Neuro Flashcards
What is optic neuritis?
Optic neuritis is the most common presentation of multiple sclerosis.
It involves demyelination of the optic nerve.
What is a central scotoma?
A central scotoma is an enlarged central blind spot.
It is a key feature of optic neuritis.
What disease is characterized by pain with eye movement, impaired colour vision, RAPD and a central scotoma
optic neuritis.
What does a relative afferent pupillary defect indicate?
A relative afferent pupillary defect indicates a problem with the optic nerve.
It is assessed using the swinging flashlight test. The affected eye constricts more when shining a light in the other eye than the affected eye. There is a reduced pupil responsive to shining light in the eye affected
Causes of optic neuritis
MS
SARCOID
SLE
SYPHILIS
MEASLES/ MUMPS
NEUROMYELITIS OPTICA
LYME DISEASE
What cranial nerves are affected by lesions that cause double vision and nystagmus?
Oculomotor (CN III), trochlear (CN IV), and abducens (CN VI)
These nerves are responsible for controlling eye movements.
What does oscillopsia refer to?
The visual sensation of the environment moving and being unable to create a stable image
Oscillopsia can be distressing and is often associated with vestibular disorders.
What condition is caused by a lesion in the medial longitudinal fasciculus?
Internuclear ophthalmoplegia
This condition affects the coordination of eye movements.
What do the nerve fibres of the medial longitudinal fasciculus connect?
Cranial nerve nuclei that control eye movements
Specifically, the 3rd, 4th, and 6th cranial nerve nuclei.
What is the effect of a lesion in the medial longitudinal fasciculus on eye movement?
Impaired adduction on the same side as the lesion and nystagmus in the contralateral abducting eye
This results in the affected eye’s inability to move towards the nose during adduction.
What type of disorder does a lesion in the abducens (CN VI) cause?
Conjugate lateral gaze disorder
This disorder affects the ability of both eyes to move together laterally.
When looking laterally in the direction of the affected eye due to an abducens lesion, what happens to the affected eye?
The affected eye will not be able to abduct
For example, in a left abducens lesion, the left eye will not move left.
True or False: In a left abducens lesion, when looking to the left, the right eye will abduct.
False
The right eye will adduct instead.
Fill in the blank: The term ‘conjugate’ in conjugate lateral gaze means _______.
Connected
This indicates that both eyes are supposed to move together.
What are some examples of focal weakness in multiple sclerosis?
- Incontinence
- Horner syndrome
- Facial nerve palsy
- Limb paralysis
These symptoms indicate focal neurological deficits associated with multiple sclerosis.
What are some examples of focal sensory symptoms in multiple sclerosis?
- Trigeminal neuralgia
- Numbness
- Paraesthesia (pins and needles)
- Lhermittes sign
These symptoms reflect sensory disturbances that can occur in multiple sclerosis.
What does Lhermitte’s sign indicate?
It indicates disease in the cervical spinal cord in the dorsal column.
Lhermitte’s sign is characterized by an electric shock sensation traveling down the spine when flexing the neck.
What is Lhermitte’s sign?
An electric shock sensation that travels down the spine and into the limbs when flexing the neck.
This sign is caused by stretching the demyelinated dorsal column.
What is transverse myelitis?
A site of inflammation in the spinal cord resulting in sensory and motor symptoms depending on the lesion location.
Transverse myelitis can lead to various neurological deficits based on the affected area.
What is ataxia?
A problem with coordinated movement.
Ataxia can manifest as sensory or cerebellar types.
What causes sensory ataxia?
Loss of proprioception.
Proprioception is the ability to sense the position of joints.
What is a positive Romberg’s test and what is it indicative of?
Loss of balance when standing with eyes closed.
This is a common finding in sensory ataxia.
What can sensory ataxia lead to?
Pseudoathetosis.
Pseudoathetosis is characterized by involuntary writhing movements.
What lesion can cause sensory ataxia?
Lesion in the dorsal columns of the spine.
The dorsal columns are responsible for proprioception.
What causes cerebellar ataxia?
Problems with the cerebellum coordinating movement.
Cerebellar ataxia suggests a lesion in the cerebellum.
What investigation can support the diagnosis of MS
MRI scans
What can a lumbar puncture detect in the cerebrospinal fluid (CSF) in MS
Oligoclonal bands
How are MS relapses managed
Steroids - methylpred
NICE: 500mg orally daily for 5 days
1g IV 3-5 days (severe/ orals have failed prev)
What type of inheritance is Facioscapulohumeral muscular dystrophy?
Dominantly inherited
This means that only one copy of the mutated gene is sufficient to cause the disorder.
At what age does Facioscapulohumeral muscular dystrophy typically present?
Usually in the first and second decades of life
However, it may present at any age, including infancy, though this is rare.
What is the typical progression pattern of muscle involvement in Facioscapulohumeral muscular dystrophy?
Starts in the face and progresses to the shoulder girdle, humeral muscles, abdominal muscles, and then the anterolateral compartment of the leg
This reflects the characteristic downward progression of the disease.
What is the variability in disease severity for Facioscapulohumeral muscular dystrophy?
Very variable and progression is very slow
Some patients may remain asymptomatic.
What percentage of patients with Facioscapulohumeral muscular dystrophy are asymptomatic?
As many as one third
This highlights the variability in disease manifestation.
What initial symptoms indicate weakness in the facial muscles?
Weakness starts in the orbicularis oculi, mouth, and cheek
These symptoms can lead to characteristic signs during sleep and facial activities.
Which muscles are spared in Facioscapulohumeral muscular dystrophy?
Extraocular and pharyngeal muscles
This sparing is significant in distinguishing the disease from other muscular dystrophies.
What is a characteristic sign of weakness in facial muscles?
Eyes remain slightly open when asleep
This sign is particularly notable in young children.
What difficulties may suggest weakness of facial muscles?
Difficulties with pursing lips to whistle, drinking through a straw, or blowing up balloons
These functional challenges can indicate muscle involvement.
What is the most characteristic sign of Facioscapulohumeral muscular dystrophy?
Winging of the scapula
This sign is a key diagnostic feature.
How does the scapula appear in patients with winging?
More lateral than normal and moves upwards with shoulder abduction
This change is due to weakness in specific shoulder muscles.
Which shoulder muscles may be spared in Facioscapulohumeral muscular dystrophy?
Deltoid muscle
Selective weakness can lead to significant functional impairment.
Fill in the blank: Facioscapulohumeral muscular dystrophy shows selective weakness of the _______ muscles.
thoracoscapular
This selective weakness contributes to the characteristic winging of the scapula.
What is the most common type of epilepsy in childhood
Benign Rolandic epilepsy
