500.Neurology Flashcards
Upper motor neurons cause weakness. How does this wekness differ from lower motor neurons?
UMN weakness- Affects groups Affects extensors of the arm and flexors of the leg
LMN- depending what neurone is damaged indicates what individual muscles are weak
What are the signs of an UMN lesion aside from weakness?
Spasticity- opposite muscle groups ot weakness (ar, fexors, leg extensors)
Less prominent muscle wasting
Hyperreflexic
Upgoing plantars
Significant loss of fine motor skills
What are the signs of a lower motor neuron lesion (besides weakness)?
Muscle wasting and fasiculations
Hypotonia/flaccidity
Reduced or absent reflexes
What diseases caused mixed upper motor neurone and lower motor neurone signs?
Motor neuroene disease
Reduced B12
Tertirary syphillis that affects spinal cord (taboparesis)
Where do pain and temperature senses travel along?
The spinothalamic tract (anterolateral)
What fibres travel along the dorsal columns?
joint position and vibration
What is the muscle weakness grading scale?
Grade 0- no muscle contractions
Grade 1- flicker of contraction
Grade 2- some movememnt
Grade 3- against gravity
Grade 4- against resitance
Grade 5- normal power (allows for age)
What symptoms do internal capusle and corticospinal lesions cause?
Hemiparesis on the contralteral side
If there are cranial nerve palsies contralteral to a hemiplegia what does thi sindicate?
Brain stem lesion
What drugs are dopamine antagonsits and shouldnt ve used in parkinsons?
Chlorpromazine
Metoclopramide
A patient presents with the following. Which artery is occluded?
Weak numb contralateral leg
Similari/slightly milder arm symptoms
No facial abnormalities
Anterior cerebral artery
A patient presents with the following. Which artery is occluded?
Contralateral hemiparesis
Hemisensory loss in face and arm
Contralateral homonymous heminaopia
Dysphasia in dominant hemisphere
Middle cerebral artery or
Internal carotid artery (presents similalrly)
A patient presents with the following. Which artery is occluded
Contralateral homonymous heminopia (macular sparing)
Posterior cerebral artery
A patient is dizzy. Which arteries could be occluded
Superior cerebellar artery- Just dizzy
Anterior inferior cerebellar artey- deaf and dizzy
Posterior inferior cerebellar artery- diizzy, dysphagic and dysphonic
What are the sypmtoms of a vetrobasilar circulation infarct?
Many many sings: Hemianopia, blindess, diplopia, vertigo, nystagmus, ataxia, dysarthria, dysphagia. Hemi or quadraplegia
Horner;s syndrome
Locked-in syndrome- damage to the ventral pons
What is the diagnosis is blood pressure is different by 20mmHg in each arm?
Subclavian steal syndrome
What are the so called “cheat sheet” movements for upper limb myotomes
Shoulder- Abduction- C5
Adduction- C5-C7
Elbow- Flexion C5-C6
Extension- C7
Wrist-Flexion- C7-8
Extension-C7
Fingers- Flexion- C8
Extension-C7
Abduction- T1
What are the so called “cheat sheat” movements for lower limb myotomes
Hip- Flexion L1-L2
Adduction L2-L3
Extnesion- L5-S1
Knee- Flexion- L5-S1
Extension- L3-L4
Ankle- Dorsiflexion- L4
Eversion- L5-S1
Plantarflexion- S1-S2
Toe- Big toe extension- L5
Name some imporant dermatomes?
C6/7- Lateral arm/forearm
T1- medial side of arm
C6-Thumb
C7-Middle finger
C8- Little finger
T10- umbilicus
L1- inguinal ligament
L2-L3 anterior and inner leg
L5- medial big toe
S1- lateral foot
S2-S4 perineum
What are the signs of a space occupying lesion?
Headahce worse on walking, lying down, bending forward or coughing
Seizures
Focal neurology
Personality change
What are the differentials for a space occupying lesion?
Tumour
aneurysm
Abscess
Chronic subdural heamatoma
Granuloma
Cyst
What are the various types of cancer that can exist in the brain
Astrocytoma
Glioblastoma- aggressive
Oligodendrogiloma- type of glioma
Ependymoma- tumour of CSF cells
Meningioma, CNS lymphoma, cerbellar heamangiobalstoma
Disucss the management of a malignant space occupying lesion?
Surgery
Radiotherapy
Chemo (can be localised through carmustine wafers)
Seizure prophylaxis
Dexmethasone/mannitol- raised ICP
palliative care
What are some sings a temporal lobe lesion
Dyphasia
Contralateral homonymous hemianopia
Amnesia
Odd feeling phenomenoms
A lesion in the frontal lobe produces what signs
Personality changes
Hemiparesis
Broca’s dysphagia
Anosmia
Parietal lobe lesions produce what signs?
Hemisensory loss
Cant recognise objects without seeing them
Sensory innatention
The acronym “DANISH” is used for the signs of celebellar lesions. Explain DANISH
D- ysdiadochokinesis/ dysmetria
A- taxia
N- ystagmus
I- ntention tremor
S- lurred speech
H-yptonia
What are the signs of a vestibular schwannoma?
Ipsilateral deafness,
Nystagmus
Reduced corneal reflex
Facial weakness
Ipsilateral cerbellar sifns
Papilloedema
What is the management for idiopathic intracranial hypertension (seen in obese 30 year old woman, associated with neurogical abnormalities)
Weight loss
Acetazolamide
Loop diuretics
Prednisolone
(optic nerve seath/ lumbar shunt)
