Neurology Flashcards
What kind of aura would you expect for epilepsy?
Dizziness
Deja vu/Jamais vu
Unusual smell/taste/vision
Which cranial nerves may be affected by a cavernous sinus thrombosis?
3, 4, 5, 6
5 is particularly associated with pain and loss of corneal reflex
Give 5 causes of any cranial nerve palsy.
Diabetes Stroke MS Tumour Vasculitis
Give 3 causes of a unilateral Ptosis. Will they be partial or complete?
Horner’s - partial
CN 3 palsy - complete
Congenital
Give 3 causes of a bilateral Ptosis.
Myaesthenia gravis
Myotonic dystrophy
Congenital
What are the features of a cranial nerve 3 palsy?
Eye down and out
Complete Ptosis
Dilated pupil
What are the signs of Horner’s syndrome?
Unilateral:
Partial Ptosis
Miosis (constricted pupil)
Anhydrosis
How would you differentiate between Bell’s palsy and a umn facial nerve palsy?
If frontalis is spared then it is umn stroke.
Due to bilateral innervation of this muscle.
What are the bulbar signs? What are they indicative of?
Slurred speech, dysphagia, absent gag reflex.
LMN damage to CN9-12 in medulla
Polio
MND
Myaesthenia gravis
What is your differential for a CN1 problem?
Trauma
Viral infection
Meningitis
What is your differential for monocular blindness?
Retinal detachment
Ophthalmic artery thrombus
Giant cell arteritis
What is your differential for bitemporal hemianopia?
Pituitary adenoma
Aneurysm in the circle of Willis
What is your differential for a homonymous hemianopia?
Anything behind the chiasm:
Stroke
Tumour
Abcess
What is your differential for a CN5 problem?
Trigeminal neuralgia
Herpes zoster
What is your differential for a CN8 problem?
Furosemide
Gentamicin
Age
What kind of aura would you expect for a simple vasovagal faint?
Nausea
Sweating
Dizziness
What are the myotomal roots of the reflexes?
Ankle - S1/2
Knee - L3/4
Biceps and brachioradialis - C5/6
Tricep - C7/8
What are the cardinal signs of Parkinson’s?
Bradykinesia
Rigidity (cog wheel)
Resting tremor (pill rolling)
May also have masked fascies and slurred speech.
What are the signs of a cerebellar lesion?
DANISH
Disdiadokinesis Ataxia Nystagmus Intention tremor Speech - slurred Hypotonia
What are the signs of an ulnar nerve lesion?
LMN signs in fourth and fifth fingers
What are the signs of a median nerve lesion?
LMN signs in the thenar muscles and palmar surface
What are the signs of a radial nerve lesion?
Wrist drop and weakness of extension of the elbow
What are the signs of an upper motor neuron lesion?
Hypertonia Hyperreflexia Spastic muscle weakness Babinski's Clonus
What are the signs of a lower motor neuron lesion?
Hypotonia Hyporeflexia Flaccid weakness Muscle wasting Fasciculations
How would you grade muscle weakness?
0 - no movement 1 - flicker 2 - unable to move against gravity 3 - unable to move against resistance 4 - reduced power, able to move against resistance 5 - normal
What birth injury causes damage to the upper brachial plexus? How does it present?
Erbs = waiters tip
Shoulder adducted
Arm internally rotated
Forearm pronated
What birth injury causes damage to the lower brachial plexus? How does it present?
Klumpke’s
Wasting of small muscles in hand - claw
Flexion of the elbow and wrist
Horner’s may accompany
Give 5 causes of peripheral neuropathy?
Diabetes Uraemia (kidney failure) Vasculitis Anaemia Alcohol
Give 4 causes of foot drop.
Common peroneal nerve palsy
Stroke
L4/5 lesion
Motor neurone disease
What is syringomyelia? How does it present?
Blockage of CSF in spinal canal - syrinx
Affects spinothalamic tracts as they cross
Loss of pain and temperature on both sides in a cape like pattern.
What is brown squared syndrome and how does it present?
Lateral hemi section of the spinal cord
Lose vibration and proprioception on same side
Lose pain and temperature and crude touch on opposite side.
What is cauda equina? How does it present?
Damage to the lumbar region L1-5 can also damage the sacral nerve roots.
Leads to saddle anaesthesia, urinary incontinence, sexual dysfunction, motor and sensory deficits.
What is the differential for a positive Romberg test?
NOT cerebellar, they will not balance with eyes open.
Lesion to dorsal columns (proprioception) eg Neurosyphilis
Alcohol
B12/thiamine deficiency
MS
Give three types of gait and what causes them.
Festinating - Parkinson’s
Trendelenberg - superior gluteal nerve palsy or fractured neck of femur
Antalgic - arthritis
Give four types of tremor and what causes them.
Intention tremor - cerebellar lesion
Resting tremor - Parkinson’s
Flapping - metabolic
Drug induced - anti psychotics
What are the main causes of carpal tunnel syndrome?
Idiopathic Pregnancy Repetitive strain injury Arthritis Diabetes Hypothyroid
Give three causes of nystagmus
Alcohol
Cerebellar lesion
CN8 lesion
