Neuro signs Flashcards
What are the signs of a cerebellar lesion?
DANISH Dysdiadochokinesia and Dysmetria Ataxia Nystagmus Intention tremor Slurred, staccato, scanning speech Hypotonia
What is lateral medullary syndrome? What are the signs?
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)
What is pyramidal weakness?
Weakness affecting the extensors > flexors in the upper limbs and flexors > extensors in lower limbs. A key part of the UMN syndrome
What are some signs of UMN lesion?
Pyramidal weakness
Spasticity +/- clonus
Brisk reflexes
Upgoing plantars
What are some signs of LMN lesion?
Muscle wasting and fasciculation
Flaccid tone
Reduced reflexes
Normal plantars
What is Brown-Sequard syndrome?
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
What is Romberg’s test?
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
What is internuclear ophthalmoplegia?
Defect of the MLF (medial longitudinal fasciculus) causing ophthalmoplegia
- Ipsi eye fails to adduct
- Contra eye has nystagmus on abduction
- Can converge normally
How do you name a nystagmus?
Named by the direction of the fast phase
eg. right-beating has fast phase to the right, slow saccade to the left
What are some causes of ptosis?
- Horner’s syndrome
- 3rd nerve palsy
- MG
What is Horner’s syndrome?
A syndrome caused by compression of the sympathetic fibres supplying the 3rd nerve
- > Ptosis
- > Miosis
- > Anhydrosis
- > Enophthalmos
What are the causes of Horner’s syndrome?
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
Describe how to assess GCS
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
Describe the difference between bulbar signs and pseudobulbar signs
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