Neurological Overview Flashcards
What anatomy must you consider in neurology cases?
Brain Spinal Cord Nerve roots Peripheral nerves NMJ
What categories of pathology can cause lesions?
VIITT
Vascular Infection Inflammation Toxic/Metabolic Tumor
Summarise the cranial nerves
I: sense of smell II: VA, VF, pupils, fundoscopy III, IV, VI: diplopia V: sensation, corneal reflex VII: facial palsy VIII: hearing IX, X: Speech, swallowing XI: Sternocleidomastoid, trapezius XII: tongue movements
What is the order when carrying out examinations on upper and lower limbs?
Inspection Tone Power Reflexes Coordination Sensation Gait Back
What are UMN lesion signs?
Increased tone
Hyper-reflexia
Decreased power
What are LMN lesion signs?
Decreased tone
Decreased power
Decreased reflexes
Pt presents with Diplopia (bilateral 6th) Bilateral ptosis Slurred speech Dysphagia Sluggish pupillary response to light Descending symmetric muscle weakness Multiple skin abscesses on arms & legs Where is the lesion?
NMJ
Multiple features relating to multiple parts of body (cranial nerves and limbs)
Botulism
DDx - Myasthenia Gravis
What are cerebellar signs?
Ataxia Nystagmus Dysdiadokinesia Intention tremor Speech (slurred,scanning)
What anatomy can result in abnormal sensation?
Cerebral cortex (hemisensory loss)
Spinal cord (which level?)
Nerve roots (Radiculopathy, dermatomes?)
Mononeuropathy (specific area)
Polyneuropathy (glove and stockings distribution)
55 yr old man Numbness & tingling in hands & feet PMH: type 1 DM On basal/bolus insulin HbA1C: 50 mmol/mol B12: 500 pg/ml (200 – 900) eGFR: 90
Reduced Sensation to PP (glove & stocking distribution)
What to prescribe?
Duloextine
Peripheral neuropathy
Toxic/metabolic pathology
How can toxins/metabolism cause pathology?
Drugs Alcohol B12 deficency Diabetes Hypothyroidism Uraemia Amyloidosis (abnormal protein)
What are other causes of peripheral neuropathy?
Infection:
HIV
Inflammation/Autoimmune:
Vasculitis, CTD, inflammatory demyelinating neuropathy
Tumour/Malignancy:
Paraneoplastic
Paraproteinaemia
Hereditary:
Hereditary sensory motor neuropathy
What are different causes of blurred vision?
Amaurosis fugax Anterior uveitis Papilloedema Papillitis Vitreous haemorrhage
What is Amaurosis Fugax?
‘transient darkening’ temporary loss of vision through one eye, which returns to normal afterwards
This is usually due to a temporary disturbance of the blood flow to the back of the eye
TIAs/Stroke
What is anterior uveitis?
Uveitis is inflammation of the middle layer of the eye, called the uvea or uveal tract. It can cause eye pain and changes to your vision.
What is Papilloedema?
Papilledema is the swelling of the optic nerve as it enters the back of the eye due to raised intracranial pressure.
What is Vitreous haemorrhage?
Bleeding into vitreous humour
What is papilitis?
Optic neuritis (papillitis)
Blurred optic disc margins
Blurred vision
Pain on eye movement
What is spastic paraparesis?
Spinal cord inflammation
What is MS?
Two lesions
Separated by time and place
e.g. spinal cord and cranial nerve
How do you differentiate between lesions in the brain/spinal cord?
If in the brain you get contralateral, unilateral signs
60 year old man Pain & paraesthesia on anteriolateral thigh PMH: Type 2 Diabetes Metformin HbA1C: 60 mmol/mol
BMI: 30 kg/m2
Reduced PP sensation anterolateral thigh
What is the most appropriate next step in his management? Diagnosis?
Compression of lateral femoral cutaneous nerve
‘Meralgia parasethetica’
Reassure
Avoid tight garments
Lose weight
If persistent:
Carbamazepine
Gabapentin
Sensory innervation of the hand?
See diagram
What is radiculopathy?
Disease of the nerve roots
Can be caused by compression by
- disc herniation
- spinal canal stenosis
