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Junior IM Posting > APPROACH TO THE PATIENT WITH NEUROLOGICAL SYMPTOMS: MUSCLE WEAKNESS AND HEADACHE > Flashcards

APPROACH TO THE PATIENT WITH NEUROLOGICAL SYMPTOMS: MUSCLE WEAKNESS AND HEADACHE Flashcards

1
Q

Two important questions to answer in neurological evaluation

A

Where is the lesion
What is causing the lesion

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2
Q

Muscle weakness VS fatigue VS asthenia

A

An inability to carry out a desired movement (at first repetition) with normal force because of a reduction in strength of the muscles necessary to carry out the movement

inability to continue performing a task after multiple repetitions; lack of energy

a sense of weariness or exhaustion in the absence of muscle weakness

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3
Q

The evaluation of the patient presenting with a complaint of “WEAKNESS” involves three steps:

_______________________________

_________________________________

_________________________________

A

Distinguishing true muscle weakness from lassitude or motor impairment not due to loss of muscle power.

Localizing the site of the lesion that is producing weakness.

Determining the possible aetiology (cause) of the lesion

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4
Q

Localizing the lesion

It could be in the :

Mention 7

A

Muscles
NMJ
peripheral nerves
Motor cortex
Anterior horn
Spinal nerve root
Corticospinal tracts

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5
Q

Localization of muscle weakness

_________- upper motor neuron

_________- lower motor neuron

__________ - neuromuscular junction

A

Brian

Spain cord

Muscle and nerve junction

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6
Q

Patterns of muscle weakness

Plegia: ___________
Paresis: _______ ,_________

A

complete paralysis

reduction of power, incomplete paralysis

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7
Q

Patterns of muscle weakness

The paresis or plegia can be :

  • ___________
    – Restricted to _______ or _______
    – Restricted to a _________
A

Generalized

specific muscle or nerve

body region

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8
Q

Patterns of muscle weakness

The paresis or plegia can be Restricted to a body region. The following terms are used: ______,______,_______,_______

A

Mono
Hemi
Para
Quadri

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9
Q

Muscle weakness is being Unable to ___________ even at ___________

Not ___________
Not ___________
Not ___________
Not ___________ restricting movement
Not ‘___________’

A

perform movements ; first attempt

Not fatigue
Not asthenia
Not stiffness (or rigidity)
Not pain restricting movement
Not ‘apraxia’

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10
Q

Taking history of muscle weakness

Clarify what patient means by ‘weakness’

Determine the __________ of the muscle weakness

Determine the _______

Determine the ____________

Explore possible ____________

A

spatial distribution

associated symptoms

temporal characteristics

aetiologies

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11
Q

Temporal characteristics of muscle weakness
- ___________
– ___________ (neuromuscular junction)
– ___________ (NMJ)
– Tempo of ___________ and ___________

A

Persistent
– Fluctuating (neuromuscular junction)
– Fatigability (NMJ)
– Tempo of onset and progression:

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12
Q

Associated symptoms of muscle weakness

Other neurological symptoms

———- symptoms and distribution
_________ symptoms and distribution
____________ symptoms and distribution

Other systemic symptoms
_________,_________,__________ complaints

Other co-morbidities or systemic illness
Endocrine (______,________ , metabolic disorders) Vascular risk factors
Infections (on going or preceding)

A

Motor; Sensory; autonomic

Rheumatologic , dermatologic, endocrine

DM, thyroid disorders

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13
Q

In the patient with suspected myopathy, muscle tenderness suggests an _________ aetiology or a ________ myopathy such as _________ disease.

A

infectious

Metabolic

McArdle’s

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14
Q

In comparison, tenderness is an unusual finding in the idiopathic inflammatory myopathies such as __________ or __________

A

polymyositis or dermatomyositis.

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15
Q

Increased muscle tone or rigidity is present in _______ disease, a disorder in which weakness or decreased motor function may be an initial complaint.

Increased tone also occurs in ______ motor neuron lesions or in ________ diseases.

A

Parkinson

upper

demyelinating

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16
Q

Myotonia describes ________________ after ____________ and is typical of _____________.

A

abnormal lack of relaxation

muscle contraction

myotonic dystrophy

17
Q

Myoedema is an unusual finding of localized “_____________” of the muscle where it has been ___________________

It is a sign of severe _______________ or ?

A

mounding-up

tapped by a reflex hammer.

hypothyroidism

18
Q

MRC Grading of muscle power

Scale Muscle strength
0
1
2
3
4
5

A

No flicker of contraction

Flicker or trace of contraction

Active movement with gravity eliminated

Active movement against gravity

Active movement against gravity and with resistance

Normal power

19
Q

CLINICAL INVESTIGATIONS

Laboratory studies
Chemistry and urinalysis – Elevations of plasma muscle enzymes ( ________,________,__________ , and the ____________ ) are highly suggestive of muscle diseases.

Elevated in motor neuron disease or can be induced by strenuous exercise, intramuscular injections, or muscle trauma in the absence of generalized muscle disease.

A positive test for urine blood, in the absence of red blood cells in the sediment, is suggestive of _________

A

creatine kinase, aldolase, lactate dehydrogenase

Aminotransferases

myoglobinuria

20
Q

CLINICAL INVESTIGATIONS Electrophysiologic studies —

____________ and ___________ studies are used when the site of the lesion causing weakness is suspected to be in the __________ nervous system, the ___________, or the __________.

A

Nerve conduction and electromyographic (EMG)

peripheral ; neuromuscular junction; muscle itself

21
Q

The EMG is also of value in directing the site of muscle biopsy

T/F

A

T

22
Q

Magnetic resonance imaging (MRI) may be useful in selecting a muscle for biopsy.

T/F

A

T

23
Q

Magnetic resonance imaging (MRI)

Has an advantage over EMG in cases of suspected _______________ in that the actual muscle to be biopsied can be identified,.

A

inflammatory myopathy

24
Q

Probable Aetiology of headaches

Idiopathic (primary) headaches

Most common are _______,______,_______ headache
Recognizable by the core headache characteristics
Diagnosed when the characteristic HA is not attributable to any other condition

A

tension-type, migraine, cluster

25
Q

Probable Aetiology of Headaches

Secondary
Characterized by the presence of additional features that point to a plausible cause for the HA
Includes intracranial, extracranial (systemic) causes of diverse.
Some secondary HA connote serious cause not to be missed

A

Okay🌚

26
Q

________________ Headaches
Most common form of headache

A

Tension-Type

27
Q

Tension-Type Headaches (TTH)

Features: HA lasts ___________-___________

A

30 minutes –7 days

28
Q

Tension-Type Headaches (TTH)

At least 2 of these features:
____lateral location
___________ or ___________ (___________) quality
______ or _________ intensity (may inhibit but not prohibit activity)
Not aggravated by ____________________

Has both of these features:
no ___________ or ___________
not > one of either ___________ or ___________

A

Bilateral

Pressing or tightening (non-pulsating)

Mild or moderate

routine physical activity

nausea or vomiting

photophobia or phonophobia

29
Q

Migraine Headaches: Diagnostic Criteria

5
4
3
2 of the following : ____lateral; _______ quality; ______ or ——— intensity ; aggravated by __________
1 of the following: ______ or ________ ; ______ or ______

A

5 episodes
4hrs to 3days duration

Uni; pulsating; moderate or severe; routin physical activity

Nausea or vomiting

Photophobia or phonophobia

30
Q

___________ headaches may have an aura, last for ————, develop ________, and is completely (reversible or irreversible?)

A

May have an aura

Migraine

last no longer than 60 minutes

gradually

completely reversible

31
Q

Migraine headaches has (male or female?) Preponderance

A

Female Preponderance

32
Q

Simple, Accurate, Fast screener for migraine headaches

PIN diagnosis

A

Photophobia
Inability for a day or more in the last 3 month
Nausea

33
Q

Cluster Headaches

Features: at least ___ episodes of headaches

Intensity: ________ or _________

Location: _______,______,_______ or ______

Duration: lasting ______ to ________ if untreated
–

A

5

Severe or very severe

unilateral, orbital, supraorbital, temporal pain

lasting 15 to 180 minutes

34
Q

Indications of Secondary Headaches

Mnemonic: SNOOP4 red flags

A

Systemic Illness
Neurologic
Onset that is sudden
Onset after age 40
Progressive
Postural
Precipitation by valsalva or exertion
Previous headache history with new or different features

35
Q

Investigations for headaches

___________
_____________
Further investigations dictated by suspected Aetiology

A

Neuroimaging

Lumbar puncture

Junior IM Posting (20 decks)

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