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3A REVISION > NEUROLOGY 2 > Flashcards

NEUROLOGY 2 Flashcards

1
Q

Why are brain tumours not benign or malignant?

A

Even benign tumours if they continue to grow can cause adverse effects of any space occupying lesion

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2
Q

What are high and low grade tumours?

A

High - rapid growing, aggressive

Low - slow growing but may/may not be able to be treated

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3
Q

Main causes of space occupying lesions? (6)

A 
Tumour - primary or metastatic
Aneurysm
Abscess
Chronic subdural haematoma
Granuloma
Cyst
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4
Q

Main types of primary brain tumours? (5)

A

Gliomas - Astrocytoma, Ependymoma, Oligodendroglioma, Glioblastoma multiforme
Meningioma

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5
Q

Signs of increased ICP? (6)

A 
Headache worse on waking, lying down, coughing
Vomiting
Papilloedema
Decreased GCS
Seizures
Focal neurology
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6
Q

What 3 primaries do brain metastases usually come from?

A

Breast
Lung
Melanoma

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7
Q

Tests for SOLs?

A

CT/MRI
Possible biopsy
Avoid LP until diagnosed as coning risk

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8
Q

Management of brain tumours? (6)

A

If benign remove if accessible
If malignant accessible - excise, chemo-radiotherapy
If inaccessible - chemo-radiotherapy
If hydrocephalus/oedema - ventriculo-peritoneal shunt, dexamethasone/mannitol
Anticonvulsants
Temozolomide for glioblastomas

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9
Q

How do SOLs exert their effects? (3)

A

1) Direct mass effect - local function impaired; symptoms depend on site; 2) Secondary effects - raised ICP/shift of intracranial structures; 3) Provoke focal > generalized seizures

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10
Q

What are astrocytomas?

A

Tumours of astrocytes - support cells, blood brain barrier cells
Low grade - pilocytic
High grade - glioblastoma multiforme

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11
Q

What are oligodendrogliomas?

A

Tumours of oligodendrocytes - myelin producing cells

Slow growing

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12
Q

What are meningiomas?

A

Tumours of arachnoid mater, slow growing

Penetrate venous sinuses

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13
Q

What is MND?

A

Motor neurone disease
Cluster of degenerative diseases characterised by selective loss of neurons in the motor cortex, cranial nerve nuclei and anterior horn cells

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14
Q

How to distinguish MND from MS, MG?

A

MND has no sensory loss or sphincter disturbance unlike MS

MND never affects eye movements unlike MG

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15
Q

What are the types of MND?

A

ALS (amyotrophic lateral sclerosis)
Progressive bulbar palsy
Progressive muscular atrophy
Primary lateral sclerosis

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16
Q

What is ALS?

A

50% of MND
Loss of motor neurons in motor cortex and anterior horn of the cord
Weakness and upper motor neuron signs
Lower motor neuron wasting/fasciculation

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17
Q

What is progressive bulbar palsy?

A

Only affects cranial nerves 9-12
LMN lesion of tongue - flaccid, fasciculating
Quiet/hoarse speech

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18
Q

What is progressive muscular atrophy?

A

Anterior horn cell lesion only, no UMN signs

Affects distal muscles then proximal

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19
Q

What is primary lateral sclerosis?

A

Loss of Betz cells in motor cortex
Mainly UMN signs
Marked spastic leg weakness
Pseudobulbar palsy - UMN lesion of swallowing/talking muscles

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20
Q

Classic presentation of MND?

A 
>40 years old
spastic gait
Foot drop, proximal myopathy
Weak grip
Shoulder abduction
Aspiration pneumonia
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21
Q

What are some UMN signs?

A

Spasticity
Brisk reflexes
Upgoing plantas

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22
Q

What are some LMN signs?

A

Wasting
Fasciculation
Weakness i.e. of swallowing

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23
Q

Diagnosis of MND?

A

Clinical
Brain/cord MRI to exclude structural causes
LP to exclude inflammatory causes

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24
Q

Prognosis of MND?

A

Fatal within 2-4 years

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25
Q

Treatment of MND? (5)

A

MDT approach - palliative nurse, physio, OT, SALT
Riluzole (antiglutamatergic) prolongs life by 3 months
NG tube/PEG
Analgesia for joint pain
Non-invasive ventilation for sleep apnoea

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26
Q

Which types of MND have the best and worse prognosis?

A

Best - progressive muscular atrophy

Worst - progressive bulbar palsy

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27
Q

What causes MND?

A

Unknown

Associated with some gene mutations - SOD1, C9orf72, TARDBP

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28
Q

What is MS?

A

Multiple sclerosis

Chronic autoimmune T cell mediated inflammatory disorder of the CNS

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29
Q

Pathology of MS?

A

Discrete plaques of demyelination occur at multiple CNS sites
From T cell mediated immune response in white matter
Demyelination heals poorly - relapsing and remitting
Prolonged demyelination causes axonal loss - progressive

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30
Q

Where is MS more common?

A

Temperate northern areas i.e. Britain, Scandinavia

Migrants take risk with them, children acquire risk of where they settle

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31
Q

Possible risk factors for MS? (4)

A

Country you live in
Lack of exposure to sunlight/vitamin D
Possibly viral infections such as EBV, HHV6 if exposed at critical times in development
Presents between 20 and 40

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32
Q

Types of MS? (3)

A

Relapsing remitting (90%) - attacks of symptoms followed by complete/incomplete recovery, on average 1 relapse a year
Secondary progressive - late stage, gradually worsening disability, normally follows 30-40yrs of relapsing remitting
Primary progressive - least common, gradually worsens with no remission

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33
Q

Presentation of MS? (4)

A 
Usually monosymptomatic
Unilateral optic neuritis - pain on eye movement, decrease in vision
Numbness/tingling in limbs
Leg weakness
Brainstem/cerebellar - diplopia/ataxia
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34
Q

What is Uhtoff’s phenomenon?

A

Decreased vision gets worse in heat i.e. in a hot bath, on exercise

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35
Q

Other symptoms of MS? (7)

A 
Decreased vibration sense
Trigeminal neuralgia
Spastic weakness
Swallowing disorders
Cognitive decline
Erectile dysfunction
Incontinence
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36
Q

How is MS diagnosed? (4)

A

Lesions disseminated in time and space, unattributable to other causes
MRI for plaque detection
CSF shows oligoclonal bands of IgG not present in serum
Delayed visual, auditory, sensory evoked potentials

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37
Q

How is MS treated? (5)

A 
Decrease stress
Give vitamin D if deficient
Methylprednisolone for 3 days to shorten relapses
Interferons decrease relapses
Alemtuzamab acts against T cells
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38
Q

Palliation for MS? (3)

A

Baclofen/diazepam for spasticity
Botulinum toxin for tremor
Tolterodine for urinary symptoms

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39
Q

What is epilepsy?

A

Tendency to spontaneous, intermittent, abnormal electrical activity in part of the brain manifesting as seizures

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40
Q

What are convulsions?

A

Motor signs of electrical discharges

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41
Q

What is a prodrome?

A

Change in mood or behaviour that precedes the seizure, may last hours or days

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42
Q

What is the aura?

A

Part of the seizure which the patient is aware of and may precede its other manifestations
May be an experience of deja vu, strange smells or flashing lights

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43
Q

Give some post ictal symptoms? (6)

A 
Headache
Confusion
Myalgia
Sore tongue
Weakness
Dysphasia
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44
Q

Cause of epilepsy?

A

2/3 idiopathic, may be familial
Cortical scarring - head injury, developmental problems, SOL, stroke, vascular malformations
Sarcoidosis
SLE

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45
Q

Give some non epileptic causes of seizures? (6)

A 
Trauma
Stroke
Haemorrhage
Increased ICP
Alcohol/benzo withdrawal
Metabolic disturbance - low oxygen, hypo/hypernatraemia, hypo/hypercalcaemia, hypo/hyperglycaemia
Infection - meningitis, encephalitis
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46
Q

Triggers of epileptic seizures? (6)

A 
Alcohol
Stress
Infection
Certain sounds
Flickering lights
Reading/writing
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47
Q

Investigations of seizures? (5)

A 
Bloods (infection)
Drugs screen
LP
EEG
CT/MRI
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48
Q

Advice to give in epilepsy?

A

Dangers of swimming, driving

Avoid driving until seizure free for >1 year - tell DVLA

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49
Q

What are partial (focal)seizures?

A

Focal onset seizures with features referable to a part of one hemisphere
More related to structural problem

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50
Q

How are partial seizures classified?

A

Simple partial seizure
Complex partial seizure
Partial seizure with secondary generalisation

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51
Q

What is a simple partial seizure? (2)

A

Unimpaired awareness, with focal motor/sensory/autonomic or psychic symptoms
No post ictal symptoms

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52
Q

What is a complex partial seizure? (5)

A 
Impaired awareness
May have an aura
Most arise from temporal lobe
Automatisms - lip smacking, wandering
Post ictal confusion common if temporal, rapid recovery if frontal
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53
Q

What is a partial seizure with secondary generalisation? (2)

A

Seizure starts focally as simple/complex partial seizure

Spreads causing secondary generalised seizure which is typically convulsive

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54
Q

What are primary generalised seizures?

A

Simultaneous onset of electrical discharge throughout the cortex with no localising features referable to only one hemisphere

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55
Q

How are generalised seizures classified?

A 
Absence seizures - petit mal
Tonic clonic seizures - grand mal
Myoclonic seizures
Atonic seizures
Infantile spasms
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56
Q

What are absence seizures? (2)

A

Brief <10s pauses, such as stopping talking mid sentence then carries on after
Presents in childhood

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57
Q

What are tonic clonic seizures? (4)

A

Loss of consciousness
Limbs stiffen (TONIC)
Limbs jerk (CLONIC)
Post ictal confusion and drowsiness

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58
Q

What are myoclonic seizures? (3)

A

Sudden jerk of a limb, trunk or face
Patient may be thrown suddenly to ground
Have one violently disobedient limb

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59
Q

What are atonic seizures?

A

Sudden loss of muscle tone causing a fall, no loss of consciousness

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60
Q

What are features of a temporal partial seizure? (7)

A 
Automatisms - lip smacking, fumbling
Abdominal rising sensation/pain
Dysphasia
Memory phenomena - deja vu, jamais vu
Emotional disturbance
Hallucinations of smell/taste/hearing
Delusional behaviour
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61
Q

What are features of a frontal partial seizure? (5)

A

Motor features - posturing (involuntary flexion or extension), movements of head/eyes, peddling of the legs
Jacksonian march - spreading focal motor seizure with retained awareness
Motor arrest
Behavioural disturbances
Dysphasia

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62
Q

What are features of a parietal partial seizure?

A

Sensory disturbance - tingling, numbness

Motor symptoms

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63
Q

What are features of an occipital partial seizure?

A

Visual phenomena - spots,flashed, lines

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64
Q

What is Todd’s palsy?

A

Transient neurological deficit (paresis) after a seizure
Face, arm or leg weakness
Aphasia or gaze palsy
Lasts from 30min to 36hr

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65
Q

When are medications offered for epilepsy?

A

After the 2nd fit

After the 1st fit if high risk of recurrence - i.e. focal deficit, structural abnormality

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66
Q

What is used to treat generalised tonic clonic seizures?

A

1st line - Sodium valproate or Lamotrigine

2nd line - carbamazepine

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67
Q

What is used to treat absence seizures?

A

Sodium valproate or lamotrigine

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68
Q

What is used to treat tonic, atonic and myoclonic seizures?

A

Sodium valproate of lamotrigine

Carbamazapine may make worse

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69
Q

What is used to treat partial seizures? +/- secondary generalisation

A

1st line - carbamazepine
2nd line - sodium valproate, lamotrigine
Others - levetiracetam, phenytoin, gabapentin

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70
Q

How should medications be prescribed in epilepsy? (3)

A

Build up dose over 2/3 months until seizures controlled or side effects are too bad or max dose
If ineffective/not tolerated switch to next line
Withdraw 1st drug when established on the 2nd
Dual therapy rare

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71
Q

What is medications for epilepsy don’t work?

A

Neurosurgical resection if cause such as tumour,sclerosis
Vagal nerve stimulation
MDT management - relaxation training, epilepsy nurse

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72
Q

Reccommendations for pregnant women with epilepsy?

A

Take folic acid

Avoid sodium valproate - use lamotrigine, can breastfeed

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73
Q

How does lamotrigine work? 3 side effects

A

Sodium channel blocker

Maculopapular rash, hypersensitivity i.e. photo, double/blurred vision

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74
Q

How does sodium valproate work? 3 side effects

A

Sodium channel blocker, potentiates GABA

Weight gain, ataxia, teratogenic

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75
Q

How does carbamazepine work? 3 side effects

A

Increases refractory period of sodium channel
Potentiates GABA
Leucopaenia, double/blurred vision, drowsy

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76
Q

What is status epilepticus?

A

Seizures lasting >30min or repeated seizures without regaining consciousness

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77
Q

Complications of status epilepticus?

A

Death
Permanent brain damage
Risk increases with length of seizure

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78
Q

When should status epilepticus be treated?

A

Seizures over 5 min, try to terminate before 20 min

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79
Q

Treatment of status epilepticus? (7)

A

Maintain airway, intubate if needed, oxygen
IV access and take blood
Slow IV bolus lorazepam
2nd dose lorazepam if no response in 10 min
If no response, phenytoin infusion
If no response, diazepam infusion
General anaesthesia last resort

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80
Q

What is NEAD?

A

Non epileptic attack disorder

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81
Q

How to distinguish NEAD from epilepsy?

A 
Non-neuroanatomically accurate convulsions
Wild shaking or completely still
Arms flexing and extending
Pelvic thrusting, arched back
Wax and wane
Eyes closed firmly
Move away from you
May be aware, won't lose sats etc
Recovery quick, emotionally distressed
Background of MUS, abuse
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82
Q

What is mononeuropathy?

A

Lesion of an individual peripheral or cranial nerve

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83
Q

What usually causes mononeuropathies?

A

Local causes such as trauma, entrapment

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84
Q

What is mononeuritis multiplex?

A

2 or more peripheral nerves affected, causes tend to be systemic

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85
Q

Causes of mononeuritis multiplex?

A

Wegeners, AIDS, Rheumatoid, Diabetes, Sarcoidosis

86
Q

What is the commonest mononeuropathy?

A

Carpal tunnel syndrome

87
Q

What is carpal tunnel syndrome?

A

Compression of the median nerve causing pain and paraesthesia in the hand

88
Q

What is the carpal tunnel?

A

Passageway in the wrist containing 9 tendons and the median nerve, covered with the flexor retinaculum

89
Q

What does the median nerve supply?

A

LOAF - lumbricals, opponens pollicis, abductor pollicis brevis, flexor pollicis brevis
Sensory innervation to palmar side of thumb, index, middle fingers

90
Q

Spinal roots of median nerve?

A

C6-T1

91
Q

Causes of carpal tunnel syndrome?

A 
Myxoedema
Enforced flexion
Diabetic neuropathy
Idiopathic
Acromegaly
Neoplasms
Tumours - benign
Rheumatoid arthritis
Amyloidosis
Pregnancy
Sarcoidosis
92
Q

Symptoms of carpal tunnel syndrome? (6)

A 
Aching pain in hand worse at night
Paraesthesia in tumb, index, middle finger
Pain relieved by shaking hand
Sensory loss
Weakness of abductor pollicis brevis
Wasting of thenar eminence
93
Q

Tests for carpal tunnel syndrome? (3)

A

Neurophysiology
Phalens test - maximal wrist flexion may elicit symptoms
Tinels test - tapping the nerve over the wrist induces tingling

94
Q

Treatment of carpal tunnel syndrome? (3)

A

Splinting
Local steroid injection
Decompression surgery

95
Q

What is the ulnar nerve root?

A

C7-T1

96
Q

Cause of ulnar nerve mononeuropathy?

A

Elbow trauma

97
Q

Presentation of ulnar nerve mononeuropathy?

A

Weakness of the ulnar side wrist flexors, interossei so can’t cross fingers, and medial 2 lumbricals = claw hand, weak little finger abduction
Sensory loss of ulnar 1.5 fingers

98
Q

What is the radial nerve root?

A

C5-T1

99
Q

Cause of radial nerve mononeuropathy?

A

Compression against humerus

100
Q

Presentation of radial nerve mononeuropathy?

A

Can’t extend wrist and fingers
Muscles - brachioradialis, extensors, supinator, triceps
Sensory loss lateral dorsum of hand, anatomical snuffbox

101
Q

What is the root of the brachial plexus?

A

C5-T1

102
Q

Cause of brachial plexus damage?

A

Trauma
Radiotherapy
Heavy rucksack
Thoracic outlet compression

103
Q

Presentation of damaged brachial plexus?

A

Pain/paraesthesia and weakness, variable distribution

104
Q

What is the root of the phrenic nerve?

A

C3,4,5 keep the diaphragm alive

105
Q

Cause of damaged phrenic nerve?

A

Lung cancer, cervical spondylosis/trauma, thoracic surgery, HIV, TB

106
Q

Presentation of damaged phrenic nerve?

A

Orthopnoea with raised hemidiaphragm on x ray

107
Q

What is the root of the lateral cutaneous nerve of the thigh?

A

L2-L3

108
Q

What is meralgia parsaesthetica?

A

Anterolateral burning thigh pain from entrapment under the inguinal ligament

109
Q

What is the root of the sciatic nerve?

A

L4-S3

110
Q

What causes damage to the sciatic nerve?

A

Pelvic tumours or fractures to pelvis or femur

111
Q

Presentation of damaged sciatic nerve?

A

Foot drop - affects hamstrings and all muscles below the knee
Loss of sensation below the knee laterally

112
Q

What is the root of the common peroneal nerve?

A

L4-S1

113
Q

What causes damage to the common peroneal nerve?

A

Trauma

Sitting cross legged

114
Q

Presentation of damaged common peroneal nerve?

A

Foot drop
Weak ankle dorsiflexion/eversion
Sensory loss over dorsum of foot

115
Q

What is the root of the tibial nerve?

A

L4-S3

116
Q

Presentation of damaged tibial nerve?

A

Inability of plantarflexion, foot inversion, toe flexion

Sensory loss over sole of foot

117
Q

What are the cranial nerves?

A

12 nerves that emerge directly from the brain/brainstem

118
Q

Name the cranial nerves

A 
I - olfactory 
II - optic 
III - oculomotor
IV - trochlear
V - trigeminal (opthalmic maxillary mandibular)
VI - abducens
VII - facial
VIII - vestibulocochlear
IX - glossopharyngeal
X - vagus
XI - accessory
XII - hypoglossal
119
Q

How does CNI lesion present?

A

Anosmia

120
Q

Causes of CNI lesion? (3)

A

Trauma
URTI
Meningitis

121
Q

How does CNII lesion present?

A

Low visual acuity
Visual field defect
Pupil defect - size, symmetry, light reaction, accommodation

122
Q

Causes of CNII lesion? (6)

A 
MS
GCA
Optic chiasm compression
Stroke
Raised ICP
Diabetes
123
Q

How dies CNIII lesion present?

A

Eyes go down and out due to unopposed CNIV/VI action

124
Q

Causes of CNIII lesion?

A

MS
Diabetes
GCA
Posterior communicating artery aneurysm

125
Q

How does CNIV lesion present?

A

Diplopia on looking down

126
Q

Causes of CNIV lesion?

A

Rare - orbit trauma

127
Q

How does a CNVI lesion present?

A

Horizontal diplopia on looking out

128
Q

Causes of a CNVI lesion? (3)

A

MS
Wernickes
Pontine stroke

129
Q

How does a CNV lesion present?

A

Open jaw deviates to side of lesion
Trigeminal neuralgia
Cluster headache

130
Q

Causes of CNV lesion? (3)

A

Stroke
Trigeminal neuralgia
Herpes zoster

131
Q

How does CNVII lesion present?

A

Facial droop, weakness

Loss of taste in anterior 2/3 tongue

132
Q

Causes of CNVII lesion? (3)

A

Bells palsy - unilateral LMN lesion
Skull fracture
Stroke

133
Q

How does CNVIII lesion present?

A

Abnormal Webers/Rinnes test - hearing problems

Dizziness

134
Q

Causes of CNVIII lesion?

A

Noise damage
Acoustic neuroma
Herpes zoster

135
Q

How does CNIX lesion present?

A

Loss of taste posterior 1/3 of tongue

Absent gag reflex

136
Q

How does CNX lesion present?

A

Absent gag reflex
Raised BP, HR
Hoarse voice

137
Q

Cause of CNIX/X/XI lesions?

A

Trauma
Brainstem lesions
Neck tumour

138
Q

How does CNXI lesion present?

A

Can’t shrug shoulders or turn neck against resistance

139
Q

How does CNXII lesion present?

A

Tongue deviates to side of lesion

Tongue fasciculation

140
Q

What causes CNXII lesion?

A

Rare - polio, stroke, tumour, bulbar palsy, trauma

141
Q

What is the difference between mononeuropathy and radiculopathy?

A

Mononeuropathy affects nerve itself

Radiculopathy affects nerve root

142
Q

What is a radiculopathy?

A

Pinched nerve root causing radicular pain (pain along dermatome)

143
Q

Presentation of radiculopathy?

A

Dermatomal pain - sharp/shooting
Dull reflexes
Numbness, tingling, pain

144
Q

What nerve roots are usually affected in radiculopathy in upper and lower limbs?

A

Commonly from cervical spine
Upper C6 C7
Lower L5 S1

145
Q

Causes of radiculopathy?

A

Degenerative disc disease
Osteoarthritis
Facet joint hypertrophy or degeneration
Ligament hypertrophy

146
Q

What is sciatica?

A

Leg pain from lower back, often caused by spinal disc herniation compressing nerve root

147
Q

Compression of which nerve roots can cause sciatica? (ie what are the roots of the sciatic nerve)

A

L4, L5

S1, S2, S3

148
Q

How is sciatica treated?

A

Spontaneous resolve for a lot of disc herniations
NSAIDs
Discectomy

149
Q

What is peripheral neuropathy?

A

Condition of peripheral or cranial nerves causing motor/sensory symptoms

150
Q

Difference between mononeuropathy, mononeuritis multiplex and polyneuropathy?

A

Mononeuropathy is neuropathy affecting only 1 nerve
MM is 2 or more separate nerves in disparate areas
Polyneuropathy is multiple nerves involved in roughly the same areas on both sides of the body

151
Q

Classification of peripheral neuropathy?

A

Course - Acute or chronic
Function - Sensory, motor, autonomic or mixed
Pathology - demyelination, axonal degeneration, both

152
Q

Causes of mostly motor peripheral neuropathies? (3)

A

Guillain Barre
Lead poisoning
Charcot Marie Tooth syndrome

153
Q

Causes of mostly sensory peripheral neuropathies? (3)

A

Diabetes mellitus
Renal failure
Leprosy

154
Q

Medication causes of peripheral neuropathies?

A 
Alcohol
Isoniazid
Phenytoin
Metronidazole
Nitrofurantoin
Cisplatin
Vincristine
155
Q

Metabolic causes of peripheral neuropathies?

A

Diabetes
Renal failure
Hypothyroid
Hypoglycaemia

156
Q

Vasculitis causes of peripheral neuropathies?

A

Polyarteritis nodosa
Rheumatoid arthritis
Wegeners granulomatosis

157
Q

Malignant causes of peripheral neuropathy?

A

Polycythaemia rubra vera

Paraneoplastic syndrome

158
Q

Inflammatory causes of peripheral neuropathy?

A

Guillain Barre syndrome

Sarcoidosis

159
Q

Infective causes of peripheral neuropathy?

A

Leprosy
HIV
Syphilis
Lyme

160
Q

Nutritional causes of peripheral neuropathy?

A 
Low B1
Low B12
Low vit E
Low folate
High B6
161
Q

Symptoms of sensory neuropathy? (5)

A 
Numbness
Paraesthesia
Burning
Glove and stocking distribution affecting extremities first
Signs of trauma on hands
162
Q

Symptoms of motor neuropathy? (6)

A 
Weak/clumsy hands
Difficulty walking
Falls, stumbles
Difficulty breathing
Wasting/weakness in distal muscles of hands/feet causing foot or wrist drop
Reduced/absent reflexes
163
Q

Symptoms of autonomic neuropathy?

A 
Constipation/urinary retention - parasympathetic
Erectile dysfunction - parasympathetic
Ejaculatory failure - sympathetic
Postural hypotension - sympathetic
Sweating - sympathetic
Horners syndrome - sympathetic
164
Q

Tests in peripheral neuropathy? (6)

A 
Bloods inc TSH, B12, glucose
Plasma antibodies, electrophoresis
CXR
Urinalysis
Possible LP or specific genetic tests
Nerve conduction to distinguish axonal from demyelinating
165
Q

Management of peripheral neuropathy? (6)

A

Treat cause
Physio and OT
Foot care
Immunoglobulin i.e. for GBS
Steroids/immunosuppressants for vasculitis
Amitriptyline, gabapentin, pregabalin for pain

166
Q

How does cord compression usually present?

A

Weak legs

167
Q

Symptoms of cord compression? (3)

A

Spinal/nerve root pain may precede
Leg weakness, possible less severe arm weakness
Bladder and anal sphincter involvement - late sign - hesitancy, frequency, retention

168
Q

Pattern of symptoms in cord compression?

A

Normal above the level of the lesion
LMN signs at the level
UMN signs below the level

169
Q

Causes of cord compression? (3)

A

Secondary malignancy in the spine
Infection - epidural abscess
Disc prolapse

170
Q

Investigations of cord compression? (4)

A

MRI spine
Biopsy/surgical exploration if mass
Screening bloods - infection markers, B12, syphilis, serum electrophoresis
CXR

171
Q

Treatment of cord compression?

A

If malignancy - dexamethasone, radio/chemotherapy, decompressive laminectomy
If infection, decompress and antibiotics

172
Q

Difference between cauda equina and higher spinal cord lesions?

A

Cauda equina - leg weakness is flaccid and areflexic, not spastic and hyperreflexic

173
Q

What is cauda equina syndrome?

A

Compression of the nerves that form the cauda equina (from L2 down)

174
Q

Causes of cauda equina syndrome?

A

Same as cord compression - metastases, infection, disc prolapse
Lumbar disc disease and lumbosacral nerve lesions

175
Q

Symptoms of cauda equina syndrome? (5)

A

Back pain and radicular pain down legs
Asymmetrical, atrophic, areflexic paralysis of the legs
Sensory loss in root distribution - perineum
Sexual dysfunction
Decreased sphincter tone

176
Q

Investigations for cauda equina?

A

MRI spine

177
Q

Management of cauda equina syndrome?

A

Urgent surgical decompression

Antiinflammatory agents/antibiotics if needed

178
Q

What is anterior cord syndrome?

A

Complete motor loss below the lesion
Loss of pain and temperature perception
Sensation preserved

179
Q

What causes anterior cord syndrome?

A

Ischaemia of the anterior spinal artery - loss of function of the anterior 2/3 of the spinal cord

180
Q

What is Brown Sequard syndrome?

A

Damage to one half of the spinal cord resulting in paralysis and loss of proprioception on the ipsilateral side, and loss of pain and temperature contralaterally

181
Q

What are the 3 sensory (ascending) tracts of the spinal cord?

A

Dorsal column-medial lemniscus tract - proprioception and vibration
Anterolateral system - pain and temperature
Spinocerebellar pathways - unconscious proprioception

182
Q

What are the tracts in the DCML system?

A

The gracile fasciculus and the cuneate fasciculus

183
Q

What are the tracts in the ALS system?

A

Spinothalamic
Spinoreticular
Spinotectal

184
Q

What are the tracts in the spinocerebellar system?

A

Posterior, anterior and rostral spinocerebellar

Cuneocerebellar

185
Q

What are the 2 motor (descending) tracts of the spinal cord?

A

Pyramidal tracts - voluntary movement

Extrapyramidal tracts - involuntary movement

186
Q

What are the tracts in the pyramidal system?

A

Corticospinal

Corticobulbar

187
Q

What are the tracts in the extrapyramidal system?

A

Tectospinal
Vestibulospinal
Recticulospinal
Rubrospinal

188
Q

What is myelopathy?

A

Injury to the spinal cord due to severe compression that may result from trauma, stenosis, disc herniation, neoplasm

189
Q

What may cause a brain abscess?

A

Infection - ear, sinus, dental
Skull fractire
Congenital heart disease/endocarditid
Bronchiectasis

190
Q

Signs of brain abscess? (6)

A 
Increased ICP
Fever
Increased WCC
Seizures
Coma
Signs of sepsis
191
Q

Investigations of brain abscess?

A

CT/MRI - ring enhancing lesion
Bloods - WCC, ESR
Biopsy

192
Q

Treatment of brain abscess?

A

Treat increased ICP

ANTIBIOTICS

193
Q

What is myopathy?

A

Disease of muscle fibres where they do not function properly, resulting in weakness

194
Q

Difference between myopathy and neuropathy?

A

Myopathy more gradual onset, symmetrical, PROXIMAL weakness
Effect specific muscle groups
Preserved reflexes
Neuropathy more likely if paraesthesiae, bladder problems, distal weakness,rapid onset

195
Q

What can cause myopathies?

A 
Muscular dystrophy (i.e. Duchenne)
Drugs - statins, steroids, alcohol
Myotonic
Inflammatory
Metabolic (glycogen/lipid storage disease)
196
Q

What are myotonic disorders?

A

Cause tonic muscle spasm i.e. dystrophia myotonica

197
Q

What are inflammatory myopathies?

A

Inclusion body myositis - aggregates of protein

Polymyositis and dermatomyositis

198
Q

Dermatome of clavicles?

A

C3-4

199
Q

Dermatome of lateral arm/forearm?

A

C6-7

200
Q

Dermatome of medial side of arm?

A

T1

201
Q

Dermatome of thumb?

A

C6

202
Q

Dermatome of middle finger?

A

C7

203
Q

Dermatome of little finger?

A

C8

204
Q

Dermatome of nipples?

A

T4

205
Q

Dermatome of umbilicus?

A

T10

206
Q

Dermatome of inguinal ligament?

A

L1

207
Q

Dermatome of anterior and inner leg?

A

L2-3

208
Q

Dermatome of medial side of big toe?

A

L5

209
Q

Dermatome of posterior and outer leg?

A

L5, S1-2

210
Q

Dermatome of lateral margin of foot and little toe?

A

S1

211
Q

Dermatome of perineum?

A

S2-4

3A REVISION (17 decks)

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