Kumar and clark Flashcards
what can worsen symptoms of demyelination
warm baths
what stimuli can trigger epilepsy
sensory
headaches worse on waking and on lying flat suggests
raised ICP
3 inherited neurological disorders
Huntingtons chorea, myotonic dystrophy, Charctot Marie Tooth disease
global lesions typically affect
cognition and consciousness
focal lesions resultant signs may eb
asymmetric
is up going planters upper or lower motor neurone
upper
if upper motor neurone lesions have a pyramidal pattern where stronger muscles overwhelm weaker then which ones are stronger
upper limb flexors and lower limb extensors
if there is contralateral UMN signs then where is the lesion
cerebral cortex/ internal capsule
if got nystagmus where is the lesion
cerebellum
lesions in the brainstem cause what symptoms
impaired consciousness, global signs, cranial nerve abnormalities
spinal cord lesions presents as
UMN paraplegia/ quadriplegia with sensory level
nerve root lesion signs
LMN myotomal signs, dermatomal signs
single peripheral nerve lesion signs
LMN signs and sensory loss according to distributions of nerve
lesion in all peripheral nerves cause what signs
length dependent LMN signs ( worse in hands and feet) , glove and stocking sensory loss
what are signs of neuromuscular junction lesions
only motor signs present. fatiguability common, wasting and fasciculation
lesions in cerebral cortex ad spinal cord cause – signs and lesions in nerves cause — signs
UMN, LMN
spasticity is more pronounced in what kind of muscles
extensors
what is clonus
involuntary extensor rhythmic leg jerking
clonus can occur in
spasticity
what is the gait like in Parkinson
shuffling
what are uncommon in Parkinsons expcept in later stage disease and may indicate a Parkinson’s plus syndrome
falls
gait becomes broad based in what
lateral cerebellar lobe disease e.g when walking they veer towards the affected side of the cerebellar lobe
peripheral sensory loss(polyneuropathy) causes what kind of gait
stamping- broad based, high stepping
rombergs test is positive in what
sensory ataxia (peripheral sensory loss)
what can cause a slap noise when walking
common peroneal nerve palsy
walking becomes a waddle in what
weakness of Proximal leg muscles
what can show normal sensory and motor function on couch but when walking it can be shuffling with small steps, gait ignition failure and hesitancy with fear of falling
frontal lobe disease- diffuse cerebrovascular disease, normal pressure hydrocephalus
what tests joint position
small movements of DIP joints in toes and fingers
dysgraphaethesia and asterogenesis
cortical sensory loss
normal muscle power is grade
5
what are the 3 inhibitory neurotransmitters
GABA, histamine and glycine
synaptic transmission is mediated by
neurotransmitters released by action potentials passing down an axon
aphasia means what area of brain is not working
dominant frontal lobe
hemiparesis has what area of brain not working
internal capsule
synchronous discharge of neurones by irritate lesions cause
epilepsy
the dominant hemisphere and the one that for most people affects language is
left
temporal lesions effects
visual hallucinations, complex partial seizures, memory disturbance eg deja vu
brocas area is in what lobe
frontal
wernickes is in what area
temporo- parietal
words are muddled, insertion of a few incorrect or unnecessary words or profuse outpouring of jargon (non existent words)
wernickes
disjointed words and and failure to construct sentences
brocas
what is nominal aphasia. It is an early detection in all types of aphasia
difficulty naming objects
what aphasia includes brocas and werniceks and is the most common aphasia after a severe left hemisphere infarct
global aphasia
what is dysarthria
slurred speech. language is intact
gravelly speech in
pseudo bulbar palsy
jerky speech of what lesions
cerebellar
hypophonic monotone speech of
parkinsons
speech that fatigues and dies away
myasthenia
what disorders are difficult to recognise ins right handed patents
right hemisphere lesions
semantic memory is
knowledge of word meaning
what is implicit memory
not conscious eg riding a bike
what lesions are necessary to cause amnesia
bilateral
tumours of the olfactory groove can cause loss of smell eg
meningioma
each — carries information from the contralateral visual hemifield
optic tract
what is normal acuity
6/6
white and red targets and fingers used to assess
visual fields(peripheral and central)
difference between temporal and parietal lesion in visual pathway
temporal affects superior region and parietal affects inferior region
what is the hallmark of an optic nerve lesion
unilateral visual loss, with a scotoma
optic nerve lesions particularly affect what parts of vision
central vision and colour vision
what does a total optic nerve lesion cause
unilateral blindness with loss of pupillary light reflex
pale disc reflects
optic atrophy
papilloedema is
swelling of the optic disc
visual symptoms of papilloedema
few if any visual symptoms, other than momentary visual obscurations with changes in posture. the blind spot is enlarged but this is not noticed by the patient. however over time visual fields are affected and eventually leading to optic atrophy
what is almost universal in optic neuritis
pain on eye movement
how does disc usually appear in optic neuritis
normal
most common cause of optic neuritis
plaque of demyelination within the optic nerve
what should be done for optic neuritis
steriods
common causes of bitemporal hemianopia/ quadrantanopia
pituitary tumours
meningioma
craniopharyngioma
what lobe lesions causes upper quadratic defects and what causes lower
upper- temporal lobe lesions
lower- parietal lobe lesions
what eye things can unilateral posterior cerebral artery infarction cause
homonymous hemianopia defects
what causes a dilated pupil and a afferent pupillary defect
optic nerve lesion
features of corners syndrome
constricted pupil (miosis)
partial ptosis
loss of sweating on the same side
horners syndrome is damage to the
sympathetic nerve supply
argyll robertson pupil is occassionalky seen in diabetes or MS and what is it
small and irregular pupil, it is fixed to light but constricts on convergence
what cranial nerves supply the extraocular muscles
oculomotor, trochlear and abducens
nystagmus can indicate what lesions
cerebellar or brainstem pathology
occipital cortex is concerned with
tracking objects
vestibular nuclei is involved with
linking eye movements with the position of head and neck
what causes internuclear ophthalmoplegia
damage to one medial longitudinal fasciculus
in internuclear ophthalmoplegia the other eye that is able to abduct develops nystagmus
what is almost pathognomonic for MS
Bilateral INO
what examination is of diagnostic value in coma
vestibulo ocular reflex
failure of upgaze can be seen in
dorsal midbrain lesion,
progressive supranuclear palsy
most common cause of trochlear nerve palsy ( two objects when looking down)
head injury
what can damage the abducence nerve
MS or brainstem infarction, raised ICP, tumours
what is the largest cn
trigeminal
modalities of trigeminal
mainly sensory with motor component to muscles of mastication
diminution of the corneal reflex can be a sign of
trigeminal nerve lesion
in trigeminal lesion causes what to jaw when mouth opens
it deviates to side of pathology
facial nerve main modality
mainly motor supplying muscles of facial expression. sensory to anterior 2/3 of tongue and motor to stapedius
upper motor neurone lesions cause what to face
weakness of the lower part of the face on the opposite side. frontalis is spared. can furrow brow, close eyes and blink.
complete unilateral lower motor neurone lesion causes
ipsilateral weakness of all facial expression muscles. frontalis and eye closure are weak
most common cause of UMN lesion in face
hemispheric stroke
lateral rectus nerve palsy and unilateral LMN facial weakness causes are
glioma, MS and infarction. This is at the PONS where the facial nerve loops around the abducens
what virus causes bells palsy
herpes simplex
what is common at onset with bells palsy
pain behind the ear
vague altered facial sensation is often reported in bells palsy but what
examination of facial sensation id normal
even though bells palsy is caused by virus what treatment
steriods as poor evidence for antivirals
vesicles alongside bells palsy
Ramsay hunt syndrome
treatment for Ramsay hunt
antiviral alongside steriods
outside the skull, glossopharyngeal, vagus, spinal accessory and hypoglossal lie close to the
carotid artery and sympathetic trunk
modalities of glossopharyngeal
largely sensory supply sensation and taste to posterior 1/3 of tongue and pharynx. motor to pharyngeal muscles and parasympathetic to parotid
