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Neurology Flashcards

1
Q

Which nerve roots supply the musculocutaneous nerve

A

C5, C6, C7

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2
Q

Which nerve supplies sensation to the lateral forearm

A

Musculocutaneous nerve

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3
Q

Which nerve supplies flexion of the elbow (biceps, brachialis)

A

Musculocutaneous nerve

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4
Q

What are the clinical features of musculocutaneous nerve palsy

A

Sensory: numbness over lateral forearm

Motor: very weak elbow flexion and forearm supination, absent biceps reflex

Deformity: wasting of anterior compartment of arm, elbow held in extension

Note: musculocutaneous nerve palsy is rare - may be damaged by trauma

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5
Q

Which nerve roots does the axillary nerve arise from

A

C5, C6

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6
Q

What is the sensory function of the axillary nerve

A

“Sergeant’s patch” - lower part of deltoid

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7
Q

What is the motor supply of the axillary nerve

A

Shoulder muscles - deltoid, teres minor

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8
Q

Which nerve roots does the radial nerve arise from

A

C5, C6, C7, C8, T1

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9
Q

Which nerve supplies sensation to the posterior arm and forearm

A

Radial nerve

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10
Q

Which nerve supplies sensation to the lateral 2/3 of dorsum of hand

A

Radial nerve

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11
Q

Which nerve innervates the triceps muscle

A

The radial nerve

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12
Q

Which nerve innervates extension of wrist and fingers

A

Radial nerve

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13
Q

Which nerve innervates abduction of thumb

A

Median nerve

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14
Q

Which nerve palsy causes a wrist drop

A

Radial nerve - wrist flexion, forearm pronation, thumb adduction

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15
Q

Which nerve roots supply the median nerve

A

C5, C6, C7, C8, T1

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16
Q

What is the sensory innervation of the median nerve

A

Skin over thenar eminence
Lateral 2/3 palm of hand
Palmar aspect of lateral 3.5 fingers
Dorsal fingertips of lateral 3.5 fingers

(thumb, index, middle and half of ring finger)

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17
Q

What is the motor innervation of the median nerve

A

Anterior compartment of the forearm - wrist flexion and abduction, finger flexion, thumb flexion

Intrinsic muscles of hand - LOAF
Lateral two lumbricals
Opposes thumb
Abducts thumb
Flexes thumb

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18
Q

Which nerve palsy is caused by carpal tunnel syndrome

A

Median nerve

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19
Q

Which nerve palsy causes hand of benediction (unable to flex index or middle fingers)

A

Median nerve

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20
Q

Which nerve roots supply the ulnar nerve

A

C8, T1

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21
Q

Which nerve supplies sensation to the hypothenar eminence, medial 1/3 of palm of hand and medial 1.5 fingers

A

Ulnar nerve

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22
Q

What is the motor supply of the ulnar nerve

A

Flex ring and little fingers
Abduct little finger
Finger abduction and adduction
Medial two lumbricals
Thumb adduction

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23
Q

Which nerve palsy causes “claw hand” (fixed flexion of ring and little fingers)

A

Ulnar nerve

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24
Q

What is the dermatome testing point of C5

A

Seargent’s patch (lateral antecubital fossa just proximal to elbow joint)

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25
Q

What is the dermatome testing point for C6

A

Palmar side of thumb

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26
Q

What is the dermatome testing point for C7

A

Palmar side of middle finger

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27
Q

What is the dermatome testing point for C8

A

Palmar side of little finger

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28
Q

What is the dermatome testing point for T1

A

Medial antecubital fossa just proximal to elbow joint

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29
Q

What does pronator drift indicate

A

Contralateral corticospinal tract lesion

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30
Q

Which myotome is assessed with shoulder abduction

A

C5 (axillary nerve)

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31
Q

Which myotome is assessed with shoulder adduction

A

C6/7 (thoracodorsal nerve)

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32
Q

Which myotome is assessed with elbow flexion

A

C5/C6 (musculocutaneous and radial nerve)

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33
Q

Which myotome is assessed with elbow extension (triceps)

A

C7 (radial nerve)

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34
Q

Which myotome is assessed with wrist extension

A

C6 (radial nerve)

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35
Q

Which myotomes are assessed with wrist flexion

A

C6/C7 (median and ulnar nerves)

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36
Q

Which myotome is assessed with finger extension

A

C7 (radial nerve)

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37
Q

Which myotome is assessed by finger abduction

A

T1 (ulnar nerve)

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38
Q

Which myotome is assessed by thumb abduction

A

T1 (median nerve)

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39
Q

Which myotomes are assessed by biceps reflex

A

C5/C6

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40
Q

Which myotomes are assessed by brachioradialis reflex

A

C5/C6

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41
Q

Which myotome is assessed by triceps reflex

A

C7

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42
Q

Which spinal column does pin-prick sensation involve

A

Spinothalamic tracts

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43
Q

Which tests involve the dorsal columns

A

Vibration, proprioception, light touch

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44
Q

What is myotonic dystrophy

A

Autosomal dominant multisystem disorder

Progressive muscle weakness, myotonia and early onset cataracts (+ many more)

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45
Q

What are the 2 types of myotonic dystrophy

A

Type 1: CTG trinucleotide repeat that demonstrates anticipation

Type 2: tetranucleotide repeat, doesn’t show as much anticipation

Both AD

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46
Q

What is myotonia

A

Inability of a contracted muscle to relax

E.g. difficulty letting go of something after grasping, difficulty opening eyes after closing

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47
Q

What are the clinical features of myotonic dystrophy

A

Frontal balding, bilateral ptosis, temporalis and masseter weakness (myopathic face)

May have CPAP machine by bed (resp muscle weakness)

Eyelid myotonia - close eyes very tight for 5s then ask to open, pt will have difficulty opening

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48
Q

What is the clinical difference between type 1 and 2 myotonic dystrophy

A

Type 1: distal weakness

Type 2: proximal weakness

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49
Q

How can you assess myotonia

A

Ask pt to grip your fingers for 5 seconds then relax - difficulty relaxing

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50
Q

What causes a RAPD

A

Any cause of unilateral optic nerve damage:

  • Optic neuritis (MS, NMO)
  • ischaemic optic neuropathies (GCA)
  • glaucoma
  • sarcoid, SLE, Sjögren’s
  • infection (cat scratch disease, syphilis, Lyme, CMV etc)
  • hereditary (eg Leber’s)

Unilateral retinal causes:
- ischaemic retinal disease (CRVO, CRAO)
- retinal detachment
- severe macular degeneration
- retinal infection (CMV, HSV)

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51
Q

What is the driving advice after a first seizure

A

6 months

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52
Q

What is the driving advice after an epileptic seizure

A

1 year

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53
Q

What is the difference between optic neuropathy and optic atrophy

A

Optic neuropathy = optic nerve not working

Optic atrophy = optic nerve permanently and irrecoverably damaged (looks pale on fundoscopy)

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54
Q

What can transiently make MS symptoms worse

A

Increased body temperature (hot showers, going for a run) - Uhthoff phenomenon

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55
Q

Where is the lesion typically found in INO

A

Brainstem

  • affected side will fail to adduct on lateral gaze, other side will develop nystagmus
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56
Q

Where is the lesion usually found in a RAPD

A

Optic nerve

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57
Q

What is the NIHSS used for

A

Quantify severity of stroke

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58
Q

What is the modified rankin scale used for

A

Measure the degree of disability after a stroke

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59
Q

What are the features of an occulomotor nerve palsy

A

Ptosis
Strabismus - down and out gaze
Ophthalmoplegia - failure to adduct
Dilated pupil - if surgical nerve palsy

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60
Q

What are the first line medical options for Parkinson’s disease

A
  • Co-beneldopa/co-careldopa
  • MAO-B inhibitors e.g. selegiline
  • dopamine agonists e.g. ropinirole, pramipexole, rotigotine
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61
Q

Which Parkinson’s meds increase risk of impulse control disorders

A

Dopamine agonists

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62
Q

What are the complex management options for Parkinson’s disease

A

Deep brain stimulation, apomorphine infusion, duodopa (gel version of dopamine into jejunum via PEJ)

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63
Q

What will happen during Weber’s test in conductive hearing loss

A

Heard in the bad ear

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64
Q

What will happen during Weber’s test in sensorineural hearing loss

A

Heard in the good ear

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65
Q

What happens during rinne’s test in conductive hearing loss

A

Bone conduction > air conduction

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66
Q

What happens during rinne’s test in sensorineural hearing loss

A

Air conduction > bone conduction

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67
Q

What does a positive rhomberg’s indicate

A

Loss of proprioceptive (or vestibular) function

(Does not assess cerebellar function)

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68
Q

What are the nerve roots of the femoral nerve

A

L2-L4

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69
Q

What are the motor functions of the femoral nerve

A

Anterior thigh muscles (flex hip, extend knee)

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70
Q

What is the sensory function of the femoral nerve

A

Anteromedial thigh, medial leg

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71
Q

What are the nerve roots of the sciatic nerve

A

L4-S3

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72
Q

What is the motor function of the sciatic nerve

A

Posterior thigh
Whole leg (tibial + common fibular nerve branches)
Whole foot (tibial + common fibular)

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73
Q

What is the sensory function of the sciatic nerve

A

No direct sensory innervation

Tibial branch - posterolateral leg, lateral foot, sole of foot

Common fibular - lateral leg, dorsum of foot

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74
Q

What nerve damage causes foot drop

A

Common or deep fibular nerve

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75
Q

Where will wasting and weakness be seen most in myotonic dystrophy

A

Distal muscles (type 1 most common)

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76
Q

What are the extra-neurological features of myotonic dystrophy

A

Frontal balding
Cataracts
Cardiomyopathy
Diabetes
Testicular atrophy
Dysphagia

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77
Q

What will show up on EMG in myotonic dystrophy

A

‘Dive-bomber’ potentials

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78
Q

What are the common causes of bilateral ptosis

A
  • Myotonic dystrophy
  • Myasthenia Gravis
  • Oculopharyngeal muscular dystrophy
  • Chronic progressive external ophthalmoplegia (Kearns-Sayre)
  • Congenital
79
Q

What are the common causes of unilateral ptosis

A

Third nerve palsy, Horner’s syndrome

80
Q

In a cerebellar lesion, which way does the fast-phase of nystagmus go in relation to the lesion

A

Towards the lesion

81
Q

In a CNVIII/vestibular lesion, which way does the fast-phase of nystagmus go in relation to the lesion

A

Away from the lesion

82
Q

What are the causes of cerebellar syndrome

A

Paraneoplastic
Alcoholic
Sclerosis (MS)
Tumour
Rare (Freidrich’s, ataxia telangiectasia)
Iatrogenic (phenytoin toxicity)
Endocrine (hypothyroidism)
Stroke

83
Q

What are the common cranial nerve findings in MS

A

INO (can be bilateral), optic atrophy, reduced visual acuity, any other cranial nerve palsy

84
Q

What are the common limb nerve findings in MS

A

UMN spasticity, weakness, brisk reflexes, altered sensation

85
Q

What will be seen on visual evoked potentials in MS

A

Delayed velocity but normal amplitude (evidence of previous optic neuritis)

86
Q

What are the DMARDS used in MS

A

Interferon-beta (reduces relapse)
Alemtuzumab (anti-CD52) and Natalizumab (blocks T-cell trafficking) - slow progression

87
Q

Which drugs are useful in acute attack of MS

A
  • Methylprednisolone - shortens duration
  • anti-spasmodics e.g. baclofen
88
Q

What is MRC grade 2 power

A

Moves with gravity neutralised

89
Q

What extended investigations should be considered in a young person with CVA

A
  • echo
  • MRI/A/V (dissection, VST)
  • clotting screen inc APLS
  • vasculitis screen
90
Q

What is Gerstmann’s syndrome

A

Dominant parietal lobe cortical syndrome:
- dysgraphia, dyslexia, dyscalculia
- L-R disorientation
- finger agnosia

91
Q

What is the most common brainstem vascular syndrome

A

Lateral medullary (Wallenberg) syndrome

92
Q

Which artery is occluded in lateral medullary (Wallenberg) syndrome

A

Posterior inferior cerebellar artery (PICA)

93
Q

What are the clinical signs associated with lateral medullary (Wallenberg) syndrome

A
  • Ipsilateral cerebellar signs
  • Ipsilateral nystagmus
  • Ipsilateral Horner’s
  • Ipsilateral loss of trigeminal pain and temperature sensation
  • contralateral loss of pain and temperature sensation
94
Q

What are the causes of retinitis pigmentosa

A
  1. Usher’s syndrome
  2. Bardet-biedl syndrome
  3. Kearns-Sayre syndrome
  4. Refsum’s disease
  5. Abetalipoproteinemia
  6. Familial isolated vit E deficiency
95
Q

Which condition presents with a lower motor neuropathy and peri-oral faciculations

A

Kennedy’s disease

96
Q

What is the inheritance of Kennedy’s syndrome

A

X linked recessive

97
Q

What exam features can distinguish between ALS and Kennedy’s disease

A

Fasciculations around mouth/neck in Kennedy’s syndrome

Kennedy’s is only LMN, ALS is UMN+LMN

98
Q

What features in the history can differentiate between ALS and Kennedy’s

A
  • ALS has rapid progression over months, Kennedy’s is gradual over years
  • Kennedy’s will have family Hx
99
Q

Which myotome assesses ankle dorsiflexion

A

L4/L5 (deep peroneal nerve)

100
Q

Which myotome is assessed with big toe extension

A

L5 (common peroneal nerve)

101
Q

Which nerve roots are assessed with knee jerk

A

L3, L4 (quadriceps - femoral nerve)

102
Q

Which myotome is assessed with ankle jerk

103
Q

Where is the lesion in foot drop with preserved eversion

A

Deep branch of common peroneal nerve

104
Q

Where is the lesion in foot drop if the only sensory loss is 1st webspace

A

Deep branch of common peroneal nerve

105
Q

Which nerve does the common peroneal arise from

A

Sciatic nerve

106
Q

What are the 4 lacunar syndromes

A
  1. Pure sensory
  2. Pure motor
  3. Sensorimotor
  4. Ataxic hemiparesis (Ipsilateral cerebellar-like ataxia)
107
Q

Which condition can cause a pseudo-INO due to fatiguability of the ocular muscles

A

Myasthenia gravis

108
Q

What side is the lesion on in INO

A

The side of the eye that fails to ADduct

109
Q

What are the causes of simultaneous bilateral optic disc swelling

A
  1. Malignant hypertension
  2. Raised ICP (papilloedema)
110
Q

What does rebound phenomenon indicate

A

Cerebellar syndrome (inability for arm to move back to original position after pushing downwards with pts eyes closed)

111
Q

Which drugs result in a cerebellar syndrome

A

Phenytoin
Lithium
Carbemazapine
Chemotherapy agents

112
Q

What is the significance of ankle jerk in foot drop

A
  • Unaffected in common peroneal nerve palsy
  • depressed in motor neuropathy
113
Q

How can a common peroneal nerve palsy and L5 nerve root lesion be differentiated as a cause of foot drop

A
  • positive SLR with L5 lesion
  • weakness of inversion and eversion with L5 lesion (only eversion with CPN)
  • sensory loss extends to lateral thigh with L5 nerve lesion
114
Q

What is the most common cause of an L5 nerve root lesion

A

L4-L5 disc prolapse

115
Q

What are the causes of a mononeuritis multiplex

A
  • diabetes
  • vasculitis (PAN, EGPA, GPA)
  • Rheum (RA, SLE, Sjögren’s)
  • infiltrative (sarcoid, amyloid)
  • malignancy
  • infection (Lyme, Leprosy)
116
Q

What is the DDx of depressed knee and ankle jerks with extensor plantars

A
  1. Combination of conditions (eg peripheral neuropathy + stroke, or cervical + lumbar spondylosis)
  2. SCD (B12 deficiency)
  3. Tabes dorsalis (syphilis)
  4. Freidrich’s ataxia
  5. MND
  6. Lesion of conus medullaris
117
Q

What are the extra-neuronal features of Freidrich’s ataxia

A
  1. Hypertrophic cardiomyopathy (50%)
  2. Optic atrophy (25%)
  3. Diabetes (10%)
  4. Sensorineural deafness (10%)
118
Q

What does the presence of pyramidal, cerebellar and/or dorsal column signs point towards

A

Multiple sclerosis

119
Q

What is the classic triad of miller fisher syndrome

A

Ophthalmoplegia, ataxia and areflexia

120
Q

What are the causes of Lhermitte’s sign

A
  • MS
  • cervical myelopathy
  • cervical cord tumour
  • SCD
121
Q

What are the causes of CSF oligoclonal bands

A
  • MS (present in 80% of cases)
  • Neurosarcoidosis
  • Neurosyphilis
  • CNS lymphoma
  • NMO
  • GBS
  • SSPE
122
Q

What is a scissoring gait suggestive of

A

Spastic paraparesis

123
Q

What are the common causes of spastic paraparesis of the lower limbs

A
  • multiple sclerosis
  • cervical myelopathy
  • trauma to spinal cord
  • MND
124
Q

What are the upper limb signs in syringomyelia

A
  • weakness and wasting of small muscles of hands
  • absent reflexes
  • loss of pain and temp, normal dorsal columns
125
Q

What are the common causes of Charcot joints

A
  • tabes dorsalis
  • diabetes
  • syringomyelia
126
Q

What are the neurological causes of pes cavus

A
  • HSMN (CMT)
  • cerebral palsy
  • Freidrich’s ataxia
  • spinal cord lesions
  • poliomyelitis
  • ALS
  • leprosy
  • Huntington’s
127
Q

What causes weakness, dramatic wasting, areflexia and lower limb shortening

128
Q

What does pes cavus suggest

A

Chronic neuromuscular disease, usually one that started in childhood

129
Q

What are the cardinal components of pseudobulbar palsy

A

Dysphagia, dysarthria, emotional apathy

130
Q

What causes a Donald-duck ‘nasal’ like speech

A

Bulbar dysarthria (LMN) causing palatal weakness

131
Q

What are the causes of a bulbar palsy of CN IX, X and XII (LMN)

A
  • MND
  • Syringobulbia
  • GBS
  • Neurosyphilis
132
Q

What are the causes of a pseudobulbar palsy of CN IX, X and XII (UMN)

A
  • bilateral stroke affecting the internal capsule
  • Multiple sclerosis
  • MND
133
Q

What is the speech like in bulbar palsy

A

Nasal speech - Donald Duck (LMN)

134
Q

Which neurological conditions demonstrate anticipation

A
  • myotonic dystrophy
  • Huntington’s chorea
  • freidrich’s ataxia
135
Q

What is the pattern of sensory loss in syringomyelia

A

Loss of pain and temp in upper limb, preserved joint position and vibration

136
Q

Which muscles are most commonly affected in inclusion body myositis

A

Proximal muscles (quadriceps) and finger flexors

137
Q

What is the differential for MND with a pure LMN presentation

A
  • multifocal motor neuropathy with conduction block
  • spinobulbar muscular atrophy (kennedy’s)
  • motor-predominant CIDP
  • benign fasciculations
  • inclusion body myositis
  • spinal muscular atrophy
138
Q

What is the differential for MND with a pure UMN presentation

A
  • primary progressive MS
  • hereditary spastic paraparesis
  • vitamin B12 deficiency
139
Q

What is the differential for MND with a mixed UMN and LMN presentation

A
  • cervical myelopathy
  • syringomyelia
  • B12 deficiency
140
Q

What does the “on off phenomenon” associated with levodopa describe

A

Phases of improved Parkinson symptoms followed by sometimes abrupt wearing off of dopamine effect, associated with dyskinesias

141
Q

What are the non-motor features of Parkinson’s

A
  • Anosmia
  • REM sleep disorder
  • constipation
  • pain
  • orthostatic hypotension
  • mood disturbance
  • cognitive impairment
  • visual hallucinations
142
Q

What determines urgency of MRI spine in patients with myelopathy

A
  • Onset and rapid progression of symptoms
  • severity of symptoms
143
Q

What are the 3 cardinal signs of Friedrich’s ataxia

A
  1. Bilateral cerebellar ataxia
  2. Dorsal column signs
  3. Leg wasting with absent reflexes and bilateral upgoing plantars
144
Q

Other than the 3 cardinal features, what are the other signs of Friedrich’s ataxia

A
  • wheelchair/ataxic gait
  • pes cavus
  • optic atrophy
  • HOCM
  • diabetes
  • high arched palate
  • sensorineural deafness
145
Q

What is the inheritance pattern of Friedrich’s ataxia

A

Autosomal recessive

146
Q

What are the causes of extensor plantars and absent knee reflexes

A
  • Friedrich’s ataxia
  • SCD
  • MND
  • tabes dorsalis
  • conus medullaris lesions
  • concurrent UMN+LMN pathologies
147
Q

What are the skin changes associated with tuberous sclerosis

A
  • facial adenoma sebaceum
  • periungual fibromas
  • shagreen patches
  • ash leaf macules
148
Q

What are the renal manifestations of tuberous sclerosis

A
  • renal angiomyolipomas
  • renal cysts
  • renal carcinoma

(genes for TSC and AKPKD both on Chr 16 so some overlap)

149
Q

What are the CNS features of tuberous sclerosis

A
  • Epilepsy in 80%
  • Low intelligence in 50%
150
Q

What condition is associated with retinal phakomas on fundoscopy

A

Tuberous sclerosis

151
Q

What are the investigations into tuberous sclerosis

A
  • urine dip
  • bloods inc UEs
  • CT/MRI head - tuberous masses
  • abdo USS - renal cysts
152
Q

How can ocular myaesthenia be tested for on exam

A

Sustained upwards gaze will cause worsening ptosis and diplopia

153
Q

What is the speech like in pseudobulbar palsy (UMN)

A

‘Hot potato’ strangling speech due to spastic tongue

154
Q

What are the causes of a postural tremor (worse with hands outstretched)

A
  • benign essential tremor
  • anxiety
  • thyrotoxicosis
  • C02 retention, hepatic encephalopathy
  • alcohol
155
Q

What are the causes of painful diplopia

A

Restrictive causes: trauma, myositis, thyroid

156
Q

What are the causes of painless diplopia

A

Neurological causes (CN III, IV, VI palsies, MG)

157
Q

What are the cutaneous manifestations of neurofibromatosis

A
  1. Cutaneous neurofibromas (>=2)
  2. Cafe au lait patches (>6, >15mm)
  3. Axillary freckling
  4. Lisch nodules in eyes
158
Q

What are the visceral findings associated with neurofibromatosis

A
  1. Hypertension (phaeochromocytoma, renal artery stenosis)
  2. Lung fibrosis
  3. Neuropathy
  4. Reduced visual acuity (optic glioma)
159
Q

What are the complications of neurofibromatosis

A

Epilepsy
Intellectual disability (10%)
Hypertension (phaeochromocytoma, renal artery stenosis)
Sarcomatous change (5%)
Scoliosis (5%)

160
Q

What is the inheritance of neurofibromatosis

A

Autosomal dominant

161
Q

What are the causes of chorea

A
  • Huntington’s
  • Wilson’s
  • Rheumatic fever
  • Stroke
  • Drugs (levodopa, phenytoin, carbamazapine)
  • SLE
162
Q

What are the 5 screening tools that can be used at the start of UL neuro exam

A
  1. Pronator drift
  2. Tight grip and release
  3. Finger tapping
  4. Touch chin
  5. Hands forward and feel scapulae
163
Q

What are the 3 tests of motor function in the hands for the 3 main nerves

A

Radial - finger extension
Ulnar - finger abduction
Median - thumb abduction

164
Q

What is the difference between spasticity and rigidity

A

Spasticity (pyramidal) - velocity dependent

Rigidity (basal ganglia) - velocity independent

165
Q

What are the differentials for cerebellar + UMN signs

A
  • spinocerebellar ataxia
  • MS
  • B12 deficiency
  • vascular (multiple strokes)
  • paraneoplastic
  • Friedrich’s ataxia
166
Q

How can a resting tremor be exaggerated in PD

A

Ask patient to count backwards from 20 during initial inspection

167
Q

List the Parkinson plus syndromes

A
  1. MSA
  2. PSP
  3. Drugs - antipsychotics, antiemetics
  4. Wilson’s, Huntingtons
  5. Vascular - symmetrical, LLs
  6. Corticobasal degeneration
  7. Toxins - MPTP
168
Q

What are the causes of a bilateral cerebellar syndrome

A
  • alcohol
  • B12 deficiency
  • toxins/drugs (eg phenytoin)
  • paraneoplastic
  • neuroinflammatory (eg MS)
  • genetic (SCA, Friedrich’s, AT)
169
Q

What are the 3 types of tremor

A
  1. Resting - PD
  2. Postural (worse when arms out)
  3. Intention - cerebellar
170
Q

What are the causes of a bilateral spastic scissoring gait

A
  • cortical: parasagittal meningioma, CP
  • brainstem: stroke, inflammatory
  • spinal: tropical infection, neuroinflammatory, compression, vascular, metabolic
171
Q

What does difficulty with tandem gait but negative rhomberg’s suggest

A

Cerebellar ataxia

172
Q

What does difficulty with tandem gait and positive rhomberg’s suggest

A

Sensory ataxia

173
Q

What question can be used to determine if diplopia is monocular or binocular

A

Does the double vision resolve with closing either eye?

174
Q

What is the difference in presentation of optic neuritis in MS vs NMO

A

MS: red vision loss, painful eye movements

NMO: under 20, female, rapid and profound bilateral vision loss

175
Q

What are the key investigations for myaesthenia gravis

A
  • antibodies (AchR Ab, MUSK)
  • repetitive nerve stimulation
  • single fibre EMG
  • CT Thorax

+ thyroid Abs/TFTs

176
Q

Which sensory modalities do large fibres carry

A

Vibration, proprioception

177
Q

What are the acute causes of a lower motor neuropathy

A
  • Guillian Barre
  • Botulism
  • Transvere myelitis/cauda equina

Chronic causes = HSMN, CIDP, Lead poisoning, porphyria

178
Q

What is the difference between type 1 and type 2 HSMN on neurophysiology

A

Type 1: demyelinating
Type 2: axonal

179
Q

What are the differentials for a typical myaesthenia gravis presentation

A
  • LEMS
  • Botulism
  • Inclusion body myositis
180
Q

What is the first line management of stable myasthenia gravis

A

Pyridostigmine

(Consider corticosteroid as adjunct)

181
Q

Which drugs can worsen myasthenia gravis

A

Penicillamine
Quinidine
Gentamicin

+ BASIC LM (b-blockers, acetazolomide, statins, Iodine, CCB, Lithium, Magnesium)

182
Q

What is the clinical hallmark of multifocal motor neuropathy with conduction block

A

Finger drop

183
Q

What are the features of transverse myelitis

A
  • sensory/motor/autonomic dysfunction
  • no evidence of cord compression
  • bilateral signs/symptoms
  • clearly defined sensory level
  • CSF inflammation/T2 signal change on MRI
184
Q

What is the usual onset of transverse myelitis

A

Hours to days

185
Q

What are the causes of transverse myelitis

A
  1. Demyelination (MS, NMO, ADEM)
  2. Infection (HSV, Hep, CMV, EBV, TB..)
  3. Inflammatory (SLE, sarcoid, Sjögren)
  4. Paraneoplastic (Anti-GAD, anti-Hu)
  5. Nutritional (B12, copper)
186
Q

Which manouvres can be performed during examination to look for meningism

A
  • kernig’s sign (pain on straightening knee)
  • brudzinski sign (flex knee on neck flexion)
187
Q

What are the central causes of Horner’s syndrome

A
  1. Brain/brainstem - stroke, SOL, brainstem demyelination
  2. Spinal cord - trauma, syringomyelia
188
Q

What are the causes of a surgical third nerve palsy

A
  • PCA aneurysm
  • Cavernous sinus pathology
  • Uncal herniation
189
Q

What are the causes of a medical third nerve palsy (normal pupil)

A
  • mononeuritis multiplex (e.g. DM)
  • midbrain infarct
  • midbrain demyelination (e.g. MS)
190
Q

How will brown-sequard syndrome present

A
  • Ipsilateral asymmetrical spastic paresis
  • Ipsilateral loss of vibration and proprioception
  • contralateral loss of pain and temperature
191
Q

What are the causes of a brown-sequard syndrome

A
  • Compressive: disc herniation, tumours, spinal stenosis
  • AI: MS, lupus, sarcoid
  • Infectious: HIV, VZV
  • Nutritional: B12 deficiency
192
Q

What are the differentials for a partial seizure

A
  • migraine with aura (lasts hours)
  • TIA (negative symptoms)
  • Transient global amnesia (elderly)
193
Q

When is a CT head indicated in suspected TIA

A
  • anticoagulated
  • residual neurology
  • headache

Otherwise, can start aspirin and refer to TIA clinic for MRI brain

PACES (6 decks)

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