NEUROLOGY 2 Flashcards
Why are brain tumours not benign or malignant?
Even benign tumours if they continue to grow can cause adverse effects of any space occupying lesion
What are high and low grade tumours?
High - rapid growing, aggressive
Low - slow growing but may/may not be able to be treated
Main causes of space occupying lesions? (6)
Tumour - primary or metastatic Aneurysm Abscess Chronic subdural haematoma Granuloma Cyst
Main types of primary brain tumours? (5)
Gliomas - Astrocytoma, Ependymoma, Oligodendroglioma, Glioblastoma multiforme
Meningioma
Signs of increased ICP? (6)
Headache worse on waking, lying down, coughing Vomiting Papilloedema Decreased GCS Seizures Focal neurology
What 3 primaries do brain metastases usually come from?
Breast
Lung
Melanoma
Tests for SOLs?
CT/MRI
Possible biopsy
Avoid LP until diagnosed as coning risk
Management of brain tumours? (6)
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
How do SOLs exert their effects? (3)
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
What are astrocytomas?
Tumours of astrocytes - support cells, blood brain barrier cells
Low grade - pilocytic
High grade - glioblastoma multiforme
What are oligodendrogliomas?
Tumours of oligodendrocytes - myelin producing cells
Slow growing
What are meningiomas?
Tumours of arachnoid mater, slow growing
Penetrate venous sinuses
What is MND?
Motor neurone disease
Cluster of degenerative diseases characterised by selective loss of neurons in the motor cortex, cranial nerve nuclei and anterior horn cells
How to distinguish MND from MS, MG?
MND has no sensory loss or sphincter disturbance unlike MS
MND never affects eye movements unlike MG
What are the types of MND?
ALS (amyotrophic lateral sclerosis)
Progressive bulbar palsy
Progressive muscular atrophy
Primary lateral sclerosis
What is ALS?
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
What is progressive bulbar palsy?
Only affects cranial nerves 9-12
LMN lesion of tongue - flaccid, fasciculating
Quiet/hoarse speech
What is progressive muscular atrophy?
Anterior horn cell lesion only, no UMN signs
Affects distal muscles then proximal
What is primary lateral sclerosis?
Loss of Betz cells in motor cortex
Mainly UMN signs
Marked spastic leg weakness
Pseudobulbar palsy - UMN lesion of swallowing/talking muscles
Classic presentation of MND?
>40 years old spastic gait Foot drop, proximal myopathy Weak grip Shoulder abduction Aspiration pneumonia
What are some UMN signs?
Spasticity
Brisk reflexes
Upgoing plantas
What are some LMN signs?
Wasting
Fasciculation
Weakness i.e. of swallowing
Diagnosis of MND?
Clinical
Brain/cord MRI to exclude structural causes
LP to exclude inflammatory causes
Prognosis of MND?
Fatal within 2-4 years
Treatment of MND? (5)
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
Which types of MND have the best and worse prognosis?
Best - progressive muscular atrophy
Worst - progressive bulbar palsy
What causes MND?
Unknown
Associated with some gene mutations - SOD1, C9orf72, TARDBP
What is MS?
Multiple sclerosis
Chronic autoimmune T cell mediated inflammatory disorder of the CNS
Pathology of MS?
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
Where is MS more common?
Temperate northern areas i.e. Britain, Scandinavia
Migrants take risk with them, children acquire risk of where they settle
Possible risk factors for MS? (4)
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
Types of MS? (3)
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
Presentation of MS? (4)
Usually monosymptomatic Unilateral optic neuritis - pain on eye movement, decrease in vision Numbness/tingling in limbs Leg weakness Brainstem/cerebellar - diplopia/ataxia
What is Uhtoff’s phenomenon?
Decreased vision gets worse in heat i.e. in a hot bath, on exercise
Other symptoms of MS? (7)
Decreased vibration sense Trigeminal neuralgia Spastic weakness Swallowing disorders Cognitive decline Erectile dysfunction Incontinence
How is MS diagnosed? (4)
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
How is MS treated? (5)
Decrease stress Give vitamin D if deficient Methylprednisolone for 3 days to shorten relapses Interferons decrease relapses Alemtuzamab acts against T cells
Palliation for MS? (3)
Baclofen/diazepam for spasticity
Botulinum toxin for tremor
Tolterodine for urinary symptoms
What is epilepsy?
Tendency to spontaneous, intermittent, abnormal electrical activity in part of the brain manifesting as seizures
What are convulsions?
Motor signs of electrical discharges
What is a prodrome?
Change in mood or behaviour that precedes the seizure, may last hours or days
What is the aura?
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
Give some post ictal symptoms? (6)
Headache Confusion Myalgia Sore tongue Weakness Dysphasia
Cause of epilepsy?
2/3 idiopathic, may be familial
Cortical scarring - head injury, developmental problems, SOL, stroke, vascular malformations
Sarcoidosis
SLE
Give some non epileptic causes of seizures? (6)
Trauma Stroke Haemorrhage Increased ICP Alcohol/benzo withdrawal Metabolic disturbance - low oxygen, hypo/hypernatraemia, hypo/hypercalcaemia, hypo/hyperglycaemia Infection - meningitis, encephalitis
Triggers of epileptic seizures? (6)
Alcohol Stress Infection Certain sounds Flickering lights Reading/writing
Investigations of seizures? (5)
Bloods (infection) Drugs screen LP EEG CT/MRI
Advice to give in epilepsy?
Dangers of swimming, driving
Avoid driving until seizure free for >1 year - tell DVLA
What are partial (focal)seizures?
Focal onset seizures with features referable to a part of one hemisphere
More related to structural problem
How are partial seizures classified?
Simple partial seizure
Complex partial seizure
Partial seizure with secondary generalisation
What is a simple partial seizure? (2)
Unimpaired awareness, with focal motor/sensory/autonomic or psychic symptoms
No post ictal symptoms
What is a complex partial seizure? (5)
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
What is a partial seizure with secondary generalisation? (2)
Seizure starts focally as simple/complex partial seizure
Spreads causing secondary generalised seizure which is typically convulsive
What are primary generalised seizures?
Simultaneous onset of electrical discharge throughout the cortex with no localising features referable to only one hemisphere
How are generalised seizures classified?
Absence seizures - petit mal Tonic clonic seizures - grand mal Myoclonic seizures Atonic seizures Infantile spasms
What are absence seizures? (2)
Brief <10s pauses, such as stopping talking mid sentence then carries on after
Presents in childhood
What are tonic clonic seizures? (4)
Loss of consciousness
Limbs stiffen (TONIC)
Limbs jerk (CLONIC)
Post ictal confusion and drowsiness
What are myoclonic seizures? (3)
Sudden jerk of a limb, trunk or face
Patient may be thrown suddenly to ground
Have one violently disobedient limb
What are atonic seizures?
Sudden loss of muscle tone causing a fall, no loss of consciousness
What are features of a temporal partial seizure? (7)
Automatisms - lip smacking, fumbling Abdominal rising sensation/pain Dysphasia Memory phenomena - deja vu, jamais vu Emotional disturbance Hallucinations of smell/taste/hearing Delusional behaviour
What are features of a frontal partial seizure? (5)
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
What are features of a parietal partial seizure?
Sensory disturbance - tingling, numbness
Motor symptoms
What are features of an occipital partial seizure?
Visual phenomena - spots,flashed, lines
What is Todd’s palsy?
Transient neurological deficit (paresis) after a seizure
Face, arm or leg weakness
Aphasia or gaze palsy
Lasts from 30min to 36hr
When are medications offered for epilepsy?
After the 2nd fit
After the 1st fit if high risk of recurrence - i.e. focal deficit, structural abnormality
What is used to treat generalised tonic clonic seizures?
1st line - Sodium valproate or Lamotrigine
2nd line - carbamazepine
What is used to treat absence seizures?
Sodium valproate or lamotrigine
What is used to treat tonic, atonic and myoclonic seizures?
Sodium valproate of lamotrigine
Carbamazapine may make worse
What is used to treat partial seizures? +/- secondary generalisation
1st line - carbamazepine
2nd line - sodium valproate, lamotrigine
Others - levetiracetam, phenytoin, gabapentin
How should medications be prescribed in epilepsy? (3)
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
What is medications for epilepsy don’t work?
Neurosurgical resection if cause such as tumour,sclerosis
Vagal nerve stimulation
MDT management - relaxation training, epilepsy nurse
Reccommendations for pregnant women with epilepsy?
Take folic acid
Avoid sodium valproate - use lamotrigine, can breastfeed
How does lamotrigine work? 3 side effects
Sodium channel blocker
Maculopapular rash, hypersensitivity i.e. photo, double/blurred vision
How does sodium valproate work? 3 side effects
Sodium channel blocker, potentiates GABA
Weight gain, ataxia, teratogenic
How does carbamazepine work? 3 side effects
Increases refractory period of sodium channel
Potentiates GABA
Leucopaenia, double/blurred vision, drowsy
What is status epilepticus?
Seizures lasting >30min or repeated seizures without regaining consciousness
Complications of status epilepticus?
Death
Permanent brain damage
Risk increases with length of seizure
When should status epilepticus be treated?
Seizures over 5 min, try to terminate before 20 min
Treatment of status epilepticus? (7)
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
What is NEAD?
Non epileptic attack disorder
How to distinguish NEAD from epilepsy?
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
What is mononeuropathy?
Lesion of an individual peripheral or cranial nerve
What usually causes mononeuropathies?
Local causes such as trauma, entrapment
What is mononeuritis multiplex?
2 or more peripheral nerves affected, causes tend to be systemic
Causes of mononeuritis multiplex?
Wegeners, AIDS, Rheumatoid, Diabetes, Sarcoidosis
What is the commonest mononeuropathy?
Carpal tunnel syndrome
What is carpal tunnel syndrome?
Compression of the median nerve causing pain and paraesthesia in the hand
What is the carpal tunnel?
Passageway in the wrist containing 9 tendons and the median nerve, covered with the flexor retinaculum
What does the median nerve supply?
LOAF - lumbricals, opponens pollicis, abductor pollicis brevis, flexor pollicis brevis
Sensory innervation to palmar side of thumb, index, middle fingers
Spinal roots of median nerve?
C6-T1
Causes of carpal tunnel syndrome?
Myxoedema Enforced flexion Diabetic neuropathy Idiopathic Acromegaly Neoplasms Tumours - benign Rheumatoid arthritis Amyloidosis Pregnancy Sarcoidosis
Symptoms of carpal tunnel syndrome? (6)
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
Tests for carpal tunnel syndrome? (3)
Neurophysiology
Phalens test - maximal wrist flexion may elicit symptoms
Tinels test - tapping the nerve over the wrist induces tingling
Treatment of carpal tunnel syndrome? (3)
Splinting
Local steroid injection
Decompression surgery
What is the ulnar nerve root?
C7-T1
Cause of ulnar nerve mononeuropathy?
Elbow trauma
Presentation of ulnar nerve mononeuropathy?
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
What is the radial nerve root?
C5-T1
Cause of radial nerve mononeuropathy?
Compression against humerus
Presentation of radial nerve mononeuropathy?
Can’t extend wrist and fingers
Muscles - brachioradialis, extensors, supinator, triceps
Sensory loss lateral dorsum of hand, anatomical snuffbox
What is the root of the brachial plexus?
C5-T1
Cause of brachial plexus damage?
Trauma
Radiotherapy
Heavy rucksack
Thoracic outlet compression
Presentation of damaged brachial plexus?
Pain/paraesthesia and weakness, variable distribution
What is the root of the phrenic nerve?
C3,4,5 keep the diaphragm alive
Cause of damaged phrenic nerve?
Lung cancer, cervical spondylosis/trauma, thoracic surgery, HIV, TB
Presentation of damaged phrenic nerve?
Orthopnoea with raised hemidiaphragm on x ray
What is the root of the lateral cutaneous nerve of the thigh?
L2-L3
What is meralgia parsaesthetica?
Anterolateral burning thigh pain from entrapment under the inguinal ligament
What is the root of the sciatic nerve?
L4-S3
What causes damage to the sciatic nerve?
Pelvic tumours or fractures to pelvis or femur
Presentation of damaged sciatic nerve?
Foot drop - affects hamstrings and all muscles below the knee
Loss of sensation below the knee laterally
What is the root of the common peroneal nerve?
L4-S1
What causes damage to the common peroneal nerve?
Trauma
Sitting cross legged
Presentation of damaged common peroneal nerve?
Foot drop
Weak ankle dorsiflexion/eversion
Sensory loss over dorsum of foot
What is the root of the tibial nerve?
L4-S3
Presentation of damaged tibial nerve?
Inability of plantarflexion, foot inversion, toe flexion
Sensory loss over sole of foot
What are the cranial nerves?
12 nerves that emerge directly from the brain/brainstem
Name the cranial nerves
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
How does CNI lesion present?
Anosmia
Causes of CNI lesion? (3)
Trauma
URTI
Meningitis
How does CNII lesion present?
Low visual acuity
Visual field defect
Pupil defect - size, symmetry, light reaction, accommodation
Causes of CNII lesion? (6)
MS GCA Optic chiasm compression Stroke Raised ICP Diabetes
How dies CNIII lesion present?
Eyes go down and out due to unopposed CNIV/VI action
Causes of CNIII lesion?
MS
Diabetes
GCA
Posterior communicating artery aneurysm
How does CNIV lesion present?
Diplopia on looking down
Causes of CNIV lesion?
Rare - orbit trauma
How does a CNVI lesion present?
Horizontal diplopia on looking out
Causes of a CNVI lesion? (3)
MS
Wernickes
Pontine stroke
How does a CNV lesion present?
Open jaw deviates to side of lesion
Trigeminal neuralgia
Cluster headache
Causes of CNV lesion? (3)
Stroke
Trigeminal neuralgia
Herpes zoster
How does CNVII lesion present?
Facial droop, weakness
Loss of taste in anterior 2/3 tongue
Causes of CNVII lesion? (3)
Bells palsy - unilateral LMN lesion
Skull fracture
Stroke
How does CNVIII lesion present?
Abnormal Webers/Rinnes test - hearing problems
Dizziness
Causes of CNVIII lesion?
Noise damage
Acoustic neuroma
Herpes zoster
How does CNIX lesion present?
Loss of taste posterior 1/3 of tongue
Absent gag reflex
How does CNX lesion present?
Absent gag reflex
Raised BP, HR
Hoarse voice
Cause of CNIX/X/XI lesions?
Trauma
Brainstem lesions
Neck tumour
How does CNXI lesion present?
Can’t shrug shoulders or turn neck against resistance
How does CNXII lesion present?
Tongue deviates to side of lesion
Tongue fasciculation
What causes CNXII lesion?
Rare - polio, stroke, tumour, bulbar palsy, trauma
What is the difference between mononeuropathy and radiculopathy?
Mononeuropathy affects nerve itself
Radiculopathy affects nerve root
What is a radiculopathy?
Pinched nerve root causing radicular pain (pain along dermatome)
Presentation of radiculopathy?
Dermatomal pain - sharp/shooting
Dull reflexes
Numbness, tingling, pain
What nerve roots are usually affected in radiculopathy in upper and lower limbs?
Commonly from cervical spine
Upper C6 C7
Lower L5 S1
Causes of radiculopathy?
Degenerative disc disease
Osteoarthritis
Facet joint hypertrophy or degeneration
Ligament hypertrophy
What is sciatica?
Leg pain from lower back, often caused by spinal disc herniation compressing nerve root
Compression of which nerve roots can cause sciatica? (ie what are the roots of the sciatic nerve)
L4, L5
S1, S2, S3
How is sciatica treated?
Spontaneous resolve for a lot of disc herniations
NSAIDs
Discectomy
What is peripheral neuropathy?
Condition of peripheral or cranial nerves causing motor/sensory symptoms
Difference between mononeuropathy, mononeuritis multiplex and polyneuropathy?
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
Classification of peripheral neuropathy?
Course - Acute or chronic
Function - Sensory, motor, autonomic or mixed
Pathology - demyelination, axonal degeneration, both
Causes of mostly motor peripheral neuropathies? (3)
Guillain Barre
Lead poisoning
Charcot Marie Tooth syndrome
Causes of mostly sensory peripheral neuropathies? (3)
Diabetes mellitus
Renal failure
Leprosy
Medication causes of peripheral neuropathies?
Alcohol Isoniazid Phenytoin Metronidazole Nitrofurantoin Cisplatin Vincristine
Metabolic causes of peripheral neuropathies?
Diabetes
Renal failure
Hypothyroid
Hypoglycaemia
Vasculitis causes of peripheral neuropathies?
Polyarteritis nodosa
Rheumatoid arthritis
Wegeners granulomatosis
Malignant causes of peripheral neuropathy?
Polycythaemia rubra vera
Paraneoplastic syndrome
Inflammatory causes of peripheral neuropathy?
Guillain Barre syndrome
Sarcoidosis
Infective causes of peripheral neuropathy?
Leprosy
HIV
Syphilis
Lyme
Nutritional causes of peripheral neuropathy?
Low B1 Low B12 Low vit E Low folate High B6
Symptoms of sensory neuropathy? (5)
Numbness Paraesthesia Burning Glove and stocking distribution affecting extremities first Signs of trauma on hands
Symptoms of motor neuropathy? (6)
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
Symptoms of autonomic neuropathy?
Constipation/urinary retention - parasympathetic Erectile dysfunction - parasympathetic Ejaculatory failure - sympathetic Postural hypotension - sympathetic Sweating - sympathetic Horners syndrome - sympathetic
Tests in peripheral neuropathy? (6)
Bloods inc TSH, B12, glucose Plasma antibodies, electrophoresis CXR Urinalysis Possible LP or specific genetic tests Nerve conduction to distinguish axonal from demyelinating
Management of peripheral neuropathy? (6)
Treat cause
Physio and OT
Foot care
Immunoglobulin i.e. for GBS
Steroids/immunosuppressants for vasculitis
Amitriptyline, gabapentin, pregabalin for pain
How does cord compression usually present?
Weak legs
Symptoms of cord compression? (3)
Spinal/nerve root pain may precede
Leg weakness, possible less severe arm weakness
Bladder and anal sphincter involvement - late sign - hesitancy, frequency, retention
Pattern of symptoms in cord compression?
Normal above the level of the lesion
LMN signs at the level
UMN signs below the level
Causes of cord compression? (3)
Secondary malignancy in the spine
Infection - epidural abscess
Disc prolapse
Investigations of cord compression? (4)
MRI spine
Biopsy/surgical exploration if mass
Screening bloods - infection markers, B12, syphilis, serum electrophoresis
CXR
Treatment of cord compression?
If malignancy - dexamethasone, radio/chemotherapy, decompressive laminectomy
If infection, decompress and antibiotics
Difference between cauda equina and higher spinal cord lesions?
Cauda equina - leg weakness is flaccid and areflexic, not spastic and hyperreflexic
What is cauda equina syndrome?
Compression of the nerves that form the cauda equina (from L2 down)
Causes of cauda equina syndrome?
Same as cord compression - metastases, infection, disc prolapse
Lumbar disc disease and lumbosacral nerve lesions
Symptoms of cauda equina syndrome? (5)
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
Investigations for cauda equina?
MRI spine
Management of cauda equina syndrome?
Urgent surgical decompression
Antiinflammatory agents/antibiotics if needed
What is anterior cord syndrome?
Complete motor loss below the lesion
Loss of pain and temperature perception
Sensation preserved
What causes anterior cord syndrome?
Ischaemia of the anterior spinal artery - loss of function of the anterior 2/3 of the spinal cord
What is Brown Sequard syndrome?
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
What are the 3 sensory (ascending) tracts of the spinal cord?
Dorsal column-medial lemniscus tract - proprioception and vibration
Anterolateral system - pain and temperature
Spinocerebellar pathways - unconscious proprioception
What are the tracts in the DCML system?
The gracile fasciculus and the cuneate fasciculus
What are the tracts in the ALS system?
Spinothalamic
Spinoreticular
Spinotectal
What are the tracts in the spinocerebellar system?
Posterior, anterior and rostral spinocerebellar
Cuneocerebellar
What are the 2 motor (descending) tracts of the spinal cord?
Pyramidal tracts - voluntary movement
Extrapyramidal tracts - involuntary movement
What are the tracts in the pyramidal system?
Corticospinal
Corticobulbar
What are the tracts in the extrapyramidal system?
Tectospinal
Vestibulospinal
Recticulospinal
Rubrospinal
What is myelopathy?
Injury to the spinal cord due to severe compression that may result from trauma, stenosis, disc herniation, neoplasm
What may cause a brain abscess?
Infection - ear, sinus, dental
Skull fractire
Congenital heart disease/endocarditid
Bronchiectasis
Signs of brain abscess? (6)
Increased ICP Fever Increased WCC Seizures Coma Signs of sepsis
Investigations of brain abscess?
CT/MRI - ring enhancing lesion
Bloods - WCC, ESR
Biopsy
Treatment of brain abscess?
Treat increased ICP
ANTIBIOTICS
What is myopathy?
Disease of muscle fibres where they do not function properly, resulting in weakness
Difference between myopathy and neuropathy?
Myopathy more gradual onset, symmetrical, PROXIMAL weakness
Effect specific muscle groups
Preserved reflexes
Neuropathy more likely if paraesthesiae, bladder problems, distal weakness,rapid onset
What can cause myopathies?
Muscular dystrophy (i.e. Duchenne) Drugs - statins, steroids, alcohol Myotonic Inflammatory Metabolic (glycogen/lipid storage disease)
What are myotonic disorders?
Cause tonic muscle spasm i.e. dystrophia myotonica
What are inflammatory myopathies?
Inclusion body myositis - aggregates of protein
Polymyositis and dermatomyositis
Dermatome of clavicles?
C3-4
Dermatome of lateral arm/forearm?
C6-7
Dermatome of medial side of arm?
T1
Dermatome of thumb?
C6
Dermatome of middle finger?
C7
Dermatome of little finger?
C8
Dermatome of nipples?
T4
Dermatome of umbilicus?
T10
Dermatome of inguinal ligament?
L1
Dermatome of anterior and inner leg?
L2-3
Dermatome of medial side of big toe?
L5
Dermatome of posterior and outer leg?
L5, S1-2
Dermatome of lateral margin of foot and little toe?
S1
Dermatome of perineum?
S2-4
