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Neurology > Neuroanatomical Localisation > Flashcards

Neuroanatomical Localisation Flashcards

1
Q

What is the focal pattern of weakness?

A

In distribution of peripheral nerve or spinal root, hemi-distribution, pyramidal distribution

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2
Q

What is the non-focal pattern of weakness?

A

Generalised = predominantly proximal or distal

Includes bulbar motor function if truly generalised (otherwise quadri/tetraparesis)

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3
Q

What is the distribution of UMN weakness?

A

Corticospinal, hemiparesis, quadriparesis, paraparesis, monoparesis, faciobrachial

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4
Q

What are some features of UMN pattern?

A

Central pattern sensory loss
Increased deep tendon reflexes (flaccid if very acute)
decreased superficial reflexes
Increased pathological reflexes
Sometimes impaired sphincter function
Increased muscle tone and muscle hypertrophy

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5
Q

What are some features of LMN pattern?

A

Normal/decreased deep tendon reflexes
Normal superficial and pathological reflexes
Usually normal sphincter function -except cauda equina
Normal/decreased muscle tone with muscle wasting

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6
Q

What is the UMN patter of weakness?

A

Increased tone with brisk reflexes

Pyramidal or corticospinal pattern = weakness in arm extensors and leg flexors

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7
Q

What is the LMN pattern of weakness?

A

Wasting, fasciculation, decreased tone and absent/decreased reflexes, flexor plantars

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8
Q

What is the muscle disease pattern of weakness?

A

Wasting = usually proximal
Decreased tone
Absent/decreased tendon reflexes

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9
Q

What is the NMJ pattern of weakness?

A

Fatiguable weakness
Normal or decreased tone
Normal tendon reflexes and no sensory symptoms

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10
Q

What is the pattern of functional weakness?

A

No wasting, normal tone and reflexes, erratic power, non-anatomical loss

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11
Q

What can cause UMN lesions in the CNS?

A

Acute stroke, space occupying lesions and spinal cord problems

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12
Q

What are some patterns of UMN lesions?

A

Hemispheric = contralateral pyramidal weakness in face, arms or legs
Spinal cord = pyramidal weakness below level of lesion (cervical = arms and legs, thoracolumbar = legs)
Parasagittal frontal lobe lesion = paraparesis

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13
Q

What causes LMN lesions in anterior horn cells?

A

Motor neuron disease and spinal muscular atrophy

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14
Q

What are some causes of LMN lesions in peripheral nerves?

A

Diabetes, alcohol or metabolic insults

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15
Q

How may LMN lesions in peripheral nerves present?

A

Symmetrical polyneuropathy with weakness and sensory symptoms
Mononeuropathy due to nerve compression
Mononeuritis multiplex due to diabetes or vasculitis

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16
Q

What are the nerves and muscles involved in shoulder abduction and elbow extension?

A

Shoulder abduction = deltoid muscle, axillary nerve, C5 nerve root
Elbow extension = triceps muscle, radial nerve, C7 nerve root

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17
Q

What are the nerves and muscles involved in finger extension and index finger abduction?

A

Finger extension = extensor digitorum, posterior interosseous nerve, C7 nerve root
Index finger abduction = first dorsal interosseous, ulnar nerve, T1 nerve root

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18
Q

What muscles and nerves are involved in hip and knee flexion?

A

Hip flexion = iliopsoas muscle, femoral nerve, L1-2 nerve roots
Knee flexion = hamstring muscle, sciatic nerve, S1 nerve root

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19
Q

What muscles and nerves are involved in ankle dorsiflexion?

A

Peroneal muscle = innervated by common peroneal and sciatic nerves, L4-5 nerve roots

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20
Q

What are the roots of the deep tendon reflexes?

A 
Ankle = S1-2
Knee = L3-4
Biceps = C5-6
Triceps = C7-8
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21
Q

What are some patterns of sensory loss?

A

Stocking = implies length dependent neuropathy
Dermatomal = mononeuropathy, radicular/plexus lesion
Sensory level = implies spinal cord lesion

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22
Q

What does hemianaesthesia suggest?

A

Contralateral cerebral lesion or a non-organic disorder if there is an absence of other signs

23
Q

What symptoms are suggestive of hemicord damage?

A

Dissociated sensory loss with lost spinothalamic but preserved dorsal column

24
Q

What are the signs of cerebellar dysfunction?

A

Broad based and unsteady gait
Intention tremor, ataxia, nystagmus, dysarthria
Dysdiadochokinesis = clumsy fast alternating movements

25
Q

How is an intention tremor or ataxia assessed?

A

Arms = finger-nose test
Legs = knee-heel test
Tremor gets worse nearer to target

26
Q

What are the characteristic features of extrapyramidal symptoms (Parkinsonism)?

A

Bradykinesia, rigidity, resting tremor and impaired gait/posture

27
Q

What are some additional extrapyramidal symptoms?

A

Hypomimia and hypophonia

Reduced arm swing, stooped posture, small steps, festination, turning en bloc and impaired postural reflexes

28
Q

How can symptom distribution be used to differentiate between different causes of Parkinsonism?

A 
Asymmetry = Parkinson's disease 
Symmetry = drug induced or atypical Parkinson's
29
Q

What is the function of the frontal lobe?

A

Generates novel strategies and executive functions

30
Q

What are some features of the orbitofrontal cortex?

A

Responds to primitive stimuli

Damage causes disinhibition

31
Q

What is the function of the dorsolateral prefrontal cortex?

A

Responds to external stimuli

32
Q

What are the cingulate gyrus and dorsomedial frontal lobe responsible for?

A

Motivation = damage causes lack of will or even akinetic mutism

33
Q

What are some signs of frontal lobe dysfunction?

A

Personality dysfunction, paraparesis, paratonia, magnetic gait, cortical hand, seizures, incontinence, visual field defects, expressive dysphasia, anosmia

34
Q

What are some signs of temporal lobe dysfunction?

A

Memory dysfunction = especially episodic memory
Agnosia and temporal lobe epilepsy
Congruous upper homonymous quadrantanopia
Auditory and limbic dysfunction
Receptive aphasia

35
Q

What are some signs of parietal lobe dysfunction?

A

Congruous lower homonymous quadrantanopia
Sensory dysfunction, dyspraxia, inattention and denial
Gerstmann’s syndrome

36
Q

What is Gerstmann’s syndrome?

A

Disease of the dominant angular gyrus = dysgraphia, left-right disorientation, finger agnosia, acalculia

37
Q

What is the treatment of Parkinson’s disease?

A

Levodopa or dopamine agonists
MAO-B inhibitors may be used as add on or alone
Anticholinergics have severe side effects
Amantadine may help resting tremor

38
Q

What are the symptoms of Parkinson’s disease?

A

Asymmetrical = resting tremor, rigidity, bradykinesia, postural instability

39
Q

What does postural instability lead to in Parkinson’s disease?

A

Falls = usually late in disease course

40
Q

What would be a strong indicator that a patient doesn’t have idiopathic Parkinson’s disease?

A

Failure to respond to large doses of levodopa

41
Q

What is a common side effect of levodopa?

A

Dyskinesia

42
Q

What are some features of multiple sclerosis?

A

Symptoms = visual compromise, stiffness, weakness
Symptoms may worsen after fever or high temperature
May have lesions on MRI without clinical compromise directly related to those lesions

43
Q

What are some features that would indicate a patient has had an ischaemic stroke?

A

Sudden onset, focal signs and symptoms usually in keeping with a vascular territory, usually negative symptoms (ie loss of function)

44
Q

How common is intracerebral haemorrhage as a cause of stroke?

A

Account for 10% of all strokes

45
Q

What imaging can be used to identify strokes?

A

MRI T1/2 and FLAIR = old lesions, non-vascular lesions
T2 = bleeds and microbleeds
Time of flight sequences and diffusion weighted image
CT

46
Q

What are diffusion weighted images used to identify?

A

New ischaemic lesions (hyperintensities) and a decrease in signal on apparent diffusion coefficient of water

47
Q

What do time of flight sequences identify?

A

Occlusions of extra and intracranial arteries

48
Q

What may a CT show in a patient with an ischaemic stroke?

A

Hyperintensities = bleeds
Subtle ischaemic signs in acute phase of stroke = loss of lentiform nucleus limit, poor white matter differentiation, loss of insular ribbon

49
Q

What are some features of lacunar strokes?

A

No visual field defect or higher cortical/brainstem issue
Pure motor hemiparesis, pure sensory unilateral deficit, sensorimotor/ataxic hemiparesis
At least two of face, arm or leg involved

50
Q

What is needed to diagnose a posterior circulation stroke?

A

Any 1 of = cranial nerve palsy, cerebellar dysfunction, unilateral or bilateral motor/sensory deficit, disorder of conjugate eye movements, homonymous hemianopia or cortical blindness

51
Q

What are the symptoms of a total anterior circulation stroke?

A

Hemiplegia and homonymous hemianopia contralateral to lesion
Either aphasia or visuospatial disturbances
May also have sensory deficit contralateral to lesion

52
Q

What is needed to diagnose a partial anterior circulation stroke?

A

One or more of = unilateral motor or sensory deficit, aphasia, visuospatial neglect (with or without homonymous hemianopia)

53
Q

How can you differentiate between a partial anterior circulation stroke and a lacunar stroke?

A

Motor or sensory deficits may be more extreme in a lacunar stroke

Neurology (48 decks)

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