Neuro revision Flashcards
What is syringomyelia?
Collection of cerebrospinal fluid within spinal cord
Causes of syringomyelia?
Chiari malformation
Trauma
Tumours
Idiopathic
In syringomyelia which sensation is affected?
Cape- like loss of temperature sensation, preservation of light touch, proprioception and vibration
Clinical features of syringomyelia?
Cape- like loss of temperature sensation
Spastic weakness
Neuropathic pain
Upgoing plantars
autonomic features
Horner’s syndrome
Scoliosis
Treatment for generalised tonic clonic seizures?
Males - sodium valproate
Females - lamotrigine or levetiracetam
Treatment for absence seizures?
1st line = ethosuximide
2nd = male - sodium valproate
female - lamotrigine/ levetiracetam
Treatment for focal seizures?
First line = lamotrigine or levetiracetam
Second line = carbamexapine, oxycarbazepine
Which medication may exacerbate absence seizures?
Carbamezapine
What is another name for absence seizures?
Petit mal
Treatment for myoclonic seizures?
Males - sodium valproate
Females - levetiracetam
Treatment for tonic or atonic seizures?
Males - sodium valproate
Females - lamotrigine
What nerves does the sciatic nerve divide into?
Tibial and common peroneal nerves
Where does injury often occur in common peroneal nerve lesion?
Neck of fibula
Characteristics of common peroneal nerve lesion?
Foot drop
Weak foot dorsiflexion, foot eversion
Weak extensor hallucis longus
Sensory loss over dorsum of foot, and lower lateral leg
Wasting of anterior tibial and peroneal muscles
Factors suggesting true epileptic seizure?
Tongue biting
Raises serum prolactin
Factors suggesting pseudoseizure?
Pelvic thrusting
Family member with epilepsy
Female»_space;
Crying after seizure
Don’t occur when alone
Gradual onset
Classic history - vestibular schwannoma/ acoustic neuroma?
Vertigo
Unilateral SNHL
Tinnitus
Absent corneal reflex
Interpretation of Webers?
Normal - midline
Conductive - bad ear
SNHL - good ear
Which artery occluded in lateral medullary syndrome/ Wallenberg’s?
Posterior inferior cerebellar artery
Cerebellar features of posterior inferior cerebellar artery occlusion/ lateral medullary syndrome?
Cerebellar: ataxia, nystagmus
Brainstem features of posterior inferior cerebellar artery occlusion/ lateral medullary syndrome?
Ipsilateral: Dysphagia, facial numbness, cranial nerve palsy e.g. Horner’s
Contralateral: limb sensory loss
What is Guillain- Barre syndrome?
Immune mediated demyelination of peripheral nervous system, often triggered by infection
Which infection often causes GBS?
Campylobacter jejuni
What is the characteristic feature of GBS?
Progressive, symmetrical weakness of all limbs
Classically ascending weakness
Reduced/ absent reflexes
Few sensory signs/ symptoms
Investigations in GBS?
Lumbar puncture - rise in protein, normal WBC count
Nerve conduction studies - dec motor nerve conduction velocity (demyelination)
Parietal lobe lesions?
Sensory inattention
Apraxia
Tactile agnosia
Inferior homonymous quadrantanopia
Occipital lobe lesion?
Homonymous hemianopia (with macular sparing)
Cortical blindness
Visual agnosia
Temporal lobe lesion?
Wernicke’s aphasia
Superior homonymous quadrantanopia
Auditory agnosia
Prosopagnosia (difficulty recognising faces)
Frontal lobe lesion?
Broca’s aphasia (expressive)
Disinhibition
Perseveration
Anosmia
Inability to generate list
Cerebellum lesions?
Midline - gait and truncal ataxia
Hemisphere lesion - intention tremor, past pointing, dysdiadokinesia, nystagmus
Dysdiadochokinesia?
Inability to perform rapid alternating muscle movements
Cause of brown sequard syndrome?
Lateral hemisection of the spinal cord
Features of brown squared syndrome?
Ipsilateral weakness below lesion
Ipsilateral loss of proprioception and vibration sensation
Contralateral loss of pain and temperature sensation
Does unilateral cerebellar lesion cause contra or ipsi- lateral signs?
Ipsilateral
Symptoms of cerebellar disease?
DANISH
D- dysdiadochokinesia,, dysmetria (past- pointing), ‘drunk’
A- ataxia
N- nystagmus
I- intention tremor
S- slurred staccato speech, scanning dysarthria
H - hypotonia
GCS - motor response?
- Obeys commands
- Localises to pain
- Withdraws from pain/ normal flexion
- Abnormal flexion to pain (decorticate posture)
- Extending to pain
- None
GCS - verbal?
- Orientated
- Confused
- Words
- Sounds
- None
GCS - eye opening?
- Spontaneous
- To speech
- To pain
- None
What can Lambert- Eaton syndrome be associated with?
Small cell lung cancer»_space;>
Breast, ovarian cancer
Independent autoimmune disorder
Cause of Lambert- Eaton syndrome?
Antibody against presynaptic voltage- gated calcium channels in PNS
Features of Lambert- Eaton syndrome?
Repeated muscle contractions lead to inc muscle strength
Limb- girdle weakness
Hyporeflexia
Autonomic symptoms
EMG in Lambert- Eaton syndrome?
Incremental response to repetitive electrical stimulation
Management of Lambert- Eaton syndrome?
Treat underlying
Immunosuppression e.g. prednisolone +/- azathioprine
What is myasthenia gravis?
Autoimmune disorder resulting in insufficient functioning acetylcholine receptors
What causes myasthenia gravis?
Antibodies to acetylcholine receptors seen in 85-90%
Key features of myasthenia gravis?
Muscle fatigability
Extraocular muscle weakness: diplopia
Proximal muscle weakness
Ptosis
Dysphagia
Associations with myasthenia gravis?
Thymomas
AI disorders e.g. pernicious anaemia, AI thyroid disorders, rheumatoid, SLE
Thymic hyperplasia
Investigations for myasthenia gravis?
Single fibre EMG
CK normal
Antibodies to acetylcholine receptors, some + for anti- muscle- specific tyrosine kinase AB’s
Management of myasthenia gravis?
Long- acting acetylcholinesterase inhibitors - pyridostigmine
Eventually require immunosuppression - prednisolone, azathioprine
Thmectomy
Management of myasthenia crisis?
Plasmapharesis
IV immunoglobulins
Ankle reflex?
S1-S2
Knee reflex?
L3-L4
Biceps reflex?
C5-C6
Triceps reflex?
C7-C8
What causes subacute combined degeneration of the spinal cord?
Vitamin B12 deficiency resulting in impairment of dorsal columns, lateral corticospinal tracts and spinocerebellar tracts
Features of subacute combined degeneration of the spinal cord - dorsal column?
Distal tingling/burning/sensory loss is symmetrical and tends to affect the legs more than the arms
Impaired proprioception and vibration sens
Features of subacute combined degeneration of the spinal cord - lateral corticospinal tract?
Muscle weakness, hyperreflexia, and spasticity
upper motor neuron signs typically develop in the legs first
Brisk knee reflexes
absent ankle jerks
extensor plantars
Features of subacute combined degeneration of the spinal cord - spinocerebellar tracts?
Sensory ataxia - gait abnormalities
Positive Romberg’s sign
Anterior cerebral artery stroke?
Contralateral hemiparesis and sensory loss, lower extremity > upper
Middle cerebral artery stroke?
Contralateral hemiparesis and sensory loss, upper extremity > lower
Contralateral homonymous hemianopia
Aphasia
Posterior cerebral artery stroke?
Contralateral homonymous hemianopia with macular sparing
Visual agnosia
Weber’s syndrome/ branches of posterior cerebral artery that supply midbrain?
Ipsilateral CN III palsy
Contralateral weakness of upper and lower extremity
Posterior inferior cerebellar artery (lateral medullary syndrome, Wallenberg’s syndrome)
Ipsilateral: facial pain and temperature loss
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus
Anterior inferior cerebellar artery (lateral pontine syndrome)?
Similar to Wallenberg’s
Ipsilateral: facial paralysis and deafness
Lacunar stroke?
Isolated hemiparesis, hemisensory loss or hemiparesis with limb ataxia
Strong assoc. w/ hypertension
Basal ganglia, thalamus, internal capsule
