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Year 2 LCRS > Neurology 14 - Clinical Cases > Flashcards

Neurology 14 - Clinical Cases Flashcards

1
Q

Compare the lower and upper motor system

A
  • Lower is peripheral nerves

- Upper is the brain and spinal cord

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2
Q

What do you assess when you examine the limbs?

A
  • Tone
  • Power
  • Reflexes (babinskis)
  • Wasting
  • Fasciculations
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3
Q

What is seen in patients with an upper motor neuron lesion?

A
  • 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
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4
Q

What is seen in patients with a lower motor neuron lesion?

A
  • Power is reduced
  • Reflexes are reduced
  • Fasciculations
  • Wasting
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5
Q

What can cause a patient to drag their feet?

A
  • 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)
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6
Q

Define dysarthria.

A

Slurred speech

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7
Q

Define dysphagia

A

Difficulty swallowing

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8
Q

Define dysphasia

A

Cant think of the correct words

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9
Q

How is it determined that a lesion is affecting the corticospinal tract?

A
  • No sensation problem

- Affecting pyramidal pathways

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10
Q

Why are abdominal reflexes absent while other reflexes are brisk?

A

This is what you get in upper motor neuron lesions

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11
Q

What are fasciculations?

A

Involuntary abnormal contraction of all the muscle fibres in a single motor unit

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12
Q

What causes fasciculations?

A
  • Denervation (death of motor neurons)
  • Reinnervation (neighbouring axons increase branching to stimulate the denervated muscle fibre)
  • Random firing results in fasciculations
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13
Q

Define paraesthesiae

A

Abnormal sensations (eg.pins and needles)

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14
Q

What can cause the foot to jerk spasmodically when put is certain positions?

A
  • Clonus
  • Upper motor neuron cause
  • Mark of spasticity
  • Rhythmic contraction
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15
Q

Which segments supply the biceps and supinator reflexes?

A

C5/6

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16
Q

Which segment supplies the triceps reflex?

A

C7

17
Q

Which segment supplies the finger jerks?

A

C8

18
Q

How can you have upper and lower motor neuron symptoms?

A
  • 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.
19
Q

What is the plantar response?

A

Babinski response

20
Q

Compare rigidity and spasticity

A
  • 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)
21
Q

Define bradykinesia

A

Slowed movement

22
Q

What is the triad of parkinsons?

A
  • Bradykinesia
  • Rigidity
  • Tremor (when distracted)
23
Q

How is writing changed in parkinsons?

A
  • Micrographia

- Smaller writing

24
Q

Where do the cranial nerves emerge?

A

1,2,3,4 Midbrain
5,6,7,8 Pons
9,10,11,12 Medulla

25
Q

What causes things to happen suddenly?

A

Stroke (vasular cause)

26
Q

List the causes of ptsosis

A
  • Horners syndrome (failure of sympathetic)
  • 3rd cranial nerve palsy
  • Myasthenia (muscle disease where there are problems with ACh)
27
Q

Which cranial nerve opens the eyelid?

A

3rd - Oculomotor

28
Q

What is ptosis?

A

Drooping eyelid

29
Q

Compare the effects of third nerve palsy caused by a lesion and third nerve palsy caused by stroke

A
  • 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
30
Q

What is Weibers syndrome?

A
  • Midbrain lesion
  • Causes oculomotor nerve compression
  • Damage of corticobulbar and corticospinal tract (opposite side)
31
Q

What can cause slurred speech (dysarthria)?

A
  • 12th cranial nerve (hypoglossal)
  • Cerebellar lesion
  • Facial nerve damage
32
Q

Define dysconjugate

A

The eyes do not move together

33
Q

Define gaze palsy

A

When you cant move your eyes in a particular direction

34
Q

What is hemiparetic posture?

A
  • 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
35
Q

What can result in unsteadiness?

A
  • Vestibulococchlear nerve
  • Brainstem damage
  • Cerebellar damage
36
Q

What is a verticular dissection or carotid dissection?

A
  • 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
37
Q

Which area of the brain not working causes nystagmus?

A

Cerebellum

38
Q

What is lateral medullary syndrome?

A

Damage to

  • Sympathetic
  • Facial nerve
  • Cerebellar
  • Spinothalamic

Year 2 LCRS (128 decks)

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