Neurology 14 - Clinical Cases Flashcards
Compare the lower and upper motor system
- Lower is peripheral nerves
- Upper is the brain and spinal cord
What do you assess when you examine the limbs?
- Tone
- Power
- Reflexes (babinskis)
- Wasting
- Fasciculations
What is seen in patients with an upper motor neuron lesion?
- Tone is increased
- Power is decreased
- Reflexes are increased (and pathologically brisk in the arms and legs)
- Toes curl up (babinskis)
- No fasciculations or wasting
What is seen in patients with a lower motor neuron lesion?
- Power is reduced
- Reflexes are reduced
- Fasciculations
- Wasting
What can cause a patient to drag their feet?
- If you can’t lift your feet up properly then you will trip and drag your feet
- Caused by weakness and spasticity
- Bilateral foot drop (weakness of ankle dorsiflexion)
Define dysarthria.
Slurred speech
Define dysphagia
Difficulty swallowing
Define dysphasia
Cant think of the correct words
How is it determined that a lesion is affecting the corticospinal tract?
- No sensation problem
- Affecting pyramidal pathways
Why are abdominal reflexes absent while other reflexes are brisk?
This is what you get in upper motor neuron lesions
What are fasciculations?
Involuntary abnormal contraction of all the muscle fibres in a single motor unit
What causes fasciculations?
- Denervation (death of motor neurons)
- Reinnervation (neighbouring axons increase branching to stimulate the denervated muscle fibre)
- Random firing results in fasciculations
Define paraesthesiae
Abnormal sensations (eg.pins and needles)
What can cause the foot to jerk spasmodically when put is certain positions?
- Clonus
- Upper motor neuron cause
- Mark of spasticity
- Rhythmic contraction
Which segments supply the biceps and supinator reflexes?
C5/6
Which segment supplies the triceps reflex?
C7
Which segment supplies the finger jerks?
C8
How can you have upper and lower motor neuron symptoms?
- Nerve roots are lower motor neuron
- If squashed or damaged then this will cause lower motor neuron symptoms (weakness, loss of sensation.eg)
- If you have a spinal cord injury there is upper motor neuron symptoms
- Disc prolapses will press on the spinal cord as well as the nerve root.
What is the plantar response?
Babinski response
Compare rigidity and spasticity
- Spasticity the more force you give the more resistance until it gives
- Rigidity is like bending something that is a very dense material (you have to exert the same amount of force the entire time)
Define bradykinesia
Slowed movement
What is the triad of parkinsons?
- Bradykinesia
- Rigidity
- Tremor (when distracted)
How is writing changed in parkinsons?
- Micrographia
- Smaller writing
Where do the cranial nerves emerge?
1,2,3,4 Midbrain
5,6,7,8 Pons
9,10,11,12 Medulla
What causes things to happen suddenly?
Stroke (vasular cause)
List the causes of ptsosis
- Horners syndrome (failure of sympathetic)
- 3rd cranial nerve palsy
- Myasthenia (muscle disease where there are problems with ACh)
Which cranial nerve opens the eyelid?
3rd - Oculomotor
What is ptosis?
Drooping eyelid
Compare the effects of third nerve palsy caused by a lesion and third nerve palsy caused by stroke
- You can damage the vascular supply to the third nerve specifically in stroke
- Will not affect branches involved in pupillary constriction
- Lesion will initially result in pupillary dilation
What is Weibers syndrome?
- Midbrain lesion
- Causes oculomotor nerve compression
- Damage of corticobulbar and corticospinal tract (opposite side)
What can cause slurred speech (dysarthria)?
- 12th cranial nerve (hypoglossal)
- Cerebellar lesion
- Facial nerve damage
Define dysconjugate
The eyes do not move together
Define gaze palsy
When you cant move your eyes in a particular direction
What is hemiparetic posture?
- Increased tone is not equal in all muscles
- In the arms the flexors are stronger than extensors (wrist pulls down, arm clutched to chest)
- In the legs, the extensors are stronger than the flexors
What can result in unsteadiness?
- Vestibulococchlear nerve
- Brainstem damage
- Cerebellar damage
What is a verticular dissection or carotid dissection?
- Opening between layers of the artery wall in the neck (common carotid or vertebral artery)
- Results in blood filling the opening, so the lumen becomes more narrow and irregular
Which area of the brain not working causes nystagmus?
Cerebellum
What is lateral medullary syndrome?
Damage to
- Sympathetic
- Facial nerve
- Cerebellar
- Spinothalamic
