Lesions

Question 1

What are the Sx of a musculocutaneous nerve lesion?

Answer 1

Sensory to lateral forearm
Brachial plexus injury
Inability to FLEX + SUPINATE arm at elbow

Question 2

What are the nerve roots of the:
musculocutaneous
Axillary
Radial
Median
Ulnar
Long thoracic
nerves??

Answer 2

M: C5-7
A: C5-6
R: C5-8
Med: C6, C8, T1
U: C8, T1
LT: C5-7

Question 3

What are the Sx of an axillary nerve lesion?

Answer 3

Sensory function to inferior deltoid (Regimental badge)
Flattened deltoid
Reduced abduction
Usually high humeral #/dislocation

Question 4

What are the Sx of a radial nerve lesion?

Answer 4

Wrist drop

Usually humeral mid shaft #

Question 5

What are the Sx of a median nerve lesion?

Answer 5

Sensory function to palmar aspect of lateral 3.5 fingers
Hand of benediction
Carpal tunnel syndrome

Question 6

What are the Sx of an ulnar nerve lesion?

Answer 6

Sensation to medial 1.5 fingers
Inability to ABDUCT fingers
CLAW hand
Usually medial epicondyle #

Question 7

What are the Sx of a long thoracic nerve lesion?

Answer 7

Winged scapula
Usually high impact sport injury- blow to ribs
Complication of mastectomy

Question 8

What are the Sx of Erb’s palsy?

Answer 8

ADDUCTED arm
INTERNAL rotation
EXTENDED elbow
(Waiter’s tip)

Question 9

What nerve roots does Erb’s & Klumpke’s palsy affect? How are they damaged?

Answer 9

E = C5-6 damage to upper trunk of brachial plexus by shoulder dystocia
K = C8, T1 damage to lower trunk of brachial plexus by shoulder dystocia or extensive stretching of arm in delivery

Question 10

What are the Sx of Klumpke’s palsy?

Answer 10

Horner’s Syndrome

CLAW hand

Question 11

What are the Sx of a CNIII palsy?

Answer 11

Ptosis (droopy eyelid)
Eye DOWN + OUT
Dilated fixed pupil

Question 12

What are the Sx of a CNIV palsy?

Answer 12

Defective DOWNWARD gaze = vertical diplopia

Head tilt

Question 13

What are the Sx of a CNV palsy?

Answer 13

U/L Trigeminal neuralgia 
Loss of corneal reflex
Loss of facial sensation
Paralysis of muscles of mastication 
Jaw jerk to side of weakness

Question 14

What are the Sx of a CNVI palsy?

Answer 14

Defective ABDUCTION = Horizontal diplopia

Question 15

What are the Sx of a CNVII palsy?

Answer 15

Flaccid paralysis of upper & lower face
Loss of corneal reflex & taste
Hyperacusis (sensitivity to certain frequencies)

Question 16

What are the Sx of a stroke affecting CNVII?

Answer 16

UMN lesion=

I/L Facial nerve paralysis w/Forehead sparing

Question 17

What are the Sx of Bell’s palsy?

Answer 17

LMN Lesion =
I/L Facial nerve paralysis
Inability to raise eyebrows
I/L ear numbness & pain (hyperacusis)
↓taste

Question 18

How is Bell’s palsy treated?

Answer 18

High dose Prednisolone

Question 19

What are the causes of bilateral facial nerve palsy?

Answer 19

Sarcoidosis
Guillain Barre
Lyme disease
B/L Acoustic neuroma (NFMt2)

Question 20

What are the causes of unilateral facial nerve palsy?

Answer 20

Stroke
Bell’s (infection)
Ramsey-Hunt
MS

Question 21

What are the risk factors for a brain tumour?

Answer 21

Ionising radiation
Vinyl Chloride
ImmunoS (AIDS)
Inherited (Neurofibromatosis, Li-Fraumeni)

Question 22

What are the types of high grade & low grade brain tumours?

Answer 22

HIGH: Glioma, medulloblastoma, primary cerebral lymphoma
LOW: Meningioma, acoustic neuroma, neurofibroma, pineal, pituitary

Question 23

Which cancer commonly spread to the brain?

Answer 23

Lung
Breast
Stomach
Prostate
Thyroid
Colorectal
Melanoma
Kidney

Question 24

What investigations need doing for a brain tumour?

Answer 24

CT/MRI Head +/- Whole spine
Bone scan
Biopsy if possible

Question 25

How are brain tumours managed?

Answer 25

Surgery: Resection
Palliative surgery- reduce mass effect & hydrocephalus
RT: Brain mets, whole brain RT = Medulloblastoma & primary CNS lymphoma
Dexamethasone: ↓ICP

Question 26

What are the complications of a brain tumour?

Answer 26

Acute haemorrhage
Hydrocephalus
Raised ICP
RT complications