Neuro Flashcards
Causes of olfactory nerve problems
COVID
Trauma to nose which disrupts cribriform plate
Frontal and temporal lobe tumours
Kallmans syndrome
If problem with visual acuity what is first thing do
Assess with pinhole occluder to see if refractive errors
What does impaired colour vision suggest
Problem with the optic nerve
CN7 tests
Smile
Raise eyebrows
Close eyes and then try to oppose opening
If notice impaired hearing on crude assesment what do
Otoscopy
Webers and rinnes
How assess CN9-10
Look for NG tube/PEG
Ask to repeat phrases to assess speech- british constitution, red lorry, yellow lorry
Look at uvula and say ahhh
Offer gag reflex
How assess CN12
Look at tongue
Ask to poke out tongue
What looking for in inspection of limb exams
Involuntary movements
Wasting
Fasiculations
Scars
Trauma damage
Spasticity vs rigidity
Spasticity- increases as move the limb
Rigidity- tense throughout
Potential sites of neuro lesions
Brain
Spine
Spinal root
Peripheral nerve
Neuromuscular junction
Acute stroke management
A-E approach initially- low GCS requiring intubation or identifying AF etc
Examination-assessing dysfunction with NIHSS
CT scan to exclude haemorrhage and identify if proximal cerebral artery occlusion, could then do CTPA and MRI to identify ischaemic penumbra if
Management then could involve thrombolysis, thrombectomy or 300mg aspirin depending on duration of symptoms
Post stroke management
Swallow assessment and feeding- SALT within 24 hours
Glycaemic control
BP control
Fluid balance
Rehab assessed using barthel index
What is the mcdonald criteria
Used to diagnose MS
Gold standard is 2 clinical attacks disseminated in time with 2 objective lesions on MRI
Other options include
- 2 clinical attacks with evidence of 1 lesion but then require additional evidence such as CSF oligoclonal bands or another attack
UMN differentials
Stroke
Tumour
Infection- encephalitis, abscess
Motor neurone disease
Spinal pathology- traumatic transection, ischaema, infection
Cerebellar differential causes
MS
Stroke
Tumour
Infection
Drug induced- alcohol, anti-epileptics like phenytoin, carbamazepine
B12 deficiency
Wernickes
Cerebral palsy
Genetic- friedrichs ataxia, ataxia telengiectasia, episodic ataxia
Paraneoplastic syndromes
MS management
MDT approach led by neurology team including physios, occupational therapists, opthalmologist, SALT, psychologists
Managing exacerbations- oral or IV methylprednisolone depending on severity
Preventing progression with immunological agents such as natalizumab, peg interferon b and alemtuzumab
Managing complications
- spasticity with gabapentin, benzos, baclofen
- erectile dysfunction with sildenafil
- tiredness- amantadine and CBT
- incontinence- intermittent catheterisation or oxybutynin
- depression- amitryptyline
Causes of horners
Split into central, preganglionic and post ganglionic
Central- MS, stroke
Pre ganglionic- cervical rib, trauma, thyroidectomy
Post- carotid artery dissection and
Causes of motor neuropathy
Acquired
- GBS
- Lead poisoning
- Diphteria
Hereditary
- porphyria
- hereditary sensorimotor neuropathy
Sensory predominant peripheral neuropathy
Metabolic
- uraemia
- B12
- hypothyroid
- alcohol
- uraemia
Infective
- leprosy
Systemic diseases
- Amyloidosis
- vasculitis
Charcot marie tooth presentation
Pes cavus
Wine shaped leg
Foot drop
Hyporeflexia
Weakness in foot
Charcot marie tooth management
MDT approach led by neurology
- physiotherapy which encourages exercise
- occupational therapy
- bracing
- orthopaedics to correct foot
Nerve conduction studies findings
Demyelination- reduced speed
Axonal injury- reduced amplitude
Investigations for charcot marie tooth disease
Nerve conduction studies- depends on the subtype
- CMT 1 is axonal loss
- CMT 2 is demyelination
Causes of peripherla demyelination
GBS
Chronic inflammatory demyelination polyradiculoneuropathy
CMT type 2
Central demyelination conditions
MS
JC virus causing progressive multifocal leukoencephalopathy
Parkinsons management
MDT approach led by neurology
- include physio, OT, SALT
- medication includes- levodopa, dopamine agonists, monoamine oxidase B inhibitors
- first line depends if interruption of daily life, if so then levodopa with peripheral decarboxylase inhibitor like carbidopa
Differentials for parkinsons
Drug induced
Essential tremor
Lewy body dementia
Investigations for parksinsons
Clinical diagnosis but if diagnostic uncertainty could do DAT scan which will show reduced dopamine uptake in substantia nigra
Proximal muscles weakness
Endocrine- cushings, steroids, thyrotoxicosis
Muscular dystrophy
Osteomalacia
Inflam- myositis, polymyalgia rheumatica
Neuromuscular disorders- MG, LEMs
Bilateral upper motor neurone signs
MS
Myelopathy
MND
Myelopathy damage areas and main findings
Central transection- spinothalamic+UL>LL
Anterior transection- bilateral below lost, dorsal preserved
Posterior transection- dorsal column
Brown sequard
Causes of central spinal transection
Syringiomyelia
