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1
Q

Predominant motor neuropathy - 4 causes

A
  1. Hereditary motor and sensory neuropathy
  2. Guillain-Barré syndrome, CIDP
  3. Other (eg acute intermittent Porphyria, lead poisoning, diphtheria)
  4. Diabetes mellitus
  5. Multifocal motor neuropathy
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2
Q

Causes of predominantly sensory neuropathy (6)

A
  1. Diabetes
  2. Alcohol
  3. Deficiency if Vit B12
  4. CKD

Vit B6 intoxication, B12 deficiency

  1. Carcinoma
  2. Diabetes
  3. Paraproteinemia
  4. Idiopathic
  5. Sjögren’s syndrome
  6. Syphillis
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3
Q

Painful peripheral neuropathy - 6 causes

A
  1. Vit B1 or 12 deficiency
  2. Alcohol
  3. Diabetes
  4. Carcinoma
  5. Arsenic or thallium poisoning
  6. Porphyria
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4
Q

Proximal myopathy and peripheral neuropathy - 4 causes

A

Connective tissue disease
Hypothyroidism
Alcohol
Paraneoplastic syndrome

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5
Q

Proximal muscle weaknesses

A

Myopathic (see causes for myopathy)
NMJ
neurogenic (MND, anterior horn cell disease, polyradiculopathy)

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6
Q

Tests for myopathy

A
  1. CK - highest in duchenne
  2. EMG
  3. ECG
  4. Muscle bx
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7
Q

Causes of (proximal) myopathy

A
  1. Hereditary muscular dystrophy
    - duchenne (pseudohypertrophy, dilated cmp)
    - Becker
    - limb girdle (shoulder and pelvic girdle, heart spared)
    - facioscapulohumeral (face and shoulder, pelvis spared)
  2. Congenital myopathy
  3. Acquires myopathies:
    PACES PODS
    - Polymyosotis or dermatomyositis
    - Alcohol
    - Carcinoma
    - Endocrine (hyper or hypothyroidism, Cushing, acromegaly, diabetic amyotrophy , hypopit)
    - Periodic paralysis
    - Osteomalacia
    - drugs (steroids)
    - Sarcoidosis
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8
Q

Signs with friedreich’s ataxia (7)

A
  1. Cerebellar signs including nystagmus, ataxia
  2. Posterior column loss in limbs
  3. UMN signs in limbs (although ankle reflexes are absent), pyramidal weakness
  4. Peripheral neuropathy
  5. Optic atrophy
  6. Pes cavus
  7. Cardiomyopathy
  8. Diabetes
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9
Q

Signs of HSMN/CMT (7)

A
  1. optic atrophy
  2. argyll Robertson pupil
  3. distal muscle atrophy due to peripheral nerve degeneration, not usually extending above elbow, or above middle 1/3 of thigh
  4. Thickened nerves
  5. Absent reflexes
  6. No sensory loss/slight
  7. Pes cavus
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10
Q

Causes of pes cavus (4)

A
  1. Friedreich’s ataxia or other spinocerebellar degeneration
  2. Hereditary motor and sensory neuropathy
  3. Neuropathies in childhood
  4. Idiopathic
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11
Q

Myotonic dystrophy - exam findings (9)

A 
Frontal baldness 
Ptosis
No diplopia
Cataracts
Facial weakness (wasted temporalis, masseters, SCM)
Dysphagia
Myotonia (handshake)
Reflexes reduced
Distal muscle weakness

Also check heart (Aortic regurgitation), lungs (aspiration pneumonia), urine (diabetes), gynecomastia and testicular atrophy

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12
Q

3 causes of myotonia

A
  1. Dystrophia myotonica
  2. Myotonia congenita
  3. Paramyotonia congenita
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13
Q

Clinical features suggestive of multiple sclerosis

A
  1. Internuclear ophthalmoplegia
  2. Optic neuritis
  3. RAPD
  4. UMN weakness
  5. Cerebellum signs
  6. Posterior Column sensory loss
  7. Fecal or urinary incontinence
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14
Q

Wasting of small muscles of the hands

A
  1. Nerve lesions - ulnar, median nerve, brachial plexus, peripheral motor neuropathy, hereditary and sensory motor neuropathy
  2. Anterior horn cell disease - MND, polio, spinal muscular atrophy
  3. Myopathy - dystrophia myotonica
  4. Spinal cord lesions - syringomyelia, cervical spondylosis
  5. Trophic disorders - arthropathies and disuse, ischemia
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15
Q

Cerebellar signs - what else do you want to look for ?

A
  1. CN 5,7,8 (CP angle tumour)
  2. CN 5,9,10, horners, contra lateral sensory loss (Lat medullary sx)
  3. Midline cerebellar lesion
    - midline tumour, paraneoplastic syndrome
  4. Bilateral disease
    - MS, friedreich’s ataxia, hypothyroidism
  5. Spares arms
    - alcoholic cerebellar degeneration
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16
Q

Peripheral neuropathy (sensory or motor) - differential diagnoses

A
  1. Drugs (isoniazid, vincristine, phenytoin, cisplatin, heavy metal, amiodarone)
  2. Alcohol abuse
  3. Metabolic (diabetes, CKD)
  4. Immune mediated -GBS
  5. Malignancy (lung ca, leukaemia, lymphoma)
  6. Vitamin deficiency eg B12, or excess B6
  7. Connective tissue disease or vasculitis (eg PAN, SLE)
  8. Hereditary (hereditary motor and sensory neuropathy)
  9. Other (anyloidosis, HIV)
  10. Idiopathic
17
Q

Causes of fasciculation (5)

A
  1. Benign idiopathic fasciculation
  2. MND
  3. Motor root compression
  4. Malignant neuropathy
  5. Any motor neuropathy (less commonly)
18
Q

Paraplegic patient with sensory level - ddx

A
  1. MS
  2. Cord compression
  3. Transverse myelitis (check cerebellar signs)
  4. Intrinsic cord lesion
  5. Anterior spinal artery occlusion
19
Q

Paraplegic patient + CN signs

20
Q

Paraplegic pt + peripheral neuropathy - Ddx

A
  1. Vit b12 deficiency
  2. Friedreich’s ataxia
  3. Carcinoma
  4. Hereditary spastic paraplegia
  5. Syphillis
21
Q

Paraplegic patient + arm signs - Ddx

A
  1. Cervical spondylosis
  2. Syringomyelia
  3. MND
  4. MS
22
Q

7 causes of chronic Mononeuritis multiplex

A
  1. Multiple compressive neuropathies
  2. Sarcoidosis
  3. Acromegaly
  4. HIV
  5. Leprosy
  6. Lyme disease
  7. Others - carcinoma rare
23
Q

Dorsal column loss only

A
  1. Subacute combined degeneration
  2. Brown sequard sx (ipsilat leg)
  3. Spinocerebellar degeneration (eg friedreich’s ataxia)
  4. MS
  5. Tabes dorsalis
  6. Sensory neuropathy or ganglionopathy (eg carcinoma)
  7. Peripheral neuropathy from diabetes or hypothyroidism
24
Q

Spinothalamic (pain+temperature) loss only

A
  1. Syringomyelia (cape distribution)
  2. Brown-sequard sx (contrast leg)
  3. Anterior spinal artery stenosis
  4. Lateral medullary sx
  5. Peripheral neuropathy (eg diabetes, amyloid, fabry’s disease)
25
Q

Syringomyelia triad

A
  1. Pain and temperature loss in neck, shoulder and arms (cape distribution)
  2. Amyotrophy in arms (weakness, atrophy, areflexia)
  3. UMN signs in lower limbs
26
Q

Motor neuron disease

A
  1. Amyotrophic lateral sclerosis (50%)
    - flaccid arms, spastic legs
  2. Bulbar (25%) - bulbar/pseudobulbar
  3. Progressive muscular atrophy (25%)
    - LMN signs. a lesion in the anterior horn cell affecting distal muscles; retention of deep tendon reflexes in the presence of severe muscular atrophy
  4. Primary lateral sclerosis (rare)
    - signs progress from upper to lower motor neuron type
27
Q

Multifocal motor neuropathy

A

Fasciculation
Lower motor neuron signs
More in upper limbs

28
Q

4 causes of foot drop

A
  1. Common peroneal nerve palsy
    - also weak eversion
    - sensory loss over lateral aspect of leg and dorsum of foot
  2. L5 lesion
    - weak inversion and eversion
  3. Charcot Marie tooth
  4. Motor neurone disease
29
Q

6 UMN signs+ cerebellar signs

A
  1. MS
  2. Spinocerebellar degeneration
  3. Arnold chiari malformation or meningioma at craniospinal junction
  4. Syringomyelia
  5. Infarction (upper pons or bilateral internal capsule)
  6. Syphyllitic meningomyelitis
30
Q

Small muscle wasting + increased reflexes

A
  1. Cervical myelopathy
  2. Cervical cord lesion
  3. MND
31
Q

Small muscle wasting + reduced reflexes

A
  1. Syringomyelia
  2. Brachial plexus trauma
  3. CHarcot Marie tooth
  4. GBS
32
Q

Causes of a spastic gait

A
  1. MS
  2. Cervical spondylotic myelopathy
  3. Spinal trauma
  4. Spinal tumour
  5. Vascular causes - eg spinal cord ischemia
  6. MND
  7. Thoracic cord meningioma
  8. Hereditary spastic paraplegia
  9. Syringomyelia
33
Q

Extensor/up going plantars + absent knee and ankle jerks

A
  1. Subacute combined degeneration of the cord (b12 deficiency)
  2. Conus medullaris lesion
  3. Combination of UMN lesion with cauda equine compression or peripheral neuropathy (eg stroke in a diabetic)
  4. Syphillis (taboparesis)
  5. Friedreich’s ataxia
  6. MND
34
Q

3 acute causes of Mononeuritis multiplex

A
  1. PAN
  2. DM
  3. Connective tissue disease (RA, SLE)

Neuro - Syndromes (2 decks)

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