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Neurology Flashcards

1
Q

How do you examine mental status in neuro?

A 
Attention
Language
Memory
Visuospatial function
Neglect
Frontal lobe function
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2
Q

How do you examine cranial nerve II?

A

Visual acuity
Visual fields
Pupils
Funds copy

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3
Q

What nerves are extra ocular movements testing?

A

Cranial nerves III, IV and VI

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4
Q

How do you test the trigeminal nerve?

A

Facial sensation

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5
Q

What nerve supplies facial muscles?

A

Facial, CNVII

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6
Q

How do you test cranial nerves IX, X and XII?

A

Palate and tongue movement

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7
Q

What are the aspects of testing motor function?

A

Bulk (inspection)
Tone
Power

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8
Q

What is the C5 myotome?

A

Shoulder abduction

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9
Q

Describe the myotomes of the upper limb

A 
C5 shoulder abduction
C5,6 elbow flexion
C7 elbow extension
C6,7 wrist extension
C7,8 wrist flexion
C7 finger extension
C8 finger flexion
T1 thumb/finger abduction
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10
Q

Describe the myotomes of the lower limb

A 
L1,2 hip flexion
L5,S1,2 hip extension
L5,S1,2 knee flexion
L3,4 knee extension
L4,5 ankle dorsiflexion
S1,2 ankle plantar flexion
L5 dorsiflexion of great toe
L4,5 ankle inversion
L5,S1 ankle ever soon
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11
Q

Describe the MRC grading of muscle power

A

0 no visible contraction
1 flicker or trace of contraction
2 active movement with gravity eliminated
3 active movement against gravity
4 active movement against some resistance
5 normal power

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12
Q

Describe the innervation of the upper limb reflexes

A

Biceps C5/6
Brachioradialis C5/6
Triceps C7

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13
Q

Describe the innervation of the lower limb reflexes

A

Knee L3/4

Ankle S1/2

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14
Q

What is the babinski reflex?

A

Stroke the lateral sole
Up going plantar reflexes is an UMN sign
I.e. The first movement is up = abnormal

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15
Q

What are the aspects to checking sensation?

A

Pinprick
Temperature
Vibration
Proprioception

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16
Q

How do you test coordination?

A

Finger-to-nose or heel-to-shin

Rhythm of movements - rapid alternating movements

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17
Q

What is Romberg’s test?

A

Steadiness with feet together and eyes closed

Tests for sensory ataxia

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18
Q

What are you looking for in gait in neuro exam?

A

Stance - narrow or wide base
Shuffling gait and decrease arm swing (PD)
Ataxia

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19
Q

What are the distinguishing features of a brain lesion?

A 
Higher cortical functions disrupted I.e. Speech, personality, memory etc
Unilateral signs (contra lateral to affected side)
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20
Q

What are extra pyramidal signs?

A

Akinesia
Rigidity
Tremor

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21
Q

What are the signs of a brainstem problem?

A

Cranial nerve signs / abnormalities

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22
Q

What are the cerebellar signs?

A 
Dysdiadokinesia
Ataxia
Nystagmus
Intention tremor
Slurred speech
Past-pointing
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23
Q

What are the distinguishing features of a spinal cord lesion?

A

Attributable to a level
Bilateral
Bladder/bowel involvement

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24
Q

How does a nerve root lesion present?

A

Dermatomal and myotomal distribution

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25
How does a peripheral nerve lesion present?
LMN signs Glove and stocking sensorineural deficit Sensory ataxia
26
Where and what is Broca's area?
Frontal lobe Motor area for speech Damage leads to expressive dysphasia
27
Where are what is Wernicke's area?
Parietal lobe Sensory input for speech Receptive dysphasia
28
What are the symptoms and signs of a frontal lobe lesion?
Personality changes Mono paresis (legs) Incontinence Dysphasia (expressive)
29
What are the signs and symptoms of parietal lobe lesions?
``` Language difficulties Hemlineglect Visuospatial deficit Leg weakness Homonomous hemianopia Dyspraxia Agnosia ```
30
What is the function of the temporal lobe?
Auditory
31
What is the function of the occipital lobe?
Visual
32
What is the function of the cerebellum?
Coordination
33
What are the different parts of the brainstem called?
Midbrain Pons Medulla oblongata
34
What are the functions of the meninges?
Support and mechanically stabilise the contents of the cranium Organise/divide cranial cavity into anatomical parts Membranous envelopes that completely cover the brain
35
What are the meningeal layers?
Dura mater (periosteal + meningeal layers) Arachnoid mater Pia mater
36
What is in the subarachnoid space?
CSF
37
What are the functions of CSF?
Bathes the brain Cushions against mechanical agitation Reservoir for metabolic substrates for the brain Dissolves and carries away products of metabolism
38
What is the difference between the meninges of the brain and spinal cord?
Dura mater is a single layer in the spinal cord
39
At what level is an LP done and why?
L3/4 in adults | Spinal cord terminates at L2
40
Where is the thalamus?
Wrapped around the 3rd ventricle
41
What is the function of the hypothalamus?
Regulates visceral functions eg temperature, endocrine, feeding/drinking, emotional states and sexual behaviour
42
What is the function of the cerebellum?
Integration, regulation and coordination of motor processes
43
What forms the brainstem?
Midbrain, medulla oblongata and pons
44
What is the function of the medulla oblongata?
Controls autonomic function | Eg respiration, cardiac centre + baroreceptors, vomiting, coughing, sneezing and swallowing centres
45
Where do the cranial nerves originate?
3&4 midbrain 5,6,7,8 pons 9,10,11,12 medulla
46
What is the cauda equina?
Group of nerve roots running in the lumbar cistern | Extend beyond the termination of the cord at L2 level, to reach the remaining vertebral foramina
47
Where does the spinal cord terminate in adults?
L2
48
How does cauda equina present?
Bladder, bowel and sexual dysfunction Sensory changes in saddle and perianal areas Back pain Sensory changes or weakness in lower limbs Reduction or loss of reflexes in lower limbs
49
What are the common causes of cauda equina syndrome?
Large central IV disc at L4/5 or L5/S1 level | Tumours, trauma, spinal stenosis, inflammatory disease
50
Which tract is responsible for fine touch and Proprioception?
Dorsal column
51
Where does the dorsal column decussate?
Medulla (brainstem)
52
What tract is responsible for pain and temperature sensation?
Lateral spinothalamic
53
Where does the lateral spinothalamic tract decussate?
Spinal cord (ie straight away)
54
Which column is responsible for crude touch and pressure sensation?
Anterior spinothalamic
55
What is the clinical significance of the decussation of the lateral spinothalamic tract?
It decussates straight away in the spinal cord, meaning a lesion always causes CONTRAlateral signs - for pain and temperature
56
What are pyramidal tracts?
Originating in cerebral cortex
57
What are extra-pyramidal tracts?
Don't originate in the cerebral cortex | Eg originating in brainstem eg tectospinal, rubrospinal
58
Name 2 descending tracts of the pyramidal system
Lateral corticospinal | Ventral corticospinal
59
What is amyotrophic lateral sclerosis?
Progressive degenerative disease in which corticospinal tracts and central horn cells degenerate Results in weakness and loss of control to muscles
60
What is Brown-Sequard syndrome?
Lateral hemisection of the cord | Causes loss of sensation and motor function
61
How does Brown-Sequard syndrome present?
Spastic paralysis of ipsilateral side Loss of fine touch and proprioception ipsilaterally Loss of pain, temp and pressure sensation to CONTRAlateral side due to damage to spinothalamic tract
62
What is the classic cause of Brown-Sequard syndrome?
Stab wound to back
63
What is anterior spinal artery syndrome?
Caused by ischaemia of the spinal artery | Affects corticospinal tracts and results in motor paralysis
64
What is syringomyelia?
Development of cyst/cavity around the central canal Grows and spreads out over time Typically affects spinothalamic tract as this decussates just anterior to the central canal Reduced temp and pain sensation at level of lesion Can affect motor as it extends
65
Name the bones of the skull
``` Frontal Parietal Occipital Ethmoid Sphenoid Temporal ```
66
What are the cranial fossae?
Anterior, middle and posterior | Accommodate and support the brain
67
Name the meninges
Dura mater Arachnoid mater Pia mater
68
What are the falx cerebri and tent oriel cerebelli?
Thick infoldings of the meninges
69
What are the CSF spaces in the brain?
Sulci Fissures Basal cisterns Ventricles
70
What are the calcified structures within ventricles?
Choroid plexus
71
What is the difference between white and grey matter on CT and why?
White matter is darker It has a high content of myelinated (fatty) axons So it has a lower density
72
What are the important grey matter structures in the brain?
Cerebral cortex Insula Basal ganglia Thalamus
73
What is the insula?
Inner surface of the cortex | Found deep in the Sylvian fissure
74
What are the internal capsules?
White matter tracts which connect with the corona radiata, white matter of cerebral hemispheres and the brainstem
75
What is the corpus callosum?
White matter tract located in the midline | Arches over lateral ventricles
76
How can malignant lesions spread between hemispheres?
Via the corpus callosum
77
What is found in the posterior cranial fossa?
Cerebellum and brainstem
78
Which artery supplies the largest area of cortex?
Middle cerebral artery
79
What calcified structures are found within the brain?
Choroid plexus Pineal gland Basal ganglia Falx cerebri
80
How can you differentiate between cranial sutures and fractures?
Along the edge of the lesion, if the bone is corticated this means it is a suture Fractures are also straighter than suture lines
81
What is hydrocephalus?
Increased production or decreased absorption of CSF | Can result in massive enlargement of ventricles
82
What changes do you see on CT in Alzheimer's disease?
Temporal lobes reduced in volume | Enlargement of temporal horns of lateral ventricles
83
What is the likely diagnosis with generalised reduction in CSF space volume?
Cerebral oedema
84
What is small vessel disease on CT?
Generalised low density (darkening) of cerebral white matter Represents chronic ischaemia Associated with vascular risk factors
85
What are lacunae infarcts?
Area of brain cell death due to a focal ischaemia event
86
What are the signs of acute stroke on CT?
Subtle low density Hyper dense artery sign - thromboembolic material within a cerebral artery Insular ribbon sign - loss of clarity in the insular ribbon
87
What are the different types of extra-axial haemorrhage?
Extra dural, su dural and subarachnoid
88
Where does the blood commonly originate from in an epidural haematoma?
An intracranial artery, most commonly middle meningeal
89
What does an extra dural haematoma look like on CT?
Lens-shaped collection
90
What is the underlying pathology of a sub dural haematoma?
Fragile cerebral VEINS Increased risk in elderly and anticoagulated May result from minor trauma, or no trauma at all
91
What does a sub dural haematoma look like on CT?
Crescent-shaped collection (ie all along one side of the brain)
92
What are subarachnoid haematomas commonly caused by?
Trauma | Spontaneous bleeding from an intracranial aneurysm
93
What does a subarachnoid haemorrhage look like on CT?
Blood in ventricles or Sulci, fissures | Small foramina connect the subarachnoid space with the CSF spaces
94
What is the difference between intra- and extra-axial lesions?
Intra axial are within the brain | Extra axial are outside the brain
95
What are the most common intraaxial lesions?
Neoplastic and malignant Single - more likely to be primary Multiple - more likely to be metastatic
96
What are the most common extra axial lesions seen on head CT?
Meningiomas
97
What are Meningiomas?
Benign tumours arising from meninges and remaining in contact with them Can grow very large and surrounded by an area of cerebral oedema
98
What is mass effect in the cranium?
Intracranial volume can't change Any space-occupying intracranial lesion may increase the intracranial pressure and displace the soft tissues of the brain
99
What pathological process affects mass effect?
Cerebral oedema - worsens mass effect | In infarcts, mass effect comes solely from cerebral oedema
100
What happens in extreme cases of mass effect?
Coning - extrusion of the posterior fossa structures through the for amen magnum
101
What is herniation?
Tentorial - structures pass through the incisura tentoria (gap at top of tent normally occupied by brainstem and basal cisterns)
102
What is meningism?
Acute severe headache Felt over most of head Accompanied by neck stiffness
103
What are the causes of meningism?
Meningitis Encephalitis Subarachnoid haemorrhage
104
How do you manage a patient presenting with meningism?
Admit urgently for CT head | If CT negative, do LP to look for signs of infection or blood products in CSF
105
What are the features of meningitis?
``` Fever Photophobia Stiff neck Purpuric rash Coma ```
106
What are the features of venous sinus thrombosis?
Subacute or sudden headache | Papilloedema
107
How does sinusitis present?
Dull constant ache over frontal or maxillary sinuses Post-nasal drip Pain worse on bending over
108
How does acute glaucoma present?
Constant aching pain around 1 eye Radiates to forehead Reduced vision & visual haloes, nausea and vomiting Eye looks red and congested, cornea cloudy Dilated non-responsive pupil
109
How do you manage acute glaucoma?
Seek expert help immediately | If delay >1hr start acetazolamide 500mg IV over few mins
110
What are the common causes of recurrent attacks of headache?
Migraine Cluster headache Trigeminal neuralgia Recurrent meningitis
111
What are the features of cluster headaches?
Rapid onset excruciating pain around 1 eye Eye may become watery and bloodshot, lid swelling, lacrimation, facial flushing Pain always UNIlateral Lasts 15-60mins, 1-2x per day, often nocturnal
112
How do you treat cluster headaches?
100% O2 for 15mins | Sumitriptan subcut 6mg at onset
113
What are the features of trigeminal neuralgia?
Intense, stabbing pain lasting seconds in trigeminal nerve distribution Unilateral Face screws up with pain
114
What are common triggers for trigeminal neuralgia?
``` Washing affected area Shaving Eating Talking Dental procedures ```
115
Give some secondary causes of trigeminal neuralgia
Compression of trigeminal root eg tumour Chronic meningeal inflammation MS Zoster
116
What drugs are used to treat TN?
Carbamazepine Lamotrigine Phenytoin Gabapentin
117
How does Giant Cell Arteritis present?
Subacute headache Tender, thickened, pulseless temporal arteries Jaw claudication
118
What investigation is required in suspected GCA?
ESR (>40mm/HR)
119
How do you treat GCA?
Prednisolone
120
What are the features of tension headache?
Bilateral Non-pulsatile Scalp muscle tenderness
121
What are the features of raised ICP?
``` Worse on waking / lying down / bending forward / coughing Vomiting Papilloedema Seizures False localising signs ```
122
What is medication overuse headache?
Episodic headaches becoming chronic daily headache | Especially with mixed analgesics (paracetamol + codeine/opiates)
123
What are the classic symptoms of migraine?
Visual or other aura for 15-30mins | Followed within 1 hour by unilateral throbbing headache
124
What are the other presentations of migraine?
Isolated aura with no headache Episodic headaches without aura - often premenstrual Allodynia - all stimuli produce pain eg brushing hair
125
What is a migraine prodrome?
Precedes headache by hours or days | Yawning, cravings, mood or sleep changes
126
What is aura?
Precedes migraine headache by minutes May continue during it Visual, somatosensory, motor, speech
127
What are the criteria for diagnosing migraine (if no aura)?
``` 5 or more headaches lasting 4-72hrs, nausea or photophobia + 2 of... Unilateral Pulsating Impairs or worsened by routine activity ```
128
What are the common triggers of migraine?
``` CHOCOLATE Chocolate Hangovers Orgasms Cheese Oral contraceptives Lie-ins Alcohol Tumult Exercise ```
129
What are the differential diagnoses for migraine?
``` Cluster or tension headache Cervical spondylosis Hypertension Intracranial pathology Sinusitis or otitis media TIAs can mimic aura ```
130
What are the principles of migraine treatment?
Analgesia Abortive eg triptans Prevention eg propanolol, amitriptyline
131
What medications are used in acute migraine?
NSAIDs eg aspirin Triptans (5HT agonists) eg sumatriptan Ergotamine 1mg PO as headache starts
132
What are the medications used to prevent migraines?
Propanolol Amitriptyline Topiramate
133
What are the non-pharmacological measures to treat migraine?
Warm or cold packs to head Rebreathing into paper bag Spinal manipulation
134
What is the relationship between migraine and the pill?
Slight increased risk of stroke if on the pill and have migraine with aura Women should stop the pill immediately if they develop migraine with aura, and use alternative or low-dose pill
135
Define stroke
Syndrome of rapidly developing symptoms or signs of focal loss of CNS function Symptoms last more than 24hrs or result in death
136
What are the vascular mechanisms causing stroke?
Infarction - embolisation or thrombotic | Haemorrhage
137
In what conditions can cardiac emboli arise and cause stroke?
AF Endocarditis MI
138
What are the modifiable risk factors for stroke?
``` Hypertension Smoking Diabetes Heart disease - valvular, ischaemia, AF PVD Past TIA Carotid bruit Hyperlipidaemia Excess alcohol ```
139
What are the different types of stroke according to the Oxford classification?
TACS PACS LACS POCS
140
What artery is involved in TACS?
Middle or anterior cerebral
141
What is the commonest cause of TACS?
Cardiac emboli (AF)
142
What are the signs of TACS?
Higher cortical dysfunction Hemiparesis or hemisensory Homonymous hemianopia
143
What artery is affected in PACS?
Middle or anterior cerebral
144
What is the commonest cause of PACS?
Carotid disease
145
What is the difference between TACS and PACS?
PACS has better prognosis | PACS only has 2 out of 3 signs, or higher cortical dysfunction alone
146
What is the cause of a lacunar stroke?
Thrombus in situ
147
What are the signs of LACS?
Only motor or only sensory | Arm, face and leg
148
What are the signs of POCS?
1 of: A. Cerebellar or brainstem syndromes B. LOC C. Isolated homonymous hemianopia
149
What is the prognosis of posterior cerebral stroke?
Many don't survive, but if they do then prognosis is good
150
What is the ROSIER score?
``` Score greater than 0 raises suspicion of stroke. 1 pt each: Face Arm Leg weakness Speech disturbance Visual field defect Minus 1 for: seizure, LOC or syncope ```
151
What is the acute management of suspected stroke?
``` Airway Pulse, BP, ECG Blood glucose: aim for 4-11 Urgent CT if thrombolysis considered or high-risk of bleed or signs of raised ICP Thrombolysis: if onset within 4-5hr NBM if ?dysphagia Aspirin 300mg AFTER haemorrhage excluded ```
152
What is used for thrombolysis?
IV alteplase
153
What are the contraindications to thrombolysis?
``` Major infarct or haemorrhage on CT Past CNS bleed Severe liver disease Seizures at presentation Anticoagulants or INR>1.7 Platelets <100 BP >220/130 ```
154
What is the NIHSS?
National institute of health stroke scale Used to assess deficits on admission then again at review Higher score means more severe stroke
155
What are the differential diagnoses for stroke?
``` SAH Subdural haemorrhage Venous infarcts Malignancy Abscesses Hemiplegic migraine Functional hemiparesis ```
156
What are the factors involved in primary prevention of stroke?
Treat hypertension, diabetes, Hyperlipidaemia, cardiac disease Exercise Smoking cessation Folate supplements Anticoagulation for AF, prosthetic valves
157
How do you decide if someone with AF should be anticoagulated?
CHADSVASc
158
What is secondary prevention for stroke?
Prevent further strokes... Control risk factors Antiplatelets after stroke - clopidogrel (as long as no haemorrhage) Anticoagulation if stroke from AF - warfarin from 2 weeks after stroke
159
What investigations are done in stroke patients and why?
``` BP, HbA1c, lipid profile 24hr ECG ?AF CXR Echo ?mural thrombus Carotid Doppler USS (>70% stenosis is significant) ```
160
What is the mortality for strokes in the UK?
20% at 1 month
161
What are the complications of stroke?
``` Aspiration pneumonia Broncho-pneumonia Pressure sores Subluxation (flaccid paralysis) or contractures (spastic) Constipation Vascular dementia Depression ```
162
What 4 areas can you quickly assess for cognitive functions?
Perceptual function: point to a part of body Spatial ability: copying matchstick patterns Apraxia: copy a clock face Agnosia: picking out and naming easy objects
163
How are TIAs followed up?
Aspirin 300mg for 14 days Clinic appt within 24hrs if high-risk; 7days if low No driving for 1 month Return immediately if they have more symptoms
164
How do you calculate risk of imminent stroke following TIA?
``` ABCD2 score... Age >60 BP >140/90 Speech disturbance (1) unilateral weakness (2) Duration of TIA 10-59mins (1) >60mins (2) Diabetes 1-3=Low 4-5=Mod 6-7=High ```
165
What is myasthenia gravis?
``` Autoimmune Antibodies against nACh receptors Causes depletion of post-synaptic sites Interferes with neuromuscular transmission Fluctuating weakness of skeletal muscles ```
166
What muscle groups are commonly involved in myasthenia gravis?
Extra ocular Bulbar: dysphagia, dysphonia, dysarthria Limbs Respiratory
167
What is the characteristic symptom of myasthenia gravis?
Fatiguability of skeletal muscle during activity Fluctuating, painless weakness Muscles strong in morning and progressively weaker with activity
168
What are the effects on extra ocular muscles in MG?
Ptosis - often worse 60-90seconds sustained upgaze. Gradual ptosis with compensatory frontalis contraction. Resting (closing eyes) causes muscle power to return Pupils are UNaffected Facial mobility may be impaired
169
What factors can precipitate myasthenia gravis?
``` Emotional stress Pregnancy Menses Thyroid dysfunction Trauma Hypokalaemia Drugs eg beta-blockers, CCBs, ACEi Surgery ```
170
What are the complications of myasthenia gravis?
Respiratory failure, aspiration or infection Myasthenic crisis Cholinergic crisis
171
What is myasthenic crisis?
``` Severe exacerbation, can be dramatic... Facial muscles slack, expressionless Slack jaw Unable to support head Limp body Gag reflex lots - risk of aspiration ```
172
What is cholinergic crisis?
``` Miosis + SSLUDGE Salivation Sweating Lacrimation Urinary incontinence Diarrhoea GI upset Emesis ```
173
What causes cholinergic crisis?
Excess cholinesterase inhibitors Excessive ACh stimulation of striated muscle at nicotinic junctions produces flaccid paralysis, clinically hard to distinguish from weakness due to MG
174
How do you diagnose myasthenia gravis?
AChR antibodies Tensilon test: IV anticholinesterase (tensilon) - improves muscle contractility Caution in asthma, MI and bradycardia (cardiac monitoring and have atropine ready) EMG may show muscle fatigue
175
How do you diagnose cholinergic crisis?
Tensilon test - IV anticholinesterase agent, makes weakness worse NB in diagnostic tensilon test for MG, improvement is seen
176
How do you manage acute myasthenia gravis?
Beside spirometry: monitor FBC | Falling FVC may require ICU for ventilation
177
What are the drugs used to treat myasthenia gravis?
Anticholinesterase inhibitors e.g. Neostigmine Steroids: decrease immune response Azathioprine
178
What is Lambert-Eaton syndrome?
Destruction of pre synaptic calcium channels to prevent neurotransmitter release Gives a lot of autonomic symptoms due to similarity between channels NB no autonomic problems in myasthenia gravis
179
What is Guillain-Barré syndrome?
Ascending polyneuropathy
180
What is the commonest form of GBS?
Post-infectious polyneuropathy Causes ascending polyneuropathic paralysis Acute, rapidly progressing and potentially life-threatening
181
What is the Miller Fisher variant of GBS?
Sensory ataxia Arreflexia Ophthalmoplegia
182
What are the required features for GBS diagnosis?
Progressive weakness in both arms and legs | Arreflexia
183
When does GBS commonly occur?
1-3 weeks after URTI or GI infection
184
What are the complications of GBS?
``` Autonomic dysfunction: Cardiac arrhythmias Postural hypotension Hypertension Urinary retention Ileus Resp failure: bedside spirometry! ```
185
How do you manage Guillain-Barré syndrome?
``` Close observation (weakness is progressive) Bedside spirometry Ventilatory support ECG Nutritional support VTE prophylaxis Catheter Laxatives Pain control ```
186
What is the prognosis for Guillain-Barré syndrome?
25% require ventilation 70% have complete recovery at 1yr 25-30% have some residual deficit
187
How do polyneuropathies present?
Distribution usually symmetrical and widespread | Often distal weakness and sensory loss (glove and stocking)
188
What conditions cause mainly motor polyneuropathy?
Gillian-barre syndrome Lead poisoning Charcot-Marie-Tooth syndrome
189
What conditions cause mostly sensory polyneuropathy?
Diabetes Renal failure Leprosy
190
What are the features of autonomic polyneuropathy?
``` Postural hypotension Erectile dysfunction Reduced sweating Constipation and nocturnal diarrhoea Urinary retention Horner's syndrome ```
191
What are the causes of autonomic polyneuropathy?
``` Diabetes Guillain-Barre Sjögren's syndrome HIV Leprosy SLE ```
192
What is the treatment of choice for neuropathic pain?
Amitriptyline 10-25mg at night | Or gabapentin/pregabalin
193
What is cervical spondylosis?
Degeneration of the annulus fibrosus of cervical intervertebral discs Causes narrowing of the spinal canal Most people have no nerve impairment, but it can cause compression of the cord and nerve roots
194
What are the features of cervical spondylosis?
Neck stiffness Limited painful neck movement Neck flexion may produce tingling down the spine
195
What is radiculopathy and what are the features?
Root compression Pain / electrical sensations in arms or fingers at level of compression Dull reflexes LMN weakness and eventual muscle wasting of affected root UMN signs below level of affected root
196
What is the management of cervical spondylosis?
Firm neck collar restricts to relieve pain | Surgical root decompression: laminectomy or laminoplasty
197
What are the diagnostic criteria for neurofibromatosis type 1?
``` 6 or more cafe au lait patches 2 or more neurofibromas Freckling in axillary or inguinal regions Optic glioma Lisch nodules - hamartomas on iris 1st degree relative with NF1 ```
198
How does neurofibromatosis type 2 differ from type 1?
Bilateral vestibular schwannomas (acoustic neuroma)
199
What is motor neuron disease?
Selective loss of neurones in the motor cortex, cranial nerve nuclei and anterior horn cells Upper and lower motor neurones affected
200
What are the important negatives in motor neurone disease?
No sensory loss or sphincter disturbance
201
What are the 4 clinical patterns of MND?
1. ALS (50%) 2. Progressive bulbar palsy 3. Progressive muscular atrophy 4. Primary lateral sclerosis
202
What are the common presenting features of MND?
``` >40y Stumbling spastic gait Foot drop Proximal myopathy Weak grip Weak shoulder abduction Aspiration pneumonia ```
203
What are the UMN signs seen in MND?
Spasticity Brisk reflexes Up going plantars
204
What are the LMN signs seen in MND?
Wasting | Fasciculation
205
What are the bulbar signs in MND?
Speech or swallowing affected
206
What makes MND diagnosis definite?
Lower and upper motor neuron signs in 3 regions
207
What is the treatment for MND?
``` Antiglutamatergic drugs Drooling: amitriptyline Dysphagia: blend food, NG or PEG Analgesia NIV at home for resp failure ```
208
What part of the nervous system does MS affect?
White matter of brain and spinal cord and optic nerves
209
What is the pathophysiology of MS?
Inflammatory demyelination of CNS tracts Causes reduction in conduction velocity, as well as distortion and loss of information Changes not uniformly distributed, foci of inflammation and demyelination = plaques
210
What is gliosis?
Plaques evolve with time and ultimately result in CNS equivalent of scarring
211
What is the epidemiology of MS?
Females 3:1 Usually presents age 20 - 40 UK prevalence 1 in 1000
212
What are the most common presentations of MS?
Visual disturbance Limb weakness Sensory disturbance
213
What is optic neuritis?
Inflammatory demyelination of one optic nerve Pain around one eye, especially on movement Rapid decline in central vision (central scotoma) RAPD Pink, swollen optic disc
214
What are the sensory features of MS?
Dysaesthesia Pins and needles Decreased vibration sense Trigeminal neuralgia
215
What are the motor features of MS?
Spastic weakness | Myelitis
216
What is the progression of MS?
Symptoms worsen over days/weeks, reach plateau then resolve partially or completely Relapses Remissions are incomplete with time, so disability accumulates
217
What are poor prognostic signs in MS?
Older male Motor signs at onset Many relapses early on Axonal loss
218
How is MS diagnosed?
Clinically MRI is sensitive but not specific for plaque detection Lesions disseminated in time and space, with no other causes - further evidence needed after 1st episode CSF: oligoclonal bands of IgG on electrophoresis suggest CNS inflammation
219
What is the treatment for MS?
Steroids: methylprednisolone shortens acute relapse Interferons Monoclonal antibodies e.g. Alemtuzumab / Natalizumab
220
What drugs are used to treat spasticity?
Baclofen Diazepam Dantrolene
221
What is cervical spondylosis?
Degeneration of the annulus fibrosus of cervical intervertebral discs Causes narrowing of the spinal canal Most people have no nerve impairment, but it can cause compression of the cord and nerve roots
222
What are the features of cervical spondylosis?
Neck stiffness Limited painful neck movement Neck flexion may produce tingling down the spine
223
What is radiculopathy and what are the features?
Root compression Pain / electrical sensations in arms or fingers at level of compression Dull reflexes LMN weakness and eventual muscle wasting of affected root UMN signs below level of affected root
224
What is the management of cervical spondylosis?
Firm neck collar restricts to relieve pain | Surgical root decompression: laminectomy or laminoplasty
225
What are the diagnostic criteria for neurofibromatosis type 1?
``` 6 or more cafe au lait patches 2 or more neurofibromas Freckling in axillary or inguinal regions Optic glioma Lisch nodules - hamartomas on iris 1st degree relative with NF1 ```
226
How does neurofibromatosis type 2 differ from type 1?
Bilateral vestibular schwannomas (acoustic neuroma)
227
What is motor neuron disease?
Selective loss of neurones in the motor cortex, cranial nerve nuclei and anterior horn cells Upper and lower motor neurones affected
228
What are the important negatives in motor neurone disease?
No sensory loss or sphincter disturbance
229
What are the 4 clinical patterns of MND?
1. ALS (50%) 2. Progressive bulbar palsy 3. Progressive muscular atrophy 4. Primary lateral sclerosis
230
What are the common presenting features of MND?
``` >40y Stumbling spastic gait Foot drop Proximal myopathy Weak grip Weak shoulder abduction Aspiration pneumonia ```
231
What are the UMN signs seen in MND?
Spasticity Brisk reflexes Up going plantars
232
What are the LMN signs seen in MND?
Wasting | Fasciculation
233
What are the bulbar signs in MND?
Speech or swallowing affected
234
What makes MND diagnosis definite?
Lower and upper motor neuron signs in 3 regions
235
What is the treatment for MND?
``` Antiglutamatergic drugs Drooling: amitriptyline Dysphagia: blend food, NG or PEG Analgesia NIV at home for resp failure ```
236
What part of the nervous system does MS affect?
White matter of brain and spinal cord and optic nerves
237
What is the pathophysiology of MS?
Inflammatory demyelination of CNS tracts Causes reduction in conduction velocity, as well as distortion and loss of information Changes not uniformly distributed, foci of inflammation and demyelination = plaques
238
What is gliosis?
Plaques evolve with time and ultimately result in CNS equivalent of scarring
239
What is the epidemiology of MS?
Females 3:1 Usually presents age 20 - 40 UK prevalence 1 in 1000
240
What are the most common presentations of MS?
Visual disturbance Limb weakness Sensory disturbance
241
What is optic neuritis?
Inflammatory demyelination of one optic nerve Pain around one eye, especially on movement Rapid decline in central vision (central scotoma) RAPD Pink, swollen optic disc
242
What are the sensory features of MS?
Dysaesthesia Pins and needles Decreased vibration sense Trigeminal neuralgia
243
What are the motor features of MS?
Spastic weakness | Myelitis
244
What is the progression of MS?
Symptoms worsen over days/weeks, reach plateau then resolve partially or completely Relapses Remissions are incomplete with time, so disability accumulates
245
What are poor prognostic signs in MS?
Older male Motor signs at onset Many relapses early on Axonal loss
246
How is MS diagnosed?
Clinically MRI is sensitive but not specific for plaque detection Lesions disseminated in time and space, with no other causes - further evidence needed after 1st episode CSF: oligoclonal bands of IgG on electrophoresis suggest CNS inflammation
247
What is the treatment for MS?
Steroids: methylprednisolone shortens acute relapse Interferons Monoclonal antibodies e.g. Alemtuzumab / Natalizumab
248
What drugs are used to treat spasticity?
Baclofen Diazepam Dantrolene

Phase 2 (21 decks)

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