Neurological Exam Flashcards
What are the causes of anosmia/ reduced olfaction include?
URTI
Smoking
Nasal Polyps
Older Age
Tumours: ethmoid sinus, meningioma of the olfactory groove, frontal lobe tumours
Congenital: Kallman syndrome
Degenerative: Parkinson’s and Alzheimer’s dementia
What are the sites of lesions causing reduced visual acuity?
Cornea, e.g. Chlamydia trachomatis
Aqueous humour, e.g. aberrant drainage in glaucoma
Lens, e.g. cataract
Vitreous, e.g. preretinal haemorrhage
Retina, e.g. retinitis pigmentosa or macular degeneration
Optic nerve, e.g. optic neuritis
Intracerebral, e.g. tumour or stroke
What are the causes of a peripheral scotoma?
Toxic effects of methanol
Nutritional deficiencies
Vascular changes with hypertension.
What are the causes of a central scotoma?
Papilloedema or optic atrophy
What are the differentials for a small pupil?
Horner’s syndrome (includes meiosis, psosis, anhidrosis and enophthalmos)
Argyll-Robertson pupil: a small irregular pupil which accommodates but does not react to light
What are the differentials for a large pupil?
Third nerve palsy: pupil fixed and dilated, eye in down and out position and ptosis
Holmes-Adie pupil: the pupil is large and irregular and accommodates but reacts only slowly to light. - It is a tonic pupil because, once constricted, it is slow to dilate. If associated with absent deep tendon reflexes, it is known as Holmes-Adie syndrome. This is a normal variant
What are the causes of relative afferent pupillary defect (Marcus-Gun pupil)?
Optic neuritis
Optic atrophy
Retinal detachment
How do you differentiate trigeminal nerve palsy from cavernous sinus syndrome?
The mandibular division is not affected in cavernous sinus syndrome because it leaves through the foramen ovale in the middle cranial fossa before reaching the cavernous sinus.
What is “Bell’s phenomenon”?
On attempted eye closure, the orbit rolls upwards
What are the types of gait?
Parkinsonian
Hemiparetic
Ataxic
Paraparetic
Spastic
Choreoathetoid
High Stepping
Waddling
Shuffling (marche a petit pas)
What does standing on toes test?
Strength of the ankle plantar flexors, gastrocnemius and soleus, served by nerve roots S1-2
What does standing on heels test?
Failure to do so indicates a foot drop
This is a screen of the ankle dorsiflexor, tibialis anterior, served by the deep peroneal nerve from roots L4-5.
(foot drop may be bilateral suggesting Charcot-Marie-Tooth disease (CMT or hereditary sensory motor neuropathy/HSMN) or unilateral, as with a localised common peroneal nerve palsy.
How do you interpret Romberg’s test?
To maintain balance there must be input from 2 of the 3 senses: proprioception, vestibular function and vision.
If patient has poor balance with eyes open you cannot proceed with Romberg’s test; this suggests cerebellar ataxia.
If the patient maintains balance with eyes open but on closing beings to sway or tilt, this is a positive Romberg’s test, indicating lack of proprioception and disease of the dorsal column.
(note can also indicate vestibular disease but history and examination would help to distinguish these in practice)
What are the differentials for pes cavus?
Unilateral: poliomyelitis, spinal cord tumour, spinal trauma
Bilateral: idiopathic (20%), cerebral palsy, CMT/HMSN, Friedreich’s ataxia, muscular dystrophies, syringomyelia.
What muscle, nerve and root level does hip flexion test?
Iliopsoas
Femoral
L1, L2 (L3)
What muscle, nerve and root level does Hip extension test?
Gluteus maximus
Inferior gluteal
L5, S1 (S2)
What muscle, nerve and root level does hip adduction test
Adductors (obturator externus, adductor longus, magnus and brevis and gracilis
Obturator nerve
L2, L3 (L4)
