DPD: Amir Sam Neuro cases Flashcards
Which sites may a lesion causing a neurological pathology be found?
Brain Spinal cord Nerve roots Peripheral nerves Neuromuscular junction
What may cause neurological pathology broadly speaking?
Vascular Infection Inflammation/ AI Toxic/ Metabolic Tumour/ malignancy
State what would be affected by pathology of each of the cranial nerves
I: sense of smell II: VA, VF, pupils, fundoscopy III, IV, VI: diplopia V: sensation, corneal reflex VII: facial palsy VIII: hearing IX, X: Speech, swallowing XI: Sternocleidomastoid, trapezius XII: tongue movements
Describe the tone, power and reflexes seen in upper motor neurone lesions
Tone: Increased (spasticity)
Power: Decreased
Reflexes: Increased (brisk), upgoing plantar
Describe the tone, power and reflexes seen in lower motor neurone lesions
Tone: Decreased (flaccid)
Power: Decreased
Reflexes: Diminished
List 3 examples of UMN conditions
Stroke
Multiple sclerosis
Huntingtons disease
Using the acronym, list the cerebellar signs
Dysdiadochokinesa Ataxia Nystagmus Intention tremor Slurred/ staccato speech Hypotonia
How would you locate the lesion based on the distribution of abnormal sensation?
Cerebral cortex: Hemisensory loss Spinal cord: reduced up to certain Level Nerve roots (Radiculopathy): Dermatome Mononeuropathy: Specific area Polyneuropathy: Glove + stocking
Considering the broad causes of pathology, what can cause peripheral neuropathy?
Vascular: No.
Infection: HIV
Inflammation/ AI: Vasculitis, CTD, inflammatory demyelinating neuropathy
Toxic/ Metabolic: DM, Alcohol, B12 deficiency
Tumour/ Malignancy: Paraneoplastic feature
Give 3 features of papillitis (optic neuritis at head of optic nerve)
Blurred vision
Blurred optic disc margins
Pain on eye movement
What features are suggestive of MS?
2 lesions
Separated in time + space
Give 4 differentials for apparent confusion and decreased AMTS
Post-ictal (post seizure)
Dysphasia
Dementia
Depressive pseudo dementia
Describe the GCS
Eyes 4 = Spontaneous 3 = Opens in response to voice 2 = Opens in response to painful stimuli 1 = Does not open
Verbal response 5 = Oriented 4 = Confused 3 = Words 2 = Sounds 1 = No sounds
Motor response 6 = Obeys commands 5 = Localizes pain 4 = Withdraws to painful stimuli 3 = Abnormal flexion 2 = Extension 1 = No movements
List the 10 components of AMTS
DOB Age Time Year Place Recall (West Register Street) Recognize doctor + nurse PM/ Monarch Date of 2nd WW Count backwards from 20 to 1
Give 3 signs of meningitis
Fever
Neck stiffness
Kernig’s sign
Give 4 signs of a migraine
Throbbing headache
Vomiting
Photo/ phonophobia
Aura
What indicates SAH? What should yo do?
Sudden onset headache
CT
LP (xanthochromia)
What makes you suspect GCA as cause of headache? What measurement may be found? What should you do?
> 50s
High ESR
Urgent steroids e.g. prednisolone
Biopsy
How do you manage a patient presenting with stroke within 4.5 hours of onset?
CT
If no haemorrhage- Thrombolysis
How do you manage a patient presenting with stroke after 4.5 hours of onset?
CT head (exclude haemorrhage) Aspirin (300mg, swallow assessment) Maintain hydration, oxygenation
How do you manage a patient presenting with TIA?
Aspirin Don't treat BP acutely (unless >220/120) ECG Echo Carotid doppler Risk factor modification
In the context of reduced pinprick sensation what may Duloxetine be used to treat?
Peripheral neuropathy in diabetics
What is Meralgia paraesthetica? What are the symptoms of this?
Compression of lateral femoral cutaneous nerve
Pain + parasthesia on anterolateral thigh
How is Meralgia paraesthetica treated?
Reassure
Avoid tight garments
Lose weight
If persistent: Carbamazepine or Gabapentin
List 5 risk factors for Meralgia paraesthetica
Obesity Pregnancy Trauma Diabetes Long lies
What symptom would arise from lumbosacral nerve root compression? What is this also known as?
Pain in the buttock radiating down the leg to below the knee
Sciatica
Give 2 causes of lumbosacral nerve root compression
Disc herniation
Spinal canal stenosis
Give 6 differentials for confusion and decreased consciousness
Hypoglycaemia Vascular: bleed Infection Inflammation Malignancy Toxic/ Metabolic: Drugs, LFTs, Vit déficiences, Endocrinopathies
What 4 differentials must be excluded for headache presentation in the ED?
Meningitis: Neck stiffness, Kernig’s
SAH: Sudden onset
GCA: High ESR, >50
Migraine: Throbbing, photophobia
What could cause backache and LMN weakness, with indications for FVC monitoring and IVIG?
Guillain Barre Syndrome
