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PAN- Neurology > Hani Book Part 2 > Flashcards

Hani Book Part 2 Flashcards

1
Q

What is an RAPD a sign of?

A

An optic nerve lesion- pupil appears to dilate when light is shone into it (consensual reaction is still in tact)

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2
Q

What is the most common cause of an RAPD?

A

Optic neuritis- most often due to MS

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3
Q

What are the features of Horner’s syndrome?

A

Miosis
Ptosis
Anhidrosis

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4
Q

What might be a painful cause of horner’s syndrome?

A

Carotid dissection/aneurysm as the sympathetic fibres run along the carotid artery into the brain

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5
Q

What malignancy can cause Horner’s syndrome?

A

Pancoast’s Tumour- Apical lung malignancy

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6
Q

What are some causes of Horner’s syndrome?

A 
Apical lung tumour
Carotid dissection
Surgical damage to sympathetic chain
Idiopathic
Tumour elsewhere e.g. nasopharyngeal
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7
Q

What is Argyll Robertson pupil? What is it due to?

A

Small irregular pupil that reacts with accommodation but not to light. Due to syphilis or diabetes.

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8
Q

What is Adie’s pupil?

A

Unilateral dilated pupil not reacting to light in young or middle aged women.

Holmes-Adie is this with reduced or absent reflexes

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9
Q

What is a homonymous hemianopia?

A

Impairment of the temporal field on one side and the nasal field on the other. It is due to an optic tract lesion (behind the chiasm)

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10
Q

What side is the lesion on for a left homonymous hemianopia?

A

The right side- it will be a lesion of the optic tract (behind the chiasm)

Could be due to ischaemia, haemorrhage, tumour

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11
Q

What lesion would cause only a quadrant in the visual field to be lost? State where for superior quadrant and inferior quadrant?

A

Superior Quadrant- Temporal

Inferior Quadrantanopia- Parietal

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12
Q

What can cause papilledema?

A

Papilledema is swelling of the optic disc due to raised ICP

It may be due to mass effect (tumour) or idiopathic intracranial hypertension (in young obese women)

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13
Q

What kind of vision loss does papilledema cause?

A

Peripheral

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14
Q

What is seen in a third nerve palsy?

A

Down and out pupil

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15
Q

What is an emergency cause of a third nerve palsy?

A

PCA Aneurysm
May have associated headache

Other causes are microvascular ischaemia, or brainstem tumour.

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16
Q

What muscles are supplied by the trigeminal nerve?

A

Temporalis

Masseter

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17
Q

What does a sixth nerve palsy cause?

A

Failure to abduct the eye on the affected side

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18
Q

How does a sixth nerve palsy cause double vision? What kind of double vision is seen?

A

Double vision is horizontal and on looking laterally double vision is created. This is due to failure to track the eyes together when looking laterally.

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19
Q

What can cause a sixth nerve palsy?

A

Microvascular ischaemia- often diabetes or HTN too
Raised ICP- Due to long course
Brainstem lesions- MS or tumour

20
Q

What does the facial nerve supply?

A 
Muscles of facial expression
Lacrimal glands
Parotid glands
Taste to anterior two thirds of the tongue
Stapedius muscle
21
Q

How does an UMN and LMN facial nerve lesion present differently?

A

UMN- sparing of upper quadrant

LMN- entire half of face is affected

22
Q

What is the most common cause of a facial nerve lesion?

A

Bell’s Palsy

23
Q

What is the treatment for Bell’s Palsy?

A

Steroids but this is controversial

Eye care is important- taping the eye lid shut and using eye drops/ointment to protect the cornea

24
Q

What are some additional features of facial nerve lesion seen other than paralysis?

A

Sounds louder than usual- hyperacusis

Altered taste

25
Q

What are the features of benign paroxysmal positional vertigo?

A

Short episodes of vertigo that are provoked by sudden movements of the head

26
Q

What might cause lower motor neuron signs in the tongue?

A

Fasciculations and weakness may be seen in the tongue in MND

Also ischaemia and tumour.

27
Q

What is a bulbar palsy?

A

This is a lower motor neuron lesion affecting the tongue- it is atrophic with fasciculations

28
Q

What is a pseudo-bulbar palsy?

A

This is a small, slow moving spastic tongue that is due to an UMN lesion

29
Q

What causes a mixture of bulbar and pseudobulbar palsy?

A

Most often it is MND

30
Q

What are some features of pseudobulbar palsy?

A 
Spastic tongue
Atrophy of tongue
Slow moving tongue
Brisk jaw jerk reflexes
Dysarthria
Swallowing difficulties
31
Q

What are some features of bulbar palsy?

A 
Fasciculation of tongue
Weakness
Depressed jaw jerk reflex
Dysarthria
Swallowing difficulties
32
Q

Which sternocleidomastoid muscle contracts to turn the head right?

A

The left SCM

The side the SCM is on is the opposite to the direction that turns the head

33
Q

What innervates SCM?

A

Spinal accessory nerve

34
Q

What is a cause of spinal accessory nerve palsy?

A

Jugular foramen syndrome- Vagus exists here too

Tumours- neurofibroma, meningioma
Neurosarcoid
Malignant otitis externa
Uvula deviates away from the affected side
Dysphagia
Dysarthria
35
Q

What often causes brown sequard syndrome?

A

MS or spinal cord tumour is the most common cause

36
Q

What causes the features of Brown sequard syndrome?

A

Hemisection of the spinal cord or compression of the half of the spinal cord (tumour) (MS is also a cause)

There is:
Loss of pain, temperature and crude touch on the opposite side below the lesion (as decussates in the SC via the anterior white commissure)
Loss of proprioception, vibration and fine touch on the same side
UMN signs on the same side below (Ipsilateral Hemiplegia)+ LMN signs at the level

If thoracic level it can damage sympathetic chain leading to horner’s.

37
Q

What investigation should be done for spinal cord lesions?

A

MRI

38
Q

What are some causes of predominantly sensory peripheral neuropathies?

A

Diabetes
Vitamin B12 and Thiamine Deficiency- Dorsal columns are usually affected first
Paraneoplastic
Drugs- esp anti TB (Isoniazid and ethambutol) and chemotherapy agents

39
Q

What does vitamin b12 deficiency cause?

A

Subacute combined degeneration of the spinal cord- dorsal columns are usually affected first (reduced proprioception, vibration and fine touch)

Common in alcoholics

40
Q

What are the features of peripheral neuropathy?

A

Paresthesia
Glove and stocking distribution
Impairment in vibration and proprioception

41
Q

What are the features of peripheral motor neuropathy?

A

Bilateral generalised weakness
Greater weakness distally
Reduced reflexes

42
Q

What causes peripheral motor neuropathy?

A

GBS
Charcot Marie Tooth Disease
Chronic inflammatory demyelinating polyradiculoneuropathy

43
Q

What is ataxia?

A

Lack of coordination including gait abnormality (main feature), speech disturbance and abnormalities in eye movements.

Often due to cerebellar dysfunction.

44
Q

What might you see on examination of a patient with ataxia?

A 
Broad based gait (ataxic gait)
Difficulty heel to toe walking
Nystagmus (side to side eye movements)
Dysarthria
Reduced coordination
Intention tremor
Dysdiadochokinesia
45
Q

What can cause ataxic syndrome?

A

MS
Alcoholic cerebellar degeneration (often gait ataxia seen)
Drugs- anticonvulsants (phenytoin and carbamazepine) and lithium
Stroke- affecting cerebellum
Posterior fossa tumours
Hypothyroidism
Spinocerebellar ataxia and Friedreich’s Ataxia (genetic)

46
Q

What investigations might you consider doing for a patient with ataxic syndrome?

A

MRI Brain
CSF- Looking for oligoclonal bands
Drugs history and serum levels (phenytoin, carbamazepine and lithium)
Nerve conduction studies
EMG
Bloods- Thyroid, Thiamine, LFTs (alcoholics)

PAN- Neurology (10 decks)

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