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Neuro Shorts Flashcards

1
Q

What are saccades?

A

Small, fast movements of the eyes

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2
Q

Which phase of nystagmus is pathological?

A

Slow phase

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3
Q

Pattern of cerebellar nystagmus

A

Unilateral or bilateral, causes eye to drift back (slow phase) to centre, with fast phase in direction of gaze. Also called gaze-evoked nystagmus

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4
Q

What is Alexander’s law?

A

Phenomenon in which the spontaneous nystagmus of a patient with a vestibular lesion is more intense when the patient looks in the quick-phase than in the slow-phase direction.

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5
Q

Pattern of peripheral vestibular nystagmus

A

Unidirection, frequently horizontal although sometimes tortional, follows ALexander’s law

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6
Q

Causes of monocular nystagmus

A

CN III, IV, or VI palsy

INO

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7
Q

What is Bell’s phenomenon?

A

With ipsilateral 7th nerve palsy, eye on side of the lesion may roll superiorly with the corneal stimulus

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8
Q

Causes of Horner’s syndrome

A
  1. Carcinoma of lung apex
  2. Neck - thyroid malignancy, trauma
  3. Carotid arterial lesion - aneurysm or dissection, tumour, cluster headache
  4. Brain stem lesions - vascular disease (esp lateral medullary syndrome), syringobulbia, tumour
  5. Retro-orbital lesions
  6. Syringomyelia (rare)
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9
Q

Causes of bilateral anosmia

A
  1. URTI
  2. Meningioma of olfactory groove (late)
  3. Ethmoid tumour
  4. Head trauma (including cribriform plate fracture)
  5. Meningitis
  6. Hydrocephalus
  7. Congenital - Kallmann’s
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10
Q

Causes of unilateral anosmia

A
  1. Meningioma of olfactory groove (early)

2. Head trauma

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11
Q

Causes of absent light reflex but in tact accommodation reflex

A
  1. Midbrain lesion (e.g. Argyll Robertson pupil)
  2. Ciliary ganglion lesion (e.g. Adie’s pupil)
  3. Parinaud’s syndrome
  4. Bilateral anterior visual pathway lesions (bilateral afferent pupil deficits)
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12
Q

Causes of absent convergence but intact light reflex

A
  1. Cortical lesion (e.g. cortical blindness)

2. Midbrain lesions (rare)

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13
Q

What is one and a half syndrome?

A
  1. Horizontal gaze palsy (both eyes unable to look ipsilateral to side of lesion)
  2. INO
    - Means only contralateral eye can ABduct (with nystagmus)
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14
Q

Location of lesion causing upper quadrant homonymous hemianopia

A

Temporal lobe

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15
Q

Location of lesion causing lower quadrant homonymous hemianopia

A

Parietal lobe

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16
Q

Causes of pupillary constriction:

A
  1. Horner’s syndrome
  2. Argyll Robertson pupil
  3. Pontine lesion (often bilateral, but reactive to light)
  4. Narcotics
  5. Pilocarpine drops
  6. Old age
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17
Q

Causes of pupillary dilatation

A
  1. Mydratics, atropine poisoning, cocaine
  2. 3rd nerve lesion
  3. Adie’s pupil
  4. Iridectomy, lens implant, iritis
  5. Post-trauma,
  6. Congenital
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18
Q

Sign’s of Adie’s syndrome

A
  1. Dilated pupil
  2. Decreased or absent reaction to light (direct and consensual)
  3. Slow or incomplete reaction to accommodation with slow dilation afterwards
  4. Decreased tendon reflexes
  5. Patients are commonly young women
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19
Q

Causes of Argyll Robertson pupil

A
  1. Syphilis
  2. Diabetes
  3. Alcoholic midbrain degeneration (rare)
  4. Other midbrain lesions
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20
Q

Signs of Argyll Robertson pupil

A
  1. Small, irregular, unequal pupil
  2. No reaction to light
  3. Prompt reaction to accommodation
  4. If tabes associated, decreased reflexes
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21
Q

Causes of optic neuropathy

A
  1. Multiple sclerosis
  2. Toxic (ethambutol, chloroquine, nicotine, alcohol)
  3. Metabolic - B12 def.
  4. Ischaemia (DM, temporal arteritis, atheroma)
  5. Familial - Leber’s disease
  6. Infective - infection mononucleosis
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22
Q

Causes of cataract

A
  1. Old age
  2. Endocrine - DM, steroids
  3. Hereditary or congenital - dystrophia myotonica, Refsum disease
  4. Ocular disease - glaucoma
  5. Irradiation
  6. Trauma
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23
Q

Causes of ptosis with normal pupils:

A
  1. Senile ptosis (common)
  2. Myotonic dystrophy
  3. Fascioscapulohumeral dystrophy
  4. Ocular myopathy e.g. mitochondiral myopathy
  5. Thyrotoxic myopathy
  6. Myasthenia gravis
  7. Botulism, snake bite
  8. Congenital
  9. Fatigue
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24
Q

Causes of ptosis with constricted pupils:

A
  1. Horner’s

2. Tabes dorsalis

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25
Causes of ptosis with dilated pupils:
1. CN III lesion
26
What does superior oblique muscle do?
INtorts the eye, supplied by IV nerve
27
Central causes of CNIII lesion
1. Vascular (brain stem stroke) 2. Tumour 3. Demyelination (rare) 4. Trauma 5. Idiopathic
28
Peripheral causes of CNIII lesion
1. Compressive: - Aneurysm (PCOM) - Tumour causing raised ICP (dilated pupil occurs early) - Nasopharyngeal carcinoma - Orbital lesions - Tolosa-Hunt syndrome (superior orbital fissue syndrome- painful lesion of 3rd/4th/6th and V1) - Basal meningitis 2. Infarction - DM, arteritis (pupil usually spared) 3. Trauma 4. Cavernous sinus lesions
29
Cause of bilateral CN VI lesions
1. Trauma (head injury) 2. Wernicke's encephalopathy 3. Raised ICP 4. Mononeuritis multiplex
30
Cause of unilateral CN VI lesions
``` Central: 1. Vascular 2. Tumour 3. Wernicke's 4. MS (rare) Peripheral: 1. DM, other vascular lesions 2. Trauma 3. Idiopathic 4. Raised ICP ```
31
Upbeat vertical nystagmus suggests
Lesion in floor of fourth ventricle
32
Downbeat vertical nystagmus suggests
Foramen magnum lesion
33
Toxic causes of vertical nystagmus
Phenytoin, alcohol (may be multidirectional)
34
Central causes of Parinaud's syndrome
1. Pinealoma 2. MS 3. Vascular lesions
35
Peripheral causes of Parinaud's syndrome
1. Trauma 2. DM 3. Other vascular lesions 4. Idiopathic 5. Raised ICP
36
Central causes of CN V palsy
Pons, medulla, upper cervical cause 1. Vascular 2. Tumour 3. Syringobulbia 4. MS
37
Peripheral causes of CN V palsy
``` Posterior fossa 1. Aneurysm 2. Tumour (skull base, acoustic neuroma) 3. Chronic meningitis Trigeminal ganglion - petrous temporal bone 1. Meningioma 2. Fracture of middle fossa ```
38
Cavernous sinus causes of CN V palsy (associated CN III, IV, VI palsy)
1. Aneurysm 2. Thrombosis 3. Tumour
39
Other causes of CN V palsy
1. Sjogren's 2. SLE 3. Toxins 4. Idiopathic
40
If loss of CN V pain but preservation of touch, consider lesion where?
Brain stem or upper cervical cord
41
If loss of CN V touch but preservation of pain, consider lesion where?
Pontine nucleus lesion
42
Cause of UMN CN VII palsy
1. Vascular | 2. Tumour
43
Cause of LMN CN VII palsy
1. Pontine (vascular, tumour, syringobulbia, MS) 2. Posterior fossa (acoustic neuroma, meningioma) 3. Petrous temporal bone (Bell's, Ramsay Hunt, OM, fracture) 4. Parotid (tumour, sarcoid
44
Causes of bilateral LMN facial weakness
1. GBS 2. Bilateral parotid disease (e.g. sarcoidosis) 3. Mononeuritis multiplex (rare) 4. Myopathy (usually genetic) 5. Myasthenia
45
Causes of sensorineural deafness:
1. Degeneration (presbycusis) 2. Trauma (high noise exposure, fracture of petrous temporal bone) 3. Toxic (aspirin, EtOH, streptomycin) 4. Infection (congenital rubella, congenital syphilis) 5. Tumour (acoustic neuroma) 6. Brain stem lesion 7. Vascular disease of internal auditory artery
46
Causes of conductive deafness:
1. Wax 2. Otitis media 3. Otosclerosis 4. Paget's disease of bone
47
Central causes of CN IX/X palsy
1. Vascular (lateral medullary due to vertebral or PICA disease) 2. Tumour 3. Syringobulbia 4. MND (vagus nerve only)
48
Peripheral/posterior fossa causes of CN IX/X palsy
1. Aneurysm 2. Tumour 3. Chronic meningitis 4. GBS (X only)
49
Aetiology of UMN CN XII lesion
1. Vascular 2. MND 3. Tumour 4. MS
50
Aetiology of unilateral LMN CN XII lesion
Central: 1. Vascular - thrombosis of vertebral artery 2. MND 3. Syringobulbia Peripheral (posterior fossa): 1. Aneurysm 2. Tumour 3. Chronic meningitis 4. Trauma 5. Arnold-Chiari malformation 6. Fracture or tumour of base of skull
51
Causes of bilateral LMN CN XII lesion
1. MND 2. Arnold chiari malformation 3. GBS 4. Polio
52
Diagnoses to consider with multiple CN palsies
1. Nasopharyngeal carcinoma 2. Chronic meningitis (carcinoma, TB, sarcoid) 3. GBS (spares I/II/VIII), including Millfer-Fisher 4. Brain stem lesions - look for crossed signs 5. Arnold-Chiari malformation 6. Trauma 7. Base of skull lesion (Paget's, large meningioma, metastasis) 8. Mononeuritis multiplex (rare) secondary to DM for e.g.
53
What are the features of Gerstmann's syndrome?
Acalculia, agrapha, left-right disorientation, finger agnosia
54
Causes of peripheral neuropathy
1. Drugs - isoniazid, vincristine, phenytoin, nitrofurantoin, cisplatinum, amio, high dose B6, heavy metals 2. Alcohol, amyloidosis 3. Metabolic - diabetes, uraemia, hypothyroidism, porphyria 4. Immune-mediated - GBS 5. Tumour - lung Ca 6. Vit B12 / B1 deficiency, or B6 excess 7. Idiopathic 8. CTD or vasculitis - SLE, PAN 9. Hereditary
55
Causes of predominantly motor neuropathy
1. GBS, CIDP 2. HMSN (CMT) 3. Acute intermittent porphyria 4. Diabetes 5. Lead poisoning 6. Multifocal motor neuropathy
56
Causes of predominantly sensory neuropathy
1. Diabetes 2. Carcinoma (lung, ovary, breast) - may be neuronopathy, length independent 3. Paraproteinaemia 4. Vit B6 intoxication 5. Sjogren's (often neuronopathy) 6. Syphilis 7. Vit B12 deficiency 8. Idiopathic
57
Causes of painful peripheral neuropathy
1. Diabetes 2. EtOH 3. Vit B12/B1 deficiency 4. Carcinoma 5. Porphyria 6. Arsenic or thallium poisoning 7. Hereditary (although most not painful)
58
Nerve conduction study findings in demyelinating neuropathy (diabetes, paraprotein, CMT, CIDP)
Velocity < 75%, distal latency > 130%, normal amplitude
59
Nerve conduction study findings in axonal neuropathy (diabetes, toxins, metabolic, paraneoplastic)
Amplitude < 50%, velocity > 70%
60
Causes of acute mononeuritis multiplex
Diabetes, CTD, PAN
61
Causes of chronic mononeuritis multiplex
1. Multiple compressive neuropathies 2. Sarcoidosis 3. Acromegaly 4. Leprosy 5. Lyme disease 6. Carcinoma (rare) 7. Idiopathic
62
Causes of thickened nerves
1. HMSN 2. Acromegaly 3. CIDP 4. Amyloidosis 5. Leprosy 6. Others - sarcoid, neurofibromatosis

BPT Clinical (5 decks)

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