Neuro Flashcards
Causes of peripheral neuropathy
Alcohol, Autoimmune (GB, Lupus), Diabetes, Infection, Charcot Marie, Amyloid, Trauma, Tumour, Kidney/Liver disease, Hypothyroid, Vitamin B deficiency
Upper motor neuron lesions are above the…
anterior horn cell
Interruption of UMN have greatest effect on which type of muscles?
antigravity muscles (flexors)
UMN lesions increase…
tone and reflexes
Fasciculations are seen in UMN or LMN?
LMN
Distinguish between LMN and myasthenia?
Myasthenia will have normal tone and reflex, only weakness which is worse with repitition
Footdrop DDx
L4, L5 lesion, sciatic nerve palsy, common peroneal palsy, distal myopathy, motor neuron disease, peripheral neuropathy,
Describe hemiplegic gait…
foot is plantar flexed and leg swung in lateral arc
Parkinsonian gait description
hesitation in starting (bradykinisea), shuffling, freezing, festination (hurrying), propulsion, retropulsion,
Waddling gait suggests…
myopathy
Cerebellar gait description
wide base and staggering
High stepping gait usually means… UMN or LMN
Lower motor neuron
Posterior column lesion= what gait?
clumsy slapping down of foot on broad base
First comment to make about gait…
symmetrical or assymetrical
Upper motor neuron lesion causes which resting positions for upper limb?
adductioxtn at shoulder, flexion at elbow, pronation wrist and fist made
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.
Thalamic strokes can have different presentations due to what??
4 different vascular supplies (3 vertebrobasilar, 1 PCA)
Lacunar infarcts are…
small subcortical infarcts in brainstem, thalamus, internal capsule, basal ganglia
Key features of internal capsule stroke
sensory and motor deficits, cranial nerve involvement
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
Temporal lobe testing
short and long term memory, upper quad hemianopia, dysphasia
Frontal lobe testing
emotional disinhibition, gait apraxia, grasp reflex, anosmia
Parietal lobe testing (dominant)
AALF- acalculia, agraphia, left right disorientation, finger agnosia
Brainstem stroke vs internal capsule
brainstem will affect ipsilateral (LMN) cranial nerve but contralateral limbs
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
