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Clinical Exam - Differential Diagnosis > Neurology > Flashcards

Neurology Flashcards

1
Q

Ddx for Relative Afferent Pupillary Defect

A

perform the swinging torch test

  • pupil appears to dilate when light is swung from unaffected to affected eye
  • decreased response to light from the afferent defect
optic nerve lesion
- optic neuritis (MS)
- optic nerve ischaemia
- optic nerve compression (tumours, thyroid eye disease)
- asymmetrical glaucoma
severe retinal disease
- large retinal detachment
- central retinal artery or vein occlusion
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2
Q

Ddx for jaw jerk

A

UMN lesion of the trigeminal nerve

ALS
MND
Pseudo bulbar palsy
MS

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3
Q

Ddx vertical nystagmus

A

brain stem lesion (some variations for Courtney)
- malignant - primary or metastatic
- vascular - ischaemic or hemorrhagic
toxic - phenytoin, alcohol

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4
Q

Ddx facial droop

A

UMN: lower face only

  • vascular - ischaemic or hemorrhagic
  • tumour
LMN: upper and lower face
pontine
- vascular, tumour, MS, syringobulbia
posterior fossa
- acoustic neuroma, meningioma
petrous temporal bone
- Ramsay Hunt, Bell's palsy, otitis media, fracture
parotid
- tumour, sarcoid
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5
Q

DDx for diplopia

A

Disorder of muscle/orbit: thyroid eye disease, trauma, myasthenia
Disorder of cranial nerve: 3/4/6 palsy, Miller-Fischer,
Supranuclear pathology: INO, wernickes, tumour, aneursym, migraine

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6
Q

DDx for vertigo

A

Peripheral: vestibular neuronitis, Menieres disease, benign paroxysal positional vertigo, Herpes zoster oticus, aminoglycoside toxicity, otitis media, acoustic neuroma

Central: migraine, brainstem stroke/TIA, Wallenburgs syndrome (lateral medullary syndrome), cerebellar infarct or haemorrhage, Chiari malformation, MS

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7
Q

DDx for Horners syndrome

A

Central: Stroke, demyelination, brainstem/spinal cord tumour, syringomyelia

Pre-ganglionic: subclavian artery aneurysm, apical lung tumour, mediastinal tumour, cervical rib, trauma from IJ line/chest tube, thyroid malignancy

Post-ganglionic: dissection or aneurysm of internal carotid artery, cavernous sinus lesion, cluster headache

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8
Q

DDx for tongue fasciculations

A

LMN lesion of CN XII

  • MND - ALS, SMA
  • post polio syndromes
  • benign
  • drug induced
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9
Q

Patterns of visual field loss

A

Homonymous hemianopia - optic tract to occipital cortex
Lower quadrant homonymous hemianopia - parietal lobe lesion
Upper quadrant homonymous hemianopia - temporal lobe lesion
Bitemporal hemianopia - optic chiasm lesion
Unilateral field loss - optic nerve lesion
Central scotomata - optic nerve head to chiasm lesion eg demyelination, nutritional, vascular, toxic
Tunnel vision - glaucoma, papilloedema
Enlarged bling spot - optic nerve head enlargement

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10
Q

DDx for horizontal nystagmus

A

Vestibular
Cerebellar
Internuclear opthalmoplegia

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11
Q

Ddx of predominantly motor peripheral neuropathy

A
  1. Guillain-Barre Syndrome and
    Chronic Inflammatory Demyelinating Polyradiculopathy
  2. Hereditary motor and sensory neuropathy e.g. CMT
  3. Diabetes

Others: Lead poisoning, acute intermittent porphyria, Multifocal motor neuropathy

MND and NMJ disorders must be considered in distal motor weakness

remember causes of peripheral neuropathies:
30% diabetes
30% Hereditary
30% idiopathic
10% the rest
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12
Q

Ddx proximal muscle weakness

A 
Myopathy (PACEPODS)
NMJ disease e.g. Myasthenia Gravis
Neurogenic causes:
- MND
- polyradiculopathy
- Kugelberg-Welander disease

Polymyositis, Dermatomyositis
Alcohol, AIDS (HIV)
Carcinoma
Endocrine - hyper/hypo- thyroids, Cushing’s syndrome, acromegaly,

Periodic paralysis
Osteomalacia
Drugs - steroids, chloroquine, statins
Sarcoidosis

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13
Q

Ddx length-dependent peripheral neuropathies

A

Same as causes for peripheral neuropathy

Diabetes, diabetes, diabetes
Medications
- Vincristine, Cisplatin, Isoniazid, Phenytoin, Amiodarone, Nitrofurantoin
Toxins - heavy metals, large doses of vitamin B6
Alcohol
Metabolic - diabetes, uraemia, hypothyroidism
Immune mediated - sensory form of GBS
Carcinoma
Vit B12 def
Idiopathic
Connective tissue diseases or vasculitis - SLE, PAN
Hereditary

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14
Q

Chorea

A 
Genetic
- Huntingtons
- Wilsons disease
- Benign hereditary chorea
- Fredrichs ataxia
- Mitochondrial disorders
Aquired
- Sydenhams chorea (rheumatic fever)
- Drugs (OCP, levodopa, neuroleptics, phenytoin)
- SLE
- Post infectious autoimmune central nervous system disorders (PANDAS)
- chorea gravidarum
- antiphospholipid syndrome
- PCV
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15
Q

Painful peripheral neuropathy

A 
Hereditary
- Fabrys disease
- Hereditary amyloid neuropathy
Aquired
- post herpetic neuralgia
- GBS
- chemotherapy induced
- paraneoplastic
- diabetic
- HIV associated
- CTD related (sjogrens)
- Alcoholic neuropathy
- Uremic neuropathy
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16
Q

Foot drop

A

LMN
- trauma -> direct injury to dorsiflexors of foot e.g compartment syndrome
- myopathy e.g fascioscapulohumeral dystrophy
- peroneal nerve lesion
- sciatic nerve lesion
- L5 nerve root compression
- sacral plexopathy
UMN
- spinal cord (myelopathy) - demyelination, compression
- stroke

Bilateral

  • hereditary sensorimotor neuropathies e.g CMT
  • freiderichs ataxia
17
Q

Deficits in proprioception/vibration

A

Spinal cord

  • tabes dorsalis (syphillitic myelopathy)
  • subacute combined degeneration of the cord due to Vit B12 def, Vit E def, and copper def
  • Friedreichs ataxia
  • multiple sclerosis
  • brown sequard (ipsilateral loss of proprioception/vibration)

Peripheral nerves
(large myelinated nerves so demyelinating processes affect these sensory modalities)
- diabetic neuropathy
- CIDP
- hereditary motor and sensorineuropathies (ie. CMT)

18
Q

Spastic paraparesis

A

Hereditary

  • hereditary spastic paraparesis
  • motor neuron disease
  • spinocerebellar ataxia
  • chiari malformation
  • adrenoleuckodystrophy

Aquired

  • spinal cord compression (above conus)
  • myelopathy (compressive, demyelinating, malignancy)
  • cerebral palsy
  • Vitamin B12 def
  • Vitamin E def
  • syphillis/HIV infection
19
Q

Cerebellar disease

A 
Congenital malformations e.g. arnold chiari
Hereditary e.g Freiderichs ataxia (AR), spinocerebellar ataxias (AD)
Aquired
- vascular e.g infarction/haemorrhage
- space occupying lesion
- nutritional e.g. thiamine, gluten
- infection
- toxins e.g. alcohol, heavy metals
- drugs e.g. phenytoin
- MS
- paraneoplastic cerebellar degeneration (anti-yo)
Idiopathic
20
Q

Wasting of small muscles of the hand

A 
Spinal cord
- spinal cord compression
- motor neuron disease
- syringomyelia
- syphillis
- poliomyelitis
Brachial plexus
- apical lung tumor
- trauma
- cervical rib
Peripheral nerve involvement
- rheumatoid arthritis
- ulnar nerve palsy
- median nerve palsy
21
Q

Tremor

A

Essential tremor
Parkinsonism
Enhanced physiological tremor (caffeine, anxiety)
Drugs (amiodarone, B-agonists, lithium, valproate etc)
Cerebellar lesion (stroke, MS, brainstem tumors)
Psychogenic tremor
Wilsons disease
Hyperthyroid
Alcohol withdrawl
Hyperparathyroidism
Liver disease/kidney disease

22
Q

Causes for Brown-Sequard syndrome (stabbed in the back syndrome)

A 
MS
CNS tumour
Trauma - being stabbed or shot in the back on one side
myelitis
post-radiation myelopathy
23
Q

Combination of extensor plantar response and absent reflexes

A

Extensor plantar response due to UMN signs
Absent reflexes due to peripheral neuropathy

DDx
Subacute combined degeneration of the cord (B12)
Friedreichs ataxia
Syphillis - tabes dorsalis
Conus medallris lesion
Adrenoleucodystrophy
24
Q

Myopathic pattern of weakness

A

Congenital

  • muscular dystrophys (FSHD, myotonic dystrophy, DMD, Beckers, limb girdle MD)
  • mitochondral disorders

Inflammatory

  • inclusion body myositis
  • polymyositis/dermatomyositis
  • SLE, RA, PMR
  • sarcoidosis

Drugs

  • statins
  • steroids
  • alcohol

Endocrine

  • hyper/hypothyroidism
  • cushings
  • acromegaly
  • electrolyte abnormalities
  • Vit D deficiency

Viral/infection
- HIV, viral

Clinical Exam - Differential Diagnosis (6 decks)

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