Neurology Flashcards by Jack Griffiths

Sensory ataxia

High-stepping gait due to peripheral sensory neuropathy

Possible anaemia/B12 deficiency/DM/cord degeneration

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What comprises the GCS?

Eye opening response

Best verbal response

Best motor response

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GCS - eye opening response

4 = Spontaneously
3 = To speech
2 = To pain
1 = No response

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GCS - best verbal response

5 = Oriented to TPP
4 = Confused
3 = Inappropriate words
2 = Incomprehensible words
1 = No response

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GCS - best motor response

6 = Obeys commands
5 = Moves to localised pain
4 = Flexion withdrawal from pain
3 = Abnormal flexion (decorticate)
2 = Abnormal extension (decerebrate)
1 = No response

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Medullary stroke

Also known as a ‘bulbar stroke/palsy’

Ipsilateral vagus nerve palsy –> palate deviates AWAY
Ipsilateral hypoglossal nerve palsy –> tongue deviates TOWARDS

Clinically, this = dysarthria (nasal voice)+ swallowing problems

Investigation = MRI

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Pontine stroke

Sudden LOC, pinpoint pupils, Cheyne-Stokes breathing, eyes deviate towards hemiparesis

Investigation = MRI

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Thalamic stroke

Burning/shooting pain down hemiparetic limbs

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Subarachnoid haemorrhage

SUDDEN ONSET severe occipital headache

MC rupture berry aneuryms (RF = HTN, ADPKD, collagen Dx)

Vomiting, meningism, photophobia

**CT = BICONVEX shape

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Subdural haemorrhage

Insidious bleed = increasing ICP

Headaches, focal neurology, fluctuating GCS

**CT = CRESCENT SHAPE

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Extradural haemorrhage

Temporoparietal injury (pterion)

Lucid interval –> rapidly deteriorating consciousness + focal neurology

***CT = BICONVEX shape

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Stroke — frontal cortex

Monoparesis, personality changes, urinary incontinence

Broca’s dysphasia (LEFT only)

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Stroke — parietal cortex

Complex disabilities, contralateral sensory neglect, dyspraxia

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Stroke — occipital cortex

Cortical blindness

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Stroke — Temporoparietal cortex

CONTRALATERAL symptoms

Receptive dysphasia, contralateral sensory inattention, homonymous field defects, hemiparesis

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Stroke — Cerebellar

IPSILATERAL symptoms

Past-pointing, dysdiadochokinesia, nystagmus, hypotonia/reflexia

Bilateral –> ataxia, slurred/scanning speech

Seizure — simple partial

Anatomical site of abnormal epileptic focus

Motor/sensory/olfactory/aphasic

NO loss of consciousness

Seizure — complex partial

Imparied level of consciousness

Prodromal feelings, responsive to surrounding, AUTOMATISMS

Post-ictal drowsiness

Seizure — typical absence

Spikes/waves at 3Hz on EEG

Decreases consciousness +/- myoclonic/tonic/autonomic components

Seizure — tonic-clonic

Tonic phase = jaw/face contracts, cyanosis, tongue biting, bellowing cry, incontinence

Clonic phase = rhythmic contraction of truncal/limb muscles

Post-ictal = headache + drowsy

Seizure — status epilepticus

> 30min without regaining consciousness

IV benzodiazepines –> IV phenytoin

Labyrinthitis

MCC vertigo

Viral origin?

Explosive severe vertigo, vomiting and ataxia WITHOUT tinnitus and deafness

Cerebellar speech

Dysarthria
Ataxia
Nystagmus
Poor coordination

Stroke/alcohol excess

Wernicke’s aphasia

Wernicke’s area found in LEFT TEMPORAL LOBE near PRIMARY AUDITORY CORTEX

Fluent aphasia with poor comprehension and poor repetition (due to intact Broca’s area)

Note: the two areas are connected by the ARCUATE FASCICULUS

Broca's aphasia

Broca's area found in LEFT TEMPORAL LOBE near PRIMARY MOTOR CORTEX Non-fluent aphasia with good comprehension and poor aphasia (due to intact Wernicke's)

Arcuate fasciculus lesion

Fluent aphasia with good comprehension but poor repetition

Pseudobulbar palsy (speech)

UPPER MOTOR NEURONE Sx Small, contracted tongue + jaw jerk MND, MS, brainstem lesion

Sagittal sinus thrombosis

Sudden-onset headache, seizures, and signs of raised ICP ****CT/MRI to confirm ('empty delta sign')

Brown-sequard syndrome

Hemisection of spinal cord IPSILATERAL motor loss + proprioception CONTRALATERAL spinothalamic loss

Syringomyelia

20-30yo Dorsal and motor column INTACT Neck/shoulder achey pain ****MRI to confirm

Central cord syndrome

Cervical spondylosis Flaccid weakness of arms but lower limb preserved (located in peripheral spinal cord)

Cauda equina syndrome

Narrowing of spinal canal below L2 TRIAD of incontinence/retention, bilateral leg pain/weakness, and loss of sensation in the perineal area

Posterior cord syndrome

Hyperextension injury Loss of DORSAL column function Impaired gait due to impaired proprioception

Anterior cord syndrome

Flexion-compression injury Impaired SPINOTHALAMIC and CORTICOSPINAL function Legs >>> arms

How do you manage a stroke in the acute setting?

Patient must be put NBM and then sent for an URGENT CT HEAD

What is subacute combined degeneration of the spinal cord?

Results from B12 DEFICIENCY Peripheral neuropathy --> burning sensation in hands a feed + GLOVE and STOCKING sensory/vibratory loss Spinal involvement --> demyelination of posterior columns and corticospinal tracts = UMN signs of weakness, increased tone, hyperreflexia, Babinski's sign Treat w/ IM B12

What will the CSF findings be with TUBERCULAR meningitis?

Low glucose with HIGH protein Lymphocytes +++ predominant Negative India ink stain

Wernicke-Korsakoff syndrome

A-NO! Ataxia, nystagmus, opthalmoplegia Due to chronic thiamine deficiency

Meningitis - bacterial (young)

Haemophilus influenzae Benzylpenicillin