Neurology Flashcards
Comatose state
diffuse cortical disturbance
Seizure
paradoxical discharge of cerebral neurones which is apparent to an external observer or as an abnormal perceptual experience by the subject
Epilepsy
recurrent tendency to have seizures
Diplopia
Double vision
Dysmetria (eyes)
Overshooting of eyes during scanning movements. Sign of a cerebellar lesion
Dysmetria (fingers)
Past pointing
Dysphagia
Difficulty swallowing
Dysphonia
Definition - difficulty producing sound (low in volume, speech in terms of quality is completely normal)
Dysarthria
difficulty in articulating, can include slurring
Dysphagia - definition, difference between Receptive and Expressive
Dysphagia - difficulty of language
Receptive (cannot understand what someone else is saying. Problem is in Wernicke’s area. e.g. Unable to follow commands)
Expressive (cannot find the word, non fluent. Problem is in Broca’s area. e.g. Unable to name objects)
NB: Both areas are supplied by MCA therefore most people will have a mixed picture
Aphemia
Complete lack of ability to make a sense
Bradykinesia
slowing of movement
Akinesia
loss of voluntary movement
Tremor
* Resting * Postural * Intention
Tremor - oscillation of a body part, usually involuntary
* Resting - tremor at rest * Postural - tremor when arms are held out * Intention - tremor when patient attempts to do something, e.g. Going towards a target
Myoclonus
rapid, lighting fast muscle jerks (can be a form of focal epilepsy, sign of vCJD etc)
Chorea
random and involuntary movements of the limbs and trunk (“dance like jerks”)
Dystonia
co-activation of muscles causing cramping and seizing of muscle groups (spasms and contractions)
Stereotyped movements
itching, pulling, rocking, tics etc are all signs of potential neurological disturbance
Tic
single or complex motor or vocal expression with partial control. A type of stereotyped movement
Spasticity
velocity dependent resistance to passive muscle stretch
Decerebrate
Type of posture - lack of cerebral function therefore there is a loss of brain stem, presents as extension to pain (very serious)
1/5 on the motor portion of the GCS
Decorticate
Type of posture - lack of cortical function, presents as flexion to pain (UMN presentation to pain)
3/5 on GCS scale for motor
What are the signs of cerebellar disease? (HINT: think DANISH)
Dysmetria (past-pointing) Ataxia Nystagmus Intention tremor Slurred speech Hypotonia
List the “5 As” of complex, partial seizures
Aura Autonomic change Awareness lost Automatisms Amnesia
What are the potential causes of collapse/blackout?
CARDIAC - stoke-adams, vagal overactivity (eg: vasovagal), sympathetic underactivity (eg: postural hypotension), vertebrobasilar insufficiency (eg: migraine), shock
NEUROLOGICAL - epilepsy, TIA, stroke
OTHER - metabolic (eg: hypoglycaemic episode), respiratroy (eg: hypoxia)
What is a “resting tremor”?
- Describe what you would see and when
- What causes it (i.e. ddx)
Pill rolling tremor
Improves (absent) on voluntary movement
Worse on distraction
Cause - parkinsonism
What is an “action tremor”? (aka: essential tremor)
- Describe what you would see and when
- What causes it (i.e. ddx)
Absent at rest
Worse on movement
Cause - essential tremor, thyrotoxicosis, withdrawal, anxiety
What is an “intention tremor”?
- Describe what you would see and when
- What causes it (i.e. ddx)
Irregular
Worse towards the end of movement
Cause - cerebellar damage
Define myoclonus and list some causes
Sudden involuntary jerks
Causes - metabolic, neurodegenerative diseases, epilepsy
Define chorea and list some causes
Non-rhythmic, purposeless, jerking movements
Causes - huntington’s, sydenham’s chorea, wilson’s, L-DOPA
List some of the triggers for migraine (HINT: think CHOCOLATE)
Chocolate cHeese OCP Caffeine alcohOL Anxiety Travel Exercise
What are the (3) cardinal features of parkinson’s disease?
Rigidity
Tremor (resting / pill rolling)
Bradykinesia
In addition to the cardinal features, list some of the other symptoms of Parkinson’s disease
Akinesia Postural instability Slow shuffling gait Postural hypotension Depression Dementia Mask-like facial expression Psychosis Sleep disturbance
List the common presenting features of MS (HINT: think TEAM)
Tingling
Eyes: optic neuritis
Ataxia
Motor disturbance - commonly spastic paresis
What is the difference between a medical and a surgical third (occulomotor) nerve palsy?
Medical 3rd nerve palsy is pupil sparing
Surgical 3rd nerve palsy involves the pupil - it is fixed and dilated. This is a SURGICAL EMERGENCY to save the eye
Describe the symptoms of Bell’s Palsy. Which cranial nerve is affected?
Sudden onset of - unilateral facial weakness, failure to close eye, eye dryness, bell’s sign, drooling, decreased taste, hyperacusis
Facial nerve (CN VII)
List the three classical symptoms of Horner’s Syndrome
Miosis - pupil constriction (due to paralysis of papillae muscles)
Ptosis - eyelid droop
Anhydrosis - absence of sweating (on affected side of face)
How can you differentiate between Horner’s Syndrome and 3rd nerve palsy on examination? How are they similar?
In both pathologies there is ptosis
In Horner’s syndrome - there is miosis (pupil constriction)
In 3rd nerve palsy - there is a dilated pupil AND it points DOWN and OUT
