Lecture 3 - Neuro Flashcards
What are the main anatomical regions a neurological lesion can be located?
Brain
Spinal Cord
Nerve Roots
Peripheral Nerves
NMJ
How would you classify the potential causes of a neurological lesion?
Vascular
Infection
Inflammation/Autoimmue
Toxic/Metabolic
Tumour/Malignancy
Hereditary/Congenital
Degenerative
Which symptoms indicate an UMN lesion?
Increased spastic tone
Decreased Power
Brisk Reflexes
Upgoing Plantar (Babinski’s Sign)
Which symptoms would indicate a LMN lesion?
Flaccid Tone
Decreased Power
Decreased/Absent Reflexes.
Which cranial nerves could be damaged in a patient presenting with diplopia?
III, IV, VI
Which cranial nerves could be damaged in a patient presenting with dysphagia (due to a neurological deficit)?
IX, X
How would Botulism typically present?
Multiple, separate cranial nerve lesions (ie. Diplopia and Dysphagia)
Abscesses on Limbs (Due to IV drug use)
Symmetric, descending muscle weakness
Slurred Speech
Which signs point to a lesion in the cerebellum?
Ataxia
Nystagmus
Dysdiadokinesia
Intention Tremor
Speech - Slurred & Scanning
How would sensation be changed in a patient with a lesion in the cerebral cortex?
Hemisensory Loss
How would sensation be changed in a patient with a lesion in the spinal cord?
Sensation is lost either below or above the specific level of the lesion.
How would sensation be changed in a patient with a lesion in the nerve roots (radiculopathy)?
Loss of sensation in a particular dermatome.
How would sensation be changed in a patient with a mononuropathy?
A specific area will lose sensation.
How would sensation be changed in a patient with a polyneuropathy?
Glove & Stocking distribution of sensory loss.
How would you manage a patient with Diabetic Peripheral Neuropathy?
Duloxetine
What are the causes of peripheral neuropathy?
Infection - HIV
Inflammation/Autoimmune - Vasculitis, CTD, Inflammatory demyelinating neuropathy (GBS)
Toxic/Metabolic
Tumour/Malignancy - Paraneoplasia, paraproteinaemia
Hereditary - Hereditary sensory motor neuropathy (identified by the presence of long-term stigmata, ie. Pes Cavus)
What are the toxic/metabolic causes of peripheral neuropathy?
Drugs (Hx)
Alcohol (Hx, raised GGT/MCV)
B12 Deficiency (Macrocytic Anaemia)
Diabetes (HbA1C)
Hypothyroidism (TFTs)
Uraemia (U&Es)
Amyloidosis (Hx of Myeloma/chronic infection/inflammation)
What are the two causes of a blurred optic disc on fundoscopy?
Papillitis (Younger, presence of inflammation, painful, blurred vision) [Optic Neuritis]
Papilloedema (Older, raised ICP, not painful)
What does a spastic paraparesis describe?
Increased tone and weakness on both sides - UMN lesion.
Which artery supplies the anterior side of the spinal cord?
Anterior Spinal Artery
What is TB affecting the spine called?
Pott’s Disease (Tuberculosis spondylitis)
What are the causes of a spastic paraparesis?
Vascular (Stroke) - sudden onset
Infection (Abscess, Pott’s)
Inflammation (Demyelination) - Transverse Myelitis
Toxic/Metabolic - B12 Deficiency
Tumour
What could 2 lesions separated in time/space in a single patient indicate?
Multiple Sclerosis
What is Meralgia Paraesthetica?
Compression of the lateral femoral cutaneous nerve
How does Meralgia paraesthetica present?
Pain & Paraesthesia on Anteriolateral thigh
How would you manage a case of Meralgia Paraesthetica?
Reassure
Avoid tight garments
Lose weight
If persistent:
Carbamazepine
Gabapentin
What is sciatica?
Compression of the Lumbosacral Nerve, due to disc herniation or spinal canal stenosis.
Presents as pain in the buttock, which radiates down the leg below the knee.
Form of Radiculopathy
What would Parkinsonism & Limited upgaze indicate?
Progressive Supranuclear Palsy (Steele-Richardson Syndrome)
What are the key symptoms to remember for Parkinson’s?
Tremor
Rigidity
Bradykinesia
What causes Parkinson’s Disease?
Destruction of dopaminergic neurons in the Substantia Nigra
What are the key symptoms of Lewy Body Dementia?
Features of Alzheimer’s Disease
Parkinson’s
Vivid Hallucinations
What are the main causes of confusion, excluding VIITT causes?
V I I T T
&
Post-Ictal
May only be apparent confusion due to Dysphasia (eg. after a stroke)
Dementia
Depressive Pseudodementia
What are the main causes of confusion?
Hypoglycaemia (DNEFG)
Vascular:
- Bleed (associated with headache, collapse)
- Subdural Haematoma (fluctuating consciousness, Hx of fall)
Infection (?Fever, ?Intracranial, ?extra-cranial)
Inflammation (?raised CRP)
Malignancy
Metabolic (Drugs, U&Es, LFTs, Vitamin deficiencies, endocrinopathies)
What are the most important conditions to exclude when a patient presents with headache?
Meningitis
SAH
Giant Cell Arteritis
Migraine
What are the key symptoms to recognise in a patient with Meningitis?
Headache
Fever
Neck Stiffness
Non-blanching rash (severe)
Kernig’s Sign (Pain on extension of the knee)
Which symptoms would raise concerns that a patient has suffered from a Sub-Arachnoid Haemorrhage?
Sudden-onset, worst ever headache.
‘ThunderClap’
How would you investigate a possible SAH?
CT Head
LP (Xanthochromia would be positive, breakdown of RBCs in CSF - Straw yellow)
How does Giant Cell Arteritis present?
Over 50s
Headache, painful on touch (ie. combing hair)
Temporal region
Jaw claudification and Blindness
How would you manage a case of Giant Cell Arteritis?
Steroids, to prevent blindness
Check ESR and perform a temporal artery biopsy.
Which symptoms are indicative of a migraine?
Throbbing Headache
Vomiting
Photo/phonophobia
FHx
Aura preceding the attack.
How would you manage a stroke that began <4.5 hours ago?
CT Head to exclude Haemorrhage
Thrombolysis (If no contraindications)
How would you manage a stroke that began >4.5 Hours ago?
CT Head, to exclude haemorrhage
Asprin 300g & Swallow assessment
Maintain hydration, oxygenation, monitor glucose.
How would you manage a TIA?
Aspirin
Only treat BP acutely if malignant (over 220/120)
ECG, Echo
Carotid Doppler
Risk Factor modification
What is important to regularly monitor in a patient with Guillain-Barre Syndrome?
FVC
Fuck off Adam
These cards are quality
