LL Neuro

Question 1

What would you expect to see in a pt with sensory neuropathy?

Answer 1

blisters, ulcers, Charcot joints

Question 2

What is the point of heel-shin test?

Answer 2

cerebellar ataxia

Question 3

What could cause spastic bilateral leg weakness?

Answer 3

spastic paraparesis = bilateral UMN signs

• sagittal sinus lesion - parasagittal meningioma
• bilateral strokes
• syringomyelia (w/ upper limb signs)
• cord trauma
• cord compression - extradural tumor; disc prolapse; spondylosis
• intrinsic cord disease - tumor; vascular myelopathy; MS

Question 4

What could cause flaccid bilateral leg weakness?

Answer 4

flaccid paraparesis = bilateral LMN signs

• polio
• if mostly motor peripheral neuropathy,
  
  • Guillain-Barre syndrome; Lead poisoning
• if mixed peripheral neuropathy,
  
  • CMT
• if mixed UMN and LMN signs:
  
  • motor neurone disease; SCDC

Question 5

What could cause unilateral leg weakness?

Answer 5

UMN - stroke; tumor; MS

LMN - Root lesion; nerve lesion

Question 6

What could cause peripheral neuropathy?

Answer 6

mostly sensory
- DM
- Uraemia (renal failure)
most motor
- Guillain-Barre
- Lead poisoning
mixed
- CMT
- B12/folate deficiency (also causes SCDC)
- Thiamine deficiency
- alcohol
- vasculitis/SLE - also look for nailfold infarcts
- paraneoplastic
- amyloid

Question 7

SCDC has been mentioned a lot, what is SCDC due to? What symptoms would you expect to see in a pt?

Answer 7

SCDC - due to B12/folate deficiency
symptoms:
- spastic paraparesis
- upgoing plantars
- reduced knee jerks
- dorsal column loss - loss of vibration and proprioception w/ sensory ataxia (+ve Rombergs test)

Question 8

What does a positive Romberg’s test indicate? What do you suspect in a pt w/ +ve Romberg’s test?

Answer 8

Sensory ataxia

+ve Romberg’s test

1) dorsal column loss
- tabes dorsalis (syphilis)
- SCDC
- MS
2) sensory peripheral neuropathy