Miscellaneous Flashcards
When asking about amaurusis fugax, how would you ask about it in simple terms to a patient?
Was there ever a point in time where you felt like there were curtains over your eyes, covering part or all of your vision?
What is Hauffman sign?
What is it testing for?
It is a neurological test used to assess for UMN lesions (hyperreflexia), particularly those affecting the cervical spinal cord.
The examiner should hold the patient’s middle finger and flick the nail downwards. A positive sign will be if there is involuntary flexion of the thumb/index finger.
This indicates hyperreflexia
If you see a patient with history of MS or Subacute degeneration of the spinal cord (B12 deficiency) or cervical spondylosis/spinal cord compression. What clinical test can you conduct for all of them?
What does it test for?
LHermitte’s sign looking for evidence of demyelination (common with all of them)
Flexion of the neck causes an electric shock sensation down the spine and possibly into the limbs.
If I tell you someone cannot feel their T7 dermatome, what is this patient’s sensory level?
Sensory level T6
Point is that it is the first dermatome that they can sense
Give a few differentials for the following case:
44 year old man presenting with a 1 week history of progressive pins and needles in their lower limbs. No cranial nerve abnormality. On examination, you also note hyperreflexia
Does Guillian Barre fit as a ddx?
No cranial nerve abnormality => not likely to be affecting the brainstem.
Brisk reflexes indicate that it is an UMN lesion
It is a progressive neurological deficit
=> B12 deficiency, MS, SOL (tumour), Transverse myelitis, neuromyelitis Optica (NMO), Guillian Barre syndrome (lower on the differentials as it typically has absent reflexes + history of recent infection)
NMO or neuromyelitis optica is a disease often mistaken for MS. What are the key features of NMO?
What is the main difference between NMO and MS?
What are the 2 main antibodies used in the diagnosis of NMO?
How is it treated?
Optic neuritis (infl of optic nerve causing vision loss or opthalmoplegia)
Transverse myelitis (infl. of the spinal cord => weakness, sensory loss, bladder/bowel incontinence)
The difference is the pattern of attack. NMO is more specific and severe in the optic nerve and spinal cord whereas MS has a wider range of effect (note it also has a relapsing remitting course)
Diagnosis: Anti-aquaporin4 (AQP4-IgG) and Anti-MOG (obv. these are not present in MS).
Note: It also wont respond to Ms therapies. Instead, immunosuppressive therapies are used
Why is the optic nerve typically targetted in demyelinating diseases such as NMO and MS?
what cell myelinates the optic nerve
Because it is the most (relatively) myelinated nerve in the body.
As it is a nerve in the CNS, oligodendrocytes myelinate it and not Schwann cells
