromes
c) emergency treatment at epileptic state cause.
7. Preventive measures and expertize of the workable:
a) prognosis and prophylaxis of epilepsy and convulsive syndromes;
b) medical labor examinations;
c) military medical examinations;
d) preventive medical examination.
Seminar discussion of theoretical issues (12:30-14.00).
Test evaluation and situational tasks.
Tests:
1. Histological classification of brain tumors.
2. Which syndromes are typical for brain tumors.
3. Characteristic of cerebrospinal fluid in patients with brain or spinal tumors?
4. Clinical features of hypertension syndrome.
5. Name the diagnostic methods of brain tumors.
6. What changes in the optic nerve may produce the brain tumors?
7. Name the drugs which cure hypertension syndrome.
8. Clinical features of acoustic neuroma.
9. Classification of the spinal tumors.
10. What are the signs of spinal cord compression?
11. What are the early clinical features of intramedullar tumors?
12. What are the early clinical features of extramedullar tumors?
13. Differential diagnosis of intramedullar tumors.
14. Differential diagnosis of extramedullar tumors.
15. Name the liquor (SCF) tests.
16. What tumors give metastasis in the brain?
17. What tumors give metastasis in the spinal cord?
18. Clinical forms of intracerebral tumors.
19. Clinical features of Broons’ syndrome.
20. Characteristic features of headache in patients with brain tumors.
21. Characteristic features of nausea and vomiting in patients with brain tumors.
22. Characteristic features of convulsions in patients with brain tumors.
23. Characteristic features of mental symptoms in patients with brain tumors.
24. Clinical symptoms of meningioma in the anterior fosse.
25. Clinical symptoms of meningioma in the posterior fosse.
26. Clinical symptoms of falx meningioma.
27. Clinical symptoms of cerebella tumor.
28. Classification of the Generalized (Grand mal) convulsions form and without convulsions form
29. Classification of the focal (partial) form
30. Make differential diagnostics between epileptic and hysterical attacks
31. Name the causes of the convulsive attacks
32. Enumerate the main principles of epilepsy treatment
33. Enumerate the main pathogenetic groups of medicines for the epilepsy treatment. Prescribe benzonalum and carbamazepine.
34. What is it epileptic status?
35. Emergency therapy at cause of epileptic status. Prescribe thiopental natrium in amp.
36. Pathophysyology of the epileptic focus.
37. EEG-picture of the convulsive state of the brain.
38. The three main conditions of the epileptic attack.
39. Differential clinical signs of epilepsy and convulsive syndromes at cause of absent of the organic lesions of the brain.
40. Kinds of generalized seizures.
41. Clinical forms of epileptic status
42. What kind of seizures localized epileptic focus?
43. The role of epileptic aura in topical diagnostics.
44. What component of generalized attack to determine epileptic focus?
45. Where is focus at adversive attack?
46. Classification of the Generalized (Grand mal) convulsions form and without convulsions form
47. Classification of the focal (partial) form
48. Make differential diagnostics between epileptic and hysterical attacks
49. Name the causes of the convulsive attacks.
50. Enumerate the main principles of epilepsy treatment
51. Enumerate the main pathogenetic groups of medicines for the epilepsy treatment. Prescribe benzonalum and carbamazepine.
52. What is it epileptic status?
53. Emergency therapy at cause of epileptic status. Prescribe thiopental natrium in amp.
54. Pathophysyology of the epileptic focus.
55. EEG-picture of the convulsive state of the brain.
56. The three main conditions of the epileptic attack.
57. Differential clinical signs of epilepsy and convulsive syndromes at cause of absent of the organic lesions of the brain.
58. Kinds of generalized seizures.
59. Clinical forms of epileptic status
60. What kind of seizures localized epileptic focus?
61. The role of epileptic aura in topical diagnostics.
62. What component of generalized attack to determine epileptic focus?
63. Where is focus at adversive attack?
Real-life situations to be solved:
1. What symptoms belong to tumor of thoracic part of spinal cord?
2. Clinical features of hypertension syndrome.
3. Which symptoms are typical for pituitary tumor?
4. Characteristic features of cerebrospinal fluid in patients with brain or spinal tumors?
5. Differential diagnosis between epileptic and hysterical attack.
6. 2. Kinds of the focal (partial) epilepsy.
7. 3. Name the main medicines for epilepsy treatment.
Initial level of knowledge and skills are checked by solving situational tasks for each topic, answers in test evaluations and constructive questions.
Student should know:
1. Histological classification of brain tumors
2. Clinical features of brain tumors
3. Clinical features of spinal tumors
4. Clinical forms of intracerebral tumors.
5. Classification of the epileptic attacks,myopathy
6. Pathogenesis of the epilepsy and convulsive syndromes, myopathy.
7. Treatment of the epilepsy and convulsive syndromes.
Student should be able to:
1. To examine neurological patient with tumor
2. To make the topical and clinical diagnosis
3. To prescribe adequate treatment program and prophylactic measures
4. Examine the patients and to diagnose epilepsy and convulsive syndromes.
5. Prescribe treatment for the patients with epilepsy and convulsive syndromes.
Correct answers of test evaluations and situational tasks:
Real-life situations:
1. Pelvic disorders, lower spastic paraplegia, conductive disorders of sensibility and trophic disorders.
2. Headaches, nausea and vomiting, choked discs, convulsions and absorptive changes in the bones of the skull.
3. Tumors of the Pituitary Gland. Signs: Headache, frequently frontal; Visual symptoms – visual field defects involve the temporal fields (bitemporal hemianopsia); Endocrine symptoms (acromegalia, Cushing’s disease, amenorrhea-galactorrhea); Erosion of the floor of sella turcica.
4. An increased pressure and an increased protein content, xanthochromic.
5. Grand mal seizure may occur at any time of day or night and there is no evidence of seasonal incidence. In some patients, there is an apparent periodicity to the attacks, particularly in women in whom they may be associated with the menstrual periods. In a small percent-age, the attacks occur only at night or while the patient is sleeping, but in most patients the attacks are evenly distributed during the twenty-four hours. In classical form the grand mal attack consists of an aura which is followed by shrill cry, loss of consciousness and generalized tonic and clonic movements. During the convulsive phase of the attack there may be tongue-biting, urinary or fecal incontinence and, rarely, ejaculation. During the tonic phase of the attack the respirations may be suspended and the face becomes cyanotic. With the onset of the clonic phase respirations are jerky and stertorous. Saliva, mixed with blood if the tongue or inside of the cheek has been bitten, is blown from the mouth. After cessation of the convulsive movements, the patient relaxes. Consciousness may return within a few minutes or the patient may lapse into a heavy sleep to awaken several hours later. Hysterical attack may occur only at time of day, without disorders of consciousness, can see hysterical arches.
6. With simple symptomatic: a) motor; b) sensory. With combined symptomatic: a) motor, b) sensory.
7. Seduxen, oxybutirat Na, thiopental Na, ATPh, dexona, viadril, aminazin.
Independent work of students (14:15-15:00).
References:
А – Basic:
1. WEB-site of tdmu.
Material for practical classes
2. Basic Neurology Second Edition. John Gilroy, M.D.- McGraw-Hill international editions, medical series, 1990.
3.Methodological instructions for general clinical examination of a neurology patient and filling in the patient’s Case Report.
4. Clinical examinations ieurology – Mayo clinic and Mayo foundation.- 4-th edition.- W.B. Saunders Compani, Philadelphia, London, Toronto.- 1976 y.
В – Additional:
4. Neurology for the house officer.- 3th edition.-Howard L. Weiner, MD and Lawrence P. Levitt, MD,- Williams &Wilkins.- Baltimore.- London.- 1980 y.
5. Van Allen’s Pictorial Manual of Neurologic Tests.- Robert L.Rodnitzky.- Third edition.-Year Book Medical Publishers, inc. Chicago London Boca Raton.- 1981y.
6. Neurology in lectures. Textbook. Edited by the head of Neurology Department – prof. S.І. Shkrobot. – 2005.
Methodical instruction has been worked out by: dotsent N. R. Sokhor
Methodical instruction was discussed and adopted at the Department sitting
29.05.2013. Minute № 9
Methodical instruction was adopted and reviewed at the Department sitting
__________201 . Minute № ___
