Meeran Neuro exam Flashcards
Meningitis
didnt listen
SAH
Severe headache-thunderclap in
CT head,
LP
Extradural heamorrhage
Lens shaped on CT after trauma
Lucid interval-LOC-> wake up, feel fine for a few H -> die later
its not that common
but if concussed- need to stay in 24h
Usually Middle meningeal A hit
need burrhole
Subdural Heamorgahe
Banana shaped on CT, after MINOR trauma (or not)
usually old/alcoholic-and as the brain is atrophied and its venous==its slow
and neurosurgeons leave it
care-can mimic dementia
or burrhole
acutely after trauma–no lucid interval
Horners
ptosis, meisosi, anhydrosis
darken room to see the dilation better
exam- examine eyes, cranial nerves
upper lung cancer
iatrogenic-exam guy has it from central line
commonest cause is SURGERY
UMN vs LMN
UMN-power down, tone, reflex up, plantars up, (pyramidal posture/pronator drift)
LMN-Power down, tone, reflex down, fasciculations, atrophy of muscle
need to be natural ->
always have 1 cause of each on head
UMN- stroke, MS
LMN- Radiculopathy,
Parkinsons exam
Bradykinesia, Rigidity-like lead pipe-all the way through-stiff (doesnt give), tremor,
cogwheel is tremor+stiffness
distraction makes tremor and ridigity worse
hypomimesis, low voice, mootonous voice
Parkisonian gait
Difficulties inintiating movements (akinesia)
ANS dysf, falls
Mx- Levodopa, dopamine agnonist
DAT Scan Ix
care of ANS (BP), loss of inhibition
Down and out eye
3rd nerve palsy
often with ptosis
3rd nerve palsy
common in paces
makes eye affected down and out
with ptosis
medical or surgical
big if surgical (bleeding/space occypying)- dilated pupils
normal if medical (eg diabetic)–(outside is damaged-ischemia eg-mononeuritis multiplex)
exam-
ASK PATIENT TO OPEN THE EYELID
Carpal tunnel syndrome
pain at night hurts -hands shake
Median nerve radiculopathy
1st 3 fingers neuropathy
Thenar wasting
tinnels
causes- RA, pregnancy, acromegaly, diabetes
check bloods
Cerebellar stroke/damage
common in paces
need to know DANISH very well as they are stable (also normal strokes are common)
dysdiadokinesia
Ataxia
nystagmus
Intention tremor
Scanning speech
Hypotonia
MRI of cerebellum
know causes
Most common neuro paces cases-
UMN –STROKES
both normal and basilar/cerebellar
brain tumours too
MS
LMN-
diabetes/peripheral neuropathy (alcohol/etc), bells palsy
carpal tunnel
Myasthenia gravis
think of ddx of those
these would be recovering
even if you know differential
always say “its a UMN/LMN”-dont just jump at the diagnosis
“it is typical of an UMN/LMN, i would like to do a scan, and my main differential is Stroke, but it could be a SOL”
and often questions after will be about other signs of UMN/LMN and other causes
MS
never ever LMN
sensory and UMN possible
optic neuritis- see RAPD (swing torch dilate)
and intranuclear ophthalmoplegia-adduction issue (cant look in)
and cerebellar issues if lesion-DANISH//nystagmus in eyes
