Neurology Flashcards
Patient with sensory loss in little finger and lateral half of ring finger.
weakness bending fingers, but can raise thumb vertically with good resistance
reflees preserved
which nerve was injured?
Ulnar nerve
supplies
* sensation to little finger and medial half of ring finger
* most flexor muscles in the hand ( not the thumb)
( sensory nerve distributionL RUM
neuropathic pain management
1st line
rescue therapy in exacerbations
topical management
non-medical option
1ST Line: amitriptyline, duloxetine, gabapentin, pregabalin
* neupathic pain analgesis are montherapy - if one doesnt work, swith to another ( no compounding)
rescue therapy - tramadol
localised - topoical capsaicin ( e.g. post-herpetic neuralgia)
non0medical - pain clinic
defective downward gaze and vertical diplopia is caused by danmage to what nerve
ipsilateral CN IV ( trochlear)
Pt with double vision, worse going down stairs. On inspection, the left eye is deviated laterally. What CN is the cause
L trochlear
Palsy – defective downward gaze & vertical diplopia
LR6SO4 , rest of mvmts are occulomotor
abducens nerve oalsy
ipsilateral medially deviated eye
LR6SO4
lateral rectus function lost –> cannot pul laterally –> mediallyu deviated eye
appearance of CNIII palsy
isposilateral down and out
LR6SO4, everything else uis occuulomotor
so LR6 functions ( out) and SO4 functions (down)
define
- TIA
- crescendo TIA
TIA - transient neurological dysfunction secondary to ischaemia without infarction
crescendo TIA - >=2TIAs in a week ( high stroke risk)
stroke management
- where to admit
- what dDx to exclude
- Ix
- Rx
- stroke centre
exclude hypoglycaemioa - CT brain 9 exclude intracerebral haemorrhage)
Aspririn 300mg stat (post CT), 14 days
most common type of stroke
ischaemic ( 85%)
A patient with generalised headache, fluctuating GCS and history of alcohol abuse. What type of stroke are they likely to have had and how would this appear on a CT
subdural haemorrhage ( bridging veins )
star shaped - SAH
crescent shape - bridging veins subdural
lemon shape - epidural (EGGsrradural - extradural)
Medical thrombectomy in ischaemia is performed using
(med)
(mechanism o action)
(window of opportunity)
alteplase
tissue plasminogen activator (rapid clot breakdown)
within 4.5 hrs of storke onset
3 featyures of TIA managment
300mg Aspirin daily
2ndary CVD prevention (statins)
24hr referral to stroke specialist
ischaemic stroke doses and durations
Aspirin
clopidogrel ( alternative)
Atorvastatin
Aspirin 300mg 14 days
clopidogrel 75mg OD / Dipyridamole 200mg BD)
Atorvastatin 80mg
sections of the “eye” section of GCS
spontaneous opening = 4
speech = 3
Pain = 2
None=1
what are the 3 sections of the GCS and the points for each
eyes = 4
voice response = 5
Motor response = 6
sections of the “verbal” section of GCS
oriented = 5
confused conversation - 4
innappropiate words =3
incomprehensible = 2
none = 1
sections of the “motor response “ section of GCS
obeys commands = 6
localises pain - 5
normal flexion - 4
abnormal flexion - 3
extension - 2
none- 1
two groups of people in which subdurals are more common
elderly
alcoholics
brain atrophy - increased likelihood of bridging veins tearing
30 yo man collapses when playing rugby. He is taken to the stroke unit with unilateral weakness and headache. The CT shows a lemon shaped bleed, which does not cross the sutures, what artery is most likely to have been ruptured
middle meningeal
this is an extradural haemorrhage (EGGstradural)
- associated w/ temporal bone fracture
-CT - biconvex shape, limpited by the cranial sutures
-Typical pt: young pt, traumatic head injury & ongoing headache. Has a period of improved neurological Sx followed by rapid decline over hrs ( bleed begins to compress)
where dose subarachnoid bleeds occur
bleed into subarachnoid space - where cerebrospinal fluid is located
most commonly ruptured brain aneurysm
typical presentation
- sudden onset OCCIPITAL headache
- during strenuous activity ( sex/weight lifting
2 key risks associated with SAH
cocaine
sickle cell anaemia
5 features of “thunderclap headache” in SAH
- occipital headache
- Neck stiffness
- Photophobia
- Vision changes
???meningitis??? - Neuro Sx (speech, weakness, seizure, LOC)
A pt is brought to the stroke specialist unit with a suspected SAH (sudden extreme occipital pain, meningism and weakness). The 1st line Ix is conducted but is negative. what other test should be used, give the 2 findings suggesgting SAH
1st lien - CT
2nd - CSF
- RCC raised
- Xanthochromia (yellow due to bilirubin)
SAH Mx
MDT supportive Mx
reduced conciousness - intubate & ventilate
surgical intervention (coiling/clipping) - Tx aneurysm
Nimodipine - CCP, prevents vasospasm ( which causes ischaemia)
hydrocephalus - LP/shunt
are parkinsons symptoms typically symmetrical or assymetrical
assymetricalp
parkinsons triad
- resting tremor “pillrolling tremor - 4-6Hz,slow)
- rigidity
- bradykinesia
5 signs of parksinons ( not in the triad
facial masking
stooped posture
forward tilt
reduced arm swing
shuffling gait
( triad - bradykinesia, resting tremor, rigidity)
others: depression, sleep disturbance, anosmia ( smell), cognitive impairmenr/ memory problesm
Parkinsons vs bening essential tremor
asymmetrical
5-8hz
improves at rest
improves with intentional movement
improves with alcohol
no other parkinsons features
asymmetrical - Par
5-8hz - BET (Par=4-5)
improves at rest BET
improves with intentional movement Par
improves with alcohol (BET (Par - no change)
no other parkinson’s features (BET)
name 4 parkinsons plus syndromes
multiple system atrophy
dementia with lewy bodies
progressive supranuclear palsy
corticobasal degeneration
desrribe Sx of multiple system atrophy
mulitple areas of brain degenerate
parkinsonism - basal ganlglia affected
autonomic dysfunction ( postural hypotension, constipation, abnormal sweatign, sexual dysfunction )
Ataxia - cerebellar dysfunction
1st line parkinson tx
- if motor Sx affecting QOL
- if motor Sx NOT affecting QOL
motor Sx - Levodopa
dopamine replacement, often given w/ peripheral decarboxylase inhibitor ( stop L-dopa breakdown) :
Co-benyldopa (benserazide), Co-careldopa (carbidopa)
no-motor Sx - dopamine agonist/ L-dopa/ MAO-B inhibitor - selegiline/rasageline)
L-dopa’s effect decreases over time, so is reserved for when other medications are not helping.
excess dosing of L-dopa leads to
dyskinesas
Dystonia(excess muscle contraction –> abnormal postures / exaggerated Mvmt)
Chorea (involuntary jerking …huntingtons choriea)
athetosis ( involuntary twistign/writhing movments in hands/feet)
presentation of anterior cerebral artery stroke
contralateral hemiparesis & sensory loss
worse in lower extremity
stoke in middle cerebral artery
contralateral hemiparesis & sensory loss
upper>lower extremity
contralateral homonymous hemianopia
Posterior cerebral artery
contralateral homonymous hemianopia with macular sparing (central vision remains)
visual agnosia impairment in recognition of visually presented objects.
An 88-year-old woman is having difficulty recognising objects around the house.
On examination, when asked to point to a pen, she selects a newspaper and she cannot give the correct name for any of the items in the room.
She can recognise familiar faces, there is no weakness, aphasia or unsteadiness.
She has homonymous hemianopia with preservation of the central visual fields.
What cerebral vessel is most likely to have been occluded to cause these symptoms?
Posterior cerebelar artery - homonymous hemianopia w/ macular sparing & visual agnosia).
Webers syndrome ( branches of PCA supplying midbrain)
ipsilateral CNIII palsy
contalateral weekness of upper & lower extremities
Posterior inferiror cerebella artery ( Wllenberg/lateral medullary syndrom)
ipsilateral facial pain & temperature loss
contralateral: limb/torso pain & temp loss
Ataxia , nystagmus
Anteriori inferior cerebellar arteriy ( lateral pontine syndrome)
ipsilateral facial pain & temperature loss
ipsilateral facial paralysis and deafness
contralateral: limb/torso pain & temp loss
Ataxia , nystagmus
retinal/ ophthalmic arteriy
amaurosis fugax
basilar artery
locked-in syndrome
lacunar stroke
hemiparesis, hemisensory loss, hemiparesis with limb ataxia
ass. w/ HTN
common sites: basal ganglia, thalamus, internal capsule
describe visual field and sight of lesion: total blindness to one eye
cause: ipsilateral lesion of optic nerve (pre-chiasm: optic nerves –> chiasm –> tract –> lateral geniculate body –> optic radiations)
describe visual field and sight of lesion: bipolar hemianopia
tunnel vision ( bilateral lateral loss of vision)
cause midline chiasm lesion ( so outer parts of the chiasm preserved, so partial eyesight)
Nasal hemianopia
lesion of ipsilateral perichiasmal area
describe visual field and sight of lesion: homonymous hemianopia
bilateral vision loss on same half of visual field ( e.g. both eyes lose left vision in left homonymous hemianopaia)
cause: lesion/ pression in contralateral optic tract
OR
lesion in contralateral occipital lobe ( all optic radiations damaged)
optic nerve –> optic chiasm –> optic tract –> lateral geniculate body –> optic radiations
describe visual field and sight of lesion: homonymous inferior quadrantinopia
bottom quadrant visual field loss bilaterally of same side ) e.g. both left homonymous inferior quadrantanopia)
contalateral, lower optic radiations lesion
describe visual field and sight of lesion: homonymous superior quadrantanopia
same quadrant vison loss bilaterally
cause: lesion of contralateral upper optic radiations
at what vertebral level does the spinal cord terminate
L2/3
. The nerve roots exit either side of the spinal column at their vertebral level (L3, L4, L5, S1, S2, S3, S4, S5 and Co).
what 3 functions does the cauda equina supply
sensation: lower limbs, perineum, bladder, rectum
motor: lower limbs, anal sphincter, urethral sphincter
Parasympathetic: bladder, rectum
what is the most common cause of caude equina syndrome
herniated disc
give 5 causes of cauda equina syndrome
- Herniated disc (the most common cause)
- Tumours, particularly metastasis
- Spondylolisthesis (anterior displacement of a vertebra out of line with the one below)
- Abscess (infection)
- Trauma
give 3 red flag Sx of cauda equina
- Bilateral sciatica
- Bilateral or severe motor weakness in the legs
- Reduced anal tone on PR examination
( * Saddle anaesthesia (loss of sensation in the perineum – around the genitals and anus)
* Loss of sensation in the bladder and rectum (not knowing when they are full)
* Urinary retention or incontinence
* Faecal incontinence
)
what are the features of incomplete CES ( cauda equina syndrome)
pts complain about urinary Sx - altered urinary sensation, loss of desire to void, hesitancy, urgency
what are the features complete cauda equina syndrome
definitive urinary retention with associated overflow incontinence
what is the Mx in CES
NEURO EMERGENCY
- Immediate Adx
- Emergency MRI
- Neurosurgical input to consider lumbar decompression surgery
where does metastatic spinal cord compression occur
L1/2 ( occlusion of end of spinal cord, not cauda equina)
CES & MSCC ( metastatic cord compression) have similar symptoms,
- back pain*
worse on - straining: cough/ sneezing/bowel movement.
- lying down
Claudication ( muscle pain/cramp on walking or exercising)
Cauda equina - LMN signs (reduced tone and reduced reflexes). As nerves LMN; have already exited the spinal cord.
SCC: compression higher up –> UMN signs (increased tone, brisk reflexes and upping plantar responses) will be seen.
Tx for MSCC
high-dose oral dex ( immediately, even before imaging)
* Analgesia
* Surgery, Radiotherapy, Chemotherapy
what Ix is appropriate in MSCC
Whole spine MRI <24hrs
Neisseria meningitidis is a cause of bacterial meningitis, what type of bacteria is N.meningitis
G-ve Diplococci
what is the 1st line test used to screen for HIV in ASx or Sx pts
HIV antibody and HIV antigen
HIV antibody - HIV1/2 differentiation assay, ab devlop 4-6wks later in most (the rest by 3 months)
what viruses most commonly causeviral meningitis
enteroviruses (e.g. coxsackie)
Herpes simplex virus (HSV)
Varicella zoster virus (VZV)
what are the two special tests in examining form meningitis
Kernigs test (straigtening the Knee w/hip flex –> spinal pain/ ressitance to mvmt)
Brudzinkis test (Bending neck (flex chin to chest) –> involuntary flexing of hips and knees)
characteristics of CSF in bacterial meningitis
appearance
Glucose
Protein
WCC
appearance - cloudy
Glucose - low ,1/2 plasma
Protein high >1g/l
WCC 10-5,ooo polymorphs/mm3
characteristics of CSF in viral meningitis
appearance
Glucose
Protein
WCC
appearance - clear/ cloudy
Glucose 60-80% plasma glucose (slightly reduced)
Protein - normal/raised
WCC - 15-1000 lymphocytes/mm3
characteristics of CSF in tuberculus meningitis
appearance
Glucose
Protein
WCC
appearance - slightly cloudy, fibrin web
Glucose low <1/2plasma ( TB - bactaeria, so glucose same as with bacteria)
Protein high >1g/l)
WCC 30-300 lymphocytes/mm3
characteristics of CSF in fungal meningitis
appearance
Glucose
Protein
WCC
appearance: cloudy
Glucose low
Protein high
WCC 20-200 lymphocytes
fungal = cryptococcal meningitis
what medication should be added to tx in suspected viral meningitis
aciclovir
what medication should be added to in meningitis tx iif penicillin resisstant pneumococcal infection is suspected
vncomycin
penecillin resistant - e.g. Hx foreign travel/ prolonged Abx exposure
what is used in bacterial menignitis mx to prevent neurological/ hearing complications
steroids - e.g. dex
what MSK condition is temporal arteritis associated with?
polymyalgia rheumatica
what irreversible condition is associated with GCA
vision loss
what visual Sx are found in GCA
blurred/double vision
loss of vision
- Scalp tenderness (e.g., noticed when brushing the hair)
- Jaw claudication
- Blurred or double vision
- Loss of vision if untreated
temporal artery: tender, thickened, w/ reduced/absent pulsation
GCA can be diagnosed clinically. but also w/ inflammatory markers, biopsy or Duplex US. what finding in a temporal artery biopsy indicates temporal arteritis?
multinucleated giant cells
GCA can be diagnosed clinically. but also w/ inflammatory markers, biopsy or Duplex US. what finding in a Duplex US indicates temporal arteritis?
hypoechoic “halo” sign
stenosis of temporal artery
Mx of GCA involves immediate steroids ( before confirming dx ) .
what is the med & dose in
GCA w/o visual Sx/jaw claudication
GCA w/ visual Sx/ jaw claudication
w/o visual/jaw Sx: 40-60 prednisolone daily
w/ visual/jaw Sx: 500mg-1000mg methylpred daily
what non-steroidal meds are used in GCA Mx
Aspirin 75 mg daily - reduces vision loss/strokes
PPI - gastroprotecion due to steroids
Bisphosphonates & AdCal due to steroids
a pt w/ suspected GCA is started on 60mg prednisolone and biopsy is conducted. however this returns normal, what is the most appropriate next step
carry on prednisolone, retake biopsy in 7-14 days
there may be skip lesions, hence the biopsy will be normal instead of showing multinucleated giant cells
what is the most likely cause of encephalitis
HSV-1 ( 95%)
temporal & inferior frontal lobes)
what Ix are appropriate in ?encephalitis
CSF (lymphocytes, raised protein, –> PCR for HSV, VZV, enteroviruses)
neuroimaging - medial temporal & inferior frontal changes ( e.g. petechial haemorrhage) , normal in 1/3 of pts
EEG 0 lateralised periodic discharges at 2Hz
Mx encephalitis
IV aciclovir
biconvex (or lentiform) mass on CT scan indicates what type of haemorrhage
extradural
( biconvEXtradural) - limited by suture lines
subdural- bridging veins
injury of what artery results in extradural haemorrhage
middle meningeal
in which type of haemorrhage in bleeding limited by suture lines
extradural
occlusion of what artery causes Amaurosis fugax
retinal/ophthalmic artery
internal carotid artery > ophthalmic artery > central retinal artery
A 72-yo man presents to the ED with new-onset left-sided weakness. He is orientated. On examination, the patient has reduced L arm and leg power, and a left facial droop.
Ophthalmic examination identifies left homonymous hemianopia. what type of stroke is this?
Partial anterior circulation infarct
PACs
2/3
- unilateral hemiparesis +/-hemisensory loss in face, arm & leg
- homonymous hemianopia
- higher cognitive dysfunction ( e.g. dysphasia)
features of pseudo seizures ( psychogenic non-epileptic seizure)
- pelvic thrusting
- family member with epilepsy
- females
- crying after seizure
- don’t occur when alone
- gradual onset
what blood test can differentiate true seizures from psuedoseizures
prolactin - raised in true seizures
what age group of women and of men are affected by myasthenia gravis
women <40
men >60
e.g. A 35-yo woman presents to her GP with increasing fatigue, SOB and feeling increasingly tired with increasing weakness in her neck and limbs.
A 35-yo woman presents to her GP with increasing fatigue, SOB and feeling increasingly tired with increasing weakness in her neck and limbs.
PMHx: pernicious anaemia
DHx: oral cyanocobalamin ( for anaemia)
Examination: ptosis of her right eye.
most appropriate Ix?
Acetylecholine receptor antibody test
tumours in which gland are strongly linked to myasthenia gravis
thymus
20-40% of pts with thymoma develop myasthenia gravis
name 2 antibodies associated with myasthenia gravis
MuSK - muscle specific kinase
LRP4 - low-density lipoprotein receptor related protein 4
Myasthenia gravis
-receptor antibodies block recepts, preventing movement
- receptors cause complement system –> damage at post synaptic memebrane
features of myasthenia gravis
summarised: muscle weakness ( proximal muscle / small muscles of head and neck) , worsens with mvmt, improves with rest
diplopia - extraocular muscle weakness
ptosis - eyelid weakness causes drooping
weakness in facial mvmts
weak swallow
jaw fatigue when chewing
slurred speach
progressive weakness w/ repetitive mvmts
what examinations can be used to elicit muscle fatiguability in myasthenia gravis
repeated blinking –> ptosis
prolonged upward gazine –> diplopia
abduction of 1 arm 20 times –> unilateral weakness
?thymectomy scar
tests for Dx myasthenia gravis
- antibodies
- imaging
- test where there is doubt about Dx
ab: ACh-R (85%), MuSK (10%) LRP4 (<5%)
imaging: CT /MRI for thymoma
edrophonium test: IV edrophonium chloride ( neostigmine) blocks ACh-esterase enzymes, increases ACh, so temporarily relieving weakness
Tx options in Myasthenia gravis
Pyridostigmine/ neostigmine ( reversible ACh-esterase inhibitors)
Prednisolone/ azathioprine - immunosuppressants, prevent antibody production
thymectomy ( Sx relief even w/o thymoma)
MAb: rituximab
what is a common trigger of myasthenic crisis
another illness - eg resp. tract infection
causes resp failure ( due to muscle weakness)
Mx in myastbhenic crises
muscle weakness - BiPAP/ full intubation & ventilation
medical ( immunomodulatory therapies : IV immunoglobulins, plasma exchange)
which medication is used for headache prophylaxis in cluster headaches
sumatriptan, verapamil or propanolol
verapamil
acute tx in cluster headache
sumatriptan and high flow O2
( verapamil is prevention)
what medication is used as migraine prophylaxis
propanolol
what eye sign on fundoscopy indicates raised ICP in pt with headach
Papilloedema
triggers for tension headaches ( x5)
stress
depression
alcohol
skipping meals
dehydration
(mild headache, band like pattern, gradual appearance and resolution, no visual changes )
Tx in tension headach e
conservative: reassure, relaxation techniques, hot towels
basic analgesia
Mx of sinusitis
resolves in 2-3wks
mostly viral
medical
nasal irrigation
steroid nasal spray -prolonged Sx
may need abx
Mx in hormonal headache
hormonal headache : tension-like headache due to oestrogen, occur2-3days pre menstruation, perimenopause, early pregnancy ( late pregnancy = ? preeclampsia)
Mx OCP
1st ine mx in trigeminal neuralgia
carbamazepine
surgery - decompress/ damage nerve
features of cluster headache
severe, unilateral headache, (around the eye)
clusters: 3-4/day for weeks/months, the 1-2yrs w/o
duration 15 mins- 3hrs
red, swollen, watery eye, miosis, ptosis, nasal discharge, ipsilateral hyperhidrosis
Medications (x3) for cluster headache prophylaxis
verapamil
lithium
prednisolone ( short course)
what are the 4 types of migraines
- Migraine without aura
- Migraine with aura
- Silent migraine (migraine with aura but without a headache)
- Hemiplegic migraine
typical features of a migraine
unilateral
pounding/throbbing
headache
photophobia
phonophobia
acute management of migraines
paracetamol
triptans ( sumatriptan 50mg as migraine starts - serotonin receptor agonist (5HT receptors))
NSAIDs (ibuprofen/naproxen)
antiemetics in vomiting - metoclopramide
medication for migraine prophylaxis
propanolol
topiramate ( teratogenic)
amitriptyline
presentation of CNIV palsy
Presentation – eye upwards ( as SO depresses eye)
There will also be a compensatory head tilt
Struggling to go down the stairs * cant see the floor with cranial nerve 4*
in addition to thymomas, myasthenia gravis is associated to which conditions?
autoimmune disorders: pernicious anaemia, autoimmune thyroid disorders, rheumatoid, SLE
thymic hyperplasia in 50-70%
what antibodies are associated with LEMS
Voltage-gated calcium channel (VGCC) antibodies
LEMS - opposite of Myasthenia as the weakness imprioves with movement
it is ass. w/ malignancies - esp SCLC
what is the antiplatelet regimen in an ischaemic stroke
Aspirin 300mg daily 2weeks
clopidogrel 75mg daily long-term
also offer statin if pt is not already on one
in medication overuse headaches, the analgesics should be stopped
what is the advice in
simple analgesia
triptans
opioids
simple analgesia - stop immediately
triptans - stop immediately
opioids -wean down
what risk is increased by giving pts with history of migraine with aura COCP
ischaemic stroke risk is greatly increased
automatism (smacking lips) and staring o into the space without being aware of what is happening is found in what epileptic seizure
focal impaired awareness seizure
differs from absence seizures which are in children, w/o automatisms
what seizure is characterised by a sudden loss of muscle tone, limp limbs and loss of consciousness?
generalised atonic seizure
which seizure is characterised by jerking movements, brief duration ( <1 minute), typically without loss of awareness?
myoclonic
a 74-year-old presents to his general practitioner after experiencing a number of episodes of light headedness, occuring when he stands up from a sitting or lying down.
PMHx - includes Parkinson’s disease for DHx - levodopa
Exam: BP 130/80mmHg (lying), HR 60/min, RR 14/min and afebrile.
After 3 minutes standing - BP: 100/70mmHg (standing), respiratory rate 14/min, and heart rate 62/min with no compensatory tachycardia. On auscultation of the chest, heart sounds are dual with no murmur, and the lungs are clear.
Which is the most likely cause of hispostural hypotension?
Parkinson’s disease - causes hypotension due to autonomic failure
A woman presents with altered sensation in her left eye following an RTA. .
Exam: patient’s pupils are equal and reactive to light.
No visual field defects
Visual acuity is 6/6 with contact lenses. Gentle application of cotton wool to the right globe elicits blinking and tearing, while the application to the left globe elicits no response.
In what nerve is the cranial lesion?
CN V1 - ophthalmic branch of trigeminal
causes loss of corneal reflex
CNV - facial sensation and mastication
Lesions may cause:
trigeminal neuralgia
loss of corneal reflex (afferent)
loss of facial sensation
paralysis of mastication muscles
deviation of jaw to weak side
A patient presenting with mixed UMN & LMN Sx & fasciculations with few/no sensory signs suggests what condition?
motor neurone disease
A patient presenting with mixed UMN & LMN Sx & fasciculations with few/no sensory signs. and asymmetric limb weakness suggests what condition?
Amyotropic lateral sclerosis
subset of MND
LMN Sx in arms & UMN Sx in legs
what are the 3 main types of MND
amyotrophic lateral sclerosis (ALS) - most common
progressives bulbar palsy - 2nd most common; muscles of talking & swallowing
progressive muscular atrophy , primary lateral sclerosis
what areas of the body are generally unaffected in MND
external ocular muscles
cerebellum
abdo reflexes & sphincter ( until later)
describe MND
progressive, fatal condition where upper and lower motor neurones stop functioning - no sensory involvement
Mx in MND
non e
Riluzole - slows progression by some months in ALS
NIV - non-invasive ventilation when resp muscles affected
apart from the hands, benign essential tremor is present in …
head tremor, jaw tremor and vocal tremor
( affects voluntary muscles)
features of essential tremor
- Fine tremor
- Symmetrical
- More prominent on voluntary movement
- Worse when tired, stressed or after caffeine
- Improved by alcohol
- Absent during sleep
what is the hereditary pattern of benign essential tremor?
autosomal dominant
Mx in benign essential tremor
none
purely symptomatic
- propranolol ( selective B-blocker)
- Primidone ( barbituate anti-epileptic medication)
how would damage to the ulnar nerve present?
hypothenar muscle wasting
loss of thumb adduction
wasting of 1st web space
ulnar claw hand ( hyperextension @ metacarpophalangeal joint, flexion at interphalangeal joint)
how would radial nerve palsy present
wrist drop
loss of sensation in 1st dorsal web space
how would musculocutaneous nerve plsy present
reduced flexion at elbows & loss of supination
how would a median nerve compression present
carpal tunnel syndrome
nerve innervates thenar muscles & sensory innervation to lateral 3 & half digits
how would an axillary nerve palys present
wastage of deltoid muscles
loss of sensation from the badge area
a pt presents with a Hx of AF presents with left-sided ptosis, miosis and ataxia. There is a loss of pain sensations in the right limbs and trunk and the left side of the face.
BM and Sats are normal, a non-contrast CT head is ordered.
Where is the site of the pathology causing this presentation?
left posterior inferior cerebellar artery
this is Wallenberg’s (lateral medullary syndrome)
which presents as:
- ipsilateral horner’s
- ipsilateral facial numbness
- contralateral body numbness
