Neuro Flashcards
Features of cauda equina
Pain in back and radicular pain down legs
Weakness: bilateral flaccid, arefleixa
Saddle anaesthesia
Poor anal tone
Features of beck syndrome
Paresis
Impaired pain and temp
Preserved touch and proprioception
Signs of syringomyelia
Dissociated sensory loss - loss of pain and temp - scars from burns - preserved dorsal columns - cape distribution Wasting/weakness of hands +/- claw hand Loss of reflexes in upper limb Charcot joints UMN weakness in lower limbs with extensor plantars
Syrinx the expansion affects…
Deccusatating spinothalmic neurone
Anterior horn cells
Corticospinal tracts
Feature of Parkinson
Tremor- ⬆️stress⬇️by sleep
Rigidity - lead pipe, cog wheeling
Akinesia- difficulty with repatitive movement, slow imitation, mask like face
Postural instability- stopped gait with festination
Postural hypotension, constipation, ED, ⬆️saliva
Sleep disorders: EDS, OSA, RBD, dopamine SE
Psychosis - Visual hallucination
Depression/ dementia/ drug SE
Causes of tremor
Resting: Parkinsonism Intention: cerebellar Postural (worse with arms outstretched) - benign essential tremor - endocrine: ⬆️T4 - alcohol withdrawal - toxins: b-agonist - sympathetic: anxiety
Side effects of l-dopa
Dyskinesia On-off phenomena Psychosis ABP - decreased Mouth dryness Insomnia Nausea and vommiting Excessive daytime sleepiness
Cerebellar signs
DANISH Dysdiadochokinesia Ataxia Nystagmus Intention tremor Slurred speech Hypotonia
Cause of cerebellar signs
DASIES
Demyelination
Infarct- brain stem stroke
Space occupying lesion - schwannoma and CPA Tumour
Inherited: Wilson, Friedrich ataxia, VHL
Epilepsy medication: phenytoin
System atrophy - multiple
Cerebellar vermis lesion
Ataxic trunk and gait
Normal arms
Feature of cord compression
Pain: at level and anaesthesia below
Weakness: LMN at level and UMN below level
Sphincter disturbance
Features of lateral medullary syndrome
DANVAH Dysphagia Ataxia Nystagmus Vertigo Anaesthesia - ipislateral face, contralateral body Horner syndrome
Presentation of vestibular schwannoma
Unilateral SNLH, Tinitus and vertigo Increased ICP - headache Ipislateral CN 5,6,7, 8 palsied and cerebellar signs - facial anaesthesia and absent corneal reflex - lateral rectus palsy - LMN facial nerve palsy - SNLH -DAMISH
Cause of cerebellopointine angle syndrome
Vestibular schwannoma - 80% Meningioma Cerebellar astrocytoma Metastase Epidermoid cyst
Von hippel Lindau
Renal cyst Bilateral renal cell carcinoma Haemangioblastoma - often in cerebellum Phaeochromctyome Islet cell rumours
Features of Friedrich ataxia
Pes cavus
Bilateral cerebellar ataxia
Leg wasting + arefleixa but extensor plantars
Loss of vibration and proprioception
Other: HOCM, high arched palate, optic atrophy
Detention of a stroke
Rapid onset focal neurological defecit of vascular origin lasting >24hrs
Features of TACS - total anterior circulation stroke
All 3 of the following
- contralateral hemiparesis +/- hemisensory defecit
- Homonymous heminsopia
- Higher cortical dysfunction - domiant - dysphagia, nondominant - confusion and constructional apraxia
PACS - partial anterior circuition stroke
2/3 of TACS criteria
Defecit is less dense or incomplete
5 syndrome with lacunar strokes
- Pure Motor - posterior limb of internal capsule
- Pure sensory - posterior thalamus
- Mixed sensimotor - internal capsule
- Dysathria - clumsy hand
- Ataxic hemiparesis - anterior limb of internal capsule
Milland gubler syndrome
Pontine infarct
Features: diplopia, LMN facial nerve palsy, loss of corneal reflex and contralateral hemiplegia
ABCD2 score
Predict stroke risk following TIA Age >60 BP>or equal : 140/90 Clincal features: unilateral weakness(2) speech disturbance without weakness (1) Duration: >1hr(2) 10-59 (1) Diabetes melitus
Score - 6 or more - high risk of Stoke admit
Score - above 4 - specialist clinic within 24hrs
Definition of MS
Chronic inflammatory condition of the CNS characterised by multiple plaques of demyelination disseminated in time and space
Differential of mixed UMN and LMN signs
Motor neurone disease
Friedrich ataxia
Subacute combined degeneration of the cord
Taboparesis
Features of a radial nerve palsy
Inspection: wrist drop
Power: triceps, brachioradailis, extensors in wrist, finger, MCP, thumb
Absent or weak triceps reflex
Loss of sensation over dorsal aspect of the hand at the anatomical snuff box
Features of a medial nerve palsy
Inspection: sign of benediction, thenar wasting
Weakness of LOAF muscles
- thenar: abduction, flexion and oppisiotion of the thumb
- index: flexion of DIP
Median nerve sensation loss
Feature of an ulnar nerve palsy
Inspection: wasting of dorsal interossei and hypothenar emminance, claw hand
Weakness of all muscle of the hand except LOAF
Loss of sensation over medial aspect of hand
LOAF muscles
Lateral two lumbricals
Oppens pollicis
Abductor policis
Flexor policis brevis
Sensory polyneuropathy
Diabetes melitus Alcohol B12 defficancy Chronic renal failure and cancer - paraneoplastic Vasculitis Drugs: isonizid, vincristine
Mainly motor polyneuropathy
Hereditary motor sensory neuropathy/ Charcot Marie tooth
Parenoplastic - lung cancer, renal cell cancer
Lead posising
Acute: GBS and botulinism
Femoral neuropathy/amyotrophy
Painful asymmetric weakeness and wasting of the quads with loss of knee jerks
Differential of muscle fatiguabilty
Myasthenia
Polymyositis
SLE
Botulinism
Investigation in myasthenia
Bedside: spirometery
Bloods
-Abs: anti-Achr, anti- musk
- Tft
EMG: decreased response to continuous stimulus
Tensilon test: improvement with edrophonium
CT mediastinum- thyoma in 10%
Miller fisher
Subtype of GBS
Opthalmoplegia, ataxia and arefleixa
Bells sign
Eye ball roll back on closure
Cause of bilateral facial nerve palsy
Bilateral bells Sarcoidosis GBS Lyme Pseudo palsy: MG, Myotonic dystrophy
Cause of facial palsy
75% idiopathic Bell's palsy Supranuculear: vascular, MS, SOL pontine: vascular, MS, SOL CPA: Vestibular schwannoma, Intra-temporal: Ramsay hunt, cholesteoma Infra-temporal: parotid tumour, trauma Systemic : - neuropathy - DM, Lyme, sarcoid - pseudopalsy: myasthenia gravis
Features of Horners syndrome
Ptosis - partial - superior tarsal muscle
Enopthalmos
Anhydrosis
Small pupil
Causes of an occulomotor palsy
Medical - mononeuritis - diabetes - MS - midbrain infarction - Webers - migraine Surgical - increased ICP - car venous sinus thrombosis - posterior communicating artery anneyeursm
Holmes Addie pupil
Dilated pupil that has no response to light and sluggish response to accomidation
Marcus gun pupil
Dilation on moving light from normal to abnormal eye
Features of optic atrophy
Decreased visual acuity
Decreased colour Vision - paticualry red
Central scotoma
Pale optic disc
RAPD - dilation on moving light from eye from normal to abnormal eye
Causes of optic atrophy
Congenital - lebers hereditary optic neuropathy - HSMN - Frederich ataxia Toxins: alcohol, ethambutol, lead b12 Compression: neoplasia ( optic glioma, pituitary adenoma) glaucoma, pagets Vascular: DM, GCA Inflammatory: optic neuritis Sarcoid Infection: herpes zoster, TB Odema: papilloma Neoplastic infiltration: lymphoma, leukemia
Craniopharyngioma
Benign suprasellar tumour originating from rathke pouch
Leads to ascending visual loss - bitemporal hemianopia
Cause of a complex opthalmoplegia
DM: mononeuritis multiplex
Myasthenia gravis
MS
Thyrotoxicosis
Causes of hearing loss
Conductive: impaired conduction anywhere between auricle and round window
- canal obstruction: wax, foreign body
- TM perforation: trauma, infection
- ossicle defect: otosclerosis, infection
- fluid in the middle ear
Sensireneural hearing loss: defect of cochlear, nerves or brain
- congenital: alports
- acquired: presbyacussis, drugs(gentamicin, vancomycin), infection( measles), tumour - vestibular schwannoma
Definition of dysphonia
Impaired production of voice and sounds
Definition of Dysathria
Impaired articualtion of sounds and words
Defenition of dysphagia
Impairment of language
Nail changes in psoriasis
Discolouration
Pitting
Onycholysis
Subungual hyperkeratosis
5 patterns of psoriatic athritis
- Asymmetric oligoathrtis
- Distal athritis
- Symmetric polyathritis
- Spondylitis
- Athritis mutilans
Cause of onycholysis
Psoriasis
Fungal infection
Trauma
Thyrotoxicosis
Radiologic features of psoriatic athritis
DIP erosions
Osteolysis
Periarticualr new bone formation
Pencil in cup deformity - advanced disease
Occulomotor
Motor : superior, inferior and medial rectus, inferior oblique, levator palpebrae
Parasympathetic: pupillary constriction and accomidation
Trochlear
Superior oblique
Trigeminal
Sensation to, face scalp, cornea, nasal and oral cavities and cranial dura matter
Muscle of mastication
Abducens
Lateral rectus
Facial nerve
Muscle of facial expression and stapedius muscle
Glossopharyngeal
Sensory: pharynx, posters 1/3 of the tongue, Eustachian tube, middle ear, carotid body and carotid sinus
Motor: stylopharygneal muscle - swallowing
Salivation
Vagus
Sensory: phaynx, larynx, oesophagus and external ear, aortic bodies and aortic arch, thoracic and abdominal viscera
Motor: vocal cord, pharynx
Parasympathetic: thoracic and abdominal viscera
Accessory nerve
Sternicliodmastoid and trapezius
Hypoglossal nerve
Intrinsic and extrinsic muscle of the tongue
Cause of sleep disorders in Parkinson’s
Insomnia and frequent waking ➡️ excessive day time sleepiness
- cause by an inability to turn, restless leg syndrome, obstruct sleep apnoea
REM behavioural sleep disorder - loss of movement atonia during sleep leading to violent enactment of dreams
On- off effect - Parkinson’s
Unpredictable fluctuation in motor performance unrelated to timing of dose
Cause of proximal myopathy
- Inflammation: polymyositis, dermatomyositis
- Inherited: muscular dystrophy
- Drugs: Alcohol, statins, steroids
- Pareneoplastic
- Endocrine: Cushing syndrome, acromegaly, thyrotoxicosis, osteomalacia, diabetic amyotrophy
Blood test in peripheral neuropathy
Glucose, HbA1c, FBC, Blood film, LFTS, GGT, U&E, B12, folate, ESR, ANA, ANCA, TFT
