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APPROACH TO A PATIENT WITH MONOPLEGIA AND HEMIPLEGIA Monoplegia (weakness of one arm or leg) and hemiplegia (weakness of one half of body) are common presentations in neurology (out patient department or in emergency settings). The causes of monoplegia and hemiplegia are varied and a systematic approach is required to arrive at the correct diagnosis. I have discussed the clinical approach to a patient presenting with monoplegia and hemiplegia, which was published as a chapter in the book "Progress in Medicine" by Association of Physicians in India (API), 2017.  The chapter is available free online and can be accessed at the following link: http://www.apiindia.org/pdf/progress_in_medicine_2017/mu_27.pdf I would be pleased to receive any feedback/comments from the readers. Dr Sudhir Kumar MD DM Consultant Neurologist Apollo Hospitals, Hyderabad drsudhirkumar@yahoo.com https://www.facebook.com/bestneurologist/

CROSSED LEG SIGN  Crossed leg sign is a condition, where the right leg is placed over the left leg (right leg crosses over the left leg). This is a sign of severe unilateral spatial neglect (USN), which is typically seen with large right parietal strokes. The patient is unable to locate the left half and midline, which results in wrong positioning of the right leg, while on the bed. In the initial days after right parietal stroke, one may notice frequent rubbing of the left leg by the right leg.  More details can be found in the following article, published in the journal Frontiers in Neurology (18 April, 2018 issue). The link to the article is provided below: https://doi.org/10.3389/fneur.2018.00256 Dr Sudhir Kumar MD DM (Neurology) Consultant Neurologist Apollo Hospitals, Hyderabad 04023607777 drsudhirkumar@yahoo.com https://www.facebook.com/bestneurologist/

CLINICAL EVALUATION OF AN UNCONSCIOUS PATIENT- NEUROLOGICAL VERSUS NON-NEUROLOGICAL Neurologists and internists are commonly called in to evaluate an unconscious patient, most often in an emergency room or in ICU. There are a large number of causes of unconsciousness, which can be broadly classified into neurological and non-neurological.  Common examples of neurological causes of unconscious state are: 1. Brain stroke-infarct or hemorrhage; CVST, 2. Brain tumor, 3. Head injury, 4. CNS infection- encephalitis, meningitis, 5. Seizures, 6. Demyelinating illnesses- ADEM, acute MS (rare). Common examples of non-neurological causes of unconscious state: 1. Metabolic derangements- high or low sugar, sodium, calcium, etc 2. Renal or hepatic failure, 3. Severe hypoxia or hypercapnia, 4. Hypotension & shock, 5. Drug-induced (sedatives, hypnotics) & poisoning 6. Psychogenic.  Clinical clues favouring a neurological cause of depressed consciousness level: 1. Hist

PSYCHOGENIC (NON-EPILEPTIC) SEIZURES Non-epileptic seizures (NES) are quite common and we encounter them in OPD as well the ER. It is important to make a correct diagnosis of NES in order to start them on appropriate psychiatric treatment and avoid unnecessary anti-epileptic medicines. If we adopt a systematic approach, it would be fairly easy to make a diagnosis of NES. I would classify the diagnostic clues into three headings- history, examination and investigations. Points in history that point towards a diagnosis of non-epileptic seizures 1. Non-epileptic seizures usually occur only in front of others. NES usually do not occur or occur at a lower frequency, when patients are alone. This is because most patients with NES have attention-seeking behaviour.  2. Non-epileptic seizures usually occur at a much higher frequency- in some cases, upto 20-30 or even more number of times per day. Multiple seizures per day are uncommon in patients with true seizures.  3. Immediate r

PSYCHOGENIC MOTOR WEAKNESS Motor weakness is a common symptom presenting in neurology out-patient department or in an emergency room. It is important to determine whether it is of psychogenic or neurological origin. A few clinical signs can help in this matter. 1. Hoover's sign- Place the palm of your hand under the heel of foot on the side with "normal" power and ask the patient to lift the "affected" side. In a person with neurologic (genuine) weakness, you would feel the heel (of the normal foot) pressing against your palm. The affected leg would be weaker. On the other hand, in a person with psychogenic weakness, no pressure would be felt on the palm. 2. Raise the affected arm and let it drop. In a person with neurologic weakness, it falls on the body part if allowed to drop there. On the other hand, in a person with psychogenic weakness, the falling hand avoids any body part in order to avoid getting hurt. Please ensure that while testing, the hand