Neuro Flashcards
What are the common symptoms of GCA?
Severe headache in temporal area
Jaw claudication
Visual problems (sudden blindness in 1 eye)
What type of headache is associated with polymyalgia rheumatica symptoms?
What are these ‘symptoms’ of polymyalgia rheumatica?
Temporal Arteritis
Inflammation of the muscles and joints affecting the shoulder, neck, hip as well as associated muscles
What age range and sex are affected by MS?
Symptoms are first seen between ages of 20-40
F : M
2 : 1
Twice as likely
What are the most common symptoms of MS?
MS is MONOSYMPTOMATIC. Only one symptom AT A TIME.
Blurred vision Numbness and tingling Muscle weakness and tightness Muscle pain Tiredness Mobility and balance issues Bladder and bowel problems
What is the standard treatment and duration of treatment for an MS relapse?
What are some rare and common, acute and chronic side effects of this treatment?
High Dose (1g/d) Methylprednisolone 3-5 days helps shorten the relapses.
Max use: 2x per year
Acute Side Effect: GI irritation (give PPI), agitation, restlessness, insomnia.
Chronic Side Effect: Osteoporosis, Weight Gain, Diabetes, Infection risk
Rare Side Effect: Avascular Necrosis of the hip can occur with ST High Dose steroid use.
What pharmacological and non-pharmacological treatments can be given to reduce muscle spasms and spasticity in MS?
Physiotherapy
If severe: muscle relaxants such as BACLOFEN or GABAPENTIN
What side-effects may interferon beta cause?
Mild flu-like symptoms for 48 hours post injection
i.e. headaches, chills, mild fever
Who is interferon beta NOT suitable for?
Anyone under the age of 18
Women who are PREGNANT or BREASTFEEDING
Men or Women who are trying for a baby. Must stop 3 months prior.
What questions should you ask in a patient suspected of sensory ataxia in order to further confirm a diagnosis?
Any numbness, pins and needles in the limbs or trunk? (sensory disturbances)
Do you find your balance is worse in the dark or when you’re not looking at your feet?
Do you find you fall over when you close your eyes to wash your face in the sink or in the shower? (Rhomberg’s)
Do you find you get tingling sensations when you look up (extension) or down (flexion) or get a tight-band like sensation around your torso? Do you feel you need to go to the toilet more often?
(both these questions for sensory ataxia due to a spinal cord lesion)
What questions or symptoms may help you differentiate Vertigo and Nausea caused by vestibular pathology vs cerebellar pathology?
Vestibular: Room spinning around, worse on head movement, nausea (+/- vomiting), hearing loss (+/- tinitus)
Cerebellar: Unsteadiness when walking, poor coordination of the arms, change in their voice (staccato dysarthria).
Does one side of the body feel worse than the other? If unilateral pathology (i.e. cerebellar stroke), patient will complain of ipsilateral (same side) arm and leg ataxia.
What is the criteria for ‘disease-modifying treatment’ for MS?
Patients who have had two or more relapses over a two year period
What is the role of oxybutinin and gabapentin in patients with MS?
Oxybutinin is an Anticholinergic drug used to combat the effects of bladder urgency and frequency. However a side effect is that it results in incomplete bladder emptying leaving a pool of residual urine left post micturition.
Gabapentin is an anticonvulsant which is also used as neuropathic pain which is common in MS.
What are the cardinal signs of optic neuritis?
Pain on eye movement
Blurring of vision
Red colour desaturation
What does the Romberg’s sign test for?
Sensory ataxia (i.e. spinal cord demyelination)
Extrapyramidal symptoms may indicate a lesion in which area of the brain?
The basal ganglia
List the red flags for headache
Sudden onset high severity (SAH)
Fever, neck stiffness (MENINGISM)
New onset focal neurological, cognitive or personality deficit (STROKE)
Trauma within the last 3 months
Halos around lights, worse in the dark (AACG)
Triggered by cough, sneeze, exercise or changes in posture (RAISED ICP)
Associated with jaw claudications and scalp tenderness (GCA)
What are the three P’s of syncope?
Posture - Upright only
Provocation - Pain, Dehydration, Emotion
Prodrome* - Lightheadedness, dizzy, ringing in ears, visual blurring
*NB: Syncopy w/o prodromal features may indicate a cardiogenic cause. Refer!
When performing a neuro exam, a lesion in which region may result in a pronator drift?
What type of lesion is this? UMN or LMN
Pyramidal tracts, therefore an UMN lesion
How might an extrapyramidal lesion present in a neurological examination?
‘Lead pipe’ RIGIDITY
Non-velocity dependent
Parkinsonian features
Stiffness throughout the movement
How might a pyramidal lesion present in a neurological examination?
Velocity-dependent spasticity
‘Clasped knife’
Rx for Guillain-Barre Syndrome?
IV Immunoglobulins
Plasma exchange
What are the symptoms of Myasthenia Gravis?
Ptosis
Proximal fatigable weakness (exercise)
Diplopia
Bulbar failure (swallowing and chewing)
What are the first line medications for epilepsy?
Valproate Carbamazepine Phenytoin Phenobarbital Primidone
What are the second line medications for epilepsy?
Lamotrigine Levitiracetam Topiramate Tiagibine Vigabitrin Gabapentin
What are some common side effects of anti-epileptic medications?
Nausea Abdo pain Drowsiness Dizziness Irritability and Mood Changes
Describe the pattern of symptoms in Brown-Sequard Syndrome
Lateral disruption to one side of the spinal cord
Therefore
- CONTRAlateral loss of PAIN and TEMP
- IPSIlateral loss of LIGHT TOUCH, PROPRIOCEPTION & VIBRATION
Name some causes of Brown-Sequard Syndrome
Trauma
Pressure from vertebral metastases
Cervical spondylosios
Transverse Myelitis & MS
What is transverse myelitis?
Transverse Myelitis is an inflammatory disorder of the spinal cord that is diverse in character.
It is characterised by acute symptoms of
- Motor weakness
- Sensory impairment
- Autonomic dysfunction
MRI may find white matter hyperintensity lesions within the spine. CSF analysis will show pleocytosis (raised lymphocytes in CSF)
Name 6 Sx of Cauda Equina Syndrome
Back pain RADIATING down the legs Reduced SPHINCTER tone Saddle ANAESTHESIA (sensory loss) Faecal INCONTINENCE and Urinary RETENTION Reduced REFLEXES in legs FLACCID PARALYSIS of the legs
Which nerve roots contribute to the sciatic nerve?
L3-L4
What are the causes of foot drop?
Common Peroneal Injury L4-L5 nerve root lesion Stroke MND Charcot-Marie-Tooth syndrome
Which dermatome covers the dorsal surface of the big toe?
L5
Also covers bottom 2/3rd of knee
Which nerve roots supply ankle jerk?
S1
What are some Ddx for unilateral leg weakness? (UMN vs LMN)
UMN
- Stroke
- MS
- Tumor
LMN
- Root lesion
- Nerve Lesion
What are some causes of a positive Romberg’s Test?
+VE therefore Sensory Ataxia
Dorsal Column Loss
- Syphilis
- SCDC
- MS
Sensory peripheral neuropathy
What muscles in the hand are supplied by the median nerve?
Medium sized slices of LOAF
L - lateral two lumbrical (1 & 2)
(thenar eminence)
O - opponens pollices
A - adductor pollicis brevis
F - flexor pollicis brevis
Name 3 conditions associated with CARPEL TUNNEL syndrome
Trauma
Acromegaly (enlarged bones press on nerve)
Pregnancy
Diabetes (neuropathy?)
Rheumatoid Arthritis (inflammation of nerve)
Hypothyroidism
What is a common site of trauma to the ULNAR nerve?
Cubital Tunnel of the Elbow
Guyon’s Canal of Wrists
RADIAL nerve receives fibres from which nerve root?
C5-T1
What is claw hand and sign of benediction and what is the difference between the two in signs and aetiology?
Claw hand is weakened flexion of 4th & 5th phalanges due to an ULNAR NERVE PALSY distally (around the wrist i.e. Guyon’s Canal Compression) causing wasting of the
- hypothenar eminence,
- medial 2 lumbricals,
- interossei
- wrist flexors
There is an inability to fully extend the fourth and fifth fingers due to wasting of the interossei and lumbricals.
Sign of BENEDICTION is a MEDIAL NERVE PALSY where, when asked to make a fist, the 1st 2nd and 3rd phalanges are unable to flex whereas the 4th and 5th can. There are no issues with extension of the hand.
https://youtu.be/GyqaKGg3HmM
Which nerve may be involved in a patient with a winged scapula and which nerve roots are affected in this?
Long thoracic nerve supplied by nerve roots C5 C6 C7
What are some differentials for ophthalmoplegia?
Myasthenia Gravis Cranial nerve palsy Graves disease Wenickes encephalopathy (upward gaze X) Progressive supranuclear palsy (vertical gaze)
