Neuro Short Flashcards
Causes of sensory predominant neuropathy?
B12 Diabetes EtOH Myeloma Paraneoplastic
Signs of severity in parkinson’s disease?
motor fluctuations dyskinesia psychosis dementia sleep disturbance orthostatic hypotension
Causes of motor predominant neuropathy?
AIDP CIDP charcot marie tooth MND MMN
Causes of unilateral pes cavus?
burns
compartment syndrome
polio
spinal trauma
Causes of bilateral pes cavus?
freidrich's ataxia muscular dystrophy SMA cerebral palsy hereditary spastic paraparesis
What nerves supply biceps reflex?
C5-6
What nerves supply brachioradialis reflex?
C5-6
What nerves supply triceps reflex?
C6-7
What nerves supply knee jerk reflex?
L3-4
What nerves supply ankle jerk reflex?
S1-2
What nerves supply plantar reflex?
L5-S1
Causes of unilateral cerebellar disease?
mass ischaemia paraneoplastic MS trauma
Cause of bilateral cerebellar disease?
anti epileptic drugs friedreich's hypothyroidism paraneoplastic MS trauma EtOH
Signs of Freidrich’s ataxia?
cerebellar signs posterior column loss in the limbs upper motor neuron signs in the limbs peripheral neuropathy optic atrophy pes cavus cardiomyopathy diabetes mellitus
Causes of chorea?
wilsons
drugs
sydenhams (rheumatic fever)
huntingtons
Differential diagnosis for MS?
paraneoplastic syndrome vitamin B12 deficiency CNS vasculitis SLE sarcoidosis HIV syphilis migraine somatoform disorders
Causes of Horner’s syndrome?
lung apex carcinoma thyroid malignancy carotid artery aneurysm brain stem lesion retro orbital lesions syringomyelia
Causes of pupil constriction?
horner’s syndrome
argyll robertson pupil
pontine lesion
narcotics
Causes of pupil dilatation?
third nerve lesion adie's pupil iritis post trauma cerebral death congenital
Causes of papilloedema?
space occupying lesion hydrocephalus IIH hypertension central retinal vein thrombosis cerebral venous sinus thrombosis
Causes of ptosis with normal pupils?
myotonic dystrophy
facioscapulohumeral dystrophy
thyrotoxic myopathy
myasthenia gravis
Causes of ptosis with constricted pupils?
horner’s syndrome
Causes of ptosis with dilated pupils?
third nerve lesion
Clinical features of third nerve palsy?
ptosis
down and out eye
unreactive dilated pupil
Causes of third nerve palsy?
tumour demyelination trauma brain stem infarction diabetes aneurysm
Causes of unilateral lower motor neuron seventh nerve palsy?
tumour MS acoustic neuroma meningioma bell's palsy ramsay hunt otitis media fracture of temporal bone parotid tumour/sarcoid
Causes of bilateral lower motor neurone facial weakness?
GBS
sarcoidosis of parotid
mononeuritis multiplex
Causes of sensorineural deafness?
degenerative high noise exposure congenital rubella congenital syphilis acoustic neuroma vascular disease of internal auditory artery brain stem lesion
Causes of multiple cranial nerve palsies?
nasopharyngeal carcinoma
chronic meningitis
GBS
vascular brain stem lesions
Site of lesion in Wernicke’s aphasia?
posterior part of first temporal gyrus in dominant lobe
Site of lesion in Broca’s aphasia?
posterior part of third frontal gyrus
Signs of a lower motor neurone lesion?
weakness
wasting
decreased/absent reflexes
fasciculation
Signs of an upper motor neurone lesion?
weakness
spasticity
clonus
hyperreflexia
Causes of painful peripheral neuropathy?
diabetes mellitus alcohol vitamin B12/B1 deficiency carcinoma porphyria
What are the nerve conduction study findings in a demyelinating peripheral neuropathy?
slowed conduction velocity
delayed or absent F waves
What are the nerve conduction study findings in an axonal peripheral neuropathy?
reduced amplitude
relative normal conduction velocity
Causes of mononeuritis multiplex?
diabetes polyarteritis nodosa SLE RA sarcoid acromegaly
Causes of thickened nerves?
hereditary motor and sensory neuropathy
acromegaly
CIDP
amyloidosis
Causes of fasciculation?
benign idiopathic fasciculation motor neuron disease motor root compression malignant neuropathy spinal muscular atrophy
What are the clinical features of Charcot-Marie-Tooth?
pes cavus (high arch of foot)/clawing of the toes
distal muscle atrophy
symmetrical distal weakness
absent reflexes
thickened nerves
high stepping gait/foot drop
reduced sensation (motor symptoms usually predominant over sensory symptoms)
What are the clinical features of C5/C6 upper trunk brachial plexus lesion?
hand in waiter’s tip position
sensory loss over lateral aspect of arm/forearm and thumb
What are the clinical features of a radial nerve lesion?
wrist and finger drop
sensory loss over anatomical snuffbox
What are the clinical features of a median nerve lesion?
inability to flex index finger
inability to abduct thumb
sensory loss over thumb, index, middle and half of ring finger on palmar aspect
Causes of carpal tunnel syndrome?
idiopathic RA hypothyroidism acromegaly pregnancy trauma/overuse
What are the clinical features of an ulnar nerve lesion?
weak finger abduction and adduction
claw hand
sensory loss over the little finger and medial half of the ring finger
What are the clinical features of a femoral nerve lesion?
weakness of knee extension
loss of knee jerk
sensory loss of inner aspect of thigh
What are the clinical features of a sciatic nerve lesion?
weakness of knee flexion
foot drop
loss of ankle jerk
sensory loss on posterior thigh and total loss below the knee
What are the clinical features of a common peroneal nerve lesion?
foot drop
loss of foot eversion
What are the causes of foot drop?
common peroneal nerve palsy sciatic nerve palsy lumbosacral plexus lesion L4/5 root lesion peripheal motor neuropathy distal myopathy motor neurone disease precentral gyrus lesion
What causes spinothalamic (pain and temperature) loss only?
syringomyelia
brown-sequard syndrome (contralateral leg)
anterior spinal artery thrombosis
lateral medullary syndrome (contralateral to other signs)
What causes dorsal column (vibration and proprioception) loss only?
subacute combined degeneration brown-sequard syndrome (ipsilateral leg) spinocerebellar degeneration multiple sclerosis tabes dorsalis (syphillis)
What are the clinical features of syringomyelia?
loss of pain and temperature in cape distribution
weakness, atrophy and areflexia of arms
upper motor neurone signs in lower limbs
Signs of lateral medullary syndrome?
ipsilateral signs: - horner's syndrome - nystagmus - facial sensory impairment - ataxia - diplopia contralateral signs - pain and temperature loss in body
Signs of myotonic dystrophy?
bilateral ptosis wasting of facial muscles frontal baldness cataracts grip myotonia (slow release of grip) percussion myotonia - tap thenar eminence - will display a muscle twitch then slow relaxation
Complications of myotonic dystrophy?
dilated cardiomyopathy cardiac arrhythmias aspiration dysphagia diabetes thyroid dysfunction infertility cataracts
Causes of parkinsonism?
parkinson's disease drugs parkinson's plus syndrome stroke in basal ganglia postencephalitis wilson's disease
What is the pathology underlying parkinson’s disease?
degeneration of the substantia nigra neurons in the basal ganglia
Investigations for peripheral neuropathy?
FBE UEC LFTs folate B12 HbA1c TFT HIV myeloma screen CSF analysis nerve conduction studies
Signs of parkinson’s?
mask like facies hypophonia pill rolling tremor cogwheel rigidity bradykinesia freezing stooped posture shuffling gait reduced arm swing
How would you differentiate a tremor in parkinsons to an essential tremor?
essential tremor usually symmetrical and worse with movement
What are the cerebellar signs?
dysdiadochokinesis dysmetria impaired heel shin test nystagmus ataxia broad based gait staccato speech
In which cause of foot drop is inversion preserved?
common peroneal nerve palsy
In which causes of foot drop is the ankle jerk preserved?
common peroneal nerve palsy, L4/5 root lesion
What does pyramidal weakness look like in the lower limbs?
weakness of hip flexion, knee flexion and dorsiflexion
What does a cranial nerve VI palsy cause?
isolated abduction defecit
Differential diagnosis for ophthalmoplegia that doesn’t fit with a specific CN palsy?
graves ophthalmopathy
myasthenia gravis
Where is the lesion for a superior quandrantonopia?
temporal lobe
Where is the lesion for an inferior quandrantonopia?
parietal lobe
What is the differential diagnosis for a bitemporal hemianopia?
pituitary tumour craniopharyngioma suprasellar meningioma glioma metastasis
What are the findings of an ulnar nerve palsy?
wasting of the small muscles of the hand sparing the thenar eminence
weakness of finger abduction/adduction
weakness of the flexion of 4th and 5th fingers
reduced sensation over 5th and half of 4th fingers
What are the causes of an ulnar nerve palsy?
lesions at elbow/wrist - fracture, compression
mononeuritis multiplex
What are the findings of a radial nerve palsy?
wrist extension weakness
finger extension weakness
forearm supination weakness
sensory loss over anatomical snuffbox
What are the findings of a median nerve palsy?
wasting of the thenar eminence
weakness of thumb abduction, flexion and opposition
sensory loss over palmar aspect of first 3 and a half digits
Differential diagnosis for hemiparesis?
stroke tumour demyelination abscess post ictal
Where is the stroke if predominantly leg weakness is involved?
anterior cerebral artery
