Neuro

Question 1

UMN

Answer 1

Increased tone
Increased reflexes
Decreased power
Extensor plantars

Question 2

UMN Bilateral causes

Answer 2

MS
Cord compression
Cord prolapse
Cord trauma

Question 3

UMN Unilateral causes

Answer 3

Stroke
MS
SOL
Cord prolapse

Question 4

Mixed UMN and LMN features

Answer 4

MND
Ataxia
Subacute combined degeneration of spinal cord - B12
Taboparesis (3tiary syphilis)

Question 5

Acute stroke

Answer 5

Rapid onset focal neurological defect of vascular origin lasting >24hrs

Ischaemic 80%
Haemorrhagic 20%

DDx: HEad injury, Inc./Dec. Glucose, SOL, infection, Drugs

Tx: Thrombolysis if

Question 6

Stroke regions: Total anterior circulation (TACS)

Answer 6

Carotid / MCA and ACA

Hemiparesis and/or hemisensory deficit
Homonymous hemianopia
Higher cortical dysfunction - aphasia(dominant), neglect and apraxia (non-dominant)

Question 7

Stroke regions: Partial anterior circulation (PACS)

Answer 7

Carotid / MCA and ACA

2/3 of TACS symptoms
Homonymous hemianopia
Higher cortical dysfunction

Question 8

Stroke regions: Posterior circulation (POCS)

Answer 8

Vertebrobasilar territory

Cerebellar syndrome
Brainstem syndrome
Homonymous hemianopia

Question 9

Stroke regions: Lacunar (LACS)

Answer 9

Infarct around basal ganglia, internal capsule, thalamus and pons

Pure motor
Pure sensory
Mixed
Dysarthria
Ataxic hemiparesis

Question 10

Non-acute stroke management

Answer 10

MDT
Eating - ng tube, ensure no aspiration
Neurorehab
DVT prophylaxis
Sores

Question 11

Multiple Sclerosis

Answer 11

A chronic inflammatory condition of the CNS characterised by multiple plaques of demyelination disseminated in time and space

Question 12

MS features

Answer 12

Sensory: dys/paraesthesia, dec vibration sense, trigeminal neuralgia
Motor: Spastic weakness, transverse myelitis
Eye: Diplopia, Optic neuritis, Bilateral INO
Cerebellum: Ataxia, scanning dysarthria, falls
GI: Swallowing disorders, constipation
Sexual/GU: ED + anorgasmia, retention, incontinence

Question 13

MS management

Answer 13

MDT

Methylpred 1g IV for 3 days - acute attack

Prevent relapse:
Disease modifying - IFN-B, Glatiramer
Biologics - Alemtuzumab (anti CD52)

Symptoms:
Modafinil - fatigue
SSRI - depression
Amitryptylline, gabapentin - pain
Physio, botulinum - spasticity
Oxybutynin - incontinence
Sildenafil - ED
Clonazepam - tremor

Question 14

Motor Neuron Disease - types

Answer 14

Amyotrophic lateral sclerosis: 50%
Corticospinal tracts - UMN + LMN signs, fasiculations

Progressive bulbar palsy: 10%
CN 9-12 - bulbar palsy

Progressive muscular atrophy: 10%
Anterior horn cell lesion - LMN only
Distal to proximal
Better prog than ALS

Primary lateral sclerosis: 30%
Loss of Betz cells in motor cortex - UMN mainly
Marked spastic leg weakness and pseudobulbar palsy
No cognitive decline

Question 15

Balbar palsy

Answer 15

Nasal speech lacking in modulation and difficulty with all consonants

Tongue is atrophic and shows fasciculations.

Dribbling of saliva.
Weakness of the soft palate, examined by asking the patient to say aah.

The jaw jerk is normal or absent.

The gag reflex is absent.

In addition, there may be lower motor neuron lesions of the limbs.

The ocular muscles are spared and this differentiates it from myasthenia gravis.

Question 16

LMN signs

Answer 16

Fasiculations
Hypotonia
Hyporeflexia
Wasting

Question 17

LMN - bilateral, symmetrical and distal

Answer 17

HMSN - Charcot Marie tooth
Paraneoplastic
Lead poisoning
GBS, Botulism

Question 18

LMN - bilateral, symmetrical and proximal

Answer 18

Inherited: Muscular dystrophy
Inflammation: Polymyositis, dermatomyositis
Endocrine: Cushings, Acromegaly, Thyrotoxicosis, Osteomalacia
Drugs: Alcholo, steroids, statins
Malignancy: paraneoplastic

Question 19

LMN - unilateral

Answer 19

Old polio - single limb and no sensory signs

Segmental (nerve roots), peripheral (mononeuropathy) - localised to group of muscles with same supply

Question 20

Foot drop causes

Answer 20

Neuromuscular disease;
Peroneal nerve (common, i.e., frequent) —chemical, mechanical, disease;
Sciatic nerve—direct trauma, iatrogenic;
Lumbosacral plexus;
L5 nerve root (common, especially in association with pain in back radiating down leg);
Cauda equina syndrome, which is cause by impingement of the nerve roots within the spinal canal distal to the end of the spinal cord;
Spinal cord (rarely causes isolated foot drop) —poliomyelitis, tumor;
Brain (uncommon, but often overlooked) —stroke, TIA, tumor;
Genetic (as in Charcot-Marie-Tooth Disease and hereditary neuropathy with liability to pressure palsies);
Nonorganic causes.