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CNS CLERKSHIP > Functional Neurological Disorders > Flashcards

Functional Neurological Disorders Flashcards

1
Q

Symptoms indicating damage of a large fibre motor nerve?

A
  • Weakness, unsteadiness, wasting.
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2
Q

Damage of a large fibre motor nerve will have what effect on power?

A

Reduced power.

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3
Q

Damage of a large fibre motor nerve will have what effect on sensation?

A

None - normal sensation.

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4
Q

Damage of a large fibre motor nerve will have what effect on reflexes?

A

Absent reflexes.

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5
Q

Symptoms indicating damage of a large fibre sensory nerve?

A
  • Numbness.
  • Paraesthesia.
  • Unsteadiness.
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6
Q

Damage of a large fibre sensory nerve will have what effect on power?

A

No effect - normal power.

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7
Q

Damage of a large fibre sensory nerve will have what effect on sensation?

A

Reduction in sensation of vibration and joint position sense.

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8
Q

Damage of a large fibre sensory nerve will have what effect on reflexes?

A

Absent reflexes.

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9
Q

Symptoms indicating damage of a small fibre nerve?

A
  • Pain.

- Dysethesia.

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10
Q

What is dyesthesia?

A

Abnormal unpleasant sensation upon being touched, due to damage to peripheral/ small fibre nerves.

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11
Q

Damage of small fibres nerves will have what effect on power?

A

None - normal power.

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12
Q

Damage of small fibres nerves will have what effect on sensation?

A
  • Reduced sensation of both pin prick and temperature.
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13
Q

Damage of autonomic nerves will have what effect on power?

A

None - normal power.

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14
Q

Damage of autonomic nerves will produce what symptoms?

A
  • Dizziness (postural hypotension).
  • Impotence.
  • Nausea and vomiting (gastroparesis).
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15
Q

Damage of autonomic nerves will have what effect on sensation?

A

None - normal sensation.

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16
Q

Damage of autonomic nerves will have what effect on reflexes?

A

Reflexes will be present.

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17
Q

Myelinated sensory fibres are responsible for which sensation?

A
  • Touch.
  • Vibration.
  • Joint position perception.
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18
Q

Thinly myelinated sensory fibres are responsible for which sensation?

A
  • Cold perception.

- Pain.

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19
Q

Unmyelinated sensory fibres are responsible for which sensation?

A
  • Warmth perception.

- Pain.

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20
Q

Thinly myelinated and un-myelinated autonomic fibres are responsible for which functions?

A
  • Heart rate.
  • BP.
  • Sweating.
  • GI tract.
  • GU tract.
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21
Q

What is pseudoathetosis?

A

Abnormal writhing movement - usually of fingers.

https://www.youtube.com/watch?v=g3JTZObWGFA

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22
Q

What causes pseudoathetosis?

A

Failure of joint position perception (proprioception).

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23
Q

What does pseudoathetosis indicate?

A

Disruption of proprioceptive pathway from nerve to parietal cortex.

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24
Q

High stepping gait implies what?

A

Foot drop due to weakness of ankle dorsiflexion.

https://www.youtube.com/watch?v=5T3eHpP6-lM

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25
Q

Differentials of high stepping gait?

A
  • Common peroneal palsy (normal ankle inversion).
  • L5 root lesion (weak ankle inversion).
  • Motor neuropathies (often bilateral).
26
Q

What is mononeuritis?

A

Inflammation of a single nerve/ nerve group e.g. carpal tunnel syndrome.

27
Q

What is mononeuritis multiplex?

A

Peripheral nerve disorders of distinctive progressive motor and sensory deficits in distribution of specific peripheral nerves.

28
Q

What is radiculopathy?

A

Nerve compression in the spinal column resulting in pain, weakness, numbness and tingling of specific areas.

29
Q

What is a plexopathy?

A

Inflammation/damage of nerve plexus resulting in pain, loss of motor control and sensory deficit.

Typically affects lumbosacral or brachial plexus.

30
Q

How are nerves damages?

A
  • Axonal loss.

- Peripheral nerve demyelination.

31
Q

What investigation can help to identify a demyelinating neuropathy?

A

Nerve conduction study.

32
Q

Give an example of a demyelinating neuropathy.

A
  • Guillain-Barre syndrome.
  • Acute inflammatory demyelinating polyneuropathy.
  • Chronic inflammatory demyelinating polyradiculopathy.
  • Hereditary sensory motor neuropathy. (Charcot-Marie-Tooth disease).
33
Q

Acute cause (days to weeks) of demyelinating neuropathy?

A
  • Guillain-Barre syndrome.

- Acute inflammatory demyelinating polyradiculoneuropathy.

34
Q

Chronic cause (months to years) of demyelinating neuropathy?

A
  • Chronic inflammatory demyelinating polyradiculopathy.

- Hereditary sensory motor neuropathy. (Charcot-Marie-Tooth disease).

35
Q

Symptoms of Guillain-Barre syndrome?

A
  • Progressive paraplegia over days to 4 weeks.
  • Sensory symptoms proceed weakness.
  • Pain is common.
  • Symptoms peak at 10-14 days.
  • Examination may be normal in early illness.
  • Possible post infectious ass. e.g. Campylobacter.
36
Q

Complications of Guillain-Barre syndrome?

A
  • 25% require mechanical ventilation.

- 10% die mainly from autonomic failure (cardiac arrhythmia).

37
Q

Management of Guillain-Barre syndrome?

A
  • Immunoglobulin infusion.
  • Plasma exchange.
  • Minimal role for steroids.
38
Q

Variants of hereditary neuropathies?

A
  • Pure motor.
  • Pure sensory.
  • Sensorimotor.
  • Small fibre (congenital insensitivity to pain syndrome).
  • Autonomic.
  • Demyelinating or axonal.
39
Q

How can the most common mutations leading to hereditary neuropathies be diagnosed?

A

Genetic testing e.g. CMT1a.

40
Q

What is the other name for HMSN type 1?

A

Charcot-Marie-Tooth syndrome.

Hereditary motor and sensory neuropathy type 1

41
Q

Symptoms suggestive of HMSN type 1?

A

Symptom onset typically in childhood or young adulthood.

  • Weakness and atrophy in lower legs in adolescence and later weakness in hands.
  • Fatigue, pain, lack of balance/ feeling/ reflexes/ sight and hearing which result from muscle atrophy.
42
Q

What is HMSN type 1?

A

Neuropathies characterised by atypical neural development and degradation of neural tissue.

43
Q

What causes axonal neuropathies?

A
  • Idiopathic.
  • Vasculitis.
  • Paraneoplastic.
  • Infection.
  • Drugs/toxins.
  • Metabolic.
44
Q

What are the vasculitic causes of axonal neuropathies?

A
  • ANCA +ve.

- Rheumatoid arthritis/ Sjogrens syndrome (ANA/ENA +ve).

45
Q

What paraneoplastic syndromes are associated with axonal neuropathies?

A
  • Myeloma.

- Antibody mediated e.g. breast cancer, SCLC anti-hu/yo.

46
Q

What infections are associated with axonal neuropathies?

A
  • HIV.
  • Syphilis.
  • Lyme.
  • Hepatitis B/C (cryoglobulin mediated).
47
Q

What drugs/toxins are associated with axonal neuropathies?

A
  • Alcohol.
  • Amiodarone.
  • Phenytoin.
  • Chemotherapy (cisplatin/vincristine).
48
Q

What metabolic syndromes are associated with axonal neuropathies?

A
  • Diabetes.
  • B12/ folate deficiencies.
  • Hypothyroidism.
  • Chronic uraemia.
  • Porphyria.
49
Q

Chronic causes of autonomic neuropathies?

A
  • Diabetes i.e. gastroparesis.
  • Amyloidosis.
  • Hereditary.
50
Q

Acute causes of autonomic neuropathies?

A
  • Guillain-Barre syndrome.

- Porphyria.

51
Q

Management of axonal peripheral neuropathies?

A
  • Treat cause e.g. clear Hep. C.
  • Treat symptoms: physio, orthotics, neuropathic pain relief.
  • If vasculitic: pulsed IV methylprednisolone + cyclophosphamide.
52
Q

Management of axonal peripheral neuropathies due to vasculitic causes?

A
  • Pulsed IV methylprednisolone + cyclophosphamide.
53
Q

Management of demyelinating (inflammatory) peripheral neuropathies?

A
  • IV immunoglobulin.
  • Steroids.
  • Azathioprine, mycophenalate, cyclophosphamide.
54
Q
  • 70 y/o right handed carpenter.
  • 6 week history of pins + needles in inner aspect of right hand. Ass. difficulty with holding cutlery.
  • Painless.
  • Power: 4 - first dorsal interosseus (FDI) and abductor digiti minimi (ADM).
  • Normal reflexes.
  • Reduced pin prick, temperature and vibration sense in medial 1 1/2 digits.

Which nerves are damaged?

A
  • Large and small fibre motor.

- Sensory.

55
Q
  • 70 y/o right handed carpenter.
  • 6 week history of pins + needles in inner aspect of right hand. Ass. difficulty with holding cutlery.
  • Painless.
  • Power: 4 - first dorsal interosseus (FDI) and abductor digiti minimi (ADM).
  • Normal reflexes.
  • Reduced pin prick, temperature and vibration sense in medial 1 1/2 digits.

Where is the nerve damage?

A

Ulnar territory.

56
Q

62 y/o retired journalist.

  • Painful paraesthesia and “burning” sensation in lower limbs for 4/52.
  • Reduced grip strength in right hand.

O/E:

  • Left abductor pollicis 4/5.
  • Left leg dorsiflexion 4/5.
  • Reduced pinprick sensation over left L5.
  • Absent left ankle reflex.

Which nerves are damaged?

A
  • Large and small fibre motor.

- Sensory.

57
Q

62 y/o retired journalist.

  • Painful paraesthesia and “burning” sensation in lower limbs for 4/52.
  • Reduced grip strength in right hand.

O/E:

  • Left abductor pollicis 4/5.
  • Left leg dorsiflexion 4/5.
  • Reduced pinprick sensation over left L5.
  • Absent left ankle reflex.

Where is the nerve damage?

A
  • Right median nerve.

- Left common peroneal nerve.

58
Q

62 y/o retired journalist.

  • Painful paraesthesia and “burning” sensation in lower limbs for 4/52.
  • Reduced grip strength in right hand.

O/E:

  • Left abductor pollicis 4/5.
  • Left leg dorsiflexion 4/5.
  • Reduced pinprick sensation over left L5.
  • Absent left ankle reflex.

NCS demonstrates axonal picture, how are the nerves damaged?

A

Mononeuritis multiplex.

59
Q

62 y/o retired journalist.

  • Painful paraesthesia and “burning” sensation in lower limbs for 4/52.
  • Reduced grip strength in right hand.

O/E:

  • Left abductor pollicis 4/5.
  • Left leg dorsiflexion 4/5.
  • Reduced pinprick sensation over left L5.
  • Absent left ankle reflex.

Nerves are damaged due to ANCA +ve mpo titre of 15iu/L.

How can nerve damage be stopped?

A

Pulsed steroids +/- cyclophosphamide.

60
Q

24 y/o female.

  • 7/7 abdominal pain admitted under surgeons for normal laparoscopic exam.
  • 4/7 history of pins and needles in all four limbs + unsteadiness and requiring assistance of 2 to walk.

PMHx: Carseview admission aged 19 with acute psychosis.

O/E:

  • Ataxic gait, absent reflexes throughout.
  • 4/5 flexors,
  • Sensory loss: patchy pin-prick and temperature, absent vibration sense and reduced joint position sense.
  • BP: significant postural drop.

What nerves are damaged?

A
  • Large fibre motor and sensory.
61
Q

24 y/o female.

  • 7/7 abdominal pain admitted under surgeons for normal laparoscopic exam.
  • 4/7 history of pins and needles in all four limbs + unsteadiness and requiring assistance of 2 to walk.

PMHx: Carseview admission aged 19 with acute psychosis.

O/E:

  • Ataxic gait, absent reflexes throughout.
  • 4/5 flexors,
  • Sensory loss: patchy pin-prick and temperature, absent vibration sense and reduced joint position sense.
  • BP: significant postural drop.

What is the manner of nerve damage?

A

Length dependent.

62
Q

24 y/o female.

  • 7/7 abdominal pain admitted under surgeons for normal laparoscopic exam.
  • 4/7 history of pins and needles in all four limbs + unsteadiness and requiring assistance of 2 to walk.

PMHx: Carseview admission aged 19 with acute psychosis.

O/E:

  • Ataxic gait, absent reflexes throughout.
  • 4/5 flexors,
  • Sensory loss: patchy pin-prick and temperature, absent vibration sense and reduced joint position sense.
  • BP: significant postural drop.

NCS demonstrates axonal picture.
Why are the nerves damaged?

A

Acute porphyria.

CNS CLERKSHIP (43 decks)

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