METHODICAL INSTRUCTION FOR STUDENTS OF THE 4 COURSE
MEDICAL FACULTY
LESSON № 13 (PRACTICAL – 6 HOURS)
Theme:
Clinical observation of the patients with Neuritis, Neuralgia, Polyneuropathy. The principles of rehabilitation of the patients with neurological pathology
Aim: Students should be able by himself to diagnosis neuritis, neuralgia, polyneuritis and polyneuropathy in patients, to prescribe adequate treatment program, to argument prophylactic measures for each patient, and to expect the ability to work ore disabled person. Students should be able to formulate and to give reason for the topical diagnosis.
Professional orientation of students: Diseases of peripheral nervous system take considerable value in general scheme of all diseases of nervous system and first place among the reasons of temporary work inability. In connection with polietiology of diseases of peripheral nervous system doctors of many specialties meet them. Very important to be able to distinguish all types of neuritis of peripheral nerves, to diagnose neuralgias (for example Trigeminal nerve), all types of polyneuritis and polyneuropathy of peripheral nerves, to prescribe adequate treatment program, to argument prophylactic measures for each patient, and to expect the ability to work ore disabled person.
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
Step I. Aim: To make clinical diagnosis. For this purpose it is necessary:
1. Examine the patient (history talking, somatic and neurology status);
2. To determine pathology (neuritis, neuropathy or neuralgia);
Several clinical patterns of peripheral neuropathy are recognized. These include:
1. Mononeuropathy. Mononeuropathy implies involvement of the peripheral nerve. This is commonly the result of trauma but also occurs in diabetes mellitus and in infarction of peripheral nerves.
2. Mononeuritis multiplex. Mononeuritis multiplex is a term used to describe involvement of several individual nerves in a haphazard fashion. The etiology is the same as for Mononeuropathy.
3. Radiculoneuropathy. A radiculoneuropathy is involvement of the nerve root as it emerges from the spinal cord. This is commonly seen with herniated disks or with epidural masses (tumor).
4. Polyradiculitis. Polyradiculitis or radiculopathy is characterized by involvement of several nerve roots and commonly seen in postinfectious polyneuritis or post-vaccinal polyneuritis.
5. Plexitis. A plexitis is an inflammation of a plexus such as the brachial plexus (brachial plexitis).
6. Polyneuritis. In polyneuritis or polyneuropathy there is a symmetric involvement of peripheral nerves. The commonest causes are diabetes mellitus and alcoholism. There are, however, numerous causes of peripheral neuropathy and the identification of the etiologic agent may be difficult in unusual causes.
3. To make differential diagnosis by help with somatic and neurology examination data, special diagnostic procedures data and logical frame.
4. To formulate clinical diagnosis.
Step II. Aim: Prescribe the adequate treatment. For this purpose it is necessary to determine treatment procedures according to the etiology and pathogenesis of pathology, for example:
1. In cause of poisoning of thallium, lead, arsenic – desintoxication medicines (Unitiolum, Dicaptolum, Dimecaptolum, BAL, Na tiosulphatis, Ca tetacini);
2. In cause of FOS polyneuropathy – atropine, reactivators of cholinesterase (Dipiroximum, Izonitrasin)
3. In cause of Guillain-Barre syndrome- antiviral (Reapheron, Acyclovir, Zovirax, Acid mephenaminicum), hormones (Prednizolon, Dexona, Methypred), vitamins B group.
4. In cause of neuritis, polyneuritis – spasmolytics (Papaverini chydrochloridi, Acid nicotinic, Nicergolin, Spasmalginum, Platyphyllinum, Nospanum, Baralginum), analgetics (Dipidololum, Tramadolum, Morfilong, Analginum, Baralginum, Spasgamum), vitamins (group В), anticholinaesterase drugs (neostigmine methylsulfate, Galantaminum), reologic medicines (Curantil, Trental, Actovegin).
1. Physiotherapeutic treatment: phonophoresis with Hydrocortizonum, electrophoresis with Novocainum, ultrasonics. Thermal procedures are prescribed at reduction of pain syndrome.
Step III. Aim: Make 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:
1. Etiology and pathogenesis of neuritis, neuralgias, polyneuritis and polyneuropathy.
2. Clinical features of neuritis:
a) classification of neuritis;
b) main clinical signs (tests) of neuritis: radial, ulnar, median, sciatic, common peroneal, superficial peroneal, femoral, facial nerves.
3. Clinical features of polyneuritis (polyneuropathy).
a) classification of polyneuritis (polyneuropathy);
b) the main clinical signs (tests) of polyneuritis: infectional polyradiculoneuritis, diphtheritic polyneuropathy, alcoholic polyneuropathy, diabetic polyneuropathy, arsenic ingestion, thallium poisoning and other
4. Clinical features of trigeminal neuralgia:
a) neuralgia of the I, II and III branches of trigeminal nerve
5. Diagnostic procedures:
a) clinical and biochemical laboratory data by blood, urine and CSF; b) ENMG.
6. Treatment of neuritis, neuralgias, polyneuritis, polyneuropathy:
a) pathogenetic
b) symptomatic
c) physiotherapeutic
7. Prophylactic measures.
Seminar discussion of theoretical issues (12:30-14.00).
Test evaluation and situational tasks.
Tests
1. Clinical features of Radial neuropathy.
2. Clinical features of Ulnar neuropathy.
3. Clinical features of Mediaeuropathy.
4. Clinical features of Superficial peroneal neuropathy.
5. Clinical features of Common peroneal neuropathy.
6. Clinical features of Trigeminal neuralgia.
7. Treatment of neuropathies.
8. Treatment of neuralgias.
9. Common (a) and differential (b) clinical signs of polyneuropathy and polyneuritis.
10. Clinical features of Diphtheric polyneuropathy
11. Clinical features of Thallium poisoning polyneuropathy.
12. Clinical features of alcoholic polyneuropathy.
13. Clinical features of Diabetic polyneuropathy.
14. Clinical features of FOS poisoning polyneuropathy.
15. Treatment of polyneuropathy (a) and polyneuritis (b).
16. Clinical features of acute alcoholic encephalopathy Haye-Wernike.
17. Clinical features of the Guillain-Barre syndrome.
Real-life situations to be solved:
1. The main clinical features of polyneuritic syndromes at Thallium poisoning.
2. Describe the clinical features of Peroneal neuropathy
3. What physiotherapeutic treatment needs the patient with Facial neuropathy in acute stage.
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. Clinical features of neuritis, neuralgias, polyneuritis and polyneuropathyes.
2. Clinical classification of neuritis, neuralgias, polyneuritis and polyneuropathyes
3. General examination scheme of a neurological status.
4. Anatomy of nervous system and special symptoms of lesion different parts.
5. Basic diagnostic procedures and treatment of neurological diseases.
Student should be able to:
1. Diagnose the Diabetes Mellitus, thallium, arsenic, lead and mercury poisoning, metabolic disorders.
2. Examine the neurological patient
3. History taking
4. Formulate clinical pre-diagnosis and make differential diagnostics
5. Find level of pathologic focus
6. Introduce dates of special methods for patients’ objective investigation
7. Make the topical and clinical diagnosis
8. Prescribe adequate treatment program and prophylactic measures
9. Examine the ability to work in disabled person
10. Record the patient’s Case report.
Correct answers of test evaluations and situational tasks:
1. Coma, thallium spastic colic, peripheral palsy of hands and feet.
2. Peripheral palsy of anterior group of legs muscles, “cock’s” gait.
3. Electrophoresis with Acid nicotinic, Proserine, Novocainum, Hydrocortisone, acupuncture
Independent work of students (14:15-15:00).
References:
А – Basic:
1. WEB-site of tdmu.
2. Basic Neurology. Second Edition. John Gilroy, M.D. – McGraw-Hill International edition.- Pergamon Press.- 1992
3. Merritt’s Textbook of neurology. – 7th edition. – Edited by Lewis P. Rowland.
4. Neurology for house officer. – 3th edition.
В – Additional:
6. Handbook of Symptom Oriented Neurology/ William H. Olson, Roger A. Brumback, Generoso Gascon, Vasudeva Iyer, Year book medical publishers, Inc.
7. Neurology in lectures. Textbook. Edited by the head of Neurology Department – prof. S.І. Shkrobot. – 2006.
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 № ___
