Classic Presentations Flashcards
Back pain made worse on movement and relieved by rest
Mechanical back pain
Shooting neuralgic pain down a dermatomal distribution in the arms / weakness and loss of reflexes in myotomes of arms
Cervical disc prolapse
Shooting neuralgic pain down a dermatomal distribution in the legs / weakness and loss of reflexes in myotomes of legs
Lumbar disc prolapse
Lower back pain with absent ankle reflexes +/- saddle paraestheisa, painless urinary retention, fecal and urinary incontinence, bilateral sciatica and genital numbness or erectile dysfunction
Cauda equina
A 60 year old obese man who used to work as a builder presents with burning leg pain precipitated by standing and worse on mobilising. The pain is less on walking uphill or with lumbar flexion and pedal pulses are preserved.
Lumbar spinal stenosis / spinal claudication
A 60 year old patient presents with slow onset stiffness and pain in the neck which can radiate to the shoulders and the occiput
Cervical spondylosis
A patient presents with bilateral ‘numb clumsy hands’, gait disturbance, pain in a non-dermatomal distribution, hyperreflexia and +ve Babinski’s sign
Cervical myelopathy
Trauma to spine has caused:
- Paralysis below level of injury (corticospinal tract)
- Loss of pain and temperature below the level of injury (lateral spinothalamic tract)
- Preserved proprioception and vibration sensation (dorsal columns)
Anterior cord syndrome
Trauma to spine has caused loss of all motor and sensory modalities affected below the lesion
Cord transaction (complete spinal cord lesion)
Trauma to spine has caused:
- Ipsilateral loss of motor function (corticospinal), proprioception and vibration sensation (dorsal columns) below the lesion
- Contralateral loss of pain and temperature sensation (spinothalamic) beginning at 1 or 2 segments below the lesion
Brown-Sequard Syndrome (Cord Hemisection)
An acute extension injury has caused bilateral upper limb weakness that is greater than lower limb weakness and “Cape-like” spinothalamic sensory loss (pain and temperature). Dorsal columns are preserved
Central cord syndrome
A tumor in which lobe of the brain would classically cause personality change?
Frontal lobe
A tumour in which lobe of the brain would classically cause memory deficits?
Temporal lobe
A tumour in which lobe of the brain would classically cause:
- Dyscalculia (difficulty with maths), dysgrapha (difficulty with writing), finger agnosia (inability to distinguish fingers) and left-right disorientation if the DOMINANT lobe is affected or
- Neglect (deficit in awareness of one side of the body), dressing apraxia and constructional apraxia if the NON-DOMINANT lobe is affected
Parietal lobe
A tumour in which lobe of the brain would classically cause contralateral homonymous hemianopia and/or visual hallucinations
Occipital
A tumour in which lobe of the brain would classically cause ipsilateral ataxia, N&V, dizziness, slurred speech and intention tremor
Cerebellum
A 30 year old patient presents with vertigo, tinnitus and unilateral sensorineural hearing loss. What kind of tumour would cause this?
Acoustic Neuroma/Vestibular Schwannoma
A patient presents with a thunderclap headache, neck stiffness, photophobia, N&V and collapse
Subarachnoid haemorrhage
A patient has a stroke that is purely motor or purely sensory or an ataxic hemiparesis (weakness and ataxia on the same side) that affects any two of face arm and leg
Lacunar infarct (LACI)
A patient presents with:
- Higher cerebral dysfunction (e.g. dysphasia, visuospatial disturbances, decreased level of consciousness)
- Homonymous visual field defect
- Ipsilateral motor and/or sensory deficit of at least two areas (out of face, arm and leg)
Total anterior circulation infarcts (TACI)
A patient presents with a stroke that causes any of the following:
- Ipsilateral cranial nerve palsy with contralateral motor and/or sensory deficit
- Bilateral motor and/or sensory deficit
- Cerebellar dysfunction
- Isolated homonymous visual field defect
- Cortical blindness (total or partial loss of vision in a normal-appearing eye)
Posterior circulation infarcts (POCI)
A patient presents with a headache, a focal neurological defect and decreased concious level but no photophobia or neck stiffness
Intracerebral haemorrhage
A young obese female presents with a throbbing headache, worst first thing in the morning, relieved on standing. On examination she has bilateral papilloedema
Idiopathic intracranial hypertension
A patient presents with orthostatic headaches (headache while vertical - relieved by lying down) +/- upper body pain, visual field abnormalities, dizziness, muffled hearing etc
Spontaneous intercranial hypotension
A young woman presents with unilateral progressive vision loss over 48hrs with pain behind eye exacerbated with eye movements, dyschromatopsia, central scotoma and RAPD on examination
Optic neuritis
A patient experiences a sudden, profound, painless visual loss. On examination the retina is pale and swollen
Ischaemic optic neuropathy
A patient presents with ipsilateral miosis (constricted pupil), ptosis (drooping upper eyelid), anhidrosis (excessive sweating) and increased warmth and redness
Horner’s Syndrome
A patient presents with unilateral anisocoria (affected pupil is larger), blurring on near vision, an absent light reflex and slow near reflex
Adie’s Pupil
A patient with diabetes presents with bilateral, irregular, small pupils
Argyll pupil
A patient presents with horizonal diplopia worse on distance and increased on looking to one side. On examination abduction is limited in one eye
CN VI (abducens nerve) palsy
A patient presents with horizonal diplopia worse on distance. On examination abduction is limited in one eye
CN VI (abducens nerve) palsy
A patient presents with vertical diplopia. They have a contralateral downward head tilt to compensate. On examination they have an ipsilateral higher eye (i.e., hypertropia) and excyclotorsion (the affected eye deviates upward and rotates outward)
CN IV (trochlear) nerve palsy
A patient who has been hit in the head has a brief loss of consciousness followed by a period of consciousness and awareness followed by rapid deterioration
Extradural haematoma
An elderly person presents with a 4 week history of headache, confusion, weakness and cognitive dysfunctions following a fall
Subdural haematoma
A child presenting with failure to thrive is found to have dilated scalp veins, increased head circumference, impaired upgaze and ‘setting sun’ appearance of the eyes (downward deviation of the globe on lid retraction)
Hydrocephalus
A patient has two separate diagnoses of dementia and urinary incontinence but you notice they also have an ataxic gait. What condition could account for all three?
Normal pressure hydrocephalus
A young woman presents with a headache that is a unilateral, throbbing pain that’s worse on movement +/- photophobia, phonophobia and nausea
Migraine (without aura)
A patient presents with recurrent bilateral headaches and describe the pain as ‘pressing’. There are no additional symptoms
Tension type headache
A 35 year old man presents with severe unilateral headaches in a trigeminal distribution. They last a couple of hours and occur at the same time each day. He experiences a few attacks each day for a few weeks and then has a few months symptom free
Cluster headaches
A 55 year old woman presents with a severe unilateral headache in a trigeminal distribution that lasts for under an hour and happens up to 40 times a day
Paroxysmal hemicrania
A patient experiences short (<2 minutes), unilateral headaches +/- red eyes and tearing
SUNCT
A patient experiences short (<2 minutes), unilateral headaches in a trigeminal distribution +/- red eyes and tearing
SUNCT
A 60 year old woman experiences severe, stabbing unilateral pain lasting around a minute in a trigeminal distribution, triggered by light stimulus
Trigeminal neuralgia
A patient presents with the classic triad of headache, neck stiffness and fever
Meningitis
A patient presents with insidious onset of fever, mental status change, seizures and focal neurological defects
Encephalitis
After an infection a patient presents tingling that progresses into pain in a glove and stocking distribution. This evolves into progressive paraplegia over days
Guillain-Barre syndrome
A 35 year old woman complains of numbness and weakness in her limbs. She also complains of problems with bladder control and instability while walking. On examination she has mild spasticity and hyperreflexia
Multiple sclerosis
A 70 year old woman becomes increasingly forgetful and disoriented. An MRI shows atrophy of temporal/parietal lobes
Alzheimer’s disease
A patient presents with memory problems and recurrent well-formed visual hallucinations. These symptoms began developing at around the same time as the patient began to develop an ataxic gait and pill rolling tremor
Lewy Body dementia
A 40 year old man has become increasingly depressed and aggressive. His executive function has decline and he has started to have involuntary jerks of his muscles
Huntington’s disease
A 55 year old patient has been reported to be ‘acting oddly’. Collateral history states they have become increasingly rude and impulsive. The patient does not believe anything is wrong
Pick’s Disease/Fronto-temporal dementia
A 65 year old man with a history of hypertension has been reported to have significant drops in cognition in a stepwise progression
Multi-Infarct dementia/Vascular dementia
A patient presents as being ‘unsteady of their feet’. On examination you note they have rigidity, bradykinesia, postural instability and a pill rolling tremor
Parkinson’s disease
A patient with a >1 year history of bradykinesia, gait abnormalities and pill rolling tremor develops hallucinations and memory problems
Parkinson’s disease dementia
During an emotionally charged argument, 60 year old patient experienced sudden onset of memory loss and confusion. They were disorientated to time and place but remembered who they and their family were. When the episode was over they had no memory of the event
Transient global amnesia
A patient presents with fatigue type weakness that’s worse throughout the day. They describe their eyes drooping by the end of the day and choking after a big meal. Their limb weakness is mainly proximal
Myasthenia gravis
On examination, a young boy is noted to have Gower’s sign and progressive muscle weakness
Duchenne’s muscular dystrophy
A 30 year old woman presents with symmetrical proximal weakness and pain
Polymyositis
A 30 year old woman presents with symmetrical proximal weakness and pain. She is also noted to have a v-shaped rash on her chest, gottron’s papules, a heliotrope rash and shawl sign
Dermatomyositis
A 60 year old man presents with asymmetrical distal muscle weakness with thumb sparing
Inclusion body myositis
A patient who is training for a marathon presents with muscle pain and weakness. They also describe brown urine. Blood tests show a raised CK
Rhabdomyolysis
A patient presents with both upper and lower MN features that started in one limb and then spread to the other limbs and trunk
Amyotrophic lateral sclerosis (ALS)
A 70 year old woman presents with dysarthria (difficult or unclear articulation of speech), dysphagia, choking and random outbursts of laughing/crying. Examination shows a fasciculating tongue
Progressive bulbar palsy (PBP)
A patient presents with slowly progressive tetraparesis (all four limbs are weak) and pseudobulbar palsy (inability to control facial movements). There are no LMN features
Primary lateral sclerosis (PLS)
A patient presents with purely LMN symptoms that start in one limb and then spreads
Progressive muscular atrophy
A patient has been seizing for >30 minutes
Status epilepticus
A child seems to regularly ‘zone out’ and are completely unrousble during these episodes. They freeze in place but tone is preserved and there is no fall. Afterwards they return to their previous activity as if nothing happened and are not confused.
Absence seizures
A child has recurrent episodes of completely losing muscle tone
Atonic seizure
A patient presents with the triad of confusion, ataxia and nystagmus
Wernicke’s encephalopathy
A known alcoholic presents with anterograde amnesia, confabulation, ataxia, nystagmus and opthalmoplegia (paralysis of the muscles within or surrounding the eye)
Wernicke–Korsakoff syndrome
A patient presents with unilateral LMN facial weakness that developed over 24-48hrs
Bell’s palsy
A patient on typical antipsycotics develops rigidity, akinesia (either bradykinesia or hypokinesia) and a pill-rolling tremor
Drug induced parkinsonism
A patient presents with axial akinesia and rigidity, loss of balance, forgetfulness, dysarthria and loss of eye movements. MRI shows midbrain atrophy with hummingbird sign
Progressive supranuclear palsy
A patient with a significant vascular history presents with parkinsonism with more problems with gait than tremor and more problems in the lower body. The progression of their disease is very slow and they have a poor response to levodopa
Vascular parkinsonism
A paediatric patient presents with a >1 year history of motor (eg blinking) and phonetic (eg throat clearing)/vocal (eg barking) tics
Gilles de la tourette syndrome
A patient presents with wild, flinging movements of one arm/leg
Hemiballism
A patient reports feeling the urge to move their legs at night that is only relieved by getting up and walking about
Restless leg syndrome
A patient has a lobar (simple partial/focal) seizure that causes stiffness/twitching/spasms. The seizure occurred in which lobe?
Frontal
A patient has a lobar seizure that causes tingling/numbness/pain. The seizure occurred in which lobe?
Parietal
A patient has a lobar seizure that causes flashing lights/hallucinations. The seizure occurred in which lobe?
Occipital
A patient has a lobar seizure that causes a change in moot/behaviour and a rising epigastric sensation. The seizure occurred in which lobe?
Temporal
A patient presents with a history of having episodes of repetitive lip smacking/fiddling/walking etc. When the episode is over they have no recollection of it
Focal impaired awareness seizure (complex focal seizure)
A 13 year old develops sudden, shock like jerks just after waking. They remain conscious during these episodes and it only lasts a fraction of a second
Muoclonic seizure/juvenile myoclonic epilepsy
A child experiences a seizure where their muscles spasm and jerk but there was no stiffness at the beginning of the episode. What type of seizure is this?
Clonic seizure
A patient experiences a seizure where they lose consciousness and fall to the ground. They extend their neck and arch their back but do not jerk. What kind of seizure is this?
Tonic seizure
A patient experiences a seizure where they lose consciousness and go stiff followed by rapid contracting and relaxing of muscles. What kind of seizure is this?
Tonic clonic seizure
A patient presents with dysphagia, slow speech and a brisk jaw jerk reflex
Pseudobulbar palsy
A <10 year old patient presents with severe cramping pain soon after starting an exercise. A short period of rest allows them to continue. CK levels are elevated
McArdle disease
A patient has grip myotonia and foot drop, facial weakness, ptosis, opthalmoplegia and bilateral christmas tree cateracts, hollowing of the temples and early frontal balding. One of their parents had the same symptoms.
Myotonic dystrophy
A patient with small cell lung cancer (OR an autoimmune condition) experiences insidious onset of weakness in proximal muscles. Lower extremities are more affected and they have a waddling gait. They also have autonomic features (dry mouth, postural hypotension etc) and diminished deep tendon reflexes
Lambert-Eaton myasthenic syndrome
A patient presents with rapidly progressing dementia, ataxia and myoclonic jerks. CSF analysis shows elevated 14-3-3 protein
Creutzfeldt-jakob disease
A patient has a headache that occurs on coughing. It is sharp, bilateral and only lasts a short duration
Primary cough headache (usually has an underlying cause like a chiari malformation, aneurysm etc)
A patient experiences a dull, aching pain in the occipital region during sex that increases with activity)
Primary sexual headache - early coital cephalgia
A patient experiences a severe headache during orgasm
Primary sexual headache - post-coital cephalgia
A middle-aged patient presents with involuntary movements of the head to one side
Cervical Dystonia
