neuro Flashcards
what and where are the sensory modalities carried in the spinal cord?
spinothalamic tract: pain temp crude touch dorsal columns: fine touch vibration sensation proprioception
What is a differential if someone has loss of pain, temp and crude touch sensation?
syringomyelia
What is a differential if someone has loss of vibration sensation, proprioception and fine touch sensation?
syphilis
subacute degeneration of spinal cord
what is syringeomylia?
expansion of the spinal cord central canal due to a CSF blockage commonly chiari malformation.
spinothalamic fibers are usually affected - pain, temp, crude touch
usually loss of pain, temp, and crude touch in cape like distirbution of the arms shoulder and upper body.
LMN signs in upper limbs
UMN signs in lower limbs
differentials for bilateral paraparesis
cauda equina, gullian barre (LMN) and acute spinal cord compression but these are all acute and progressive
spastic paresis - UMN lesion bilaterally - bilateral strokes, saggital sinus lesion (only motor signs), syringomyelia (with flaccid paralysis of upper limbs), cord trauma, cord compression due to disc prolapse or tumour or osteophytes, multiple sclerosis!!!!
flaccid paraparesis - think peripheral nerve diseases - these are mainly motor nerve affecting diseases -polio, gullian barre, lead poisoning. If mixed peripheral neuropathy think - diabetes, B12, folate deficiency, alcoholic,
never forget to mention - motor neuron disease and subacute degenration of spinal cord!
what should you never forget for differentials
mutiple sclerosis
diabetes
motor neuron disease
subacute degeneration of spinal cord
differentials for unilateral leg weakness
UMN - stroke, tumour, MS
LMN - root lesion, nerve compression
differentials for a foot drop
common peroneal nerve palsy
stroke
l4/l5 root lesion
motor neuron disease
What are some causes of parkinsonism?
idiopathic Parkinson’s dx
drug induced - lithium, metoclopramide and certain antipsychotics
Parkinson’s plus syndrome - due to mulitsystem atrophy, progressive supranuclear palsy, corticobasal degeneration and lewy body dementia.
repeated head trauma such as in boxing e.g. mohammad ali
treatments used in parkinson’s dx
L-dopa dopamine agonists anticholenergics glutamate antagonists MAO-B inhibitors
what are some conditions that present similarly to parkinson’s?
benign essential tremor
Wilson’s disease - tremor, Kaiser-fleischer rings, physciatric illness and personality changes, hepatotoxicity,
What are some long term complications of L-dopa use?
Dyskinesia increasingly worse parkinsonism dysphagia dementia autonomic neuropathy
How to differentiate between essential tremor and Parkinson’s tremor?
Parkinson’s is at rest while essential is usually when your hands are doing something (not at rest)
Parkinson’s usually has other assosciated features such as stooped posture, shuffling gait, mask-like face etc, while essential tremor usually does not have other neurological features
Parkinson’s can affect the hands, chin, and legs, while essential tremor usually only affects hands and maybe head and voice.
How to differentiate between Parkinson’s dx and Parkinson’s plus?
“Parkinson plus” syndromes refer to syndromes which look like atypical PD, but also include additional abnormalities that are not seen in PD. These include: abnormalities of eye movements, gait “ataxia” (wide based walking that looks like the walk of someone who is drunk or walking on a boat), dystonia (abnormal postures), severe problems with low blood pressure on standing,
difference bewteen benign essential tremor and exaggerated physiological tremor?
For essential tremor, the cause is unknown but is likely genetic. With physiological tremor causes can be anxiety, medications such as salbutamol, hyperthyroidism, fever.
For essential tremor, it can be resolved with alcohol.
on examination essential tremor will be postural and action related while phsyiolgic is usually only postural.
For both the management is beta blockers and if that is contraindicated then gabapentin. For physiological tremor the cause should be ruled our before prescribing these meds.
