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NMSK B Test 1 > LG1.2 An Approach to Neurologic Symptoms > Flashcards

LG1.2 An Approach to Neurologic Symptoms Flashcards

1
Q

What are important questions to ask during a neurological exam?

A
  • Where the problem is

- Is it generalized or localized

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2
Q

What is encephalopathy?

A

Disease of the brain

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3
Q

What is myelopahty?

A

disease of the spinal cord” i.e, compressive myelopathy (tumor, disc, etc causing weakness, sensory loss, spasticity below the level of compression)

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4
Q

What is radiculopathy?

A

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

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5
Q

What is neuropathy?

A

“disease of a nerve” (one is mononeuropathy or neuropathy, several individual is mononeuropathy multiplex, and many/diffuse is polyneuropathy peripheral nerves.

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6
Q

What is myopathy?

A

Primary disease of muscle

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7
Q

What is meningitis?

A

means inflammation of the membranes covering brain and spinal cord; not always infectious cause.

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8
Q

What is delirium?

A
  • 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.
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9
Q

What is cognition?

A
  • 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
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10
Q

What is Paresis?

A

Muscle weakness

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11
Q

what is Plegia?

A

Complete paraliysis

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12
Q

What is the CONTENT of consciousness?

A
  • Cognitive changes
  • Mental status change without affecting level of consciousness (psychiatric, language, dysfunction, demylenating diseases.
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13
Q

What is the LEVEL of consciousness?

A
  • Continuum between drowsiness and coma
  • Evidence of brainstem dysfunction
  • If intact then issue is diffused encephalopathic process.
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14
Q

What is the path of the corticospinal tract?

A

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

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15
Q

What lesions can cause weakness?

A

Any level of upper/lower motor neuron pathway can cause weakness.

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16
Q

What are the effects of lesions of the corticospinal tract?

A

i. Increased/pathologic reflexes

ii. Increased tone/spasticity (chronic

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17
Q

What is a TIA?

A

Transient ischemic attack

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18
Q

What effects does a brainstem lesion have?

A
  • contralateral weakness often with other brainstem lesions
  • diplopia
  • cranial nerve palsy
  • vertigo.
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19
Q

What effect does a lesion of the corticospinal tract at the spine cause?

A
  • 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**
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20
Q

What is Brown Sequard Syndrome?

A

½ spinal cord involvement: produces ipsilateral weakness, and contralateral numbness to pain and temperature.

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21
Q

What areas can be involved with a lower motor neuron lesion?

A

Lesion of:

1) anterior horn cell
2) motor nerve root
3) plexus
4) peripheral nerve
5) neuromuscular joint

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22
Q

What effects can a lower motor neuron lesion have?

A

Can have decreased reflexes or flaccidity and atrophy

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23
Q

If weakness fit a territory of a specific nerve root what type of disease would it be?

A

Radiculopathy

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24
Q

If weakness fits a region of plexus what type of disease would it be?

A

Plexopathy

25
Q

If weakness fits a region of peripheral nerve distribution what type of disease would it be?

A

neuropathy

26
Q

If weakness fits a region of multiple peripheral nerves, what type of disease would it be?

A

Polyneuropathies

27
Q

What area would a polyneurpoathies normally affect?

A

Predominantly affect the most distal parts of extremities, decreased distal reflexes, sensory findings often associated; diffuse

28
Q

What is a multifocal mononeuropathie?

A

Involve dysfunction of 2 or peripheral nerves

29
Q

What is a polyradiculopathie?

A
  • Multiple nerve roots affected

- Motor dysfunction involving multiple nerve root territories.

30
Q

What is an example of a polyradiculopathie?

A

Sciatic neuropathy and cauda equine sydrome

31
Q

What is do the lateral spinothalmic tract sense?

A

Pain and temperature

32
Q

What do thalamic lesions cause?

A

-Can cause sensory dysfunction (thalamic pain after thalamic stroke, or paresthesias or numbness over contralateral body)

33
Q

What do cortical lesions cause?

A

Sensory cortex can cause paresthesias or hypesthesia to contralateral body areas corresponding to cortical territory involved

34
Q

Is the parietal post central gyrus, motor or sensory?

A

Sensory

35
Q

What is Meralgia paresthetica?

A

Lateral femoral cutaneous nerve (sensory distribution)

36
Q

What is diabetic polyneurpathy?

A

Numbness in stocking or stocking-glove pattern

37
Q

Is the cerebral cortex precentral gyrus, motor or sensory?

A

Motor

38
Q

Where do lesions of the spinal cord cause sensory symptoms?

A

At and below the level of the lesion

39
Q

What can peripheral neuropathies cause?

A
  • Sensory deficits: Numbness/burning dysesthesias
  • Motor: weakness/atrophy
  • Autonomic: Color, temperature, circulatory
40
Q

Who is peripheral neuropahties common in?

A

Diabetics, alcoholics, medication adverse effect, hereditary, age.

41
Q

What are radiculopathic pain?

A

-May cause numbness or pain in the territory of the nerve root.

42
Q

What are examples of a radiculopathy?

A

Pinched nerve or herpes zoster (shingles)

43
Q

Where does Brown Sequard localize?

A

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.

44
Q

What are example diseases that cause Brown Sequard?

A

Multiple sclerosis or Neuromyelitis optica (Devics’s Disease)

45
Q

What is Lhermitte’s sign?

A

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

46
Q

Discuss Non-neurologic gait disorders

A
  • Often orthopedic (spine, hip, pelvis, knee)
  • Antalgic gait (secondary to lower extremity pain)
  • history and physical sensitive
47
Q

What are examples of frontal lobe disorders that cause gait disorders?

A

Frontal Lobe Disorders:

  1. Hydrocephalus, bifrontal mass lesions, aging or dementia
  2. Characterized by difficuly with initiation of gait (feet “glued to the floor”)
  3. Neurologic
48
Q

What are examples of structures that would be affected in primary neurologic gait disorders?

A

Structures that control gait and balance; frontal lobes, basal ganglia, cerebellum, motor, and sensory pathways.

49
Q

What is Parkinsonian Gait?

A

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)

50
Q

What is an ataxic Gait?

A

Wide-based unsteady gait

51
Q

What is unilateral corticospinal tract disease?

A

Hemiparetic Gait (stiff, circumduction, overextended leg)

52
Q

What is a bilateral Corticospinal tract disease?

A
  • Both legs stiff, spastic gait.

- Scissoring motion of each leg around the other

53
Q

What is an example of a corticospinal tract disease?

A

Myelopathy

54
Q

What is a Romberg sign?

A

Requires at least two of the three following senses to maintain balance while standing:
1) Vision, proprioception, and cerebellar/vestibular

55
Q

What are the main neurologic mechanisms?

A

Compressive, degenerative, epileptic, hemorrhagic, infectious, inflammatory, ischemic, migrainous, metabolic/toxic, traumatic

56
Q

What do transient focal neurologic symptoms suggest (possibly recurrent)?

A

Suggest ischemia (TIA), migraine, or seizure

57
Q

What is the normal time frame of symptoms of a ischemia (TIA)?

A

Seconds to hours

58
Q

What is the time frame of a migraine?

A

Progressive and spread over 15-30 mins

NMSK B Test 1 (27 decks)

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