Neurology

Question 1

Bells palsy

Answer 1

Acute, unilateral facial weakness or paralysis of rapid onset (<72h), none forehead sparing (ipsilateral)
Unknown cause
Associated with: dry eyes, inability to close eyes, dry mouth, hyperacusis (5%), pain when eating

Most tend to start getting better in 2-3wks
Full recovery expected in 3m

Conservative - eye lubricant, tape eye shut at night, wear sunglasses, avoid swimming/dusty areas. If affects eating - use a straw for drinking + soft foods

Medical - if presenting within 72h of onset - consider prednisolone

Question 2

Acoustic neuroma

Answer 2

Benign tumour growing on the vestibulocochlear nerve
Adults aged 30-60
Sx: unilateral hearing loss, tinitus, vertigo, headaches

Tx: monitor, surgery to remove

Question 3

Horners syndrome

Answer 3

Triad of: miosis, partial ptosis/enopthalmos, anhidrosis (ipsilateral loss of sweating)

Interruption to sympathetic nerves supplying the eye

*If arm, shoulder or hand pain then think Pancoasts tumour (apical lung tumour)

Question 4

Causes of vestibulocochlear lesions

Answer 4

DM, MS, stroke, vasculitis, tumours, syphilis
Acoustic neuroma
Drugs e.g. aminoglycosides
Noise damage
Menieres disease (causes vertigo)

Question 5

Bulbar palsy

Answer 5

Result of diseases affecting the lower CN (9-12) paralysis of muscles supplied by the medulla (tongue, pharynx, larynx, SCM, trapezius)

Causes: MND, brainstem tumours, CVA of brainstem, GBS, polio

Question 6

Pseudobulbar palsy

Answer 6

Disease of the corticobulbar tracts bilaterally
Bilateral tract damage must occur

Inability to control muscles in your face

Question 7

Peripheral neuropathy

Answer 7

Many conditions involving damage to the peripheral nervous system

• Motor
• Sensory
• Autonomic

Question 8

Allodynia

Answer 8

Pain perceived following non-noxious innocuous stimulus (light touch stimulates pain)

Question 9

Antalgia/antalgic

Answer 9

Pain provoked action

Question 10

Hyperalgesia

Answer 10

Increased perception of pain

Question 11

Parasesthesia

Answer 11

Abnormal sensations e.g. pins and needles

Question 12

UMNL

Answer 12

Damage anywhere along the corticospinal tract - from cortex to anterior horn
Increased tone, pyramidal weakness, increased reflexes, clonus, generally less wasting than lower, babinski is upgoing

Question 13

LMNL

Answer 13

Damage from anterior horn distally 
Pattern of weakness corresponds to the muscle affected
Wasting + fasciculation
Areflexia
Hypotonia 
Normal babinski

Question 14

Muscle weakness grading (MRC power scale)

Answer 14

0 = no contraction
1 = flicker of contraction
2 = some active movement
3 = active movement against gravity
4 = active movement against resistance
5 = normal power

Question 15

Which hand nerves innervate which hand muscles?

Answer 15

Thenar eminence = median nerve
Hypothenar eminence = ulnar nerve
Interossei = ulnar nerve

*radial nerve just has sensory innervation to the hand - dorsal surface of lateral 3 and half digits (thumb side)

Question 16

Sensory innervation to the hand

Answer 16

Medial 1 and 1/2 fingers = ulnar
Lateral 3 and 1/2 fingers = median
Dorsal side of lateral 3 and half fingers = radial

Question 17

Median nerve mononeuropathy (C6-T1)

Answer 17

Carpal tunnel (compression of median nerve as goes through the carpal tunnel in the wrist) or trauma

LLOAF - 2 lumbricals, opponens pollicis, abductor pollicis brevis, flexor pollicis brevis
+ thenar wasting

Sensory loss over radial 3 and half fingers and palm
Aching pain in hand esp at night - relieved by dangling hand over bed + shaking it ‘wake + shake’
Tinels and phalens +ve

Question 18

Ulnar nerve mononeuropathy (C7 - T1)

Answer 18

Result of elbow trauma
Weakness/wasting of ulnar side (medial side)
Hypothenar wasting
Interossei wasting (can’t cross fingers in good luck sign)
Medial 2 lumbricals so claw hand
Sensory loss over medial 1 and 1/2 fingers

Question 19

Radial nerve mononeuropathy (C5-T1)

Answer 19

May be damaged by compression against the humerus
This nerve opens the fist
Sensory loss is variable - most reliable is loss over anatomical snuffbox
Test for wrist and finger drop

Question 20

Causes of carpal tunnel syndrome

Answer 20

Anything causing swelling/compression of the tunnel: pregnancy, myxoedema, acromegaly, myeloma, local tumours, RA, amyloidosis

Question 21

Brachial plexus mononeuropathy

Answer 21

Pain/parasthesiae + weakness in affected arm in variable distribution
Causes: trauma, radiotherapy for BC

Question 22

Phrenic (C3-C5) mononeuropathy

Answer 22

Lesions cause orthopnoea + raised hemidiaphragm on CXR

Causes: Lung Ca, TB, paraneoplastic syndromes, myeloma

Question 23

Lateral cutaneous nerve of the thigh (L2-L3)

Answer 23

Entrapment under inguinal ligament - anterolateral burning thigh pain

Question 24

Sciatic mononeuropathy (L4-S3)

Answer 24

Causes: pelvic tumours or fractures

Hamstrings and all muscles below knee affected (foot drop) with loss of sensation below knee

Question 25

Common peroneal mononeuropathy (L4-S1)

Answer 25

originates from sciatic nerve just above knee
damaged as winds way round fibula head e.g. sitting cross legged, trauma
Signs: foot drop (can’t walk on heels), weak ankle dorsiflexion/eversion + sensory loss over dorsal foot

Question 26

Tibial nerve mononeuropathy (L4-S3)

Answer 26

Originates from sciatic nerve just above knee
Inability to plantar flex (can’t stand on tiptoes), invert the foot or flex the toes
Sensory loss over the sole

Question 27

Rest tremor

Answer 27

Tremor at rest - seen in PD

Question 28

Intention tremor

Answer 28

Tremor seen when doing a movement e.g. finger pointing - seen in cerebellar lesions

Question 29

Postural tremor

Answer 29

When holding hands out against gravity - benign essential tremor, thyrotoxicosis, anxiety, b-agonists

Question 30

Re-emergent tremor

Answer 30

Postural tremor developing after a delay of about 10secs. DO NOT mistake for essential tremor. Seen in PD

Question 31

Kernig’s sign

Answer 31

Flex thigh to 90degrees - extend knee
If cannot extend - positive
Sign of meningism

Question 32

Brudkinski’s sign

Answer 32

Pt supine - bring neck and head up - if sign is positive then pt will involuntarily flex hips and thighs
Sign of meningism

Question 33

Temporal lobe epilepsy features

Answer 33

Aura, lip smaking and clothes plucking, deja vu, hallucinations

Question 34

Occipital lobe epilepsy features

Answer 34

Visual abnormalities

Question 35

Parietal lobe epilepsy features

Answer 35

Sensory abnormalities

Question 36

Syringomyelia

Answer 36

Fluid (CSF) filled cyst forms in SC and expands over time

Slowly progressive neurological symptoms