In-Class Neurological and Eye Semiology Flashcards
Anisocoria with headache
LP
Acute angle-closure glaucoma
Sympathomimetic drugs
Should reaise suspicion for space ocupying brain lesion with uncal hernation and CN3 palsy…could be due to hemorrhage…get CT
Good for SA hemorrhage
May produce headache with dilated pupil but eye will be red and eye pain will predominate
Bilateral puillary dilation that constricts to light
EOM
LR6SO4AR3
CN 3 palsy
Command should be to look up
Eye deviated laterally and inferiorly
4 - depressed and intorted
6 - abducted
Ptsosi - loss f levator
Mydriasis - loss of PS innervaiton
Org of CN 3 palsy
External pressure will first hit PS fibers…brain hernation, tumor, aneurysm
Nerve infarction will only affect motor function - diabetes
Abducens palsy diff
MS
MG
Inc ICP, meningeal processes, dz of cavernous sinus, dz of neuropathy (diabetes) and vascular dz with brainstem ischmiea in the pons
MS - INO…no ICP or cranial nerve involvement but nuceli affected
MG - weakness beginning with muscles of face
CN 6 palsy
Problem with abduction
Diabetes
Inc ICP
Meningeal processes like infection and cancer
Tell pt to look left and look right
INO and MS
Failure of adduction TO the involved side
Unilateral from stroke…bilateral from demyelinating dz
MS - visual loss, diplopia, gait disorders, generalized fatigue
Lhermittes sign - transient electric shock like sensation from neck flexion - cervial SC path
INO commands
Look at me, look right, look left
MCA stroke
Sensory AND motor findings with lack of leg involvement
Speech center on opposite site of handedness
Graphesesia should be abnormal oin inovlved side
Romberg Dysmetria Dolls eyes Inability to furrow forehead Plamomental
POst column Cerebellum Pontomedullary jxn Facial nerve Front lobe pathology
Cortcial vs lacunar
Path
Clinical findings
Other findings
Sensorium
Cortical - cell bodies
Lacnuar - axons
Cortical - aphasia, apraxia, agraphesthesia, asterognosis
COmmon snesorium altering in cortical
Argyll-Robertson pupil
MG/ALS
Endocarditis
Cavernous sinus thrombosis
Small irregular pupils that don’t react to light but DO accomodate
Neurosyphilis, diabetes, lyme dz, MS
MG and ALS - muscle weakness but no pup probs
Endocarditis - roth spots and hematogenous spread of infection
Facial edema and CN palsies
Holme’s adie
Irregular dilated - initially unilateral but may progress to bilateral
Delayed ocnstrictio nto accommodation
Loss of DT reflexes
Horners causes
Tertiary syphilis
Thalamic hemorrhage
Poorly controleldd DM
Cancer, SC dz, neck mass, vascular aneurysm and or dissection…affarnet pupil will react to light
Argyll robertson
Uncal hernaiton and CN3 nerve palsy
May isolate CN3 or 6 palsy
Papilledema
High pressure htrough optic nerve
Systemic arterial pressure (malig HTN)
Venous pressure (central retinal vein occlusion)
High ICP
HTN retinopathy
Cotton wool spots Flame hemorrhages AV nicking Silver wiring/copper wiring Hard exudate
Central retinal artery occlusion
Pale and avascular retina
Cotton wool vs. roth
Wool - edge of micro-retinal infarct associated with HTN, diabetes, SLE, and venous infarcts
Roth - hemorrhage with a white center - IE
Diabetic dot and blot retinoapthy
Reflects retinal capillary microanuerysms and intra retinal hemorrhage
Causes of CN7 palsy
Viral infection +/- AI…other may be sarcoidosis, Lyme dz, HIV
Tell pt to close eyes
Speech centers
Dominant cerebral hemisphere
Anomic aphasia from inf parietal lobe (angular gyrus)
Broca - inf frontal cortex
Wernicke - sup termporal lobe
Bifacial weakness
MG - involves bulbar initally producing diplopia, speech probs, ptosis, etc.
G-B starts distal and ascends
Bilateral ptosis
MG, Miller-Fisher of GB, botulism
Genralized weakness
Spianl cord dz
Motor neruon dz
Demyelinating dz
Motor end-plaste dz
Myopathy
Unilaterl weakness s
Carotid artery cortical stroke
Traumatic injury.nerve trap
unilateral spinal crod dz
Lacunar storke
KNee extension
Knee felxors
Plantar flexors
L2-4 - femoral nerve
Sciatic nerve (L4-S3)
Tibial nerve
Scelral icterus
Slecritis
Finding in hepatobiliary dz and brisk hemolysis
Painful due to systemic inflam condition (RA, vasculitis)…beings with red inflamed scelra…may cause sceral thinning and can see uvea
Agrapehtestsia
Intention tremor
Post column
Contralateral to test hand
Cerebellar
Post column
Etiologies of bilateral babinski
Vit B12 def of severe intox…soucl be bilateral cortical stroke
DM can produce symmetirc polyneuropathy but not UMN
Syringomyelia
Bilaterla pain.temp loss and weaknessin upper extremities due to damage to anterir horn cells with reduced/absent refelx
Alcohol withdrawl
Seizure in 1st few days but not associated with CN palsies of papilledema
