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Neurology finals > Acute bilateral leg weakness > Flashcards

Acute bilateral leg weakness Flashcards

1
Q

Give the symptoms of cord compression

A

Bilateral leg weakness (arm weakness - less severe and suggests a cervical cord lesion)
Sensory level +/- preceding back pain
Bladder and anal sphincter involvement is late and manifests as hesitancy, frequency and later as painless retention

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2
Q

Give the signs of cord compression

A

Look for motor, reflex and sensory level with normal findings above the level of the lesion
LMN signs at the level of the lesion
UMN signs below the level of the lesion

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3
Q

List the causes of cord compression

A 
Secondary malignancy 
Infection
Cervical disc prolapse
Haematoma 
Intrinsic cord tumour 
Atlanto-axial subluxation 
Myeloma
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4
Q

What cancers commonly spread to the bone

A 
Breast
Thyroid
Renal
Lung
Prostate
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5
Q

Which infections may cause cord comprssion

A

Epidural abscess

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6
Q

What investigations should be done when cord compression is suspected?

A 
MRI spine
Biopsy or surgical exploration
CXR
Bloods - FBC, ESR, B12, syphilis serology, U&Es, LFT, PSA, serum electrophoresis 
PR
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7
Q

What is the initial treatment for cord compression?

A

Dexamethasone in malignancy
Radiotherapy or chemotherapy in malignancy
Decompressive laminectomy
Epidural abscesses may be surgically decompressed and antibiotics given

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8
Q

How do you distinguish cauda equina and conus medullaris from other cord lesions higher up

A

Leg weakness is flaccid and areflexic, not spastic and hyperreflexia

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9
Q

What causes conus medullaris and cauda equina?

A

Same causes as for cord compression plus congenital lumbar disc disease and lumbosacral nerve lesions

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10
Q

List some signs of conus medullaris lesions

A 
Mixed UMN/LMN signs 
Leg weakness
Early urinary retention 
Constipation 
Back pain 
Sacral sensory disturbance
Erectile dysfunction
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11
Q

List some signs of cauda equina lesions

A 
Back pain and radicular pain down the legs
Asymmetrical 
Atrophic
Areflexic paralysis of the legs 
Sensory loss in nerve root distribution 
Loss of sphincter tone
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12
Q

List the causes of unilateral foot drop

A 
DM
common peroneal nerve
Stroke
Prolapsed disc
MS
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13
Q

List the causes of weak legs with no sensory loss

A

MND
Polio
Parasagittal meningioma

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14
Q

List the causes of chronic spastic paraparesis

A 
MS
cord compression 
Metastasis/malignancy
MND
Syringomyelia
Subacute combined degeneration of the cord 
Hereditary spastic paraparesis 
Taboparesis
Histiocytosis X
Parasites
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15
Q

List the causes of chronic flaccid paraparesis

A

Peripheral neuropathy

Myopathy

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16
Q

List the causes of absent knee jerks and extensor plantars

A

Combined cervical and lumbar disc disease
Conus medullaris lesions
MND
Myeloradiculitis
Fredrich’s ataxia
Subacute combined degeneration of the cord
Taboparesis

17
Q

List the types of gait disorder

A 
Spastic
Extrapyramidal
Apraxic
Ataxic
Myopathic
Psychogenic
18
Q

What investigations would be done for gait disorders?

A 
Spinal Xray 
MRI
FBC
ESR
Syphilis serology 
Serum B12
U&Es 
LFT
PSA
Serum electrophoresis 
CXR
LP
EMG
Muscle and sural nerve biopsy
19
Q

Describe spastic gait

A

Stiff, circumduction of the legs and scuffing ot the toe of the shoes

20
Q

What causes a spastic gait

A

UMN lesion

21
Q

Describe extrapyramidal gait

A

Flexed posture
Shuffling feet
Slow to start
Postural instability

22
Q

Give a cause of extrapyramidal gait

A

Parkinson’s disease

23
Q

Describe an apraxic gait

A

Pathognomonic gluing to the floor on attempting walking or wide based unsteady gait with tendency to fall

24
Q

Give a cause of apraxic gait

A

Normal pressure hydrocephalus

Multiinfarct states

25
Q

Describe ataxic gait

A

Wide based, falls, can not walk heel to toe

Often worse in the dark or with eyes closed

26
Q

What causes ataxic gait

A

Cerebellar lesions - MS, posterior fossa tumour, alcohol, phenytoin toxicity
Proprioceptive sensory loss - sensory neuropathy and B12 deficiency

27
Q

Describe myopathic gait

A

Waddling gait, cannot climb steps or stand from sitting up due to hip girdle weakness

28
Q

Describe psychogenic gait

A

Suspect if bizarre gait not conforming to any pattern of organic gait disturbance and without any signs when examined on the couch

Neurology finals (32 decks)

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