Neurology Flashcards
What is decerebrate rigidity and where is the lesion
Extension of all limbs and opisthotonus
Lesion rostral brainstem
Usually stuporous or comatose
What is decerebellate rigidity and where is the lesion
Hyper extension of TLs and opisthotonus
Lesion: rostral part of cerebellum
Mentation normal
May be episodic or postural
What is schiff-Sherrington and where is the lesion
Is it prognostic
Hyperextension of thoracic limbs and paralysis of pelvic limbs
Lesion: thoracic or cranial lumbar spine
Not prognostic
Ataxia - where could the lesion be
Spinal or peripheral nerve
Vestibular
Cerebellar
Grading of spinal lesions
Grade 1 - no deficits Grade 2 - paresis, ambulatory Grade 3 - paresis, non-ambulatory Grade 4 - paralysis Grade 5 - no pain sensation
Postural reactions
Paw position Hopping Hip sway Wheelbarrow Extensor postural thrust Placing responses
Cutaneous trunci where is the lesion
Wherever reflex stops between t3-l3 or if unilaterally absent there is a severe brachial plexus lesion
Horners syndrome lesion
Sympathetic supply to eye
Midbrain- cervical spinal cord - brachial plexus(t1-t3) - tympanic bulla - eye
What does the patellar reflex assess?
L4-s6 spinal segments and the femoral nerve
Menace response tests what?
Afferent
Efferent
Afferent: Retina Optic nerve Contralateral optic tract Contralateral forebrain
Efferent:
Contralateral forebrain
Ipsilateral cerebellum
Facial nerve (brainstem)
Problems seen with forebrain disease
Altered mental status (disorientation, depression)
Contralateral blindness (reduced menace but normal PLR)
Normal gait
Circling (ipsilateral, head turn, head pressing, pacing)
Decreased postural responses and proprioception in contralateral limbs
Seizures
Hemineglect syndrome
Behavioural change
Problems seen with brainstem lesions
Cranial nerve deficits (III-XII) Depression/stupor/coma Paresis of all or ipsilateral limbs Possible vestibular signs Possible decerebrate rigidity Decreased postural response in ipsilateral or all limbs Respiratory / cardiac abnormalities
Problems seen with cerebellar lesions
Normal mentation Ipsilateral menace deficit with normal vision Possible vestibular signs Possible decerebellate rigidity Intention tremors Wide based stance Truncal ataxia Hypermetria (can only be cerebellar) Proprioceptive deficits ipsilateral limbs
Vestibular nystagmus which direction is the lesion in relation to head tilt and nystagmus
Head tilt towards lesion
Fast phase away from lesion
Problems seen with myopathies
Generalised weakness and or exercise intolerance (stiff stilted gait,neck ventroflexion)
No proprioceptive deficits
Usually normal spinal reflexes unless significant muscle atrophy
Variable muscle tone and bulk
