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Psychiatry and Neurology > Neuro- Paresis, ataxia, neuropathy and peripheral nerve lesions > Flashcards

Neuro- Paresis, ataxia, neuropathy and peripheral nerve lesions Flashcards

1
Q

What can cause an UMN lesion which leads to bilateral paresis?

A

Common:

  1. MS
  2. Cervical spondylitis
  3. Spinal trauma
  4. Spinal tumour
  5. Spinal ischemia

Rare causes:

  1. MND
  2. Vit B12 deficiency
  3. Hereditary spastic paraplegia
  4. Syringomyelia
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2
Q

If a patient presents with difficulty walking, bilateral spastic leg tone, upgoing plantars, ankle clonus and an absent biceps reflex, at which level is there likely to be a spinal cord lesion?

A

C5/6

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3
Q

What can cause an UMN lesion which leads to hemiparesis?

A
  1. Stroke
  2. Brain tumour
  3. Spinal cord lesion
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4
Q

What is the most common UMN cause of sudden hemiparesis?

A

Stroke

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5
Q

If a patient with Brown Sequard syndrome is dragging their left leg with increased left leg tone and impaired joint position sensation, whilst also having impaired pinprick and pain sensation on the right leg, on which side of the spinal cord is the lesion?

A

LEFT side of the spinal cord

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6
Q

What is ataxia?

A

Group of disorders which affects balance, coordination and speech.
Can be cerebellar or sensory

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7
Q

Right sided cerebellar lesions cause which sided ataxia?

A

Right sided

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8
Q

What is pseudoathetosis?

A

Continuous involuntary movement of outstretched fingers and hands when eyes are closed

Seen in sensory ataxia

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9
Q

What are the key clinical signs of ataxia?

A
  1. Nystagmus
  2. Ataxic (wide based) gait
  3. Dysdiadochokinesia
  4. Dysarthria
  5. Intention tremor
  6. Pseudoathetosis (continuous involuntary movements of outstretched hands and fingers when eyes are closed)
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10
Q

In sensory ataxia, which nerve pathway is affected?

A

Dorsal column

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11
Q

What causes sensory ataxia?

A

Vitamin B12 deficiency

Paraneoplastic syndrome- lung/breast

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12
Q

What are the 3 top causes of ataxia?

A
  1. MS
  2. Alcohol- mainly gait affected due to degeneration of vermis
  3. Drugs- Lithium, anticonvulsants (carbamazepine, phenytoin)
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13
Q

Friedreich’s ataxia is an autosomal recessive genetic disease that causes difficulty walking, a loss of sensation in the arms and legs and impaired speech that worsens over time, and usually onsets at which age?

A

Age 5-15 years on onset

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14
Q

Other than MS, alcohol and drugs, what can cause ataxia?

A
  1. Cerebellar stroke
  2. Genetics- spinocerebellar ataxia, Friedrich’s ataxia
  3. Paraneoplastic syndromes- lung/ breast
  4. Hypothyroidism
  5. Idiopathic
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15
Q

What are the main symptoms of peripheral neuropathy?

A
  1. Numbness
  2. Burning/stinging
  3. Tingling, pins and needles
  4. Touch sensitivity
  5. Ulcers
  6. Loss of balance
  7. Sensory ataxia
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16
Q

What are the 2 main types of peripheral neuropathy?

A

Sensory and motor

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17
Q

What are the causes of sensory peripheral neuropathy?

A
  1. Diabetes
  2. Vit B12 deficiency
  3. Alcohol -> Thiamine deficiency
  4. Drugs (Isoniazid, Ethambutol, Cisplatin, Vincristine)
  5. Amyloidosis
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18
Q

What are the 3 main clinical features of sensory peripheral neuropathy?

A
  1. Impaired pinprick sensation (glove and stocking)
  2. Impaired joint position and vibration sense
  3. Ankle jerks may be absent
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19
Q

What are the 3 main clinical features of motor peripheral neuropathy?

A
  1. Generalised weakness- worse distally
  2. Mild impaired pin prick, joint position and vibration sensation
  3. Absent ankle jerks
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20
Q

What are the top 3 causes of motor peripheral neuropathy?

A
  1. GBS
  2. CIDP
  3. Charcot Marie Tooth
21
Q

Charcot Marie Tooth is a hereditary condition resulting in which type of neuropathy?

A

Motor and sensory

22
Q

What are the key clinical features of Charcot Marie Tooth?

A
  1. Motor and sensory neuropathy
  2. High arched foot/ flat feet
  3. Champagne bottle legs
  4. Peripheral muscle weakness
  5. Peripheral numbness
23
Q

Which nerve supplies muscles for finger abduction?

A

Ulnar nerve

24
Q

Which nerve supplies muscles for finger extension?

A

Radial nerve

25
Q

Which nerve supplies muscles for thumb abduction?

A

Median nerve

26
Q

Which muscles does the radial nerve supply?

A

Triceps
Brachioradialis
Hand extensors

27
Q

The posterior interosseous nerve is a branch of which nerve?

A

Radial nerve

28
Q

At what time of day are symptoms of carpal tunnel syndrome worse?

A

Night time

29
Q

What action can relieve symptoms of carpal tunnel syndrome?

A

Shaking the hand

30
Q

What are the symptoms/ signs of carpal tunnel syndrome?

A
  1. Hand paraesthesia
  2. Weakness of thumb abduction (weak abductor pollicis brevis)
  3. Thenar eminence wasting (rare)
31
Q

Which conditions is carpal tunnel syndrome linked to?

A

Endocrine- diabetes, hypothyroid, acromegaly

Rheumatology- RA, OA

32
Q

Which gender is carpal tunnel syndrome more common in?

A

Women

33
Q

What are the potential treatments for carpal tunnel syndrome?

A
  1. Diuretics
  2. Local steroids
  3. Splint
  4. Surgery
34
Q

What are the signs/symptoms of ulnar nerve palsy?

A
  1. Sensory symptoms in 5th digit and medial half of 4th digit and medial palm up to the wrist
  2. Weak hand grip
  3. Wasting of 1st dorsal interosseous muscle
35
Q

Which nerve palsy leads to wasting of the 1st dorsal interosseous muscle?

A

Ulnar nerve

36
Q

“Claw hand” is a rare sign of which nerve palsy?

A

Ulnar nerve

37
Q

Where does the ulnar nerve usually get trapped to lead to nerve palsy?

A

At the elbow

38
Q

What are the causes of ulnar nerve entrapment at the elbow?

A 
Fracture
Dislocation
Osteoathritis
Repetitive strain
Part of mononeuritis multiplex
39
Q

Which nerve palsy leads to wrist drop?

A

Radial nerve palsy

40
Q

Which nerve palsy leads to foot drop?

A

Common Peroneal nerve palsy

41
Q

What are the signs/ symptoms of radial nerve palsy?

A
  1. Wrist drop
  2. Unable to extend/ straighten fingers
  3. Loss of sensation in 1st dorsal interosseous area

(If lesion is high in humerous leads to tricep and brachioradialis weakness)

42
Q

Acute compression at the spiral groove after general anaesthetic or being unconscious/ falling asleep with arm over a chair can lead to which nerve palsy?

A

Radial nerve

43
Q

What are the 2 branches of the common peroneal nerve?

A

Superficial

Deep

44
Q

Common peroneal nerve injury leads to weak _________- of the ankle, weak eversion of the foot and weak __________ of the big toe.

A

Weak DORSIFLEXION of foot
Weak eversion of foot
Weak DORSIFLEXION of big toe

45
Q

What are the key signs of common peroneal nerve palsy?

A
  1. Weak foot dorsiflexion and eversion
  2. Weak big toe dorsiflexion
  3. Reduced pinprick sensation on the lateral calf and foot dorsum
  4. High stepped gait
46
Q

What happens to tendon reflexes in common peroneal nerve palsy?

A

They are normal

47
Q

What are the common causes of foot drop?

A
  1. Trauma or compression to the fibula
  2. Lesion at L5
  3. Sciatic lesion
  4. MND
  5. Cauda equina
48
Q

What is spasticity?

A

Disorder of sensory/ motor control caused by an UMN lesion

Psychiatry and Neurology (9 decks)

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