Neurology Flashcards
Name the parts of an upper limb neuro examination
WIPE Observation: wasting, fasciculation, tremor, asymmetry Tone Power (and pronator drift) Sensation Reflexes Coordination
What is added in a lower limb neuro exam?
Tone includes leg roll, ankle drag and clonus
Reflexes include plantar
Coodination includes gait
What is part of a baby’s neuro exam?
Anterior fontanelle protrusion/indent (ICP) Head circumference (Hydrocephalus)
What 3 things is it key to understand in speech/language disorders?
Is it a difficulty in:
Articulation
Expression
Understanding
Name the sections of the Glasgow coma scale (GCS) and total
/15
Eye opening/4
Verbal reponse/5
Motor response/6
What are the different categories in GCS within eye opening?
Spontaneous
To sound
To pressure (supraorbital nerve)
None
What are the different categories in GCS within verbal response?
Orientated Confused (but sentences) Words Sounds (groans/grunts) None
What are the different categories in GCS within motor response?
Obey commands Localising to pain Normal flexion to pain Abnormal flexion to pain Extension to pain None
How do you test CNII?
Visual acuity Visual fields Visual inattention Fundoscopy Pupillary reflexes Accommodation
How do you test CNV?
Sensation (pain/temp/light touch)
Corneal reflex
Jaw jerk
Mastication muscles
Muscle power is defined how?
Scale 0-5
0: no contraction
1: flicker
2: Active movement without gravity
3: Active movement against gravity
4: Active movement against gravity and resistance
5: Normal power
What movement involves C5 myotome?
Shoulder abduction (deltoid) C5 Elbow flexion (biceps) C5/6 Scapula winging (serratus anterior) C5/6/7
Which myotome does the biceps reflex test?
C5/6
What movement involves C6 myotome?
Elbow flexion (biceps) C5/6 Elbow flexion (brachioradialis) and supintation (supinator) C6 Scapula winging (serratus anterior) C5/6/7
Which myotome does the supinator reflex test?
C6
Which myotome does the triceps reflex test?
C7/8
What movements involve C7?
Elbow extension (triceps) C7/8 Finger flexion (FDS and FDP) Radial and median C7/8 Finger extension (EDc, radial) C7
What movements involve C8?
Elbow extension (triceps) C7/8 Flexor digiti minimi, palmar and dorsal interossei, aductor policis (Ulnar nerve) C8/T1
What movements involve T1?
All intrinsic hand muscles
Ulnar + Median (LOAF)
What does LOAF stand for?
Median 2 lumbricals
Opponens policis
Abductor pollicis brevis
Flexor pollicis brevis
Knee reflex nerve roots?
L3/4
Ankle reflex nerve roots?
S1/2
Optic nerve compression leads to what visual field defect? Eg
Central scotoma
eg optic neuritis
Optic chiasm pathology leads to what visual field defect? eg
Bitemporal hemianopia
Pituitary tumour
Optic tract pathology leads to what visual field defect? eg?
Incongruous homonymous hemianopia
Meningioma
Optic radiation pathology leads to what visual field defect? eg?
Complete homonymous hemianopia
Temporal lobe pathology leads to what visual field defect? eg?
Superior quadrantic hemianopia
Space occupying lesion
Parietal lobe pathology leads to what visual field defect? eg?
Inferior quadrantic hemianopia
Space occupying lesion
Occipital lobe pathology leads to what visual field defect? eg?
Homonymous hemianopia +/- macular sparing
Occipital lobe infarct
Inferior and superior obliques operate the eye in…
Adduction
Causes and features of a IIIrd nerve palsy
Fixed down and out gaze with fixed dilated pupil, complete ptosis
Aneurysm, diabetes,
cavernous sinus lesion,
tentorial herniation
If a pt has unequal pupils, how do you know which is the abnormal one?
The side with ptosis
Where do you never see complete ptosis?
Horner’s syndrome
Only the smooth muscle is affected, skeletal muscle intact
How do you test CNVII?
What branches are involved?
Facial expression
Change in hearing (nerve to stapedius)
Change in taste (chorda tympani)
What symptoms involving sensation would show that the lesion is central/peripheral?
Dissociated sensory loss of 2 different sensory modalities: central rather than peripheral.
Describe what happens to motor and sensory modalities in a complete spinal lesion
Motor: LMN at site of lesion, UMN below lesion
Sensory: Sensory level
Bladder involvement
Describe what happens to motor and sensory modalities in Brown Sequard syndome
Motor: ipsilateral UMN below lesion
Sensory: Contralateral loss of pain temp (spinothalamic)
Ipsilateral loss of vibration and proprioception (dorsal column)
Whats different between complete spinal lesion and central spinal lesion?
Motor same
Sensory: spinothalamic same
Dorsal column preserved
What does radial nerve pathology present with?
Wrist drop
Makes hand muscles appear weak (so examine on flat surface)
Loss of triceps reflex
What is seen with the pupil in Horner’s? Cause?
Small constricted pupil Normal light response and accommodation Fails to dilate with cocaine Mild ptosis Damage to sypathetics
What is seen with the pupil in Adie’s? Cause?
Dilated pupil with absent light reflex, slow accommodation
Pilocarpine constricts
No ptosis
Damage to parasympathetic fibres
How can you tell is a facial nerve palsy is UMN or LMN?
UMN has forehead sparing due to bilateral innervation
What is the difference between a bulbar palsy and a pseudobulbar palsy?
Bulbar: LMN (eg MND, Myasthenia gravis)
Nasal dysarthria, dysphonia, dysphagia, wasting and fasciculations of tongue
Wasting and fascilculations of masticatory muscles, fatiguable dysarthria, facial weakness
Psudobulbar: UMN (eg MS, cerebrovascular)
Strained voice, dysphagia, small tongue, emotional lability, brisk jaw jerk
Which side does the tongue go in a right sided hypoglossal dysfunction?
Right
Towards lesion
2 causes of myasthenia
Thymoma
Idiopathic
What is seen in IVth nerve palsy?
Failure of depression in adduction
Usually due to head injury
What is parinaud?
Failure of vergence (con/divergence when focusing)
And failure of vertical gaze
Due to a dorsal midbrain lesion (eg pineal tumour)
What does a RAPD show?
An optic nerve disease (eg MS or optic neuritis)
What pathways are involved in the corneal reflex?
Afferent Va (sensory), efferent VII (orbicularis oculi)
What does hypotonia signify?
LMN lesions and cerebellar disease
Hemisection of the spinal cord leads to…
Brown-sequard syndrome
Ipsilateral paralysis and loss of proprioception and vibration sense
Contralateral loss of pain and temp (as spinothalamic crosses at spinal level)
What pathways are involved in coordination?
Inputs: spinocerebellar (ipsilateral inferior cerebellar peduncle ICP) and pontocerebellar fibres (contralateral cerebreal hemispheres)
Outputs: superior cerebellar peduncle (SCP) eg dento-rubro-thalamic)
What does an extensor plantar reflex mean?
Abnormal
Babinski sign
UMN pathology
Spasticity, late wasting, exaggerated reflexes
How can you tell a lesion is LMN?
Hypotonic Early wasting and weakness Fasciculations Tendon reflexes may be lost if specific peripheral nerve affected plantar: normal (flexor) or absent
Effect of central cord lesion and mechanism of injury
Motor loss (LMN at site, UMN below site) Sensory loss of pain/temp, dorsal column preserved
When is central cord syndrome seen?
Hyperextension injury Esp in elderly/stenotic canals Bilateral motor and sesnroy deficits, arms worse than legs Preserves proprioception Poor prognosis
Difference between spinal shock and neurogenic shock
- Spinal shock (misleading), reflex activity sometimes stops following spinal injury for about 24 hours
- Neurogenic shock: disruption of the sympathetic outflow and hence vascular tone. The whole arterial tree therefore dilates causing hypoperfusion. Treat with pressors like Noradrenaline
What muscle responsible for depression of the adducted eye?
Superior oblique
Which spinal cord tracts are involved in motor control?
Motor: Corticospinal tracts, lateral tracts cross at medulla, anterior tracts don’t cross. Ipsilateral descending.
Which tracts are involved in joint proprioception and vibration?
Dorsal columns, crosses at medulla
Which tracts are involved in pain and temp?
Spinothalamic, crosses at level of spinal cord
UMN lesions cause:
- Late wasting
- No fasciculation
- Spasticity
- Extensors weaker in upper limbs, flexors weaker in lower limbs
- Exaggerated deep tendon reflexes w/clonus
- Absent superficial reflexes
- Extensor plantar reflex (abnormal)
Name 3 primary intracranial tumours
Astrocytic, oligodendroglial, meningothelial
What are the most common cancers to cause brain mets?
Breast, bronchogenic, colorectal
Which cancers commonly cause spinal mets?
Lung, breast, GI, prostate
Features of right acoustic neuroma (vestibular schwannoma)
Ipsilateral hearing loss, if large could affect cerebellum, brainstem and cause hydrocephalus
Facial nerve palsy
Balance problems
Which is the worst brain cancer?
Glioblastoma multiforme
2% survive beyond 3yrs
Whats the best brain cancer?
Meningioma
Name 6 cauda equina symptoms
Bilateral leg pain/sensory disturbance Perianal, perineal and saddle anaesthesia Urinary/faecal incontinence Lower back pain Significant bilateral motor deficit Sexual dysfunction
Describe a C7 radiculopathy
Weakness in elbow, wrist and finger extensors. Diminished triceps reflex.
Define the term spastic paraparesis and list four common causes
Progressive and generally severe lower extremity weakness and spasticity. Causes: Hereditary spastic paraparesis, spondylosis, atlanto-axial canal stenosis, AV malformation compressing cord.
Which spinalcord tracts are particularly affected by vitamin B12 deficiency?
List five neurological features found in patients with vitamin B12 deficiency?
peripheral and optic nerves. Posterior and lateral columns of the spinal cord.
Weakness, ascending paraesthesia and sore tongue. Abnormal evoked potentials, decreased EMG motor nerve conduction velocities.
