Neurological Symptoms Flashcards
List examples of acute headache.
Migraine
SAH
Examples of subacute headache.
Hours to days: meningitis, tension headache
Days to weeks: increased ICP, intracranial mass, temporal arteritis, sinusitis
Examples of chronic headache.
Recurrent migraine
Chronic tension headache
Med overuse
What is chronic headache?
Episodic over months/years with more than 15 headaches/month
What is the difference between a primary and secondary headache?
Primary headache - headache is condition
Secondary - headache is a symptom of underlying pathology
What are examples of primary headache?
Migraine
Tension headache
Examples of secondary headache.
Increased ICP - SOL e.g. tumour or bleeding
Infection - meningitis, encephalitis, sinusitis
What are the signs (headache) of raised ICP?
Present when walking
Worse with straining, coughing, bending over, sneezing
Associated with vomiting
What are the symptoms of bacterial meningitis?
Generalized headache Fever Neck stiffness Photophobia Vomiting Intense malaise
What can cause facial pain>
Trigeminal neuralgia, temporal arteritis, sinusitis
What are some causes of neck pain?
Meningitis - fever and neck stiffness
Cervical cord compromise - trauma, limb weakness, sensory abnormalities, gait impairment, bowel/bladder dysfunction
Radiculopathy (pinched nerve) - weakness, tingling in upper limbs, numbness
- MSK - facet joint dysfunction
What is a common cause of back pain radiating to leg where leg pain is worse than back pain?
Lumbar radicular pain
What causes lumbar radicular pain?
Disc prolapse
Cauda Equina syndrome (neurosurgical emergency)
What is important to note about change in LOC?
WHat happened (px or witness) Precipitant Duration Recovery Associated symptoms
What are common causes of change in LOC?
Syncope and seizure
What is syncope?
LOC due to cerebral anoxia
What are causes of syncope?
SAH
Arrhythmia
Vasovagal (trigger)
Postural hypotension - sitting to standing
WHat is a seizure?
Sudden transient neurological event due to paroxysmal discharge of cerebral neurons
Name the two types of seizures.
General
Focal
What are the characteristics of a general seizure?
Whole brain affected
Tonic-clonic seizure
What are the features of a tonic clonic seizure?
Preceded by aura
Tonic phase: abrupt LOC and body stiffening
Followed by clonic phase: Rhythmical jerking
Urinaryy/fecal incontinence
Tongue biting
What are the characteristics of a focal seizure?
Only part of the brain is affected
May/may not cause LOC
- Aura: taste/smell, deja vu, hear music, very fearful, nausea/abdominal pain
- Motor features e.g. one limb jerking
- Transient loss of awareness or responsiveness
What is weakness?
Loss of muscle strength
What causes weakness?
UMN lesions
LMN lesions
Where is an UMN lesion?
In brain or spinal cord above the level of the anterior horn cell
Where is a LMN lesion and what are examples of this?
Interrupts the spinal reflex arc
E.g. Motor neuron disease, peripheral nerve laceration, Guillain Barre Syndrome
What is hemiparesis and what are possible causes?
One side of body weak
Contralateral motor cortex pathway lesion
Parapesis - meaning and cause
Both legs are weak
Lower spinal cord lesion (L1 or below)
Quadripesis - meaning and cause
All four limbs weak
High cervical spinal cord lesion (C3 or above), Brainstem lesion
Monoparesis - meaning and cause
Only one limb
Motor cortex or partial internal capsule lesion
What may causes disorders in gait?
Weakness in legs
Ataxia: tendency to fall to one side, with or without incoordination in the limbs (cerebellum disease/alcohol)
Loss of proprioception - positive Romberg’s sign: worsening balance with closed eyes
Describe features of the Parkinson’s gait.
Moving slower than expected for age Festinating: strides become quicker/slower than normal Jerky steps Moving arms less when walking Falling frequently Freezing of gait
What may patients feel when they say they are dizzy?
Weak
About to faint/light headed (pre-syncope)
Unsteady (poor balance)
Moving when still/world moving around them (vertigo)
What is vertigo and what may cause it?
Perceived sense of motion when there is none
Peripheral cause - problem with vestibular apparatus in inner ear
Central cause - problem with brain (less common)
What other symptoms may be associated with vertigo?
Sweating, pallor, nausea and vomiting, inability to stand/walk, hearing issues, headache
What causes nausea/vomiting?
Raised ICP
Inner ear issues e.g. vertigo
Migraine
Emotional/physical stressors
What is balance?
Being steady without falling
What may cause issues with balance?
Weakness/vertigo
What is sensory loss vs paraesthesia?
Sensory loss = absence of sensation
Paraesthesiae = abnormal sensations e.g. tingling, burning, pins and needles
What sensory changes do hemispheric brain lesions cause?
Sensory changes in opposite side of body
What sensory regions do spinal cord lesions affect?
Cause sensory changes below level of lesion
What causes peripheral sensory loss?
Particular nerve or nerve root
Nerves are diffusely involved = sensory loss is distal - glove and stocking distribution
What are some causes of loss of vision in one eye?
Disease of that eye or optic nerve
E.g. optic neuritis or amaurosis fugax (impaired bloodflow in ophthalmic or retinal artery)
What can a pituitary tumour do to vision at the optic chiasm?
Bitemporal hemianopia - loss of temporal vision in each eye
What do optic radiation and cortex lesions cause?
Homonymous hemianopia or quadrantanopia
What causes acute bilateral blindness?
Occlusion of both posterior cerebral arteries
What causes hearing loss/impairment/disturbance?
Sensorineural or conductive problems
What is phantom ear noise or tinnitus?
Ringing in the absence of external stimuli
What is dysarthria and its causes?
Disturbance of speech articulation - slurring while language is preserved
UMN weakness of muscles of articulation, cerebellar dysfunction causing disturbed rhythm, PD
What is dysphasia and aphasia?
Disturbances of language
What is dysphasia and aphasia?
Disturbances of language
What is receptive dysphasia and what area is affected?
Lesion in Wernickes area (temporal lobe)
Cannot understand spoken/written words
Cannot obey verbal commands or recognise written words
Speech is fluent but disorganized
What is expressive dysphasia and what causes it?
Lesion in Broca’s area in frontal lobe of dominant hemisphere
Understand written/spoken words but cannot answer appropriately
Speech is non-fluent
May be able to sing familiar songs
Preservation of emotional speech = upset - swear fluently
Higher intellectual function preserved
What is nominall dysphasia and why does this occur?
Temporal lobe lesion Cannot name objects Other aspects of speech/language normal Speech is fluent Will use long phrases instead of one word
What is the name given to abnormalities of the sound of voice?
Dysphonia and aphonia
What is the issue with dysphonia/aphonia?
Problem with vocal cords - lesion or weakness/paralysis of vocal cords due to recurrent layrngeal nerve palsy
What causes dysphagia?
Weakness of muscles involved in swallowing, PD, obstruction of pharynx or oesophagus by structural lesion
What usually causes involuntary movements?
Disease of basal ganglia
Postural tremor
Worst with arms raised, usually due to Benign essential tremor
Resting tremor
PD
Intention Tremor
Worsens as target is approached = cerebellar dysfunction
Myoclonus
Rapid, shock like non-repetitive jerks
Chorea
Quick dance like movements seen in HD and RF
Athetosis
Slow writhing movements e.g. cerebral palsy
Dyskinesia
Choreo-athetoid movements with levedopa treatment of PD
Dystonia
Slow movements which alter the position of the limb/head/neck E.g. antipsychotics and antiemetics
Tic
Stereotyped semi voluntary movement e.g. Tourette Syndrome, transient tic disorder
What causes dysfunction in bladder control?
Stroke, MS, spinal cord injuries
Symptom for tonic-clonic seizure
What causes dysfunction in bowel control?
Spinal cord injury, MS, PD, childbirth or pelvic surgery
What is altered cognition and what causes it?
Trouble remembering, concentrating, making decisions
Age, FHx, education level, brain injury, exposure to pesticides and toxins, physical inactivity, PD, heart disease, stroke = all risk factors
What is ataxia and what causes it?
Coordination of muscles is impaired leading to unsteady gait.
Wide placed feet to give broader base of support.
Patient may lose balance, lean or lurch to one side or veer off course.
Lots of movements in arms/trunks in order to maintain balance.
Caused by effect of alcohol intoxication on the cerebellum or mid-line cerebellar lesion
What is meningism and what causes it?
Meningeal irritation - headache, neck stiffness, photophobia
Caused by infection , SAH, encephalitis
What is delirium and its causes?
Rapid onset of disturbance of mental abilities causing confused thinking and decreased awareness of the environment.
Seen with infection/metabolic disorder/effects of toxins and drugs
What is dementia?
Deterioration in memory, thinking, behaviour and the ability to perform everyday activities.
NOT a normal part of aging, Consciousness is preserved.
AD = most common cause
Vascular dementia = second most common cause
What is Parkinsonism and its causes?
Bradykinesia (slow movements), resting tremor, rigidity (cogwheel or lead pipe)
Disorder of postural reflexes with a tendency to fall.
Bradykinesia causes soft voice, dysarthria, stooped posture and shuffling gait.
PD most common cause. Other causes antipsychotic medication
What is leadpipe vs cogwheel rigidity?
Leadpipe - constant resistance to motion
Cogwheel - resistance that starts and stops as the limb is moved through its range of motion - initially resistant, but then loses resistance as movement occurs
What is the difference between rigidity and spasticity?
Rigidity varies little with the speed of movement of the limb whereas spasticity is often brought out by rapid passive movement of the limb (spastic catch)
What causes raised ICP and what are the symptoms?
Intracerebral mass lesion e.g. tumor, hydrocephalus (dilated cerebral ventricles), altered cerebrospinal fluid dynamics (idiopathic intracranial hypertension)
- Headache (worse in mornings and wakes the patient during the night), responds well to analgesics
- Projectile vomiting, visual symptoms
Requires urgent investigation with neuroimaging. Dangerous to do lumbar puncture unless a mass lesion has been excluded.
What causes cerebellar syndrome and what tests are important?
Gait and limb ataxia
Nystagmus (jerky movement of the eyes)
Dysarthria (disturbed speech articulation)
Important tests - finger to nose test, rapid alternating movements, heel-shin test and foot tapping
Caused by stroke or MS
What is myelopathy and its causes?
Damage or disease of the spinal cord
Causes include injury, MS or trauma
What is radiculopathy and its causes?
Damage/disease of one or more nerve roots
Cervical nerve roots = pain and sensory loss in arm in a specific dermatomes with accompanying weakness in the corresponding myotomes and loss of one or more reflexes
Lower limbs - pain radiating down the leg, dermatomal sensory loss and weakness in distribution of affected root, with or without reflex change. Straight leg raising is a useful sign of nerve root compression.
Commonest cause is disc prolapse. Others = neoplasms and radiotherapy
What is neuropathy?
Damage or disease of one or more nerves
What is myopathy and its symptoms.
Neuromuscular disorder.
Primary symptom is muscle weakness due to dysfunction of the muscle fibres.
NB: Myotonic dystrophy is separate - facial weakness, eyelid drooping, distal muscle weakness in limbs.
Genetic myopathies e.g. muscular dystrophies and acquired myopathies e.g. steroid induced myopathy
UMN lesion
Brain or spinal cord above the level of the anterior horn cell. Part of body affected is determined by site of lesion. Weakness Little/no muscle atrophy Increased tone - spasticity Increased reflexes - hyperreflexia Extensor plantar response (upgoing toe)
LMN Lesion
Lesion interrupts spinal reflex arc. Part of body affected is determined by site of lesion.
Weakness
Early muscle atrophy
Fasciculation - visible spontaneous contraction of motor units
Hypotonia
Reduced or absent reflexes - hyporeflexia or areflexia
Normal plantar response or absent plantar response
