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Neurology Flashcards

1
Q

What are the causes of pes cavus?

A 
Charcot Marie Tooth Disease 
Fredrick’s Ataxia
Spina Bifida
Muscular dystrophies 
Cerebral palsy 
Spinal muscular atrophy 
Spinal cord tumours
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2
Q

What level is the biceps and brachioradialis reflex?

A

C5/6

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3
Q

What level is the triceps reflex?

A

C7/8

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4
Q

Weakness in big toe extension suggests what?

A

L5 nerve lesion

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5
Q

What are the features of Brown Sequard Syndrome?

A

Ipsilateral spastic paralysis
Ipsilateral loss of vibration and proprioception
Contralateral loss of pinprick sensation

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6
Q

What are the causes of a small stepped gait?

A 
Parkinson’s disease
Vascular Parkinson’s disease 
Normal pressure hydrocephalus 
Multi lacunar state 
(Later three have wide base)
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7
Q

Striata hand deformity description?

A

Flexion of MCP
Extension of PIP
Flexion of DIP

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8
Q

What are the three types of horners syndrome?

A

First order - sympathetic tract
Second order - preganglionic
Third order - internal carotid artery

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9
Q

What are the cardinal signs of horners syndrome?

A

Ptosis
Miosis
Anhidrosis

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10
Q

What is the path of sympathetic fibres to the eye?

A

First order - Hypothalamus to first synapse C8 to T2
Second order - sympathetic trunk through brachial plexus ascending to superior cervical ganglion
Third order - ascends within adventitia of ICA and joins V1

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11
Q

Causes of first order neuron horners syndrome?

A 
Lateral medullary syndrome 
Strokes affecting sympathetic outflow
Tumours 
Demyelination disease 
Syringomyelia 
Cervical cord trauma
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12
Q

Causes of second order neuron horners syndrome?

A

Trauma or surgery of

  1. Spinal cord
  2. Thoracic outlet
  3. Lung apex
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13
Q

Causes of third order neuron horners syndrome?

A

ICA dissection
ICA thrombosis
cavernous sinus aneurysm

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14
Q

What are the causes of Parkinsonism?

A 
Idiopathic Parkinson’s disease 
Parkinson’s plus syndromes
Medications - metoclopramide 
Toxins - manganese
Basal ganglia tumours 
Levy body dementia 
Dementia pugilistica 
Normal pressure hydrocephalus
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15
Q

What are Lewy bodies and what are they found in?

A

Spherical eosinophilia a-synuclein inclusions.

Can be present in

  • Parkinson’s disease
  • Lewy Body Dementia
  • Alzheimer’s Disease
  • Hallervorden Spatz Disease
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16
Q

What is hallervorden spatz Disease?

A

Autosomal recessive disorder characterised by dementia, Parkinsonism and retinitis pigmentosa.

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17
Q

What re the features suggestive of Parkinson plus syndromes?

A 
Symmetrical onset 
Vertical gaze palsy 
Early falls 
Early autonomic failure 
Early onset dementia 
Early onset hallucinations 
Cerebellar signs
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18
Q

What are the features of essential tremor that distinguish it from Parkinson’s?

A 
Symmetrical tremor 
Worse with movement 
Not associated with bradykinesia 
Involves the head 
Writing gets larger not smaller
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19
Q

What are the features and types of MSA?

A

Parkinsonism with early autonomic failure, cerebellar and pyramidal signs.

MSA-P - Parkinson’s predominant
MSA-C - cerebellar
Shy Drager - autonomic failure

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20
Q

What are the features of progressive supranuclear palsy

A 
Symmetrical Parkinson’s
Axial rigidity 
Prominent falls 
Speech and swallowing difficulties 
Frontal symptoms 
Vertical gaze palsies
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21
Q

What are the features of corticobasal degeneration.

A 
Limb apraxia 
Cortical sensory loss 
Alien limb phenomenon 
Myoclonus 
Dementia
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22
Q

What are the findings of a bulbar palsy?

A

Lower motor neuron disorder of cranial nerves 9-12.

Flaccid dysarthria
Reduced gag reflex
Fasciculations of the tongue
Reduced jaw jerk

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23
Q

What are the causes of a bulbar palsy?

A 
Motor neurone disease
Syringobulbia 
Poliomyelitis
Myasthenia Gravis 
Guillain Barre Syndrome
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24
Q

What are the features of a pseudobulbar palsy?

A

UMN lesion of cranial nerves 5,7,9,10,11,12.

Features include: 
Spastic dysarthria 
Exaggerated gag reflex
Shrunken and stiff tongue
Exaggerated jaw jerk 
Emotional lability 
Expressionless face
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25
What are the causes of pseudobulbar palsy?
Motor neuron disease Bihemispheric vascular disease Brainstem tumour Multiple sclerosis
26
What are the causes of myasthenic bulbar palsy?
Botulism | Myasthenia gravis
27
What causes myopathic bulbar palsy?
Muscular dystrophy | Polymyositis
28
What is the most common phenotype of musk positive myasthenia gravis?
``` Female Ocular Disease Respiratory muscle weakness Bulbar myasthenia Neck weakness ```
29
What medications can worsen myasthenia?
``` Penicillamine Aminoglycosides Fluoroquinolones Macrolides B-blockers Quinidine Lithium ```
30
In myasthenia, what other features would you examine for?
1. Immunosuppression (steroids) 2. Thymectomy scar 3. Autoimmune disease - T1DM (skin pricks, neuropathy) - hyperthyroidism (tachycardia, tremor, graves) - rheumatoid or SLE - hypothyroidism (slow ankle jerk, bradycardia)
31
What are differentials for myasthenia gravis?
``` Botulism Lambert Eaton Myasthenic Syndrome Mitochondrial myopathy Miller Fisher Syndrome Snake bite (cobra) ```
32
What are the features of Lambert Eaton Myasthenic SYndrome?
Antibodies against voltage gated calcium channels most commonly associated with SCLC. Proximal muscle weakness with post exercise facilitation. Reduced tendon reflexes Incremental improvement with RNS
33
What are the indications for thymectomy in a patient with myasthenia?
1. Thymoma | 2. Generalised myasthenia and <60 years of age
34
What are the different types of CMT disease?
CMT 1 - demyelination PNS disease | CMT2 - axonal PNS Disease
35
What are the features clinically of CMT1?
Peripheral motor and sensory neuropathy Classical presenting with sprained ankles, reduced reflexes, Pes cavus and reduced vibration and proprioception.
36
What are the features clinically of CMT2?
The classic features of CMT2 include distal weakness, atrophy, sensory loss, decreased deep tendon reflexes and variable foot deformity.
37
What is the most common genetic defect in Charcot Marie tooth?
Peripheral myelin protein 22 on chromosome 17
38
What is hereditary neuropathy with liability to pressure palsy?
Autosomal dominant disorder related to PMP22 deletion resulting in isolated nerve palsies in areas liable to compression.
39
What are the causes of a positive rombergs test?
``` Inherited - Fredricks ataxia - ataxic neuropathies Metabolic and Toxic - B 12 deficiency - vitamin E deficiency - medication related (cisplatins, vincristine) - pyridoxine excess Immunologic - Gillian barre - CIDP Infective - Tabes dorsalis ```
40
What are the causes of unilateral pes cavus?
``` Malunion of calaneal fracture Burns Poliomyelitis Spinal trauma Spinal cord tumours Compartment syndrome Stroke ```
41
What are the causes of bilateral pes cavus?
``` Friedrichs ataxia Muscular dystrophy Spinal muscular atrophy Cerebral palsy Syringomyelia Hereditary Spastic Paraparesis Spinal cord tumours Charcot Marie tooth ```
42
What are the differential diagnosis for MND?
``` Syringomyelia Cervical Myelopathy Multifocal motor neuropathy Inflammatory myopathies Hyperthyroidism ```
43
What are the differentials for MND presenting with only UMN signs?
HIV related myelopathy Spinal Cord Tumour Syringomyelia Cervical myelopathy
44
What are the differentials for MND presenting with only LMN signs?
Multifocal motor neuropathy Chronic Inflammatory Demyelinating Polyneuropathy Spinal Muscular Atrophy Occulopharyngeal muscular dystrophy
45
What are the trinucleotide repeat disorders?
``` Myotonic Dystrophy Fragile X syndrome Huntington’s Chorea Friedrichs Ataxia Spinocerebellar ataxia ```
46
What are the cardiovascular complications of myotonic dystrophy?
``` Ecg Changes Arrhythmias Conduction defects Mitral valve prolapse Cardiomyopathy ```
47
What are the endocrine complications of myotonic dystrophy?
Diabetes Mellitus Hypogonadism Nodular Thyroid Enlargement
48
What are the gastroenterological complications of myotonic dystrophy?
``` Dysphagia Reflux Delayed gastric emptying malabsorption Megacolon Bacterial Overgrowth ```
49
What are the respiratory complications of myotonic dystrophy?
Weakness of respiratory muscles Respiratory failure following anaesthesia Pneumonia
50
What are the differentials for distal muscle wasting and weakness?
``` Myotonic dystrophy Hereditary motor sensory neuropathy Inclusion body myositis Distal spinal muscle atrophy Finish distal myopathy Markesbury distal myopathy Welander distal myopathy ```
51
What are the causes of a sensorimotor polyneuropathy?
endo - diabetes, hypothyroid Toxins - Alcohol, Uraemia Autoimmune - GBS Inflammatory - mononeuritis multiplex, vasculitis, paraneoplastic Infiltrative - sarcoidosis Hereditary - HMSN, CMT Medications (vincristine, cisplatin, amiodarone)
52
What are the causes for a motor neuropathy?
``` Porphyria Lead poisoning Diphtheria CIDP AIDP Medications (dapsone) ```
53
What are the common causes of sensory neuropathies?
``` Alcohol Diabetes Hypothyroidism Uraemia Sarcoidosis Vasculitis Paraneoplastic Amyloidosis B12 deficiency Medications (isoniazid, colchicine, metronidazole) ```
54
What are the causes of autonomic neuropathy?
``` GBS Botulism Porphyria Paraneoplastic Diabetes Chagas’ disease HIV Amyloidosis ```
55
What are the causes of a small fibre neuropathy?
``` Diabetes Alcohol Amyloidosis Leprosy Heavy metals (gold, arsenic) Hypothyroidism Sjogrens Syndrome Primary biliary cirrhosis HIV Medications (cisplatin, disulfuram, metro) ```
56
What are the causes of demyelinating polyneuropathies?
``` CIDP Myeloma MGUS HSMN HNPP POEMS syndrome Multifocal motor neuropathy HIV ```
57
What are the three mechanisms of peripheral neuropathy.
Wallerian Degeneration Axonal degeneration Segmental demyelination
58
What are the causes of mononeuritis multiplex?
``` Diabetes Polyarteritis Nodosa Churg Strauss Syndrome Wegeners granulomatosis Rheumatoid SLE Sjögren’s syndrome Sarcoidosis Lymphoma Amyloidosis Lyme disease Leprosy ```
59
What are the emg findings of myopathies?
Small amplitude Polyphasic Rapid recruitment
60
What are the features on emg of neuropathy?
``` Large amplitude Reduced recruitment Late recruitment Fibrillations Positive sharp waves ```
61
What side is the pathology in an INO relative to the eye that cannot Adduct?
Ipsilateral
62
What are argyll Robertson pupils? | And what are the causes?
Pupils that accomodate but do not construct. ``` Neurosyphilis Diabetes Midbrain lesion (Tumour, infarct, demyelination) Lyme disease Wernickes Brainstem encephalitis ```
63
Causes of Lhermitte’s sign
Multiple sclerosis Cervical myelopathy Cervical Cord Tumour Subacute Combined Degeneration of the Cord
64
What is Uhtoffs Phenomenon?
Heat induced worsening of MS symptoms. Though to be related to heat induced conduction block or partially demyelinated fibres
65
Causes of internuclear opthalmoplegia.
``` Multiple sclerosis Brainstem lesions Wernickes encephalopathy Miller Fischer Syndrome SLE ```
66
What are the csf findings in MS?
Normal Glucose lymphocytosis Normal protein Oligoclonal bands
67
What are the causes of oligoclonal bands?
``` Multiple sclerosis Neurosarcoidosis Neurosyphilis CNS lymphoma Neuromyelitis optica Acute disseminating encephalomyelitis Progressive multifocal leucoencephalopathy Guillain Barre Syndrome ```
68
What are the causes of spastic paraparesis with dorsal column signs?
``` Multiple sclerosis Subacute combined degeneration of the Cord Tabes Dorsalis Friedreichs Ataxia Cervical myelopathy ```
69
What are the causes of transverse myelitis?
``` Bacterial infections Viral infections Demyelination Radiation myelopathy Anterior spinal artery occlusion Vasculitis ```
70
What is the treatment for spasticity?
``` Non pharm - physio (stretching, strengthening) - orthoses, braces - electrical stimulation Pharm - Benzos, baclofen - clonidine, gabapentin - botulinum injections Surgical - contracture release - tendon transfer - osteotomy ```
71
What are the causes of cervical myelopathy?
Cervical degenerative disc disease Cervical Cord tumours Ossification of posterior longitudinal ligament Trauma
72
Where is pathology commonly located in the setting of downbeat nystagmus?
Foramen magnum
73
What are the causes of downbeating nystagmus?
``` Arnold Chiari Malformation Tumours Syringobulbia Platybasia Spinocerebellar degeneration Vertebrobasilar infarction Wernickes Alcohol related Lithium toxicity Vitamin b 12 deficiency ```
74
Where is the pathology in upbeat nystagmus?
Anterior vermis of cerebellum
75
What are the causes of upbeat nystagmus?
``` Organophosphate poisoning Anticonvulsants Wernickes Encephalopthy Encephalitis Meningitis ```
76
What are the structures of the cavernous sinus?
Nerves 3,4,5(a/b),6 Sympathetic carotid plexus Intracavernous carotid artery
77
What are the causes of cavernous sinus syndrome?
``` Thrombosis Aneurysms Carotico-cavernous fistula Tumours Trauma Inflammation/infection. ```
78
What are the features of a cavernous sinus lesion?
``` Unilateral 3,4,6 nerve palsies Sensory loss in Va and Vb Loss of corneal reflex Painful ophthalmoplegia Proptosis Conjunctival congestion Visual loss Papilloedema Retinal haemorrhage ```
79
What are the causes of upgaze palsy?
``` PSP Miller Fischer Myasthenia gravis Graves ophthalmopathy Muscular dystrophy ```
80
What are the causes of a bitemporal hemianopia?
``` Pituitary tumour Craniopharyngioma Suprasellar meningioma Glioma Granuloma Metastasis ```
81
What are the causes of dissociated sensory loss?
Syringomyelia Anterior spinal artery occlusion Small fibre neuropathies
82
What are the causes of unilateral ptosis?
3rd nerve palsy Horners syndrome Myasthenia gravis Congenital
83
What are the causes of bilateral ptosis?
``` Myasthenia gravis Myotonic dystrophy Tabes dorsalis Bilateral horners syndrome Miller Fischer Syndrome Chronic progressive external ophthalmoplegia ```
84
What are the causes of a abducens nerve palsy?
``` Increased intracranial pressure Space occupying lesion Cavernous sinus pathology Trauma or surgery Basilar artery aneurysm Ischaemic or vasculopathic Demyelinating Idiopathic ```
85
What are the causes of proximal muscle weakness?
Inherited myopathies - muscular dystrophy, congenital myopathies Neurologic - spinal muscular atrophy, amyotrophic lateral sclerosis, BGS Metabolic - hypokalaemia, nutritional deficiencies, glycogen storage disorders Endocrine - thyroid disease, Cushings disease, calcium disturbance Drug induced - statins, steroids, amiodarone, zidovudine Myositis - autoimmune or viral Rhabdomyolysis - traumatic
86
What are the clinical features of multi focal motor neuropathy?
Subacute asymmetric weakness without sensory loss. Fasciculations and atrophy occurs late in the disease.
87
What are the investigation results of multifocal motor neuropathy?
Ganglioside antibody positive Normal CSF Motor conduction block
88
What is the treatment of multifocal motor neuropathy?
IVIG
89
What are the MRI features of corticobasal degeneration?
Asymmetric atrophy of posterior frontal and parietal lobes.
90
What are the imaging findings in PSP?
Hummingbird sign | Mid brain atrophy
91
What are the Imaging findings of MSA?
Hot cross bun sign
92
What are the features of myotonic dystrophy?
``` Myopathies facies Frontotemporal Baldness Ptosis Wasting of facial muscles Difficulty opening eyes after closure Distal upper limb wasting and weakness Grip myotonia Percussion myotonia Loss of reflexes ```
93
What are the extra neurological manifestations of myotonic dystrophy?
``` Diabetes Hypogonadism Goitre Cardiomyopathy Valvular heart defect Arrhythmia ```
94
Describe the lateral medullary syndrome.
Ipsilateral Horners Vertigo and diplopia Ipsilateral sensory facial loss Contralateral loss of pain and temperature in upper and lower limb
95
Describe the one and half syndrome.
Horizontal gaze palsy with impaired adduction on the same side.
96
What causes the one and half syndrome?
Dorsal pontine lesion - vascular - space occupying - demyelination
97
Causes of pupillary construction.
``` Horners syndrome Argyll Robertson pupil Pontine lesion Narcotics Older age ```
98
Causes of dilated pupil?
``` Third nerve palsy Congenital Adies pupil Iridectomy Traumatic ```
99
What are the findings in an Adies Syndrome?
Dilated pupil Absent reflexes to light Poor accomodation Decreased tendon reflexes
100
What causes Adies syndrome?
Lesion of efferent parasympathetic pathway.
101
What are the causes of 6th nerve palsy?
Raised intracranial pressure Mononeuritis multiplex Traumatic Wernickes Encephalopathy
102
Describe the Parinaud Syndrome.
Vertical gaze impairment Convergence nystagmus Pseudo Argyll Robertson Pupils
103
Causes of parinaud syndrome?
Central (dorsal midbrain lesion) - pineal gland Tumour - multiple sclerosis - vascular insult - traumatic - space occupying lesion - raised ICP
104
Causes of trigeminal nerve palsy.
``` Central - vascular - space occupying - demyelination Peripheral - aneurysm - space occupying lesion - trauma - cavernous sinus pathology ```
105
What are the causes of a cavernous sinus pathology?
Aneurysm Thrombosis Tumour
106
Causes of 7th nerve palsy?
``` UMN - vascular insult - space occupying - demyelination LMN - parotid Disease - traumatic/surgical - Bell’s palsy - Ramsay hunt syndrome - space occupying lesion (neuroma) - pontine insult (same as for UMN) ```
107
What is Ramsay Hunt Syndrome?
Peripheral facial nerve palsy with vesicular rash of the ear canal.
108
What is the treatment of Ramsay Hunt Syndrome?
Oral corticosteroids Oral aciclovir Neuropathic pain medications
109
Causes of optic neuropathy?
``` Ischaemic Optic Neuropathy - arteritic and non arteritic causes Optic Neuritis - demyelination - infections - inflammatory - genetic Neoplasm - optic glioma - meningioma Compression - thyroid eye disease - abscess - artery aneurysm Metabolic - drugs and toxins - nutritional deficiency - vit B1, B12, folate Hereditary - lebers optic neuropathy ```
110
What are the causes of an Argyll Robertson Pupil?
``` Neurosyphilis Diabetes Midbrain lesion Wernickes encephalopathy Brainstem encephalitis ```
111
What are the causes of bilateral ptosis?
``` Myaesthenia Gravis Myotonic dystrophy Tabes dorsalis Bilateral horners Bilateral 3rd nerve palsy Myopathies (Chronic progressive external ophthalmoplegia) Miller Fischer Syndrome ```
112
What are the features of a cerebellar dysarthria?
Slurred and indistinct Jerky and explosive Slow and scanning
113
What are the features of a pseudobulbar dysarthria
Harsh vocal quality Rigid articulation muscles Spastic dysarthria
114
What are the features of a bulbar dysarthria?
Weak voice Low volume with nasal quality Slurring of consonants
115
What are the features of an extrapyramidal dysarthria?
Slow and monotonous Frequent pauses Hypokinetic
116
What are the causes of Brown Sequard?
``` Demyelination Transverse myelitis Trauma Vascular insult Space occupying lesion (Tumour or infection) ```
117
What are the features of a Wernickes aphasia and where is the lesion?
Fluent aphasia Impaired comprehension and repetition Paraphasias Temporal lobe dominant lesion
118
What are the features of a Brocas aphasia and where is the lesion?
Non fluent speech Intact comprehension Impaired repetition Posterior dominant Frontal lobe
119
What are the features of a global aphasia? Where is the lesion?
Non fluent aphasia Impaired comprehension Impaired repetition Dominant MCA territory
120
What are the features of a conduction aphasia? Where is the lesion?
Fluent aphasia Intact comprehension Impaired repetition Dominant arcuate fasciculus
121
What are the findings in a cerebellopontine angle lesion?
Cranial nerve 5,6,7,8 palsy | Unilateral cerebellar signs
122
What are the causes of a cerebellopontine angle lesion?
``` Acoustic neuroma Meningioma Medulloblastoma Metastasis Basilar artery aneurysm ```
123
Causes of pes planus
``` Charcots arthropathy Arthritis Ligamentous laxity (marfans/ehlers danlos) Trauma Congenital ```
124
Causes of pes cavus
``` Charcot Marie tooth Fredriechs Ataxia Hereditary sensorimotor neuropathy Poliomyelitis Cerebral palsy Syringomyelia ```
125
Bulbar palsy | What would you like to do to finish your exam?
Spirometry Sip test Lying and Standing MEPs
126
What are the causes of oculomotor nerve palsy?
``` Vascular Space occupying lesion Demyelination Posterior com artery aneurysm Cavernous sinus pathology ```
127
What are the differentials for lower limb spasticity with hyperelfelxia?
``` Hereditary spastic paraparesis MND Syphilis HIV Spinocerrebellar ataxia Multiple Sclerosis ```
128
What is the mechanism of small fibre neuropathy?
Damage to small myelinated (A delta) and small in myelinated C fibres.
129
What are the causes of small fibre neuropathy?
``` Endocrine - diabetes Autoimmune - SLE, Sjogrens, coeliac Disease Inflammatory - amyloidosis, sarcoidosis Metabolic - Fabrys, B12 deficiency Infectious - HIV Toxic - chemotherapies, ETOH ```

RACP Clinical Exam (13 decks)

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