Neurological Lecture

Question 1

What are some common presenting complaints in neurological conditions?

Answer 1

Memory Loss
Loss of Consciousness
Headache
Numbness
Weakness

Question 2

Memory loss arises from four main causes :

Answer 2

Age-related changes
Mild cognitive impairment
Dementia
Depression

Question 3

What happens to older people and their memory?

Answer 3

Storage and recall of memories can take longer
Learning new tasks can be more difficult
Occasional forgetfulness may be present
Cognition is not impaired however they just need more time to recall

Question 4

What is required to diagnose dementia?

Answer 4

Requires evidence of memory loss plus cognitive or behavioural dysfunction

Question 5

Cognitive changes in dementia includeL

Answer 5

Aphasia (language difficulties)
Apraxia (difficulty performing previously learned motor activities)
Agnosia (difficulty identifying objects)
Impaired executive function (difficulty planning/organising tasks)

Question 6

What can cause LOC?

Answer 6

Seizure disorders
Cardiovascular syncope
Non-epileptic attacks

Question 7

What should we consider when a patient has numbness?

Answer 7

Ischemia (e.g., brain or spinal cord infarction, vasculitis)

Demyelinating disorders (e.g., multiple sclerosis, Guillain-Barré syndrome)

Mechanical nerve compression (e.g., by tumours or a herniated disc, in carpal tunnel syndrome)

Infections (e.g., HIV, leprosy)

Toxins or drugs (e.g., heavy metals, certain chemotherapy drugs)

Metabolic disorders (e.g., diabetes, chronic kidney disease, thiamin or vitamin B12 deficiency)

Immune-mediated disorders (e.g., post-infectious inflammation, such as transverse myelitis)

Degenerative disorders (e.g., hereditary neuropathies)

Question 8

Numbness of part of one limb =

Answer 8

Peripheral nervous system lesion

Question 9

Unilateral numbness of both limbs =

Answer 9

Brain lesion

Question 10

Bilateral numbness below a specific dermatomal level =

Answer 10

Transverse myelopathy (spinal cord lesion

Question 11

Red Flags - Numbness

Answer 11

Sudden onset (e.g., within minutes or hours) of numbness
Sudden or rapid onset (e.g., within hours or days) of weakness
Dyspnea
Signs of cauda equina or conus medullaris syndrome (e.g., saddle anaesthesia, incontinence, loss of anal wink reflex)
Neurologic deficits below a spinal segment
Loss of sensation on both the face and body (on the same side or opposite sides)

Question 12

What are some common causes of weakness?

Answer 12

Upper motor neurons (corticospinal and corticobulbar tract lesions)
Lower motor neurons (e.g., due to peripheral polyneuropathies or anterior horn cell lesions)
Neuromuscular junction
Muscle (e.g., due to myopathies)

Question 13

What are the findings in UMN and LMN?

Answer 13

Upper Motor Neuron Dysfunction
This disinhibits lower motor neurons leading to spasticity and hyper-reflexia
Lower Motor Neuron Dysfunction
This results in hypo-reflexia and decreased muscle tone/atrophy