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Neurology > Differentials > Flashcards

Differentials Flashcards

1
Q

Proximal weakness

A

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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2
Q

Bilateral UMN (pyramidal weakness)

A 
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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3
Q

Unilateral UMN (pyramidal weakness)

A

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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4
Q

Bilateral LMN (distal weakness) with abnormal sensation distally

A

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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5
Q

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

A

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

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6
Q

Unilateral LMN

A

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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7
Q

Bilateral LMN, acute

A

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

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8
Q

Mononeuritis multiplex

A

Vasculitis

Autoimmune: RA, SLE, Sjrogren, sarcoidosis

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9
Q

UMN + LMN

A
  • MND
  • Dual pathology (e.g. cervical myelopathy + polyneuropathy)
  • Cervical radiculomyelopathy (–> LMN arm weakness, UMN leg weakness)
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10
Q

Cerebellar disease

A

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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11
Q

Complex ophthalmoplegia

A

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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12
Q

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

A 
MS
Temporal arteritis
DM
Compression (SOL, raised ICP)
Glaucoma
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13
Q

3rd nerve palsy

A

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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14
Q

6th nerve palsy

A

Raised ICP

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15
Q

Unilateral 7th nerve palsy LMN

A

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

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16
Q

Bilateral 7th nerve palsy LMN

A

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

17
Q

Bulbar palsy (LMN bulbar weakness)

A

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

18
Q

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

A

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

19
Q

UMN facial weakness (forehead-sparing)

A

MSA stroke, SOL in pre-frontal gyrus

20
Q

Multiple cranial nerve lesions: CN 3-6

A

Cavernous sinus thrombosis

21
Q

CN 5-8 + cerebellar signs

A

Cerebellopontine angle lesion

22
Q

CN 9-10 + 12

A

Pseudobulbar/bulbar palsy

23
Q

CN 9-10 + 11

A

Jugular foramen syndrome

24
Q

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

A

Lateral medullary (Wallenberg) syndrome

25
Q

Homonymous hemianopia

A

MCA stroke, brain SOL

26
Q

Bitemporal hemianopia

A

Pituitary tumour, craniopharyngioma, suprasellar meningioma, aneurysm

27
Q

Tunnel vision

A

Glaucoma, retinitis pigmentosa

28
Q

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

A

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
29
Q

Homonymous quadrantopia

A

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)

30
Q

Mono-ocular loss of vision

A

Central retinal artery occlusion
Vitreous haemorrhage
Trauma
Papilloedema

31
Q

Ptosis

A

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)
32
Q

Horner’s syndrome

A

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

33
Q

Chorea

A

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

34
Q

Dystonia

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

Neurology (6 decks)

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