Diagnostic Tests for Alexander Syndrome
Alexander Syndrome Tests: Book Excerpts
Home Diagnostic Testing
These home medical tests may be relevant to Alexander Syndrome:
- Nerve Neuropathy: Related Home Testing:
- Brain & Neurological Disorders: Related Home Testing:
Alexander Syndrome Diagnosis: Book Excerpts
Diagnostic Tests for Alexander Syndrome: Online Medical Books
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for more information about the diagnostic tests for Alexander Syndrome.
DEMENTIA:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
Routine laboratory tests include a CBC, sedimentation rate, chemistry panel, VDRL test, HIV antibody titer, ANA, blood alcohol level, urine drug screens, thyroid profile, serum B
12
, and folic acid. A CT scan should probably be done in all cases. An EEG may be helpful in demonstrating drug intoxication. A spinal tap may need to be done to diagnose central nervous system lues. The best test for that is the fluorescent treponema antibody absorption test (FTA-ABS). MRI may be useful in distinguishing Alzheimer's disease from cerebral arteriosclerosis, as in cerebral arteriosclerosis small infarcts may be demonstrated. A radioiodinated serum albumin (RISA) cisternography study is useful to diagnose normal pressure hydrocephalus. Arterial blood gases should be drawn. Psychiatric testing will help differentiate organic brain syndrome from other psychiatric disorders and malingering. A neurologist or psychiatrist should be consulted before ordering expensive diagnostic tests.
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Muscle spasticity [Muscle hypertonicity]:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
When you detect spasticity, ask the patient about its onset, duration, and progression. What, if any, events precipitate its onset? Has he experienced other muscular changes or related symptoms? Does his medical history reveal an incidence of trauma or a degenerative or vascular disease?
Take the patient’s vital signs, and perform a complete neurologic examination. Test reflexes and evaluate motor and sensory function in all limbs. Evaluate muscles for wasting and contractures.
During your examination, keep in mind that generalized spasticity and trismus in a patient with a recent skin puncture or laceration indicates tetanus. If you suspect this rare disorder, look for signs of respiratory distress. Provide ventilatory support, if necessary, and monitor the patient closely.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Gait, spastic [Hemiplegic gait]:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
Find out when the patient first noticed the gait impairment and whether it developed suddenly or gradually. Ask him if it waxes and wanes, or if it has worsened progressively. Does fatigue, hot weather, or warm baths or showers worsen the gait? Such exacerbation typically occurs in multiple sclerosis. Focus your medical history questions on neurologic disorders, recent head trauma, and degenerative diseases.
During the physical examination, test and compare strength, range of motion (ROM), and sensory function in all limbs. Also, observe and palpate for muscle flaccidity or atrophy.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Muscle spasticity [Muscle hypertonicity]:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Once you detect spasticity, ask the patient about its onset, duration, and progression. What, if any, events precipitate onset? Has he experienced other muscular changes or related symptoms? Does his medical history reveal any incidence of trauma or degenerative or vascular disease?
Take the patient’s vital signs, and perform a complete neurologic examination. Test reflexes and evaluate motor and sensory function in all limbs. Evaluate muscles for wasting and contractures.
During your examination, keep in mind that generalized spasticity and trismus in a patient with a recent skin puncture or laceration indicates tetanus. If you suspect this rare disorder, look for signs of respiratory distress. Provide ventilatory support, if necessary, and monitor the patient closely.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Gait, spastic [Hemiplegic gait]:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Find out when the patient first noticed the gait impairment and whether it developed suddenly or gradually. Ask him if it waxes and wanes or if it has worsened progressively. Does fatigue, hot weather, or warm baths or showers worsen the gait? Such exacerbation typically occurs in multiple sclerosis. Focus your medical history questions on neurologic disorders, recent head trauma, and degenerative diseases.
During the physical examination, test and compare strength, range of motion, and sensory function in all limbs. Also, observe and palpate for muscle flaccidity or atrophy.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Dementia:
Physical examination.
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
The patient should undergo a thorough general and neurologic examination and Mini-Mental Status Examination (MMSE). Look for focal neurologic deficits and assess cognitive function (memory, language, perception, praxis, attention, judgment, calculation and visuospatial function). Other neuropsychiatric testing is available.
Testing
A. Clinical laboratory tests. The major value in laboratory tests is to look for potentially treatable causes of dementia. Basic tests should include complete blood count, electrolytes, basic chemistry (glucose, calcium, lipid panel), liver and thyroid function tests, vitamin B12, folate, urinalysis, erythrocyte sedimentation rate, and serologic test for syphilis. In addition, if the history indicates, consider human immunodeficieny virus (HIV) testing as well as heavy metals and toxic screens.
B. Diagnostic imaging. Computerized tomography is usually sufficient to rule out surgical (subdural hematoma, normal pressure hydrocephalus, tumor) and most cerebrovascular causes of dementia. Although more expensive, magnetic resonance imaging is superior to visualize small lacunae and temporal lobe atrophy (2). Positive emission tomography scanning is very expensive and seems to have greater resolution and sensitivity, but for now seems to be more of a research tool.
C. Other testing. Electroencephalography generally shows nonspecific changes except in cases of seizures, CJD, and hepatic encephalopathy. The MMSE, which is a widely used, simple tool that requires less than 10 minutes to perform, enables assessment of cognitive function (Chapter 4.5). Expected results somewhat depend on the patient’s educational level.
Diagnostic assessment.
The differential diagnosis in dementia most commonly includes age-associated memory impairment (AAMI), delirium, depression, schizophrenia, chronic alcoholism, and mental retardation. AAMI is a normal aging process with gradual memory loss in absence of dementia or medical conditions. Delirium has a subacute onset with hallucinations, delusions, and psychomotor agitation (Chapter 4.3). Common causes include infection (urinary tract infection, pneumonia), electrolyte imbalance, hypoglycemia, hepatic or renal dysfunction, endocrine abnormalities (thyroid), and medications or toxins (anticholinergics, benzodiazepines, narcotics).
References
1. Richards SS, Hendrie HC. Diagnosis, management, and treatment of Alzheimer dementia. Arch Intern Med 1999;159:789–798.
2. Crevel HV, van Gool WA, Walstra GJM. Early diagnosis of dementia: which tests are indicated? What are their costs? J Neurol 1999;246:73–78.
3. Weiner MF, ed. The dementias, diagnosis, management and research, 2nd ed. Washington, DC: American Psychiatric Press, Inc., 1996.
4. Kaye JA. Diagnostic challenges in dementia. Neurology 1998;51(Suppl):S45–S52.
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Dementia:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
Many patients are concerned about age-related forgetting of details, a normal phenomenon. This usually results from decreased attention. The fact that they recognize and worry about this distinguishes them from patients with early dementia. Normal forgetting preserves vocabulary and spelling and improves with cues. For example, patients with Alzheimer disease cannot recall a list of related words any better than random words. Patients with dementia on the other hand have difficulty with one or more of the following: learning and retaining new information (e.g., remembering events); handling complex tasks (e.g., balancing a checkbook); reasoning (e.g., inability to cope with unexpected events); spatial orientation (e.g., getting lost in familiar places); language (e.g., word finding); and/or behavior.
Subtle impairments in memory, attention, and concentration are often easily compensated for and therefore hard to pinpoint. Impaired judgment and abstraction on increasingly simple matters and personality changes (notably irritability) are usually noted first. The time course of onset is helpful in distinguishing dementia from delirium, but acute exacerbations of an underlying dementia that mimic delirium are common with drugs and acute physical illness.
The Mini Mental State Exam (MMSE) measures across domains of cognitive function: memory, executive function, attention, language, praxis, and visuospatial ability. A total score of less than 24/30 suggests dementia or delirium. Scores of 20 to 24 suggest mild impairment; 16 to 19, moderate; and 15 or below, severe. It also provides a quantitative assessment useful in following the course of the disease or response to therapy.
Mini-Cog Repeat three objects, Clock Drawing Test (hands at 8:20), then recall three objects. Suggestive of dementia when either 0/3 objects are recalled or when 1 to 2 are missed and CDT is abnormal.
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Muscle spasticity:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Take the patient’s vital signs, and perform a complete neurologic assessment. Test reflexes and evaluate motor and sensory function in all limbs. Evaluate muscles for wasting and contractures.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Muscle spasticity [Muscle hypertonicity]:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
When you detect muscle spasticity, ask the patient about its onset, duration, and progression. What, if any, events precipitate its onset? Has he experienced other muscular changes or related symptoms? Does his medical history reveal an incidence of trauma or a degenerative or vascular disease?
Take the patient's vital signs, and perform a complete neurologic and musculoskeletal examination. Test reflexes and evaluate motor and sensory function in all limbs. Evaluate muscles for wasting and contractures.
Alert
During your examination, keep in mind that generalized spasticity and trismus in a patient with a recent skin puncture or laceration indicates tetanus. If you suspect this rare disorder, look for signs of respiratory distress. Provide ventilatory support, if necessary, and monitor the patient closely.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Gait, spastic [Hemiplegic gait]:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Find out when the patient first noticed the gait impairment and whether it developed suddenly or gradually. Ask him if it waxes and wanes, or if it has worsened progressively. Does fatigue, hot weather, or warm baths or showers worsen the gait? Such exacerbation typically occurs in multiple sclerosis. Focus your medical history questions on neurologic disorders, recent head trauma, and degenerative diseases.
During the physical examination, test and compare strength, range of motion (ROM), and sensory function in all limbs. Also, observe and palpate for muscle flaccidity or atrophy.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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