Neuro signs

Question 1

What are the signs of a cerebellar lesion?

Answer 1

DANISH
Dysdiadochokinesia and Dysmetria 
Ataxia
Nystagmus
Intention tremor
Slurred, staccato, scanning speech
Hypotonia

Question 2

What is lateral medullary syndrome? What are the signs?

Answer 2

A syndrome caused by actue ischaemia of the lateral medulla, by occlusion of a vertebral artery -> PICA (posterior inferior cerebellar artery)  
DANVAH
Dysphagia and slurred speech 
Ataxia (ipsi)
Nystagmus (ipsi) and diplopia
Vertigo
Anaesthesia (ipsi face, contra pain)
Horner's syndrome (ipsi)

Question 3

What is pyramidal weakness?

Answer 3

Weakness affecting the extensors > flexors in the upper limbs and flexors > extensors in lower limbs. A key part of the UMN syndrome

Question 4

What are some signs of UMN lesion?

Answer 4

Pyramidal weakness
Spasticity +/- clonus
Brisk reflexes
Upgoing plantars

Question 5

What are some signs of LMN lesion?

Answer 5

Muscle wasting and fasciculation
Flaccid tone
Reduced reflexes
Normal plantars

Question 6

What is Brown-Sequard syndrome?

Answer 6

A syndrome of cord hemisection with these signs below the level of the lesion:

• Ipsi loss of touch and vibration
• Ipsi UMN signs
• Contra loss of pain and temperature

Question 7

What is Romberg’s test?

Answer 7

Test for cause of ataxia. Ask the patient to stand with their feet together and close their eyes.
If off balance with eyes open: cerebellar
If off balance with eyes closed only: Romberg +. Proprioceptive deficit

Question 8

What is internuclear ophthalmoplegia?

Answer 8

Defect of the MLF (medial longitudinal fasciculus) causing ophthalmoplegia

• Ipsi eye fails to adduct
• Contra eye has nystagmus on abduction
• Can converge normally

Question 9

How do you name a nystagmus?

Answer 9

Named by the direction of the fast phase

eg. right-beating has fast phase to the right, slow saccade to the left

Question 10

What are some causes of ptosis?

Answer 10

• Horner’s syndrome
• 3rd nerve palsy
• MG

Question 11

What is Horner’s syndrome?

Answer 11

A syndrome caused by compression of the sympathetic fibres supplying the 3rd nerve

• > Ptosis
• > Miosis
• > Anhydrosis
• > Enophthalmos

Question 12

What are the causes of Horner’s syndrome?

Answer 12

Several causes which can be classified by location of lesion

1) Central: vascular eg. brainstem stroke (wallenberg syndrome eg. LMS), SOL, demyelination eg. MS
2) Preganglionic: tumours (breast, Pancoast), dissection
3) Postganglionic: tumour, Herpes zoster, dissection

Question 13

Describe how to assess GCS

Answer 13

Eyes 4, Voice 5, Motor 6 
E: 
4) Opens spontaneously
3) Opens to voice
2) Opens to pain
1) No opening 

V:

5) Speaking clearly
4) Confused
3) Words without meaning
2) Noises
1) No vocalisation

M:

6) Obeys commands
5) Localises to pain
4) Withdraws from pain
3) Flexes to pain
2) Extensor response
1) No response

Question 14

Describe the difference between bulbar signs and pseudobulbar signs

Answer 14

Bulbar: LMN lesion

• Slurred, nasal speech
• Flaccid, fasciculating tongue
• Absent gag reflex

Pseudobulbar: UMN lesion

• Slow deliberate speech,
• Slow and spastic tongue movement
• Exaggerated gag and jaw jerk