Clinical localisation and neuroanatomy

Question 1

What is concept I of the neuro-diagnostic pathway?

Answer 1

Clinical syndrome -> imaging/investigating [CT/MRI?LLP/EMG?cerebral angiography] -> underlying pathology

Question 2

What is concept II of the separate clinical syndrome from underlying disease entity?

Answer 2

A characteristic collection of Sx and Sx with a label

Question 3

Concept III: name the 21 neuro-clinical syndromes

Answer 3

look up

Question 4

Concept IV: what are the two types of neuro patients?

Answer 4

Alert/orientated:
- history from patient
- appropriate neuro-examination 
Drowsy/confused/unconscious
- collateral history
- gen app, vital signs, mini-neuro examination

Question 5

Concept V: ‘the neuro-examination’. Which tools do you use? And what is the standard structure?

Answer 5

History is the most important part
- pain tool and lifestyle domains
- patient speak e.g. proximal myopathy
Standard structure [gen app, vitals, CN, UL/LL etc.], then appropriately pick and choose box of chocolates.
Hypothesis driven approach to neuro-examination [headache vs radiating leg pain].

Question 6

Parts of the mini-neuro examination

Answer 6

look at slides

Question 7

What causes a fixed dilated pupil? What should watch out for when looking for this sign?

Answer 7

3rd nerve palsy
- parasympathetic fibres outside of nerve
- over apex of petrous part of temporal bone
- fixed dilated pupil
!Watch out for a blind eye!

Question 8

Rules of thumb for separating if it’s a brain or spinal problem causing the neuro deficit?

Answer 8

Spine
- radiating limb pain
- bilateral limb deficit
- back pain
Brain
- headache
- visual disturbance
- contralateral deficit

Question 9

Myotome, dermatome and reflex for nerve root C5 -> T1

Answer 9

slides

Question 10

Where do you do a LP?

Answer 10

slides

Question 11

Myotome, dermatome and reflex for lumbar roots L5 to S1 [radiculopathy]

Answer 11

slides

Question 12

Describe the simple anatomy of the descending motor system

Answer 12

Interior capsule -> pyramidal decussation -> corticospinal tract

Question 13

Conditions when is the descending motor system affected?

Answer 13

Myelopathy, anterior horn cell syndrome

Question 14

Describe the simple anatomy of the sensory system

Answer 14

Thalamus -> posterior columns -> lateral spinothalamic tract

Question 15

Signs of a myyelopathy

Answer 15

Sx profile, long tract signs, treacle hands, Brown-Sequard

Question 16

What is Brown-Sequard syndrome?

Answer 16

Look up

Question 17

Signs of a cerebellar syndrome

Answer 17

Ataxia, nystagmus

Deficit is on the side of the cerebellar lesion

Question 18

Condition associated with the ascending sensory system

Answer 18

Peripheral neuropathy

Question 19

What is the rate of CSF production?

Answer 19

500ml/24 hours

Question 20

What is the total CSF volume?

Answer 20

around 120ml

Question 21

Capacity of the ventricular system?

Answer 21

20ml

Question 22

Normal pressure of the ventricular system?

Answer 22

5-15cm H20

Question 23

Symptoms of a raised ICP/hydrocephalus?

Answer 23

Symptoms:
- Headache, vomiting, visual disturbance, gait unsteadiness
Signs:
- drowsiness, papilloedema, limitation of upward gaze, reduced visual acuity

Question 24

Name the lobes and the sulci that seperate them

Answer 24

look up

Question 25

Another name for a intracranial mass, what does it cause?

Answer 25

localising syndrome, elevated ICP syndrome [hydrocephalus], epilepsy [if supratentorial]

Question 26

What is a stroke neuroanatomy

Answer 26

Sudden onset of contralateral hemiparesis:

• perforators/antchoroidal artery…internal capsule
• middle cerebral artery

Question 27

Describe the Circle of Willis and how this relates to SaH

Answer 27

look up

Question 28

Are there any clinical syndromes for the thalamus?

Answer 28

Nope

Question 29

Basal ganglia syndromes

Answer 29

Parkinsonism vs chorea

Question 30

Difference between acute subdrual and extradural hematoma in location and appeaerance on a CT

Answer 30

slides