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
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
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
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)
5
Q
Mononeuritis multiplex causes
A
Diabetes Vasculitis - ANCA (microscopic polyangiitis, (eosinophilic) granulomatosis with polyangiitis) - polyarteritis nodosa - cryoglobulinaemia Amyloidosis Sarcoidosis Rheumatoid arthritis, SLE
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)
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
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)
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
10
Q
Causes of optic neuritis
A
- demyelinating e.g. MS
- infective e.g. TB, syphillis, Lyme
- inflammatory e.g. sarcoidosis, vasculitis
11
Q
Causes of optic neuritis
A
- demyelinating e.g. MS, NMO
- infective e.g. TB, syphillis, Lyme
- inflammatory e.g. sarcoidosis, vasculitis
12
Q
Causes of dilated pupil
A
- glaucoma
- mydriatic eye drops
- simulant recreational drugs
- CN3 palsy
- Holmes-Adie
- CN2 palsy (if RAPD)
13
Q
Causes of small pupil
A
- horner’s syndrome
- argyll robertson pupil
- opioids (bilateral)
- iritis
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
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
