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AS / OS Paces RT > Neuro core > Flashcards

Neuro core Flashcards

1
Q

inattention to one hand=

A

contralateral parietal lesion.

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2
Q

Mononuclear field loss =

A

intraocular pathology or ipsilateral optic nerve lesion

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3
Q

Bitemporal hemianopia =

A

optic chiasm compression

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4
Q

. Left/right homonymous hemianopia =

A

contralateral optic tract/radiation lesion or occipital cortex lesion if macular sparing.

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5
Q

Afferent pupillary defect –

A

i.e. affected eye not sensing light – both pupils symmetrical but no constriction when light shone in affected eye CN2 lesion

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6
Q

. Efferent pupillary defect – lesion.

A

affected pupil persistently dilated, other pupil reactive to light in both eyes CN3

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7
Q

RAPD –

A

if more dilation direct vs consensual then relative defect i.e. partial optic nerve lesion

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8
Q

Partial ptosis –

A

Horner’s syndrome

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9
Q

complete ptosis

A

CN3 lesion

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10
Q

nyastagmus on lateral gaze H test

A

– cerebellar lesion

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11
Q

straight up eye hold fatiguable

A

– m gravis

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12
Q

CN4 lesion

A

CN4 lesion – can’t move eye inferiorly on medial gaze

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13
Q

CN6 lesion

A

can’t look laterally

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14
Q

forehead sparing

A

occurs because the upper face has bilateral UMN innervation

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15
Q

Weber hearing test positive

A

either conductive deficit on louder side or sensinerual on quieter side

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16
Q

Rinne test positive

A

– i.e. can’t hear air conduction after bone ended – conductive deficit.

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17
Q

uvular deviation

A

deviates away from side of CNX lesion

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18
Q

tongue deviation

A

to side of lesion

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19
Q

gaits

A

– hemiplegic (unilateral UMN), spastic (bilateral UMN), foot drop (LMN), ataxic (cerebellar), waddling (myopathic), festinating (Parkinsonian)

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20
Q

Romberg’s +ve

A

sensory ataxia due to proprioceptive defect (swaying)

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21
Q

upper motor neurone lesion

A

– increased tone, spasticity, Babinksi +ve (big toe extends), brisk reflexes, upgoing plantars, weakness

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22
Q

lower motor neurone lesion

A

muscle wasting (e.g. foot guttering), fasciculations, reduced tone, clonus (5+ beats), reduced reflexes, weakness

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23
Q

MRC grades

A

– 5 full 4 some resistance 3 gravity only 2 without grav 1 flicker 0

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24
Q

lower limb myotomes

A 
hip flexion L2/3
knee extension L3/4
hip extension L4/5 ankle dorsiflexion L4/5
knee flexion L5/S1
ankle plantarflexion S1/S2
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25
Q

upper limb myotomes

A

– shoulder abduct C5, elbow flex C6, elbow extend C7, wrist extend C7, finger extend C7, finger flex C8, finger abduct T1, thumb abduct T1

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26
Q

reflexes nerve roots

A

– patellar L3/4, ankle S1/2 // biceps C5/6, supinator C4/6, triceps C7

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27
Q

sensation testing neuro

A

distal loss -> move wool up in 3 lines in turn. light touch – dorsal column – don’t stroke, just touch. Pinprick – pain – spinothalamic – ask also if it feels sharp not just present. Dorsal columns – proprioception + vibration too. 128Hz, say when stops. Temp – use hands as rough guess, cold tuning fork.

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28
Q

pronator drift

A

palms upwards, eyes closed. Drifts upwards = cerebellar, distal flexion + drift = pyramidal weakness.

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29
Q

dermatomes UL

A

= C5 upper outer arm, C6 thumb, C7 middle fingertip,C8 little finger, T1 medial forearm, T2 medial biceps

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30
Q

dermatomes lower limb

A

= L2 inner thigh just below leg join L3 medial knee side L4 medial ankle L5 big toe S1 little toe

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31
Q

Pyramidal weakness – unilateral UMN lesion

A

– brain through to cord pathology. Intracranial – stroke,SOL (hemisensory loss), brainstem, spinal cord – disc, inf, tumour, MS, trauma (sensory level segmental sensory loss)

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32
Q

Pyramidal weakness – bilateral UMN lesion

A

MS, MND, myelopathy, bs stroke

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33
Q

mononeuritis multiplex

A

– triggered by vasculitides, AI, Lyme/HIV, diabetes. Stepwise progression with 2x peripheral nerves of different sites affected.

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34
Q

radiculopathy

A

dermatomal sensory loss -> clear spinal level + pathology

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35
Q

plexus damage

A

multiple dermatomes served by plexus affected

36
Q

median n palsy

A

median = CTS, distal radius #, forearm injuries, ulnar = elbow compression / #

37
Q

radial n palsy

A

axillary trauma/compression e.g. crutches, hum shaft #, can be elbow too

38
Q

axillary n palsy

A

shoulder disloc, surg NOH#

39
Q

common peroneal n palsy

A

= plaster cast compression or trauma (lose outer leg sense and have foot drop)

40
Q

bilateral LMN lesion - distal polyneuropathy

A

distal polyneuropathy – Alcohol, B12/thiamine deficient, CMT/ca Diabetes, drugs, Every vasculitis + some infections

41
Q

distal motor neuropathy

A

lead poisoning, progressive muscular atrophy etc

42
Q

acute flaccid paralysis

A

GBS, cauda equina syndrome, acute transverse myelitis

43
Q

c equina

A

LMN with asymmetrical weakness that is more proximal alongside sensory deficits

44
Q

proximal myopathy/weakness

A

Dystrophies, Endocrine (Cush,thyroid), Neuromusc (MG, LE), inflamm (DMyo),metabolic

45
Q

combined umn lmn SINGS

A

MND (no sensory deficit), dual cause, spinal lesions can cause UMN signs below lesion and LMN above

46
Q

cerebellar disease causes

A

MS, Alcohol, Vascular cause, Inherited, SOL

47
Q

medical CN3 palsy

A

– pupil sparing (microvasc ischaemia diabetes, migraine, MS)

48
Q

surgical CN3 palsy

A

painful (posterior Comm artery aneurysm, carvenous sinus lesion, cancers

49
Q

CN6 palsy cause

A

– ICP, SOL, trauma, diabet

50
Q

unilat facial nerve palsy

A

Bell’s, RH syndrome, SOL, Lyme

51
Q

bilateral facial nerve palsy

A

– GBS, Lyme, sarcoid (if just weak, MG)

52
Q

mutliple random CN palsies

A

multiple CN palsies at same time – any combo = m multiplex, SOL, sarcoid, Lyme

53
Q

CN3-6 palsies

A

CN3-6 = cavernous sinus lesion

54
Q

CN5-8 palsies

A

CN5-8 + cerebellar signs = CPA lesion (e.g. ac neuroma),

55
Q

CN9,10,12 palsies

A

CN9-10 +12 = pseudo/bulbar palsy

56
Q

lateral medullary syndrome

A

Horner’s + CN9,10 palsy + ipsi face, contrabod

57
Q

ophthalamoplegia

A

consider Grave’s, MG, CS lesion, m multi, MS, stroke, SOL

58
Q

ptosis causes

A

– unilat = CN3 palsy, Horner’s bilat = MG, myo dystrophy, neurosyphilis

59
Q

HOrner’s causes

A

– central 1 – MS, SOL, stroke pre-gang 2 – Pancoast, rib, thyroid post-gang 3 – carotid artery dissection

60
Q

visual field defects, all

A

Visual Field Defects – one eye gone = optic n lesion, bitemp hemi = o chiasm, homo hemi = contralat optic tract/rad lesion, homo quadrant = contra parietal lesion (if inferior quad), contra temporal lesion (if superior quad), homo hemi + mac sparing = visual cortex / PCA lesion

61
Q

median n muscles

A

all thumb muscles except adductor pollicis

62
Q

ulnar n muscles

A

intrinsic hand muscles except most of thumb

63
Q

radial n muscles

A

extensors

64
Q

ulnar palsy

A

claw hand

65
Q

wrist drop

A

radial palsy

66
Q

Phalen’s

A

reverse prayer sign

67
Q

dysarthria

A

pseudo/bulbar, cerebellar, MG, stroke

68
Q

dysphasia

A

– expressive motor Broca, receptive Wernicke’s fluent but trash

69
Q

Parkinson’s sings

A

pill rolling tremor, starts distilling, shuffling, festinating gait (accelerating to stop fall), lost arm swing unsteady, stooped, hypomimic face, failed glabellar tap, hypophonia, lead pipe + cogwheel rigidity, eyes issues suggest Parkinson’s plus syndrome tetrad = tremor, rigidity, bradykinesia, postural instab

70
Q

cerebellar signs

A

– DDDK, dysmetria, atax, nystagmus, int tremor, speech, hypoton

71
Q

stroke 4 main types and features

A

risk factors = age, AF, diabetes, HTN, obese, high chol, smoking, FH. 3 aspects affected = higher function, hemianopia, hemi-losses. TACS = 3/3, PACS = 2/3, lacunar = 1/3 affected. POCS – posterior circ stroke: occipital = isolated homo visual defect, cerebellar (ataxia etc), brainstem (CN palsies, bilat mo/sens deficit). Anterior circulation stroke = ACA or MCA. Posterior stroke= vertebrobasilar/PCA.

72
Q

middle cerebral artery occlusion

A

‘classic stroke’

most common. Visual neglect, contralat lower facial hemiplegia, arm+leg hemiplegia, contralat sensory loss, contralat homo hemianopia.

73
Q

MCA supplies

A

lateral cerebral cortex

i.e. lateral frontal, lateral parietal, superior temporal lobes

74
Q

ACA occlusion

A

ACA occlusion – contralateral hemiplegia + sensory loss leg>arm, apraxia.

75
Q

anterior cerebral artery supplies

A

medial cerebral cortex

i.e. medial frontal (leg homunclus), superiomedial parietal lobe

76
Q

posterior cerebral artery occlusion

A

contralat homo hemianopia, sensory impairment, involuntary movements. (more eye)

77
Q

posterior cerebral supplies

A

supplies posterior cerebral cortex

i.e. occipital lobe, thalamus, inferior temporal lobe

78
Q

stroke with ipsilateral cerebellar signs or CN palsies, anaesthesia to pain/temp

A

think vertebrobasilar artery system stroke

79
Q

neck pain + young + trauma + stroke signs

A

consider carotid artery dissection if anterior circ stroke or vertebral artery diss if posterior signs.

80
Q

ddx of Parkinson’s

A

DDx -Parkinson’s, vascular, multisystem atrophy (cerebellar+autonomic), PSP (vertical gaze palsy, axial rigidity), corticobulbar degen (apraxia/aphasia), LBD (hallucinations). Also consider anti-dopamine drugs, Wilson’s, hydrocephalus

81
Q

management of Parkinson’s

A

Manage – mild = MAOi rasagiliine,

mod – dop agonists ropinirole,

sev – co-careldopa.

MDT approach + OT

82
Q

notable dopamine agonist side effects (ropinirole)

A

for Parkinson’s

SE sleep attacks, impulse control disorders

83
Q

why give combo levodopa i.e. co careldopa

A

the carbidopa bit prevents peripheral enzymes from converting to dopamine

84
Q

SEs of levod0pa

A

wears off pre next dose - more immobile just prior, dyskinesias

85
Q

levodopa

adjunct therapy

A

dopamine agonist - reduces motor complications and dosage of levodopa

MAOi/COMTi reduce ‘off time’

amantadine - for dyskinesias

86
Q

multiple sclerosis define, classify, common defects

A

– chronic inflamm with demyelinating plaques in CNS. Relasping remitting, primary progressive, secondary progressive. Common deficits – optic neuritis/reduced acuity/central scotoma, lateral gaze ophthalamoplegia, cerebellar signs, lower limb sensory loss, urinary symptoms

87
Q

MS inv + manage

A

Inv – MRI brain+cord, evoked potentials, CSF oligoclonal bands. Treat – methylpred acute relapse. Alemtuzumab + symptom relief = gabapentin, anticholinergics /catheter, physio, lifestyle.

AS / OS Paces RT (11 decks)

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