Neuro Exam Flashcards
What deficits would you find in a dominant parietal lobe lesion?
AALF
Acalculia
Agraphia
Left-right disorientation
Finger agnosia
Inattention
Contralateral Inferior quadrantanopia
What deficits would you find in a non-dominant parietal lobe lesion?
Dressing apraxia
Inattention
Contralateral Inferior quadrantanopia
Causes of papilloedema?
Space-occupying lesions Hydrocephalus IIH Severe systemic HTN Venous sinus thrombosis / retinal vein thrombosis
What deficits would you find in a temporal lobe lesion?
Receptive aphasia
Memory deficits
Contralateral Superior quadrantanopia
What are frontal release signs?
Palmar-mental reflex
Grasp reflex
Pout reflex
What area is involved in expressive aphasia?
Dominant frontal lobe
Motor = expressive = Broca’s aphasia
What area is involved in receptive aphasia?
Dominant temporal lobe
Sensory = receptive = Wernicke’s aphasia:
Impaired comprehension
Parkinson’s exam findings?
General
- mask-like facies
- tremor
- paucity of movement
Gait
- shuffling
- festinating
- difficulty starting
- freezing
ULs
- rigidity
- postural BPs
- palmar-mental reflex
Face
- eyes -> gaze palsy of PSP
- speech -> soft, monotonous
Functional:
- handwriting
- dressing
Cerebellar lesion findings?
Gait
- wide-based
- heel-toe
- Rhomberg’s (neg)
ULs
- tremor, drift, bounce
- tone
- rapid alternating movements
- finger-nose (intention tremor / past pointing)
Face
- nystagmus, broken pursuit
- speech -> dysarthria
LLs
- tone
- coordination -> heel-shin, toe-finger, heel-tapping
What is Rhomberg’s test?
A test of proprioception
Description = Patients are asked to stand upright with feet together and then close the eyes
Positive if patient is markedly more unsteady with eyes closed compared with open.
Occurs because patients are using their eyes to compensate for the lack of sensory feedback they are receiving from their lower extremities.
Causes of positive test =
- peripheral neuropathy with loss of joint position sense
- posterior column dysfunction e.g. tabes dorsalis
- uncompensated acute unilateral or bilateral vestibular impairment (controversial)
Causes of unilateral cerebellar lesion?
SOL Ischaemia Trauma MS Paraneoplastic syndrome
Causes of bilat cerebellar lesion?
ETOH Hypothyroidism Drugs Trauma MS Drugs Freidrich's ataxia
How to differentiate foot drop causes?
All cause weakness of dorsi/eversion
Common peroneal -> dorsi + eversion affected
L5 root -> also weakness of INVERSION
Sciatic nerve -> reflex reduced, all movements weak
Peripheral Neuropathy DDx: predominantly sensory
DM ETOH Drugs (chemo) CKD B12 Paraneoplastic
Peripheral Neuropathy DDx: predominantly motor
CIDP / AIDP ETOH CMT Syphilis DM Critical illness
Spinal cord syndromes:
Ipsilateral weakness + loss of proprioception
Contralateral loss of pain + temperature
Brown-Sequard
Spinal cord syndromes: LMN signs at level UMN signs below Loss of sensation below Loss of anal tone / bladder / bowel
Complete cord transection
Spinal cord syndromes:
Loss of proprioception
UMN weakness
Subacute combined degeneration
Spinal cord syndromes:
Loss of pain/temp sensation cape distribution
Weakness follows, LMN in ULs, UMN in LLs
Central cord syndrome / syringomyelia
How do you test median nerve function?
C6-T1
Motor:
- LOAF of hand =
- > lateral 2 lumbricals
- > opponens pollicis brevis
- > abductor pollicis brevis
- > flexor pollicis brevis
- PIP flexion
- 2nd / 3rd finger DIP flexion
Sensory:
- lateral 3.5 fingers
How do you test radial nerve function?
Motor:
- elbow / wrist extension
- finger / thumb extension
Sensory:
- dorsal 1.5 fingers / anatomical snuff box
How do you test ulnar nerve function?
Motor:
- Finger abduction / adduction
- 4th/5th DIP flexion
Sensory:
- medial 1.5 fingers
How do you test musculocutaneous function?
Motor
- Elbow flexion (biceps)
Sensory
- lateral forearm
Gait exam -> hemiparetic / unilateral spasticity ?
CVA / central lesion
Gait exam -> paraparetic gait ?
Spinal cord lesion MS Hereditary spastic paraparesis Cerebral palsy Bilateral stroke
Gait exam -> unilateral high stepping ?
Foot drop ->
- L5 lesion
- common peroneal lesion
- sciatic lesion
Gait exam -> bilateral high stepping gait ?
Distal polyneuropathy / CIDP
MND
Lumbosacral radiculopathy
- may be sensory ataxia, will be Rhomberg’s positive
- > peripheral sensory neuropathy
- > syphilis
- > subacute combined degeneration of the cord
Gait exam -> Trendelenberg / Waddling ?
Proximal myopathy
NMJ disease e.g. myasthenia
Gait exam -> Parkinsonian ?
Parkinson’s
PSP
MSA
Medications
What is Gerstmann’s syndrome?
Dominant parietal lobe lesion
Acalculia
Agraphia
Finger agnosia
Right-left disorientation
Bilateral UMN findings + sensory involvement
DDx?
Spinal cord MS B12 deficiency Multiple strokes Arnold Chiari malformation
DDx for absent ankle jerk but upgoing plantar?
MND
Dual pathology -> UMN + peripheral neuropathy
Friedrich’s ataxia
Subacute combined degeneration of the cord
Classic presentation of inclusion body myositis?
Proximal leg weakness + distal finger flexor weakness
Scalloping of the medial forearm flexor compartment.
Facial muscles may be involved + dysphagia
*decrease in reflexes in parallel with weakness
Function of sciatic nerve?
Motor
- knee flexion (hamstrings)
- all muscles below knee
Sensory
- foot sensation + lateral calf
Function of femoral nerve?
Motor
- hip flexion (iliopsoas)
- knee extension (quads)
Sensory
- over knee and medial thigh/calf
Common peroneal nerve function?
Motor
- ankle dorsiflexion / eversion
Sensory
- dorsum of foot + lateral calf
What does standing on heels test?
What does standing on toes test?
Heels -> dorsiflexion -> L4/L5 (mainly L5)
Toes -> plantarflexion -> S1
