Introduction to clinical neurology Flashcards
What are the key areas and their functions in the frontal lobe of the brain?
Pre central gyrus (motor cortex)- motor function of the opposite side of the body
Broca’s area (inferior frontal gyrus) - controls the speech output (dominant hemisphere)
emotions
What are the key areas and their functions in the parietal lobe of the brain?
Postcentral gyrus (sensory cortex)= sensory function of the opposite side of the body
What are the key areas and their functions in the temporal lobe of the brain?
Memory
Dominant hemisphere contains the wernicke’s area (superior temporal gyrus) = controls the comprehension of speech
What are the key areas and their functions in the occipital lobe of the brain?
control vision
Why is identifying cranial nerve abnormalities important?
helps to localize the area of the brain that’s affected
What level of the vertebrae does the spinal cord end?
L1
What are the different types of localization?
Focal = single, discrete neuroanatomical locus can account for all the patient’s symptoms and signs (stroke)
Multifocal = involves more than one locus but the loci remain discrete (MS)
Diffuse = widespread dysfunction of a part of the nervous system (encephalopathy)
Specific pattern (PD)
What does the posterior (dorsal) root allow?
motor neurones to enter the spinal cord (sensory)
What does the anterior (ventral) root allow?
motor neurones to exit the spinal cord (motor)
What are the upper motor neuron signs?
increased tone (spasticity)
weakness with no wasting
brisk reflexes and clonus
upgoing planters
What are the lower motor neurons signs?
reduced tone
weakness, wasting ad fasciculations
reduced or absent reflexes
downgoing (normal) plantars
What are the motor and sensory spinal tracts?
sensory = spinothalamic (pain and temperature- course touch) and dorsal column tracts (position and vibration - fine touch) motor= corticospinal
What is the dermatome for the biceps, supinator, triceps, knee and ankle reflexes?
Biceps - C5 Supinator - C6 Triceps - C7 Knee - L4 Ankle - S1
Define:
- acute
- subacute
- recurrent-remittent
- chronic progressive
acute= minutes to hours subacute= days to weeks recurrent-remittent = episodic attacks of symptoms with a degree of recovery chronic-progressive= months to years
What are some examples of paroxysmal disorders?
headaches and facial pain
seizure and syncope
TIA
vestibular disorders
What are negative symptoms?
implies at least partial or complete failure of impulse conduction in a functional system
- reduction (weakness, numbness)
- complete loss of function (paralysis)
What are positive symptoms?
exaggeration of a physiological phenomenon
- brief and very intense (seizures)
- episodic and recurrent (trigeminal neuralgia)
- slow and continuous (tremor)
What are secondary symptoms?
symptoms referable to “mass effect”
- lesion (tumor) causes primary symptoms by local destruction and secondary symptoms as the lesion grows
What are behavioral symptoms?
complex changes in personality and behavior
What are the different neuroradiological investigations ?
CT, CTA (angiogram), CTV (venogram)
MRI, MRA, MRV
Angiography
What are the different neurohysiological investigations ?
EEG
EMG/NCS
Other than neuroradiological and neurophysiological investigations what other near investigations are there ?
LP/CSF
Genetics
Immunology - for myasthenia gravis - look for Ab
What are the benefits and disadvantages of CTs?
easily available
commonly used in emergency
useful in detecting an intracranial bleed and abnormalities in intracranial blood vessels
radiation
not helpful in detecting demyelinating plaques or spinal cord pathology
What are the benefits and disadvantages of MRI?
no radiation
detecting various brain and SC pathology
demonstrates abnormalities in intracranial blood vessels
claustrophobic
can not be used in patients with metallic foreign bodies e.g. pacemakers
What is the gold standard for imaging intracranial blood vessels?
angiography - treatment tool in coiling aneurysms
What do EEGs do?
routine sleep EEG, ambulatory and video telemetry
epilepsy
measure the neuronal activity in the brain
How NCS (nerve conduction study work?
by electrical stimulation of peripheral nerves - measure both sensory and motor function
Assessment of peripheral neuropathy and diagnosing entrapment
What is EMG (electromyography)?
fine needle inserted directly into the muscle to look for spontaneous activity and motor unit potential
assessment of peripheral neuropathy
assessment of neuromuscular disorders (MG)
demonstrating fibrillation potentials (MND)
When is an LP indicated?
acute headache or patients with a possible diagnosis of meningitis or encephalitis
possible (MS) or any other inflammatory CNS disorder
When are LPs contraindicated?
in patients with symptoms or signs attributable to raised intracranial pressure as this could lead to tentorial herniation and coning
What is CSF analyses for?
protein, cells and glucose
use spectrophotometry to look for blood break down products (subarachnoid hemorrhage)
oligoclonal bands is used to help to diagnose MS
Why do you get a post LP headache?
results from reduction in intracranial pressure
headache is wore on sitting to standing
usually resolves spontaneously within 7-10 days
