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P2 NEURO > Nerve Lesions > Flashcards

Nerve Lesions Flashcards

1
Q

What info does the dorsal-column medial lemniscus (DCML) tract convey?

A

Proprioception, vibration and 2 point touch discrimination

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2
Q

Where does the DCML decussate?

A

Medulla

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3
Q

What info does the spinothalamic tract convey?

A 
Pain and temperature (lateral)
Crude touch (anterior)
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4
Q

Where does the spinothalamic tract decussate?

A

At level of entry of spinal cord/ 2 levels above

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5
Q

What info does the spinocerebellar tract convey?

A

Balance and coordination

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6
Q

Where does the spinocerebellar tract decussate?

A

Dorsal don’t, ventral double cross

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7
Q

Name the ascending spinal tracts (3)

A

DCML
Spinothalamic tract
Spinocerebellar tract

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8
Q

Name the descending spinal tracts (3)

A

Corticospinal tract
Rubrospinal tract
Tectospinal tract

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9
Q

What does the corticospinal tract do?

A

Majority of motor functions

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10
Q

Where does the corticospinal tract decussate?

A

Lateral at medulla

Anterior at level of exit on spinal cord

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11
Q

What does the rubrospinal tract do?

A

Rudimentary motor function

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12
Q

Where does the rubrospinal tract decussate?

A

Midbrain

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13
Q

What does the tectospinal tract do?

A

Reflex head/ eye responses

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14
Q

Where does the tectospinal tract decussate?

A

Midbrain

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15
Q

What is myelopathy?

A

Compression of the spinal cord

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16
Q

What is radiculopathy?

A

Compression of the nerve root ‘pinched nerve’

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17
Q

What are the symptoms of myelopathy? (4)

A

Progressive (increasingly weak, clumsy hands)
UMN leg signs
LMN arm signs
Incontinence, hesitancy + urgency are late features

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18
Q

What are the symptoms of radiculopathy? (4)

A

Pain/ electrical sensations in arms/fingers at level of compression
Numbness
LMN weakness
Eventual wasting of muscles innervated by affected root

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19
Q

What are the investigations for myelopathy and radiculopathy?

A

MRI urgent

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20
Q

What is the treatment for myelopathy & radiculopathy?

A

Surgical decompression and dexamethasone

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21
Q

What contralateral sign is present in Brown-Sequard syndrome?

A

Loss of pain and temperature sensation below lesion

22
Q

What ipsilateral signs are present in Brown-Sequard syndrome? (2)

A

Weakness

Loss of proprioception and vibration sense

23
Q

What sign is present at the level of the lesion in Brown-Sequard syndrome? (2)

A

Flaccid paralysis

Loss of all sensation

24
Q

What are the causes of peripheral neuropathy? (5)

A 
DAVID
Diabetes
Alcohol
Vitamin deficiency (B12)
Infective (GB)
Drugs (isoniazid)
25
Q

What are some of the risk factors for carpal tunnel syndrome? (4)

A

Pregnancy
Obesity
Hypothyroidism
Rheumatoid Arthritis

26
Q

What are the symptoms of carpal tunnel syndrome? (3)

A

Pain + paresthesia in hand = wake and shake
Loss of sensation in palm, medial 3 1/2 fingers
Wasting of thenar eminence

27
Q

What muscle in particular shows wasting in carpal tunnel syndrome?

A

Abductor pollicis brevis

28
Q

In carpal tunnel syndrome, when are the pain and paresthesia worse?

A

Worse at night

29
Q

How do you investigate for carpal tunnel syndrome? (2)

A

Phalen’s (flexing) test

Tinel’s (tapping) test

30
Q

How do you treat carpal tunnel syndrome? (3)

A

Conservative: pain relief, splint at night
Hydrocortisone injection
Surgical decompression/ cut open flexor retinaculum

31
Q

What are the nerve roots for the sciatic nerve?

A

L4 - S1

32
Q

What are the causes of sciatica? (4)

A

Pelvic tumours
Fracture to pelvis/ femur
Disc prolapse
Osteoarthritis

33
Q

What are the symptoms of sciatica? (3)

A
  • Sensory loss or pain in back of thigh/ leg
  • Foot drop
  • Loss of sensation below the knee laterally
34
Q

How would you investigate sciatica?

A

MRI urgent

35
Q

How would you treat sciatica?

A

Conservative

36
Q

What is the cauda equina?

A

Bundle of spinal nerves from the level of L1/2

37
Q

What are the symptoms of cauda equina syndrome? (6)

A
  • Lumbosacral pain
  • Saddle anaesthesia
  • Areflexia
  • Fasciculations
  • Loss of bowel/ bladder control
  • Urinary retention
38
Q

How would you investigate cauda equina syndrome? (2)

A

MRI spine

PR (rectal exam)

39
Q

How would you treat cauda equina syndrome? (2)

A

Surgical decompression

High dose dexamethasone

40
Q

What are the red flags to look out for in cauda equina syndrome? (6)

A 
Bilateral sciatica
Bilateral flaccid leg weakness
Saddle anaesthesia
Bladder + bowel dysfunction
Erectile dysfunction
Areflexia
41
Q

What does damage to the right optic nerve cause?

A

Loss of vision in right eye

42
Q

What does damage to the optic chiasm cause?

A

Bitemporal hemianopia

43
Q

What does damage to the left optic tract cause

A

Right homonymous hemianopia

44
Q

What does damage to Meyer’s loop on the left (left optic radiation) cause?

A

Right homonymous superior quadrantanopia

45
Q

What does damage to Baum’s loop on the left (left optic radiation) cause?

A

Right homonymous inferior quadrantanopia

46
Q

What are the clinical features of an oculomotor nerve palsy? (3)

A
  • Tramp’s palsy (eye down + out)
  • Fixed dilated pupil, doesn’t react to light
  • Ptosis
47
Q

What nerve is affected in Bell’s palsy?

A

Facial nerve (CN 7)

48
Q

What are the clinical features of Bell’s palsy? (3)

A
  • Drooping of mouth corner
  • Inability to close eyelid
  • Smooth, wrinkle-free forehead
49
Q

How do you treat Bell’s palsy?

A

Steroid

50
Q

In CN 9/ 10 lesion, where does the uvula deviate?

A

Uvula deviates AWAY from lesion

51
Q

In CN 12 lesion, where does the tongue deviate?

A

Tongue deviated TOWARDS lesion

P2 NEURO (13 decks)

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