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Sheff 91 core clinical problems > 14 - Abnormal gait > Flashcards

14 - Abnormal gait Flashcards

1
Q

More Na/Ca/K inside or outside cell? What does this cause?

What happens during depolarisation?

Repolarisation?

A

Na and Ca outside of the cell, K inside.

The difference between the two leads to a negative charge inside the cell (what is physics?) – roughly -70mV

During depolarisation, Na enters the cell through channels causing the difference to reduce until it reaches 40mV.

K channels open and potassium leaves the cell. Repolarisation.

Na/K channels then restore and maintain the resting potential

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2
Q

Couple ways to try and clinically differentiate ischemic and haemorrhage strokes?
What other thing do you have to exclude that mimics

A

Trauma, Previous,
often ischemic dont cause headache

HYPOGYCLAEMIA

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3
Q

What is ROSIER for strokes

A

Recognition of stroke in emergency room

If BM abnormal then correct
LoC/Syncope = -1
Seizure = -1
Asymmetric facial weakness = +1
Asymmetric arm weakness = +1
Asymmetric leg weakness = +1
Speech disturbance = +1
Visual field defect = +1
Score greater than 0 = stroke is likely, call stroke team for CT and thrombolysis
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4
Q

Acute stroke Mx

A

CT ASAP

300mg aspirin daily for 2/52 if ischaemic

Thrombolysis with alteplase if ischaemic

Reverse anticoagulation and refer to neurosurgery for haemorrhagic

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5
Q

Types of stroke syndromes ?

A

TACI anterior circulation. motor and sensory defects + homonymous hemianopia + higher dysfunction (dysphasis, visuospatial disturbances, altered consciousness)

PACI two of the above.

POCI = posterior circulation. CN palsy + contralateral motor/sensory defect, cerebellar dysfunction, nystagmus, bilateral sensorimotor defects, homonymous hemianopia (isolated)

Lacunar: pure motor or pure sensory.

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6
Q

What is cushings triad in strokes?

A

Hypertension
bradycardia
irregular respirations

(Raised ICP causes decreased heart rate)

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7
Q

Where is bleeding in SAH

A

Between arachnoid and pia

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8
Q

Rfs for SAH

A

Autosomal dominant polycystic kidney disease ADPKD (berry aneurysms)

Any other tings for vascular….

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9
Q

Some features of SAH

A

Thunderclap headache

reduced GCS, seizures, vomiting, meningism

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10
Q

Subdural caused by what vessel? Time period ? shape on CT

A

bridging veins
signs of raised ICP / mass effect

Often takes weeks

Crescent

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11
Q

Epidural is where? usual vessel and cause? Common feature ?
shape?
Mx?

A

Blood between dura mater and skull

Usually caused by acceleration-deceleration injuries meningeal arteries.

Lucid period between injury and LoC
Trauma.

Punched appearance on CT due to arterial pressure

Haematoma evacuated via Burr hole craniotomy

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12
Q

When do you use ABCD2 ? what is it?

A

For use on pts with suspect TIA with NO NEURO SIGNS

Age 60+ = 1
BP 140/90 = 1
Clinical features: Unilateral weakness (2), Speech disturbance (1)
Duration 60mins+ (2), 10-60 mins (1)
Diabetes = 1
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13
Q

If you suspected TIA - What to do?

A

300mg asprin daily

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14
Q

What is CHADVASC for ? what is it? What scoring system do you compare to?

A

Risk of stroke with AF

CCF
Hypertension
Age 75+
DM
Stroke (2)
Vascular Disease
Age 65-74 
Sex

Compare score with HASBLED to evaluate pros and cons of anticoagulation

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15
Q

HASBLED score for?

What is it?

A

Major bleeding on anticoagulants

Hypertension
Abnormal Liver function
Abnormal renal function
Stroke
Bleeding
Labile INRs
Elderly
Drugs
Alcohol
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16
Q

Key CNS parts in voluntary movement

A

Motor cortex -> basal ganglia ->cerebellum -> brainstem -> corticospinal (pyramidal) tracts -> LMNs

17
Q

Compare UMN and LMN signs

Reflexes 
Muscle tone 
Fasiculation 
Atrophy 
Babinski sign
A 
UMN 
Reflexes  - hyper 
Muscle tone - increased / spastic 
Fasiculation - No 
Atrophy - no 
Babinski sign - positive 
LMN 
Reflexes - hypo
Muscle tone - decreased / flaccid 
Fasiculation - present 
Atrophy  - severe 
Babinski sign - no
18
Q

3 main features of parkinsons

A

resting tremor
bradykinesia
rigidity

19
Q

Features of parkinsons ? Overlap with side effects of which drugs?

A

Neurological: Anosmia, postural instability, reduced dexterity, micrographia, decreased arm swing, blank facies, dysphagia, neuropathy,

Autonomic: Constipation, sexual dysfunction, sweating, incontinence, drooling, dizziness,

Psychiatric: depression, insomnia, amnesia, emotional volatility, poverty of thought, visual hallucinations

Antipsychotic

20
Q

Motor signs in parkinsons …
Symmetric?
most common initial sign?
how does this progress?

A

Typically asymmetric

resting tremor in an upper extremity

Over time, patients experience progressive bradykinesia, rigidity, and gait difficulty

Axial posture becomes progressively flexed and strides become shorter

Postural instability (balance impairment) is a late phenomenon

21
Q

What is carbidopa?

A

peripheral DOPA decarboxylase inhibitor),
.
Prevents peripheral side effects.

Does not cross B-B Barrier

22
Q

What is COMT

A

(catechol-o-methyltransferase) inhibitor (Entacapone): reduces peripheral metabolism of levodopa.

23
Q

What causes normal pressure hydrocephalus?

What can it mimic?

A

Due to decreased CSF absorption

Usually in elderly

Important reversible cause of dementia.
Due to presentation usually MISDIAGNOSED as Alzheimer’s, CJD, Parkinson’s etc.

24
Q

What happens in normal pressure hydrocephalus ?

Sx?

A

Accumulation of CSF in ventricles -> dilation

Usually cerebral aqueduct obstruction

NO sx of raised ICP
Symptoms instead result from distortion of brain structure

25
Q

3 core features of normal pressure hydrocephalus

A

GAIT DISTURBANCE
URINARY INCONTINENCE
DEMENTIA

Wet, wobbly and wacky.

26
Q

Key Sx in MS?

Famous exam signs?

A

Optic neuritis is hallmark as are paraesthesias, fatigue and weakness

Also: muscle cramps, depression, incontinence, ED, trigeminal neuralgia, pain, diplopia, cognitive deficits

Lhermitte’s sign: electric shock sensation illicted by bending head forward. Also seen in Behcet’s, B12 deficiency, radiation myelopathy and Arnold-Chiari malformation.

Uhthoff’s phenomenon: symptoms become worse in a hot environment such as weather, exercise, saunas/baths etc.

27
Q

Cell causing damage in MS ?

Common triggers?

A

Destruction is T-cell mediated. B-B barrier breakdown allows T-cell entry.

Episodes usually preceded by an illness or provoked by a period of stress.

28
Q

Diagnosis of MS

A

Via clinical scenario plus imaging
MRI is best. Gadolinium contrast.

You also see oligoclonal banding on LP.

29
Q

Mx of MS ?

Think of Sx relief too…

A

Two branches: immunotherapies to treat the underlying disorder and other ancillary therapies which relieve the burden of symptoms.

Immune: prednisolone, plasmapheresis, interferon beta,

Depression: Selective serotonin reuptake inhibitors are preferred
Spasticity: Baclofen is effective in most cases
Pain: Tricyclic antidepressants are first-line drugs for primary pain
Sexual dysfunction: sildenafil

30
Q

What is acute transverse myelitis? Common DD of which other illness?
How to diagnose?
Mx?

A

Spinal cord inflammation. Inflammatory attacks damage nerve fibres and myelin, which decreases electric conductivity.

Differential for MS, but also can be caused by it (cervical most common in MS)

Diagnosis - deficit attributable to spinal cord, signs bilaterally; do not have to be symmetrical.

Plasmapheresis - good prognosis

31
Q

Causes of cerebral palsy ?

A

Hypoxic, infective, birth trauma, genetic and idiopathic causes

32
Q

3 types of CP

A

ataxic, athetoid, spastic

33
Q

Cerebllar sx?

A 
DDK
Ataxia
Nystagmus
Intention tremor
Scanning Dysarthria
Heel-Shin test +ve
34
Q

What is duchenne muscular dystrophy?
Features?
less harmful variant of this disease?

A

X-linked syndrome of muscle loss (replaced by fat)

Progressive muscle weakness.
Symptoms usually appear at 6.
Survival past early 20s is rare.
Gower’s sign (use hands to walk up body to stand)

Becker is a less harmful variant

35
Q

How is polio spread?

Sx

A

fecal oral

weakness + seroconversion illnes

36
Q

What is guillain barre?
usual preceeding ting? complication?
mx?

A

Cross-reactive damage to peripheral muscles.
Diarrhoeal (Campylobacter) or URTI

Weakness and pain leading to paralysis
Allegedly from feet up.

Can paralyse respiratory muscles.

Long lasting and requires intense rehab

Treatment is supportive + Ig + plasmapheresis.

Sheff 91 core clinical problems (51 decks)

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