Neuro Flashcards
Cerebellar causes
VINDICATE:
Vascular: stroke
neoplastic: NB
degen: FA
Drug/siatrogenic: phenytoin
C..CP
AI: MS
Trauma
Endo: Wilsons, nutritional Vit E
signs of neuro chronicity
wasting
deformity
contractures
AFOs well worn
growth asymmetry
paresis vs plegia
paresis = weakness
plegia = can’t move
cognitive impairment phrase
= “behave younger than I expect”
pes cavus = what DDx
spinocerebellar lesion (friedrich’s)
peripheral nerve (CMT)
spinal lesion e.g. spina bifida
Exam signs of myotonic dystrophy
myotonic facies - droopy mouth, expressionless (squeeze eyes)
make fist and release
percussion myotonia
types of gait + where is the lesion?
- hemiplegic (swinging, one arm in) = unilateral spinal/brain
- diplegic (both legs swing, adducted) = spinal e.g. transverse myelitis / brain e.g. CP
- ataxic (broad based) = cerebellar (with bad turning) / vestibular / sensory
- myopathic i.e. high stepping gait = ankle DF weakness from L4, L5, S1 from common peroneal palsy / radiculopathy / polyneuropathy e.g. CMT
- myopathic i.e. Trendelenburg (waddling with circumduction) = DMD, BMD, myotonic dystrophy / systemic disease e.g. thyroid, dermatomyositis
- choreoform (writhing) = HD, CP, Wilsons
- antalgic
Diplegic gait
Brain - PVL causing CP!!
Spine - inflammatory e.g. transverse myelitis, congenital e.g. spina bifida, tumour, trauma
Hereditary spastic diplegia
Toe walking gait vs can’t toe walk suggests?
Toe walking = DISTAL strength
Can’t toe walk = PF (S1) weakness e.g. CMT
Toe walking = BMD/DMD, CP/spasticity
Can’t heel walk suggests?
DF weakness (L5) - CMT!!!, DMD, CP
horner’s sign and causes
= ptosis, miosis and anhidrosis
- post-cardiac surgery
- NB
- NF
- tumour
ptosis + large pupil vs small pupil
or just ptosis
ptosis + large pupil = CNIII palsy
ptosis + small pupil = Horner’s
ptosis e.g. MG, congenital ptosis, dystrophies
causes of unilat vs bilat SNHL
unilat e.g. acoustic neuroma, trauma
bilat
1. genetic e.g. connexin
2. syndromic e.g.
3. toxins/drugs e.g. gentamicin
4. infection e.g. rubella / CMV
5. meniere’s
DDx of nystagmus
- cerebellar
- vestibular
- congenital
- physiological
CNIII, IV, VI palsies
III = down and out with ptosis and large pupil
IV = up and in, head tilts away from side of lesion
VI = in
cortical blindness = ?
loss of vision but pupillary reflex (CNII) intact
cataracts DDx
Congenital:
CMV
Turner
T21
Acquired:
Steroid
Alport
DDx of ophthalmoplegia
UMN - demyelination, tumour, vascular
LMN - nerve e.g. GBS/Bell’s/ICP, NMJ, muscle
foot drop causes
- CMT
- common peroneal palsy
- L5/S1 nerve palsy
CMT vs FA
both ataxic, loss of proprioceoption and vibration, pes cavus
FA Romberg’s positive
hemiplegia DDx
VINDICATE
V: vascular
- vessels e.g. Moya Moya, Sturge Weber, NF
- cardiac
- haem e.g. sickle cell
I: infection - inflammatory e.g. encephalitis
N: neoplasm
C: congenital - will get facial sparing
A: autoimmune
T: trauma
E: endocrine/metabolic
what level of LL flexion corresponds with what nerve root? e.g. in spina bifida
hip flexion = L1/2
knee flexion = L3/4
ankle DF = L4/5
*saddle area = S3 and below i.e. incontinence
key areas to look for in spina bifida
HC
neck - VP shunt
back - scoliosis
nystagmus
incontinence (say to look for anal tone)
percuss for bladder
abdo reflex
pressure areas
hemiplegia - how to tell where the level of the lesion is?
facial weakness side:
cortical = same side as lesion
subcortical = same side
brain stem = opposite side
spine = no facial features
key features of SMA on exam
tongue fasciculations
prox weakness
FACE AND EYE NORMAL
no reflexes
Ix - SMN1/2 gene
key features of MG on exam
fatiguability
ptosis
facial weakness
bulbar involvement
+/- prox weakness
Ix - tensilon test
peripheral polyneuropathy DDx
CMT
FA
Iatrogenic e.g. vincristine
GBS
If its UMN, think…? If its LMN, think…?
UMN - brain v brainstem v spinal cord?
diplegia - PVL, spina bifida, or rest of vindicate
hemiplegia - VINDICATE
spina bifida - where’s the lesion?
LMN
1) ant horn = SMA
2) nerve = CMT/FA/iatrogenic
3) NMJ = MG
4) muscle = myopathy/dystrophy
if you think its myopathy/dystrophy - what else to examine/ask for?
- cardiac
- scapulae / trendelenburg - pelvic girdle
- gower
- wasting and pseudohypertrophy of calves
- gait - toe walking
- scoliosis
- face - dystrophy face is fine, congenital myotonic dystrophy = myopathic faces, myopathy face is bad
- CK
- gene panel
- muscle biopsy
basically only causes of distal weakness
peripheral neuropathy
SMA
congenital myotonic dystrophy
cerebellar signs
nystagmus
dysarthria
past pointing
intention tremor
dysdiadochokinesia
upward drift pronator
truncal araxia
broad based gait / ataxic gait
additional things to ask for in a cerebellar patient
eyes - slit lamp HF
abdomen - NB, hepsplen for metabolic
bloods - nutritional e.g. Vit E, copper/ceruloplasmin, metabolic, urinary VA/MVA
genetics - GA panel
signs of FA
- cerebellar
- HCM
- hearing loss
- pes cavus, romberg’s positive
- LL weakness, no reflexes, no sensation/vibration
Ix: triplet repeat study
ataxia DDx
- cerebellar
- genetic: AT vs FA - vestibular
- acute labyrinthitis - neuropathy
- iatrogenic e.g. vinc
- CMT
- diabetes - loss of proprioception
- B12, hypothyroid
Ix for floppy weak vs floppy strong
floppy weak and areflexic = neuromuscular
CK
nerve conduction /muscle studies
genetic - SMA1/2, congenital myotonic dystrophy
floppy strong = central: congenital vs acquired??
MRI/CT - HIE!!, vascular / tumour
endocrine - TFTs
metabolic - metabolic screen
genetic - PWS
infectious
facial weakness ddx
unilat - bell’s or stroke (forehead spared)
bilat - myotonic dystrophy, FSHD, GBS, CP, MG
