Neuro week: Hx & Ex Flashcards
Neuro cardinal symptoms
- memory, cognition
- loss of consciousness
- headache
- vision
- hearing
- speech, swallowing
- limb weakness
- limb numbness
- bladder/bowel disturbance
- gait, balance
Describe degree of atrophy, fasiculations, tone, reflexes in an UMN lesion
Minimal atrophy
No fasciculations
Spastic tone
Brisk reflexes (hyperreflexia)
Describe degree of atrophy, fasiculations, tone, reflexes in a LMN lesion
Atrophy present
Fasciculations present
Reduced tone
Diminished reflexes
If the cerebrum is affected, are symptoms unilateral or bilateral
Usually bilateral
If there is lower limb weakness but no upper limb weakness, where must lesion be?
Below level of T1
Where would urinary incontinence/ urgency/ frequency indicate the lesion is?
Spinal cord
Describe Guillain Barre syndrome
- Rapid onset muscle weakness
- Immune system damages peripheral nervous system
- tends to start in feet and hands, before spreading to arms and legs
Define syncope
Transient loss of consciousness due to brain hypoperfusion
What to ask in a syncope history
- trigger
- warning symptoms
- predisposing factors
- witness account
- situation
- aftermath
What might cause cardiac syncope
LV outflow obstruction
- aortic stenosis
- hypertrophic cardiomyopathy
Arrhythmia
- complete heart block
- VT
- VF
Tends to occur during exercise
What might cause neurogenic syncope
- Vasovagal
- Cough syncope
- Micturition syncope
- Carotid sinus sensitivity
Occurs in any situation resulting in increased pressure
What might cause generalised seizure
- Alcohol excess
- Sleep deprivation
- Photosensitivity
The witness account is as follows. What type of syncope might have happened?
- Patient turned ashen grey
- Patient was had floppy limbs and minor intermittent jerking
Neurogenic or cardiac syncope
The witness account is as follows. What type of syncope might have happened?
- Patient had floppy limbs
- Continuous rhythmical convulsions
- Central cyanosis
- Abnormal noisy breathing
Generalised seizure
In a generalised seizure, where is the tongue normally bitten during the tonic movement?
Laterally
In which types of syncope does the patient recover quickly, which types does thee patient wake up confused?
Quick recovery:
Neurogenic, cardiac
Waking up confused:
Generalised seizure
Name some causes of L sided Horner’s syndrome
- L carotid artery dissection
- L apex bronchial carcinoma
- Syringomyelia of cervical spinal cord
Where in neck does CN 10 run
Carotid sheath
Bell’s palsy is caused by UMN or LMN lesion
LMN
List 0-5 on the MRC scale
0: complete paralysis
1: minimal contraction
2: active movement if no gravity
3: weak movement against gravity
4: active movement against gravity and resistance
5: normal strength
What nerve roots do the follow reflexes test:
- biceps
- supinator
- triceps
- knee
- ankle
- Babinski
Biceps: C5 Supinator: C6 Triceps: C7 Knee: L3/4 Ankle: S1 Babinski: L5/S1
Why do LMN lesions result in increased fasciculations
Ach receptors are upregulated
Where does spinal cord end
L1
Would symptoms in cerebrum be unilateral or bilateral
Unilateral
Describe degree of atrophy, fasiculations, tone, reflexes in Parkinson’s
- muscle atrophy present
- fasiculations present
- increased tone
- normal reflexes
Parkinsons is UMN disease (basal ganglia). Basal ganglia does not have direct connections to LMN so reflexes not affected
Where does sensory inattention indicate the problem is
Problem in higher cortical areas
3 types of tremor
action tremor
resting tremor
intention tremor
What type of tremor do Parkinsons patients have
Resting tremor
What is a normal Babinski reflex
Plantar reflex (foot goes down)
What is chorea
Involuntary movement disorder (type of dyskinesia)
Looks like dancing
What is dystonia
Sustained/ repetitive contractions resulting in twisting/ abnormal fixed postures
May look like tremor
Where does a positive Babinski reflex indicate damage to
UMN
corticospinal tract
What is transverse myelitis
Inflammation of the spinal cord at 1 level
What does a crossed abductor reflex indicate
UMN disease (pyramidal problem)
Pyramidal tracts = corticospinal + corticobulbar
What causes paraplegia
Spine injury at level of thoracic/lumbar vertebra
