NEURO Flashcards
Define Motor Neuron Disease
Progressive neurodegenerative disorder of cortical, brainstem and spinal motor neurons
Can be lower, upper or both.
What are the subtypes of MND?
Amyotrophic Lateral Sclerosis (ALS) - Upper + Lower
Progressive muscular atrophy - Lower
Progressive Bulbar Palsy - Dysarthria, Dysphagia, Wasted and fasciculated tongue, Brisk jaw jerk reflex.
Primary lateral sclerosis - UMN + brisk reflexes + extensor plantar
What is the epidemiology of MND?
55yo
FH
What is the PC of MND?
Limb weakness
Speech disturbance
Swallowing disturbance
Behavioural changes
What are the findings on examination of MND?
LMN signs:
- muscle wasting
- fasciculations
- flaccid weakness
- hyporeflexia
UMN signs:
- spastic weakness
- extensor plantar response
- hypereflexia
Sensory exam = normal
What investigations do you need for MND?
Bloods = raised CK ESR (raised?) Anti-GM1 ganglioside AB positive EMG Nerve conduction studies (normal) MRI (cord compresion or lesions) Spirometry
What is brown sequard syndrome
Hemisection of the spinal cord
- Ipsilateral paralysis
- Ipsilateral loss of light touch + vibration
- Contralateral loss in pain + temperature
Below the lesion.
78yo man comes in post-collapse
He can follow clear one-step commands
He gets frustrated as he cannot answer questions
He is unable to lift his R hand and R leg
He has an irregularly irregular pulse
What is this? Explain.
He can follow commands but can’t speak properly = Broca’s are is affected. This is expressive dysphasia.
Brocas is on the Left hemisphere = Left sided stroke
R side weaknes = Left sided stroke
Irregularly irregular pulse implies AF which makes pts more prone to emboli hence strokes.
What is Broca’s and Wernicke’s area function
Wernicke’s is responsible for the COMPREHENSION of speech
Broca’s area is related to the PRODUCTION of speech.
What is the most significant risk factor for stroke?
HTN
HTN
HTN
(especially for intracerebrall haemorrhage)
Other RF: smokin, lipids, diabetes. (atherosclerotic stuff), poor diet, lack of exercise,
Unmodifiable RF: age, FH, ethnicity (higher in Blacks and Asians),
What is the stroke risk for AF pts?
5% per year
Can be lowered to 1% if an INR of 2-3 is acheived with warfarin.
not a question
Jerky movements during syncopes DO NOT equate to seizure
It does when its accompanied with other features (incontinence, tonic-clonic, tongue biting, cyanosis and post ictal periods)
What is the first thing you do when a patient on the wards is having a stroke?
NBM (500 SBA’s)
Aspirin and clopidogrel (laz)
What is the absolute contraindication for thrombolysis in a stroke pt?
Onset of symptoms more than 3 hours ago.
Others: (seizures, uncontrolled BP, previous intracranialbleed, LP in the last week, ischaemic stroke or head injury in the last 3 months, active bleeding somewhere else, surgery or major trauma within the last 2 weeks)
from 500sba.
Why would you check the phenytoin levels of an epileptic patient?
Phenytoin levels are mainly ordered to check compliance because its a major cause of acute attacks in known epileptics.
Diabetic patient does not respons to any sensory stimulus on the medial side of the right lower leg on neurlogical examination.
Which dermatome is affected
L4
OE a pt has 5/5 power in all muscle groups in his upper limbs and 0/5 power in all muscle groups in his lower limbs. His CN are intact
Where is this lesion?
Spinal cord
Probably a lesion transecting the cord (either thoracic or lumbar) to result in paraplegia.
OE a pt has 5/5 power in his upper limbs and 0/5 power in his lower limbs
He has a sensory loss up to the umbilicus
CN are intact
Where is the lesion?
T10 - umbilicus dermatome
This pt is paraplegic with a lesion in t10.
Sensory levels help identify the location of the lesion (could be anything from thoracic to lumbar)
Name a few important dermatomal landmarks of the trunk
c4 shoulders t4 nipples t10 umbilicus L1 pockets "L3 knee L4 to the floor"
A light is shone into a patients R eye and it constricts
When the light is shone to the L eye the L eye constricts.
When moved back to the R eye the R eye dilates
What is the diagnosis
Relative Afferent lesion
This is a swinging torch test
When moving the light from the intact left optic nerve to the damaged right optic nerve will result in reduced detection of the stimulus thus causing the right eye to abnormally dilate in response to light.
Which sign/symptom would distinguish Myasthenia Gravis from other neuromoscular junction and muscular diseases.
Fatiguability with use.
State a few differences between Myasthenia Gravis and Lamber Eaton syndrome.
MG: muscles fatigue with use
LE: muscles improve with use
MG: AchReceptor Ab
LE: Anti-VGCC Ab
MG: normal reflexes
LE: hyporeflexia
What is Lambert eaton associated with?
Small cell lung cancer
Autoimmune disease
It’s paraneoplastic subtype of myasthenia gravis.
IX: cxr - for lung cancer.
Forehead sparing indicates what?
Forehead sparing indicates an UMN lesion
Bells palsy is NON-sparing.
