Neurology Flashcards
What is tone?
The resistance of the resting muscle to stretch
Required for maintaining posture and movements
What’s the difference between spasticity and rigidity
Spasticity is force dependent
Rigidity fixed hypertonia
Dystonia - sustained muscle contraction and is often basal ganglia insult or genetic condition
What is hypotonia a sign of
Lower motor neuron lesions
Can be benign - benign congenital hypotonia
What are the types of hypertonia
Spasticity
Rigidity
Dystonia
What is Spasticity
An UMN lesion in descending motor pathways (pyramidal tracts) and is force dependent
Most common form of hypertonia in children
What is rigidity
Basal ganglia/deep nuclei insult
Parkinsonism
Fixed hypertonia - not force dependent
How should power be assessed?
Work proximally to distal
Describe the MCR power assessment
0 - no observable contraction
1 - slight contraction
2 -
3 -
4 -
5 -
What is distal weakness a sign of?
Neuropathy - nerve problems
What is proximal weakness typically a sign of?
Myopathy - muscle
How are reflexes affected in UMN conditions?
Brisk reflexes - slowed inhibition of contralateral muscle group
How are reflexes affected in LMN conditions?
What is Babinski’s Signs?
Plantar reflex
Upgoing in a UMN lesion
White matter tracts
What is the Spinothalamic tract responsible for?
How is coordination tested in the upper limb?
finger-nose co-ordination - looking for past pointing and intention tremor
Fast movements - disdiadokinesis
Pronator drift - UMN sign of contralateral corticospinal tract
How is co-ordination tested in the lower limb?
Heel-Shin (not alone)
Gait - looking for broad based? tandem walking? tip-toe and heel walking
What is an Acoustic Neuroma?
A benign tumour of the Schwann cells surrounding the vestibulocochlear nerve that innervates the inner ear
What is another name for an Acoustic Neuroma?
Vestibular Schwannoma
What are Schwann cells?
Provide the myelin sheath in the peripheral nervous system
Where do Acoustic Neuromas occur?
Cerebellopontine angle
Therefore they are sometimes known as cerebellopontine angle tumours
What other conditions can acoustic neuromas be associated with?
Can be associated with facial nerve palsy if the tumour grows large enough to compress the facial nerve
Bilateral tumours almost certainly indicate Neurofibromatosis type II
Describe the symptoms of an Acoustic Neuroma
The typical patient is aged 40-60 years and presents with gradual onset
-Unilateral sensorineural hearing loss (often the first symptom)
-Unilateral tinnitus
-Dizziness or imbalance
-Sensation of fullness in the ear
What investigations are indicated in a suspected acoustic neuroma?
Audiometry - pattern of sensorineural hearing loss
Brain imaging - CT or MRI
Describe the types of management for Vestibular Schwannoma
Conservative - monitoring if there are no symptoms or treatment is inappropriate
Surgery - partial or total removal
Radiotherapy - reduce growth
