Neurology Flashcards
Parietal lobe signs (dominant)
AALF
Acalculia - serial 7s
Agraphia - writing
Left-right disorientation - “show left hand”
Finger agnosia - name fingers
Parietal lobe signs (non-dominant)
Agraphaesthesia - draw number on hand
Inattention - visual and sensory
Astereognosis - identify object in hand
Dressing apraxia
Constructional apraxia
Spatial neglect
Temporal lobe signs
Short term memory loss
Long term memory loss
Dysphasia, receptive (in dominant lobe lesions)
Frontal lobe signs
Grasp reflex
Palmomental reflex
Pout reflex
Gait apraxia
Anosmia
Interpret a proverb
Shoulder ABduction
nerve root
Muscles
C5 / C6
Deltoid and supraspinatus
Shoulder ADduction
Nerve root
Muscles
C6 / C7 / C8
Pectoralis major, latissimus dorsi
Elbow flexion
Nerve root
Muscles
C5 / C6
Biceps and brachialis
Elbow extension
Nerve roots
Muscles
C7 / C8
Triceps
Wrist flexion
Nerve root
Muscles
C6 / C7
Flexor carpi ulnaris and radialis
Wrist extension
Nerve root
Muscles
C7 /C8
Extensor carpi group
Finger extension
Nerve root
Muscles
C7/C8
Extensor: indicis, digiti minimi, digitorum communis
Finger flexion
Nerve root
Muscles
C7/C8
Flexor digitorum profundus
Finger ABduction
Nerve root
Muscles
C8/T1
Dorsal interossei
Finger ADduction
Nerve root
Muscles
C8/T1
Palmar interossei
Biceps reflex
C5/6
Triceps reflex
C7/8
Brachioradialis reflex
C5/C6
Radial nerve
Root
Motor and sensory functions
C5-8
Triceps, brachioradialis, wrist extension
If lesion in upper third of nerve it will cause triceps weakness
Sensation in anatomical snuff box
Median nerve
Nerve roots
Motor and sensory function
C6-T1
LOAF
Lateral two lumbricals
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis
(All muscles of the front of the forearm except the flexor carpi ulnaris and half of the flexor digitorum profundus)
Which nerves / nerve roots supply the intrinsic muscles of the hand?
Ulna and median nerve
C8-T1
Clawing of the ring and small fingers - what does this signify?
ulnar lesion
Wasting of 1st dorsal interossei - cause
ulnar lesion
Wasting of abductor digiti minimi - cause
ulnar lesion
Wasting of abductor digiti minimi - cause
ulnar lesion
Wasting of abductor policis brevis (thenar eminance, thumb abduction) - cause
median nerve lesion
Iliopsoas
function
nerve root
peripheral nerve
hip flexion
L1/2/3
Femoral
Quadriceps
function
nerve root
peripheral nerve
knee extension
L2/3/4
femoral
Gluteus maximus
function
nerve root
peripheral nerve
hip extension
L5 S1/2
inferior gluteal nerve
Hamstrings
function
nerve root
peripheral nerve
knee flexion
sciatic nerve
L5 S1/2
Hip adductors
function
nerve root
peripheral nerve
obturator nerve
L2/3/4
Myotonic dystrophy
Types
Mutations
Inheritance pattern
DM1 and DM2 (milder)
Repeat expansion in DMPK (DM1) or ZNF9 (DM2)
Autosomal dominant inheritance
Myotonic dystrophy manifestations
Weakness - facial muscles, distal forearms, hands
Muscle pain
Myotonia
Cardiac conduction disease
LVH
Pharyngoesophageal weakness and respiratory muscle weakness
Sleep disorder
Hypogonadism
Cataracts
Wasted hand
- only abductor pollicis brevis (thumb abduction)
median nerve lesion
Wasted hand
- only abductor digiti minimi and first dorsal interosseous
Ulnar lesion
How does median nerve lesion and the wrist differ to median nerve lesion at the elbow?
Weakness of abductor pollicis brevis at the wrist lesion
At elbow - will have weakness of flexors of the finger and flexor pollicis longus. (okay sign)
What is the benediction sign a sign of?
proximal median nerve lesion
What muscles are supplied by the ulnar nerve?
Flexor digitorum profundus of the little finger
Abductor digiti minimi
first dorsal interosseous
What causes weakness of all three of:
Abductor pollicis brevis
Abductor digiti minimi
First dorsal interossus
C7/8/T1 root or plexus lesion - finger extensors and triceps
C5-T1 - sensory loss of the whole arm, often associated with horners
Syringomyelia - wasting, loss of reflexes and loss of pain (light touch preserved)
C8/T1 cord lesion - wasting of both hands and spastic weakness of the legs - look for sensory level
Motor neurone disease - fasiculations, wasting, hyper-reflexia, No sensory loss
Peripheral neuropathy - wasting of all limbs distally
Myotonic dystrophy - distal wasting, hyporeflexia, baldness, ptosis, cataracts
Wrist drop patterns of weakness
- radial nerve lesion - weak brachioradialis, wrist extension, finger extension. snuff box sensory loss
- posterior interosseous nerve lesion - weakness of finger extension, radial deviation of the wrist on extension, no sensory loss, and normal reflexes.
- C7/8 root or plexus lesion - weak triceps, finger extensors and flexors, triceps reflex absent
- Corticospinal lesion - teneralised weakness, increased tone and reflexes
Lower limb weakness patterns
- Femoral nerve lesion: weakness of quads and hip flexion, reduced knee jerk. Hip adductors normal.
- L2/3/4 root or plexus injury; as per femoral nerve plus weakness of hip adduction.
- Cortical lesion: pyramidal weakness with increased tone and hyperreflexia
- Paraparesis: bilateral pyramidal pattern weakness plus sensory level
- Generalised weakness with reflexes increased- MND or quadriparesis
Foot drop patterns
- common peroneal nerve - weakness of dorsiflexion and eversion
- L4/5 nerve root - as per 1. but add inversion, and may be weakness of hip abduction, ankle jerk preserved
- Sciatic nerve - loss of all movements plus loss of ankle jerk
- peripheral neuropathy - associated with sensory loss
- cauda equina - saddle anaesthesia etc
- MND
- Corticospinal tract - brain vs. cord
- Brown-sequard - one leg weak with loss of all sensation, contralateral leg has loss of pain and temperature
Pes cavus causes
long standing neuropathy
- CMT
- Friedreich’s ataxia
- spina bifida
Gait patterns
High-stepping gait - foot drop
Bilateral high-stepping gait - bilat foot drop - think CMT, MND
High-stepping with wide base - think sensory ataxia, test rombergs
myopathic / waddling gait - weakness of hip abduction - test trendelenburg
Circumduction - hemiparesis
Scissoring gait - bilateral increased tone - cerebral palsy, hereditary spastic paraplegia, MS, cervical spondylosis
Parkinsonian gait
Frontal gait - wide base, small steps, upright posture
Cerebellar gait - broad base with irregular steps
Facial weakness patterns
- Upper motor neurone lesion; unilateral weakness sparing frontalis and orbicularis oculi.
- Lower motor neurone lesion; unilateral weakness, usually Bells (loss of taste, hyperacusis), facial nucleus (may also have CN6 nerve palsy)
- Bilateral facial weakness - GBS, sarcoidosis, myopathies (such as facio-scapulo-humeral dystrophy, mitochondrial myopathy, myotonic dystrophy, parkinson’s facies, pseudobulbar palsy / MND
- isolated weakness to one or two muscles - rare
Unilateral ptosis causes
horners - constricted pupil, partial ptosis
occulomotor palsy - down and out with dilated pupil
Lateral medullary syndrome
Horners, ipsilateral loss of temperature / pain sensation, contralateral pain and temperature loss on trunk and limbs
Bilateral ptosis
myaesthenia, myotonic dystrophy
Perinaud syndrome
convergence-retraction nystagmus
- pupils may be unractive to light but normal accommodation. Usually compression of the mid-brain, hydrocephalus or stroke
PSP eye findings
loss of voluntary vertical gaze, but reflex movements intact
