Neuro Formative Flashcards
A 50 year old woman presents with a history of collapse. She describes three previous episodes of loss of consciousness.
List four possible causes in the differential diagnosis:
1) Epileptic Fit
2) Syncope / Fainting / Vasovagal Attack
3) Cardiac Arrythmia
4) Psychogenic Psuedoseizure
A 50 year old woman presents with a history of collapse. She describes three previous episodes of loss of consciousness.
What detailed history that might support a diagnosis of epileptic seizures?
Family Hx of Epilepsy.
Aura.
Witness Account of Tonic Clonic.
Tongue Biting.
Urinary Incontinence.
Postictal deficit.
Slow recovery.
A 50 year old woman presents with a history of collapse. She describes three previous episodes of loss of consciousness.
This history suggests an epileptic fit. What Investigations would you conduct to determine the cause?
1) CT/MRI
2) ECG
3) EEG
4) Biochemistry (i.e. Blood Glucose, Ca2+)
5) Liver Function Tests (LFTs)
Define Dysphagia:
Difficulty swallowing
Define Dysarthria:
Slurred speech
A patient has progressive weakness of the limbs, difficulty swallowing and slurred speech.
The muscle weakness may be due to acute inflammatory polyneuropathy (also known as Guillain Barre syndrome) or myasthenia gravis.
Name two signs on examination that might be found in Guillain Barre syndrome but not in myasthenia gravis:
1) Areflexia
2) Sensory Loss
3) Muscle Wasting
Name two signs on examination that might be found in myasthenia gravis but not in motor neurone disease.
1) Ptosis (eyelid droop)
2) Ophthalmoplegia (paralysis of muscles surrounding eye)
3) Fatigue-ability
Name two symptoms / Signs associated with motor neurone disease:
1) Muscle Wasting
2) Fasciculations
3) Extensor plantar reflexes (Negative babinskis)
4) Upper motor neurone signs
What is the most likely cause of Guillian Barre syndrome?
Immune response post infection.
If a patient is thought to have respiratory muscle weakness, what is the reliable, repeatable investigation that can be used to monitor respiratory muscle strength?
Pulmonary Function Tests (Vital Capacity)
A left-handed 54 year old male executive, Mr. X, worried about losing his high profile job was in the boardroom making an important presentation when he collapsed. Taken to hospital, he was found to have very high blood pressure which had caused an intracerebral haemorrhage. After investigation it was established that among other things his pyramidal tract was affected at the right internal capsule.
What is the blood supply to the internal capsule?
(Right Anterior) Middle Cerebral Artery
What modality do you expect to be affected because of damage to the pyramidal tract, sensory or motor?
Motor Function Loss
Which side of the body would be affected if the the right pyramidal tracts are affected?
Left side
Where does the pyramidal tract originate from?
Originates in frontal lobe, precentral gyrus - Area 4
Name two areas in the brain that deal with language.
Broca’s Area (Speech)
Wernicke’s Area (Comprehension)
A neurology FY doctor examining Mr. X a week after his stroke (to the internal capsule) was surprised to find that his knee jerk reflex on the affected side was exaggerated.
With your knowledge of neuroanatomy, can you explain to the intern why this finding is not so surprising after all?
The knee jerk reflex is a monosynaptic reflex mediated at the spinal cord level by the lower motor neuron.
Upper motor neurones are tonically inhibitory to lower motor neurones.
As the damage is at the level of the upper motor neuron, the inhibition is not present. Therefore this will cause a brisk knee reflex.
What organism is responsible for syphillis?
Treponema Pallidum
