Neuro

Question 1

Loss of foot dorsiflexion

Sensory Loss of dorsum of foot

Which disc lesion?

Is lumbar disc prolapse pain worse when sitting or standing?

Mx of disc prolapse?

Answer 1

L5 Disc Prolapse

Disc prolapse pain is usually worse when sitting than standing

Management:

Analgaesia, Physiotherapy, Core exercises, Stretches

MRI referral if symptoms persist

Question 2

Sensory loss over anterior thigh

Weak quadriceps

Reduce knee reflex

positive femoral stretch test

Answer 2

L3 nerve root compression

Question 3

Sensory loss anterior aspect of knee

Weak quadriceps

Reduce knee reflex

Positive femoral stretch test

Answer 3

L4 Nerve root compression

Question 4

Sensory loss dorsum of foot

Weakness in foot and big toe dorsiflexion

Reflees intact

Positive sciatic nerve stretch test

Answer 4

L5 Nerve root compression

Question 5

Sensory loss posterolateral aspect of leg and lateral aspect of foot

Weakness in plantar flexion of foot

Reduced ankle reflex

Positive sciatic nerve stretch test

Answer 5

S1 Nerve root compression

Question 7

Describe:

Femoral Nerve Stretch Test

Sciatic Nerve Stretch Test

Answer 7

Femoral Nerve Stretch (Mackiewz sign)

Patient in prone, Flex knee and extend hip

Positive - pain in anterior thigh

Sciatic Nerve Stretch (Lasegue sign)

Patient lies supine, Leg raised straight to 90 degrees

Positive - pain inbetween 30-70 degrees in sciatic distribution

(nb can increase sensitivity by lifting head and dorsiflexing feet)

Question 8

How often is CT negative in SAH?

When is it best to do the LP for SAH?

What are you specificially testing for?

Answer 8

CT Negative in 5% SAH

Best to do LP 12 hours after symptom onset to allow time for XANTHACHROMIA to develop.

Mx - No clear evidence for surgery/delayed intervention. Nimodipine used (thought to reduce neurological deficit through prevention of subsequent vasospasm)

Question 10

L5 Raciculopathy vs Common peroneal neuropathy

Answer 10

Remember that L5 Radiculopathy (Sciatica)

-Affects the tibial nerve which is responsible for INVERSION of the foot.

Inversion (tibialis posterior) is spared in common peroneal neuropathy

Question 11

EMG

Low amplitude ?

Low velocity?

Answer 11

Amplitude - Axonal loss

Velocity - Demyelination

Question 13

Reflexes and their nerve roots

Answer 13

Corneal - Afferent CNV/ Efferent CNVII. Both eyes close

Jaw Jerk - CNVII

Biceps - C5

Brachioradialis - C6

Triceps - C7

Finger - C8 (Pt. rests fingers on your hand, strike your hand from underneath)

pectoral reflex - Looks for upper cervical pathology (C2-C4). Finger in pectoral groove and strike finger

hoffman’s reflex - Flick middle finger. Flexion indicates UMN lesion above T1

Lower limb

Knee - L3/L4

Ankle - S1

Adductor (medial side) of knee) - Obturator nerve (L2/L4)

Crossed aductor - opposite leg patellar tap

Babinksi reflex - L5/S1

Question 14

What is a spreading reflefx

Answer 14

The spreading of reflex activity to other muscles not innervated by that nerve root - hyperrexcitability.