Localisation

Question 1

What are the two important questions to ask in neurology?

Answer 1

Where is the localisation and what is causing it

Question 2

A patient has bilateral weakness. What origin can you exclude?

Answer 2

brain

Question 3

How to describe pattern of distribution?

Answer 3

Uni or bilateral
Proximal or distal
Sensory or motor

Question 4

What is the pattern of distribution of GBS?

Answer 4

distal and bilateral

Question 5

What is the pattern of distribution in myasthenia gravis?

Answer 5

bilateral and PROXIMAL e.g. pelvic and shoulder girdle

Question 6

How does myasthenia present and progress?

Answer 6

Starts in the eyes. Double vision, ptosis
Speech- dysphonic, dysarthria (slurred speech)
Swallowing- dysphagia
Facial muscles- droop
Neck muscles- droopy head
(MG rarely presents with limb weakness)

Question 7

Why is it important to localise the origin of lesion causing weakness when requesting an image

Answer 7

The larger the area of spinal cord you image, the lower resolution and therefore lower quality of image. If you can deduct that the lesion is likely to be lumbar or thoracic then request MRI Lumbar/sacral or MRI thoracic. If you think it could be L1/L2 then it is worthwhile requesting thoracic as well.

Question 8

If there is dysfunction in bladder and bowel, where is the problem?

Answer 8

spinal cord

Question 9

Patient with no sensation over patch of anterior thigh. Which nerve is likely to be impaired?

Answer 9

lateral cutaneous nerve= branch of lumbar plexus. Only provides sensory innervation

Question 10

A patient with common peroneal nerve injury will present with which symptoms?

Answer 10

controls dorsiflexion, therefore damage causes foot drop. Derived from sciatic nerve and bifurcates into superficial and deep peroneal nerve

Question 11

Symptoms of patient with sciatica lesion?

Answer 11

Nerve roots L4-S3
Innervates the muscles of the posterior thigh (biceps femoris, semimembranosus and semitendinosus) and the hamstring portion of the adductor magnus (remaining portion of which is supplied by the obturator nerve). NO cutaneous function. Sciatica means that there is irritation or a problem with the sciatic nerve that usually emanates from the low back, from the nerve roots in the spine. In most cases of sciatica, the pain extends down past the knee,

Question 12

Which conditions present with glove and stocking syndrome?

Answer 12

Focal sensory loss (in the absence of CNS pathology) suggests a peripheral neurological problem. A glove and stocking pattern of sensory loss suggests an axonal polyneuropathy. Nerve root lesions cause sensory loss in a dermatomal pattern. Numbness in a single nerve territory suggests trauma or entrapment neuropathy. Multiple areas of numbness in non-contiguous areas point to mononeuritis multiplex. Loss of reflexes occur with neuropathic lesions either affecting sensory or motor fibres.

Question 13

Where is the limit of glove and stocking pattern distribution?

Answer 13

mid thigh and above the elbow (think of long gloves and long stockings)

Question 14

Below which spinal nerve would you expect to not have involvement of the arms?

Answer 14

T3 and below (Arms T1-T2)

Question 15

If patient has tingling/painful band around chest, where is the lesion?

Answer 15

T5

Question 16

Patient has a brainstem lesion. What symptoms will patient have potentially?

Answer 16

Any symptoms associated with CN III-XII due to origin of cranial nerves

Question 17

Does the cauda equina contain central or peripheral nerves?

Answer 17

peripheral, termination of spinal cord at L1/L2

Question 18

Patient with bilateral leg weakness and UMN signs, which section of the spinal cord would you like to request?

Answer 18

thoracic (lesion could be L1/L2 but would include bladder and bowel symptoms).

Question 19

Patient with weakness in arms and legs bilaterally and confusion. Where is the lesion?

Answer 19

Could be two lesions! Bilateral weakness due to spinal cord lesion and confusion due to brain lesion.

Question 20

Patient with right arm and leg weakness, with left face weakness. Where is the lesion?

Answer 20

Brainstem (if face involvement then must be brainstem)

Question 21

Does the anterior horn comprise motor and sensory innervation?

Answer 21

pure motor- motor neurone disease

Question 22

Neuro presenting complaint is immediate in onset. What could be the cause?

Answer 22

vascular or trauma

Question 23

Neuro presenting complaint has occurred over hours/days. What could be the cause?

Answer 23

infection or inflammation

Question 24

Neuro presenting complaint has arisen over months. What could be the cause?

Answer 24

Space occupying lesion

Question 25

Neuro presenting complaint has arisen over years. What is the category of cause?

Answer 25

degenerative disease

Question 26

What questions should you ask in the presenting complaint of neuro patient

Answer 26

Speed of onset Exacerbating/improving factors Continuous/intermittent (does it improve on its own)

Question 27

Which aspects of social history should you ask about in neuro patient?

Answer 27

``` nutritional deficiencies job/activities- pesticides, contact sports Urban/rural- Lyme's disease STI Smoking Rec drugs Rx drugs Travel ```

Question 28

What is the best way to assess for spasticity in upper limb?

Answer 28

spastic catch

Question 29

What is the best way to assess for rigidity?

Answer 29

wrist movement

Question 30

Which dermatome supplies the area of the nipple

Answer 30

T4

Question 31

Which dermatome supplies the level of the umbilicus

Answer 31

T10

Question 32

Name two diseases that affect anterior horn cells

Answer 32

motor neuron disease | polio

Question 33

Which conditions/factors affect peripheral nerves?

Answer 33

diabetes alcohol GBS vasculitis

Question 34

Define ataxia

Answer 34

inability to coordinate voluntary muscular movements- coordination, balance, speech

Question 35

Which spinal nerve innervates biceps?

Answer 35

C5/C6

Question 36

Supinator?

Answer 36

C6

Question 37

Triceps?

Answer 37

C7

Question 38

Knee?

Answer 38

L2/L3

Question 39

Ankle?

Answer 39

S1/S2

Question 40

Where does the corticospinal tract decussate?

Answer 40

medulla

Question 41

How to illicit fasciculations?

Answer 41

flick muscle belly

Question 42

Lesion to internal capsule will result in what clinical picture?

Answer 42

hemiplegia- face/arm/leg

Question 43

Lesion in the thalamus will result in what clinical picture?

Answer 43

hemi-sensory disturbance

Question 44

Why is bulbar named as such?

Answer 44

medulla translates to bulb. Therefore the cranial nerve nuclei that are located there are described as such

Question 45

If you see crossed signs in face and limbs, where is the lesion?

Answer 45

brainstem!!

Question 46

Lesion to midbrain can lead to which symptoms?

Answer 46

oculomotor disorder- double vision

Question 47

Lesion to pons can causes which symptoms?

Answer 47

facial weakness, sensory disturbance, vertigo, deafness

Question 48

Lesion to medulla can lead to which symptoms?

Answer 48

dysphagia, dysarthria, dysphonia, weakness/wasting of tongue

Question 49

Spinal cord traumatic injury to C4. What clinical signs will you see?

Answer 49

spastic tetraparesis UMN signs Loss of sensation below suprasternal notch Breathing affected (C3,C4,C5 keeps diaphragm alive)

Question 50

RTA complete transection of T5. What clinical signs will you observe

Answer 50

Spastic paraparesis UMN Sensory loss below costal margin and nipples Breathing not affects

Question 51

How to ask about bowel and urinary symptoms if you are worried about cauda equina

Answer 51

can you feel your bottom when you wipe your bum | can you feel urine passing through and can you sense when you are finished?

Question 52

What does a positive Romberg sign indicate?

Answer 52

sensory ataxia | loss of vibration and proprioception- dorsal column issue

Question 53

Name two pathologies which selectively affect posterior columns

Answer 53

vit B12 deficiency Vit E deficiency Friedreich's ataxia

Question 54

Is motor neuron disease more common in men or women?

Answer 54

men

Question 55

What is the clinical presentation of motor neuron disease?

Answer 55

asymmetrical limb weakness | bulbar symptoms

Question 56

What is a serious complication of motor neurone disease

Answer 56

bulbar/respiratory dysfunction

Question 57

Does motor neuron disease involve sensory symptoms?

Answer 57

no it is pure motor