Neuro 1 Flashcards
Which conditions may damage any Cranial Nerve?
Diabetes
Multiple Sclerosis
Tumours
Sarcoidosis
Vasculitis
SLE
Syphilis
What could cause changes in a younger person’s sense of smell?
Frontal Lobe Tumour
Trauma, the Olfactory Nerve may be sheared as it sits in the Cribiform Plate
How does the presentation of a loss of visual acuity point to the possible cause?
Bilateral - Age-Related Macular Degeneration
Sudden - Infarct
Over a few hours - MS Inflammatory Attack (Painful)
If old - Ischaemia/Diabetes
What would be your Ddx in a patient presenting with a decrease in Optic Acuity?
Refractive Error
Ocular Media
Age related macular degeneration
Diabetic Retinopathy
Optic Neuropathy (MS/Ischaemia)
What is Conjunctivitis and how does it present?
Pink Eye
Chemosis (Eyelid Oedema)
Crust and Discharge
Foreign Body Sensation
Photophobia
How do you distinguish between the causes of Conjunctivitis?
Bacterial
- Thick Yellow/Pus Discharge
- Reduced Vision
- Urethritis/Vaginal Discharge ?STD
Viral
- Watery Clear Discharge
- Normal Vision
- Fever/Lymphadenopathy
Allergic
- Young Adults
- IGE Mediated
- Itching, Sneezing, Red, Watery Oedematous eye
- Typical Allergic cause and presentation
What are cataracts and how do they present?
Clouding of the lens and eye.
Visual impariment and glare.
‘Halos’ around lights.
painless
Reduced red reflex OE
What is glaucoma and how does it present?
Visual loss due to Optic Nerve damage.
Usually due to Raised Intraocular Pressure
Must be ruled out in a case of Acutely Red, Swollen Eye
How does Glaucoma-related visual loss progress?
Begins peripherally, then progresses more centrally.
What are the two main types of Glaucoma?
Open Angle
- Wide angle between the drainage canal and the iris - Good Drainage
- Trabecular Meshwork Dysfunction
- Bilateral, progressive, mild
Closed Angle
- Poor Drainage
- Trabecular Meshwork is fine, but the angle through which humour drains is smaller
- Unilateral, sudden, painful
What is Uveitis?
Inflammation of the Uvea (Made up of the Iris, Ciliary Body and Choroid)
Anterior involves the Iris and Ciliary Body
Posterior involves the Vitreous Body, Choroid and Retina
SBA - Can be associated with autoimmune disease
How would you differ between Anterior and Posterior Uveitis?
Anterior
- Autoimmune
- Painful, Pink Eye
- Increased Tear Production & Photophobia
Posterior
- Infective
- Painless
- Floaters and Scotomata
What are the main causes of Anterior Uveitis?
Seronegative Spondyloarthropathies
Rheumatoid Arthritis
Sarcoidosis
SLE
IBD
Behcet’s
What are the main causes of Posterior Uveitis?
CMV
EBC
HSC
VZV
Syphilis
TB
Lyme Disease
How could you classify the types of Visual Field Defects?
Prechiasmal
- One eye only
- Ipsilateral
Chiasmal
-Bitemporal Hemianopia
Post-Chiasmal
- Homonymous
- Contralateral
What are the main causes of Prechiasmal visual field defects?
Ischaemia (TIA)
Inflammation (MS, Giant Cell Arteritis)
What is Amaurosis Fugax?
Visual Field Defect seen in patients experincing a Prechiasmal TIA.
Described a being like ‘A veil coming down over one eye for a few minutes’
What are the main causes of Chiasmal Visual Field Defects?
Pituitary Tumour
Craniophyrangioma
How do Bitemporal Hemianopias develop when due to structures compressing the Optic Chiasm?
If originating superior to the Optic Chiasm, the visual field defect will begin as a Bitemporal Inferior Quadrantanopia
If originating inferior to the Optic Chiasm, the visual field defect will begin as a Bitemporal Superior Quadrantanopia
What are the main causes of Post-Chiasmal Visual Field Defects?
Tumours
Multiple Sclerosis
Strokes
In which lobes are the lesions when patients present with Hemitemporal Quadrantanopias?
Superior - Temporal
Inferior - Parietal
What is Neglect Syndrome?
Lesions in the Parietal Lobe lead to patients ignoring one side of their world.
Not Blindness, they can see things, but can’t register them.
Will eat food on one side of their plate
Shave one side of their face
Wash the right side of their body
What does the loss of the consensual pupillary light reflex indicate?
CN III Lesion
What does the loss of the direct pupillary light reflex indicate?
CN II Lesion
What is the triad associated with Horner’s Syndrome?
Ptosis
Miosis
Anhydrosis
What can cause Horner’s Syndrome?
Benign Causes, such as Migraine and Goitre
Neurological Causes, such as MS and Syringeomyelia
Life-Threatening Lesions, such as Tumours on the sympathetic pathway or Pancoast’s Tumour (Lung Apex)
Carotid Dissection
Which classic sign would you see upon Cranial Nerve examination of a patient with an Oculomotor Nerve Palsy?
Down and Out Pupil
Occurs due to unopposed action of the 4th and 6th Nerves.
Ptosis would also be seen
What is the difference between a Medical and Surgical 3rd Nerve Palsy?
Medical palsies occur due to medical causes often affecting the blood supply to the nerve. Down and out pupil occurs first.
Surgical palsies occur due to compressive lesions from outside. The parasympathetic chain is affected first, hence you see ptosis before a down and out pupil.
What are the causes of a Medical 3rd Nerve Palsy?
Diabetes
Vasculitis affecting ‘Vasa Nervosum’ - would see pupillary sparing
What are the causes of a Surgical 3rd Nerve Palsy?
Raised ICP
Aneurysm Rupture
What would you see in a patient with a Trochlear Palsy?
The eye looks Up and In
What causes Bell’s Palsy?
Idiopathic
Commonly due to viruses (Herpes Simplex Virus 1/Varicella Zoster)
Compression of Facial Nerve within the Facial Canal
Diabetes is a Risk Factor
How would you investigate a suspected case of Bell’s Palsy?
OE - Inability to:
- Wrinkle Brow
- Close Eye
- Puff Cheeks
- Smile
Viral Serology
How would you manage a patient with Bell’s Palsy?
Eyepatch - patient can’t close eyes so at risk of corneal abrasions
Prednisolone
What is Ramsay Hunt Syndrome?
LMN Facial Palsy due to Varicella Zoster
Shingles in the CNs
How does Ramsay Hunt Syndrome present?
Bell’s Palsy with more pronounced features
Pain
Vesicle formation in the Ipsilateral Ear, Hard Palate or Anterior 2/3 of the Tongue.
Typical over 60
What is the significance of forehead involvement in Bell’s Palsy?
Forehead Sparing is seen in UMN lesions, since CN 7 has double innervation from each hemisphere. Suspect a stroke.
If forehead shows signs, then it is due to a LMN condition (ie. inflammation due to a viral infection)
How is Weber’s Test used to localise Neurological deficits?
Sensioneural Hearing Loss in one ear will cause the vibration from Weber’s Test to be louder in the unaffected ear.
Conductive Hearing Loss causes the vibration to be louder in the affected ear.
What do the results of Rinne’s Test indicate?
Rinne’s Positive = Air Conduction > Bone Conduction - This is normal
Rinne’s Negative = Bone Conduction > Air Conduction - This is indicative of Conductive Hearing Loss
What can cause Conductive Hearing Loss?
External Auditory Canal
Otitis Externa, Foreign Body, Wax
Drum
Perforation (Trauma/Infection)
Middle Ear
Acute/ Serous Otitis Media
Oval Window
Otosclerosis
What can cause Sensorineural Hearing Loss?
Inflammation (Meningitis/Viral)
Tumour (Acoustic Neuroma)
Ototoxic Drugs (Aminoglycosides. eg. gentamycin, Aspirin, Loop Diuretics)
Trauma
Meniere’s Disease
What is Neurofibromatosis?
Hereditary condition causing tumours to form on Neuronal tissue.
Type 1 > Type 2
Increased risk of CNS cancer.
Describe Neurofibromatosis Type 1.
Autosomal Dominant
Peripheral and Spinal Neurofibromas - Affects whole body
Cafe au lait spots
Freckling
Optic Nerve Glioma
Learning Difficulties
Headaches
Describe Neurofibromatosis Type 2
Mainly affects the ears
Hearing Loss
Tinnitus
Balance Issues
Headache
Facial Pain/Numbness
What does a ‘Bovine Cough’ indicate?
Damage to CN IX and X
What is Bulbar Palsy?
A Lesion in the Medulla Oblongata causing LMN signs affecting CN X, XI and XII.
Presents with:
Absent gag reflex
Wasted, fasciculating tongue
Nasal Speech
Sign of MND
What is Pseudobulbar Palsy?
Lesion affecting the UMNs supplying the Bulbar LMNs. See UMN signs.
Spastic Tongue
Increased Jaw Jerk
Monotonous, slurred, high pitched speech
Labile Emotions
