502. Leg weakness and abnormal movements

Question 1

What are the causes of cord compression?

Answer 1

Secondary malignancy

Infection

Cervical disc prolapse

Haematoma (warfarin)

Intrinsic cord tumour

Atalanto-axial subluxation

Myeloma

Question 2

What is the main difference between cord compresion higher up and lower down (cauda equina, conus medullaris)

Answer 2

Upper- hyperreflexic and spastic

Cauda equina- areflexic and flaccid

Question 3

What are the differentials for unilateral foot drop?

Answer 3

Diabetus mellitus

Common peroneal nerve palsy

Stroke

Prolapsed disc

MS

Question 4

Name the various type of gate disorders

Answer 4

Spastic/swing

Apraxic- like me ice skating, wide based. Tendency to fall

Antalgic- Limp. e.g sore foot/knee.

Ataxic- wide based, falls, no heel toe. Cerebellar cause

Question 5

What non-neurological considerations are used in paralysed patients?

Answer 5

Avoid pressure sores- turn and review weight bearing areas

Avoid DVT- passive movement and LMWH

Bladder and bowel care

Exercise of limbs

Question 6

What are the various types of tremors

Answer 6

Rest tremor-Abolished on voluntary movement- parkinsons

Postural tremor- absent at rest, worse arms outstretched- benign essential, beta agonsits, thyrotoxicosis

Intention tremor- worse at end of purposeful acts- cerbellar

Re-emergent tremor postural tremor after delay of 10s- parksinsons

Question 7

What is chorea?

What causes it?

Answer 7

Non rythmic, jerky purposeless movements

Facial grimace, raising shoudlers, flexing/extednign ingfers

Huntingtons, syfenhams, levodopa makes worse

Question 8

What is myoclonus

Where is it seen

Answer 8

Sudden involuntary or focal jerks.

Seen in metabolic problems, neurodegenerative disease and myocloniuc epilepsies (infantile spasm)

Question 9

What are the cuauses of a metabolic flap?

Answer 9

Liver/kidney failure

Reduced sodium

Increased co2

Gabapentin

thalmic stroke

Question 10

What causes tardive syndromes

Answer 10

Chronic exposure to dopamine antagonistss (anti-psychotics, anti-emetics)

Question 11

What is tardive dystonia

Answer 11

Sustained sterotyped muscle spasms of twisting or turning

Question 12

What is tardive dyakinaesia

Answer 12

Repetitive movments e.g. chewing or grimacing, lip smacking

Question 13

How is tardice dykineasia treated?

Answer 13

Withold neuroepileptics and wait 3-6 months

Quetiapine, olanzapine and clozapine less likel yto cause symptoms

Question 14

What is acute dystonia

How do you treat it

Answer 14

Starts after taking neuroepileptics nad some antiemetics

Looks like tetanus or meningitus

Dissapears after anti-cholinergic dose