Neurology Flashcards
What nerve roots make up the brachial plexus
C5 - T1
What is an erb’s palsy
Upper brachial plexus injury
Arm extended
Internally rotated - pronated
Hand extended backwards
Which nerve roots are involved in an erb’s palsy
C5 + 6 - upper brachial plexus
Common causes of an erb’s palsy
Traction injuries - e.g. Motorcycle accident, shoulder dystopia at birth.
What is a Klumpke’s palsy
Lower brachial plexus injury
Claw hand - all digits
Sensory loss over ulnar border of forearm + hand
Nerve roots involved in a Klumpke’s palsy
C8 + T1 - lower brachial plexus
Causes of Klumpke’s palsy
Breech birth injury (arm extension)
Pulling on the arm during delivery
Motorcycle accidents
(Klumpke the monkey hung from the tree)
Winging of the scapula is caused by injury to which nerve
Long thoracic nerve to serratus anterior
When may the long thoracic nerve be damaged
Breast surgery
Axillary surgery
Breast / axillary radiotherapy
Axillary trauma
What nerve runs in the spiral groove of the humerus
Radial nerve
Common causes of radial nerve palsies
Humeral shaft fracture
Elbow dislocation
Monteggia fractures
Compression of neve by prolonged use of ill fitting crutches
Falling asleep with arm hanging over Chair = Saturday night palsy
What nerve is involved in a Saturday night palsy
Radial
What causes wrist drop
Radial nerve palsy
Nerve supply of the anatomical snuffbox
Radial nerve
What does the accessory nerve supply
Trapezius
Sternocleidomastoid
Syx / signs of accessory nerve palsy
Weak shoulder shrug
Inability to turn head against pressure
What does the axillary nerve supply
Motor to deltoid
Sensory to regimental badge area
What nerve is compressed in carpal tunnel syndrome
Distal median nerve
Compression of the medial nerve by the flexor retinaculum is called what…..
Carpal tunnel syndrome
In whom is carpal tunnel syndrome more common
Women Pregnancy RA acromegally Hypothyroidism
Syx of carpal tunnel syndrome
Tingling + numbness in radial 3 1/2 digits
Wasting thenar eminence
Features of 6th CN lesion
Eyes appear conjugate in primary position
Failure of abduction of affected eye
Horizontal diplopia when looking at affected side
Features of 4th CN palsy
Diplopia on downward gaze
Sit with head tilted
Failure to aduct on downward gaze
Eyes conjugate in primary position
Features of 3rd CN palsy
Eye down and out
Ptosis
Pupil dilation
What is convgent strabismus
1or both eyes turn in
Will turn out to focus when other eye is covered
What is ramsay hunt syndrome
Herpes zoster (shingles) of the geniculate ganglion. \+ external auditory meatus
What is Ménière’s disease
Recurrent vertigo + deafness, tinnitus, aural fullness.
Benign paroxysmal vertigo symptoms
Short episodes of vertigo triggered by head movement.
Due to free floating particles in the endolymph
What is hallpikes manoeuvre used to diagnose
To confirm benign paroxysmal vertigo.
Move pt from sitting to lying with head below vertical to reproduce vertigo and nystagmus.
Most common cause of subarachnoid haemorrhage
Rupture of berry aneurysm on circle of willis.
Features predisposing to berry aneurysm formation
Defective collagen synthesis
- Polycystic kidney disease
- Ehlers Danlos
High blood pressure conditions
- coarctation of the aorta
-Investigations for suspected subarachnoid haemorrhage
CT head.
LP for xanthochromia after 12hr
Symptoms of trigeminal neuralgia
Mandibular, maxillary or ophthalmic division - unilateral stabbing pain.
Precipitated by touch.
More common in F
Early morning headache,worse on lying down and coughing suggests…
Raised intracranial pressure.
Investigate to exclude SOL.
Features of tension headache
Band-like pain around head
Stress
Features of UMN lesion
Increased tone Hyper-reflexia Spasticity Clonus Pronator drift Extensor plantar response
Features of LMN lesion
Fasciculation
Wasting
Loss of reflexes
Hypotonia
What neurological condition is worse with heat
MS
In what condition does lead-pipe / cog-wheel rigidity occur
Parkinson’s disease
In what condition does a pill-rolling tremor occur
Parkinson’s tremor
In what condition does a festinant gait with reduced arm swing occur
Parkinson’s disease
Decreased muscle action potentials after continuous stimulation suggests what neurological condition
Myasthenia gravis
Features of cauda equina syndrome
Saddle anaesthesia
Bladder and bowel disturbance
Bilateral leg pain
Features of brown sequard syndrome
Ipsilateral loss of vibration and proprioception
Contralateral loss of pain and temperature
Features of Gillian-Barre syndrome
Ascending symmetrical flaccid muscle weakness.
Loss of tendon reflexes.
+/- distal paraesthesia or pain.
20% develop respiratory muscle involvement
Preceding recent respiratory / GI infection (esp campylobacter jejuni)
What is shy-drager syndrome also known as
Multi-system atrophy
Features of multi-system atrophy
autonomic dysfunction
parkinsonism (muscle rigidity +/ tremor and slow movement)
ataxia (Poor coordination / unsteady walking)
Features of wernicke’s encephalopathy
Confusion
Nystagmus
Opthalmoplegia
Ataxia
Features of korsakoff’s syndrome
Memory problems
Confabulation
Irreversible
Cause of a bilateral high-stripping gait
Sensory ataxia
E.g. Peripheral neuropathy
Cause of a scissoring gait
Spastic paraplegia
Cause of a wide-based gait
Cerebellar lesion
Cause of bilateral pin-point pupils
Opiate overdose
Features of a 3rd nerve lesion
Dilated pupil
Ptosis
Eye deviated down and out
Features of horners syndrome
Unilateral ptosis
Facial anhydrosis
Features of an anterior circulation stroke
Unilateral weakness Unilateral sensory deficit Homonymous hemianopia Dysphagia Sensory neglect
Investigations for suspected MS?
Neuro referral - mainly clinical diagnosis EEG MRI - demyelinating plaques LP - oligoclonal bands Immunoassay for myelin antibodies
What cancers metastasise to the brain
Lung Kidney Breast Melanoma Colon
What is a todd’s paresis?
Post-ictal temporary paralysis
Features of a radial nerve palsy?
Wrist drop
Loss of sensation in the anatomical snuffbox
Inability to extend metacarpophalangeal joints
When may the accessory Nerve (CN XI) be damaged?
Surgery to the neck
What nerve wraps around the surgical Neck of the humerus?
Axillary nerve
What nerve is damaged by anterior dislocation of the shoulder?
Axillary nerve
Features of axillary nerve lesion?
Absent sensation to the upper outer arm (Regimental badge patch)
Deltoid muscle paralysis
Limited arm Abduction (0-90. Above 90 = suprasipinatus)
Is clawing of the 4th and 5th digits more marked in a proximal or distal ulnar nerve lesion?
More marked in a distal lesion
Normal pressure on LP
50-180 mm H2O
Normal values and colour of CSF on LP
Clear RBC 0-4 WBC 0-4 Glucose >60% of blood value Protein <4.5 g/L Microbiology - sterile
CSF values suggesting bacterial meningitis on LP
Normal / raised pressure Cloudy RBC 0-4 (normal) WBC >1000 -neutrophils Glucose 0.45g/L
CSF values suggesting viral meningitis on LP
Normal pressure Clear RBC 0-4 (normal) WBC 60% blood value Protein - Normal <0.45g/L
CSF values suggesting TB meningitis on LP
Normal / raised pressure Clear / cloudy RBC 0-4 (normal) WBC >1000 - Lymphocytes Glucose 0.45g/L
CSF values suggesting fungal meningitis on LP
Normal pressure Clear RBC 0-4 (normal) WBC 0-50 - Lymphocytes Glucose 0.45g/L
What does India ink stain
Cryptococcus neoformans (fungi)
What Do oligoclonal bands on CSF indicate?
MS
When is xanthochromia seen in the CSF?
Subarachnoid haemorrhage (Due to erythrocyte breakdown products --> Yellow colour)
Neurological manifestations of Wilson’s disease
Dementia
Tremor
Dyskinesia
What are the MRC grades of power. And what does each one mean
Grade 5 = normal power
Grade 4 = movement against gravity and mild resistance
Grade 3= active movement against gravity
Grade 2 = active movement when gravity eliminated
Grade 1 = flicker of contraction
Grade 0 = no contraction
What is Gillian-Barre syndrome
Post-infective demyelination polyneuropathy.
Immune-mediated demyelination of spinal roots or peripheral nerves.
Management of Gillian-Barre syndrome
Supportive
Ventilatory support if respiratory involvement
What is miller-fisher syndrome
Rare variant of GBS.
Descending paralysis, (reverse order of normal GBS.)
Triad of ophthalmoplegia, ataxia, and areflexia.
Features of a Bell’s palsy
Unilateral loss of facial movement Normal facial sensation Pain around ear Hyperacusis Loss of salivation / tear secretion
What is a Bell’s palsy
LMN lesion of the facial nerve
CN 7
Cause unknown
What is / what causes myasthenia gravis
Autoimmune destruction of post-synaptic acetylcholine receptors in neuromuscular junction
What is a typical patient with myasthenia gravis
Female
20-40yo
Features of myasthenia gravis
(Inability to sustain a maintained or repeated contraction of striated muscle) Diplopia Ptosis Fatiguability Syx worse after exercise Syx worse at end of day
What is a myasthenic crisis
Sudden onset paralysis of the respiratory muscles.
Necessitating assisted ventilation
Crises may be triggered by infection, fever, an adverse drug reaction or emotional stress.
What is the tension test and what is it used for
AKA edrophonium test
IV edrophonium bromide administered to a patient with suspected MG.
MG confirmed if weakness transiently improves.
Why do all patients with myasthenia gravis need a CT
To rule out thymoma
Management of myasthenia gravis
Anticholinergics (pyridostigmine)
What does an overdose of anticholinergics do
Cholinergic crisis Muscle fasciculation Paralysis Pallor Sweating Excessive salivation Small pupils
What is motor neuron disease
Progressive degeneration of motor neurons within the spinal cord, motor cortex and cranial nerve nuclei.
Features of motor neuron disease
Combination of upper and lower motor neuron signs Limb weakness Fasciculation Spasticity Exaggerated reflexes
Types of motor neuron disease
Progressive muscular atrophy (weakness of distal limb muscles 1st)
Progressive bulbar palsy (early involvement of tongue and pharyngeal muscles)
Amyotrophic lateral sclerosis ( combination of distal and proximal muscle wasting)
Management of motor neuron disease
Supportive
Riluzole improves life expectancy
What is lambert eaton syndrome
Impaired neurotransmitter release due to autoantibodies to pre-synaptic voltage gated calcium channels
Associated with underlying malignancy - often lung
Features of lambert eaton syndrome
Muscle weakness - improves with sustained contraction
Autonomic dysfunction - dry mouth, blurred vision, impotence
Absent tendon reflexes
Presentation of a subarachnoid haemorrhage
Severe Sudden onset Occipital headache Vomiting Irritability Photophobia Neck stiffness Reduced consciousness
Presentation of a cluster headache
Unilateral Severe Peri orbital pain Conjunctival injection Lacrimation Nasal congestion 30-90min Same time every day
Typical patient with cluster headaches
Male
Heavy smoking
Excess alcohol
Prophylaxis against cluster headaches
Verapamil (CCB)
Ergotamine
Presentation of trigeminal neuralgia
Sharp stabbing pain
Severe, brief, repetitive
Trigeminal nerve distribution - most commonly mandibular or maxillary
Management of trigeminal neuralgia
Carbamazepine
Phenytoin
Gabapentin
Features of migraine
Unilateral throbbing headache Severe Photophobia Vomiting \+/- aura
Migraine triggers / exacerbants
Poor sleep Dehydration Alcohol - esp red wine COCP Chocolate Cheese
Options for migraine prophylaxis
Beta blockers (commonly propranolol) Pizotifen Amitryptilline
Features of idiopathic intracranial hypertension
Raised intracranial hypertension in the absence of a SOL, ventricular dilation or impaired consciousness.
Intermittent headaches
Transient diplopia / blurred vision
Papilloedema
Typical patient with idiopathic intracranial hypertension
Female
Younger
Obese
Can be triggered by COCP, tetracyckines, steroid withdrawal
Management of idiopathic intracranial hypertension
Weight loss
Remove trigger
Acetazolamide
Repeated LP
(Untreated can lead to blindness. Hence no longer called ‘benign’)
Dermatome supply of the back of the head
C2
Dermatome supply of the neck
C3
Dermatome supply of the thumb
C6
Dermatome supply of the middle finger
C7
Dermatome supply of the little finger
C8
Dermatome supply of the axilla
T2
Dermatome supply of the nipple line
T4
Dermatome supply of the level of the xiphoid process
T6
Dermatome supply of the level of the umbilicus
T10
Dermatome supply of the inguinal ligament
T12 / L1
Dermatome supply of the medial thigh
L2
Dermatome supply of the big toe
L4
Dermatome supply of the dorsum of the foot
L5
Dermatome supply of the sole of the foot
S1
Dermatome supply of the popliteal fossa
S2
Dermatome supply of the bottom (ischial tuberosity)
S3
Dermatome supply of the perianal area
S4/5
Dermatome supply of the penis
S3
What is multiple sclerosis
Autoimmune destruction of the myelin producing oligodendrocytes
Myelin loss in CNS causes slow nerve conduction
Symptoms of multiple sclerosis
Optic neuritis Unilateral dorsal column loss Coarse tremor trigeminal neuralgia recurrent facial nerve palsy sixth cranial nerve palsy lhermitte phenomenon = Tingling in spine or limbs in neck flexion
Diagnosis of MS requires all of the following
> Age less than 60
Deficit in two or more anatomically distinct sites
Abnormity present on examination
- Two episodes lasting >24 hours and >1 month apart
- OR Slow progression over six months
No other explanation for symptoms
Types of MS
Relapsing and remitting 80% Primary progressive 15% Secondary Progressive Benign Childhood MS
What are the muscular dystrophies
Group of inherited disorders with progressive degeneration of groups of muscles No involvement of the nervous system Symmetrical wasting and weakness No fasciculations no sensory loss
How is duchenne muscular dystrophy inherited
X linked recessive
Presentation of duchenne muscular dystrophy
Onset in childhood
Effects proximal arms and legs
Pseudohypertrophy of the calves - replacement of muscle by fat and fibrosis.
Waddling gait
Difficulty standing (gowers sign-walk hands up legs)
Inheritance pattern of Becker muscular dystrophy
X-linked recessive
Inheritance pattern of myotonic dystrophy
Autosomal dominant
Features of myotonic dystrophy
Weakness of temporal, facial, sternocleidomastoid and distal limb muscles Myotonia - Slow relaxation of muscles Frontal balding Cataract Ptosis Gonad atrophy
What is mononeuritis multiplex
Peripheral neuropathy where there is damage to 2 or more peripheral or spinal nerves
Common causes of mononeuritis multiplexed
Diabetes mellitus
Polyarteritis nodosa
Rheumatoid arthritis
Systemic lupus erythematous
What is charcot-marie-tooth disease
Hereditary motor and sensory neuropathy
Autosomal dominant inheritance is most common
Autosomal recessive and X-linked forms have been identified
Symptoms of Charcot-Marie-Tooth disease
Symmetrical, distal, slowly progressive muscle wasting
Foot drop
Claw toes
Pes cavus
Areflexia
Distal sensory loss
Inverted bottle appearance of legs due to distal muscle wasting
Causes of sciatic nerve injury
Fracture dislocation of the hip
Misplaced gluteal injection
Presentation of a sciatic nerve palsy
Paralysis of hamstrings
Paralysis of all muscles of foot and leg
Loss of sensation below knee - (except medial leg = saphenous)
Causes of tibial nerve injury
Posterior dislocation of knee
Features of a tibial nerve palsy
Loss of toe flexion
Loss of Ankle inversion
Loss of ankle jerk
Loss of sensation over sole of foot
What is the tibial nerve a branch of
Sciatic nerve
Boundaries of the femoral triangle
It is bounded by:
(superiorly) inguinal ligament
(medially) medial border of adductor longus muscle
(laterally) medial border of sartorius muscle
Contents of the femoral triangle
from medial to lateral:
> femoral veins and its tributaries
> femoral artery and its branches
> femoral nerve and its branches
Presentation of a femoral nerve palsy
Loss of knee extension
Loss of sensation over anterior thigh and medial leg
What is meralgia paresthetica
Trapped lateral femoral cutaneous nerve at the inguinal ligament
Esp obese or pregnant patients
Causes pain / burning of lateral thigh
Often caused by prolonged standing
What nerve may be injured by ankle plaster casts
Common peroneal nerve (branch of sciatic)
When may the saphenous nerve be damaged.
What does this cause
Surgery on long saphenous vein
Causes loss of sensation to medial aspect of calf
When may the sural nerve be damaged.
What does this cause
Surgery to the short saphenous vein
Loss of sensation to the lateral side if the foot and little toe
When may the obturator nerve be damaged.
What does this cause
Obstetric procedures
Pelvic disease
Loss of hip adduction
Loss of sensation to upper inner thigh
What does superior gluteal nerve damage cause
Loss of hip abduction
Pelvic dip in walking = trendelenburg gait
What does inferior gluteal nerve damage cause
Loss of hip extension
Buttock wasting
Eyes component of GCS
4 - eyes open spontaneously
3 - eyes open to speech
2 - eyes open to pain
1 - no eye opening
Verbal component of GCS
5 - Coherent speech 4 - Confused/disorientated speech 3 - Inappropriate words without conversational exchange 2 - Incomprehensible sounds 1 - no verbal response
Motor component of GCS
6 - obeys commands
5 - localises to pain
4 - withdraws from pain
3 - abnormal flexion to pain (decorticate)
2 - abnormal extension to pain (decerebrate)
1 - no motor response
What is conversion disorder?
Sudden appearance of neurological symptoms following acute Psychological distress.
Non-volitional
Presentation of common peroneal nerve injury
Foot drop
High stepping gait
Loss of sensation over anterolateral lower leg and dorsum of foot
Features of wernickes aphasia
Wernickes is responsible for recognising and analysing spoken language. Fluent aphasia Poor comprehension Poor repetition (Left temporal lobe)
What connects wernickes and Broca’s areas
Arcuate fasciculus
Features of Broca’s aphasia
Broca's area is responsible for producing coherent speech Non-fluent aphasia Good comprehension Poor repetition (Left frontal lobe)
What is fluent aphasia
Normal number of words - but wrong words spoken
What is non-fluent aphasia
Reduced verbal output - but correct words
What would a lesion in the Arcuate fasciculus (between Broca’s and wernickes) do
Patient can comprehend (wernickes)
Patient can speak (Broca’s)
But cannot repeat back what is said to them - due to no connection between the 2 areas
Is a pseudobulbar palsy upper or lower motor neuron
UMN lesion
Is a bulbar palsy UMN or LMN
LMN
What nerves are involved in bulbar and pseudobulbar palsies
CN 9 - 12
Features of a pseudobulbar palsy
UMN Small, contracted tongue Immobile tongue - cannot protrude Brisk jaw jerk 'Donald Duck' speech. Palatal movements absent. Dribbling persistently - Dysphagia Facial muscles may also be paralysed. Nasal regurgitation . Dysphonia Emotional lability.
Causes of a pseudobulbar palsy
MMD
MS
brain stem tumour
Brain stem stroke
Features of a bulbar palsy
LMN Fasciculations of tongue and lips Weak wasted Tongue Drooling dysphagia Absent palate movements. Dysphonia Articulation - difficulty pronouncing r
Causes of a bulbar palsy
MND
Syringobulbia
GBS
MG
Presentation of venous sinus thrombosis
Sudden onset headache
Seizures
Signs of raised intracranial pressure (papilloedema, hypertension, bradycardia)
Symptoms of a cavernous sinus thrombosis
Sudden onset headache / Seizures / Signs of raised ICP \+ Proptosis Ptosis Ophthalmoloplegia Reduced sensation in opthalmic division
Symptoms of a transverse sinus thrombosis
Sudden onset headache / Seizures / Signs of raised ICP
+
Hemiparesis
Risk factors for venous sinus thrombosis
COCP
Pregnancy
Nephrotic syndrome
Thrombophilia
How is venous sinus thrombosis confined
CT / MRI
Management of a venous sinus thrombosis
Anticoagulation - s/c enoxaparin
And warfarin for 6m
Presentation of anterior cord syndrome
Follows flexion-compression injury
Loss of spinothalmic function (pain and temp)
And cortiocspinal tracts (motor)
Greater motor loss in the legs
What is syringomyelia
A longitudinal fluid cavity (syrinx) in the spinal cord
Features of syringomyelia
Usually 20-30yo
Disrupt spinothalmic tracts
Segmental loss of pain and temperature
What is syringobulbia
A longitudinal cavity of fluid in the brainstem
Presentation of a central cord lesion
In older pts with cervical spondylosis who have a hyperextension injury.
Flaccid weakness of arms
Motor and sensory to limb - relatively spared
At what level does the spinal cord end
L1 and L2
Presentation of posterior cord syndrome
Follows hyperextension of the neck
Dorsal column loss
Gait impaired due to loss of proprioception
Features of poliomyelitis
Infects grey matter
Mild fever and headache
Progresses to aseptic meningitis
Weakness
Features of rabies
Fever Paraesthesia at site of bite Prodrome of anxiety Refusal to drink water - provokes painful diaphragm spasm Delusions Hallucinations Spitting Biting Mania Hyperpyrexia Death within 1 week
Features of cerebral abscess
Fever Headache Meningism Drowsiness Seziures Focal neurology
What causes subacute sclerosing panencephalitis
Measles virus
Years after measles infection
Symptoms of tetanus
Trismus - painless masseter spasm
Facial muscle contraction
Neck and trunk muscle contraction
Death due to asphyxia / exhaustion / aspiration pneumonia
Management of tetanus
IV tetanus anti-toxin
IV benzylpenicillin
What does the olfactory nerve supply
Sense of smell
What does the optic nerve do
Visual acuity
Visual fields
Afferent pupillary reflex
Pupil accommodation
What does the oculomotor nerve supply
Eye muscles - inferior oblique, medial/superior/inferior rectus,
Levator palpabrae muscles
Efferent arm of pupil reflex
What does the trochlear nerve supply
Superior oblique muscle
What does the trigeminal nerve supply
Sensation of face
Corneal reflex
Muscles of mastication
Jaw jerk
What does the abducens nerve supply
Lateral rectus muscle
What does the facial nerve supply
Muscles of facial expression
Taste to anterior 2/3 tongue
Nerve to stapedius
Sensation around skin of ear
What does the vestibulocochlear nerve supply
Hearing
Vestibular system
What does the glossopharyngeal nerve supply
Taste to posterior 1/3 tongue
Afferent gag reflex
What does the vagus nerve supply
Motor to pharynx and larynx
Efferent arm of gag reflex
What does the accessory nerve supply
Trapezius
Sternocleidomastoid muscle
What does the hypoglossal nerve supply
Muscles of the tongue
Symptoms of essential tremor
Slow tremor Often familial May be mad more obvious by certain movements e.g. Writing Improved by alcohol Beta-blockers may help
Symptoms of physiological tremor
Normal tremor
Exaggerated by anxiety, fatigue, fever, alcohol withdrawal
Symptoms of resting tremor
Occurs in Parkinson’s
Pill-rolling
Asymmetrical
Symptoms of an intention tremor
Cerebellum disease
Broad tremor at end of purposeful movement
Due to breakdown in feedback mechanisms
What is chorea
Jerky, small, involuntary movements
Causes of chorea
Huntingtons chorea (autosomal dominant)
Wilson’s disease
Cerebral trauma
Rheumatic fever
What is athetoses
Slow, writhing movements of the limbs
What is hemiballismus
Big movements of the limbs unilaterally
What is dystonia
Limb or head takes up an abnormal posture
E.g. Torticollis / blepharospasm / oculogyric crisis
Features of neurofibromatosis type 1
Cutaneous neurofibromas Cafe-au-lait spots Axillary freckling Iris fibromas (lisch nodules) Phaeochromocytoma Acoustic neuroma Scoliosis
Features of neurofibromatosis type 2
No cutaneous features
Bilateral acoustic neuromas
Optic nerve gliomas
Meningiomas
What is an Arnold-chiari malformation
Congenital herniation of the cerebellar tonsils
Features of von-Hippel-Lindau syndrome
Retinal and intracranial haemangiomas and haemangioblastomas Renal cysts Renal cell adenocarcinoma Pancreatic tumours Phaeochromocytoma
Features of ataxia telangiectasia
Childhood progressive ataxia and athetosis
Conjunctival/cheek/ear Telangiectasia
Immunodeficiency
Futures of shy-drager syndrome
Parkinsonian symptom - tremor, bradykinesia, rigidity
Autosomal failure - incontinence, postural hypotension, gastoparesis, ED
Features of a total anterior circulation stroke (TACS)
Triad of hemiplegia, hemianopia, higher cortical dysfunction (aphasia etc)
Features of a partial anterior circulation stroke (PACS)
2 of - hemiplegia, hemianopia, higher cortical dysfunction (aphasia etc)
Features of a posterior circulation stroke (POCS)
Affects the brainstem –> Vertigo, dysphagia, dysarthria, facial weakness
Features of a lacunar stroke (LACS)
Pure motor - hemiparesis
Or pure sensory
Or a combination
In 2 of - face, leg, arm
No visual defect. No higher cortical dysfunction. No brain stem problems. No impaired consciousness
In neurofibromatosis type 1 what would a CT spine show
Benign tumours at nerve root exits
= dumb bell tumours
What can lower the seizure threshold
Drugs - tramadol, fluoxetine, clozapine, cocaine, penicillin, Hormone change - menstruation, menopause Tiredness Fasting Sleep deprivation Stress Alcohol Flashing lights
When do febrile convulsions occur, why + what’s the prognosis
6m - 3 yr
Response to rapid increase in temperature
Benign but - Increased risk of seizures later in life - esp male
What is status epilepticus
Continued tonic-colonic seizures, without regaining consciousness in between
Emergency
What is serial epilepsy
A succession of tonic clonic seizures but with recovery between
What is cataplexy
Sudden loss of postural tone
Patient crumples
Remains conscious
Tetrad of symptoms in narcolepsy
Excessive daytime sleepiness
Cataplexy
Sleep paralysis
Hypnagogic hallucinations
What is retrograde amnesia
Impaired memory of events before injury / illness
What is anterograde amnesia
Inability to learn new information after injury / illness
Characteristics of a postural tremor
Absent at rest Present on maintained posture Rapid Fine amplitude Slow, insidious onset Uppe limbs \+/- titubation
Characteristics of a cerebellar tremor
Absent at rest
Maximal on approaching target
Slow + coarse
Symptoms and signs of cebellar disease
Ataxia Dysmetria Dysdiadochokinesia Intention tremor Rebound phenomenon Titubation Pendular reflexes Nystagmus Altered speech Vermis lesion --> truncal ataxia
What bacteria causes meningitis In adults / elderly
Adults - N. meningitidis, strep penumoniae, TB
elderly - strep penumoniae, listeria
What is uhtoffs phenomenon
Transient increase or recurrence of symptoms in MS due to an increase in body temperature
E.g. Getting in warm bath
What area is affected in expressive dysphasia
Broca’s area
What area is affected in a receptive dysphasia
Wernickes area
Symptoms of trigeminal neuralgia
Episodic intense facial pain
Trigeminal nerve distribution
Lasts secs-mins
100s x per day
Signs of base of skull fracture
Panda eyes CSF rhinorhoea CSF otorrhoea Battles sign Haemotympanum
What is Ramsay hunt syndrome
Lower motor nerve facial palsy
Associated with herpes zoster infection of the external auditory meatus (shingles)
Most common primary CNS tumour
Meningioma
Benign
What is encephalitis
Inflammation of the brain parenchyma
Clinical features of cerebellar tonsilar herniation
Reduced consciousness
Respiratory irregularities
Neck stiffness
Head tilt
What conditions pre-dispose to cerebral abscesses
Acute endocarditis
Bronchiectasis
Cyanotic congenital heart disease
Otitis media
Features of freidrichs ataxia
Gait disturbance Ataxia Dysarthria Scoliosis DM Heart disorders
What is lhermittes phenomenon
Electric shock-like sensations in the arms and legs caused by neck flexion.
Due to involvement of dorsal columns
Common in MS
What is gélineaus syndrome
Narcolepsy
Causes of a transudative pleural effusion
Heart failure
Liver failure
Renal failure
(<20g/L protein)
Causes of an exudative pleural effusion
Infection Infarction Malignancy Acute pancreatitis (>30g/L protein)
Causes of respiratory acidosis
COPD Pneumonia PE Pulmonary oedema Sleep apnoea Respiratory muscle weakness (Raised CO2)
In what condition is serum ace elevated
Sarcoidosis
