Neurology Flashcards
How to differentiate between PD + Parkinsons plus
- lack response to L-DOPA
- faster progression
- symmetry
MSA: postural hypotension, autonomic dysfn, cerebellar signs
PSP: supranuclear palsy
CBD: limb apraxia
Causes of parkinsonism
- idiopathic
- drugs e.g. metoclopramide
- toxins e.g. CO
- parkinson plus syndromes
- encephalopathy
- Wilson’s disease
Parkinsons tremor vs essential tremor
PD (4-6Hz): asymmetrical, rest > postural, no head tremor, micrographia
Essential: symmetrical, postural > rest, head tremor (titubation), tremulous writing
Findings of CMT
- stocking distribution sensory loss
- foot drop
- pes cavusm, hammer toe
- distal muscle wasting (inverted champagne bottle)
- absent reflexes
- high stepping gait, Rombergs +
- palpable nerves
Causes of foot drop
Peroneal nerve: weak eversion
L5 radiculopathy: weak eversion + inversion
Causes of peripheral neuropathy
Motor predominant
- Diabetes
- Hereditary e.g. CMT
- Guillain Barre, CIDP (inflammatory demyelinating polyneuropathy)
Other
- EtOH
- B12 deficiency
- Drugs e.g. cisplatin, isoniazid, phenytoin, amiodarone
- Paraneoplastic neuropathy (esp lung)
- Toxins e.g. lead
- Vasculitis
Weak prox UL + distal LL
- FSHD (Facioscapulohumeral muscular dystrophy)
- -> OE: scapula winging, biceps wasting, facial wasting
- -> Ix: genetic testing
Weak prox LL + distal UL
- inclusion body myositis
Proximal myopathy
- Inflammatory myopathy e.g. dermatomyositis, polymyositis (other features of gottrons papules, heliotrope rash, ILD, cancer, antisynthetase syndrome)
- Drugs e.g. statins, steroids
- Endocrine e.g. thyroid, cushings
- EtOH
- Metabolic e.g. liver or renal failure
Bulbar vs pseudobulbar palsy
Bulbar (LMN CN IX/X/XII): wasted tongue, fasciculations, no gag reflex, absent jaw jerk, nasal inarticulate speech
Pseudobulbar (UMN CN IX/X/XII): spastic tongue, increased gag reflex, increased jaw jerk, spastic speech, bilateral UMN UL signs
Investigations of GBS
- CSF: cytoloalbuminological dissociation
- NCS: decreased motor nerve conduction velocity, prolonged distal motor latency, increased F wave latency, conduction blocks, and temporal dispersion
- Antibodies: GQ1b for Miller Fischer
Miller-Fisher variant signs
Ataxia
Opthalmoplegia
Areflexia
Myasthenia Gravis signs
- complex opthalmoplegia
- fatiguability (>30secs)
INO vs CN 3 palsy
INO: failure of ipsilateral adduction + contralateral nystagmus on lateral gaze, no impairment on convergence
CN 3 palsy: failure of both adduction on gaze and convergence
