ESTHER AND HER PATTERN RECOGNITION Flashcards
Muscle tone in UMN / LMN lesions
Increased in UMN
Normal or decreased in LMN
UMN corticospinal pattern of weakness
= weak extensors in the arms, weak flexors in the legs
Key thing about neuromuscular junction disease
NO SENSORY SYMPTOMS !!!
Hemianaesthesia: where is the lesion?
Contralateral cerebral lesion, or with no other signs, a non-organic disorder
Sensory level sensory loss: where is the lesion
Spinal cord lesion
Stocking (and later glove) sensory loss - what type of neuropathy?
This implies length dependent neuropathy
Dissociated sensory loss with lost spinothalamic (temperature/pain) but with preserved dorsal column (vibration, light touch, proprioception) suggests what kind of damage?
Hemicord damage
e.g. anterior spinal artery syndrome, Brown sequard syndrome, syringomyelia
Difference between extrapyramidal symptoms in PD and drug induced/atypical PD
- Symptoms are asymmetrical in PD
- Symptoms are symmetrical in drug induced or atypical PD
Extra-pyramidal/parkinsonism symptoms?
- bradykinesia
- rigidity, tremor
- hypophonia
- hypomimia
- shuffling gait
- reduced arm swing
- impaired postural reflexes
- small steps
- festination
- turning en bloc
Damage to which part of the brain causes disinhibition?
The orbitofrontal cortex (this part of the brain is responsible for primitive function e.g. hunger, thirst, sexual function)
Damage to which part of the frontal lobe causes disinhibition?
Orbitofrontal cortex
Which part of the frontal lobe is responsible for response to external stimuli (working memory, cognitive flexibility, decision making etc)?
Dorsolateral prefrontal cortex
Which part of the frontal lobe is responsible for motivation and what does damage to this part cause?
Cingulate gyrus and dorsomedial frontal lobe
Damage causes abulia (lack of will) or even akinetic mutism
The following symptoms may result from damage to which part of the brain? :
- personality dysfunction
- paraparesis
- paratonia
- grasp reflex
- frontal gait dysfunction
- cortical hand
- seizures
- incontinence
- visual field defects (anterior visual pathway incl optic chiasms are beneath frontal lobe)
- expressive dysphasia (Broca’s area is in the dominant frontal lobe)
- Anosmia (olfactory pathway is found beneath frontal lobes)
Frontal lobe
Damage to the temporal lobe results in impairments in which type of memory specifically?
Episodic
Nystagmus and dysarthria are features of which disorders
Cerebellar disorders
How can you test intention tremor?
With finger-nose test and in the leg by knee-heel testing
Which side of the brain is the speech centre in?
In the left (dominant) hemisphere in about 99% of right handed people
The 4 primary symptoms of Gerstmann’s syndrome
- Dysgraphia/agraphia (inability to write)
- Finger agnosia (can’t distinguish fingers on hand)
- Dyscalculia: can’t learn/comprehend mathematics
- Left-right disorientation
Imaging for MS
MRI imaging including gadolinium contrast
Treatment for acute relapses of MS
High dose steroids (oral or IV)
Frequent presenting symptoms in MS
- visual compromise
- stiffness
- weakness
Oligoclonal bands and MS
Oligoclonal bands are found in the CSF of MS patients but these are also found in other conditions
When might MS symptoms be worse?
Symptoms may worsen with fever or higher temperatures
A pure upper motor neuron syndrome
Primary lateral sclerosis
Stroke imaging method to identify old lesions and lesions of non-vascular origin
MRI T1/T2 and FLAIR images
Which type of imaging in stroke will identify new ischemic lesions and how will they show up?
Diffusion weighted images identify new ischemic lesions and they will appear hyperdense
-there will also be a decrease in signal on the apparent diffusion coefficient of water
Which weighting of image will identify bleeds and microbleeds?
T2
Which imaging sequences will identify occlusions of the extra- and intracranial arteries
Time of flight sequences
What are perfusion weighted images (PWI) useful for?
Useful for identifying brain areas at risk of ischemia
Criteria for lacunar syndromes
- no visual field defect
- no new higher cortical or brainstem dysfunction
- pure motor hemiparesis, or pure sensory deficit of one side of the body, or sensorimotor hemiparesis or ataxic hemiparesis (dysarthric clumsy hand syndrome or ipsilateral ataxia with crural hemiparesis)
Cranial nerve palsy
Posterior circulation
Unilateral or bilateral motor or sensory deficit
Cerebellar dysfunction
Posterior circulation
Isolated homonymous hemianopia
Posterior circulation
Cortical blindness
Posterior circulation
