Neuro PTS Flashcards
Symptoms facial nerve palsy
Facial weakness
Altered taste (anterior 2/3 tongue)
Unable to close eyes
Hyperacusis (sensitivity to sound)
Distinguishing feature of UMN lesion vs LMN lesion in a facial nerve palsy
UMN: frontalis and orbicularis oculi muscles preserved (forehead sparing) - lesion A
LMN: forehead muscles NOT preserved - lesion B
Causes of LMN facial nerve palsy + treatment for each (2)
Bell’s palsy - steroids
Ramsay Hunt (herpes zoster) - acyclovir
Clinical presentation of trigeminal neuralgia
Stabbing pains
Unilateral
Usually 1 distribution
No symptoms between attacks
Examples of pain relief in trigeminal neuralgia
Carbamazepine
Gabapentin/lamotrigine/phenytoin
Median nerve muscle innervation (4)
LOAF
Median nerve origination
C5 - T1
Median nerve sensory innervation
2 treatments for a median nerve lesion
Splinting
Corticosteroid injection
Peripheral nerve revision
Ulnar nerve
Radial nerve
Lateral cutaneous nerve of the thigh
nerves of the foot
Symptoms of UMN lesion
Everything goes UP
Hyperreflexia
Hypertonia
Up going plantars
Spasticity
Symptoms of LMN lesion
Hyporeflexia
Hypotonia
Types of MND
Amyotrophic lateral sclerosis - most common
Progressive bulbar palsy - second most common (primarily affects talking + swallowing)
Progressive muscular atrophy
Primary lateral sclerosis
ALS pathophysiology
Progressive degeneration of both upper and lower motor neurones - sensory neurones are spared
Genetic component 5-10% cases (family history important)
Typical ALS patient presentation
Late middle aged man possibly with an affected relative
Insidious progressive weakness of the muscles throughout the body affected the limbs, trunk, face and speech (often first noticed in the upper limbs)
Clumsiness,
Dysarthria (slurred speech)
Investigation for motor neurone disease
Electromyography - fasciculations and fibrillations
Diagnosis MND
Clinical presentation and exclusion of other conditions
Management MND
Riluzole (extends life)
Baclofen for symptom control
Non-invasive ventilation
Prognosis: fatal, 3-5 years
Types of seizure (need to redo all of this)
Tonic - generalised muscle stiffening
Clonic - rhythmic jerking
Myoclonic - brief jerks
Atonic - loss of tone
Spasms - sudden flexion/extension
Prodromal
Subjective feeling/sensation
Confusion, irritability
Early-ictal
Aura
Sensory/cognitive/emotional/behavioural
Focal epilepsy
Ictal
Depends on seizure
Urinary incontinence and tongue biting
Post-ictal
Recovery period
Altered consciousness
Todd’s paresis
Status epilepticus
Seizure > 5 mins, or multiple seizures with incomplete recovery between
Initial management: lorazepam 4mg IV, repeat after 10 mins if no resolution
Clear environment
Tx: IV dextrose, thiamine
