Neuro Flashcards by rob Duguid

Causes of peripheral neuropathy

Alcohol, Autoimmune (GB, Lupus), Diabetes, Infection, Charcot Marie, Amyloid, Trauma, Tumour, Kidney/Liver disease, Hypothyroid, Vitamin B deficiency

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Upper motor neuron lesions are above the…

anterior horn cell

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Interruption of UMN have greatest effect on which type of muscles?

antigravity muscles (flexors)

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UMN lesions increase…

tone and reflexes

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Fasciculations are seen in UMN or LMN?

LMN

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Distinguish between LMN and myasthenia?

Myasthenia will have normal tone and reflex, only weakness which is worse with repitition

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Footdrop DDx

L4, L5 lesion, sciatic nerve palsy, common peroneal palsy, distal myopathy, motor neuron disease, peripheral neuropathy,

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Describe hemiplegic gait…

foot is plantar flexed and leg swung in lateral arc

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Parkinsonian gait description

hesitation in starting (bradykinisea), shuffling, freezing, festination (hurrying), propulsion, retropulsion,

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Waddling gait suggests…

myopathy

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Cerebellar gait description

wide base and staggering

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High stepping gait usually means… UMN or LMN

Lower motor neuron

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Posterior column lesion= what gait?

clumsy slapping down of foot on broad base

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First comment to make about gait…

symmetrical or assymetrical

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Upper motor neuron lesion causes which resting positions for upper limb?

adductioxtn at shoulder, flexion at elbow, pronation wrist and fist made

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When asked about specific location of a lesion…

Further testing would be required. Do upper and lower limb and cranial nerve testing. Frontal and temporal lobe too.

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Thalamic strokes can have different presentations due to what??

4 different vascular supplies (3 vertebrobasilar, 1 PCA)

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Lacunar infarcts are…

small subcortical infarcts in brainstem, thalamus, internal capsule, basal ganglia

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Key features of internal capsule stroke

sensory and motor deficits, cranial nerve involvement

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define site of stroke by blood supply

ACA: frontal affected. leg weakness
MCA: face and arm>leg, gaze preference, speech difficulty if in dominant hemisphere
PCA: heminaopia, if thalamus involved sensory loss too

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Temporal lobe testing

short and long term memory, upper quad hemianopia, dysphasia

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Frontal lobe testing

emotional disinhibition, gait apraxia, grasp reflex, anosmia

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Parietal lobe testing (dominant)

AALF- acalculia, agraphia, left right disorientation, finger agnosia

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Brainstem stroke vs internal capsule

brainstem will affect ipsilateral (LMN) cranial nerve but contralateral limbs

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Basal ganglia stroke symptoms

swallowing, tremor, ataxia

Violent frequent hiccups=

Wallenburg syndrome- PICA artery. Contralateral pain and temp. Ipsilateral cranial nerve

Ddx of LMN

Peripheral nerve lesion, nerve root lesion (radiculopathy), Spinal Cord lesion

DDx of UMN

Cerebral cortex, basal ganglia, brainstem, cerebellum, spinal cord

Radial nerve lesion=

wrist drop, loss of sensation over snuff box

Median nerve lesion=

weakness of APB, loss of sensation in distribution

Ulnar nerve lesion=

4th and 5th claw finger, loss of sensation in distribution

Upper brachial plexus=

waiters tip, sensory over lateral arm

Lower brachial plexus=

claw hand, sensory over ulnar side of hand and forearm

Lateral cutaneous nerve of thigh=

loss of sensation only!

Femoral nerve=

inner thigh and leg sensation, weakness of knee extension

Sciatic nerve=

footdrop, loss of sensation on posterior of whole leg

Common peroneal nerve=

footdrop, sensory loss over dorsum of foot

Cause of peripheral nerve lesion DDx

DM, entrapment, RA, vasculitis

Nerve root damage in cauda equina=

saddle distribution

Radiculopathies are caused by...

disk herniation, narrowing of foramen from spondylysis

Spinal cord lesion causes

complete loss of sensation below level,or if hemisection depends on column

Causes of anterior column spinal cord lesion

anterior spinal artery embolism

Causes of posterior column spinal cord lesion

trauma, tumour, MS, cervical spondylysis

Causes of cerebral cortex UMN lesion

stroke, seizure, tumour

Brainstem stroke to midbrain v pons v medulla. symptoms

midbrain: CN3,4= diplopia, ptosis, non reactive pupil Pons: C6,7: LMN facial weakness Medulla: CN 8,10: lateral medullary syndrome

Cerebellar stroke Sx

nystagmus, ataxia

Spinal cord injury C1-5

UMN in upper and lower limbs

Spinal cord injury C6-T2

LMN in upper, UMN in lower

Spinal injury T3-L3

Upper limb normal , UMN in lower

Spinal injury L4-S2

Upper limb normal, LMN lower

Why do UMN and LMN look same initially

takes a while for hyperreflexia and spascitiy to develop for UMN

LMN Sx

wasting, fasciculation, hypotonia, reduced reflex

Primary muscle disease vs LMN

symmetrical loss and no sensory loss (eg myasthenia)

Causes of peripheral neuropathy

Idiopathic, alcohol, GBS, DM, vit 12, CT disease, Heavy metal, drugs (eg phenytoin)

Ix for peripheral neuropathy

nerve conduction, electromyography

Rx peirpheral neuropathy

anti-depressants, anti-convulsants, opiods

Sx of peripheral neuropathy

Motor: muscle weakness Sensory: glove and stocking Autonomic: BP, constipation, bladder, incontinence, sexual

3 key symptoms for Parkinsons

Resting tremor, bradykinesia, rigidity

Other PD Sx

Postural instability, lack of facial expression, micrographia, cognitive, mood

Mx PD

levodopa frontline | use COMT inhibitors, MAO-B inhibitors as adjunct

Causes of ataxia

Focal lesion: stroke, tumour, MS | Alcohol, Vit B12 deficiency, Wilsons, idiopathic

Mx Cerebral ataxia

physio, OT

What tract is affected in hemiplegia?

corticospinal

Causes hemiplegia

Stroke, meningitis, neoplastic (glioma), traumatic, congenital (cerebral palsy), MS

Causes of fasciculation

Motor neuron disease, Motor root compression, peripheral neuropathy, primary dystrophy, thyrotoxicosis

Cause of footdroop

L4,L5 lesion, peripheral neuropathy, MND, stroke, sciatic nerve palsy, peroneal nerve palsy

What is syringiomelia?

Fluid filled cavities in spinal cord

winging of scapula is paralysis of which muscle and damage to which nerve?

serratus anterior, long thoracic nerve