General Neuro Cases and Revision

Question 1

Describe reflexes in an upper motor neuron problem.

Answer 1

Brisk/exaggerated reflex

Question 2

Describe reflexes in an lower motor neuron problem.

Answer 2

Reduced or absent

Question 3

What else would be seen in someone with a LMN lesion?

Answer 3

Muscle atrophy
Decreased tone

Question 4

How many cranial nerves arise from the brainstem?

Answer 4

10

Question 5

How many cranial nerves arise from the midbrain? Which ones?

Answer 5

2
Oculomotor and trochlear

Question 6

How many cranial nerves arise from the pons? Which ones?

Answer 6

4
Trigeminal, abducens, facial, vestibulocochlear

Question 7

How many cranial nerves arise from the medulla? Which ones?

Answer 7

4
Glossopharyngeal, vagus, accessory, hypoglossal

Question 8

Which type of imaging tells us exactly in the brain/spinal cord a lesion is?

Answer 8

MRI

Question 9

What is a typical onset of radial nerve pasly?

Answer 9

Someone who has fell asleep drunk with their arm over the back of a chair or something.
This puts pressure on the radial nerve causing the palsy

->reason being drunk or not fully conscious is relevant as would not feel pins and needles

Question 10

Where would the lesion be in a sixth nerve pasly?

Answer 10

Pons

-> abducent nerve arises from pons

Question 11

Where would the lesion be if a patient only has left face, arm and leg weakness?

Answer 11

Right internal capsule

Question 12

Where would the lesion be if the patient has bilateral hand weakness, spastic gait, bladder dysfunction and UMN signs?

Answer 12

Cervical cord

Question 13

If the damage is in the spinal cord, will there be UMN signs or LMN signs?

Answer 13

LMN signs

Question 14

If the damage is in the brain, will there be UMN signs or LMN signs?

Answer 14

UMN signs

Question 15

Where would the lesion in fatigable, bilateral, UL weakness with ptosis and diplopia?

Answer 15

NMJ

->would be myasthenia gravis, fatigable key part of history

Question 16

In which type of condition may there be a distracted tremor?

Answer 16

Functional neurological disorder

Question 17

What is meant by a distracted tremor?

Answer 17

A tremor which increases with attention and decreases or disappears when distracted

Question 18

Which sign is indicative of functional neurological problems?

Answer 18

Hoover’s Sign

Question 19

Stiffness usually suggests spasticity. Is spasticity an UMN or LMN sign?

Answer 19

UMN

Question 20

If the bladder is impacted, it it more likely to be an UMN issue or LMN issue?

Answer 20

UMN

Question 21

If there is a positive Babinski sign (big toe bends up rather than down when lightly running blunt end of neurotip from heel upwards), is this suggestive of an UMN or LMN isuue?

Answer 21

UMN

Question 22

Are peripheral nerve problems due to UMN or LMN?

Answer 22

LMN

Question 23

Polyneuropathy?

Answer 23

General degeneration of peripheral nerves

Question 24

What usually causes cauda equina syndrome?

Answer 24

Herniated disc in lumbar spine

Question 25

If there are UMN signs in all four limbs, what is probably affected?

Answer 25

Spinal cord

Question 26

What can cause polyneuropathy?

Answer 26

Alcohol
Diabetes

Question 27

If there was a tumour of the spinal cord, more specifically the cauda equina, which type of symptoms would you expect to see?

Answer 27

Bladder or bowel symptoms

Question 28

What is seen in muscle in those with motor neurone disease?

Answer 28

Muscle wasting/atrophy

Question 28

Motor neurone disease is a progressive disease which causes what?

Answer 28

Progressive weakness

Question 29

Which nerves are affected first in polyneupathy?

Answer 29

Longest nerves so nerves to the feet

Question 30

What is the maximum score on GCS?

Answer 30

15

Question 31

What is the minimum score on GCS and what does it suggest?

Answer 31

3- they are in complete coma