5.6 Pattern recognition in neurology Flashcards
pyramidal
UMN features
-pyramidal weakness
-spasticity
corticospinal / pyramidal tract
EPS
basal ganglia
ataxia
cerebellum
truly generalised weakness should include
bulbar motor function
otherwise, quadri/tetraparesis
UMN pattern weakness is—?
weak extensors in arm
weak flexors in leg
causes of UMN pattern of weakness
stroke
SOL
spinal cord problems
what kind of pattern will these cause?
- motor neuron disease
- spinal muscular atrophy
- lead poisoning
- polimyelitis
anterior horn cell - lower motor neurone lesion
organophosphate poisoning inhibits which enzyme?
acetylcholinesterase
causes of hemicord damage symptoms
- lost spinothalamic (temperature, pain)
- preserved dorsal colum (vibration, light touch, proprioception)
anterior spinal artery syndrome
brown sequard syndrome
syingomyelia
cerebellar signs
broad unstead gait intention tremor/ataxia dysdiadochokinesis - clumsy fast alternating movements nystagmus dysarthria
damage here causes disinhibition
-hunger, thirst, sexual functions becomes disinhibited
orbitofrontal cortex
damage here causes decreased response to external stimuli
dorsolateral prefrontal cortex
damage here causes abulia - lack of will or akinetic mutism
cingulate gyrus and dorsomedial frontal lobe
-motivation is affected
where does auditory dysfunction localise to?
herschel’s gyrus of temporal lobe
syndrome:
- dysgraphia
- left right disorientation
- finger agnosia
- acalculia
Gerstmann’s syndrome
-disease of the domiant angual gyrus, in the inferior parital lobe
site of lesion for:
-inattention
non-dominant angular gyrus of parietal lobe
where would deep brain stimulation work for parkinsons disease?
subthalamic nucleus
globus pallidus internal
cross the blood brain barrier and act directly as D2-type receptors. These agents include pramipexole, ropinirole, and bromocriptine.
Dopamine agonists
such as selegiline and rasagiline can improve symptoms in patients with mild disease (as monotherapy) as well patients already on levodopa.
MAO-B inhibitors
such as trihexyphenidyl or diphenhydramine (Benadryl) aim to combat tremor, but usually cause severe side effects
Anticholinergics
blocks NMDA receptors and has a mild attenuation of resting tremor and dystonia. May alleviate levodopa induced dyskinesias.
Amantadine
diagnosis of MS
neurological assessment
MRI imaging brain- including gadolinium contrast
primary lateral sclerosis- affects which modality
upper motor neurone ONLY
what imaging identifies old lesions and lesions of non-vascular origin in ischaemic stroke?
MRI T1/2 and FLAIR imaging
what imaging identifies new ischaemic lesions in stroke?
Diffusion weighted images
-hyperintensities in stroke
decreased signal on apparent diffusion coefficient of water
What imaging for bleeds and microbleeds (stroke)?
T2
What imaging for identifying brain areas at risk of ischaemia?
perfusion weighted images
name the lesion
No visual field defect
No new higher cortical or brainstem dysfunction
Pure motor hemiparesis, or pure sensory deficit of one side of the body, or sensorimotor hemiparesis or ataxic hemiparesis (dysarthric clumsy hand syndrome or ipsilateral ataxia with crural hemiparesis)
At least 2 of the 3 areas (face, arm, leg) should be involved in its entity
lacunar syndrome
name the syndrome- any 1 of: Cranial nerve palsy Unilateral or bilateral motor or sensory deficit Disorder of conjugate eye movements Cerebellar dysfunction Homonymous hemianopia Cortical blindness
posterior circulation syndrome
name the syndrome :
Hemiplegia and homonymous hemianopia contralateral to the lesion, and
Either aphasia or visuospatial disturbances
+/- sensory deficit contralateral to the lesion
total anterior circulation syndrome
name the syndrome:
One or more of unilateral motor or sensory deficit, aphasia or visuospatial neglect (with or without homonymous hemianopia)
Motor or sensory deficit may be less extensive than in lacunar syndromes
partial anterior circulation syndrome
