7.7 DD in Neurology Flashcards
What are the DD for presentations over seconds, minutes and hours?
Sec: trauma, vascular (stroke), seizure
Min: vascular, seizure, migraine
Hours: haemorrhagic, inflammatory
What are the most common DD for presentations over days, weeks and months
Day: infectious, compressive, malignant
Weeks: compressive, malignant, neurodegenerative
Months: compressive and neurodegenrative
What are positive symptoms?
When neurons are doing something extra
jerks, twitches, convulsions, sensation, tingling, hallucinations, coloured spots in vision, migraines
What are negative symptoms?
When there is a deficit in neuronal function
Paralysis, weakness, numbness, monocular blindness, visual field defects, neuronal death
What do you have if you have everything on one side affected?
Brain lesion on the C/L side
What would you have with both legs, arms and trunk (sparing arms and face)
Cord lesion at or above the highest involved dermatome
What would you have with everything affected except the face?
Cervical cord lesion
What would you have if hands, distal limbs affected
Peripheral nerve lesion
What is affected if you have face and body affeced on opposite sides?
Brainstem lesion
What is the pattern in Brown-Sequard syndrome and what causes it?
Weakness and dorsal column loss on one side, spinothalamic on the other
Caused by damage to one half of the spinal cord
What is the difference in presentation of cauda equina syndrome and a peripheral neuropathy ?
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
What are the characteristics of a UMN lesion
Spastic weakness, increased tone, pyraidal pattern of weakness (preservation of UL flexors and LL exten), increased reflexes, positive babinski and hoffmans, minimal atrophy
What are the characteristics of a LMN lesion?
Flaccid weakness, decreased tone, non pyramidal weakness, decreased reflexes, negative babinski and hoffmans, marked atrophy, fasciculation’s
What will you see in UMN and LMN lesions of the face?
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
What sensory pettern will you have in a cortical lesion?
cognitive dimension to the sensory loss (agraphaesthia, astereognosis, tactile extinction) and they are usually truncal sparing
What is occam’s razor?
The simplest explanation, involving the least number of causes/assumptions is likely to be correct
If the arm is involved what does ocams razor indicate
Lesion will be above T2
If the face is involved what does ocams razor suggest?
High cervical cord or brain lesion
If cranial nerves and arms involved what does ocams razor suggest?
The brainstem must be involved
What symptoms, in the presence of long tract deficits suggest brainstem involvement?
Vertgo, diplopia, dysarthria and dysphagia
What CNS, PNS and combined can cause lesions from a single disease?
CNS: MS, multiple strokes, multiple metastases
PNS: mononeuritis multiplex, vasculitis, malignancy
CNS and PNS: diabetes, vasculitis, motor neuron disease
What diseases commonly present with UMN and LMN symptoms?
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
What are the symptoms that suggest stroke?
Increasing age Sudden onset, maximum at onset Negative symptoms Preceding neurological symptoms Symptoms focal and usually referable to a single arterial territory
What are the CV risk factors for stroke?
hypertension, diabetes, smoking, hypercholesterolaemia
What is important with a stroke history?
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
What pattern of loss will you have in a middle cerebral artery stroke?
Unilateral arm weakness
What pattern of loss will you have in a anterior cerebral artery stroke?
Unilateral leg
Where will you have a stroke with unilateral face, arm and leg loss?
Total anterior and middle cerebral (blocked carotid) or internal capsular (lacunar) infarct
What will you have in a PACI (posterior anterior circulation infarct)?
Monoplegia, hemiparesis, hemianasthesia + either dysphasia or hemianopia
What will you have in a TACI (total anterior circulation infarct)?
hemiparesis, hemianaesthesia + both dysarthria and hemianopia
What will you have in a LACI (lacunar infarct)
Pure unilateral motor or sensory deficit, unilateral weakness + ataxia
What will you have in a POCI (posterior circulation infarct)
Brainstem/cerebellar features +/- hemianopia
What must you always exclude in a sudden onset headache?
SUBARACHNOID HAEMORRHAGE Meningitis/encephalitis Temporal arteritis Sleep apnoea Raised ICP Low pressure headaches
