Neuro - symptoms + signs Flashcards
Meningitis - symptoms + signs
- Non-specific features
- fever, headache, N+V, lethargy, irritability, muscle/joint pains, refusing food, respiratory symptoms
- Stiff neck
- Non-blanching/purpuric rash
- Back ridgidity
- Photophobia
- Altered mental state
- Kering’s sign - pain + resistance on passive knee extension with hips fully flexed
- Brudzinski’s sign - hips flex on bending the head forward
- Paresis, focal neurological defcits (incl cranial nerve involvement, abnormal pupils)
- Seizures, LOC
- Shock (tachy, hypotension, resp distress, poor urine output, increased cap refill time, altered mental state, leg pain, cold hands + feet, unusual colour)
Subdural haemorrhage signs and symptoms
Fluctuating consciousness Confusion Personality changes Symptoms of increased ICP Can present as UMN signs (e.g. pronator drift)
Main difference between meningitis + encephalitis
In meningitis consciousness is not impaired where is in encephalitis it is usually always affected
Anterior cerebral artery stroke symptoms + signs
Contralateral hemiparesis lower limb>upper limb
Behavioural changes
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Middle cerebral artery stroke symptoms + signs
Contralateral hemiparesis upper limb/face>lower limb
Contralateral hemisensory loss (makes sense because somatosensory cortex in the parietal lobe is affected)
Apraxia (bc parietal lobe is affected - involved in bringing together + combining information needed to perform skillfull actions)
Receptive/expressive aphasia (involvement of Wernicke’s + Broca’s areas)
Broca’s area - expressive aphasia, broken speech
Wernick’s area - receptive aphasia
(optic radiation contains tracts that carry information from the lateral geniculate nucleus to the primary visual cortex in 2 loops: Meyer’s + Baum’s)
Quadrantanopia
Superior optic radiation (Baum’s loop) - parietal lobe, causes contralateral inferior quadrantopoia
Inferior optic radiation (Meyer’s loop) - temporal lobe, causes contralateral superior quadrantopoia
Hemineglect (parietal lobe)
Facial weakness
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Posterior cerebral artery stroke symptoms + signs
Contralateral homonymous hemianopia
(often damage to the occipital lobe/visual cortex leads to macular sparring - large macular representation, dual blood supply (PCA, MCA))
Visual agnosia (damage to the visual association cortex)
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Brainstem damage in stroke
Reduction in consciousness
Cranial nerve pathology
IPSILATERAL SIGNS
Cerebellar stroke
DANISH
Dydiadochochenesia Ataxia Nystagmous Intention tremor Slurred speech Hypotonia
IPSILAERAL SIGNS
Total anterior circulation stroke (TACS) vs Partial anterior circulation stroke (PACS)
Contralateral motor or sensory deficit
Homonymous hemianopoia
Higher cortical dysfunction (e.g. aphasia)
TACS - all 3 of them
PACS - any 2 of them
Posteror circulations stroke
Any of:
Isolated homonymous hemianopoia
Brainstem signs
Cerebellar ataxia
Lacunar stroke (LACS)
Any of
Pure motor deficit
Pure sensory deficit
Sensorimotor deficit
Cauda equina presentation
LMN symptoms (nerve roots affected and not the CNS so no UMN signs as in spinal cord compression)
Perianal anaesthesia
Bladder retention
leg weakness
Lacunar infarct affecting the
o Affecting the internal capsule/pons
Internal capsule - Pure motor, pure sensory, mixed motor + sensory signs
Pons - dizziness/vertigo, ataxia
Lacunar infarct affecting the
o Affecting the thalamus
loss of consciousness, hemisensory deficit
Lacunar infarct affecting the
o Affecting the basal ganglia
Dyskinesias
hemichorea, hemiballismus, parkinsonism
Intact cognition/consciousness
Lacunar infarct affecting the
o Multiple lacunar infarcts
Vascular dementia Urinary incontinence Gait apraxia Shuffling gait Normal or excessive arm-swing
Normal pressure hydrocephalus signs - popular SBA
Hakim’s triad (weird walking water)
- Urinary incontinence
- Dementia
- Gait disturbance (ataxia, shuffling)(also cognitive impairement, hyperreflexia)
Hydrocephalus symptoms + signs
Acute onset
Papilledema Headache Vomiting Impaired upward gaze Sunset eyes
Hydrocephalus symptoms + signs
Gradual onset
- Unsteady, slow, cautious gait
- Unsteady gait (Levodopa-unresponsive gait apraxia (spasticity in legs))
- Large head
- Unilateral/bilateral 6th nerve palsy (2o to raised ICP)
- Double vision
- CN palsies
- Cognitive impairement
Multiple sclerosis symptoms + signs MS
CNS so UMN signs Visual - Blindness/hemianopoia - Optic neuritis - Scotoma - Symmetrical HORIZONTAL jerking nystagmus - LR weakness - may cause double vision - Eye pain commonly exacerbated on eye movement as the inflamed optic nerve sheath is stretched - INO (intranuclear ophthalmoplegia)
Face
- Bell’s palsy
- Trigeminal neuralgia
- Paroxysmal dysarthria
Ears
- Deafness
- Unsteadiness
Autonomic system
- Bladder - urgency, frequency, incontinence, impaired bladder emptying
- Sexual problems - impotence
- Loss of thermoregulation - excess sweating
Cognitive
- Visual + auditory attention affected
- Loss of memory
Perineum + genital numbness, altered sphincter function –> characteristic feature of MS
intention tremor, ataxia, dysmetria - cerebellar signs
Lhermitte’s sign = electric shock sensations
MS with cervical posterior column involvement
Sudden neck flexion causes electric-shock sensations to the limbs
Motor neurone disease symptoms MND
MND=ALS
- UMN + LMN dysfunction
Oculomotor + sphincter functions spared!!
Limb onset more most common (usually upper limbs)
- Pt drop objects, can’t manipulate objects with one hand
- Wasting of intrinsic muscles
- Fasciculations
Lower limb problems
- Foot drop
- Gait disorder
- Difficulty rising from low chairs + climbing stairs (+ wasting, fasciculation, change in tone + reflexes unlike MG)
Progressive ASYMMETRICAL weakness of bulbar, limb, thoracic, abdominal muscles
Onset can also be bulbar (20%) - slurring of speech, emotional lability, dysphagia, wasting + fascisulation of tongue
Onset can rarely be respiratory - dyspnoea, orthropnoea, hypoventilation overnight (unrefreshing sleep, early morning headahces)
NO sensory involvement
Course of disease in myasthenia gravis
Starts in the eyes with weakness to the extrinsic ocular muscles and LPS
Myasthenis gravis symptoms
- Muscle weakness that increases with exercise and improves with rest
- Fatiguable muscles
- Ptosis (but pupils are spared unlike in Horner’s syndrome where there is miosis)
- Double vision
- Oropharungeal/appendicular weakness
Dysphagia, dysarthria
Reading aloud may provoke dysarthria of nasal speech after 3 mins
Proximal limb weakness
- difficult in getting out of chairs, climbing stairs but no muscle wasting, no fasciculations, normal tone, normal reflexes, normal sensation unlike MND
- SOB
NO sensory signs
Weakness is greater in proximal muscles (rather than distal as in GBS) + commonly involves spinal nerves
Median nerve damage symptoms
- Wasting of the thenar muscles
- Lack of ability to abduct + oppose the thumb
- Weakness in forearm pronation + wrist + finger flexion
- Sensory loss in thumb, index, middle finger + radial aspect of ring finger
Ataxic gait
what is it a sign of?
Where is it seen?
Cerebellar sign
Seen in Wernicke’s encephalopathy
Hemiplegic gait sign
Typically following a stroke
Shuffling gait sign
PD
Scissor gait sign
Cerebral palsy cord lesions (e.g. MS)
results from increased spasticity in both legs
Choreiform gait sign
Huntington’s
Wernicke’s encephalopathy triad
- Ophtalmoplegia
- Confusion
- Ataxia
Wernicke’s encephalthy triad vs NPH triad vs encehalitis
Wernicke’s encephalopathy
- Eye signs - ophthalmoplegia, nystagmus, diplopoia
- Confusion
- Ataxia (due to cerebellar damage)
NPH triad (Hakim’s triad)
- Urinary incontinence
- Dementia
- Gait disturbance (ataxia, shuffling)
Encephalitis
- Fever
- Headache
- Altered mental status
Basal skull fracture signs
haemotympanum
panda eyes
CSF leakage from ear or nose
Battle’s sign
Guillaine Barre syndrome symptoms GBS
PNS so LMN signs Weakness, paraesthesia and hyporeflexia Progresses acutely SYMMETRICAL I fasciculation T flaccid tone P ascending pattern of progressive SYMMETRICAL weakness starting at the lower extremities affects proximal before distal muscles R hyporeflexia or absent S neuropathic pain, back pain, sensory abnormalities usually mild
Autonomic symptoms - decreased sweating, decreased heat intolerance, tachycardia, HTN, postural hypotension, ileus, urinary retention
Face - Facial weakness - facial droop, facial nerve palsy, Dysphasia, dysarthria
Extra-ocular muscle weakness - Diplopoia
Bulbuar dysfunction causing oroharyngeal weakness - Dysphagia
Trigeminal neuralgia symptoms + signs
- Paroxysms of Sudden, Unilateral, Stabbing/electric-shock like pain
- Most common in 2nd + 3rd divisions of the trigeminal nerve
- Does not interfere with sleep
- Following an episode of pain there is a refractory phase of several minutes during which there will not be another paroxysm of pain even if the triggering stimulus recurs
- Autonomic symptoms - lacrimation +/- redness of eye
- Progressive increase in frequency, duration, severity of attacks
Encephalitis symptoms
o Meningism (photophobia, neck stiffness, headache)
Followed by: o Altered state of consciousness o Seizures o Personality changes o Cranial nerve palsies o Speech problems o Motor + sensory deficits o Focal neurological signs (hemianopia, aphasia, hemiparesis, ataxia, brisk tendon reflexes, babinski's signs, CN deficits) o Increased ICP
Triad of encephalitis
- Fever
- Headache
- Altered mental status
Cognitive dysfunction
Memory disturbances
Psychiatric + behavioural manifestations
(hallucinations, withdrawal apathy, personality changes)
What do we mean by meningism?
o Photophobia
o Neck stiffness
o Headache
BPPV symptoms + signs
• Vertigo
Sudden onset
Severe
Brief duration - <30s
Episodic
Rapid resolution if the head is kept still
Brief latent period 5s-20s between the provocative movement + the experience of vertigo
- Specific provoking positions - looking up, bending down, getting up, turning head, rolling over in bed to one side
- Symptoms worse in the mornings
- Nausea, imbalance, light-headedness
• Positive Dix-Hallpike/Nylen-Barany manoeuvre – posterior canal BPPV
o Positive test – reproduction of vertigo + nystagmus
o Nystagmus
- Torsional – L ear has a clockwise torsional nystagmus response, R ear has an anti-clockwise response, horizontal nystagmus suggests horizonal canal BPPV
- Reversible with seating
- Fatigable with repeat testing
- Occurs with 1-5s latency
- Lasts <30s
• Positive supine lateral head turn – lateral canal BPPV
o Positive test – vertigo + nystagmus
o Horizontal nystagmus without torsional component
o When head is rotated towards the affected side the nystagmus will beat towards the ground (geotropic + be more intense)
- Normal neurological examination
- Normal otological examination
Meniere’s triad
- Vertigo m to h N+V attacks tend to cluster in groups - Unilateral Hearing loss - Unilateral Tinnitus
Not provoked by positional changes
Meniere symptoms + signs
Triad
- Vertigo m to h N+V attacks tend to cluster in groups
- Unilateral Hearing loss
- Unilateral Tinnitus
- Unilateral aural fullness
- Positive Romberg’s test
- Fukunda’s stepping test
o Turning towards the affected side when asked to march in place with eyes closed
Type 1 neurofibromatosis symptoms + signs
NF
- Painless mobile lumps under the skin (SC neurofibromatomas may be tender to touch + cause tingling in the distribution of the affected nerve)
- Cafe au lait spots - back, buttocks, thighs
- Lisch nodules on iris
- Spinal scoliosis
- RAS
- Phaeochromocytomas
- Large neurofibromas can develop in the abdominal cavity + press against nearby organs and impair their function (e.g. kidneys, constipation, abdominal pain)
- Optic gliomas (15%) – visual acuity loss, abnormal colour vision, visual field loss [most common presentation is asymmetrical visual fields]
- Disruption of bone maintenance and reduced bone mineral density – possibility of osteoporosis
- Most common additional manifestations: LEARNING DISABILITIES, optic pathway gliomas, diffuse plexiform neurofibromas, dystrophic SCOLIOSIS, sphenoid wing dysplasia, renovascular hypertension, malignant nerve sheath tumours, SHORT STATURE
- Also risk of seizures, bone dysplasia, Congenital heart disease (PS, HTN), Pheochromocytoma, RAS
Type 2 neurofibromatosis symptoms + signs
- BILATERAL acoustic neuromas (acoustic neuromas can occur in individuals that don’t have neurofibromatosis but in neurofibromatosis type II they tend to occur bilaterally) – tinnitus, gradual hearing loss on both sides, +/- loss of balance, facial weakness due to vestibular schwannomas –> SENSORINEURAL HEARING LOSS
- Intracranial meningiomas
- Spinal gliomas – pain, numbness, weakness (compression of the spinal cord)
- Paraspinal schwannomas
- Cataracts (Posterior subcapsular lenticular opacities)
- Hamartomas in the retina
- Absence of café-au-lait spots
symptomatic by age 20
Huntington’s symptoms
Chorea Athetosis - writhing movements of hands, early in course of disease pt can mask involuntary movements by incorporating them into socially acceptable movements .e.g. twiddling thumbs Ataxia Loss of coordination + balance Deficit in fine motor coordination Dysarthria, dysphagia
Cognitive decline
Impaired work or school performance
Personality changes - irritability, impulsativity, temper outbursts, loss of enthusiasm or involvement in previously engaging activities, self-neglect, depression
Dementia
Parkinson’s disease cardinal features PD
- Bradykinesia
- Rigidity - Lead pipe, cogwheel rigidity
- Postural instability - seen late, lack of ability to voluntarily adjust position in response to postural disturbance
- Resting tremor - 3-4 hz, pill rolling, can be induced by concentration, absent with activity
Parkinson’s disease symptoms PD
- Tremor at rest (can be induced by concentration, absent with activity, Low frequency – 3-4 Hz, pill rolling)
- Rigidity - Lead pipe, cogwheel rigidity
- Bradykinesia
- Postural instability - seen late, lack of ability to voluntarily adjust position in response to postural disturbance
5Ms
- Hypomimic face/masked facies
- Monotonous speech/hypophonia
- Micrograpia
- Misery - depression
- Memory loss - dementia
- Marche a petit pas*
- Stooped posture
- Shuffling gate
- Difficulty rising from a sitting position + starting to walk
- Small shuffling steps, unsteadiness on turning (taking several steps to turn), difficulty in stopping*
Neuropsychiatric: hallucinations, anxiety, confusion, stupor, impulsivity, depression, cognitive decline, dementia, paranoia, visuospatial dysfunction
Autonomic + Vegetative: bladder, bowel, hypotension, Impotence, dysarthria, dysphagia, drooling, rash, anosmia
Sleep: restless legs, REM sleep disorder, nightmares
Parkinson’s disease signs
4 cardinal signs
- Bradykinesia
- Rigidity - Lead pipe, cogwheel rigidity
- Postural instability - seen late, lack of ability to voluntarily adjust position in response to postural disturbance
- Resting tremor - 3-4 hz, pill rolling, can be induced by concentration, absent with activity
- Lack of arm swing when walking
SAH symptoms
- Thunderclap headache
Peaks within 1-5mins
Lasts more than 1h - N+V
- Photophobia
- Non focal neurological signs
- Depressed/loss of consciousness or confusion – caused by blockage of the normal CSF circulation by blood in the subarachnoid space
- Isolated pupillary dilation with loss of light reflex may indicate bran herniation as a result of rising intracranial pressure
- if blood irritates the meninges - signs of meningismus present (neck stiffness, photophobia)
Symmetrical or asymmetrical symptoms
MND
GBS
MND - asymmetrical
GBS - symmetrical
Difference between
Vasovagal syncope
Arrhythmias
Strokes-Adam attack
Epilepsy
Vasovagal (reflex)
- Precipitating factor
- Sweating
- Nausea
- Pale
- Dizzy
- Narrowing of visual fields
- May twitch + be incontinent
- Seconds
- Quick recovery on sitting
Arrhythmias (cardiac)
- Chest pain
- Palpitations
- Seconds
- Quick recovery on sitting
Strokes-Adam attack (cardiac - transient arrhythmias cause a drop in CO and LOC, underlying problem - complete heart block or sinoatrial disease) - Pale - Seconds - Facial flush (treatment is pacemaker)
Epilepsy
- Aura or no warning
- <3 mins
- Tongue biting
- Twitching
- Incontinence
- Slow recovery
- Post-ictal Confusion/Headache/Myalgia
Difference between an aura + a prodrome
Aura
- part of the seizure
- can last up to a few minutes
- strange smells, flashing lights, deja vu etc
- suggests that the epilepsy is focal
Prodrome
- not part of the seizure
- can last up to a few hours
- change in the patient’s experience or mood
What is Tood’s paresis?
- Syndrome assosciated with weakness or paralysis of part/all the body
- Happens after focal-onset seizure
Focal seizure - Frontal lobe epilepsy symptoms + signs
- Motor symptoms
- Jacksonian march - muscular spasm spreads from distal part of the limb to a larger area of the body
- Post-ictal flaccid weakness (Todd’s paralysis)
- Disinhibition –> Involuntary actions
Focal seizure - parietal lobe epilepsy
Sensory disturbances (pain, tingling, numbness)
Focal seizures - occipital lobe epilepsy
Visual disturbances (spots, lines, flashes)
Focal seizures - temporal lobe epilepsy
- Aura (epigastric discomfort)
- Automatisms (playing with fingers, lip smacking)
- Hallucinations
- Olfactory hallucinations
also called complex partial seizures
Exertional syncope sign of
AS, HOCM
HOCM - L ventricular outflow obstruction due to asymmetrical septal hypertrophy - occludes the outflow tract during systole
What is the Miller-Fischer syndrome and what are the signs and symptoms?
Variant of GBS
Triad of
- Ophthalmoplegia
- Areflexia
- Ataxia
but no muscle weakness
Brown sequard syndrome
What is it
describe the symptoms
Occurs when the spinal cord is injured on one side much more than the other
Lateral corticospinal tract crosses over in the medulla (motor)
Dorsal columns cross over in the medulla (sensation, vibration, proprioception)
Spinothalamic tract crosses over in the spinal cord (pain+temperature)
Therefore
- Ipsilateral loss of motor function, sensation, vibration, proprioception
- Contralateral loss of pain + temperature
Crossing + function of
Lateral corticospinal tract
Anterior corticospinal tract
Dorsal columns cross
Spinothalamic tract crosses
Lateral corticospinal tract crosses over in the medulla (motor to distal digits, limbs)
Anterior corticospinal tract crosses over in the spinal cord
(motor to proximal muscles of the trunk)
Dorsal columns cross over in the medulla (sensation, vibration, proprioception)
Spinothalamic tract crosses over in the spinal cord (pain+temperature)
Difference and similarities between spinal cord compression + cauda equina syndrome
Spinal cord compression
- LMN at lesion
- UMN below lesion
- Leg weakness
- Urinary incontinence retention
- Sensory level
- In acute injury there may initially be LMN signs
Cauda equina sydrome
- LMN
- Perianal anaesthesia
- Leg weakness
- Bladder retention
Radiculopathy symptoms + signs
• Motor
o LMN symptoms for the muscles innervated by this spinal root
• Sensory
o Dermatomal pattern
o Pain, numbness
Spinal cord compression symptoms + signs
- Acute onset – trauma
- Chronic onset – osteoporosis, tumours
• Motor
o Limb weakness (hemiplegia/paraplegia)
o LMN symptoms at the level of the lesion
o UMN symptoms below the level of the lesion
• Sensory
o Sensory loss below a specific level
o Back pain
• Autonomic
o Constipation
o Urinary incontinence/retention
o Erectile dysfunction
Cauda equina symptoms
- LMN symptoms
- Perianal anaesthesia
- Bladder retention
- Leg weakness
Cushing’s reflex/triad
What is it sign of?
Bradycardia
HTN
Irregular breathing
Sign of increased ICP
Mononuclear visual loss
optic nerve lesion
Homonymous hemianopoia
Lesion in the occipital lobe
Bitemporatal hemianopoia
Lesion in the optic chiasm
Fatiguability - where is the lesion
NMJ
Syringomyelia symptoms + signs
o Syrinx starts in cervical cord
o Spinothalamic tract is affected – bilateral loss of pain + temperature along the back and arms
o Dorsal roots not affected – vibration, proprioception, fine touch not affected
o LMN signs at the level of the syrinx (arms)
o UMN below the syrinx (legs)
o Paralysis, weakness
o MRI spine
o If fluid cavity is in the brainstem – syringobulia vocal cord paralysis, ipsilateral tongue wasting, trigeminal sensory loss
What is weird about myoclonic seizures?
o Pt often remains conscious + alert throughout
brief shock like jerk of a muscle or muslce groups
Complex partial seizures also called temporal lobe epilepsy describe
Focal seizures
- Impairement of consciousness
- Patient may still be awake
- Aura (epigastric discomfort)
- Automatisms (playing with fingers, lip smacking)
- Hallucinations
- Olfactory hallucinations
- Abnormal posture may be adopted due to dystonia
- Patient doesn’t remember the events after the attack
- often derived from temporal lobes
What are Jacksonian seizures?
Focal motor seizure
Simple partial seizure spreads from the distal part of the limb to the rest of the ipsilateral side of the body
Can lead to paralysis of involved limbs for several hours
Subtype of SPS (simple partial seizure)
Electrical activity causes a tingling sensation to march across a region of the body from one group of distal muscles to the other
This is often accompanied by automatisms, muscle cramping, hallucinations, head turning
Spinal stenosis symptoms + signs
Spinal stenosis
Pain relieved when sitting/leaning forwards
Caused by narrowing of the spinal canal due to spondylosis
Presents with: a)back pain + b) sciatica
Pain worse when spine is extended going downhill, walking
Pain better when spine is flexed going uphill, sitting
Lateral medullary syndrome symptoms + signs
- Ipsilateral sensory deficits of the face + CN
- Contralateral sensory deficits of the trunk + the extremities
- Sudden onset vomiting + vertigo
- Diminished gag reflex
- Palatal paralysis
- Nystagmus
- Horner’s syndrome
- Broad based ataxic gait
Caused by occlusion of the posterior inferior cerebelar artery
How does a head injury present?
Agitation
Headaches
Vomiting
Dizziness
Which is most commonly affected in MS?
cone cells
or
rod cells
Cone cells (colour vision + high acuity central vision) – myelinated, therefore more commonly affected
Rod cells (dark vision + peripheral vision) – non-myelinated, less commonly affected
Difference between
Essential tremor/familial tremor
PD tremor
Cerebellar tremor
Essential tremor/familial tremor
Absent at rest
Appear on action
6-12 Hz
Fine amplitude
May be ameliorated by alcohol or beta blockers
No other parkinsonian symptoms are present
PD tremor
Present at rest, exacerbated by concentration
Disappear on action
3-7 Hz
Coarse amplitude
Commonly affects the distal limbs asymmetrically
Cerebellar tremor
Increases in magnitude throughout the movement to be maximal on approaching the target
4-6 Hz
Associated with other cerebellar signs (DANISH)
cavernous sinus pathology
complete ophthalmoplegia of the affected side + loss of forehead sensation on the affected side
The cavernous sinuses of either side communicate with one another - thrombosis + fistula formation can cause symptoms on the other side as well
Damage in
Wernicke’s area
Broca’s area
Wernicke’s area – inability to understand language, able to produce fluent, non-sensical speech [Temporal lobe]
Broca’s area – ability to understand language, inability to produce fluent speech (broken speech) [Frontal lobe]
Central pontine myelinolysis is a result of….
signs + symptoms
Raising the Na too quickly in a hyponatraemic patient
Damage to the myelin sheath of the neurones that make up the pons
Acute paralysis, dysarthria, dysphagia
Lumbar spinal stenosis
what makes it worse
what makes it better
pain in the lower limbs
Worse when walking/standing for long periods of time
Eased by bending forwards to widen the spinal canal
stroke affects _____ side of face
brainstem lesions affect _______ side of face
stroke affects contralateral side of face
brainstem lesions affect ipsilateral side of face
How do you elicit Hoffman’s sign and what does it represent?
Positive Hoffman’s sign
Flick the distal phalanx of the middle finger - thumb contracts
This indicates an UMN lesion
Cerebellar problem vs proprioceptive problem
Cerebellar problem - patients can’t stand with their feet together even if their eyes are open
Proprioceptive loss - patients can stand with their feet together if they have their eyes open but lose their balance once they close their eyes (positive Romberg’s test)
What does the Romberg’s test test?
Proprioception
Ventricular septal defect VSD symptoms + signs
Pansystolic murmur
Cyanosis
Clubbing
Raised JVP often occurs
Haemorrhagic stroke presents…
Suddenly with a thunderclap headache
Lacunar strokes can present with
Unilateral motor disturbance affecting the face, arm or leg or all 3
Complete one sided sensory loss
Ataxia hemiparesis
