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Contents
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Cord compromise
Cord compromise
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History History
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Physical examination Physical examination
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Investigation and management Investigation and management
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Prognosis measured in hours to days prior to the onset of this problem (symptom control) Prognosis measured in hours to days prior to the onset of this problem (symptom control)
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Prognosis measured in weeks prior to the onset of this problem (in addition to symptom control) Prognosis measured in weeks prior to the onset of this problem (in addition to symptom control)
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Prognosis measured in months to years prior to the onset of this problem (in addition to the above) Prognosis measured in months to years prior to the onset of this problem (in addition to the above)
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Cervical lesions may impair diaphragmatic function Cervical lesions may impair diaphragmatic function
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Further reading Further reading
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Delirium: acute confusional states
Delirium: acute confusional states
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History History
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Delirium requires four key features for diagnosis: Delirium requires four key features for diagnosis:
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Physical examination Physical examination
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Investigations and management Investigations and management
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Prognosis measured in hours to days prior to the onset of this problem (symptom control) Prognosis measured in hours to days prior to the onset of this problem (symptom control)
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Prognosis measured in weeks prior to the onset of this problem (in addition to symptom control) Prognosis measured in weeks prior to the onset of this problem (in addition to symptom control)
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Prognosis measured in months to years prior to the onset of this problem (in addition to the above) Prognosis measured in months to years prior to the onset of this problem (in addition to the above)
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Further reading Further reading
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Seizures
Seizures
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History History
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Physical examination Physical examination
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Investigations and management Investigations and management
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Prognosis measured in hours to days prior to the onset of this problem (symptom control) Prognosis measured in hours to days prior to the onset of this problem (symptom control)
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Prognosis measured in weeks prior to the onset of this problem (in addition to symptom control) Prognosis measured in weeks prior to the onset of this problem (in addition to symptom control)
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Status epilepticus is an emergency. Status epilepticus is an emergency.
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Prognosis measured in months to years prior to the onset of this problem (in addition to the above) Prognosis measured in months to years prior to the onset of this problem (in addition to the above)
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Further reading Further reading
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Meningitis
Meningitis
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History History
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Physical examination Physical examination
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Investigations and management Investigations and management
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Prognosis measured in hours to days prior to the onset of this problem (symptom control) Prognosis measured in hours to days prior to the onset of this problem (symptom control)
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Prognosis measured in weeks prior to the onset of this problem (in addition to symptom control) Prognosis measured in weeks prior to the onset of this problem (in addition to symptom control)
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Prognosis measured in months to years prior to the onset of this problem (in addition to the above) Prognosis measured in months to years prior to the onset of this problem (in addition to the above)
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Intracranial bleeding
Intracranial bleeding
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History History
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Physical examination Physical examination
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Investigations and management Investigations and management
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Prognosis measured in hours to days prior to the onset of this problem (symptom control) Prognosis measured in hours to days prior to the onset of this problem (symptom control)
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Prognosis measured in weeks prior to the onset of this problem (in addition to symptom control) Prognosis measured in weeks prior to the onset of this problem (in addition to symptom control)
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Prognosis measured in months to years prior to the onset of this problem (in addition to the above) Prognosis measured in months to years prior to the onset of this problem (in addition to the above)
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Raised intracranial pressure
Raised intracranial pressure
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History History
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Physical examination Physical examination
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Investigations and management Investigations and management
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Prognosis measured in hours to days (symptom control) Prognosis measured in hours to days (symptom control)
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Prognosis measured in weeks prior to the onset of this problem (in addition to symptom control) Prognosis measured in weeks prior to the onset of this problem (in addition to symptom control)
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Prognosis measured in months to years prior to the onset of this problem (in addition to the above) Prognosis measured in months to years prior to the onset of this problem (in addition to the above)
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Cerebral CT Cerebral CT
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Urgent neurosurgical consultation Urgent neurosurgical consultation
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Cite
Extract
Cord compromise
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Causes of cord compromise
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History
The most important and common cause of spinal cord compromise is malignant spinal cord compression. The need to consider this diagnosis and initiate prompt treatment cannot be overemphasized.
People with spinal cord compression typically present with back pain. This pain often pre-dates neurological changes by months. It may be worse on lying flat and may be exacerbated by coughing, bending, or sneezing. The pain may be localized to the back, or people may describe a heavy band-like sensation that radiates anteriorly.
Limb weakness and sensory changes are late changes.
The distribution of changes will depend upon the height of the cord involved.
Bladder and bowel disturbance (urinary retention and incontinence, constipation, and faecal incontinence) occur late in the presentation.
Lesions of the cauda equina present with back pain that may radiate down both legs. There may be difficulty in walking because of gluteal muscle weakness. There is loss of perineal sensation. These people will also develop urinary problems (incontinence and retention) and may have faecal incontinence due to loss of anal tone.
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