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
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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?
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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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