Neurology Flashcards
Visual inattention to one side?
Contralateral parietal defect
How far should you sit from patient when testing for visual fields
1m
In reflexes response
-Afferent vs efferent defects
Afferent: CN II
- when light is shone into affected eye- neither eye will constrict
Efferent CN III
- Affected eye is contantly partially dilated
- Contralateral eye will constrict when eye is shone into affected eye.
What is a relative afferent defect
Swinging light test.
When light is shone into the affected eye then the pupils this will contrict less/ dilate more
Horizontal vs vertical nystagmus
Vertical: Central pathology
Horizontal: cerebellar
Fatigue on staring upwards?
Myasthenia gravis
Which nerve is affected?
- Eye cannot move laterally?
- Eye cannot move down when looking medially?
- Cannot move in most directions
- Complex opthalmoplegia
- CN6- Abducens - lateral rectus
- CN4- trochlear - superior oblique
- CN3
- Myasthenia or graves disease or brainstem lesion
Corneal reflex afferent and efferent nerves?
Afferent? CN 5
Efferent? CN 7
Jaw reflex afferent and efferent?
CN5
Why is the forehead spared in an UMN lesion?
the nucleus supplying the upper part of the face has a bilateral UMN innervation.
Which way does the uvula deviate in a CN 10 lesion?
TOWARDS from the lesion
What might cause Unilateral UMN weakness?
Brain: Stroke/ SOL
Brainstem: stroke/ SOL
Spinal cord: MS, SOL, Trauma, Haemorrhage, Syringomyelia
What might cause bilateral UMN weakness?
MS
Motor Neurone N.B. would have normal sensation
Myelopathy e.g. cord compression/ trauma/ transverse myelitis/ syringomyelia
OR
brainstem stroke OR Cerebral palsy
What cause bilateral LMN DISTAL weakness with abnormal sensation?
Alcohol
B12/ thiamine deficiency
Charcot-Marie Tooth/ Carcinomas
Diabetes/ Drugs (e.g. TB drugs/ metronidazole)
Every vasculitis (SLE/ RA/ polyarteritis nodosa)
And some infections e.g. HIV/ Leprosy/ herpes
What causes bilateral DISTAL LMN
Lead poisoning
Chronic inflammatory demyelinating polyneuropathy
Inclusion body myositis
Porphyria
What causes bilateral DISTAL LMN with acute flaccid paralysis?
Guillan- Barre
Cauda equina
Acute transverse myelitis
What can cause unilateral LMN
Radiculopathy- pinching of the nerve at the root
Plexopathy
Peripheral neuropathy: pinching of the nerve further down. ( including mono neuritis multiplex)
What causes LMN proximal weakness with normal sensation?
DENIM
Dystrophies e.g. Beckers/ Duchenne
Endocrinological e.g. Cushing’s/ Hypo-hyperthyroid
Neuromuscular e.g. myasthenia gravy/ Lambert-Eatin
Inflammatory
Metabolic/ mitochondrial
What vision abnormalities might you expect in someone who has a cerebellar pathology?
- Horizontal nystagmus
- Saccadic Demetria ( difficulty focusing on one target)
- Hypometric saccades (slow eye movements)
CT of a subdural?
Looks like a banana
CT of an extradural?
Looks like a circle
CT of subarachnoid?
Bleeding at the sulci
Presentation of an extradural bleed?
Management?
Trauma at the Period
Losses consciousness
Followed by LUCID period
Craniotomy + evacuation of haematoma
Presentation of a subdural and management
Due to trauma or shredding of the veins in the head
- Fluctuating consciousness
If acute: craniotomy
If chronic and large: burr holes
Subarachnoid CT
Management
Bleeding surrounding the sulci
Nimodipine to prevent vasospasm
Hypodense vs hyperdense for ischaemic stroke?
Hyperdense: early- as early as 90 mins
Hypodense: Late- >6 hours
