LG1.2 An Approach to Neurologic Symptoms Flashcards
What are important questions to ask during a neurological exam?
- Where the problem is
- Is it generalized or localized
What is encephalopathy?
Disease of the brain
What is myelopahty?
disease of the spinal cord” i.e, compressive myelopathy (tumor, disc, etc causing weakness, sensory loss, spasticity below the level of compression)
What is radiculopathy?
disease of the nerve root(s)” i.e., any process affecting a single or multiple nerve roots at cervical, thoracic or lumbar or sacral level
What is neuropathy?
“disease of a nerve” (one is mononeuropathy or neuropathy, several individual is mononeuropathy multiplex, and many/diffuse is polyneuropathy peripheral nerves.
What is myopathy?
Primary disease of muscle
What is meningitis?
means inflammation of the membranes covering brain and spinal cord; not always infectious cause.
What is delirium?
- Generally a temporary disorder of mental faculties often characterized by restlessness, delusions, agitation or withdrawal.
- If delirium is “anything but” generalized, you immediately look for cortical structural lesion.
What is cognition?
- Implies a group of mental processes that includes attention, memory learning, reasoning, and problem solving.
i. Bi-hemispheric
ii. Critical task it to separate reversible from irreversible
What is Paresis?
Muscle weakness
what is Plegia?
Complete paraliysis
What is the CONTENT of consciousness?
- Cognitive changes
- Mental status change without affecting level of consciousness (psychiatric, language, dysfunction, demylenating diseases.
What is the LEVEL of consciousness?
- Continuum between drowsiness and coma
- Evidence of brainstem dysfunction
- If intact then issue is diffused encephalopathic process.
What is the path of the corticospinal tract?
i. Synapse with anterior horn cells in spinal cord gray matter,
ii. Second order neurons become cervical, thoracic and lumbosacral roots.
iii. Cervical roots become brachial plexus
iv. Lumbosacral roots: from cauda equine, exit spinal cord as lumbosacral plexus
What lesions can cause weakness?
Any level of upper/lower motor neuron pathway can cause weakness.
What are the effects of lesions of the corticospinal tract?
i. Increased/pathologic reflexes
ii. Increased tone/spasticity (chronic
What is a TIA?
Transient ischemic attack
What effects does a brainstem lesion have?
- contralateral weakness often with other brainstem lesions
- diplopia
- cranial nerve palsy
- vertigo.
What effect does a lesion of the corticospinal tract at the spine cause?
- Cause weakness below the level of the spinal cord
- Weakness of just a leg can imply a spinal cord lesion below the cervical level; or can be due to early or partial process affecting cervical cord**
What is Brown Sequard Syndrome?
½ spinal cord involvement: produces ipsilateral weakness, and contralateral numbness to pain and temperature.
What areas can be involved with a lower motor neuron lesion?
Lesion of:
1) anterior horn cell
2) motor nerve root
3) plexus
4) peripheral nerve
5) neuromuscular joint
What effects can a lower motor neuron lesion have?
Can have decreased reflexes or flaccidity and atrophy
If weakness fit a territory of a specific nerve root what type of disease would it be?
Radiculopathy
If weakness fits a region of plexus what type of disease would it be?
Plexopathy
If weakness fits a region of peripheral nerve distribution what type of disease would it be?
neuropathy
If weakness fits a region of multiple peripheral nerves, what type of disease would it be?
Polyneuropathies
What area would a polyneurpoathies normally affect?
Predominantly affect the most distal parts of extremities, decreased distal reflexes, sensory findings often associated; diffuse
What is a multifocal mononeuropathie?
Involve dysfunction of 2 or peripheral nerves
What is a polyradiculopathie?
- Multiple nerve roots affected
- Motor dysfunction involving multiple nerve root territories.
What is an example of a polyradiculopathie?
Sciatic neuropathy and cauda equine sydrome
What is do the lateral spinothalmic tract sense?
Pain and temperature
What do thalamic lesions cause?
-Can cause sensory dysfunction (thalamic pain after thalamic stroke, or paresthesias or numbness over contralateral body)
What do cortical lesions cause?
Sensory cortex can cause paresthesias or hypesthesia to contralateral body areas corresponding to cortical territory involved
Is the parietal post central gyrus, motor or sensory?
Sensory
What is Meralgia paresthetica?
Lateral femoral cutaneous nerve (sensory distribution)
What is diabetic polyneurpathy?
Numbness in stocking or stocking-glove pattern
Is the cerebral cortex precentral gyrus, motor or sensory?
Motor
Where do lesions of the spinal cord cause sensory symptoms?
At and below the level of the lesion
What can peripheral neuropathies cause?
- Sensory deficits: Numbness/burning dysesthesias
- Motor: weakness/atrophy
- Autonomic: Color, temperature, circulatory
Who is peripheral neuropahties common in?
Diabetics, alcoholics, medication adverse effect, hereditary, age.
What are radiculopathic pain?
-May cause numbness or pain in the territory of the nerve root.
What are examples of a radiculopathy?
Pinched nerve or herpes zoster (shingles)
Where does Brown Sequard localize?
A spinal cord lesion resulting in weakness/paralysis on one side of the body and decreased sensation (pain, temperature) on the opposite side, all below the level of the spinal cord lesion.
What are example diseases that cause Brown Sequard?
Multiple sclerosis or Neuromyelitis optica (Devics’s Disease)
What is Lhermitte’s sign?
Lhermitte’s sign or the Lhermitte sign, sometimes called the barber chair phenomenon, is an electrical sensation that runs down the back and into the limbs. In many patients, it is elicited by bending the head forward. It can also be evoked when a practitioner pounds on the posterior cervical spine while the neck is flexed; this is caused by involvement of the posterior columns
Discuss Non-neurologic gait disorders
- Often orthopedic (spine, hip, pelvis, knee)
- Antalgic gait (secondary to lower extremity pain)
- history and physical sensitive
What are examples of frontal lobe disorders that cause gait disorders?
Frontal Lobe Disorders:
- Hydrocephalus, bifrontal mass lesions, aging or dementia
- Characterized by difficuly with initiation of gait (feet “glued to the floor”)
- Neurologic
What are examples of structures that would be affected in primary neurologic gait disorders?
Structures that control gait and balance; frontal lobes, basal ganglia, cerebellum, motor, and sensory pathways.
What is Parkinsonian Gait?
It is similar in this manner basal ganglion dysfunction, gait is characteristically slow, shuffling, flexed posture bradykinetic. Turning 180 degrees takes extra steps. Festination (can’t stop forward progress once engaged)
What is an ataxic Gait?
Wide-based unsteady gait
What is unilateral corticospinal tract disease?
Hemiparetic Gait (stiff, circumduction, overextended leg)
What is a bilateral Corticospinal tract disease?
- Both legs stiff, spastic gait.
- Scissoring motion of each leg around the other
What is an example of a corticospinal tract disease?
Myelopathy
What is a Romberg sign?
Requires at least two of the three following senses to maintain balance while standing:
1) Vision, proprioception, and cerebellar/vestibular
What are the main neurologic mechanisms?
Compressive, degenerative, epileptic, hemorrhagic, infectious, inflammatory, ischemic, migrainous, metabolic/toxic, traumatic
What do transient focal neurologic symptoms suggest (possibly recurrent)?
Suggest ischemia (TIA), migraine, or seizure
What is the normal time frame of symptoms of a ischemia (TIA)?
Seconds to hours
What is the time frame of a migraine?
Progressive and spread over 15-30 mins
