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Neurology Flashcards

1
Q

Where does damage occur between in an UMN lesion?

A

Damage to motor fibres between pre-central gyrus and anterior horn cells of spinal cord

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2
Q

Where does damage occur between in a LMN lesion?

A

Damage to motor fibres between anterior horn cells of spinal cord and peripheral nerve

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3
Q

What is the pattern of involvement/distribution in UMN disease?

A

Pyramidal (affects corticospinal tract)

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4
Q

What is the difference in pattern of sensory loss between UMN and LMN lesions?

A

UMN: central sensory loss
LMN: glove-stocking/nerve distribution sensory loss

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5
Q

What is the difference in pattern of tendon reflexes and tone between UMN and LMN lesions?

A

UMN: hyper-reflexia, hyper-tonia
LMN: hypo-reflexia, hypo-tonia

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6
Q

The anterior cerebral artery supplies which parts of the brain? What would be the clinical signs as a result of damage to this artery?

A

Supplies frontal and medial part of the cerebrum

Weakness and numbness in the contralateral leg + arm symptoms

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7
Q

The middle cerebral artery supplies which parts of the brain? What would be the clinical signs as a result of damage to this artery?

A

Supplies lateral hemispheres
Contralateral hemiparesis + hemisensory loss in face and arm
Contralateral homonymous hemianopia
Cognitive change - dysphasia, visuo-spatial disturbance

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8
Q

The posterior cerebral artery supplies which parts of the brain? What would be the clinical signs as a result of damage to this artery?

A

Supplies occipital lobe

Contralateral homonymous hemianopia with macular sparing

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9
Q

List general causes of headache

A 
Raised ICP
Infections (meningitis)
Giant cell arteritis
Haemorrhage, trauma
Venous sinus thrombosis
Sinusitis
Acute glaucoma
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10
Q

List red flags for headache

A 
New onset in over 55 yo
Early morning onset
Known/previous cancer
Immunosuppressed
Exacerbated by Valsalva
Autonomic upset
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11
Q

What is the commonest cause of intermittent headache?

A

Migraine

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12
Q

What is the proposed pathophysiology of migraine?

A

Vascular constriction-dilation, substance P and 5-HT release, trigeminovascular activation, cerebral hyperactivity
All of the above are proposed to play some role

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13
Q

What are some risk factors/aetiology for migraine?

A 
Obesity
Excess oestrogen, OCP use
Patent foramen ovale
Genetics
Stress, anxiety
Poor diet
Physical exertion
CHOCOLATE: CHeese, Oral contraceptive, Caffeine, alcohOL, Anxiety, Travel, Exercise
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14
Q

What are some prodromal signs of migraine?

A

Yawning
Food craving
Change in sleep/appetite/mood

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15
Q

What are some auras that might occur prior to migraine headache?

A

Visual - central scomata/fortification/hemianopia
Motor - dysarthria, ataxia, ophthalmoplegia
Sensory - paraesthesiae

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16
Q

What is the criteria for diagnosing migraine without aura?

A

5 or more eps of headache lasting 4-72h
1 of nausea, vomiting, photophobia, phonophobia
2 of unilaterality, pulsating, limiting, worse on activity

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17
Q

What is the treatment for acute migraine?

A

NSAID (aspirin, ibuprofen)
Anti-emetic
Triptan (rizatriptan)

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18
Q

What drugs can be used for migraine prophylaxis?

A 
Propranolol
Topiramate
Amitryptilline
Valproate
Gabapentin
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19
Q

What are some contraindications to triptan use?

A

IHD, coronary spasm
Uncontrolled BP
Recent lithium/SSRI use

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20
Q

What are trigeminal autonomic cephalgias?

A

Headaches in a unilateral trigeminal distribution with cranial nerve features

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21
Q

List the main trigeminal autonomic cephalgias?

A

Cluster headache
Trigeminal neuralgia
SUNCT
Paroxysmal hemicrania

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22
Q

What causes cluster headache?

A

Superior temporal artery smooth muscle hyperactivity to 5-HT

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23
Q

Describe the presentation of cluster headache, commenting on pain and duration

A

Rapid onset severe unilateral orbital pain
Watery, bloodshot, oedematous eye with miosis
Lasts 15 mins - 3 hours, occurring once or twice a day
Often nocturnal
Clusters last 4-12 weeks with pain-free periods

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24
Q

How is cluster headache treated?

A

Acute: high-flow O2, sumatriptan
Prophylaxis: verapamil, topiramate, steroid

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25
What causes trigeminal neuralgia?
Compression of trigeminal nerve root by e.g. aneurysm, tumour, inflammation Triggered when pressure applied in trigeminal region
26
Describe the presentation of trigeminal neuralgia, commenting on pain and duration
Paroxysmal intense stabbing pain in V2/V3 region Facial screwing Triggered typically by washing, shaving, eating, denchers Lasts 1 - 90 seconds Can get up 100 eps a day
27
How is trigeminal neuralgia treated?
``` Carbamazepine Lamotrigine Phenytoin Gabapentin Surgical decompression ```
28
What is SUNCT?
Short Unilateral Neuralgiform headache with Conjunctival infections and Tearing
29
How long does SUNCT typically last?
5 seconds - 2 mins | Occurs in frequent bouts
30
How is SUNCT treated?
Gabapentin
31
What is paroxysmal hemicrania?
Similar to cluster headache but more frequent and shorter
32
How is paroxysmal hemicrania treated?
Indomethicin
33
What are the main aetiology/risk factors behind subarachnoid haemorrhage?
Rupture of saccular aneurysm AV malformations Risk factors includes smoking, alcohol excess, hypertension, bleeding disorder, post-menopause, polycystic kidneys, coarctation of aorta
34
Where are saccular aneurysms usually found?
Junction of posterior communicating and internal carotid Junction of anterior communicating and anterior cerebral Birfurcation of middle cerebral artery
35
List clinical features of subarachnoid haemorrhage
``` Sudden severe "thunderclap" headache, usually occipital Vomiting Collapse Seizure Coma Neck stiffness Papilloedema Focal neurological deficit ```
36
What investigations are done for subarachnoid haemorrhage?
``` CT scan (may be normal or show blood) LP if CT inconclusive and 12h post-onset - typically bloody (xanthochromatic) CSF ```
37
Outline treatment of subarachnoid haemorrhage
Refer to neurosurgery Bed rest, support, hydration - aim for systolic BP 160 Nimodipine to reduce vasospasm and ischaemia Surgery - endovascular coil, clipping, stent, balloon remodelling
38
What are some complications of subarachnoid haemorrhage?
Rebleeding Ischaemia Hydrocephalus Hyponatraemia
39
What are the two main intracranial venous thromboses that occur?
Deep vein sinus thrombosis (usually sagittal sinus) | Cortical vein sinus thrombosis
40
List some aetiology/risk factors for intracranial venous thrombosis?
``` Pregnancy Oral contraceptive Head injury Dehydration Malignancy Recent lumbar puncture Hyperthyroidism Nephrosis Infection Autoimmunity Tranexamic acid, infliximab ```
41
List clinical features of intracranial venous thrombosis
``` Worsens gradually over days Headache Vomit Seizure Focal neurological signs ```
42
What investigations are done for intracranial venous thrombosis?
CT/MRI sinuses Exclude SAH and meningitis LP if high opening pressure
43
Outline treatment of intracranial venous thrombosis
Heparin | Streptokinase via catheterisation
44
Where does bleeding come from in a subdural haemorrhage?
Bleed from bridging veins between cortex and venous sinuses, causing haematoma between dura and arachnoid
45
List some aetiology of subdural haemorrhage
``` Deceleration injury Trauma, often forgotten about Reduced ICP Tumour mets Falls Anticoagulation ```
46
List clinical features of subdural haemorrhage
``` Fluctuating consciousness Insidious intellectual slowing Sleepiness Headache Personality change Focal neurological deficit ```
47
What does CT/MRI of subdural haemorrhage show?
Midline shift | Crescent-shaped haematoma
48
How is subdural haemorrhage treated?
Monitor if small Irrigate/evacuate via burrhole craniosotomy Craniotomy if organised clot
49
Where does the bleeding occur in an extradural haemorrhage?
Bleed due to laceration of middle meningeal artery, causing haematoma between dura and bone
50
List some aetiology of extradural haemorrhage
Head injury | Trauma to temple lateral to eye
51
List clinical features of extradural haemorrhage
``` Initial lucid interval with no LOC Progressive decrease in GCS Headache Vomit Confusion Fits UMN signs Pupil dilation Comatose Limb weakness Abnormal breathing ```
52
What does CT/MRI show in an extradural haemorrhage?
Lens-shaped haematoma | Fracture lines
53
How is an extradural haemorrhage treated?
Clot evacuation + ligation of vessel | Mannitol to reduce ICP
54
LP is recommended in extradural haemorrhage. True/False?
False | LP is contraindicated
55
List some aetiology of space-occupying lesions
``` Tumour (usually mets from breast, lung, skin) Aneurysm Abscess Chronic haematoma Granuloma ```
56
List clinical features of space-occupying lesions
``` Headache, worse on waking/lying down/bending Papilloedema Vomiting Low GCS Seizures Focal neurology (esp VI) Personality change ```
57
What investigations would you order for suspected space-occupying lesion?
CT, MRI | Avoid LP! (coning)
58
Outline treatment for space-occupying lesions
``` Debulking surgery or excision (N.B. rarely accessible) Carmustine wafers VP shunt Chemoradiotherapy Treat headache and seizures Dexametasone to reduce oedema ```
59
Who is particularly at risk of idiopathic intracranial hypertension?
Obese women
60
List clinical features of idiopathic intracranial hypertension
Blurred vision, diplopia, VI palsy Enlarged blind spot Preserved consciousness and cognition
61
Outline treatment for idiopathic intracranial hypertension
``` Weight loss Acetazolamide Loop diuretic Prednisolone Consider optic nerve sheath fenestration or lumbar-peritoneal shunt ```
62
What is a seizure?
Abnormal spontaneous electrical activity in the brain
63
What is epilepsy?
Tendency to have recurrent seizures
64
What are the two types of seizure?
Focal: electrical activity in one part of cortex Generalised: electrical activity involving both hemispheres
65
What is the difference between simple and complex seizures?
Simple - no impairment of awareness/consciousness | Complex - impaired awareness/consciousness
66
List some aetiology of epilepsy
``` Genetics Developmental/structural abnormality Trauma Inflammation Alcohol withdrawal Space-occupying lesion Tuberous sclerosis SLE Drugs (antibiotics, opioids) ```
67
Give examples of aura that may precede a seizure
Strange feeling/sensations Deja vu Altered smell/taste Seeing lights
68
How does a Jacksonian seizure present?
Simple seizure involving unilateral jerk in one body part
69
What is the most common complex focal seizure?
Temporal lobe epilepsy involving loss of awareness/deja vu
70
List the main generalised seizures
Absence (petit mal) Tonic-clonic (grand mal) Atonic Myoclonic
71
What investigations would you order for epilepsy?
``` ECG in everyone Bloods, toxicology CT/MRI Lumbar puncture EEG if unsure ```
72
What is the treatment for focal epilepsy?
Carbamazepine | Lamotrigine 2nd line
73
What is the treatment for generalised epilepsy?
Sodium valproate Ethosuximide 2nd line/absence seizures Lamotrigine can also be used
74
What is the pathophysiology of benign paroxysmal positional vertigo (BPPV)?
Debris/otoliths in semicircular canals are disturbed by head movement, causing dizziness
75
List some aetiology of BPPV
``` Idiopathic Middle ear disease Head injury Otosclerosis Viral illness ```
76
List clinical features of BPPV
Sudden vertigo lasting seconds following head movement
77
Which test is used for BPPV?
Hallpike test illicits nystagmus and vertigo
78
Which maneuvre is used to treat BPPV? What other treatment is available?
Epley maneuvre | Betahistine
79
What is the pathophysiology of Meniere's disease?
Dilation of endolymphatic space in ear causes dizziness
80
List clinical features of Meniere's disease
Recurrent attacks of vertigo lasting 20+ mins Sensorineural hearing loss and tinnitus Nausea, vomiting Aural fullness
81
Outline treatment for Meniere's disease
Acute: bed rest, antihistamine, surgery Prophylaxis: low-salt diet, betahistine
82
What is the difference between myelopathy and radiculopathy?
Myelopathy: cord compression Radiculopathy: nerve root compression
83
What is a tremor?
Involuntary sinusoidal oscillation of a body part
84
Describe a resting tremor
Tremor occurs on rest and abolished on voluntary movement | Typically present in Parkinsonism
85
Describe an intention tremor
Tremor occurs on movement, irregular and large amplitude worse at end of purposeful act Typically present in cerebellar disease
86
Describe an essential tremor
Tremor present on maintained posture, usually bilateral | Typically has strong family history
87
Outline treatment options for tremor
Propranolol Primidone Gabapentin
88
What is dystonia?
Involuntary sustained muscle contraction in a body part, leading to abnormal posture
89
Give examples of primary dystonias
Torticollis Blepharospasm Writer's cramp Usually present in childhood, strong family history
90
List aetiology of secondary dystonias
``` Brain injury Cerebral palsy Wilson's disease MS Parkinson's disease Drugs (metoclopramide, cyclizine) ```
91
Outline treatment for dystonia
Focal: botox injection Generalised: anticholinergic (trihexyphenidyl), deep brain stimulation Maneuvres (breath-holding, arm-cooling) Muscle relaxants
92
What is chorea?
Non-rhythmic jerky purposeless movements
93
Give examples of choreas
Facial grimacing Raising shoulders Finger/hand movements
94
List causes of inherited choreas
Huntington's chorea Wilson's disease Spinocerebellar ataxia Sydenham's chorea
95
List causes of autoimmune choreas
SLE Thryotoxicosis Antiphospholipid syndrome Coeliac disease
96
What is the genetic abnormality in Huntington's chorea?
Excessive CAG trinucleotide repeats | Autosomal dominant inheritance
97
What are tics?
Brief repeated stereotyped movements that provide relief when performed
98
Give examples of physiological tics
Blinking Clearing throat Singing out loud
99
What is the commonest tic disorder? How can it be treated?
Tourette's syndrome | Try clonazepam, clonidine
100
What is myoclonus?
Brief sudden shock-like contraction, usually affecting distal muscle
101
What is a stroke?
Rapid-onset cerebral deficit with focal neurological signs due to vascular ischaemia
102
Which type of stroke is more common - haemorrhagic or ischaemic?
Ischaemic stroke
103
List causes of ischaemic stroke
Atherothrombosis Artery stenosis Emboli
104
List causes of haemorrhagic stroke
Hypertension Bleeding, trauma Anticoagulant medication Thrombolysis treatment
105
List risk factors for having a stroke
``` Hypertension Smoking Alcohol excess Low exercise High cholesterol Atrial fibrillation Diabetes Malignancy Anti-phospholipid syndrome Thrombophilia ```
106
List clinical features of stroke
``` Focal neurological signs relate to cerebral vascular territories Limb weakness Facial droop Altered consciousness Slurred speech ```
107
List clinical features of hemisphere infarct
Contralateral hemiplegia Slurred speech Dysphasia Homonomous hemianopia
108
List clinical features of a brainstem infarct
Quadriplegia Disturbed vision "locked-in syndrome"
109
List clinical features of a lacunar infarct
Motor and/or sensory deficit | Cognition usually intact
110
What investigations would you order for suspected stroke?
ECG Carotid doppler USS CT/MR angiography Bloods - FBC, U+E, glucose, antibodies
111
Outline treatment of acute stroke
ABCDE approach Antiplatelet (once haemorrhagic stroke excluded!) - aspirin 300mg, dipyridamole 200mg Thrombolysis if not contraindicated Lifelong warfarin prophylaxis if embolic stroke
112
What is a transient ischaemic attack (TIA)?
Temporary occlusion of cerebral circulation, causing focal neurological deficit without impaired consciousness
113
List causes of TIA
``` Atherothromboembolism Mural thrombus (AF, post-MI) Valve disease Hyperviscous blood (polycythaemia, sickle cell) Vasculitis ```
114
List clinical features of TIA
Single or multiple attacks Amaurosis fugax - curtain down over vision Carotid bruit Signs mimic vascular territory
115
Outline treatment of TIA
Control CVS risk Aspirin 300mg/clopidogrel 75mg Carotid endarterectomy Avoid driving for 1 month
116
What is delirium?
Acute confusional state involving impaired cognition and fluctating awareness
117
List risk factors/causes of delirium
Post-operative period Infection Withdrawal from substances Drugs - opiates, BZD's, antibiotics, anticonvulsants, levodopa Metabolic upset (glucose, urea, anaemia, liver failure)
118
List clinical features of delirium
``` Disordered thinking Euphoria or sedation Language impairment Illusions Reversed sleep-wake cycle Inattention Unaware Memory deficit ```
119
What investigations would you order for suspected delirium?
``` Bloods - FBC, U+E, glucose, LFT's Sepsis screen (urinalysis, CXR, culture) ECG, EEG Lumbar puncture CT/MRI Usually clinical diagnosis, however ```
120
Outline acute management of delirium
Optimise environment, reduce stressors Hearing aids, glasses Haloperidol BZD if alcohol withdrawal
121
What is Parkinson's disease?
Neurodegenerative disorder of dopaminergic neurons in the substantia nigra pars compacta
122
List causes/risk factors of Parkinson's disease
``` Ageing Non-smokers Genetics: LRRK2 (dominant), parkin (recessive) Lewy body dementia Post-encephalopathy Hygeine hypothesis ```
123
List clinical features of Parkinson's disease
``` Bradykinesia Resting tremor Postural instability Rigidity Non-motor features: anosmia, depression, dementia, hallucinations, sleep disorder, autonomic upset ```
124
What investigations would you order for Parkinson's disease?
Extrapyramidal examination | Dopamine transporter imaging
125
Outline treatment for Parkinson's disease
``` Levodopa + carbidopa COMT inhibitor (tolcapone) Dopamine agonist (bromocriptine) MAO inhibitor (selegelline) Education, exercise Deep brain stimulation ```
126
What is multiple sclerosis?
Inflammatory (T-cell mediated) demyelinating disorder of the CNS
127
What are the different types/subdivisions of MS?
Relapsing remitting (most common): relapses with partial/full recovery Primary progressive: gradually worsening without remission Secondary progressive: gradually worsening with remissions Relapsing progressive: secondary progressive with remissions in the progressive phase
128
List causes/risk factors for MS
``` Temperate areas Females Early exposure to sublight Genetics, family history Epstein-Barr virus Autoimmunity ```
129
List clinical features of MS
Unilateral optic neuritis Numbness/tingling in limbs Paraesthesia Paraparesis Weak flexors of arms, extensors of legs (pyramidal) Brainstem dysfunction - diplopia, nystagmus, vertigo Cerebellar dysfunction - ataxia, intention tremor
130
What investigations would you order for MS?
LP for CSF PCR - shows oligoclonal bands of IgG MRI shows demyelination Mainly clinical diagnosis, however
131
Outline treatment of MS and its complications (spasticity, fatigue, sensory disturbance, lower urinary dysfunction)
``` Acute flare: IV steroid (methylprednisolone) B-interferon Biologics Spasticity - botox, baclofen Fatigue - amantadine, modafinil Sensory - gabapentin, amitryptiline Lower urinary dysfunction - oxybutinin ```
132
What is dementia?
Progressive deficit in cognition and mental function with memory loss
133
List causes/risk factors for dementia
``` Alzheimer's, vascular, Lewy body, frontotemporal Hypothyroidism Low B12/folate Depression Syphilis Malignancy Haematoma Ageing Family history, genetics Vasculitis Infection ```
134
List clinical features of dementia
``` Wandering Aggression Flight of ideas Irritability Repetitive behaviour Memory loss ```
135
What investigations would you do for dementia?
Cognitive tests (AMTS, Addenbrooke's) MMSE Bloods - FBC, U+E, glucose CT scan to exclude structural lesions
136
List clinical features of vascular dementia
Previous CVS events (strokes, lacunar infarcts) Sudden-onset Stepwise deterioration
137
What are Lewy bodies?
Tangled tau and alpha-synuclein proteins that deposit in cortex and brainstem in Lewy body dementia
138
List clinical features of Lewy body dementia
Fluctuating cognitive impairment Visual hallucinations Parkinsonism
139
List clinical features of frontotemporal dementia
``` Personality and behaviour changes Executive impairment Early preservation of memory Disinhibition Stereotyped behaviour ```
140
What is the pathophysiology of Alzheimer's disease?
Deposition of B-amyloid plaques (breakdown product of amyloid precursor protein), causing neuronal damage, loss of ACh and neurofibrillatory tangles of tau
141
Which genetic allele is associated with Alzheimer's?
apoE4
142
List clinical features of Alzheimer's disease
``` Loss of visuospatial skill Language difficulty Forgetfullness Lack of insight Impaired organisation and planning Depression ```
143
What structural changes occur in Alzheimer's disease?
Neuronal loss in hippocampus, amygdla, temporal cortex and Nucleus basalis of Meynert
144
Outline treatment of Alzheimer's disease
Support and symptom relief, specialist care Palliative (BZD's, antipsychotic) Cholinesterase inhibitor (donepezil) NMDA antagonist (memantine, rivastigmine) Antidepressants
145
What is myasthenia gravis?
NMJ disorder caused by autoimmunity to post-synaptic ACh receptors
146
List causes/risk factors for myasthenia gravis
Females Thymic hyperplasia Autoimmunity
147
List clinical features of myasthenia gravis
Increasing muscular fatigue and weakness, tends to start in eyes (ptosis) Bulbar palsy (chewing, swallowing difficulty) Dysphonia
148
What investigations would you do for myasthenia gravis?
``` Anti-ACh receptor antibody Anti-MuSK antibody Neurophysiology - EMG CT thymus (thymoma) Tensilon test (edrophonium improves power) ```
149
Outline treatment for myasthenia gravis
Acetylcholinesterase inhibitor (pyridostigmine) Immunosuppression (prednisolone, azathioprine) Thymectomy + IV Ig
150
What treatment is given in myasthenia crisis?
Ventilatory support Plasmapharesis IV Ig
151
What is Lambert Eaton Myasthenic Syndrome?
NMJ disorder due to autoimmune destruction of pre-synaptic Ca channels
152
Which cancer is LEMS associated?
Small cell lung cancer
153
Outline treatment of LEMS
3,4-diaminopyridine | IV Ig
154
What inheritance pattern do Duchenne/Becker muscular dystrophy follow? Which protein is affected?
X-linked recessive disorders in dystrophin production, a component of the cytoskeleton
155
List clinical features of Duchenne muscular dystrophy
Gower's sign (walk up body to stand up) Calf pseudohypertrophy Proximal limb weakness Respiratory failure, leading to death
156
What investigations would you order for suspected muscular dystrophy?
CK | Muscle biopsy
157
What is the commonest muscular dystrophy?
Myotonic dystrophy
158
What inheritance pattern does myotonic dystrophy follow? Which protein is affected?
Autosomal dominant Cl- channelopathy
159
List clinical features of myotonic dystrophy
``` Distal weakness Myotonia Hand/foot drop Facial weakness Male frontal baldness Cataracts Genital/gonadal atrophy Cognitive impairment ```
160
What investigations would you order for myotonic dystrophy?
Glucose intolerance Histology - central nuclei Low levels of IgG
161
What treatment options may be tried for myotonic dystrophy?
Phenytoin | Procainamide
162
What happens in motor neuron disease?
Progressive degeneration of motor neurones in the motor cortex, cranial nerve nuclei and anterior horn cells
163
Is sensation usually preserved in motor neurone disease?
Yes
164
List causes/aetiology of motor neuron disease
Genetics - hexanucleotide repeat in C9ORFT22 on c9 | Family history
165
List clinical features of motor neurone disease
``` Focal onset of weakness with continuous spread Usually affects upper extremities UMN/LMN signs Stumbling spastic gait Foot drop Weak grip ```
166
What treatment options are there for motor neuron disease?
MDT and supportive care Anti-glutaminergic (riluzole) Ventilatory support
167
List the main phenotypes of motor neuron disease
Amyotrophic lateral sclerosis Progressive muscular atrophy Progressive bulbar palsy/pseudobulbar palsy Primary lateral sclerosis
168
Does amyotrophic lateral sclerosis affect UMN or LMN?
Both UMN and LMN involvement!
169
Does progressive muscular atrophy affect UMN or LMN?
Purely LMN - lesion of anterior horn cells
170
What part of the CNS does pseudobulbar palsy affect?
Cranial nerves IX, X, XI, XII | Purely UMN lesion
171
Does primary lateral sclerosis affect UMN or LMN?
UMN lesion - loss of Betz cells in motor cortex
172
What is mononeuropathy?
Lesion of individual peripheral or cranial nerve
173
List causes/aetiology of mononeuropathy
Trauma or pressure Haemorrhage Nerve entrapment Tumour invasion
174
What is mononeuritis multiplex? List some causes
Lesion of 2 or more peripheral nerves at the same time | Causes include GPA, AIDS, amyloid, rheumatoid, diabetes, sarcoid
175
List clinical features of mononeuropathy
Pain Weakness Paraesthesiae Usually in distribution of specific nerve affected
176
How might mononeuropathy be treated?
Surgical decompression Rest, heat, NSAID Splint Steroid
177
What are the roots of the median nerve? Mononeuropathy of this nerve causes what clinical signs?
C6, C7, C8, T1 Weak abductor pollicis brevis Reduced sensation of radial 3.5 digits (Carpal tunnel syndrome)
178
What are the roots of the ulnar nerve? Mononeuropathy of this nerve causes what clinical signs?
``` C7, C8, T1 Weak wrist flexors Hypothenar wasting Claw hand Reduced sensation over medial 2.5 digits ```
179
What are the roots of the radial nerve? Mononeuropathy of this nerve causes what clinical signs?
C5, C6, C7, C8, T1 Wrist/finger drop Reduced sensation in anatomical snuff box
180
What are the roots of the phrenic nerve? Mononeuropathy of this nerve causes what clinical signs?
C3, C4, C5 Orthopnoea Raised hemidiaphragm
181
What are the roots of the sciatic nerve? Mononeuropathy of this nerve causes what clinical signs?
L4, L5, S1, S2, S3 Weak hamstrings Foot drop Numbness and tingling down back of leg
182
What are the roots of the common fibular nerve? Mononeuropathy of this nerve causes what clinical signs?
L4, L5, S1 Foot drop Weak dorsiflexion/eversion Reduced sensation over dorsum of foot
183
What are the roots of the tibial nerve? Mononeuropathy of this nerve causes what clinical signs?
L4, L5, S1, S2, S3 Weak plantarflexion/inversion Reduced sensation over plantar of foot
184
What is polyneuropathy?
Symmetrical generalised nerve lesions of peripheral/cranial nerves Can be acute/chronic, motor/sensory/autonomic/mixed
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List causes/aetiology of polyneuropathy?
Motor: Guillan Barre syndrome, lead poisoning, Charcot Sensory: diabetes, renal failure, leprosy
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List clinical features of polyneuropathy
Progressive paraplegia Difficulty walking UMN/LMN signs Numbness, tingling in glove-stocking distribution
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What investigations would you order for polyneuropathy?
Bloods: FBC, U+E, ESR, glucose, LFT, TSH, B12, antibodies LP for CSF - albuminocytologic dissociation EMG distinguishes demyelination from degeneration
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What treatment options are there for polyneuropathy?
Physio, OT, podiatry Splinting IV Ig for Guillan Barre Steroid

4MB Medicine (19 decks)

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