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Year 4 Mind and Movement > Neurology 4 limb Weakness > Flashcards

Neurology 4 limb Weakness Flashcards

1
Q

With limb weakness what could a FBC show

A

Could show evidence of infection or anaemia suggestive of vitamin deficiency eg B12

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2
Q

what electrolytes could be deranged that would cause on contribute to limb weakness

A

potassium, calcium, phosphate and magnesium

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3
Q

in a patient with reduced mobility and weakness what must you always consider

A

assessing the risk of a VTE as LMWH may be indicated

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4
Q

If a patient with GBS becomes more breathless what should you consider

A

Chest infection? fever, night sweats, productive cough
PE? DVT symptoms
Is the GBS affecting his breathing? Need to ask if lying flat worsens his breathing (this commonly occurs in neuromuscular ventilatory failure due to a weak diaphragm), has his limb weakness worsened, does his neck feel weaker?

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5
Q

in a patient with GBS why does lying flat worsen their breathing

A

neuromuscular ventilatory failure due to a weak diaphragm

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6
Q

GBS becomes chronic if I lasts for how many weeks

A

8 weeks

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7
Q

what does acute myelopathies mean and what reflexes would they exhibit

A

involves the spinal cord

could have brisk reflexes

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8
Q

what is botulism

A

Very rare but life-threatening condition caused by toxins produced by Clostridium botulinum bacteria

Think of a heroin user who has necrotic skin lesions

causes double vision, dysarthria and dysphagia

descends rather than ascends

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9
Q

if there is a very low cell count in the CSF what should you be considering

A

HIV

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10
Q

what key measurements does a LP measure

A 
Opening pressure
White cell count 
Red cell count 
Protein 
Glucose
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11
Q

what percentage of glucose should be in CSF compared to plasma

A

2/3

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12
Q

in MS there is IgG synthesis in the CNS therefore what should you see in CSF

A

oligoclonal bands

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13
Q

what does the CSF fluid show if it is bacterial infection

A

high opening pressure
100-50000 cells mainly neutrophils
proteins greater than 1
glucose less than 40%

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14
Q

what does the CSF fluid show if it is viral infection

A

opening pressure normal
5-1000 cells mainly lymphocytes
protein between 0.5-1
glucose 50-66%

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15
Q

what does the CSF fluid show if it is an infection with TB

A

opening pressure is high/very high
5-500 cells mainly lymphocytes
protein greater than 1
glucose less than 33%

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16
Q

what does the CSF fluid show if it is a fungal infection

A

opening pressure is very high
0-1000 cells mainly lymphocytes
protein between 0.5-2
glucose 30-50%

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17
Q

what kind of infection would show neutrophils predominately in the CSF fluid

A

bacterial

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18
Q

which kind of infection would show mainly lymphocytes in the CSF

A

viral or fungal infection

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19
Q

what would you expect to see in the CSF if someone has MS

A

often normal CSF except OCB would be positive

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20
Q

what would you expect to see in the CSF if someone has GBS

A

normal cells and glucose however there would be raised protein

21
Q

what would you expect to see in the CSF if someone has cancer

A

high WBC and proteins

very low glucose and abnormal cytology

22
Q

what would you expect to see in the CSF if someone has a subarachnoid haemorrhage

A

there would be high RBC and xanthochromia which is raised bilirubin and oxyhemoglobin (however will only appear after 12 hours)

23
Q

what is the most common viral encephalitidies

A

herpes simplex

24
Q

what is transverse myelitis (TM)

A

an inflammation of the spinal cord

25
Q

GBS presents with weakness however it is important to be able to list other differentials

A

acute cervical cord syndrome, cauda equina syndrome, Myasthenia Gravis and acute myositis (eg polymyositis)

26
Q

how can you differentiate acute cervical cord syndrome

A

mixture of 4 limb motor and sensory signs, may have pain but not always the case
if damage to just posterior cord then there may be no motor symptoms and may be very unsteady due to sensory ataxia

27
Q

how can you differentiate caudal equina syndrome

A

will have lower limb symptoms and signs, but normal upper limbs
most have a combination of motor and sensory problems
bladder disturbance very common
saddle anaesthesia may occur
may have pain if it is compressive

28
Q

what is the cardinal symptoms of Myasthenia Gravis

A

muscle weakness (there are no sensory problems)

29
Q

in Myasthenia Gravis it can affect any muscle but which are typically affected

A

eyes (ptosis and diplopia), mouth (dysarthria and dysphagia) and proximal limbs. Respiratory muscles as well which may be shown when lying down

30
Q

how do you differentiate Myasthenia Gravis from GBS

A

cardinal symptom is weakness (there are no sensory problems). Weakness can affect any muscle but often eyes, mouth and respiratory
weakness is fatiguable so worse towards end of the day or after exercise (ie diplopia after watching TV for a while)

31
Q

how do you differentiate acute myositis (eg polymyositis) from GBS

A

principle problem is weakness- proximal limb muscles tend to be most involved
some patients feel pain (myalgia)
on examination reflexes and sensation should be normal

32
Q

What is GBS and what is is usually triggered by

A

acute paralytic polyneuropathy
causes acute ascending weakness as well as sensory symptoms
usually triggered by an infection

33
Q

what infections is GBS particularly associated with

A

campylobacter jejuni, cytomegalovirus and EBV

34
Q

what is the main pathophysiology of GBS

A

molecular mimicry where the B cells of the immune system create antibodies against the antigens on the pathogen of the preceding infection
these also match the proteins on the myelin sheath of the motor nerve or the axon

35
Q

what is the main presentation of GBS

A

symmetrical ascending weakness (starting at the feet and moving up the body)
reduced reflexes
may be peripheral loss of sensation or neuropathic pain
may progress to the cranial nerves and cause facial nerve weakness

36
Q

what is the clinical course of GBS

A

symptoms usually start within 4 weeks of the preceding infection. Typically start in the feet and progress upwards. Symptoms peak within 2-4 weeks and then there is a recovery period that can last from months to years

37
Q

how is GBS diagnosed

A

it is made clinically and the Brighton criteria can be used for diagnosis
supported by nerve conduction studies and lumbar puncture

38
Q

what does LP show in GBS

A

raised protein with a normal cell count and glucose

39
Q

what is the management of GBS

A

IV immunoglobulins
plasma exchange (alternative to IV IG)
supportive care
VTE prophylaxis (PE is the leading cause of death)

40
Q

what is the main issue in severe cases of GBS

A

respiratory failure

41
Q

What is polymyositis

A

autoimmune disorder where there is inflammation in the muscles (myositis)

42
Q

what is the key investigative for diagnosing myositis

A

creatine kinase and this is the main enzyme found inside muscle cells

43
Q

there are other cases of raised creatine kinase, name them

A

rhabdomyolysis, AKI, MI, statins and strenuous exercise

44
Q

polymyositis can be caused by an underlying malignancy which makes then paraneoplastic syndromes. What are the most common associated cancers

A

lung, breast, ovarian and gastric

45
Q

What is the main presentation for polymyostiis

A

muscle pain, fatigue and weakness, occurs bilaterally and typical affects the proemial muscles, mostly affects the shoulder and pelvic girdle, develops over weeks

46
Q

what are the main autoantibodies associated with polymyositis and dermatomyositis

A

Anti-Jo-1 antibodies: polymyositis (but often present in dermatomyositis)
Anti-Mi-2 antibodies: dermatomyositis.
Anti-nuclear antibodies: dermatomyositis.

47
Q

what is diagnosis of polymyositis based on

A

clinical presentation, elevated CK, autoantibodies and EMG however muscle biopsy’s can be used for a definitive diagnosis

48
Q

what is the main management of polymysositis

A

management by rheumatologist. New cases should be assessed for possible underlying cancer. May require physiotherapy and occupational therapy to help with muscle strength and function. corticosteroids are the first line treatment

Year 4 Mind and Movement (3 decks)

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