Kumar and clark 2 Flashcards
modalities of vagus
largely motor, - muscles of pharynx (gag reflex), larynx (vocal cords), upper oesophagus. sensory fibres from larynx. parasympathetic to heart and abdominal viscera
accessory supplies
trapezius and sternocleidomastoid
hypoglossal modaliteit
motor to tongue muscles
what recurrent laryngeal is more commonly injured
left as it loops beneath the aorta
hypoglossal nerve palsy cause tongue to go to what side
the weaker side of the pathology
what is bulbar palsy
LMN weakness of muscles whose cranial nerve nuclei lie in the medulla (bulb) (9,10,11), myasthenia graves, botulism , muscle disease
bulbar palsy causes what to tongue
spastic tongue
things that can cause bulbar palsy
MND, supranuclear palsy, MS
motor control systems
corticospinal (pyramidal), extrapyramidal, cerebellum
weakness or paralysis, spasticity , changes in reflex is what system
pyramidal
bradykinesia, stiffness, tremor, chorea is what system
extra pyramidal
what is ataxia
unsteady and very movements
what system is ataxia, past pointing, action tremor, incoordination, gait ataxia
cerebellum
where does the pyramidal system cross
medulla
pyramidal system, disease of which causes what lesions
UMN
pyramidal is used interchangeably with what word
UMN
extensors plantar response is what lesion
upper motor neurone
unilateral pyramidal lesion above decussation of medulla causes weakness in what limbs
opposite
what happens to fingers and toes in upper motor neurone lesions
loss of skilled finger/toe movements
internal capsule infarct causes
hemiplegia - pyramidal tract
what is spasticity characterised b y
sudden changing resistance to rapid passive movement
what can emerge in spasticity
clonus
paraparesis is
weakness of lower limbs
paraparesis is usually diagnostic of
cord lesion
weakness and or skilled movement confined to one contralateral limb - arm or leg - or part of limb eg hand. Is lesion where. aphasia or focal epilepsy may occur with this
motor cortex
sudden dense contralateral hemiplegia
middle cerebral artery infarction - internal capsule (corticospinal fibres are tightly packed in the internal capsule)
lesion in pons (MS plaque) causes
affects abducens and facial nerve - diplopia, facial weakness, INO, lateral gaze palsy with contralateral hemiparesis
spinal cord injury causes what signs
ipsilateral UMN lesion ??? not sure about this - page 819
paraparesis is usually due to damage of what
cord
what is a general term for basal ganglia motor systems
extrapyramidal systen
basal ganglia motor systems include
corpus striatum ( caudate nucleus, globus pallidus and putamen), sub thalamic nucleus, substantia nigra an parts of the thalamus
features of extrapyramidal systems
bradykinesia or akinesia (no movement) with MUSCLE RIGIDITY OR HYPERKINETIC MOVEMENTS( tremor, chorea, dystonia, tics, myoclonus)
most common extra pyramidal disorder
Parkinson
levels of GABA in Parkinsons and Huntington’s is
decreased
side effect of levodopa
unwanted dyskinesias
what is characteristic of cerebellum
ataxia ie unsteadiness
what is the midline structure in the cerebellum
vermis
expanding lesions where can cause hydrocephalus
cerebellum as obstructs the aqueduct
gait in cerebellar lesions
tilts towards the side of lesion
rotatory hand movements becomes disorganised in
cerebellar lesions
intention tremor is seen in cerebellar lesions and what is this
action tremor with past pointing
lesions of the flocculondoualr lobe cause what signs
vertigo and vomit
3 physics drugs that can cause tremor
sodium valproate, lamotrigine, lithium
intention tremor is
tremor exacerbated by action
LMN pathway originates in
anterior horn cell
LMN lesion at cranial nerve nuclei is
Bells palsy
LMN lesion at anterior horn cell is
MND
LMN lesion at spinal root is
radiculopathy
pain on straight leg raise
lumbar disc prolapse
cough and straining increase pain in what
spinal subarachnoid space
what are common causes of spinal root lesions
cervical and lumbar disc protrusions
clumsiness can bet caused by
spinal cord lesions
in a spinal cord lesion what is lost below the lesion
position sense ( produces a stamping gait) , vibration , light touch , two point discrimination
what is lhermittes phenomenal
electric shock sensation down trunk and limbs on neck flexion- points to a cervical cord lesion. common in exacerbations of MS, cervical myeloapthy
contralteal loss of pain nd temp (spinothalmic tract lesions) typically seen in
syringomyelia
central cord lesion affects what fibres first
deeper
what does cord compression causee
progressive spastic paraparesis with sensory loss below the level of the lesion
what disturbance is common in spinal cord compression
sphincter
pontine lesions causes
loss of all forms of sensation on side opposite the lesion and combination of cranial nerves can be affected
constant pain after stroke could be
thalamic lesion
brown squared affects what limbs
legs
central cord lesions affects what
chest and arms
what disease is from a dorsal column lesion
MS
spinothalmic tract is for
pain localisation
spin-reticular tract is for
emotional component of pain
diminished proprioception and light touch affects where
posterior columns
aspirin, paracetamol NSaids and opiates are all
analgesics
some opioids such as tamadolol and tapentadol have what
monoamine reuptake inhibition mechanism
what is licensed for chronic migraine
botulinum
bilateral UMN lesion spinal cord can cause what
urinary frequency and incontinecne
scan for carotid stenosis
US - Doppler
what can detect arteiorvenous malformations
catheter angiography
what’s main use is to characterise epilepsy syndromes
electroencephalography
what are hallmarks of epilepsy on EEG
SPIKES - but often have normal EEG between spikes
slow wAVE EEG IS IN
encephalopathy, encephalitis and prion disease
studies for nerve function
electromyography and nerve conduction
electroencephalography measures
brain electrical activity
conduction block and slowing of conducting velocity indicates what
demyelinating neuroapthy
what is receptive nerve stimulation used for
NMJ conduction disorders (myasthenia)
