Neuro Exam Qs Flashcards
Risk factors for Cerebrovascular Disease
Hypertension Smoking Diabetes mellitus Hyperlipidaemia Atrial fibrillation, bacterial endocarditis, myocardial infarction (emboli) Haematological disease Family history of stroke
What is Kernig’s sign?
Limited extension of the knee whilst hip is flexed due to spasm of the hamstrings (which in turn causes pain) when there is meningism due to inflammatory exudates around lumbar spinal roots.
Symptoms and Signs in Higher Centre Dysfunction in the:
Parietal lobe
- Dysphasia (dominant)
- Acalculia
- Agraphia
- Left-Right disorientation
- Finger agnosia
- Sensory and visual inattention (non-dominant parietal lobe)
- Construction and dressing apraxia
- Spatial neglect and inattention
- Lower quandrantic hemianopia
- Astereognosis
Symptoms and Signs in Higher Centre Dysfunction in the:
Temporal lobe
- Memory loss
- Upper quandrantic hemianopia
- Dysphasia (receptive if dominant lobe)
- Seizures
Symptoms and Signs in Higher Centre Dysfunction in the:
Frontal lobe
- Personality change
- Primitive reflexes: e.g. grasp, pout
- Anosmia
- Optic nerve compression (optic atrophy)
- Gait apraxia
- Leg weakness (parasagittal)
- Loss of micturition control
- Dysphasia (expressive)
- Seizures
Symptoms and Signs in HIgher Centre Dysfunction in the.
Occipital lobe
- Homonymous Hemianopia
- Alexia
- Seizures (flashing light aura)
Causes of Anosmia
Bilateral:
-Upper respiratory tract infection
-Meningioma of the olfactory groove
-Ethmoid Tumours
-Basal skull fracture or frontal fracture or after pituitary -surgery
-Congenital: Kallmann’s syndrome (hypogonadotrophic -hypogonadism)
-Smoking and increasing age
unilateral:
-head trauma w/o fracture
-early meningioma of the olfactory groove
Causes of Cataracts
- Old age (senile cataracts)
- Endocrine: diabetes mellitus, steroids
- Hereditary or congenital - dystrophia myotonica, Refsum’s disease
- Radiation
- Trauma
Features of Papilloedema
- Optic disc swollen w/o venous pulsation
- Acuity normal (early)
- Large blind spot
- Peripheral constriction of visual fields
- Colour vision normal
- Usually bilateral
Features of Papillits
- Optic disc swollen
- Acuity poor
- Large central scotoma
- Pain on eye movement
- Onset usually sudden and unilateral
- Colour vision affected (particularly red desaturation)
Causes of papilloedema
- Space-occupying lesion –> causing raised intracranial pressure or a retro-orbital mass
- Hydrocephalus (large cerebral ventricles
- Obstructive: a block in the ventricle, aqueduct or outlet to the 4th ventricle
- Communicating:
Increased CSF formation (choroid plexus papilloma)
Decreased CSF absorption (tumour causing venous compression) - benign intracranial hypertension (pseudotumour cerebri)
a) Idiopathic
b) the contraceptive pill
c) Addison’s disease
d) Drugs: nitrofurantoin, tetracycline, vitamin A, steroids
e) Head trauma - Hypertension (grade 4)
- Central retinal vein thrombosis
Causes of Optic Atrophy
- Chronic papilloedema or optic neuritis
- Optic nerve pressure or division
- Glaucoma
- Ischaemia
- Familial: retinitis pigmentosa, Leber’s disease, Friederich’s disease
Causes of Optic Neuritis
- Multiple sclerosis
- Toxic: Ethambutol, chloroquine, nicotine, alcohol
- Metabolic: Vitamin B12 deficiency
- Ischaemia: diabetes mellitus, temporal arteritis, atheroma
- Familial: Leber’s disease
- Infective: infectious mononucleosis
Causes of Wasting of the Small Muscles of the Hand
- Spinal Cord Lesions
- Syringiomelia
- cervical spondylosis with compression of the C8 segment
- Tumour - Anterior Horn Cell Disease
- Motor neurone disease, poliomyelitis
- Spinal muscular atrophies - Root lesion
- C8 compression by a disc lesion - Brachial Plexus Lesion
- Thoracic outlet syndrome
- Trauma, radiation, infiltration - Peripheral Nerve Lesions
- Median and ulnar nerve lesions
- Peripheral motor neuropathy - Myopathy
- Dystrophia myotonica - forearms ar emore affecteed that the hands
- Distal myopathy - Trophic Disorders
- Arthropathies (disuse)
- Ischaemia, including vasculitis
- Shoulder-hand syndrome
Signs of a complete brachial plexus lesion
- Lower motor neurone signs affect the whole arm
- Sensory loss (whole limb)
- Horner’s syndrome (important clue)
N.B. this is often painful
Signs of an Upper brachial plexus Lesion (Erb Duchenne; C5 C6)
- Loss of shoulder movement and elbow flexion - the hand is held in the waiter’s tip position
- Sensory loss over the lateral aspect of the arm and forearm
Signs of a Lower brachial plexus Lesion (Klumpke’s; C8, T1)
- True claw hand with paralysis of all the intrinsic muscles
- Sensory loss along the ulnar side of the hand and forearm
- Horner’s syndrome
Signs of Cervical Rib Syndrome
- Weakness and wasting of the small muscles of the hand (claw hand)
- C8 and T1 sensory loss
- Unequal radial pulses and blood pressure
- Subclavian bruits on arm manoeuvring (may be present in normal persons)
- Palpable cervical rib in the neck (uncommon)
Causes of spinal cord compression
- Vertebral
- Spondylosis
- Trauma
- Prolapse of a disc
- Tumour
- Infection - Outside the dura
- Lymphoma, metasases
- Infection - e.g. abscess - Within the dura but extramedullary
- Tumour, e.g. meningioma, neurofibroma - Intramedullary
- Tumour, e.g. glioma, ependymoma
- Syringomelia
- Haematomyelia
Causes of Spastic and Ataxic Paraparesis (Upper motor neurone and cerebellar signs combined)
In adolescence:
- Spinocerebellar degeneration: Marie’s spastic ataxia
In Young adults:
- Multiple sclerosis
- Syphillitic meningomyelitis
- Spinocerebellar degeneration
- Arnold-Chiari malformation or other lesion at the craniospinal junction
In Later life:
- Multiple sclerosis
- Syringomelia
- Infarction (in upper pons or internal capsule - ataxic hemiparesis)
Lesion at the craniospinal junction - e.g. meningioma
