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PACES > Neuro > Flashcards

Neuro Flashcards

1
Q

LMN Signs

A

 Wasting
 Fasciculation
 Hypotonia
 Hyporeflexia

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2
Q

UMN Signs

A

↑tone

Pyramidal distribution of weakness
 Leg: extensors stronger than flexors
 Arm: flexors stronger than extensors

Hyper-reflexia
Extensor plantars

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3
Q

Causes of bilateral LL: spastic paraparesis

A 
Common
 MS
 Cord compression
 Cord Trauma
 CP
Other
 Familial spastic paraparesis
 Vascular: e.g. aortic dissection → Beck’s syndrome
 Infection: HTLV-1
 Tumour: ependymoma
 Syringomyelia
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4
Q

Causes of bilateral LL spastic paraparesis with mixed UMN/ LMN signs

A

MAST

 MND
 Ataxia, Friedrich’s
 SCDC: B12
 Taboparesis

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5
Q

Unilateral LL UMN signs

A 
Hemisphere → Spastic Hemiparesis
 Stroke 
 MS
 SOL
 CP

Hemicord → Spastic Hemiparesis or Monoparesis
 MS
 Cord Compression

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6
Q

Causes of cerebellar syndrome

A

DAISIES

 Demyelination
 Alcohol
 Infarct: brainstem stroke
 SOL: e.g. schwannoma + other CPA tumours
 Inherited: Wilson’s, Friedrich’s, Ataxia, Telangiectasia, VHL
 Epilepsy medications: phenytoin
 System atrophy, multiple

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7
Q

Causes of Parkinsonism

A

Idiopathic PD

Parkinson Plus Syndromes
 Progressive supranuclear palsy 
 MSA
 Lewy Body Dementia
 Corticobasilar degeneration

Multiple infarcts in the substantia nigra

Wilson’s disease

Drugs: neuroleptics and metoclopramide

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8
Q

Main symptoms of PD

A

Bradykinesia
Pill rolling tremor
Rigidity
Postural instability

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9
Q

Mx of PD

A

General
 MDT: neurologist, PD nurse, physio, OT, social worker,
GP and carers
 Assess disability
 e.g. UPDRS: Unified Parkinson’s Disease Rating Scale
 Physiotherapy: postural exercises
 Depression screening

Specific
 L-DOPA + Carbidopa or benserazide 
 Da agonists: ropinerole, pramipexole 
 Apomorphine: SC rescue drug
 MOA-B inhibitors: rasagiline
 COMT inhibitors: tolcapone
 Amantidine
 Anti-muscarinics: procyclidine

Adjuncts
 Domperidone: nausea
 Quetiapine: psychosis
 Citalopram: depression

Other
 Deep brain stimulation
 Basal ganglia disruption

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10
Q

Signs of MSA

A

 Autonomic dysfunction: postural hypotension
 Parkinsonism
 Cerebellar ataxia

If autonomic features predominate, may be referred to as Shy Drager Syndrome

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11
Q

Features of Progressive supranuclear palsy

A

 Postural instability → falls
 Vertical gaze palsy
 Pseudobulbar palsy: speech and swallowing problems
 Parkinsonism

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12
Q

Signs of cerebellar dysfunction

A 
 Dysdiadochokinesia: hands and feet
 Ataxia 
 Nystagmus + Rapid Saccades
 Intention tremor and dysmetria
 Slurred speech
 Hypotonia
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13
Q

What is lateral medullary syndrome?

A

Occlusion of vertebral artery or PICA

Ipsilateral: ataxia, nystagmus, dysphagia, facial numbness, cranial nerve palsy e.g. Horner’s

contralateral: limb sensory loss

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14
Q

Features of cord compression

A

Pain
 Local, deep
 Radicular

Weakness
 LMN @ level
 UMN below level

Sensory level
Sphincter disturbance

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15
Q

Signs of a TACS (MCA and ACA territory)

A

 Hemiparesis and/or hemisensory deficit
 Homonymous hemianopia
 Higher cortical dysfunction (e.g. dominant: aphasia)

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16
Q

Features of a lacunar stroke

A

Infarct around basal ganglia, internal capsule, thalamus and pons

 Pure motor: post. limb of internal capsule
 Pure sensory: post. thalamus (VPL)
 Mixed sensorimotor: internal capsule
 Dysarthria / clumsy hand
 Ataxic hemiparesis: ant. limb of internal capsule

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17
Q

Features of Posterior circulation stroke?

A

 Cerebellar syndrome
 Brainstem syndrome
 Homonymous hemianopia

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18
Q

Classifications of MS

A

 Relapsing-remitting: 80%
 Secondary progressive
 Primary progressive: 10%
 Progressive relapsing

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19
Q

Definition of LMN lesion

A

Pathology anywhere from anterior horn to muscle itself

20
Q

Causes of proximal myopathy

A

Inherited: muscular dystrophy

Inflammation
 Polymyositis
 Dermatomyositis

Endocrine
 Cushing’s Syndrome 
 Acromegaly
 Thyrotoxicosis
 Osteomalacia
 Diabetic Amyotrophy

Drugs: alcohol, statins, steroids

Malignancy: paraneoplastic

21
Q

Causes of peripheral polyneuropathy

A 
Mainly Sensory
 DM
 Alcohol
 B12 deficiency
 Chronic Renal Failure and Ca (paraneoplastic)
 Vasculitis
 Drugs: e.g. isoniazid, vincristine
Mainly Motor
 Hereditary Motor & Sensory Neuropathy / Charcot Marie Tooth
 Paraneoplastic: Ca lung, RCC
 Lead poisoning
 Acute: GBS and botulism
22
Q

In a patient with PD, how can you assess cogwheel rigidity?

A

Froment’s maneuver

  • Ask them to do something with the other hand while you assess the hand with PD
23
Q

What does it mean if a patient has a pronator drift?

A

The presence of pronator drift indicates a contralateral pyramidal tract lesion.

i.e. a problem between the cerebral cortex and the spinal cord

24
Q

What is the difference between spasticity and rigidity?

A

Spasticity is associated with pyramidal tract lesions (e.g. stroke) and rigidity is associated with extrapyramidal tract lesions (e.g. Parkinson’s disease).

Spasticity is velocity-dependent whereas rigidity is velocity independent

25
Q

Myotomes assessed in the upper limb examination

A 
C4: shoulder shrugs
C5: shoulder abduction and external rotation; elbow flexion
C6: wrist extension
C7: elbow extension and wrist flexion
C8: thumb extension and finger flexion
T1: finger abduction
26
Q

Myotomes assessed in the lower limb examination

A 
L2: hip flexion
L3: knee extension
L4: ankle dorsiflexion
L5: big toe extension
S1: ankle plantarflexion
S4: bladder and rectum motor supply
27
Q

What is a myotome?

A

A myotome is a group of muscles innervated by a single spinal nerve

28
Q

What is a bulbar palsy?

A

Impairment of the function of the cranial nerves 9, 10, 11 and 12, which occurs due to a LMN lesion in the medulla oblongata or from lesions of the lower cranial nerves outside the brainstem

29
Q

What is a pseudobulbar palsy?

A

Impairment of cranial nerves 5, 7, 10, 11 and 12 due to UMN lesion

30
Q

Signs of bulbar palsy?

A

Fasciculating tongue
Tongue atrophy
Absent jaw jerk

31
Q

Causes of bulbar palsy?

A

MND
GBS
MG
Central pontine myelinolysis

32
Q

Signs of pseudobulbar palsy?

A

Inability to protrude tongue
Dysarthria/slurred speech
Increased jaw jerk

33
Q

Causes of pseudobulbar palsy?

A

Parkinson’s disease

Parkinson’s plus syndromes e.g. PSP

34
Q

Causes of an UMN facial nerve palsy?

A

SOL
Stroke
MS

35
Q

Causes of a LMN facial nerve palsy?

A 
Compressive:
Parotid tumours
Sarcoid
TB
Cerebellar pontine angle lesions
Neurological:
Bell's palsy
MG
GBS
Lyme disease
Ramsay Hunt syndrome
36
Q

Causes of mioisis?

A 
Medications - opioids, anticholinesterases, pilocarpine
Horner's syndrome
Brainstem stroke
Argyll Robertson pupil
Cluster headache
37
Q

Causes of mydriasis?

A

Medications - tropicamide, anticholinergics (atropine), phenylephrine
Surgical 3rd N palsy - posterior communicating artery aneurysm

38
Q

Causes of Horner’s syndrome?

A

Pre-ganglionic (superior cervical ganglion):
Pancoast tumour
Cervical rib

Central (also anhydrosis):
Stroke
Cluster headache
SOL
MS

Post-ganglionic (also anhydrosis):
Carotid artery dissection/aneurysm

39
Q

Features of 3rd N palsy?

A

eye is deviated ‘down and out’
ptosis
absent light reflex but preserved consensual constriction in other eye
pupil may be dilated and painful (‘surgical’ third nerve palsy)

40
Q

Causes of 3rd N palsy?

A

DM
Vasculitis: temporal arteritis, SLE
Raised ICP: false localising sign* due to uncal herniation through tentorium
Posterior communicating artery aneurysm (most common cause of surgical 3rd N)
Cavernous sinus thrombosis
Weber’s syndrome: ipsilateral third nerve palsy with contralateral hemiplegia (caused by midbrain strokes)
Systemic: Amyloid, MS

41
Q

Causes of bilateral facial nerve palsy?

A 
sarcoidosis
Guillain-Barre syndrome
Lyme disease
bilateral acoustic neuromas (NF2)
Bell's palsy (since it is relatively common it accounts for up to 25% of cases f bilateral palsy, but this represents only 1% of total Bell's palsy cases)
42
Q

Causes of ataxic gait

A 
P - Posterior fossa tumour
A - Alcohol
S - Multiple sclerosis
T - Trauma
R - Rare causes
I - Inherited (e.g. Friedreich's ataxia)
E - Epilepsy treatments
S - Stroke
43
Q

Signs you might see O/E in MS?

A

Eyes:
optic neuritis: common presenting feature
optic atrophy
Uhthoff’s phenomenon: worsening of vision following rise in body temperature
internuclear ophthalmoplegia

Sensory:
pins/needles
numbness
trigeminal neuralgia
Lhermitte's syndrome: paraesthesiae in limbs on neck flexion

Motor
spastic weakness: most commonly seen in the legs

Cerebellar
ataxia: more often seen during an acute relapse than as a presenting symptom
tremor

44
Q

Bamford stroke classification of TACS?

A

All 3 must be present

  1. unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
  2. homonymous hemianopia
  3. higher cognitive dysfunction e.g. dysphasia
45
Q

Bamford stroke classification of PACS?

A

2 must be present

  1. unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
  2. homonymous hemianopia
  3. higher cognitive dysfunction e.g. dysphasia
46
Q

Bamford stroke classification of lacunar stroke?

A

presents with 1 of the following:

  1. unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three.
  2. pure sensory stroke.
  3. ataxic hemiparesis
47
Q

Bamford stroke classification of posterior stroke?

A

presents with 1 of the following:

  1. cerebellar or brainstem syndromes
  2. loss of consciousness
  3. isolated homonymous hemianopia

PACES (13 decks)

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