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Neurology Flashcards

1
Q

Upper and lower limb reflexes

A

Bicep - C5/6
Supinator - C5/6
Tricep - C7

Knee jerk - L3/4
Ankle jerk - S1

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2
Q

Myotomes & innervating nerves & muscle

A

Shoulder adduction

  • deltoid
  • axillary
  • C5/6

Elbow flexion

  • biceps
  • musculocutaneous
  • C5/6

Elbow extension

  • triceps
  • radial
  • C7

Wrist extension

  • extensor carpi radialis / ulnaris
  • radial, (posterior interosseous)
  • C7

Wrist flexion

  • flexor carpi radialis / ulnaris
  • median
  • C5/7

Finger abduction

  • ulnar
  • T1

Thumb opposition

  • opponens pollicis
  • median
  • T1

Hip flexion

  • L1-L3
  • Femoral / lumbar sacral plexus
  • Iliopsoas

Knee extension

  • Quadriceps
  • L3, L4
  • Femoral

Knee flexion

  • Hamstrings
  • L5, S1
  • Sciatic

Dorsiflexion

  • Deep peroneal
  • L4/5

Plantar flexion

  • S1
  • Gastrocnemius
  • tibial

Inversion

  • L4
  • Tibial
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3
Q

Sensory levels

A 
Shoulder - C4
Arm - C5-T3
Nipple - T5
Umbilicus - T10
Hips - L1
Leg - L2-S2 (S1 little toe, S2 back of upper leg)
S3 buttock
S4-5 perianal region
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4
Q

Peripheral polyneuropathy

A

Motor predominant

  • distal predominant
  • –> GBS
  • –> (poliomyelitis - anterior horn cell)
  • –> paraprotein associated e.g. MGUS / amyloid
  • –> toxins e.g. heavy metals
  • proximal
  • –> diabetic amyotrophy (proximal)

Sensory predominant

  • distal predominant
  • –> diabetes
  • –> B12 deficiency - axonal
  • –> alcohol related
  • –> paraneoplastic
  • –> chemotherapy related

Sensorimotor

  • distal predominant
  • –> hereditary sensory motor neuropathy (charcot marie tooth)
  • –> vasculitis - axonal
  • –> leprosy
  • –> drug / toxin related: isioniazid, ethambutol, nitro, metro, phenytoin
  • non-length dependent
  • –> CIDP (varying patterns including distal predominant)
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5
Q

Mononeuritis multiplex causes

A 
Diabetes
Vasculitis
- ANCA (microscopic polyangiitis, (eosinophilic) granulomatosis with polyangiitis)
- polyarteritis nodosa
- cryoglobulinaemia 
Amyloidosis
Sarcoidosis
Rheumatoid arthritis, SLE
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6
Q

Causes of spastic paraparesis

A

Spinal

  • demyelinating / inflammatory
  • –> MS
  • –> transverse myelitis (e.g. NMO spectrum)
  • –> tropical spastic paraparesis (HTLV1)
  • anterior spinal cord syndrome
  • –> cord compression: trauma, SOL, bleed, abscess, bone spurs
  • –> anterior spinal artery infarct (may cause flaccid with anterior horn cell involvement)
  • combined / other features
  • –> syrigomyelia (1 - spinothalamic, 2 - corticospinal, 3 - dorsal column)
  • –> subacute combined degeneration of the cord (dorsal column + corticospinal tract degeneration)
  • –> friedrich ataxia (corticospinal, dorsal column, spinocerebellar tract degeneration) + pes cavus, SN hearing loss, high arched palate, optic atrophy

Cerebral

  • cerebral palsy (may not be symmetrical)
  • bilateral infarcts (may have other signs)
  • traumatic brain injury (may have other signs)
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7
Q

Causes of flaccid paraparesis

A

Spinal cord involving anterior horn cells

  • transverse myelitis (also sensory)
  • anterior spinal cord syndrome -> anterior horn cells at affected levels (NB: may be UMN signs below effected levels if corticospinal tracts also affected)
  • MND (NB: may be mixed UMN / LMN)

Peripheral nerves

  • motor predominant peripheral neuropathy
  • –> GBS
  • –> CIDP (may have sensory component)
  • –> paraprotein associated (amyloid / MGUS)
  • –> toxins e.g. heavy metals
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8
Q

RAPD name, definition and causes

A

Marcus Gunn pupil
- relative pupillary dilatation on moving from good eye to bad eye (direct and consensual)

Causes

  • severe intra-ocular / retinal pathology
  • –> glaucoma
  • –> thyroid eye disease
  • –> vitreous haemorrhage
  • demyelinating
  • –> MS
  • –> NMO
  • ischaemic
  • –> arteritic - GCA
  • –> non-arteritic - HTN, DM
  • inflammatory
  • –> vasculitis (ANCA / polyarteritis nodosa)
  • –> sarcoid
  • nutritional / toxic
  • –> b12 deficiency
  • –> methanol
  • infective
  • –> TB, syphillis, Lyme
  • inherited
  • –> Leber’s (bilateral; mitochondrial)
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9
Q

Holmes-Adie pupil

A
  • moderately dilated pupil with poor response to light and sluggish response to accommodation
  • benign condition, often seen in females
  • associated absent knee and ankle jerks —> HOLMES ADIE SYNDROME
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10
Q

Causes of optic neuritis

A
  • demyelinating e.g. MS
  • infective e.g. TB, syphillis, Lyme
  • inflammatory e.g. sarcoidosis, vasculitis
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11
Q

Causes of optic neuritis

A
  • demyelinating e.g. MS, NMO
  • infective e.g. TB, syphillis, Lyme
  • inflammatory e.g. sarcoidosis, vasculitis
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12
Q

Causes of dilated pupil

A
  • glaucoma
  • mydriatic eye drops
  • simulant recreational drugs
  • CN3 palsy
  • Holmes-Adie
  • CN2 palsy (if RAPD)
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13
Q

Causes of small pupil

A
  • horner’s syndrome
  • argyll robertson pupil
  • opioids (bilateral)
  • iritis
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14
Q

Features and causes of horner’s

A

Features

  • partial ptosis
  • miosis
  • (anhydrosis) - distal lesions
  • enopthalmos (elevation lower lid)
  • ?heterochromia

Causes - interruption of sympathetic fibres

  • brainstem disease: MS, CVA (e.g. lateral medullary),
  • spinal cord disease: SOL, syrinx
  • neck: pancoast tumour, ICA aneurysm
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15
Q

CNIII palsy features and causes

A

Features

  • ptosis
  • down and out appearance
  • only lateral and inferior gaze preserved
  • mydriasis
  • –> typical of compressive lesions
  • –> atypical of microvascular lesions

Causes

  • microvascular causes: diabetes, hypertension
  • vasculitis
  • compression
  • –> tumours e.g. frontal meningioma
  • –> cavernous sinus syndrome (III, IV, V1, V2, VI) e.g. pituitary lesions, ICA aneurysm, cavernous sinus thrombosis, abscess
  • –> posterior communicating artery aneurysm
  • midbrain pathology
  • –> MS, NMO
  • –> stroke e.g. Weber’s (contralateral hemiparesis)
  • migraine?
  • complex ophthalmoplegia
  • –> thyroid eye disease
  • –> myaesthenia gravis
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16
Q

CN IV palsy (trochlear) features and causes

A

Features

  • vertical / diagnoal diplopia
  • defect in external rotation
  • head tilted to contralateral side to compensate
  • in neutral gaze, affected eye sits higher than contralateral eye

Causes

  • idiopathic
  • microvascular disease: diabetes, hypertension
  • vasculitis
  • pontine pathology
  • –> CVA
  • –> demyelination: MS, NMO
  • –> SOL
  • cavernous sinus syndrome (III, IV, v1, v2, VI): thrombus, abscess, pituitary lesion, ICA aneurysm
17
Q

CN VI palsy (abducens) features and causes

A

Features

  • eye held in unopposed adduction
  • horizontal diplopia

Causes

  • microvascular disease: diabetes, hypertension
  • vasculitis
  • raised ICP
  • pontine pathology
  • –> demyelination: MS, NMO
  • –> CVA
  • –> SOL
  • cavernous sinus syndrome (III, IV, v1, v2, VI): thrombus, abscess, pituitary lesion, ICA aneurysm
  • cerebellar-pontine angle tumour (V, VI, VII, VIII) e.g. meningioma, cholesteatoma, acoustic neuroma
18
Q

Features and causes of CN VII (facial) palsy

A

Features

  • LMN: frontalis involvement
  • UMN: frontalis sparing

Causes LMN

  • Bell’s palsy
  • Ramsay Hunt
  • cerebellopontine angle tumour
  • pontine stroke that involves the nucleus (-> LMN)
  • parotid tumour
  • Lyme
  • sarcoidosis
  • GBS
  • diabetes
  • vasculitis

Causes LMN (bilateral)

  • GBS
  • lyme
  • sarcoid
  • bilateral bell’s
  • myaesthenia

Causes UMN

  • demyelination: MS
  • SOL
  • CVA (not involving CNVII nucleus)
19
Q

Bulbar palsy features and causes

A

LMN IX-XII (medulla origin)

Features

  • soft / indistinct voice / nasal
  • poor swallow ?PEG
  • failure of soft palate to elevate
  • gag reflex absent / normal
  • absent / normal jaw jerk
  • fasciculating tongue

Causes

  • medullary lesions involving nuclei
  • –> CVA
  • –> SOL
  • inflammatory
  • –> GBS
  • myaesthenia
  • polio
  • degenerative
  • –> MND
  • syringobulbia
20
Q

Pseudobulbar palsy features and causes

A

UMN IX-XII

Features

  • slurred, high pitched speech
  • poor swallow ?PEG
  • failure of soft palate to elevate
  • BRISK JAW JERK
  • slow movements of tongue, non-fasciculating

Causes

  • supranuclear lesions
  • –> demyelination: MS
  • –> CVA
  • –> SOL
  • –> trauma
  • degenerative
  • –> MND
21
Q

Causes of ptosis

A
  • horner’s

- CNIII

22
Q

Causes of mixed UMN / LMN signs

A
  • MND
  • –> ALS: mixed
  • –> PLS: UMN
  • –> progressive bulbar palsy: mixed
  • –> progressive muscular atrophy: LMN
  • subacute combined degeneration of the cord (upgoing plantars, absent reflexes)
  • –> degeneration of dorsal columns + corticospinal tracts
  • friedrich’s ataxia AR (upgoing plantars, absent reflexes, cerebellar ataxia, pes cavus, SN hearing loss, high arched palate, optic atrophy)
  • –> degeneration of spinocerebellar, corticospinal, dorsal columns
  • syringomyelia
  • –> spinothalamic -> anterior horn (LMN at the level) -> corticospinal (UMN below the level)
  • cervical myeloradiculopathy (degenerative, bone spurs)
  • –> cortical spinal tract involvement + anterior horn involvement / anterior nerve root compression
23
Q

Causes of foot drop

A

UNILATERAL

Common peroneal nerve palsy (inversion preserved)
- compression femoral head e.g. trauma / pressure

L5 radiculopathy (inversion lost)

Mononeuritis multiplex

  • diabetes
  • vasculitis
  • amyloidosis
  • sarcoidosis
  • rheum: RA, SLE

BILATERAL

Inflammatory
- GBS

Hereditary
- charcot marie tooth

Critical care neuropathy/myopathy

Nutritional
- subacute combined degeneration of the cord

Paraprotein associated (amyloid, light chain deposition)

Drug associated e.g. chemo

(diabetes, vasculitis)

24
Q

Causes of tremor

A

Resting tremor

  • idiopathic PD (assymetric)
  • vascular parkinsonism
  • drug induced parkinsonism (dopamine antagonists)
  • parkinson’s plus syndromes
  • –> multisystem atrophy (+ autonomic features & cerebellar signs)
  • –> progressive supranuclear palsy (+ vertical gaze palsies)
  • –> corticobasal degeneration (dystonias, alien limb phenomenon)
  • systemic disease
  • –> thyrotoxicosis
  • –> Wilson’s (AR)
  • benign essential tremor

Intention tremor

  • cerebellar syndrome
  • –> stroke
  • –> MS
  • –> SOL
  • –> alcoholic
  • –> nutritional e.g. b12
  • –> paraneoplastic
  • –> friedrich’s ataxia (AR)
  • –> ataxic telangiectasia (AR, cancer risk, immune)

Hemiballism / chorea

  • damage to subthalamic nucleus
  • –> CVA
  • –> demyelination
  • –> trauma
  • Huntington’s (AD, progressive neuropsych, anticipation)
  • Wilson’s

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