Work down (nerve root to peripheral nerve) - Radiculopathy (disc herniation, cervical spondylosis, spinal stenosis) --> dermatomal sensory loss - Plexopathy (brachial neuritis, trauma, thoracic outlet syndrome, neoplastic infiltration) --> vast dermatomal sensory loss - Isolated nerve palsy (median, ulnar, radial, axillary, common peroneal)

- MND - Dual pathology (e.g. cervical myelopathy + polyneuropathy) - Cervical radiculomyelopathy (--> LMN arm weakness, UMN leg weakness)

MAVIS: - MS - Alcohol - Vascular (infarction, stroke) - Inherited (Friedreich's ataxia, spinocerebellar ataxia, ataxia telangiectasia) - SOL Investigations: - Bloods including thyroid function, WBC (FBC), CRP - B12, folate, vitamin E, thiamine - MRI +/- contrast - LP if suspect infectious/inflammatory cause (MS, infection) - Genetic testing if this is suspected

Differentials Flashcards by Zoe b

Proximal weakness

MIND:
Metabolic: Cushing’s disease, hypothyroidism
Inflammatory: polymyositis/dermatomyositis, inclusion body myositis*
Neuromuscular: myaesthenia, LEMS
Dystrophies: Becker’s, FSHD, limb girdle

*(note: IBM primarily affects knee extension and finger flexors -> dexterity difficulties)

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Bilateral UMN (pyramidal weakness)

3Ms:
MS
MND --> normal sensation
Myelopathy --> sensory level
- cervical myelopathy, disc prolapse, SOL, trauma, transverse myelitis, syringomyelia

Others: brainstem stroke, anterior cord infarction (–> sensory level)

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Unilateral UMN (pyramidal weakness)

Work down (brain to cord)

Intracranial: (+/- hemisensory loss): CVA, SOL, MS
Brainstem: MS
Spinal cord: –> sensory level. Trauma, SOL, abscess, AVM/haematoma

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Bilateral LMN (distal weakness) with abnormal sensation distally

VIT DIM:
Vasculitis (SLE, RA, PAN)
Infection (herpes zoster, HIV)
Toxins (alcohol, TB drugs, vincristine/cisplatin, amiodarone)
Diabetes
Inherited (Charcot-Marie-Tooth)
Metabolic (B12 deficiency, B1 deficiency)

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Bilateral LMN (distal weakness) with normal sensation, i.e. distal motor neuropathy

Guillain-Barre, CIDP
Myotonic dystrophy
Inclusion body myositis (proximal in legs but distal weakness in arms)
Progressive muscular atrophy (MND)

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Unilateral LMN

Work down (nerve root to peripheral nerve)

Radiculopathy (disc herniation, cervical spondylosis, spinal stenosis) –> dermatomal sensory loss
Plexopathy (brachial neuritis, trauma, thoracic outlet syndrome, neoplastic infiltration) –> vast dermatomal sensory loss
Isolated nerve palsy (median, ulnar, radial, axillary, common peroneal)

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Bilateral LMN, acute

CES (leg weakness but also saddle anaesthesia, autonomic symptoms)
Guillain-Barre (sensation normal)

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Mononeuritis multiplex

Vasculitis

Autoimmune: RA, SLE, Sjrogren, sarcoidosis

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UMN + LMN

MND
Dual pathology (e.g. cervical myelopathy + polyneuropathy)
Cervical radiculomyelopathy (–> LMN arm weakness, UMN leg weakness)

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Cerebellar disease

MAVIS:

MS
Alcohol
Vascular (infarction, stroke)
Inherited (Friedreich’s ataxia, spinocerebellar ataxia, ataxia telangiectasia)
SOL

Investigations:

Bloods including thyroid function, WBC (FBC), CRP
B12, folate, vitamin E, thiamine
MRI +/- contrast
LP if suspect infectious/inflammatory cause (MS, infection)
Genetic testing if this is suspected

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Complex ophthalmoplegia

Work posteriorly from the eye, i.e. soft tissue to brainstem:

Soft tissue: thyroid eye disease
NMJ: myaesthenia gravis (tip: test fatiguability)
Multiple CNs: cavernous sinus syndrome, mononeuritis multiplex
Midbrain/pons: stroke, SOL, trauma

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Optic nerve atrophy, i.e. causes of reduced visual acuity

MS
Temporal arteritis
DM
Compression (SOL, raised ICP)
Glaucoma

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3rd nerve palsy

Medical: diabetes/hypertension/hyperlipidemia (i.e. microvascualr disease), MS, mononeuritis multiplex affecting 3rd nerve. NB: if partial pupil-sparing 3rd, still worry about compression i.e. SOL or aneurysm.

Surgical (ptosis, down and out, dilated pupil): posterior comm. artery aneurysm, epidural haematoma (ipsilateral 3rd palsy), cavernous sinus thrombosis, SOL

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6th nerve palsy

Raised ICP

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Unilateral 7th nerve palsy LMN

Bell’s palsy, Ramsay-Hunt syndrome, brainstem [SOL, nucleus demyelination, stroke], parotid tumour/surgery, nerve infiltration (sarcoid, lymphoma)

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Bilateral 7th nerve palsy LMN

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Bilateral Bell’s palsy, nerve infiltration (sarcoid, lymphoma), autoimmune (myaesthenia, vasculitis), inflammatory (GBS), myotonic dystrophy

Bulbar palsy (LMN bulbar weakness)

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MND, brainstem infart/SLO, myaesthenia gravis, GBS, syphilis

Pseudobulbar palsy (UMN bulbar weakness due to damage of corticobulbar tracts)

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Pathologies: MND, MS, PSP / neurodegenerative disorders
Structural: brainstem infarct/SLO/MS, internal capsule infarct/small vessel disease, high brainstem tumour, PSP

UMN facial weakness (forehead-sparing)

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MSA stroke, SOL in pre-frontal gyrus

Multiple cranial nerve lesions: CN 3-6

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Cavernous sinus thrombosis

CN 5-8 + cerebellar signs

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Cerebellopontine angle lesion

CN 9-10 + 12

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Pseudobulbar/bulbar palsy

CN 9-10 + 11

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Jugular foramen syndrome

CN 9-10 + Horner’s syndrome + cerebellar disturbance + sensory disturbance (ipsilateral face, contralateral body)

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Lateral medullary (Wallenberg) syndrome

Homonymous hemianopia

MCA stroke, brain SOL

Bitemporal hemianopia

Pituitary tumour, craniopharyngioma, suprasellar meningioma, aneurysm

Tunnel vision

Glaucoma, retinitis pigmentosa

Central scotoma (area of depressed vision that corresponds with point of fixation, i.e. central vision)

Due to optic neuropathy, macular retinopathy (due to cotton wool spots), ischaemia of either the retina or optic nerve, stroke, macular degeneration. If bilateral, think pituitary tumour, MS, or raised ICP. - MS (unilateral or bilateral central scotoma) - Central retinal artery occlusion - Temporal arteritis - Compression (SOL or raised ICP) - DM

Homonymous quadrantopia

Lesion of optic radiation PITS Parietal pathway lesion = Inferior quadrantopia (loss of vision in the same lower quadrant of visual field in both eyes) Temporal pathway lesion i.e. Meyer's loop = Superior quadrantopia (loss of vision in the same upper quadrant of visual field in both eyes)

Mono-ocular loss of vision

Central retinal artery occlusion Vitreous haemorrhage Trauma Papilloedema

Ptosis

Unilateral or bilateral: - Myaesthenia - Myotonic dystrophy (frontal balding, facial muscle wasting) Unilateral: - 3rd nerve palsy - Horner's syndrome (pupil constricted) - Idiopathic Bilateral: - Congenital - Argyll Robertson pupils (bilateral small pupils that accommodate but don't react to light; sign of syphilis or diabetic neuropathy)

Horner's syndrome

Central (1st order): MS, spondylosis, SOL, syringomyelia, stroke/lateral medullary syndrome Pre-ganglionic (2nd order): Pancoast tumour, cervical rib Post-ganglionic (3rd order): carotid artery dissection

Chorea

Huntington's disease Drugs (e.g. anti-psychotics, levodopa) Stroke HIV

Dystonia

``` Primary dystonia Brain trauma Drugs Wilson's disease PD Huntington's disease Stroke SOL Encephalitis ```

Differentials Flashcards

(34 cards)