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Z Year3 Clinical Presentations > Limb weakness > Flashcards

Limb weakness Flashcards

1
Q

What things may be confused for limb weakness?

A
  1. Ataxia
  2. Reduced sensation
  3. Lumb too painful to move
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2
Q

What may cause a sudden onset (secs to mins) of limb weakness?

A
  1. trauma e.g. displaced vertebral fractures due to major trauma
  2. vascular insult e.g. stroke, TIA
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3
Q

What may cause a subacute onset of limb weakness (hours to days) of limb weakness?

A
  1. progressive demyelination (e.g. Guillain-Barre syndrome, MS)
  2. slowly expanding haematoma (e.g. subdural haematoma)
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4
Q

What may cause a chronic onset (weeks to months) of limb weakness?

A
  1. Slow growing tumour

2. Motor neuron disease

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5
Q

What is the pathway that could be damaged in limb weakness?

A
  1. cerebral cortex
  2. corona radiata
  3. internal capsule
  4. pons
  5. along corticospinal tract of spinal cord
  6. out along a nerve root
  7. down a peripheral nerve to neuromusclar junction
  8. muscle itself
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6
Q

What are the differential diagnosis for a brain lesion with a sudden onset of limb weakness?

A
  1. Ischaemic stroke
  2. TIA
  3. Haemorrhagic stroke
  4. Hemiplegic migraine
  5. Todd’s palsy (post-seizure paralysis)
  6. Hypoglycaemia
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7
Q

What are the differential diagnosis for a spinal cord lesion with a sudden onset of limb weakness?

A
  1. Spinal disc prolapse
  2. Spinal cord transection
  3. Spinal cord infarction
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8
Q

What are the differential diagnosis for a nerve lesion with a sudden onset of limb weakness?

A
  1. spinal disc prolapse

2. vertebral fracture

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9
Q

What are the differential diagnosis for a peripheral nerve or nerve plexus lesion with a sudden onset of limb weakness?

A
  1. Acute limb ischaemia (e.g. peripheral artery embolus)

2. Traumatic nerve injury (e.g. laceration

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10
Q

What are the differential diagnosis for a brain lesion with a subacute onset of limb weakness?

A
  1. MS
  2. Haematoma (e.g. subdural, extradural)
  3. Tumour
  4. Abscess
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11
Q

What are the differential diagnosis for a spinal cord lesion with a subacute onset of limb weakness?

A
  1. MS
  2. Tumour
  3. Transverse myelitis
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12
Q

What are the differential diagnosis for a nerve root lesion with a subacute onset of limb weakness?

A
  1. Guillain-Barre syndrome

2. Poliomyelitis

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13
Q

What are the differential diagnosis for a neuromuscular junction lesion with a subacute onset of limb weakness?

A
  1. botulism

2. tetanus

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14
Q

What are the differential diagnosis for a spinal cord lesion with a chronic onset of limb weakness?

A
  1. Spinal canal stenosis

2. Vitamin B12 deficiency

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15
Q

What are the differential diagnosis for a peripheral nerve or nerve plexus lesion with a chronic onset of limb weakness?

A
  1. DM

2. Vasculitis

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16
Q

What are the differential diagnosis for a neuromuscular lesion with a chronic onset of limb weakness?

A
  1. Myasthenia gravis
  2. Lambert-Eaton syndrome
  3. Myositis
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17
Q

What key points must be covered in history of limb weakness?

A
  1. time of onset
  2. speech or visual disturbances
  3. headache?
  4. seizure or loss of consciousness?
  5. neck or back pain?
  6. trauma to head in last few months?
  7. RF for stroke or TIA
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18
Q

Why is it important to know the time of onset?

A

stroke window to administer thrombolysis: only 4.5hr after onset of symptoms

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19
Q

What would limb weakness and deficit in speech or vision suggest?

A

problem in brain rather than spine or PNS

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20
Q

Is a headache usual in stroke or TIA?

A

No

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21
Q

What would a sudden onset terrible headache with limb weakness suggest?

A

subarachnoid haemorrhage

22
Q

What would a unilateral headache preceding limb weakness suggest?

A

hemiplegic migraine

23
Q

What would a gradual onset headache preceding limb weakness suggest?

A

intracranial mass (e.g. slowly expansing subdural haemorrhage)

24
Q

Is a seizure or loss of consciousness typical in stroke?

25
Q

If there was a seizure or loss of consciousness with limb weakness what would this suggest?

A

Todd’s paresis (post seizure) or hypoglycaemia

26
Q

What would neck or back pain with limb weakness suggest?

A
  • spinal pathology:
    1. spontanenous disc prolapse
    2. traumatic injury to spine
    3. discitis
    4. spinal abscess
27
Q

Which neurological condition is usually accompanied with back pain?

A

guillian barre syndrome

28
Q

What would trauma in the last few months with limb weakness suggest?

A

slowly expanding subdural haemorrhage

29
Q

What are 3 key risk factors for stroke or TIA?

A
  1. previous stroke or TIA
  2. AF
  3. Atherosclerotic risk factors
30
Q

What are interesting RF for ischaemic stroke?

A
  1. migraine with aura

2. SLE

31
Q

What are UMN lesion signs?

A
  1. Increased tone
  2. Increased reflexes
  3. Increased plantars (babinski reflex)
  4. Clonus (sometimes)
32
Q

What are LMN lesion signs?

A
  1. Decreased tone
  2. Decreased reflexes
  3. Fasciuclations (sometimes)
  4. wasting
33
Q

What would language defects suggest?

A

pathology in cortex of the dominant hemisphere

34
Q

Where is the lesion in receptive dysphasia?

A

Wernicke’s area (in temporal lobe of the dominant hemisphere)

35
Q

Where is the lesion in expressive dysphasia?

A

lesion in Broca’s area (frontal lobe) of the dominant hemisphere

36
Q

Where would a lesion be located if attention defect (ignoring half of sensory world - if only responding to ques on one side of bed)?

A

parietal cortex

37
Q

What are common eye signs with limb weakness?

A
  1. Complete blindness in one eye
  2. Homonymous hemianopia or loss of same half of field of vision in both eyes
  3. Eye deviation
38
Q

Where may lesion be if complete blindness in one eye?

A
  • optic nerve

- globe itself

39
Q

Where may lesion be in homonymous heminaopia or loss of same half of field of vision in both eyes?

A

lesion (ischaemia, mass) at some point between optic chiasm and visual cortex on contralateral side

40
Q

If the eye deviates away from the weak side where may the lesion be?

A

cortical lesion

41
Q

If the eye deviates towards the weak side where may the lesion be?

A

brain-stem lesion

42
Q

What do sensory symptoms include?

A

paraesthesia or loss of one or all sensory modalities

43
Q

If there is limb weakness with LMN signs what can sensory symptoms help determine?

A
  1. nerve root or peripheral nerve lesion (sensory signs present)
  2. neuromuscular or musclar lesions (absent)
44
Q

If there is limb weakness with UMN signs what can sensory symptoms help determine?

A

indicate damage to specific tracts

45
Q

What sensory part is in the spinothalamic tract?

A

pain and temperature

46
Q

What sensory part is in the dorsal columns?

A
  1. light touch
  2. vibration
  3. position sense
  4. proprioception
47
Q

Why is it important to know which tracts are affected/

A

helps distinguish types of spinal cord pathology (e.g. anterior spinal artery infarct spares dorsal columns)

48
Q

What If there is left sided facial weakness with sparing of forehead wrinkling and blink what sort of lesion is it?

A

UMN not LMN as forehead has bilateral innervation

49
Q

What are differentials for a cerebral cortex lesions?

A
  1. Stroke (infarct or haemorrhage)
  2. Cerebral mass (e.g. tumour, abscess, potentially with bleed into it)
  3. Hemiplegic migration
  4. Hypoglycaemia
50
Q

What would decreased tone in limb be consistent with?

A

LMN lesion or acute phase of UMN lesion

Z Year3 Clinical Presentations (37 decks)

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