Lecture day 1 Flashcards
What are the first questions you ask during a neuro history?
- Age
- Dexterity
- Occupation
What questions would you ask to establish a timeline?
- When in your life did you first ever have one of these events?
- You never had anything like this before that?
- What is the longest interval free of events and when did that occur?
- When were these attacks at their worst?
- Have you had any bad patches with more frequent or more
severe attacks? - How many of these events have you had in the recent past?
(week, month, 3 months, 6 months) - When was the last event?
- Are you completely normal between events?
What questions would you ask to understand the aggravating and precipitating factors?
- Have they occurred while you are standing, sitting or lying down, or any of these?
- Are they related to a change of position or exercise?
- Do they occur at any particular time of day or night?
- Indoors or outdoors, or both?
- Do you know of anything which specifically triggers an attack?
- Are you conscious of your heartbeat or breathing?
- In women: are they related to your periods?
What are CT scans used for?
- Head trauma
- Intracerebral haemorrhage
- Acute stroke
What are the advantages of CT?
Quick, good visualisation of the brain
What does MRI image?
Water and fat
What are the advantages of MRI?
Very good contrast and very sensitive
What is MRI used for?
- Cerebral oedema, gliosis
- Encephalitis
- Plaques of demyelination
- Acute infarcts
What are the contraindications for MRI?
Claustrophobia
Metalic implants
What is cerebral angiography used for?
Interventional technique
When would you use imaging for someone who had a headache?
- Meningitis (sometimes)
- Encephalitis (CT shows oedema and swelling in medial temporal lobe)
- Cerebral abscess (common in IV drug users)
- Subarachnoid haemorrhage (CT)
- Brain tumours
What are the CT findings for a subarachnoid haemorrhage?
- High density in the cisterns
- Communiciating hydrocephalus
- Cerebral angiogram is usually done in first 24 hours after injury
what causes a subarachnoid haemorrhage?
Usually due to rupture of berry aneurysm from the circle of willis; others due to arteriovenous malformation or trauma
What are the most common brain tumours?
Glioma (35%) - Astrocytoma most common
Meningiomas (15%) - often benign
Metastases (20%) - lung or breast
Besides headache, what are other indications for head imaging?
- TIA and stroke (doppler, US, MRI)
- Epilepsy or fit (most have normal CT)
- MS (MRI can look at plaques)
- Coma (look for cause)
- Trauma (CT preferred)
What are absolute indications for CT head after trauma?
- Decreased conscious level
- Focal neurological signs and symptoms
- Seizures
- Depressed fracture, penetrating injury
What are relative indications for CT head after trauma?
- Persistent or severe headache
- Vomiting
- Temporary loss of consciousness
- Amnesia
What does a CT for an acute extradural haematoma show?
Biconvex shapes
What does a CT for a subdural haematoma show?
Moon shaped
What are the parts of an ophthalmic history?
- Hx of PC
- Past ocular history
- Eye and systemic medications
- Allergies including eye drops
- Social history (driving, job, smoking)
- Family eye history
- Systems review
How would you perform a visual acuity test?
Snellen chart at 6 meters
Measure eye separately through pinhole
If someone cannot see the Snellen chart from 3 meters, what would you check next?
- Count fingers
- Hand motions
- Perception of light
- No perception of light
What ocular muscle is responsible for the up and out movement?
Superior rectus
What ocular muscle is responsible for the up and in movement?
Inferior oblique
What ocular muscle is responsible for the down and out movement?
Inferior rectus
What ocular muscle is responsible for the down and in movement?
Superior oblique
What ocular muscle is responsible for the lateral movement?
Lateral rectus
What ocular muscle is responsible for the medial movement?
Medial rectus
How do pupils change when they accommodate to see a near target?
Constrict
What are the causes of RAPD?
Extensive retinal disease
Optic nerve disease (demyelinating optic neuritis)
What would you observe of someone’s gait?
- Speed
- Stride length
- Arm swing
- Base
- Steadiness
- Initiation, turning and freezing
- Abnormal movements or posture
How would you describe a Parkinsonian gait?
- Shuffling, short gait
- Reduced arm swinging
- Forward tilt of trunk
- Tremors
What muscle helps raise the eyebrows?
Frontalis
What muscle screws up tights really tight?
Orbicularis oculi
What muscle puffs out your cheeks?
Buccinator
What muscle helps show your teeth?
Orbicularis oris
How would you test the hypoglossal nerve?
- Observe tongue for wasting or fasciculations
- Tongue protrusion (deviates to side of lesion)
- Power and speed of movement
How would you test the vagus nerve?
- Listen to speech
- Say “aa” and watch palatal elevation
- Cough
- Swallow
- Gag reflex
How would you test the glossopharyngeal nerve?
taste to back 1/3 tongue, pharyngeal sensation, gag reflex, some palatal elevation
What is location of a spastic and velocity dependent tone?
UMN
What is location of a rigid and lead-pipe like lesion?
Basal ganglia
What are the characteristics of a UMN lesions?
Hypertonia – an increased muscle tone
Hyperreflexia – increased muscle reflexes
Clonus – involuntary, rhythmic muscle contractions
Babinski sign – extension of the hallux in response to blunt stimulation of the sole of the foot
Muscle weakness
What are the characteristics of a LMN lesions?
- Muscle paresis or paralysis (FLACCID paralysis)
- Fibrillations
- Fasciculations – caused by increased receptor concentration on muscles to compensate for lack of innervation.
- Hypotonia or atonia – Tone is not velocity dependent.
- Hyporeflexia - Along with deep reflexes even cutaneous reflexes are also decreased or absent.
- Strength – weakness
Where can UMN lesions be?
Brain, brainstem, spinach cord
Where can LMN lesions be?
Root, plexus, nerve
What causes LMN lesions?
Trauma Guillain–Barré syndrome West Nile fever C. botulism Polio Cauda equina syndrome ALS
What causes UMN lesions?
Upper motor neuron lesions occur in the brain or the spinal cord as the result of stroke, multiple sclerosis, traumatic brain injury, cerebral palsy, atypical parkinsonisms, multiple system atrophy, and amyotrophic lateral sclerosis.
