Neurology Flashcards
What are the dermatomes in your arms?
C4 - shoulder
C5 - lateral upper arm
C6 - thumb
C7 - three middle fingers
C8 - pinkie
T1 - medial upper and lower arm
T2 - axilla
What are the dermatomes in your legs anteriorly?
L1 - pelvic area
L2 - lateral upper thigh (upper corner)
L3 - medial upper thigh to the knees
L4 - medial lower leg
L5 - lateral lower leg to big toe and 3 middle toes
S1 - pinkie toe to heel
What is stocking glove neuropathy?
Symptoms of peripheral neuropathy that cause numbness, weakness, or sensory changes in the hands and feet.
What is chronic fatigue syndrome?
aka myalgic encephalomyelitis is sudden or gradual onset of persistent disabling fatigue, post-exertional malaise (PEM), unrefreshing sleep, cognitive and autonomic dysfunction, and pain, with symptoms lasting at least 6 months.
RF for chronic fatigue syndrome
F
Epstein-Barr infection in adolescents
coronavirus disease 2019 (COVID-19)
positive family history of ME/CFS
adolescence and 30-50 years
Sx of ME/CFS?
post-exertional malaise/fatigue (PEM; exertional exhaustion)
persistent disabling fatigue
cognitive dysfunction
sore throat
headache
sleep alteration
pain in muscles
Ix for ME/CFS?
DePaul symptom questionnaire
FBC with WBC - to exclude infection
ESR/CRP
Tx for ME/CFS?
Multidisciplinary support + rehabilitation + management of pain and sx
What is Bell’s palsy?
An acute unilateral peripheral facial nerve palsy in patients - physical examination and history are otherwise unremarkable. Consists of deficits affecting all facial zones equally that fully evolve within 72 hours.
Tx of Bell’s palsy?
High-dose corticosteroids
What is Parkinson’s disease?
A condition where there is a progressive reduction in dopamine in the basal ganglia, leading to disorders of movement.
Sx of Parkinson’s?
** Bradykinesia - slower + smaller movement - micro-graphia, shuffling gait, difficulty initiating movement
** Tremor - resting, pill-rolling tremor, worse when px distracted
** Rigidity - increased tone, cogwheel rigidity
Other sx:
Depression
Postural instability - inc. falls
Cognitive impairment
Anosmia
Difference between Parkinson’s resting tremor and benign essential tremor?
Parkinson’s - asymmetrical, worse at rest, improves with intentional movement, no change with alcohol
Benign - symmetrical, improves at rest, worse with intentional movement, improves with alcohol
What kind of dementia is associated with Parkinson’s disease?
Dementia with Lewy bodies
Tx of Parkinson’s?
NOT CURABLE!
1st line - Levodopa + combined with decarboxylase inhibitors - c0-beneldopa
2nd line - COMT inhibitors or Dopamine agonists
What is the SE of Levodopa + decarboxylase inhibitor?
Dyskinesia - abnormal movements associated with excessive motor activity
Restlessness
What is cauda equina?
Collection of nerve roots at the bottom of the spine (below level L1-L5) are compressed.
What do the nerves of the cauda equina supply?
Mention sensory, motor and parasympathetic innervation
Sensation to the lower limbs, perineum, bladder and rectum
Motor innervation to the lower limbs and the anal and urethral sphincters
Parasympathetic innervation of the bladder and rectum
What are the possible causes of compression in cauda equina? (3)
MC Herniated disc
Tumours
Spondylolisthesis (anterior displacement of a vertebra out of line with the one below)
Abscess (infection)
Trauma
Sx of cauda equina?
** 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)
Sexual dysfunction
Urinary retention/incontinence
Faecal incontinence
Bilateral sciatica
Bilateral motor weakness in the legs
Reduced anal tone on PR examination
Ix for cauda equina?
GS - MRI lumbar spine
PR exam
Tx of cauda equina?
Emergency Tx!!
Immediate hospital admission
Emergency MRI scan confirm cauda equina syndrome
Lumbar decompression surgery
Define radiculopathy
Compression of the nerve roots as they exit the spinal cord and spinal column, leading to motor and sensory symptoms.
What is metastatic spinal cord compression (MSCC)?
When a metastatic lesion compresses the spinal cord (before the end of the spinal cord and the start of the cauda equina) - different to cauda equina.
How does cauda equina present differently to MSCC?
Cauda equina presents with lower motor neuron signs (reduced tone and reduced reflexes)
MSCC presents with upper motor neuron signs (increased tone, brisk reflexes and upping plantar responses) - compression occurs higher up
What are the 4 main types of migraines?
Migraine without aura
Migraine with aura
Silent migraine (migraine with aura but without a headache)
Hemiplegic migraine
What are the 5 stages of migraine?
- Premonitory or prodromal stage (can begin several days before the headache)
- Aura (lasting up to 60 minutes)
- Headache stage (lasts 4 to 72 hours)
- Resolution stage (the headache may fade away or be relieved abruptly by vomiting or sleeping)
- Postdromal or recovery phase
Typical features of a migraine?
Usually unilateral but can be bilateral
Moderate-severe intensity
Pounding or throbbing in nature
Photophobia (discomfort with lights)
Phonophobia (discomfort with loud noises)
Osmophobia (discomfort with strong smells)
Aura (visual changes)
Nausea and vomiting
How does aura present?
Sparks in the vision
Blurred vision
Lines across the vision
Loss of visual fields (e.g., scotoma)
What’s a hemiplegic migraine?
Main Sx - hemiplegia (unilateral limb weakness)
+ ataxia + impaired consciousness
Can mimic stroke or TIA
Migraine triggers?
Stress
Bright lights
Strong smells
Certain foods (e.g., chocolate, cheese and caffeine)
Dehydration
Menstruation
Disrupted sleep
Trauma
Tx of migraine - acute + prophylaxis management?
Acute:
NSAIDs
Paracetamol
Triptans (e.g. sumatriptan)
Prophylaxis:
Propranolol (a non-selective beta blocker)
Amitriptyline (a tricyclic antidepressant)
Topiramate (teratogenic and very effective contraception is needed)
How do tension headaches present?
Mild ache or pressure in a band-like pattern around the head.
No visual changes
RF for tension headaches?
Stress
Depression
Alcohol
Skipping meals
Dehydration
Tx of tension headache?
Simple analgesia (e.g., ibuprofen or paracetamol)
If chronic: Amitriptyline
What are the 3 branches of the trigeminal nerve?
Ophthalmic (V1)
Maxillary (V2)
Mandibular (V3)
What is trigeminal neuralgia?
Severe unilateral pain in the distribution of one or more trigeminal branches.
Patients with what cdtn commonly experience trigeminal neuralgia?
multiple sclerosis
Describe features of trigeminal neuralgia
Sudden onset
Lasts seconds to hours
Electricity-like, shooting, stabbing or burning pain
Can be triggered by touch, talking, eating, shaving or cold etc
Tx of trigeminal neuralgia?
1st line - Carbamazepine
Causes of syncope
Dehydration
Missed meals
Extended standing in a warm environment, such as a school assembly
A vasovagal response to a stimuli, such as sudden surprise, pain or the sight of blood
Secondary causes:
Hypoglycaemia
Anaemia
Infection
Anaphylaxis
