Neurology

Question 1

Upper Motor Neurone (UMN) sign

Answer 1

Increased tone (hypertonicity)
Increased reflexes (hyperreflexia)
Upgoing plantar responses

Pyramidal distribution of weakness -
Lower limb: hip flexors are weaker than hip extensors, knee flexors are weaker than knee extensors, dorsiflexion of foot is weaker than plantarflexion

Upper limb: flexors are stronger than extensors

Question 2

Spastic paraparesis

Answer 2

lower limbs are affected but upper limbs are normal

Question 3

TACI

Total anterior circulation infarct

Answer 3

contralateral hemiparesis (severe or dense)
contralateral homonymous hemianopia
higher cortical dysfunction
dysphasia, dyspraxia, inattention

Question 4

PACI

Partial anterior circulation infarct

Answer 4

2 of 3 features of TACI - typically:

higher cortical dysfunction
contralateral weakness or sensory loss

Deficit is often incomplete e.g. face and arm or face and leg
High risk of early reoccurence

Question 5

POCI

Posterior circulation infarct

Answer 5

Any of:
contralateral homonymous hemianopia
cerebellar signs
brainstem signs
   Horner's, conjugate gaze palsy
   ipsilateral CN lesion with contralateral hemiparesis

higher risk of later reoccurence

Question 6

LACI

Lacunar infarct

Answer 6

Four features are ABSENT

no higher cortical dysfunction as cortex is not affected
no homonymous hemianopia as lesion is away from optic radiation
no drowsiness
no brainstem signs

Question 7

Lacunar syndromes

Answer 7

Pure motor stroke - posterior limb of internal capsule
Pure sensory stroke - posterior thalamus
Sensorimotor stroke - internal capsule
Dysarthria-clumsy hand syndrome - middle of internal cap
Contralateral hemiballismus - subthalamic nucelus infacrt

Question 8

Gliomas

Answer 8

Astrocytomas
cerebral hemisphere in adults
cerebellum and brain stem in children
most common type of CNS tumour - 50%
Burger classification Grade 1 - 4
1 - pilocytic astrocytoma - curable
2 - low grade astrocytoma - 2nd & 3rd decades, 7-9 yrs
3 - anaplastic astrocytoma - 4th decade, 2-3 yr survival
4 - glioblastoma multiforme - 5th & 6th dec, 9-12 mths

Oligodendroglioma
    arise from olidodendrocytes
    more common in adults in their 40s
    usually found in frontal lobe
    low grade to anaplastic
    CT is useful for detecting calcification - 90% cases

Ependymoma
arise from ependymal cells of ventricular lining
common in children
usually found in floor of left fourth ventricle
low grade to anaplastic

Question 9

Non-gliomas

Answer 9

Meningioma
Pituitary adenoma
Acoustic neuroma
Medulloblastoma
Craniophyarngioma
Colloid cyst
Metastasis - most common type of brain tumour!!