Neuro

Question 1

What are 4 main UMN signs?

Answer 1

Increased tone - spasticity, rigidity
Brisk reflexes
Upgoing plantar reflex (Babinski sign)
Reduced power in UMN pattern - upper limb extensors, lower limb flexors

Question 2

What are 4 main LMN signs?

Answer 2

Hypotonia, reduced tone
Reduced power
Wasting and fasciculations
Decreased reflexes

Question 3

What are definitions for power ratings 0-5?

Answer 3

5 - normal
4 - active movement against gravity and resistance
3 - active movement against gravity
2 - active movement with gravity eliminated
1 - flicker of contraction
0 - complete paralysis

Question 4

Diplegic gait?

Answer 4

Signs
* Bilateral problems
* Normal arm swing
* Stiffness both legs
* Flexion at hip, extension of knee and ankle
* Adductor overactivity with scissoring during walking
Ankles - equinovarus

Question 5

DDx - diplegic gait?

Answer 5

Brain
* Prematurity - periventricular leukomalacia
Spinal cord
* Congenital - spina bifida
* Tumour
* Inflammatory
* Traumatic
* Vascular
* Hereditary spastic diplegia

CP

Question 6

What are definitions for power ratings 0-5?

Answer 6

5 - normal
4 - active movement against gravity and resistance
3 - active movement against gravity
2 - active movement with gravity eliminated
1 - flicker of contraction
0 - complete paralysis

Question 7

Floppy baby - strong/central - features + DDx?

Answer 7

Strong floppy - Central
Features
* Decreased axial tone
* Increased peripheral tone
* Hyperreflexia or normal
* Clonus
* Fisting of hands
* Dysmorphic features
* Seizures
* Sleepy, decreased alertness
* Macro-microcephaly
* Global delay (vs isolated motor delay)

DDx
* HIE
* Infection
* Endocrine
* Genetic - PWS, T21, Fragile X
* Structural/cerebral malformations - lissencephaly
* Metabolic (Zellweger)
Neurocutaneous

Question 8

Floppy baby - peripheral cause - features + DDx?

Answer 8

• Weak
• Areflexic
• Tongue fasciculations
• Ptosis and eye movements
• Myopathic facies
• Alert
• Muscle atrophy
• Contractures, DDH, ortho
• FHx neuromuscular

DDx
* Anterior horn - SMA
* Peripheral Neuropathy - infantile neuropathies
* Neuromuscular junction - myaesthenia syndromes
* Muscle - congenital myopathy, congenital muscular dystrophies, congenital myotonic dystrophy, metabolic myopathy

Question 9

Key Cerebellar Signs?

Answer 9

• D - Dysmetria, dysdiadokinesia, dysarthria, dysphagia
• A - Ataxic gait, truncal ataxia (titubation)
• N - Nystagmus
• I - intention tremor
• S - Staccato speech,
• H - Hypotonia - upward pronator drift
  Pendular knee jerk

Question 10

Signs to differentiate cerebellar vs sensory Ataxia?

Answer 10

• Gait - broad base, staggering in cerebellar, high stepping unsteady in sensory
• Nystagmus - present in cerebellar, absent in sensory
• Dysarthria - scanning/staccato speech in cerebellar, absent in sensory
• Eye movements - normal/slow in cerebellar, sensory sometimes abnormal
• Romberg - classically neg in cerebellar, pos in sensory
• Vibration/proprioception - normal in cerebellar, impaired in sensory
• Finger nose/heel shin ataxia - present in cerebellar, present in sensory
  Reflexes - normal/pendular in cerebellar, absent/present in sensory

Question 11

DDx for cerebellar lesion?

Answer 11

Signs are ipsilateral
* Vascular - haemorrhage, stroke
* Infective - post viral cerebellitis
* Genetic - Fredriech ataxia, ataxia telangiectasia, spinocerebellar ataxia
* Nutritional - Vitamin E
* Toxicity - chemotherapy cytarabine, phenytoin, EtOH
* Tumour - medulloblastoma, metastati
* Metabolic - lysosomal storage disorder
* Demyelinating - GBS, ADEM
Endocrine - Wilson’s

Question 12

DDx for sensory Ataxia?

Answer 12

• Nutritional - B12 deficiency, B6 toxicity
• Peripheral sensory neuropathy - Hereditary sensory motor neuropathy
• Infection - GBS, HIV
• Toxic - chemotherapy - platin
  Autoimmune - Diabetes, Sjogrens

Question 13

CN VI Palsy?

Answer 13

• Lateral rectus palsy, can’t abduct eye, horizontal diplopia, esotropia primary gaze
• Congenital - congenital esotropia, Duane syndrome, Moebius syndrome
• Any cause of raised ICP
• Sub-arachnoid space lesions - haemorrhage, infection, inflammation
• Inflammatory- post viral, demyelinating
• Pontine glioma
  Otitis media

Question 14

CN III Palsy?

Answer 14

• Eye down and out, ptosis, fixed dilated pupil
• Space occupying lesion - suprasellar - craniopharyngioma, pituitary, midbrain
• Posterior communicating aneurysm
• Opthalmoplegic migraine
• Orbital lesion
  Cavernous sinus thrombosis

Question 15

CN IV Palsy?

Answer 15

• Superior oblique palsy, head tilt away from affected side, vertical diplopia
• Congenital
• Raised ICP
• Trauma
• Tumour - midbrain
• Aneurysm
• Demyelination - ADEM, MS
  Microvascular disease - Diabetes, HTN

Question 16

Microcephaly DDx?

Answer 16

Congenital
· Malformations - lissencephaly
· Chromosomal - trisomies
· Syndromes Angelman, Cri-du chat, FAS, fetal hydantoin
· Hereditary - AR/AD microcephaly, NF1, TS, Sturge Weber

Acquired
· Infection - TORCH, encephalitis, meningitis
· Trauma - perinatal asphyxia, head injury
· Endocrine - hypothyroidism, hypopituitarism
· Metabolic - maternal diabetes, PKU
· Drugs - fetal alcohol, fetal hydantoin syndrome (maternal AEDs)
· Malnutrition

Question 17

Microcephaly Ix?

Answer 17

· Path - TORCH screening, karyotype/microarray, newborn screening, TSH, metabolic
· Urine - CMV
· Imaging - skull X-ray.- calcifications, craniosynostosis, CT/MRI - cerebral malformations
CSF - TORCH

Question 18

Cerebellar DDx?

Answer 18

VITAMIN
* Vascular - haemorrhage, stroke
* Infective - post viral cerebellitis
* Toxicity - chemotherapy cytarabine, phenytoin, EtOH
* Tumour - medulloblastoma, metastatic
* Acquired - Genetic - Fredriech ataxia, ataxia telangiectasia, spinocerebellar ataxia
* Metabolic - lysosomal storage disorder
* Inflammatory - demyelinating - GBS, ADEM
Nutritional - Vitamin E

Question 19

Key Cerebellar Signs?

Answer 19

• D - Dysmetria, dysdiadokinesia, drift - upward pronator drift
• A - Ataxic gait, truncal ataxia (titubation)
• N - Nystagmus
• I - intention tremor
• S - Staccato speech, dysarthria
• H - Hypotonia
  R - reflexes pendular