Lists

Question 1

Signs of cerebello-pontine angle tumour

Answer 1

• Damage to CN 7 and 8
• -> hearing loss
• -> tinnitus
• -> facial nerve palsy
• cerebellar signs
• papilledema
• CN 5 can be involved as well

Question 2

Causes of sensorineural deafness (7)

Answer 2

• degeneration (eg presbycusis)
• vascular disease of the internal auditory meatus
• Trauma (high noise exposure, fracture of Petrous temporal bone)
• brainstem lesion
• infection (eg congenital rubella, syphillis)
• toxic (alcohol, aspirin, streptomycin)
• tumour (acoustic neuroma)

Question 3

Causes of conductive deafness (4)

Answer 3

• wax
• otitis media
• otosclerosis
• Paget’s disease of the bone

Question 4

Damage to dorsal pons –> what eye signs?

Answer 4

One and a half syndrome

Question 5

Damage to dorsal midbrain –> what signs?

Answer 5

Parinaud’s syndrome

• impaired vertical (up gaze affected first) gaze
• light-near dissociation (pupils react to accomm but not light)

Question 6

Jugular foramen lesion - what are the signs ?

Answer 6

Unilateral CN 9, 10, 11, 12 involvement.

• CN 9 not usually tested (afferent of gag reflex)
• CN 10 - check uvula deviation, speak (hoarseness), cough (bovine)
• CN 11 - SCM and trapezius
• CN 12 - tongue wasting and deviation
• Horner’s syndrome

Question 7

Bilateral UMN lesions of CN 9, 10, 12- causes (3)

Answer 7

Pseudo bulbar palsy

1. Motor neuron disease
2. MS
3. Bilateral CVA eg both internal capsules

Question 8

Bilateral LMN lesions of CN 9, 10, 12 - causes

Answer 8

Bulbar palsy

1. Motor neuron disease
2. GBS
3. Polio
4. Brainstem infarct

Question 9

Causes of complex ophthalmoplegia (4)

Answer 9

• NMJ disorder eg myasthenia gravis
• demyelination eg miller-fisher sx
• myopathy eg mitochondrial myopathy
• metabolic causes eg thyroid or Wernicke’s

Question 10

Causes of multiple cranial nerve palsies in general (5)

Answer 10

• GBS (demyelination)
• brainstem lesion eg vascular
• Arnold chiari malform
• trauma
• Paget’s disease
• Mononeuritis

Question 11

Lateral medullary syndrome signs (4)

Answer 11

1. Ipsilateral Horner’s
2. ipsilateral CN 5, 9, 10 palsy
   - -> facial sensory loss, palate and vocal cord weakness
3. contralat arm and leg sensory loss
4. ipsilateral cerebellar signs

Question 12

Lateral medullary syndrome - causes

Answer 12

Vascular event (PICA)
Trauma
SOL

Question 13

Medial medullary syndrome

Answer 13

1. Tongue deviation (ipsilateral CN 12 palsy) and wasting
2. Contralat arm and leg UMN weakness
3. Contralat arm and leg loss of dorsal column sensations (proprioception and joint position sense)

Question 14

Causes of unilateral ptosis (4)

Answer 14

1. Third nerve palsy (dilated pupils, unreactive to light/accom)
2. Horners syndrome (constricted pupils, reactive)
3. Myasthenia gravis
4. Congenital or idiopathic

Question 15

Causes of bilateral ptosis (8)

Answer 15

1. Myasthenia gravis
2. Myotonic dystrophy
3. Miller fisher (with ophthalmoplegia)
4. Mitochondrial dystrophy
5. Ocular myopathy
6. Bilateral horners (eg syringomyelia)
7. Congenital
8. Tabes dorsalis

Question 16

Causes of argyll Robertson pupils (7)

Answer 16

1. Brainstem encephalitis
2. Diabetes/other causes of autonomic neuropathy
3. Pinealoma
4. Neurosyphillis/tabes dorsalis
5. MS
6. Sarcoidosis
7. Syringobulbia

Question 17

Cerebellopontine angle tumour - differentials

Answer 17

Acoustic neuroma/vestibular schwannoma
Meningioma
Hemangioma
AVM

Question 18

Multiple sclerosis MRI findings

Answer 18

• Gadolinium enhanced T1 weighted scans - enhancing lesions=new active lesions, usually corresponds to areas of high signal on T2 scans
• black holes on T1 scans = thought to be due to axonal loss