Differentials from Examination

Question 1

Neglect syndrome (contralateral weakness) is caused by

Answer 1

cortical lesions

Question 2

Damage to the internal capsule (+corticospinal pathway brainstem lesions) causes

Answer 2

Contralateral hemiparesis with a pyramidal pattern of weakness

Question 3

If hemiplegia occurs with epilepsy, reduced cognition or homonymous hemianopia what lesion is it?

Answer 3

Cerebral hemisphere lesion

Question 4

CN palsy (3-12) contralateral to hemiplegia =

Answer 4

Brainstem lesion on same side as the CN palsy

Question 5

Cord lesions cause

Answer 5

Parapesis (both legs) or quadraparesis/tetraplegia below level of lesion. There will be LMN at level of lesion, UMN sign below level of lesion.

Question 6

Presentation of peripheral neuropathies

Answer 6

Is typically distal weakness - footdrop, weak hand

Question 7

Involvement of a single nerve (mononeuropathy) in peripheral neuropathy suggests

Answer 7

Trauma/entrapment (capral tunnel)

Question 8

Involvement of several nerves (mononeuritis complex) suggests

Answer 8

DM or vascuites

Question 9

What tract deals with pain an temperature

Answer 9

Spinothalamic tract

Question 10

What tract deals with vibration, light touch and proprioception

Answer 10

Posterior/dorsal columns

Question 11

Distal sensory loss suggests

Answer 11

Suggests a neuropathy - may involve all sensory modalities or may be selective.

Question 12

What is dissociated sensory loss

Answer 12

Lesion to a single tract in the spinal cord which involes selective loss of pain and temperature with sparing of joint position and vibration (or vice versa)

Question 13

What parts of the CNS are involved in UMN lesion?

Answer 13

Cortical, subcortical white matter, internal capsule, basal ganglia, brainstem, cerebellum, connections, spinal cord

Question 14

What parts of the CNS are involved in LMN lesion

Answer 14

Anterior horn cell, nerve root, peripheral nerve, neuromuscular junction, muscle

Question 15

UMN weakness is also known aa

Answer 15

A pyramidal pattern of weakness

Question 16

Describe a pyramidal pattern of weakness

Answer 16

Upper limbs:
Weak extensors = shoulder abduction, elbow, wrist,finger extension, small muscles of hand
Strong flexors

Lower limbs:
Stron extensors
Weak flexors - hip flexion, knee flexion, ankle dorsiflexion and evertors

Question 17

Describe features of UMN lesion

Answer 17

Spasticity, increased tone, increased reflexes, bibnski positive (up going plantar), clonus (inreased, <3 beats normal), hoffman’s reflex positive

Question 18

Describe features of LMN lesion

Answer 18

Wasting of muscles and fasiculations, reduced tone (hypotonia), reduced reflexes, flaccidity, symmetrical weakness (distal > proximal)