Neurology Flashcards
What movement tests C5 nerve root? Which muscle is involved?
Shoulder abduction
Deltoid. Also tests axillary nerve.
What movement tests C6 nerve root? Which muscle is involved?
Elbow flexion
Brachioradialis
Not biceps, which has mixed root innervation.
What movement tests C7 nerve root? Which muscle is involved?
Wrist extension
Wrist extensors. Also tests radial nerve.
What movement tests C8 nerve root? Which muscle is involved?
Finger extension
Long extensors.
What movement tests T1 nerve root? Which muscle is involved?
Finger abduction
Interossei muscles. Also tests ulnar nerve.
How do you specifically test the median nerve.
Thumb abduction.
Abductor pollicis brevis. Part of LOAF in the thenar eminence
What do you get claw hand in an ulnar nerve palsy?
Loss of lumbricals that normally flex the MCPs and extend the fingers.
Explain these findings:
Positive Rinne’s with equal Weber’s
Normal.
Positive Rinne’s = AC > BC
Explain these findings:
Negative Rinne’s on L side
Weber’s louder on L side
L sided conductive hearing loss
Explain these findings:
Positive Rinne’s
Weber’s louder on R side
L sided SNHL
What is the ABCD2 score for TIAs
Age >60 BP >140/90 Clinical features: unilateral weakness (2) or speech impairment (1) Duration (0-59 = 1, >60 = 2) Diabetes
0-3 - discharge with review
Holmes-Adie pupil
Myotonic dilated pupil that is unresponsive to light and sluggish response to accommodation.
Argyll-Robertson pupil
Syphilitic Prostitute’s pupil
Accommodates but doesn’t react.
Small, irregular pupil with atrophied iris.
Marcus Gunn pupil
RAPD - pupil dilates on direct aspect of swing test.
Optic nerve atrophy and retinal disease
What happens to evoked potentials in MS?
They are delayed in all modalities including auditory, visual and sensory.
Causes of optic atrophy
Commonest: MS and glaucoma
VISION CAC Vascular - DM, GCA, CVA Inflammatory - MS Sarcoid Infectious - VZV, TB, syphilis Oedema - papilloedema Neoplasia - hymphoma/leukaemia infiltration
Compression - Glaucoma, neoplasm, Paget’s
Alcohol and other toxins
Congenital - Leber’s, HMSN, Friedrich’s
Causes of RAPD
Optic atrophy
Retinal disease
- retinal detachment
- retinal vein or artery occlusion
- severe diabetic retinopathy
- age-related macular degeneration
Signs of Lateral Medullary Syndrome
The key finding is loss of sensation to pain and temperature contralaterally in body and ipsilaterally in face. Due to disruption of spinothalamic tract and spinal trigeminal nucleus.
DANVAH
- Dysphagia: disrupt CN IX + X
- Ataxia: inferior cerebellar peduncle
- Nystagmus: inferior cerebellar peduncle
- Vertigo: vestibular nuclear
- Anaesthesia - dissociated
- Horner’s
Definition of strabismus
Abnormal alignment of eyes
Features of an oculomotor CN III palsy
Ptosis + divergent strabismus (down and out) + opthalmoplegia
Medical = normal pupil Surgical = mydriasis
How does the direction of nystagmus differ between cerebellar and vestibular cause?
Cerebellar: fast phase towards side of lesion, maximal towards side of lesion.
Vestibular: fast phase away from lesion, maximal away from side of lesion.
What are the 4 types of Motor Neurone Disease?
Amyotrophic Lateral Sclerosis (50%)
Primary Lateral sclerosis (30%)
Progressive muscular atrophy (10%)
Progressive bulbar palsy (10%)
Which type of MND has the best prognosis?
Progressive muscular atrophy
Which type of MND has the worst prognosis?
Progressive bulbar palsy
Which type of MND has only LMN signs?
Progressive motor atrophy
Anterior Horn cell lesion
Affects from distal to proximal
Which type of MND has predominantly motor signs?
Progressive Lateral Sclerosis
Loss of Betz cells in motor cortex
Which type of MND affects the CN 9-12?
Progressive Bulbar Palsy
Which type of MND produces UMN and LMN signs?
Amyotrophic Lateral Sclerosis
Cause of mixed UMN and LMN signs
MAST
MND
Ataxia,Friedrich’s
SCDC - B12
Taboparesis
