Neuro core Flashcards
1
Q
inattention to one hand=
A
contralateral parietal lesion.
2
Q
Mononuclear field loss =
A
intraocular pathology or ipsilateral optic nerve lesion
3
Q
Bitemporal hemianopia =
A
optic chiasm compression
4
Q
. Left/right homonymous hemianopia =
A
contralateral optic tract/radiation lesion or occipital cortex lesion if macular sparing.
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
6
Q
. Efferent pupillary defect – lesion.
A
affected pupil persistently dilated, other pupil reactive to light in both eyes CN3
7
Q
RAPD –
A
if more dilation direct vs consensual then relative defect i.e. partial optic nerve lesion
8
Q
Partial ptosis –
A
Horner’s syndrome
9
Q
complete ptosis
A
CN3 lesion
10
Q
nyastagmus on lateral gaze H test
A
– cerebellar lesion
11
Q
straight up eye hold fatiguable
A
– m gravis
12
Q
CN4 lesion
A
CN4 lesion – can’t move eye inferiorly on medial gaze
13
Q
CN6 lesion
A
can’t look laterally
14
Q
forehead sparing
A
occurs because the upper face has bilateral UMN innervation
15
Q
Weber hearing test positive
A
either conductive deficit on louder side or sensinerual on quieter side
16
Q
Rinne test positive
A
– i.e. can’t hear air conduction after bone ended – conductive deficit.
17
Q
uvular deviation
A
deviates away from side of CNX lesion
18
Q
tongue deviation
A
to side of lesion
19
Q
gaits
A
– hemiplegic (unilateral UMN), spastic (bilateral UMN), foot drop (LMN), ataxic (cerebellar), waddling (myopathic), festinating (Parkinsonian)
20
Q
Romberg’s +ve
A
sensory ataxia due to proprioceptive defect (swaying)
21
Q
upper motor neurone lesion
A
– increased tone, spasticity, Babinksi +ve (big toe extends), brisk reflexes, upgoing plantars, weakness
22
Q
lower motor neurone lesion
A
muscle wasting (e.g. foot guttering), fasciculations, reduced tone, clonus (5+ beats), reduced reflexes, weakness
23
Q
MRC grades
A
– 5 full 4 some resistance 3 gravity only 2 without grav 1 flicker 0
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
25
upper limb myotomes
– shoulder abduct C5, elbow flex C6, elbow extend C7, wrist extend C7, finger extend C7, finger flex C8, finger abduct T1, thumb abduct T1
26
reflexes nerve roots
– patellar L3/4, ankle S1/2 // biceps C5/6, supinator C4/6, triceps C7
27
sensation testing neuro
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.
28
pronator drift
palms upwards, eyes closed. Drifts upwards = cerebellar, distal flexion + drift = pyramidal weakness.
29
dermatomes UL
= C5 upper outer arm, C6 thumb, C7 middle fingertip,C8 little finger, T1 medial forearm, T2 medial biceps
30
dermatomes lower limb
= L2 inner thigh just below leg join L3 medial knee side L4 medial ankle L5 big toe S1 little toe
31
Pyramidal weakness – unilateral UMN lesion
– brain through to cord pathology. Intracranial – stroke,SOL (hemisensory loss), brainstem, spinal cord – disc, inf, tumour, MS, trauma (sensory level segmental sensory loss)
32
Pyramidal weakness – bilateral UMN lesion
MS, MND, myelopathy, bs stroke
33
mononeuritis multiplex
– triggered by vasculitides, AI, Lyme/HIV, diabetes. Stepwise progression with 2x peripheral nerves of different sites affected.
34
radiculopathy
dermatomal sensory loss -> clear spinal level + pathology
35
plexus damage
multiple dermatomes served by plexus affected
36
median n palsy
median = CTS, distal radius #, forearm injuries, ulnar = elbow compression / #
37
radial n palsy
axillary trauma/compression e.g. crutches, hum shaft #, can be elbow too
38
axillary n palsy
shoulder disloc, surg NOH#
39
common peroneal n palsy
= plaster cast compression or trauma (lose outer leg sense and have foot drop)
40
bilateral LMN lesion - distal polyneuropathy
distal polyneuropathy – Alcohol, B12/thiamine deficient, CMT/ca Diabetes, drugs, Every vasculitis + some infections
41
distal motor neuropathy
lead poisoning, progressive muscular atrophy etc
42
acute flaccid paralysis
GBS, cauda equina syndrome, acute transverse myelitis
43
c equina
LMN with asymmetrical weakness that is more proximal alongside sensory deficits
44
proximal myopathy/weakness
Dystrophies, Endocrine (Cush,thyroid), Neuromusc (MG, LE), inflamm (DMyo),metabolic
45
combined umn lmn SINGS
MND (no sensory deficit), dual cause, spinal lesions can cause UMN signs below lesion and LMN above
46
cerebellar disease causes
MS, Alcohol, Vascular cause, Inherited, SOL
47
medical CN3 palsy
– pupil sparing (microvasc ischaemia diabetes, migraine, MS)
48
surgical CN3 palsy
painful (posterior Comm artery aneurysm, carvenous sinus lesion, cancers
49
CN6 palsy cause
– ICP, SOL, trauma, diabet
50
unilat facial nerve palsy
Bell’s, RH syndrome, SOL, Lyme
51
bilateral facial nerve palsy
– GBS, Lyme, sarcoid (if just weak, MG)
52
mutliple random CN palsies
multiple CN palsies at same time – any combo = m multiplex, SOL, sarcoid, Lyme
53
CN3-6 palsies
CN3-6 = cavernous sinus lesion
54
CN5-8 palsies
CN5-8 + cerebellar signs = CPA lesion (e.g. ac neuroma),
55
CN9,10,12 palsies
CN9-10 +12 = pseudo/bulbar palsy
56
lateral medullary syndrome
Horner’s + CN9,10 palsy + ipsi face, contrabod
57
ophthalamoplegia
consider Grave’s, MG, CS lesion, m multi, MS, stroke, SOL
58
ptosis causes
– unilat = CN3 palsy, Horner’s bilat = MG, myo dystrophy, neurosyphilis
59
HOrner's causes
– central 1 – MS, SOL, stroke pre-gang 2 – Pancoast, rib, thyroid post-gang 3 – carotid artery dissection
60
visual field defects, all
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
median n muscles
all thumb muscles except adductor pollicis
62
ulnar n muscles
intrinsic hand muscles except most of thumb
63
radial n muscles
extensors
64
ulnar palsy
claw hand
65
wrist drop
radial palsy
66
Phalen's
reverse prayer sign
67
dysarthria
pseudo/bulbar, cerebellar, MG, stroke
68
dysphasia
– expressive motor Broca, receptive Wernicke’s fluent but trash
69
Parkinson's sings
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
cerebellar signs
– DDDK, dysmetria, atax, nystagmus, int tremor, speech, hypoton
71
stroke 4 main types and features
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
middle cerebral artery occlusion
'classic stroke'
most common. Visual neglect, contralat lower facial hemiplegia, arm+leg hemiplegia, contralat sensory loss, contralat homo hemianopia.
73
MCA supplies
lateral cerebral cortex
i.e. lateral frontal, lateral parietal, superior temporal lobes
74
ACA occlusion
ACA occlusion – contralateral hemiplegia + sensory loss leg>arm, apraxia.
75
anterior cerebral artery supplies
medial cerebral cortex
i.e. medial frontal (leg homunclus), superiomedial parietal lobe
76
posterior cerebral artery occlusion
contralat homo hemianopia, sensory impairment, involuntary movements. (more eye)
77
posterior cerebral supplies
supplies posterior cerebral cortex
i.e. occipital lobe, thalamus, inferior temporal lobe
78
stroke with ipsilateral cerebellar signs or CN palsies, anaesthesia to pain/temp
think vertebrobasilar artery system stroke
79
neck pain + young + trauma + stroke signs
consider carotid artery dissection if anterior circ stroke or vertebral artery diss if posterior signs.
80
ddx of Parkinson's
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
management of Parkinson's
Manage – mild = MAOi rasagiliine,
mod – dop agonists ropinirole,
sev – co-careldopa.
MDT approach + OT
82
notable dopamine agonist side effects (ropinirole)
for Parkinson's
SE sleep attacks, impulse control disorders
83
why give combo levodopa i.e. co careldopa
the carbidopa bit prevents peripheral enzymes from converting to dopamine
84
SEs of levod0pa
wears off pre next dose - more immobile just prior, dyskinesias
85
levodopa
| adjunct therapy
dopamine agonist - reduces motor complications and dosage of levodopa
MAOi/COMTi reduce 'off time'
amantadine - for dyskinesias
86
multiple sclerosis define, classify, common defects
– 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
MS inv + manage
Inv – MRI brain+cord, evoked potentials, CSF oligoclonal bands. Treat – methylpred acute relapse. Alemtuzumab + symptom relief = gabapentin, anticholinergics /catheter, physio, lifestyle.
