7.7 DD in Neurology

Question 1

What are the DD for presentations over seconds, minutes and hours?

Answer 1

Sec: trauma, vascular (stroke), seizure
Min: vascular, seizure, migraine
Hours: haemorrhagic, inflammatory

Question 2

What are the most common DD for presentations over days, weeks and months

Answer 2

Day: infectious, compressive, malignant
Weeks: compressive, malignant, neurodegenerative
Months: compressive and neurodegenrative

Question 3

What are positive symptoms?

Answer 3

When neurons are doing something extra

jerks, twitches, convulsions, sensation, tingling, hallucinations, coloured spots in vision, migraines

Question 4

What are negative symptoms?

Answer 4

When there is a deficit in neuronal function

Paralysis, weakness, numbness, monocular blindness, visual field defects, neuronal death

Question 5

What do you have if you have everything on one side affected?

Answer 5

Brain lesion on the C/L side

Question 6

What would you have with both legs, arms and trunk (sparing arms and face)

Answer 6

Cord lesion at or above the highest involved dermatome

Question 7

What would you have with everything affected except the face?

Answer 7

Cervical cord lesion

Question 8

What would you have if hands, distal limbs affected

Answer 8

Peripheral nerve lesion

Question 9

What is affected if you have face and body affeced on opposite sides?

Answer 9

Brainstem lesion

Question 10

What is the pattern in Brown-Sequard syndrome and what causes it?

Answer 10

Weakness and dorsal column loss on one side, spinothalamic on the other
Caused by damage to one half of the spinal cord

Question 11

What is the difference in presentation of cauda equina syndrome and a peripheral neuropathy ?

Answer 11

In cauda equina syndrome the back doesn’t equal the front - often involves sacral dermatoms, up the back of the leg and buttocks and perianal region

Peripheral neuropathy front = back - spares buttocks and back of thighs, usually lengthy dependent pattern

Question 12

What are the characteristics of a UMN lesion

Answer 12

Spastic weakness, increased tone, pyraidal pattern of weakness (preservation of UL flexors and LL exten), increased reflexes, positive babinski and hoffmans, minimal atrophy

Question 13

What are the characteristics of a LMN lesion?

Answer 13

Flaccid weakness, decreased tone, non pyramidal weakness, decreased reflexes, negative babinski and hoffmans, marked atrophy, fasciculation’s

Question 14

What will you see in UMN and LMN lesions of the face?

Answer 14

UMN: facial weakness usually spares the upper face because of bilateral cortical representation of the face

LMN: facial weakness usually affects whole side of face

Question 15

What sensory pettern will you have in a cortical lesion?

Answer 15

cognitive dimension to the sensory loss (agraphaesthia, astereognosis, tactile extinction) and they are usually truncal sparing

Question 16

What is occam’s razor?

Answer 16

The simplest explanation, involving the least number of causes/assumptions is likely to be correct

Question 17

If the arm is involved what does ocams razor indicate

Answer 17

Lesion will be above T2

Question 18

If the face is involved what does ocams razor suggest?

Answer 18

High cervical cord or brain lesion

Question 19

If cranial nerves and arms involved what does ocams razor suggest?

Answer 19

The brainstem must be involved

Question 20

What symptoms, in the presence of long tract deficits suggest brainstem involvement?

Answer 20

Vertgo, diplopia, dysarthria and dysphagia

Question 21

What CNS, PNS and combined can cause lesions from a single disease?

Answer 21

CNS: MS, multiple strokes, multiple metastases
PNS: mononeuritis multiplex, vasculitis, malignancy
CNS and PNS: diabetes, vasculitis, motor neuron disease

Question 22

What diseases commonly present with UMN and LMN symptoms?

Answer 22

Cervical spondylosis: UMN in legs from cord compression, LMN from radiculopathy
Diabetes: stroke and peripheral vasculitis
Motor neuron disease: UMN and LMN degeneration without sensory features

Question 23

What are the symptoms that suggest stroke?

Answer 23

Increasing age 
Sudden onset, maximum at onset 
Negative symptoms 
Preceding neurological symptoms 
Symptoms focal and usually referable to a single arterial territory

Question 24

What are the CV risk factors for stroke?

Answer 24

hypertension, diabetes, smoking, hypercholesterolaemia

Question 25

What is important with a stroke history?

Answer 25

Cardiac abnormalities: recent MI, known vascular disease, AF, patent foramen ovale, atrial septal defect
Recent surgery or other cause of prolonged hypotension
Features of vasculitis
Medications: warfarin, anticoagulants, anti-platelet, OCP
Family Hx: stroke, MI, diabetes, hypotension

Question 26

What pattern of loss will you have in a middle cerebral artery stroke?

Answer 26

Unilateral arm weakness

Question 27

What pattern of loss will you have in a anterior cerebral artery stroke?

Answer 27

Unilateral leg

Question 28

Where will you have a stroke with unilateral face, arm and leg loss?

Answer 28

Total anterior and middle cerebral (blocked carotid) or internal capsular (lacunar) infarct

Question 29

What will you have in a PACI (posterior anterior circulation infarct)?

Answer 29

Monoplegia, hemiparesis, hemianasthesia + either dysphasia or hemianopia

Question 30

What will you have in a TACI (total anterior circulation infarct)?

Answer 30

hemiparesis, hemianaesthesia + both dysarthria and hemianopia

Question 31

What will you have in a LACI (lacunar infarct)

Answer 31

Pure unilateral motor or sensory deficit, unilateral weakness + ataxia

Question 32

What will you have in a POCI (posterior circulation infarct)

Answer 32

Brainstem/cerebellar features +/- hemianopia

Question 33

What must you always exclude in a sudden onset headache?

Answer 33

SUBARACHNOID HAEMORRHAGE 
Meningitis/encephalitis 
Temporal arteritis 
Sleep apnoea 
Raised ICP 
Low pressure headaches