Clinical localisation and neuroanatomy Flashcards
What is concept I of the neuro-diagnostic pathway?
Clinical syndrome -> imaging/investigating [CT/MRI?LLP/EMG?cerebral angiography] -> underlying pathology
What is concept II of the separate clinical syndrome from underlying disease entity?
A characteristic collection of Sx and Sx with a label
Concept III: name the 21 neuro-clinical syndromes
look up
Concept IV: what are the two types of neuro patients?
Alert/orientated: - history from patient - appropriate neuro-examination Drowsy/confused/unconscious - collateral history - gen app, vital signs, mini-neuro examination
Concept V: ‘the neuro-examination’. Which tools do you use? And what is the standard structure?
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].
Parts of the mini-neuro examination
look at slides
What causes a fixed dilated pupil? What should watch out for when looking for this sign?
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!
Rules of thumb for separating if it’s a brain or spinal problem causing the neuro deficit?
Spine - radiating limb pain - bilateral limb deficit - back pain Brain - headache - visual disturbance - contralateral deficit
Myotome, dermatome and reflex for nerve root C5 -> T1
slides
Where do you do a LP?
slides
Myotome, dermatome and reflex for lumbar roots L5 to S1 [radiculopathy]
slides
Describe the simple anatomy of the descending motor system
Interior capsule -> pyramidal decussation -> corticospinal tract
Conditions when is the descending motor system affected?
Myelopathy, anterior horn cell syndrome
Describe the simple anatomy of the sensory system
Thalamus -> posterior columns -> lateral spinothalamic tract
Signs of a myyelopathy
Sx profile, long tract signs, treacle hands, Brown-Sequard
What is Brown-Sequard syndrome?
Look up
Signs of a cerebellar syndrome
Ataxia, nystagmus
Deficit is on the side of the cerebellar lesion
Condition associated with the ascending sensory system
Peripheral neuropathy
What is the rate of CSF production?
500ml/24 hours
What is the total CSF volume?
around 120ml
Capacity of the ventricular system?
20ml
Normal pressure of the ventricular system?
5-15cm H20
Symptoms of a raised ICP/hydrocephalus?
Symptoms:
- Headache, vomiting, visual disturbance, gait unsteadiness
Signs:
- drowsiness, papilloedema, limitation of upward gaze, reduced visual acuity
Name the lobes and the sulci that seperate them
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Another name for a intracranial mass, what does it cause?
localising syndrome, elevated ICP syndrome [hydrocephalus], epilepsy [if supratentorial]
What is a stroke neuroanatomy
Sudden onset of contralateral hemiparesis:
- perforators/antchoroidal artery…internal capsule
- middle cerebral artery
Describe the Circle of Willis and how this relates to SaH
look up
Are there any clinical syndromes for the thalamus?
Nope
Basal ganglia syndromes
Parkinsonism vs chorea
Difference between acute subdrual and extradural hematoma in location and appeaerance on a CT
slides
