Neurology Flashcards
What is Horner’s syndrome
Ptosis, miosis and anhidrosis
Oculosympathetic paresis (disruption of sympathetic nerve supply to eye)
What is Argyll-Robertson pupil
Pupils accommodate but don’t react to direct or consensual light stimulation
Primarily in neurosyphilis
How does third nerve palsy present
Ptosis, mydriasis and ‘down + out’ deviation of eye
What is Holmes-Adie pupil
Unilateral dilated pupil that reacts poorly to light and slow constriction on accommodation
Associated absent reflexes e.g. ankle jerk
Features of motor neuron disease
Asymmetric limb weakness - most common presentation of ALS
Mixture of upper and lower motor neuron signs
Wasting of the small hand muscles/tibialis anterior
Fasciculations
Absence of sensory signs/symptoms
Doesn’t affect external ocular muscles
No cerebellar signs
Abdominal reflexes usually preserved and sphincter dysfunction is late feature if present
Management of carpal tunnel syndrome
6 week trial of conservative treatments if mild-moderate symptoms - corticosteroid injection, wrist splints at night
Severe symptoms or persisting then surgical decompression
Anterior cerebral artery stroke symptoms
Contralateral hemiparesis and sensory loss - more in lower limbs
Middle cerebral artery stroke symptoms
Contralateral hemiparesis and sensory loss - more in upper limbs
Contralateral homonymous hemianopia
Aphasia
Posterior cerebral artery stroke symptoms
Contralateral homonymous hemianopia with macular sparing
Visual agnosia (unable to recognise images)
Weber’s syndrome (branches of posterior cerebral artery that supply midbrain)
Ipsilateral CN III palsy
Contralateral weakness of upper + lower extremity
Posterior inferior cerebellar artery stroke (aka Wallenburg syndrome/lateral medullary syndrome) symptoms
Ipsilateral facial pain and temp loss
Contralateral limb/torso pain and temp loss
Ataxia, nystagmus
Anterior inferior cerebellar artery stroke (lateral pontine syndrome) symptoms
Ipsilateral facial paralysis and deafness
Basilar artery stroke symptoms
Locked in syndrome
Cluster headache management
Neurology referral
Acute - 100% oxygen, subcut triptan
Prophylaxis - verapamil
MS features
Visual:
- Optic neuritis - common
- Optic atrophy
- Uhthoff’s phenomenon - worsening of vision following rise in body temp
- Internuclear ophthalmoplegia
Sensory:
- Pins/needles
- Numbness
- Trigeminal neuralgia
- Lhermitte’s syndrome - paraesthesia in limb on neck flexion
Motor:
- Spastic weakness - most commonly legs
Cerebellar:
- Ataxia
- Tremor
Other:
- Urinary incontinence
- Sexual dysfunction
- Intellectual deterioration
Essential tremor
Autosomal dominant
Worse if arms are outstretched
Improved by alcohol and rest
Essential tremor management
Propranolol first line
Primidone
Trigeminal neuralgia management
Carbamazepine
Failure to respond to treatment or atypical features then refer to neuro
Guillain-Barre presentation
Progressive, symmetrical weakness of limbs
Ascending weakness
Reduced or absent reflexes
Very few sensory signs
Guillain-Barre investigations
LP - rise in protein with normal WCC
Nerve conduction studies:
- Decreased motor nerve conduction velocity
- Prolonged distal motor latency
- Increased F wave latency
Myasthenia gravis presentation
Muscle fatigue especially after exercise and ocular manifestations - droop of upper eyelids with weakness of external ocular muscles causing diplopia
Normal reflexes, normal tone, sensation fine
Polymyositis presentation
Diffuse weakness in proximal muscles
Weakness varies from week to week
Acute transverse myelitis presentation
Acute episode of weakness or paralysis of both legs, with sensory loss + loss of control of bowels and bladder
Associated back or leg pain
