Internal Medicine

0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:18

Pericardial Tamponade Peripheral Neuropathies 1155

specific therapy

■consider balloon pericardiotomy or surgical drainage for recurrent

effusions

follow-up

■repeat echo after drainage

■during hospitalization, regularly assess for reaccumulation of effu-

sion

complications and prognosis

Complications

■death from untreated tamponade is most immediate complication

■complications of pericardiocentesis include pneumothorax, bleed-

ing, cardiac perforation

Prognosis

■largely depends on underlying etiology of pericardial effusion

PERIPHERAL NEUROPATHIES

MICHAEL J. AMINOFF, MD, DSc

history & physical

■Numbness, paresthesias, dysesthesias or hyperpathia

■Weakness, fasciculations or cramps of affected muscles

■Pain, often deep & burning, commonly present during rest

■Symptoms may be in distribution of single nerves (mononeuropa-

thy), multiple individual nerves (mononeuropathy multiplex) or dif-

fusely (polyneuropathy)

■May be family history of neuropathy

■May be history of systemic illness (eg, diabetes, uremia, AIDS,

vasculitis, connective tissue disease, malignancy, infections), toxin

exposure or use of medication assoc w/ neuropathy

■May be history of repetitive strain injury or recurrent trauma

■Distribution of deficit depends on nerves affected; depending on

type of neuropathy, may be motor, sensory or mixed deficit

■Motor: weakness, wasting or both in muscles supplied by affected

nerves

■Sensory: loss or impairment depending on nerve fibers affected,

in stocking-and-glove distribution (polyneuropathy) or territory of

individual nerves