Neurology Flashcards
1
Q
What can a CN 3 palsy cause?
A
Ptosis, large pupil, eyes down and out
2
Q
What does CN 4 palsy cause?
A
Diplopia on looking Down and in
Head tilting for compensation
3
Q
What does a CN 5 palsy cause?
A
Nystagmus
4
Q
What can cause horizontal nystagmus?
A
Vestibular lesion (chronic: towards affected side, acute: towards normal) Cerebellar lesion (towards lesion)
5
Q
What can cause nystagmus in abducting eye?
A
MS
6
Q
What can cause nystagmus with tinnitus, hearing loss and balance loss?
A
CN 8 lesion
7
Q
What is a sign of a CN 5 palsy?
A
Open mouth, jaw deviates towards lesion
8
Q
What is lost first in a CN 5 palsy?
A
Corneal reflex
9
Q
What does an upper facial motor neuron lesion cause?
A
Drooping and weakening in lower 2/3rds of face (because forehead has bilateral representation in the brain)
10
Q
What does a lower facial motor neurone lesion cause?
A
Drooping and weakness in half of the face
11
Q
What is a sign of a CN 10 palsy?
A
Palate deviates to normal side
12
Q
What does a CN 12 lesion cause?
A
Deviation of tongue to affected side
13
Q
What can affect all CN nerves?
A
DM, MS, stroke, tumours, syphilis, meningitis, sarcoidosis, SLE
14
Q
What can cause a CN 1 lesion?
A
Trauma, resp infection, frontal love tumour
15
Q
What can cause a CN 2 lesion?
A
Monocular blindness: MS, giant cell arteritis
Binocular blindness: DM, ms, neurosyphilis
16
Q
What can cause a CN VI lesion?
A
Wernicke’s encephalopathy, pontine stroke
17
Q
What can cause sensory CN V problems?
A
Trigeminal neuralgia, skull fracture, acoustic tumour, herpes zoster, nasopharyngeal cancer
18
Q
What can cause CN VII lesions?
A
LMN: Cerebellar pontine tumours, Bell’s palsy, otitis media, skull fracture
UMN: stroke
19
Q
What can cause a CN VIII lesion?
A
Noise damage, acoustic neuroma, meinere’s disease, pagat’s
20
Q
What can affect CN VIII, then CN V, VI, IX, X?
A
Cerebellar pontine tumours
21
Q
What can affect CN III, IV, VI?
A
Tumours, wernicke’s aphasia, stroke, MS
22
Q
What can affect CN III, IV, Va, and VI?
A
Cavernous sinus thrombosis, sup. orbital fissure
23
Q
What can affect CN IX, X, XI?
A
Jugular Foramen lesions
24
Q
Where can a lesion cause Broca’s aphasia?
A
Infero lateral on dominant frontal lobe
25
Where can a lesion cause Wernicke's aphasia?
Posterior superior dominant temporal lobe
26
Where can a lesion cause nominal aphasia?
Posterior dominant temperoparietal lobe
27
What can occur to speech in case of cerebellar disease?
Drunken, slurred speech, irregular in volume and staccato like
Ataxia of vocal muscles
28
What can extra pyramidal lesions do to speech?
Soft, indistinct, monotonous speech
29
What can a pseudo bulbar palsy do to speech?
Spastic, umn lesion
| Nasal, effort full speech
30
What can a bulbar palsy(guillan barre, MND, or facial nerve palsy) do to speech?
Nasal quality
31
What can cause dressing dyspraxia?
Non dominant hemisphere lesions
32
What can cause gait dyspraxia?
Bilateral frontal lesions, posterior temporal lesions, hydrocephalus
33
What can cause Constructional dyspraxia?
Non dominant hemisphere lesions, hepatic encephalopathy
34
What is athetosis and what's it caused by?
Sinuous writhing movements, caused by lesions in putamen
35
What's pseudo athetosis, and what' sit caused by?
Athetoid movements in patients with proproceptive sense loss
36
What is chorea and what's it caused by?
Chorea is dance like, jerky, writhing movements
| Caused by huntingtons, stroke(basal ganglia lesions) hyperthyroidism, Wilson's, streptococci,
37
What is hemiballismus and what's it caused by?
Uncontrolled, unilateral flailing motions of proximal limbs
Contalateral subthalmic lesions
38
What are the signs of cerebellar ataxia?
| Hint: what you might get after an open sleigh accident
```
D- dysdaidokinesia
A-Ataxia,
S-slurred speech
H-Hypotonia, weakness
I-Intention tremor
N-Nystagmus
G-Gait disturbance (broad based, stamping)
```
39
What do corticospinal and internal capsule lesions cause?
Contralateral hemiparesis
40
What does hemiparesis, epilepsy, reduced cognition and homonymous hemianopia suggest?
Cerebral lesions
41
What does hemiparesis with contralateral cranial nerve palsy suggest?
Brain stem lesion on the side of CN palsy
42
What are the signs seen in a cord lesion?
Paraparesis or tetraparesis, UMN signs below the lesion, LMN signs above the lesion
Dissociated sensory loss eg fine touch without pain
43
Which tracts carry pain, crude touch and temp?
Anterolateral (spinothalamic)
44
Which tracts carry proprioception and fine touch?
Dorsal columns
45
What are the signs of UMN lesions?
Increased tone, visible in rapid movements,
Hyperreflexia
Affects groups of muscles,
46
What are the signs of LMN lesions?
Wasting, fasiculations, flaccid muscles, weak or absent reflexes, ankle remains plantar
47
What can occlusion of the carotid artery cause?
Can cause infarction of ant 2-3 of cerebral hemisphere and basal ganglia
48
The occlusion of which artery can cause akinetic mutism (due to cingulate gyri being affected), weak, numb, contralateral leg and arm with facial sparing?
Ant. Cerebral
49
The occlusion of which artery can cause contralateral homonymous hemianopia with macular sparing?
Post. Cerebral artery
50
What can an occlusion of the middle cerebral artery cause?
```
Contralateral hemiparesis
Hemisensory loss
Homonymous hemianopia
Viso spatial deficits
Dysphasia
```
51
The occlusion of what artery can cause locked in syndrome?
Pontine
52
What is subclavian steal syndrome and what is it caused by?
Subclavian artery stenosis causes retrograde blood flow to be stolen by subclavian artery
Causes brain ischaemia after use of arm
53
What are the causes for an acute, single episode of headache?
Meningitis, encephalitis, acute glaucoma, sinusitis, head injury, tropical illness, low pressure headache, venous sinus thrombosis
54
What are the signs and symptoms of acute glaucoma?
Reduced vision, nausea, vomiting, visual haloes
| Reduced acuity, cloudy cornea, dilated non responsive pupil, red congested eye
55
What can cause recurrent headaches?
Migraines
Cluster headaches
Trigeminal neuralgia
Mollaret's meningitis
56
What can cause subacute headaches?
Giant cell arthritis
57
What can cause chronic daily headaches?
```
Tension headaches
Analgesia rebound
Raised intracranial pressure
Symptom of depression,
Cervicogenic (from cervical spondylosis0)
Chronic or transformed migraine
```
58
What are the symptoms of a cluster headache?
Sharp, severe pain behind eye, unilateral, eye becomes bloodshot and watery, lid swells, facial flushing, rhinorrhea, Ptosis
59
What are the symptoms of trigeminal neuralgia?
Sharp, stabbing, short lasting unilateral pain in the distribution of trigeminal nerve.
60
What are the causes of trigeminal neuralgia?
MS, CN V nerve root compression, zoster
61
What are the symptoms of migraine?
Episodic headache, usually with visual or auditory aura, unilateral throbbing pain around head usually associated with triggers, photophobia, nausea, vomiting, allodonia- everything causes pain
62
What are the causes of black outs?
```
Vasovagal stuff
Epilepsy
Hypoglycaemia
Pain
Drop attack
Situational (cough, micturition)
Arrhythmias
```
63
What is vertigo and what are the associated symptoms?
Feeling of movement, always worsened by movement
Difficulty walking, better when still, nausea, vomiting
Hearing changes and tinnitus suggest CN VII issues
64
What are the causes of vertigo?
```
Benign postural vertigo
Acute labyrinthitis
Ménière's
Acoustic neuroma
Trauma
Zoster
```
65
What can cause conductive deafness, and how can it be tested?
Glue ear, wax build up, otosclerosis, otitis media
| Bone conduction is better than ear conduction
66
How can sensineural deafness be tested?
If unilateral, weber is negative contralateral to affected ear
67
What can cause chronic sensineural hearing loss?
Environmental noise damage
| Presbyacusis
68
What can cause sudden sensineural deafness?
Noise damage, gentamicin, acoustic neuroma, TB, mumps, MS, strokes
69
What can cause tinnitus?
Hearing loss, septic otitis media, hyper excitability of focal nerve, wax, noise damage, presbycusis
Aspirin
Divorce, retirement, redundancy,
70
What are the symptoms of cord compression?
Weakness in legs, incontinence,
| LMN signs at the level of lesion, UMN signs below lesion
71
What are the presenting complaints for a neurology history?
```
Dizziness, firs, syncope,
Paraesthesiae, weakness, loss of sensation,
Speech disturbance, dysphagia,
Headache
Tremor
Balance
Memory and cognition
Vision and hearing
```
72
What are the causes of cord compression?
Secondary carcinoma, myeloma, tumour, disk collapse, hematoma, vasculitis
MS, syphilis, spinal artery thrombosis
73
What are the symptoms of a conus medullaris lesion?
Early urinary retention and constipation, mixed UMN and LMN signs, leg weakness, back pain, erectile dysfunction
74
What are the symptoms of a cauda equina lesion?
Sensory loss in. Root distribution, reduced anal tone, asymmetric, irregular areflexic, atrophic paralysis of legs, radicular leg pains do back pain
75
What can cause unilateral foot drop?
DM, common peroneal nerve palsy, MS, stroke and prolapsed disc
76
What can cause weak legs with no sensory loss?
MND, polio, parasagittal meningioma
77
What can cause chronic spastic paraparesis?
MS, chord tumour, MND, syringomyeloma, parasites
78
What can cause chronic flaccid paraparesis?
Peripheral neuropathy, myopathy
79
What can cause absent knee jerks and plantar reflexes?
```
Combined cervical and lumbar lesions
MND
Freidrich's Atasia
Subacute cord degeneration
Taboparesis
```
80
What is an extra pyramidal gait and what can it be caused by?
Shuffling, stamping gait with swinging arms,
| Parkinson's
81
What is an apraxic gait and what can cause it?
Wobbly gait, like someone who's never ice skated before,
| Normal pressure hydrocephalus or multi infarct states
82
What is an ataxic gait and what can cause it?
Wide based gait, increased falls, can't walk heel to toe
Caused by: cerebellar lesions- MS,alcohol, post. Fossa. Tumours
Proprioception loss- peripheral neuropathy
83
What can cause a resting tremor?
Parkinson's
84
What can cause an intention tremor?
Cerebellar lesions
85
What can cause a postural tremor?
Anxiety, beta agonists, thyrotoxicosis
86
What are tics?
Brief, repeated movements that can be suppressed for awhile. Associated with Tourette's
87
What is a myoclonus?
Sudden involuntary focal or generalised jerks arising from brain stem, cord or cerebral cortex
88
What are four main causes of a stroke?
Small vessel occlusion of cerebral arteries
Cardiac thromboembolism
Artherothromboembolism
CNS bleeds
89
What signs can be seen in a brain stem stroke?
Quadriplegia, disturbances In gait and vision, locked in syndrome,
90
What can be seen in a lacunar stroke?
Ataxic hemiparesis, purely visual, purely sensory or sensorimotor loss, dysarthria/clumsy hand
91
What are the immediate actions to be taken for a patient with stroke?
```
Maintain airway,
BP, pulse and ECG
Blood glucose
CT
Thrombolysis,
```
92
Name five differential diagnosis for stroke
```
Epilepsy
Intracranial tumours
Hypo/hyperglycaemia
Encephalopathy (wernicke's or hepatic)
Subdural haemorrhage
Head injury
```
93
What prevention methods should be used for stroke?
Primary: control RF-lose weight, quit smoking
| Secondary(aft stroke): anti platelets
94
Name 7 cardiac causes for stroke
```
MI
Valve replacement
Cardiac surgery
AF
Paradoxical systemic emboli
Valve vegetarians
External cardio version
```
95
What are the causes of a TIA?
Hyper viscosity,
Emboli
Vasculitis
96
What are the differentials for a TIA?
Migraine aura, focal epilepsy, hypoglycaemia, hyperventilation
97
What is a subarachnoid haemorrhage and what is it caused by?
Spontaneous billed in the subarachnoid space caused by a ruptured berry aneurysm
98
Where are berry aneurysms most likely to form?
Junction of post communicating artery and int. carotid
Junction of ant. Communicating and ant. Cerebral artery
Bifurcation of middle cerebral artery
99
What are the signs and symptoms of a subarachnoid haemorrhage?
Thunderclap headache,
| Neck stiffness
100
What are the complications of a subarachnoid haemorrhage?
Rebleeding, formation of another aneurysm, cerebral ischaemia, hyponatremia, hydrocephalus
101
What are the signs of a sagittal venous thrombosis?
Vomiting, headache, papilloedema, reduced vision, seizures
102
What are the symptoms of a transverse sinus thrombosis?
Headache, mastoid pain, seizures, papilloedema
103
What are the signs of a sigmoid sinus thrombosis?
Cerebellar signs, CN palsies
104
What are the signs of an internal petrosal sinus thrombosis?
CN Vand VI palsies, temporal and retro orbital pain
105
What are the signs of a cavernous sinus thrombosis?
Seizures, oedematous eye lids, painful opthalmoplegia, headache, proptosis
106
What are the signs of a cortical vein thrombosis?
Thunderclap headache, cortical deficits, encephalopathy, focal seizures
107
Name 5 common causes of intracranial vein thrombosis
```
Pregnancy
Birth control pills
Intracranial abnormalities
Head injury,
Recent LP
Malignancy in the brain
```
108
What are the signs and symptoms of a subdural haemorrhage?
Insidious physical and intellectual slowing, past trauma, raised intracranial pressure, sleepiness, personality change, seizures, fluctuating consciousness, headache
109
What is the pattern seen in patients with extradural/epidural haemorrhage?
6 steps
1) Injury
2) No loss of consciousness-lucid period
3) Increasing headache, hemiparesis, vomiting, confusion, fits
4) Reducing Glasgow coma scale, bilateral limb weakness
5) Brain stem compression- breathing becomes irregular and depressed
6) Death
110
What are the 8 signs of delirium?
```
D-disordered thinking
E-euphoric, fearful, angry or depressed
L-language impairment
I-inattentive
R-reversal of sleep wake cycle
I-illusions, delusions or hallucinations
U-unaware/disorientated
M-memory loss
```
111
What are the causes of delirium?,
Drugs: levodopa, alcohol withdrawal, opiates, anticonvulsants
Systemic infection: UTI, pneumonia, malaria
Hypoxia
Deficiency: Nicotinic, B12 or thiamine
Metabolic: Uraemia, liver failure
Epilepsy
Head injury, brain tumours, raised IC pressure, stroke, MI
112
What is the presentation of vascular dementia?
Stepwise deterioration of cognition with signs of vascular causes
113
What defines Lewy body dementia?
Presence of Lewy bodies in brain stem and neocortex
114
What are the signs seen in frontotemporal dementia?
Executive impairment, hyper orality, early preservation of episodic memory, personality change, stereotyped behaviour, emotional unconcern
115
Describe the typical timeline for dementia?
Visospatial disturbances, gets lost often, cognitive impairment, memory, verbal impairment
Later: agnosia, mood impairment, irritability, psychosis
116
What are the causes of seizures?
Cortical scarring, developmental problems, stroke, trauma, haemorrhage, space occupying lesion, infection (syphilis, encephalitis), SLE, tuberous sclerosis, sarcoidosis, PAN, vascular malformations, metabolite changes
117
What is the aura of a seizure?
The part of the seizure that the patient can remember
118
What is the classic presentation of a simple partial seizure?
Awareness is unimpaired, focal motor, sensory or psychic symptoms
119
What is the presentation of a complex partial seizure?
Aura, impaired awareness,
Most commonly due to temporal lobe lesion- post ictal confusion is seen
If due to frontal lobe, rapid recovery
120
What is the presentation of an absence seizure?
Stops suddenly in whatever they're doing, for less than ten seconds, then picks up from where they left off. Typically presents in childhood
121
What is the presentation of a tonic clonic seizure?
Two phases, limbs stiffen then jerk. One can present without the other. Loss of consciousness, post ictal confusion and drowsiness
122
What's the presentation of a myoclonic seizure?
Sudden jerk of face, limb or trunk
123
What's the presentation of an akinetic or atonic seizure?
No loss of consciousness, sudden loss of muscle gone causing falls
124
What is the triad of the classic Parkinson's presentation?
Tremor, usually in one hand more than the other
Increased tone or muscle rigidity
Bradykinesia or hypokinesia
125
What are the clinical features of multiple sclerosis?
Dysaesthesia, paraesthesia, incontinence, anorgasmia, trigeminal neuralgia, loss of vibratory sense, urinary retention, spastic weakness, myelitis
126
What is the cause of multiple sclerosis?
T-cell immune response attacks CNS and causes demyelination in multiple places which manifests as progressive symptoms
127
What are the signs of a space occupying lesion?
Seizures
Personality change
Raised intracranial pressure
Evolving focal neurology
128
What are the causes of space occupying lesions?
Tumour, primary, secondary, abscess, aneurysm, cyst, subdural haematoma and granuloma's
129
Name some primary brain tumours
Meningioma, astocystoma, glioma, olgiodendroma, ependymoma
130
What is idiopathic inter cranial hyper tension and describe the classical presentation?
Patients, typically obese women, present with symptoms suggesting they have a space occupying lesion, eg, papilloedema, blurred vision, CN VI palsy, enlarged blind spot and blurred vision
131
What are idopathic intercranial hypertension a usually caused by?
Secondary to sinus venous thrombosis or drugs
132
What are the symptoms of a facial nerve palsy?
```
Bell's palsy
Drooling
Speech problems
Taste changes
Smile changes
Changes in muscles of facial expression,
Leaking eyelids
Unilateral facial weakness
Hypersensitivity to sound
```
133
What causes carpel tunnel?
Trapping of median nerves
134
What are the signs of carpal tunnel?
Weakness of pollicis longus and sensory loss in radial 3.5 fingers
135
What are the signs and symptoms of ulnar nerve palsy?
Can't cross fingers, claw hands, weakness of ulnar wrist flexors, sensory loss to ulnar 1.5 fingers
136
What are the signs and symptoms of radial nerve palsy?
```
Wrist and finger drop when arm is pronated and elbow is flexed
Variable sensory loss
Muscles affected
Brachioradials
Extensors
Supinator
Triceps
```
137
What do brachial plexus lesions present as?
Pain/paraesthesia in affected arm
138
What can a lateral cutaneous nerve of thigh palsy cause?
Anterolateral burning thigh pain
139
What do sciatic nerve lesions cause?
Foot drop and weakness of muscles below knee and hamstrings. Sensory loss of lateral below knee
140
What are the signs of a common peroneal nerve lesion?
Foot drop, weakness of foot inversion, eversion, loss of sensation of dorsal foot
141
What do you see in a tibial nerve lesion?
Inability to tip toe, foot drop, inability to invert foot, loss of sensation of sole of foot
142
What are the causes of poly neuropathies?
| Remember : vitamin c
Vascular-rheumatoid arthritis, wegener's
Infective- guillan barré, lymes, syphilis, HIV
Toxic- drugs, alcohol, lead
Autoimmune- guillain barré
Metabolic- DM, sarcoidosis
Inherited syndromes-Charcot Marie tooth
Nutritional- vit b1, b12, e and folate deficiency, high vit b6
Cancer- paraneoplastic syndromes, rubra Vera
143
What is the presentation of sensory poly neuropathy and name some causes
Loss of sensation of extremities in a glove and stocking pattern, paraesthesia, burning, trauma to extremities can suggest loss of function
Renal failure, DM, leprosy
144
What is the classic presentation of motor poly neuropathy and name some causes
LMN lesion signs, flaccidity, absent or repressed weaknesses, reduced power, ascending (sometimes rapidly) muscle weakness along the limbs which can progress to difficulty breathing
Guillain-Barré
Charcot-Marie-Tooth syndrome
Lead poisoning
145
What is motor neurone disease?
Degenerative disease causing neuronal loss in CN nerve nuclei, motor cortex and ant. Horn cells
146
What differentiates motor neurone disease from multiple sclerosis?
There is no loss of sphincter tone in MND
147
What's the difference between motor neurone disease and myasthenia gravis?
No loss of eye function in MND
148
What are the four presentations of MND?
AMyotrophic lateral sclerosis: split hand sign, upper motor signs, weakness and LMN wasting
Progressive muscular dystrophy: Ant horn cell lesion only. Affects distal muscles before proximal
Progressive bulbar palsy: affects CN IX - XII
Primary lateral sclerosis: betz cells in motor cortex are affected. Cause mainly umn signs with leg spasticity. No cognitive decline.
149
What are the signs of bulbar palsy?
LMN lesion in tongue, fasciculation in tongue, normal jaw jerk, flaccid tongue, speech is quiet, nasal or hoarse
150
What are the causes of bulbar palsy?
MND, guillain barré, polio, myasthenia, brain stem tumours
151
What can cause pseudo bulbar palsy?
Lesions bilaterally above mid pons
152
What are the signs and symptoms of pseudo bulbar palsy?
UMN lesion of muscles of swallowing and talking- slow, deliberate speech, increased jaw jerk, increased palatine and gag reflex, weeping or giggling that is mood incongruent
153
What differentiates myopathies and neuropathies?
Myopathy:
Gradual onset, on proximal muscles
Specific muscle groups, oddly firm muscles
Neuropathy: rapid onset
Paraesthesia, bladder problems
154
What are muscular dystrophies and name three
Progressive, genetic, degenerative diseases of muscle weakness
Duchenne's
Fascioscapulohumeral
Becker's
155
What is Myasthenia Gravis?
Autoimmune disorder caused by attack of Nicotinic acetylcholine receptors by antibodies
156
What is the presentation of myasthenia?
```
Increased muscle weakness on fatigue
Order of effect: ocular, bulbar,facial, neck, limb, girdle, trunk
Ptosis
Snarl on smiling
Diplopia
```
157
What is syringomyelitis caused by and what are the classical presentations?
Blocked csf
| UMN leg signs, hemi-atrophy of legs, claw hand, hand wasting, horner's ,sensory loss (dissociated), asymmetric body
158
What is the swinging light reflex seen in?
Demyelination disease
159
What are the causes of postural hypotension?
Hypovolemia, autonomic dysfunction and adrenal gland dysfunction
160
For prolonged seizures, what is the first line of treatment?
Rectal diazepam
161
What is hyperacusis?
Increased hearing sensitivity
162
What is hyperacusis caused by?
Stapedius palsy
163
What can cause a stapedius palsy?
Bell's palsy
164
What is Bell's palsy treated with?
Prednisolone and. Acyclovir
165
What worsens a benign essential tremor?
Stress, cold and caffeine
166
What kind of tremor does Parkinson's cause?
Resting tremor
167
What do Brudzinski's and kernig's sign suggest?
Meningeal irritation
168
What causes cubital tunnel syndrome and what is used to test it?
Ulnar nerve trapping in elbow,
| Tested by crossing middle finger over index finger
169
What movements test the ulnar nerve?
Crossing middle and index fingers
| Spreading extended fingers open horizontally
170
What muscle does Crossing middle and index fingers test?
Dorsal interossei
171
What muscle does Spreading extended fingers open horizontally test?
Dorsal interossei and abductor digiti minimi
172
What movements test the radial nerve?
Move wrist towards thumb laterally
| With palm facing downwards, bend wrist up towards forearm
173
What muscle does Moving wrist towards thumb laterally test?
Capri radialis longus
174
What movements test the median nerve?
Moving thumb across palm to tough the base of the little finger
With palm facing sideways, keeping hand in this position against resistance
With palm facing upwards, bend wrist towards forearm
175
What should be checked in case of prolonged seizures?
Phenytoin levels to show evidence of poorly controlled epilepsy
176
If the patient has fallen from a height what manoeuvre should be done?
Jaw thrust
| DO NOT DO head told chin lift as it may cause further damage in case of a c spine injury
177
Which nerve runs around the neck of the fibula?
Perineal nerve
178
What can damage the perineal nerve.?
Neck of fibula fractures
179
How can the perineal nerve be tested?
Bending foot towards the knee
180
What does repeat incidents of neurological disturbance suggest in a patient with hypertension?
TIA
181
How can statins cause myopathy?
Raised creatinine kinase
182
What is the most common rotator cuff injury?
Rupture of supraspinatus
183
What is used to symptomatically treat migraines?
Propanolol
184
What are the signs of a basal skull fracture?
Bruising behind ears
Peri orbital ecchymosis
Rhino/otorrhoea
Haematotympanum
185
What movement tests the tibial nerve?
Point toes and place sole of feet together
186
What movement tests the inferior gluteal nerve?
With straight leg, bury foot into couch
187
What can cause acute single episodes of headaches?
Subarch. Haemorrhage, acute-closure glaucoma, Acute meningis, vasodilator drugs
188
What can cause acute recurrent headaches?
Migraines, cluster headaches, Neuralgia (trigeminal and post-herpatic), sinusitis, acute-closure glaucoma
189
What can cause subacute single episodes of headache?
Raised ICP, idiopathic intracranial hypertension, Infections (TB meningitis, cerebral abscess)
190
What is the classic presentation of raised intracranial pressure?
Poorly localized headache, worse in the morning, worsened by coughing or stooping, focal neuralgias, seizures, nausea, weightloss
191
What is the classic presentation of a neuralgia?
Focal, sharp, stabbing, knife like pain over the distribution of the nerve. Allodonia. Pain may be percipitated by actions like combing hair and shaving
192
What is the classic presentation of temporal arthritis?
New onset headache in patients >55, jaw tenderness and jaw (and tongue) claudication
193
What is the definition of syncope?
Loss of consciousness due to cerebral hypoperfusion
194
What is the definition of a seizure?
Pathological electric conduction in the brain causing symptomatic problems
195
What is the prodromal phase of a seiizure?
Change of mood or aura
196
What occurs in the tonic phase of a seizure?
Loss of consciousness, cyanosis, falls, spasm of all muscles
197
What occurs in the clonic phase of a generalized seizure?
Jerking of limbs and trunk, tongue biting
198
What occurs in the post ictal phase of a genralized seizure?
Flaccidity, confusion, headache, amnesia
199
What are the features of focal seizures from the temporal lobe?
Bnormal behaviour, Emotional disturbance, memory change (Deja vu or jamais vu) dream-like states, hallucinations of smell, taste or sound
200
What are the features that suggest an epileptic seizure rather than syncope?
Little to no warning of the attack, tongue biting, synchronised jerking of limbs, confusion, cyanosis (instead of pallor) onset when lying on bed
201
What can cause reccurrent dizzy spells?
Arrhytmia, mediacation, postural hypotension, hyperventilation, cerebrovascular/vertebrobasilar insufficiency
202
What are the four main causes of falls?
Accidents, illness, mutliple risk factors, loss of consciousness
203
What are the common central causes of vertigo?
Migraine, MS, brainstem ischaemia or infarction
204
What are the common peripheral causes of vertigo?
Meniere's diseae, trauma, benign paroxymal positional vertigo, vestibular neuritis, drugs (gentamicin, anticonvulsants)
205
What are the risk factors for falls?
| Alcohol is most common toxin, damaging both the CNS (ataxia, seizures, cognitive symptoms) and the PNS (neuropathy). P
Disease (alzheimer's, parkinson's)
Disability (instability, gait vision or cognition impairment)
Drugs (polypharmacy)
206
What is the most common toxin to the nervous system?
Alcohol
207
What can alcohol do to the nervous system?
CNS: Ataxia, seizures, cognitive symptoms
PNS: Neuropathy
208
What drugs can cause ataxia?
Pheytoin, carbamazipine, benzodiazepines, ciclosporins, Fluorouracil
209
What drugs can cause dizziness and vertigo?
Aspirin, antihistamines, Enalapril, Flecainide
210
What drugs can cause epilepsy?
Aminophyline, fentanyl, phenothyiazides, tricyclics
211
What drugs can cause headaches?
Statins, Sildenafil, Glyceril trinitrate
212
What drugs can cause memory impairment?
benzodiazepines, Isoniazid, Corticosteroids, Chlorpromazine
213
What drugs can cause myopathy?
Statins, corticosteroids, Guanethidine, Bretyliu tosilate
214
What drugs can cause parkinsonism
Neuroleptics, prochlorperazine
215
What drugs can cause peripheral neuropathy
Amiodarone, metronidazole, statins, Isoniazis, procainamide, Cimetidine
216
What drugs can cause tremor
Salbutamol, tricyclics, Tetrabutaline
217
What drugs can cause syncope?
Antihypertensives, levodopa, antiarrhythmics
218
Name four autosomal dominant neurological disorders
Myotonic dystrophy, neurofibromatosis type 1 and 2, huntington's, tuberous sclerosis
219
Name 3 autosomal recessive neurological disorders
Wilson's disease, friedreich's ataxia, tay-Sachs disease
220
Name 3 X-linked recessive diseases
Duchenne's becker's muscular dytrophies,
| Fragile X syndrome
221
What does Kernig's sign test for?
Meningeal irritation seen in mengism ( due ti infection, blood in subarachnoid space or utis)
222
Describe kernig's test
Lie patient supine, flex hip and knee of one leg, slowly extend knee. Kernig's sign is positive when when extension is resisted by spasm in the hamstrings, and the other limb may flex at the hip and knee.
223
How does one test for neck stiffness?
Lie patient down and lex neck to chest. Hold the position and check for anytensing or spasms of neck muscles
224
What can cause a hemiplagic gait?
Unilateral UMN lesion
225
Describe a hemiplagic gait?
leg extension at the knee and ankle and circumduction at the hip, such that the plantar flexed foot describes a semicircle as the patient walks because one leg is spastic
226
What can bilateral UMN lesions do to the gait
Cause a scissor like gait due to spasticity
227
What can cause bizarre gaits?
Huntingtons, non-organic disorders
228
Define dyarthria
Disturbed articulation
229
Define dysphoni?
Impairment of voice or sound production from the larynx
230
What can cause a pseudobulbar (spastic) palsy to speech?
bilateral UMN lesion
231
What can cause a bulbar speech palsy
LMN lesion of CN
232
What causes the nasal sound in bulbar speech?
Wakened palate
233
What can cause difficulty in pronouncing consonants in pseudobulbar speech?
Spastic tongue
234
What can cause difficulty in lingual sounds in bulbar speech?
Weakness of the tongue
235
What can cause fatiguing speech?
Myasthenia gravis
236
What can cause dysphonia?
Laryngitis or damage to recurrent laryngeal nerve ( or vagus nerve)
237
What does damage to the broca's are cause?
Maintained comprehension but telegraphic speech. Expressive (motor) dysphasia
238
What does damage to the wernicke's are cause?
Receptive (sensory) dysphasia
| Poor comprehension, fluent but meaningless speech
239
Where can damage to the brain cause comprehension aphasia?
Arcuate fasciculus
240
What is global aphasia?
All the aphasias! Expressive and receptive aphasia
241
What can dominant parietal lesions affecting the supramarginal gyrus cause?
Dyslexia, dysgraphia and dyscalculia
242
Where is the precentral gyrus?
Post. frontal lobe
243
What does the precentral gyrus do?
voluntary movement
244
What does the area anterior to the precental gyrus do?
emotions and personality, social behaviour and cognition and expressive language. Contains frontal eye fields and cortical centre for micturition
245
What can a frontal lobe lesion do?
Personality change (disintrest), cognitive impairment (memory, attention and concentration), expressive aphasia (dominant lobe) loss of emotional responsivenss, conjugate gaze deviation to the side of the lesion, primitive reflexes, urinary incontinence
246
What does the temporal lobe do?
Memory and perception of smell
| opticradiation, auditory perception
247
What can a temporal lobe lesion do?
focal epilepsy, contralateral upper quadrantonopia, receptive aphasia, memory impairment
248
What does the postcentral gyeus do?
Conscious sensation
249
Where is the postcentral gyrus?
Parietal lobe
250
What does the parietal lobe do?
optic radiations pass through, conscious sensation
| Dominant-language, nondominant-spatial awareness
251
What can lesions tothe parietal lobe cause?
Dyslexia, dysgraphia, dyscalculia, apraxia, primitive reflexes, contralateral lower quadrantonopia, altered sensation
252
What does the occipital lobe do?
VISION
253
What can damage to the occiput do?
Visual field defects, visual agnosia,impaired visual perception, visual hallucinations
254
What is parosmia?
Pleasant odours are percieved as unpleasant
255
What can cause Ansomia?
Trauma, resp infection, parkinsons, huntingtons, local compression or invasion by skull base tumour
256
What nerve sends input to the lacrimal, sublingual and submandibular salivary glands?
nervus intermedius, facial nerve
257
What nerve receives, taste sensations from the ant. 2/3rd of the tongue?
chorda tympani, facial nerve
258
what are the central sensory connections to CNV and what do they do?
```
spinal trigeminal tract (pain and temp)
Mesencephalic nucleus (unconscious proprioception), principal sensory nucleus (touch, joint proprioception)
```
259
What can cause CNV pathology?
Zoster, trauma, cancer, lesions in the caverous sinus
260
What is hypoguesia or ageusia?
Impairment or loss of taste
261
What is hyperacusis?
Unpleasantly loud hearing
262
What can occur in CN VII lesions?
Hyperacusis, hypoguesia, aguesia, involuntary emotional responses, nasolabial fold flattening, mouth drooping
263
What does the glossopharyngeal nerve do?
Carries taste and from post 2/3rd of tongue and sensation from pharynx and tonsils
264
What does the Vagus nerve do?
important sensory information but also innervates upper pharyngeal and laryngeal muscles.
265
What can bilateral CNX lesions cause?
Bulbar and pseudobulbar palsies
| Nasaul regurgitation of fluids and nasal air escape when cheeks are puffed out
266
What are the two components of the accesory nerve(and what do they do)?
Cranial which runs along with the vagus, and spinal which innervates the trapezius and sternocleidomastoid
267
What can cause unilateral IX an X nerve lesions?
Skull base fracture, skull base tumour (eg meningioma), lateral medullary syndrome
268
What can cause a recurrent laryngeal nerve lesion?
Post-thyroid surgery, aortic arch aneurysm, lung metastasis, mediastinal lymphoma
269
What can cause bilateral X nerve lesions?
Bulbar palsy (MND), pseudobulbar palsy (MS, cerebrovascular disease)
270
What can cause head drop?
Wasting of the sternocleidomastoids, seen in MND, myasthenia, myopathies and dystrophies
271
What can cause deviation of upper vertebral body of the scapula towards the spine?
Wasting of the lower muscle fibres of the scapula
272
What can cause deviation of upper vertebral body of the scapula away from the spine?
Wasting of the upper muscle fibres of the scapula
273
What can a unilateral lower motor XII nerve lesion do to the tongue?
Deviation of the tongue on protrusion (to normal side), unilateral wasting of the tongue
274
What can bilateral lower motorXII nerve lesions do to the tongue?
Wasting of the tongue globally, fasciculation of the tongue
275
Compare bulbar and pseudobulbar palsies
Bulbar palsy is a LMN, with dysrthria, dysphagia and weakness, wasting and fasciculations of the tongue. Jaw jerk and emotional liability are absent.
Pseudobulbar palsy is caused by an UMN lesion, with dysarthria, DYSPHONIA and dysphagia and conical, spastic tongue. Jaw jerk is brisk and emotional liability is absent
276
What can an UMN XII do?
Pseudobulbar palsy
277
What is the typical structure of a motor examination?
Inspection, tone, reflexes, movement and power, co-ordination
278
What is the typical structure of an MSK examination?
Look, feel, move(Stress),Special tests
279
What is a fasciculation?
Irregular ripples or twitches seen under the skin overlying muscles at rest.
280
How can fasciculations be elicited in MND
Flicking the overlying skin
281
What are myoclonic jerks?
Sudden shock-like contrations of one or more muscles (focal or diffuse)and occur singly or repetitively
EG the jerk when falling asleep
282
What can cause myoclonic jerks?
Epilepsy, diffuse brain damage, dementias
283
Define a tremor
oscillatory movement about a joint or group of joints caused by repeated rhythmic alternating contractions and relation of muscles
284
What does a physiological tremor look like?
Fine, fast, postural tremor
285
What can cause a physiological tremor?
Anxiety
286
What are the causes of fine, fast tremors?
Hyperthyroidism, excess alcohol/caffeine, salbutamol and anxiety
287
What does an action tremor look like?
Course, violent tremors associated with lesions of the red nucleus and subthalamic nucleus
288
What can cause an action tremor?
Cerebrovascular disease, MS, essential tremor
289
What is an intention tremor and what is it caused by?
Absent at rest, maximal on movement, emphasized by finger-nose test,seen in cerebellar damage
290
Describe the parkinsonian tremor
Coarse resting tremor, resembling pill rolling, worse at rest and reduced on movement
291
What are the symptoms of a CNI lesion?
Ansomia, parosomia
292
What are the symptoms of a CNII lesion?
Partial sight, blindness, scotoma, hemianopia, Anisocoria, lost pupillary light reflexes
293
What are the symptoms of a CNIII lesion?
Impaired or lost accomadation reflex
294
What are the symptoms of a CNIII, IV and VI lesion?
Strabismus, diplopia, nystagmus
295
What are the symptoms of a CNV lesion?
Impaired or lost fascial sensation and cornial reflex, weakness of muscles of mastication, Jaw jerk increased in UMN lesions
296
What are the symptoms of a CNVII lesion?
Ageusia, Facial weakness
297
What are the symptoms of a CNVIII lesion?
impairedhearing, nystagmus and vertigo
298
What are the symptoms of a CNIX lesion?
Loss of pharyngeal sensation
299
What are the symptoms of a CNX lesion?
Impaired palatine movements
300
What are the symptoms of a CNXI lesion?
Weakness of neck movements
301
What are the symptoms of a CNXII lesion?
Dysarthria and dysphagia
302
Define dystonia
Twisting, repetitive movements and sometimes tremor caused by Sustained muscle contractions
303
What is the difference between chorea and athetosis?
CHorea is sharp, irregular, jerking movements, where as athetosis is more slow, and sinous
304
What is a Ballism and what causes it?
Violent flinging movements caused by proximal muscle contractions
305
What can cause flaccidity?
LMN lesions, cerebellar disease, phases of cerebral or spinal shock, when the paralysed limbs are atonic prior to developing spasticity.
306
What is spasticity?
Veliocity dependent resistance to passive movement
307
What is rigidity and what can cause it?
Sustained muscle contraction,
| Parkinsons and other extrapyramidal coditions
308
What is a clonus?
Rhythmic contractions evoked by sudden stretch of muscles. Can be normalif unsustained.
309
Whatis a tendon reflex?
Involuntary Contraction of a muscle in response to stretch, mediated by a reflex arc
310
What can cerebellar damage to to reflexes
Pendular reflexes
311
What can cause inverted reflexes
Combines spinal cord and root pathology
| eg cervical myeloradiculopathies
312
What can cause babinski's?
UMN lesion
313
What is the cremasteric reflex used for?
to test the level of spinal cord lesions
314
What level does the cremasteric reflex test?
L1 and L2
315
What level does the biceps reflex test?
c5 (C6)
316
What level does the triceps reflex test?
C6&7
317
What level does the supinator reflex test?
c5 (C6)
318
What level does the ankle reflex test?
S1
319
What level does the knee jerk reflex test?
L3-4
320
What level does the abdominal reflex test?
T8-T12
321
What level does the plantar/babinski reflex test?
S1-S2
322
What are the primitive reflexes?
Snout, grasp, palmomental and glabellar tap
323
What can cause the primitive reflexes?
Present in neonates and infants, disappeear as NS matures.
| Seen in adults with severe acquired brain damage (from trauma, anoxia of disease)
324
What do unilateral and palmomental reflexes suggest?
Contralateral frontal lobe pathology
325
What causes positive glabellar tap?
Parkinson's
326
Define paresis
Partial paralysis
327
Define plegia
Complete paralysis
328
Define monoplegia
Involvement (paralysis) of one limb
329
Define Hemiplegia
Paralysis of half of the body
330
Define paraplegia
Paralysis of the legs
331
Define Tetraplegia
Paralysis of all four limbs
332
What are the patterns of motor dysfunction
Paralysis or weaknes, Dyskinesia, hypokinesie or hyperkinesia, dysraxia, impairment of co-ordination
333
Define Dyspraxia
Loss of learned movement patterns
334
What are the causes of LMN lesions?
Peripheral neuropathies, ant. horn damage (poliomyelitis, MND), radiculopathies
335
What can caues UMN lesions?
MS, cerebrovascular disease, spinal disease
336
What can cause myopathies?
Heritable dystrophies, alcohols, lead
337
What is ideational dyspraxia?
Patient can understand the task but can't perform it
338
What is ideomotor dyspraxia?
Patient performs the task in a bizarre manner
339
What can cause ideomotor and ideational apraxia?
Frontal or prietal lesion
340
What is constructional apraxia?
Difficulty drawing a figure
341
What is constructional apraxia caused by
Parietal disturbance
342
What is dressing apraxia associated with?
Spatial disorientation and neglect
343
What can cause dressing apraxia?
Dominant hemisphere parietal lesions
344
What pathway conveys vibration?
Medial lemniscus
345
Define brown sequard syndrome
Half of the spinal cord is damaged, leading to ipsilateral loss of of muscle strength, vibratory and proprioceptive sense, and contralateralloss of pain and temp
346
What is alternating analgesia?
Loss of pain and temp on face ipsilaterally and loss of pain and temp on the opposite side of body
347
What can cause alternating analgesia?
Damage to CNV and spinothalamic tract, caused by brainstem lesions
348
What do thalamic lesions cause?
Burning pain and patchy sensory impairment contralaterally
349
what is stereoagnosis?
Loss of tactile recognition
350
What are the genetic causes of polyneuropathies?
Refsum's, Charcot-marie-tooth, hereditary
351
What drug and toxins can cause polyneuropathies?
Alcohol, statins, amiodarone, metronidazole, perhexilline, phenytoin, lead, asrenic, mercury, solvents, carbon disulphide, herbicides, pesticides
352
What vitamin deficiencies can cause polyneuropathies?
B1, b6, b12, E
353
What infections can cause polyneuropathies?
Leprosy, HIV, diphtheria
354
What inflammatory conditions can cause polyneuropathies?
Guillan-barre, chronic idiopathic demyelinating polyneuropathy, connective tissue disoders (RA, SLE, SS, poly arthritis nodosa)
355
What systemic medical conditions can cause polyneuropathies?
Sarcoidosis, DM, acromegaly, renal failure, hypothyroidism, critical illness
356
What malignancies can cause polyneuropathies>
Cancer, lymphoproliferative disease
357
What tests can be used too assess median nerve function?
Form a ring with thumb and ring finger and try tto pull them apart (oppens pollicis), test thumbs vertically upwards movement against resistence (abductor pollicis brevis)
Altered sensation over thumb, first and second fingers, and lateral half of ring finger
358
What tests can be used to assess radial nerve function?
Weakness of arm extensors
sensory loss over dorsum of the hand
Loss of triceps reflex
359
What tests assess ulnar nerve function
Abduction and adduction of the fingers - ask patients to spread apart fingers against resistance
Hold piece of paper between fingers and try to pull it out
Claw of benediction
sensory oss on ulnar side of the hand
360
What are the common features of carpal tunnel?
More common in women, paraesthesia and or pain in the hand (little finger sparinga)
May radiate up the elbow
occurs usually at night - may wake the patient
Thenar muscle wasting
Patient may hang hand and arm out of the bed for relieffrom sleep
361
What are the causes of carpal tunnel syndrome?
Idiopathic, pregnancy, carpal tunnel, rA, Distal radial fracture, hypothyroidism, amyloidosis, nephrotic syndrome
362
What can cause peroneal nerve palsies?
Head of fibula fractures, compressed by pandages or plaster of paris, or repeated kneeling/squatting
363
What do peroneal palsies cause
Foot drop
364
What can trap the lateral cutaneous nerve of thigh?
inguinal ligament
365
WHat does lateral cutaneous nerve of thigh trapping cause?
Paraesthesia in the thigh
366
What is subacute combined cord degeneration?
Subacute myelopathy with damage to posterior column and corticospinal tracts caused by b12 deficiency
367
What occurs in subacute cord degeneration?
Sensory impairment (proprioception and vibration), pain and temp lost in a glove and stocking pattern. Spasticity, extensor plantar reflexes, loss of reflexes
368
What urine tests should be used to confirm a diagnosis of diabetic neuropathy?
glucose
369
What urine tests should be used to confirm a diagnosis of diabetic ketoacidosis?
Ketones
370
What urine tests should be used to confirm a diagnosis of myeloma?
Bence Jones protein
371
What urine should be used to confirm a diagnosis of poryphyria?
Porphobilinogen
372
What blood tests should be used to confirm a diagnosis of stroke?
Hb, clotting, thrombophilia screen, antiphospholipid antibodyAntinuclear factor and dsDNA, glucose, serum lipid and cholestrol,
373
What blood tests should be used to confirm a diagnosis of peripheral neuropathy?
Vitamin B12, rheumatoid factor, LFTs, urea creatinine, glucose, drug and toxin screen
374
What blood tests should be used to confirm a diagnosis of Myasthenia gravis
AcH receptor andd muscle-specific kinase antibodies, Edrophonium test
375
What blood tests should be used to confirm a diagnosis of epilepsy?
Calcium, drug toxin screen, phenytoin levels, valproate,
376
What neurophysiology test should be used to confirm a diagnosis of epilepsy?
ECG, EEG
377
What neurophysiology test should be used to confirm a diagnosis of Stroke?
ECG
378
What neurophysiology test should be used to confirm a diagnosis of MS?
Visual evoked potential
379
What neurophysiology testshould be used to confirm a diagnosis of MND?
EMG
380
What neurophysiology testshould be used to confirm a diagnosis of Myasthenia gravis?
single fibre EMG
381
What radiological test should be used to confirm a diagnosis of MS
MR brain scan
