Neuro Flashcards
Summarise Motor component in GCS
- Obeys commands
- Localises to pain
- Withdraws from pain
- Abnormal flexion to pain (decorticate posture)
- Extending to pain
- None
Summarise Verbal response in GCS
- Orientated
- Confused
- Words
- Sounds
- None
Summarise Eye opening in GCS
- Spontaneous
- To speech
- To pain
- None
How much does spontaneous eye opening score?
4
How much does eye opening to speech score?
3
How much does eye opening to pain score
2
How much does a verbal response of sounds score?
2
How much does a verbal response of words score?
3
How much does a verbal response of confused words score?
4
How much does localising pain score?
5
How much does withdrawing from pain score?
4
How much does abnormal flexion in response to pain score?
3
How much does extension to pain score?
2
features of temporal lobe seizure
May occur with or without impairment of consciousness or awareness
An aura occurs in most patients
typically a rising epigastric sensation
also psychic or experiential phenomena, such as déjà vu, jamais vu
less commonly hallucinations (auditory/gustatory/olfactory)
Seizures typically last around one minute
automatisms (e.g. lip smacking/grabbing/plucking) are common
features of frontal lobe seizures [4]
Head/leg movements
posturing
post-ictal weakness
Jacksonian march
features of parietal lobe seizures [4]
Paraesthesia
electric shock type sensations
hallucinations
dizziness.
features of occipital lobe seizures
floaters/ flashes
key features of MND
asymmetric limb weakness is the most common presentation of ALS
the mixture of lower motor neuron and upper motor neuron signs
wasting of the small hand muscles/tibialis anterior is common
fasciculations
the absence of sensory signs/symptoms
vague sensory symptoms may occur early in the disease (e.g. limb pain) but ‘never’ sensory signs
doesn’t affect external ocular muscles
no cerebellar signs
abdominal reflexes are usually preserved
sphincter dysfunction if present is a late feature
which MND has the best prognosis
progressive muscular atrophy
which MND has the worst prognosis
progressive bulbar palsy
which MND has UMN signs only
Primary Lateral Sclerosis
which MND has UMN and LMN signs
Amyotrophic Lateral Sclerosis
UMN in the legs
LMN in the arms
which MND has LMN signs only
Progressive muscular atrophy
abx for cerebral abscess
cephalosporin plus metronidazole
adverse reaction of carbamazepine
SJS
first line treatment for MS related spasticity
baclofen
gabapentin
drug treatment for MS related fatigue
amantidine
once other problems (e.g. anaemia, thyroid or depression)
CN 5 affected by acoustic neuroma causing
absence of corneal reflex
which cranial nerves can be affected by an acoustic neuroma
5,7, 8
CN 8 affected by acoustic neuroma causing [3]
unilateral tinnitus
unilateral sensory hearing loss
vertigo
drugs that predispose to Idiopathic intracranial Hypertension [5]
COCP
tetracyclines
steroids
retinoids
lithium
nerve roots for Klumpke
C8-T1
the lowest branch
nerve root for Horner’s
T1
treatment for spasticity in MS
baclofen or gabapentin
how does a chronic bleed present on CT head?
hypodense
how does an acute bleed present on CT head?
hyperdense
how is an acute subdural managed?
Small or incidental acute subdurals can be observed conservatively. Surgical options include monitoring of intracranial pressure and decompressive craniectomy.
how is a chronic subdural managed?
an incidental finding or if it is small in size with no associated neurological deficit can be managed conservatively with the hope that it will dissolve with time.
If the patient is confused, has an associated neurological deficit or has severe imaging findings then surgical decompression with burr holes is required.
investigation of choice for acoustic neuroma
what else is done alongside this?
gadolinium-enhanced MRI of cerebellopontine angle
with audiogram
which vessel is occluded in Lateral Medullary Syndrome?
posterior inferior cerebellar artery.
what are the cerebellar features of Lateral Medullary Syndrome
ataxia
nystagmus
what are the brainstem features of Lateral Medullary Syndrome?
ipsilateral: dysphagia, facial numbness, cranial nerve palsy e.g. Horner’s
contralateral: limb sensory loss
what is Lateral Medullary Syndrome also known as ?
Wallenberg’s Syndrome
what is the preferred method of nutrition for patients with Motor Neurone Disease?
percutaneous gastrostomy tube (PEG
examples of 5HT-3 antagonists [2]
ondansetron
palonosetron
adverse effects of 5HT-3 antagonists [2]
prolonged QTc
constipation
where do 5HT-3 antagonists act
CTZ in medulla oblongata
mode of inheritance of charcot Marie tooth
Autosomal dominant
features of charcot Marie tooth [4]
motor symptoms mainly
distal muscle wasting
pes cavus, clawed toes
high stepping gait due to foot drop
how long can’t someone drive for an unprovoked/first seizure with no abnormal scans
6 months
how long can’t someone drive for an seizure with abnormal scans
12 months
how long can’t someone drive if they have multiple TIAs over a short period.
3 months
how long can’t someone drive if they have had a stroke or TIA with no neurological deficits
1 month
how long can’t someone drive if they have had a craniotomy e.g. for meningioma
1 year
how long can’t someone drive for single episode of syncope that was explained and treated
4 weeks
how long can’t someone drive for single episode of syncope that was not explained
6 months
how long can’t someone drive for two or more episodes of syncope
12 months
first line treatment for essential tremor
propanolol
differences between essential and Parkinsonian tremor
Essential: mildly asymmetrical, action tremor
Parkinsons: very asymmetrical, rest tremor
mode of inheritance of essential tremor
autosomal dominant
what is secondary progressive MS
describes relapsing-remitting patients who have deteriorated and have developed neurological signs and symptoms between relapses
what is primary progressive MS
progressive deterioration from onset
visual symptoms of MS [4]
optic neuritis
optic atrophy
Uthoffs phenomenon
internuclear ophthalmoplegia
motor symptoms of MS [1]
spastic weakness
Sensory symptoms of MS [4]
Pins and needles
Lhermitte’s phenomenon
trigeminal neuralgia
numbness
Cerebellar symptoms of MS
ataxia
tremor
associated symptoms of Bells palsy [4]
hyperacusis
dry eyes
altered taste
post-auricular pain
when should Bell’s palsy patients be referred to urgently ENT
if treatment does not improve symptoms after 3 weeks
Hypo on CT ?shade
dark
4 pillars of Parkinsons
Bradykinesia
Resting tremor
Postural instability
Rigidity
additional symptoms are Parkinsons+
muscles innervated by the ulnar nerve [5]
medial two lumbricals
aDductor pollicis
interossei
hypothenar muscles: abductor digiti minimi, flexor digiti minimi
flexor carpi ulnaris
what is a cause of ulnar nerve neuropathy
Cubital Tunnel Syndrome
Three meds that can be given after the second dose of IV lorazepam in acute seizure management
Phenytoin
Sodium valporate
Levetiracetam (mostly used)
mode of inheritance of tuberous sclerosis
autosomal dominant
how do symptoms present in alcoholic neuropathy
sensory symptoms before motor symptoms
which part of the spinal tracts are affected first in B12 deficiency
Dorsal columns (joint position and vibration)
Main treatment of degenerative cervical myelopathy
decompressive surgery
what sign is positive in degenerative cervical myelopathy
Hoffman’s sign
features of degenerative cervical myelopathy
pain in the neck, arms, and legs
loss of sensory, motor (fine, dexterity) and autonomic function
what is degenerative cervical myelopathy often misdiagnosed as
carpal tunnel syndrome
what causes autonomic dysreflexia?
patients who have had a spinal cord injury at, or above T6 spinal level.
What may trigger autonomic dysreflexia?
most commonly triggered by faecal impaction or urinary retention
features of autonomic dysreflexia [4]
extreme hypertension
flushing
sweating above the level of the cord lesion
agitation
and in untreated cases severe consequences of extreme hypertension have been reported, e.g. haemorrhagic stroke.
treatment of autonomic dysreflexia
Management of autonomic dysreflexia involves removal/control of the stimulus and treatment of any life-threatening hypertension and/or bradycardia.
what site of the brain are vestibular schwannomas found?
cerebellopontine angle
features of vestibular schwannomas [4]
vertigo
hearing loss
tinnitus
an absent corneal reflex and cranial nerves pathology (5,7,8)
which part of the spine convey the sensation of fine touch, proprioception and vibration
dorsal column
are UMN or LMN signs seen in poliomyelitis?
affects anterior horns resulting in lower motor neuron signs
MoA of acetozolamide
carbonic anhydrase inhibitor
treatment of myasthenic crisis
IVIG and plasmapheresis
which malignancy is associated with myasthenia gravis
thymoma
first line treatment of myasthenia gravis
pyridostigmine (long acting acetylcholinesterase inhibitor)
neostigmine
why can extradural haematoma present with fixed dilated pupil
uncal herniation compresses CNIII
which brain bleed features a lucid interval
extradural
differentiating factor between Huntingtons and frontotemporal dementia
Huntingtons has motor symptoms while FTD does not
features of Anterior Inferior Cerebellar Artery (AICA) i.e. Lateral Pontine Syndrome stroke
ipsilateral auditory deficits e.g. deafness
vertigo and vomiting
ipsilateral facial paralysis
ipsilateral cerebellar dysfunction.
This is due to the involvement of the facial and vestibulocochlear nerves within the brainstem and cerebellum.
how does mononeuritis multiplex present
acute or subacute loss of sensory and motor function of individual nerves.
The pattern of involvement is asymmetric, however, as the disease progresses, deficit(s) becomes more confluent and symmetrical, making it difficult to differentiate from polyneuropathy.
3 neurological features of tuberous sclerosis
developmental delay
epilepsy (infantile spasms or partial)
intellectual impairment
which sensory modality is lost in syringomyelia
temperature due to compression of spinothalamic tracts
investigations for syringomyelia
MRI spine and brain
what effect does dopamine have on prolactin
inhibitory
treatment of symptomatic or persistent syringomyelia
shunt
adverse effects of levodopa [7] DOPAMINE
Dyskinesia
‘On-off’ effect
Postural hypotension and psychosis
Arrhythmias
Mouth dryness
Insomnia
Nausea & vomiting
EDS
reddish discolouration of urine upon standing
Risk factor for Bell’s Palsy
women and pregnancy
main investigation for degenerative cervical myelopathy
MRI of the cervical spine
complication of DCM
recurrence at adjacent spinal levels
needs referral back to spinal surgery
MS has UMN or LMN signs?
UMN only as it affects the CNS
a positive straight leg raise test indicates which pathology
disc herniation
which movement of the shoulder is most painful in adhesive capsulitis
Limited external rotation of the shoulder
features of viral encephalitis[5]
fever
headache
psychiatric symptoms e.g. new onset somnolence
seizures
vomiting
key investigation for viral meningitis
CSF PCR
main: HSV-1, VZV, enteroviruses
which lobes are typically affected in viral encephalitis
temporal and inferior frontal lobes
what is the timeframe for thrombolysis in acute ischaemic stroke
within 4.5 hours from onset of symptoms
what timeframe should thrombectomy be offered alongside thrombolysis in acute ischaemic stroke
who can this be offered to
within 6 hours from onset of symptoms
confirmed occlusion of the proximal anterior circulation demonstrated by computed tomographic angiography (CTA) or magnetic resonance angiography (MRA)
which nerve is affected in Saturday night palsy
radial nerve
when is aspirin given after alteplase in acute stroke treatment
within 24 hours
drug given in MND to extend life
riluzole
TIA:investigations
carotid USS
MRI (not CT)
BP, ECG, bloods for risk factor
management of TIA (w/o AF)
aspiring 300mg 14 days
ongoing: clopi+ statin 1st line;
aspirin+ dipyridamole+ statin 2nd line
Referral for specialist assessment within 24 hours (within 7 days if more than 7 days since the episode)
Diffusion-weighted MRI scan is the imaging investigation of choice.
what degree of carotid stenosis requires an endarectomy
> 50%
how is long term stroke prophylaxis determined
presence of AF:
NO AF –> clopi + statin ; aspirin+ dipyridamole+ statin
AF –> apixaban, rivaroxaban
which index is used to monitor functional status and improvement post-stroke
Barthel index
management of subarachnoid haemorrhage [3]
nimodipine (CCB, 21 days)
coiling
surgical clipping
first line treatments for Parkinsons Disease [3]
levodopa (co-careldopa)
MAO-I e.g. selegiline
DA agonist e.g. ropinirole
which antiemetic can be used in PD
domperidone (does not cross BBB unlike the other DA antagonists)
what chemical is raised in true CNS seizure
prolactin
acute management of migraine [2]
triptan (aura)
NSAID/paracetamol (no aura)
prophylaxis of migraine
topimirate
propanolol
acute management of cluster headache
100% oxygen and SC triptan
prophylaxis of cluster headache
verapamil
which antibodies are investigated for in MS
Anti-MBP (myelin basic protein)
NMO-IgG (neuromyelitis optica) → Devic’s syndrome
chronic management of MS [2]
DMARDs:
* IFN-beta
* Glatiramer
Biologicals:
* Natalizumab (anti-VLA-4 AB)
* Alemtuzumab (anti-CD52)
treatment of MS related pain
amitriptyline
treatment of MS related tremor
clonazepam
long term management of myasthenia gravis [2 lines]
immunosuppression:
1st line- prednisolone
2nd line- azathioprine, MMF etc
which cancers are associated with Lambert Eaton Syndrome [3]
SCLC
breast
ovarian
what antibody is produced in Lambert Eaton Syndrome
against presynaptic voltage-gated calcium channel (VGCC) in the peripheral nervous system
what occurs with repeated muscle contraction in Lambert Eaton Syndrome
increase in muscle strength
investigation of Lambert Eaton Syndrome
EMG
Incremental response to repetitive electrical stimulation
management of Lambert Eaton Syndrome [2]
treat the underlying cancer
immunosuppression
is sensation normal or abnormal in MND
normal
is eye movement normal or abnormal in MND
normal till very late
treatment of drooling in MND
amitriptyline
gait in Unilateral UMN lesion and Bilateral UMN lesion
unilateral –> circumducting gait
bilateral –> scissoring gait
tone in UMN lesion
increased
reflexes in UMN lesion
increased
power in UMN lesion
decreased in pyramidal distribution (voluntary muscle control)
legs: ext > flex
arms: flex > ext
Babinski and Hoffman in UMN lesion
both positive
what is the difference between pyramidal and extrapyramidal tracts
In summary, while both pyramidal and extrapyramidal tracts contribute to motor control, the pyramidal tracts are more directly involved in voluntary, skilled movements, while the extrapyramidal tracts play a modulatory role in regulating posture, muscle tone, and involuntary movements. The term “extrapyramidal” is historical and refers to the tracts that do not pass through the pyramids of the medulla.
which form of hypertonia is extra-pyramidal
rigidity “lead-pipe” like that seen in Parkinson’s
increased tone throughout ROM independent of velocity
which form of hypertonia is pyramidal
spasticity “clasp knife”
increased velocity dependent tone, more rigid at the start
Hoffman reflex: how do you illicit it and what does it cause
flick middle digit IP joint → adduction of thumb + flexion of index digit)
tone in LMN lesion
decreased
reflexes in LMN lesion
decreased
power in LMN lesion in legs and arms: extensor or flexor
legs: extensor > flexor
arms: flexor > extensor
which type of motor neurone lesion presents with wasting ad fasciculations
LMN lesion
motor predominant causes of peripheral neuropathy [5]
GBS (AIDP)
polio
CIDP
porphyria
lead poisoning
sensory predominant causes of peripheral neuropathy [4]
diabetes mellitus
alcohol
vit B12 def
isoniazid
investigations for Charcot Marie Tooth (+HSMN, peroneal muscular dystrophy)
nerve conduction studies: reduced conduction velocity and amplitude
Signs of cerebellar syndrome: DANISH
D- Dysdiadochokinesia, dysmetria, dysarthira
A- Ataxia
N- Nystagmus
I- Intention tremor
S- slurred Speech
H- Hypotonia
What quandranopia does a pituitary tumour cause
superior
what quadranopia does a craniopharngioma cause
inferior
where in the brain does a superior quadranopia originate
temporal [PITS]
where in the brain does a inferior quadranopia originate
parietal [PITS]
how does Weber syndrome present
ipsilateral third nerve palsy with contra-lateral hemiplegia due to midbrain stroke
pupil size in surgical third nerve palsy
dilated
treatment of paroxysmal hemicrania
indomethacin
head ache with fluctuating consciousness suggests
subdural
what should be done in suspected stroke/TIA before administering aspirin
non contrast CT head to exclude haemorrhagic stroke
treatment of acute pulmonary oedema that goes into hypotension/cardiogenic shock [2]
dobutamine
norepinephrine (if dobutamine doesn’t work)
viral meningitis vs encephalitis
viral meningitis: neck stiffness, photophobia etc, self limiting
encephalitis: more ill, temporal lobe seizure
contraindications to aspirin 300mg in TIA
- already taking regular aspirin
- bleeding disorder or taking anticoagulant –> need urgent CT
- aspirin CI
treatment of absence seizures
ethosuximide
secondary prevention of TIA
1st line: clopi + statin
2nd line: aspirin + dipyridamole + statin
visual symptoms of TIA
amaurosis fugax
homonymous hemianopia
diplopia
how can you distinguish flexing and localising pain in GCS assessment
To be counted as localising, the arm must be brought above the clavicle, else it should be scored as ‘flexing’
investigations for HSV encephalitis
CSF: lymphocytosis, elevated protein
PCR for HSV
CT: medial temporal and inferior frontal changes (e.g. petechial haemorrhages) - normal in one-third of patients
MRI is better
EEG pattern: lateralised periodic discharges at 2 Hz
how long do cluster headache clusters lasts
how long do the episodes last
4 to 12 weeks
15 mins to 2 hours
investigation required for cluster headaches
MRI with contrast to check for SOL
cerebellar lesions: which side do they present on
symptoms are on ipsilateral side
posterior circulation lesions [3]
ataxia
vertigo
isolated homonymous hemianopia
includes vertebral arteries
anterior circulation lesions
middle and anterior cerebral arteries
investigating thunderclap headache [3]
CT head
LP
CT angio
when is aspirin used in stroke
24h after thrombolysis or stat if no thrombolysis is planned
what signs are expected in lesions below L2 eg caudal equina
LMN signs
where do dorsal column fibres cross
medulla
where to spinothalamic tract fibres cross
spinal level
overall management of stroke [4]
Exclude hypoglycaemia
Immediate CT brain to exclude haemorrhage
Aspirin 300mg daily for two weeks (started after haemorrhage is excluded with a CT)
Admission to a specialist stroke centre where thrombolysis may be initiated
what two conditions need to be screened for when finding the underlying cause of stroke
carotid artery stenosis and atrial fibrillation
therefore do carotid imaging and ECG/monitoring
when is anticoagulation for stroke w/ AF started
after haemorrhage has been excluded and 2 weeks of aspirin has been taken
Weber’s syndrome
which branch?
Ipsilateral CN III palsy
Contralateral weakness of upper and lower extremity
posterior cerebral artery
no cerebellar signs
Posterior inferior cerebellar artery (lateral medullary syndrome, Wallenberg syndrome)
Ipsilateral: facial pain and temperature loss
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus
Broca’s dysphasia: 3 features
which lobe
speech non-fluent
comprehension normal
repetition impaired
frontal lobe
Parkinsonism with associated autonomic disturbance (atonic bladder, postural hypotension) points towards ….
Multiple System Atrophy
erectile dysfunction: often an early feature
postural hypotension
atonic bladder
cerebellar signs
There are 2 predominant types of multiple system atrophy
1) MSA-P - Predominant Parkinsonian features
2) MSA-C - Predominant Cerebellar features
treatment of myoclonic seizures in females
levetiracetam
treatment of tonic or atonic seizures in females
lamotrigine
features of MCA stroke [3]
Contralateral hemiparesis and sensory loss, upper extremity > lower
Contralateral homonymous hemianopia
Aphasia
features of PCA stroke [2]
Contralateral homonymous hemianopia with macular sparing
Visual agnosia
features of retinal artery stroke
amaurosis fugax
features of Basilar artery stroke
locked in syndrome
GBS: UMN or LMN signs?
LMN
2 investigations in GBS
lumbar puncture –> rise in protein with a normal white blood cell count (albuminocytologic dissociation) - found in 66%
nerve conduction studies –> decreased motor nerve conduction velocity (due to demyelination
drug useful for managing tremor in drug-induced parkinsonism
procyclidine (anti-musc)
Parkinson’s drug associated with pulmonary and cardiac fibrosis
dopamine receptor agonist
bromocriptine, ropinirole, cabergoline, apomorphine
Parkinsons drug that loses effect over time
levodopa
drugs that cause impulse control disorders and excessive daytime somnolence
dopamine receptor agonists e.g. bromocriptine, ropinirole, cabergoline, apomorphine
most common primary tumour in adults
glioblastoma multiform
poor prognosis
second most common primary brain tumour in adults
meningioma
Tumours that most commonly spread to the brain include
lung (most common)
breast
bowel
skin (namely melanoma)
kidney
Definition of TIA
a transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischaemia, without acute infarction
otherwise its a stroke
treatment of focal seizures [2]
first line: lamotrigine or levetiracetam
second line: carbamazepine, oxcarbazepine or zonisamide
which antiepileptic may exacerbate absence seizures
carbamazepine
cafe au lait spots: are they pigmented and which condition
hyper pigmented
in Neurofibromatosis
features of NF1 [6]
Café-au-lait spots (>= 6, 15 mm in diameter)
Axillary/groin freckles
Peripheral neurofibromas
Iris hamatomas (Lisch nodules) in > 90%
Scoliosis
Pheochromocytomas
features of NF2
Bilateral vestibular schwannomas
Multiple intracranial schwannomas, mengiomas and ependymomas
which portion of the tongue sensation is lost in Bell’s palsy
anterior two thirds
MRI finding in normal pressure hydrocephalus
ventriculomegaly in the absence of, or out of proportion to, sulcal enlargement
treatment of normal pressure hydrocephalus
ventriculoperitoneal shunting
four main features of neuroleptic malignant syndrome
rigidity
hyperthermia
autonomic instability (hypotension, tachycardia)
altered mental status (confusion)
what are the bloods like in NMS
A raised creatine kinase is present in most cases. Acute kidney injury (secondary to rhabdomyolysis) may develop in severe cases. A leukocytosis may also be seen
treatment of Bell’s palsy
prednisolone within 72 hours
+ eye care
what is a Arnold-Chiari malformation
what are 3 features
describes the downward displacement, or herniation, of the cerebellar tonsils through the foramen magnum. Malformations may be congenital or acquired through trauma.
Features
non-communicating hydrocephalus may develop as a result of obstruction of cerebrospinal fluid (CSF) outflow
headache
syringomyelia
features of progressive supra nuclear palsy [4]
- postural instability and falls
patients tend to have a stiff, broad-based gait - impairment of vertical gaze (down gaze worse than up gaze - patients may complain of difficultly reading or descending stairs)
- parkinsonism
bradykinesia is prominent - cognitive impairment
primarily frontal lobe dysfunction
features of lacunar stroke [3]
involves perforating arteries around the internal capsule, thalamus and basal ganglia
presents with 1 of the following:
1. unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three.
2. pure sensory stroke.
3. ataxic hemiparesis
what must be done for bladder dysfunction in MS
- get an bladder USS
- if significant residual volume → intermittent self-catheterisation
- if no significant residual volume → anticholinergics may improve urinary frequency
anticholinergics may worsen symptoms
what must be done for oscillopsia in MS
gabapentin
features of Miller Fischer Variant [3]
areflexia, ataxia, ophthalmoplegia
which aphasia? Speech is fluent but repetition is poor. Aware of the errors they are making, normal comprehension
Conduction aphasia
which aphasia? Speech is non-fluent, laboured, and halting. Repetition is impaired, normal comprehension
Broca’s
which aphasia has impaired comprehension
Wernicke’s
which aphasia has severe expressive and receptive aphasia
global aphasia
Difference between Ramsay Hunt and Bells
Ramsay-Hunt syndrome is caused by the varicella zoster virus (VZV). It presents as a unilateral lower motor neurone facial nerve palsy. Patients stereotypically have a painful and tender vesicular rash in the ear canal, pinna and around the ear on the affected side. This rash can extend to the anterior 2/3 of the tongue and hard palate.
i.e. abnormal ENT exam
features of pontine haemorrhage stroke [3]
reduced GCS, paralysis and bilateral pin point pupils
which vessel supplies Brocas and Wernickes area
middle cerebral artery
L5 vs common peroneal lesion
Weakened dorsiflexion, inversion and eversion of the ankle indicates an L5 nerve lesion not a common peroneal nerve lesion
Common peroneal provides sensation over the posterolateral part of the leg and knee. It is also involved in dorsiflexion and eversion of the ankle. It is NOT however involved in the inversion of the ankle and would not cause specific paraesthesia in the first web space of the foot.
what element is most severely impacted in dementia
short term memory
