Medicine/Neuro Flashcards
Cerebellar signs
- (Truncal ataxia)
- Broad based ataxic gait
- Rhomberg positive
- Nystagmus
- (Saccades)
- Past pointing
- Dysphonia/Sticato (british constitution)
- Dysdiadochokinesia
- Rebound phenonemon
- (Pronator drift)
- Hyperreflexia
- Hypotonia
- Heel to shin coordination impairement
Brief causes of cerebellar disease
- MS
- Alcohol
- Vascular
- Inherited
- Space occupying lesion
(MAVIS)
Summary of TACI, PACI, Lacunar, POCI (Full NCs under Medicine/Stroke)
- TACI
- Hemiplegia
- Homonymous hemianopia
- Higher corticol dysfunction
- PACI
- 2 of 3
- Lacunar
- Hemi-motor or hemi-sensory deficit only
* POCI - Visual fields affected
Define: hemiparesthesia, Hemiparesis and hemiplegia
Hemiparesthesia - altered sensation on one half of the body
Hemiparesis - weakness on one half of the body
Hemiplegia - paralysis of one half of the body
Explaining MS to a patient
- Multiple sclerosis (MS) is a condition that can affect the brain and/or spinal cord, causing a wide range of potential symptoms, including problems with vision, arm or leg movement, sensation or balance.
- Autoimmune condition where the body attacks the coating of nerves
- It’s a lifelong condition that can sometimes cause serious disability, although it can occasionally be mild.
- In many cases, it’s possible to treat symptoms. Average life expectancy is slightly reduced for people with MS.
Risk factors for MS
- 20-30 years old
- Female
- FHx
- Infections such as EBV
- Caucasian
- Autoimmune PMHx e.g. hypothyroid, DM I etc.
Common presentations of MS
- double or blurred vision
- numbness, weakness in one or two extremities
- instability in walking
- tremor
- problems with bladder control
- heat intolerance
Types and brief definition
- Relapsing remitting
- 80% of cases
- Episodes/attacks of MS lasting days or weeks that may fully recover or leave patient with permanent problems
- May turn into 2ary progressive
- Primary progressive
- 10% of cases
- Slow progression of sx without remission, though may have ‘stable’ phases
- 2ary progressive
- Half of people with relapsing and remiting will develop this
- Starts as relapsing and remiting then turns into a progressive picture
Investigations of suspected MS
- Refer to neuro
- 2 attacks - soft
- Full neuro exam
- MRI
- Evoked potential test (EEG with eye test)
- Lumber puncture looking for auto-immune antibodies
- Bloods - to rule out other things
Differentials of MS
- Stroke
- Toxins
- B-12 deficiency
- Space occuping lesion
- Other inflammatory disorders like lupus
- HIV
- Vasculitis
Treatment of MS
- LEMONS (lifestyle, education, monitor for complications, nutrition)
- Treat relapses
- Steriods (pred) reduce length
- Baclofen for mm spasms
- Prevent relapses
- Disease modifying drugs e.g. interferon beta, alemtuzumab
- Treat symptoms
- MDT
Circle of willis
Bells palsy features, causes, treatment
Bell’s Palsy (LMN) - temporary palsy of facial nn
Features - same side as lesion
- Unilateral facial weakness incl forehead
- Bell’s sign (eye rolls upward when trying to close eyelids)
Causes
- Herpes (Ramsay-hunt syndrome vesicles in ear)
- HIV
- Sarciod
- EBV
- Lymes disease
Treatment
- Eye protection - drops, patch
- Prednisone
Other LMN CN7 palsy causes and associated features
Acoustic neuroma - CN5,6+8 involvement
Parotid tumour/ectomy - parotid lump/scar
Cholesteatoma - CN8 involvement
All features will be same side as lesion
UMN CN7 palsy features, causes and associated sx
Features
- Forhead sparing
- Opposite side to lesion
Causes
- Stroke - hemianopia, hemiparasis/stesia, high cortical dysfunction
- MS - multiple neuro foci e.g. vision problems, sensory and motor issues, bladder problems
Horners syndrome causes, sx, investigation
Horners syndrome - Damage to sympathetic chain that supplies face
Causes
- Tumours (thyroid, brain, pancoast)
- MS
- Trauma e.g. thyriodectomy
- Cervical rib
- Migraine
- Carotid aneursym/dissection
- Otitis media
Features - all on same side as lesion
- Ptosis
- Anhydrosis (no sweating)
- Miosis (contracted pupil)
Diagnosis
- No reaction to cocaine eye drops, normally dilates
Investigation
- Identify cause
- MRI - Ca
- Carotid USS - carotid pathology
- CXR - pancoast
Motor neurone disease: presenting sx/ RF
MN disease - degeneration of motor neurones
Presenting sx
- Limb weakness
- Slurred speech
- Weak grip
- MM cramps and fasiculations
- Wgt loss
- Laughing and crying at inappropriate times
- FHx
- Age <70
Parkinsons: Triad
Parkinsons - Death of dopinergic nerves in basal ganglia
Triad (assymetrical)
- Bradykinesia
- Resting tremor
- Cog wheel rigidity
PD B symptoms
ASSYMETRICAL
- Shuffling gait, limited arm swing, hesitation when starting and turning
- Expressionless face
- Slurred/slow/monotonous speech
- Positive glabellar tap
- Anosmia
- Balance problems
- Urinary/sexual dysfunction
- Visual problems
- Swallowing issues
- Insomnia
- Micrographia
PD investigations and treatment
Investigations
- Full neuro exam
- Refer to specialist
Treatment
- MDT
- LEMON
- L-Dopa
PD plus syndromes and associated features
- Multi-system-atrophy - Low BP/postural hypotension
- Progressive supranuclear palsy (PSP) - Palsy of eye movement
- Corticobasal degeneration - apraxia, acalculia, myoclonus
- Lewy body dementia - dementia
Peripheral neuropathy definition and examples
Peripheral neuropathy - damage to nns of peripheral nervous system
Examples
- Foot drop - common peroneal nn
- Diabetic - polyneuropathy
- Carpal tunnel syndrome - median nn
- Bell’s palsy - CN7
Myopathy definition and examples
Myopathy - disease in which mm fibres don’t work properly
Examples
- dermatomyositis - autoimmune condition that attacks skin and mm
- polymyositis - inflammation of mm
- myositis ossificans - mm turns into bone when injured
Spinal cord stenosis: signs and sx, investigation, causes, treatment
Spinal cord stenosis - narrowing of spinal canal leading to pressure on spinal cord and nn roots. Can lead to cauda equina
Symptoms
- Posterior back and leg (both) pain can also be: numbess, weakness, stiffness or parasthesia (pins and needles)
- Variable exercise tolerance day to day
- Sx relieved by bending forward or sitting down (shopping trolley)
Signs
- Men
- Lumbar
- Variable hyporeflexia
- Normal strength and sensation
Investigation
- CT
Causes
- OA
- Disc degeneration
- Pagets disease
- Thick spinal ligaments
- Previous spinal trauma
Treatment
- Physio - exercise bike
- Surgery if bad - laminectomy
- Analgesia
Cauda equina: signs and symptoms, causes, investigation, treatment
Cauda equina - compression of cauda equina L2 down
Signs
- Leg weakness
- Reduced anal tone and sensation
- Urine retention check with catheter
Symptoms
- Saddly anaesthesia
- Severe lower back pain
- Urinary and bowel problems - retention/incontinence of either
- Leg pain/weakness/parasthesia bilateral
Causes
- Central disc herniation
- Spondylosis
- Spinal stenosis
- Tumour
- Trauma
- Infection
Investigation
- Emergency MRI of lumbar spine
Treatment
- Admit
- Decompress - surgery
- Analgesia
Disc herniation - signs and symptoms, causes, investigation, treatment
Disc herniation - interverterbral disc prolapse leading to pressure on nerve roots
Signs
- Decreased power, sensation, reflexes
Symptoms
- Lumbar
- Severe back pain, made worse by moving, bending forward, coughing, sitting, lateral flexion
- Radiculopathy
- Parastesia
- Weakness
- Leg pain
- Back mm spasm
Causes
- Age/degeneration
- Lifting excess wgt
- Excessive excerise
- Obesity
Investigation
- Spurlings, femoral nn stretch, straight leg raise
- PNS
Treatment
- Analgesia
- Mm relaxants
- TCA
- Gabapentin
- Rest
Cervical myelopathy: signs, symptoms, causes, investigation, treatment
Cervical myelopathy - compression of cervical spinal cord
Signs
- Weakness and wasting of hand mm
- Hypereflexia
- Clonus/Hofmans/Babinskis
- Normal sensation
Symptoms
- Progressive
- Weakness
- Arm, neck and leg pain
- Problems with fine motor
Causes
- Cord compression (tumour, disc herniation etc.)
- Ischaemia from vascular compression
- Osteophytes
Investigation
- C-spine x-ray - osteophytes
- MRI - canal stenosis, cord anomalies
Treatment
- Depends on cause
- Conservative: physio
- Surgery for pain and progressive sx
Radiculopathy: signs, symptoms, causes, investigations, treatment
Sciatica
Signs
- Leg pain
- Radiates below ankle
- Positive SLR
Symptoms
- sharp + shooting (worse w/ cough/sneeze)
- altered sensation
- reduced power corresponding myotone
- absent/reduced reflexes
- later muscle wasting/fasiculations
Causes
- Prolapsed Intervertebral disc
- Spinal stenosis
- Cauda equina syndrome
- Facet arthrosis
Investigations
- Differentiate referred pain from nerve root pain
- Referred pain
- Dull Poorly localised
- may affect both legs
- nerve root pain
- sharp well localised
- closely follows dermatone
- paraesthesia may be present
- positive SLR
- Referred pain
Treatments
- Physiotherapy and education
- Nerve root block
- Epidural steroid injection
- Foraminal steroid injection
- Surgical decompression
What is the difference between myelopathy and radiculopathy
Myelopathy - compression of spinal cord
Radiculopathy - compression of nerve root
Define: Osteophytes, spondylosis, spondylolysis and spondylolisthesis
osteophytes - bony projection associated with the degeneration of cartilage at joints
spondylosis - umbrella term for spine degeneration
spondylolysis - stress fracture in pars interarticularis (pointy bit of vertebrae)
spondylolisthesis - Slippage of vertebrae from stress facture above
what is the difference between bulbar and pseudobulbar palsy
bulbar palsy is a lower motor neuron lesion of cranial nerves 9, 10 and 12. Apseudobulbar palsy is an upper motor neuron lesion of cranial nerves 9, 10 and 12
