Basics and Upper limb neurology Flashcards
Grading of muscle power?
0 = complete paralysis 1 = flicker of contraction 2 = movement without gravity 3 = movement with gravity only 4= Movement with gravity + some resistance 5 = nrmal
Signs of a LMN lesion?
Weakness
Wasting
Decreased/absent reflexes
Fasciculation
Signs of an UMN lesion?
Weakness of muscle groups: - upper limb = extensors - lower limb = flexors Spasticity Hyperreflexia and extensor plantar response Clonus
Causes of a peripheral neuropathy?
Diabetes Hereditary Idiopathic Drugs - isoniazid, cisplatin, vincristine Toxins - heavy metals Alcohol Hypothyroidism Porphyria Vitamin B12 or B1 deficiency Vitamin B6 excess Guillain-barre syndrome Carcinoma Connective tissue disease - SLE Vasculitis
Causes of a motor neuropathy?
Diabetes
Guillain-Barre syndrome
Chronic inflammatory demyelinating polyradiculoneuropathy
Lead poisoning
Multiple motor neuropathy
Porphyria
Charcot-marie tooth disease - sensory+motor
Causes of a sensory neuropathy?
Diabetes Carcinoma Paraproteinaemia Vitamin B6 intoxication Vitamin B12 deficiency Sjogrens Syphilis Idiopathic
Causes of a painful peripheral neuropathy?
Diabetes Alcohol Vitamin B12 or B1 deficiency Carcinoma Porphyria Arsenic or thallium poisoning
Nerve conduction study findings for peripheral neuropathy?
Demyelinating = slow velocity --> increased latency Axonal = decreased amplitude
Causes of mononeuritis multiplex?
Acute: - VASCULAR
- Diabetes
- Polyarteritis nodosa
- SLE
- RA
Chronic:
- Multiple compressive neuropathies - joint deforming arthritis
- Sarcoidosis
- Acromegaly
- Leprosy
- Lyme disease
- Idiopathic
Causes of thickened nerves?
Hereditary motor and sensory neuropathy Acromegaly CIDP Amyloidosis Leprosy Sarcoidosis Neurofibromatosis
Causes of fasiculations?
Benign idiopathic fasciculation Motor neuron disease Motor root compression Malignant neuropathy Spinal muscular atrophy
Features of Charcot Marie Tooth?
Hereditary motor and sensory neuropathy
Pes cavus - short, high arched feet with hammer toes
Distal muscle atrophy - to elbows and thighs
Absent reflexes
No sensory loss
Thickened nerves
Optic atrophy
Features of a complete brachial plexus injury?
LMN whole arm
Whole arm sensory loss
Horners syndrome
Features of upper Brachial plexis injury?
Erb-Duchenne lesion
C5-C6 lesion
Waiter’s tip pose
Loss of shoulder movement
Loss of elbow flexion
Sensory loss over the lateral aspect of the arm, forearm and thumb
Features of a lower brachial plexus injury?
Klumpke lesion
C8-T1 lesion
Claw hand - wasting and weakness of the hand
Paralysis of all intrinsic muscles of the hand
Sensory loss along the ulnar side of the forearm and hand
Horner’s syndrome
Features of cervical rib syndrome?
Claw hand
Sensory loss over the medial aspect of hand and forearm
Unequal radial pulses and BP
Subclavian bruit and loss of pulse on arm manoeuvring
Palpable cervical rib in the neck
Features of a Radial nerve lesion?
C5-C6 lesion
Wrist and finger drop
Loss of elbow extension
Sensory loss over the anatomical snuff box
Features of a medial nerve lesion
C6-T1 lesion
Loss of thumb abduction - LOAF muscles
Loss of index finger flexion
Sensation loss over thumb, index, middle and lateral ring finger
Causes of carpal tunnel syndrome?
Idiopathic RA Endocrine - hypothyroidism, acromegaly Pregnancy Trauma Overuse
Features of an ulnar nerve lesion?
Wasting of the intrinsic hand muscles except the thenar eminence (LOAF muscles)
Claw-like hand
Weak finger abduction and adduction
Loss of sensation to 5th and half of 4th finger
Causes of hand wasting?
Nerve lesions
Hereditary motor and sensory neuropathy
Anterior horn disease - MND, spinal muscle atrophy, polio
Myopathy - dystrophia myotonica, distal myopathy
Spinal cord lesions - syringomyelia, cervical spondylosis
Disuse arthropathies
Ischaemia
Vasculitis
Causes of myopathy?
Hereditary muscular dystrophy Paraneoplastic syndrome EtOH Connective tissue disease Polymyositis Endocrine - hypothyroid, hyperthyroid, cushings Periodic paralysis Osteomalacia Steroids Sarcoidosis
Types of muscular dystrophy?
Duchennes Beckers Limb girdle Facio-scapulohumoral Dystrophia myotonica
Tests for myopathy?
CK EMG Muscle biopsy ECG TTE
