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Nervous system > Clinical examination of nervous system > Flashcards

Clinical examination of nervous system Flashcards

1
Q

CSF (cerebrospinal fluid)

Normal findings

  1. Pressure
  2. Color
  3. Cells (RBC and WBC count)
  4. Protein
  5. Microbiology
  6. Oligoclonal bands
A
  1. Pressure: 50-250 cm water
  2. Clear
  3. RBC- 0-4
    WBC-0-4 (×10^6/L).
  4. Glucose: 50-60% of normal blood glucose level.
  5. Protein: <0.45gm/L
  6. Sterile
  7. Negative oligoclonal bands
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2
Q

CSF findings

  1. Raised Polymorphs
  2. Hazy/cloudy appearance
A
  1. Acute Bacterial/Pyogenic meningitis
  2. Partially treated meningitis
  3. Clear/cloudy in (2)

1. Marked rise in neutrophil polymorphs in (1)

1: 1000-5000 polymorphs×10^6/L
2: Normal to raised WBC count; mixed cells

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3
Q

CSF findings

Raised lymphocyte count

A
  1. Viral meningitis (10-2000)
  2. Tuberculous meningitis (50-5000)
  3. Cryptococcal meningitis in HIV infection (20-200)
  4. Carcinomatous/lymphomatous meningitis(0-400)
  5. Multiple sclerosis (0-50)
  6. AIDP (acute inflammatory demyelinating polyneuropathy) (0-50)
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4
Q

CSF findings

Raised protein count

A
  1. Subarachnoid hemorrhage
  2. AIDP (acute inflammatory demyelinating polyneuropathy)
  3. Multiple sclerosis
  4. Carcinomatous/lymphomatous meningitis
  5. Acute bacterial/pyogenic meningitis
  6. Partially treated bacterial meningitis
  7. Viral meningitis
  8. Cryptococcal meningitis in HIV infection
  9. Tuberculous meningitis

1,2: Marked Raise
3,4: Normal/raised

1-4: Non inflammatory causes
5-9: Inflammatory causes
Protein can be normal in 6,7,8

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5
Q

Neurological emergencies

A
  1. Status epilepticus
  2. Stroke
  3. Guillian Barre syndrome
  4. Myasthenia Gravis
  5. Spinal cord compression
  6. Subarachnoid haemorrhage
  7. Neuroleptic malignant syndrome

2: If thrombolysis or mechanical thrombectomy available
4: If bulbar and/or respiratory

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6
Q

Gait examination

Difficulty raising from a chair

A

Proximal muscle weakness or joint disorders

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7
Q

Gait examination

Difficuty starting to walk, frozen

Gait initiation

A

Cerebrovascular disease
Parkinsonism

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8
Q

Gait examination

  1. Stooping
  2. Postural instability
  3. Narrow-based, short strides, freezing in doorways
  4. Enhanced tremor
  5. Reduced arm swing
  6. Shuffling/festination
A

Parkinsonism

Reduced arm swing can also be found in upper motor neuron lesions.

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9
Q

Gait examination

Slapping, High-stepping gait due to foot drop

A

L5 radiculopathy or common peroneal nerve lesion

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10
Q

Gait examination

Stiff legged, scissors gait

A

Spastic paraparesis:
* Multiple sclerosis
* Vascular disease
* Spinal cord lesions
Cerebellar lesions

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11
Q

Gait examination

Wide based, unsteady, unable to perform tandem gait
Waddling gait

A
  1. Myopathies with proximal weakness (Proximal myopathy)
  2. Dermatomyositis, polymyositis
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12
Q

Gait examination

High stepping gait/Stamping gait

A

Dorsal column lesion, Sensory neuropathy

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13
Q

Gait examination

Drunken /ataxic gait

Characterstic “broad based” gait

A
  1. Cerebellar lesion (vermis)
  2. Lesion in vestibular apparatus or peripheral nerves

Metabolic causes of acquired ataxia: Vitamin E deficiency, hypoparathyroidism

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14
Q

Gait Abnormality

Marche a Petits pas

Small, slow steps & marked instability

A

Small vessel cerebrovascular disease (e.g; Lacunar stroke in basal ganglia)

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15
Q

Gait abnormality

Arthralgic gait (gait against pain)

A

Arthropathy

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16
Q

Gait abnormality

Apraxic gait

A
  1. Diffuse bilateral hemisphere disease (e.g; normal pressure hydrocephalaus)
  2. Diffuse frontal lobe disease

Gait, power, cerebellar function, propioception are normal on examination, yet patient says their feet appear stuck to the floor, making them unable to walk.

17
Q

Fasiculation

Implies chronic denervation with partial renervation

A
  1. Spinal muscular atrophy
  2. Progressive muscular atrophy
  3. myasthenic crisis
  4. OPC poisoning (nicotinic feature)

lower motor neuron lesions

18
Q

Nerve conduction studies

  1. Diffuse?
  2. Focal?
  3. Multifocal?

Interpretation

A

1.Hereditary demyelinating peripheral neuropathy
2. Pressure palsies
3. Guillian Barre Syndrome, Mononeuritis multiplex

19
Q

Electromyelography (EMG)

  1. Motor neuron disease
  2. Guillian Barre syndrome
  3. Myasthenia
  4. Myopathy

Findings

A
  1. Widespread innervation & reinnervation
  2. Conduction block with multifocal motor slowing
  3. Jitter and blocking
  4. Low amplitude & short duration of response
20
Q

Evolution of symptoms

Sudden onset (minutes to hours)

Evolution: Stable/improvement

A
  1. Vascular (stroke/transient ischemic attack)(TIA)
  2. Nerve entrapment syndrome
  3. Functional
21
Q

Evolution of symptoms

Gradual (progressive over days)

A

Inflammation, infection

22
Q

Evolution of symptoms

Gradual (progressive over weeks to months)

A

Neoplastic/paraneoplastic

23
Q

Evolution of symptoms

Gradual (progressive over months to years)

A

Genetic/degerative

24
Q

Causes of

Flapping tremor

A
  1. Hepatic encephalopathy
  2. Severe cardiac failure
  3. Respiratory failure (due to CO2 retention in COPD)
  4. Renal failure (azotaemia)
  5. Other (rare): Cerebrovascular disease, Drug toxicity (Phenytoin, Barbiturates), Acute focal parietal or thalamic lesion (vascular), Hypoglycaemia, Wilson’s disease.

(1) Commonest cause

25
Q
A

Nervous system (6 decks)

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