Neuro (Imperial Jan Revision Course) Flashcards
Median nerve palsy
- Examination:
- Sensory loss to lateral border of the hand
- Loss of LOAF Muscles: LOAF – lateral 2 lumbricals, opponens pollicis, abductor pollicis brevis and flexor pollicis brevis
- Wasting of thenar eminence
- Look for CTS – Phalen’s and Tinel’s test
- Causes of carpal tunnel syndrome; Rheumatoid, Acromegaly, Hypothyroidism
Radial Palsy
Radial palsy
Examination:
- Sensory loss on dorsum of hand
- Weakness of wrist extension, finger extension
Causes: Humerus fracture Prolonged pressure Lipoma, fibroma Systemic causes of a mono-neuritis multiplex
Myotonic dystrophy
Myotonic dystrophy
Inheritance
Natural history
Examination
Investigate and Diagnose
Myotonic Dystrophy (diagnosis suggested by inspection and confirmed from examination)
Inheritance Trinucleotide repeat, AD, Anticipation
Natural history Presents in early adulthood, progressive muscle wasting eventually leads the myotonia to disappear
Examination;
- Myo-pathic facies, frontal balding, cataracts, decreased power in face and bulbar muscles
- Wasting of face, neck and distal arms, distal weakness
- Hand grip myotonia (GRIP MY HAND AND LET GO) and percussion myotonia (TAP ON THENAR EMINENCE)
- Absent reflexes
- To conclude my examination:
- Cognitive
- Cardiovascular system
- Urine dip for glucose – they get diabetes
Investigate and Diagnose
- Serum CK EMG MD Type 1 – genetic
- ECG and Echo - Cardiomyopathy or conduction block
- FBG or HbA1C - Diabetes
- Ophth RV - Cataracts Formal cognitive testing - Cognitive impairment
CMT PATIENT
Pes Cavus
- Charcot-Marie-Tooth
- Friedreiches Ataxia
POST POLIO PATIENT!!!!
LIKELY TO PRESENT
loss of muslce bulk
loss of reflexes
loss of tone
unilateral
shotening of limb
(MND/polio, nerve; NMJ (MG, but no muscle wasting) /muclse
Spastic paraparesis
Examination
clue to cause
Spastic paraparesis
Examination:
- Hypertonia, Clonus, Hyperreflexia, Weakness, up-going plantars
- No or mild wasting without fasiculations +/- clues to the
cause:
- Sensory involvement/ sensory level
- Scars (on limbs – tendon release)
- Cerebellar signs (Friedreich’s)
- Upper limb signs (lower MN – cervical myelopathy, UMN – cranial cause)
- Eye signs (MS)
Diabetic sensorimotor polyneuropathy
EXAMINATION
- Predominantly sensory
- Predominantly feet
- REDUCED pain and temperature sensation
- REDUCED Vibration and JPS
- REDUCED Reflexes
- Ulcers or Charcot joints
- Neurogenic pain/allodynia
- Wasting occurs only if severe
What tests?
UMN
LMN
UMN: Imaging; MRI/CSF
LMN: nerve studies
Extra pyramidal examination
- Rigidity Bradykinesia Tremor
- Gait (festinate gait with small steps and turning ‘en-bloc’ and reduced arm swing)
- Head to toe
- Mask like face Dyskinesia (on and off )
- Hypo phonic (quiet voice)
- Tremor (resting 4-6 Hz)
- Lead pipe (elbow) cog wheeling (wrist)
- Bradykinesia, synkinesia (write micro-graphia)
- Tap foot (extinction of movement)
CEREBELLAR SYNDROME EXAMINATION
- Gait (broad based gait)
- Heel to toe walk (don’t make them fall!)
- Romberg’s sign (vision, vestibular, posterior columns) – should be negative
- Examine head to toe
- Eye movements (FROM)
- Speech
- Rebound phenomena
- Finger –Nose (depth) past pointing , intention tremor)
- Rapid hand movements (dysdiadokinesia)
- Heel to shin
- Hypotonia and pendular reflex
