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Neurology Flashcards

1
Q

What is the aim of a neurological examination?

A

To determine is a lesion is present and to find the anatomical site of that lesion

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2
Q

What is the acronym for what aspects of the general neurological system you should be testing?

A

Two People Can’t Resist Sex

Tone, Power, Co-ordination, Reflexes, Sensation

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3
Q

What can differences in tone tell you about the location of a lesion?

A

Increased tone - UMN

Decreased tone - LMN

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4
Q

What is cog-wheeling?

A

Cog-wheel rigidity - tremor superimposed upon rigidity

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5
Q

What is important when testing for power?

A

Comparing both sides with similar forces

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6
Q

What is the scale for the MRC criteria of power?

A 
0 = complete paralysis
1 = flicker of contraction
2 = movement against gravity
3 = movement against gravity
4 = moderate power against resistance
5 = normal power
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7
Q

How is co-ordination tested?

A

Finger-nose command - patients own nose to your finger as fast as possible - arms length away from patient

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8
Q

What is dysdiadochokinesia?

A

Inability to repeat rapid alternating movements

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9
Q

How are reflexes tested?

A

Tendon Tap

  • Hyper-reflexia - UMN
  • Hypo-reflexia - LMN
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10
Q

How is sensation tested?

A

Light touch - cotton wools bilateral
Vibration - tuning fork
Pain - pin-prick
Temperature - metal (cold) and rubber (warm)

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11
Q

What is the Glasgow Coma Scale?

A

Rates coma severity

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12
Q

What are the factors determining the Glasgow Coma Scale?

A

Ability of the patient to open their eyes, perform movement and speech

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13
Q

If a patient has a low Glasgow coma scale what does this indicate?

A

Lower the score the more severe the loss of function

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14
Q

How many categories is the Glasgow Coma Scale split up into?

A

3
Motor response
Verbal responses
Eye opening

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15
Q

What does AMTS stand for?

A

Abbreviated Mental Test Score

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16
Q

What is the function of AMTS?

A

Rapid assessment of possible dementia in elderly patients

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17
Q

Name 3 of the initial questions in the AMTS.

A

What is your age?
What is the time?
Where do you live?

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18
Q

What is a more conclusive test than the AMTS?

A

Folstein test

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19
Q

What is a stroke?

A

Focal neurological deficit lasting longer than 24 hours due to a vascular lesion

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20
Q

What is the difference between a stroke and TIA?

A

The recovery time - TIA is a focal deficit but recovers in less than 24 hours

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21
Q

What are the three classifications of stroke based on symptoms and recovery times?

A

Minor Stroke - full evolution and recovery in < 1 week - minimal/no deficit

Stroke in evolution - symptoms that worsen in the first 48 hours

Completed stroke - stage of worst neurological deficit - typically 6-8 hours into event

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22
Q

What are the two main types of strokes with regard to pathogenesis?

A

Wet stroke - Haemorrhage into brain

Dry stroke - ischaemic vaso-occlusive brain death

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23
Q

Name a type of pathology can lead to stroke-like signs and symptoms?

A

Space-occupying lesions/tumour

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24
Q

Name three risk factors of stroke.

A

Diabetes
Cigarettes
Obesity

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25
What is the usual cause of a dry stroke?
Embolism/thrombosis affecting the vessels proximal to the brain
26
What is the usual cause of a wet stroke?
Ruptured intra-cranial micro-aneurysm
27
What is the 2 main forms of treatment for a dry stroke?
Aspirin | tPA - tissue plasminogen activator - cleaves fibrin
28
Is carotid artery occlusion fatal?
It can be, but if only one carotid artery is occluded, the other artery can maintain blood supply to the brain as long as the circle of willis is patent
29
What is the primary cause of a subarachnoid haemorrhage?
Berry aneurysm in the circle of willis
30
Name 3 symptoms of a subarachnoid haemorrhage
Sudden loss of consciousness Fast pain - headache/stiff neck Kernig's sign - patient in supine position, leg raised and bent at the knee - pain in the back is a positive Kernig's sign indicating meningeal involvement
31
Describe the features of a subdural haematoma. (Venous or Arterial) (Fast or slow onset) (Key symptom)
Venous Slow onset Loss of consciousness over hours/days
32
What is the typical aetiology of an extra dural haemorrhage?
Bleed in the Middle Meningeal Artery - normally due to trauma to the head
33
What is MS?
Multiple Sclerosis - an auto-immune disease characterised by demyelination in the CNS
34
Name 3 common effects of MS on the eyes?
Blurred Vision Stabbing eye pain Fading of the colour red
35
Name 3 common effects of MS
``` Ataxia Incontinence Dementia Blindess Spastic tetraparesis ```
36
Name 3 methods of management of MS
ACTH/Methyl Prednisolone 1g IV for 3-5 days Physiotherapy Vitamin B12 injections Beta-Interferon
37
What is the definition of allodynia?
Pain from a normally painless stimulus
38
What is the definition of hyperalgesia?
Increased response to a painful stimulus
39
What is the definition of Dysaesthesia?
An abnormal/unpleasant sensation to touch
40
What is the definition of Paraesthesia?
An abnormal/unpleasant sensation with no input
41
What is the definition of Hypoalgesia?
Diminished response to painful stimulus
42
What is the definition of neuralgia?
Intermittent pain along the course of a nerve
43
What is the definition of neuropathy?
Pathological nerve damage resulting in weakness/numbness/pain
44
Name 6 characteristics that should be assessed when investigating facial pain.
``` Onset Quality (aching/stabbing/burning etc.) Location Duration Radiation Severity ```
45
What is a primary neuralgia
Corresponds exactly to the anatomical distribution of a cranial nerve - normally idiopathic
46
What are the classic features (4) of a primary neuralgia?
Unilateral Sudden and severe pain Short lasting episodes No sensory/motor impairment
47
What is the most common facial neuralgia?
Trigeminal Neuralgia
48
Name 3 methods of management for facial pain?
LA injections - temporary Botox injections alongside nerve Carbamazepine - Anti-convulsant
49
Name another form of facial neuralgia other than trigeminal neuralgia?
Glossopharyngeal Neuralgia
50
What areas (4) are commonly painful in glossopharyngeal neuralgia?
Ear, base of the tongue, angle of mandible, tonsillar fossa
51
What are the common triggers of pain in glossopharyngeal neuralgia? (5)
Chewing, swallowing, talking, yawning and coughing
52
How is a secondary neuralgia defined?
Pain due to compression, irritation, tumour or disease.
53
Name an intra-cranial secondary neuralgia.
Schwannoma (acoustic neuroma)
54
What is the typical presentation of a schwannoma?
Unilateral deafness/tinnitus
55
What are the 2 nerves normally affected in a schwannoma and what symptoms does their implication cause?
V - loss of corneal reflex VII - palsy - later presentation
56
Name a secondary neuralgia located in the cranial base.
Pagets Bone Disease
57
What is the presentation of Pagets Bone Disease radiographically?
Hazy 'cotton wool' appearance of skull primarily base and occipitally
58
What is Giant Cell Arteritis?
A condition characterised by granulomatous inflammation of mid-sized arteries
59
Name 3 general treatments for facial pain.
Sodium channel blockers e.g. carbamapezine Lidocaine injections Gamma-knife/radiothermal ablation
60
Name all 12 cranial nerves in order.
``` Olfactory Optic Occulomotor Trochlear Trigeminal Abducens Facial Vestibulocochlear Glossopharyngeal Vagus Accessory Hypoglossal ```
61
What is the purpose of the olfactory nerve and where does it radiate from and terminate?
Sensory nerve - sense of smell Radiates from the cribriform plate where the olfactory bulb passes through and the olfactory nerves terminate at the top of the nasal cavity
62
What is the loss of sense of smell called?
Anosmia
63
How is the olfactory nerve function tested?
Probing about sense of smell - can they smell their perfume, has it changed Testing smell - coffee - seeing if they can distinguish between smells
64
What 3 features are tested in optic nerve functional tests?
Visual Acuity - ability to focus Visual Fields - breadth of vision Pupillary reflexes - reflex to stimulus (light)
65
What occurs in the optic chiasm?
Decussation of the nasal fields (medial fields) of each retina
66
What happens if there is damage to the optic chiasm?
Bi-temporal hemianopia (tunnel vision)
67
How can a pituitary tumour affect vision?
Pushes on optic chiasm - bitemporal hemianopia - tunnel vision
68
How is the optic nerve tested?
Focus tested through moving finger towards patients nose and testing to see whether eyes cross over Covering eye wiggling and moving finger from a starting position (arms length) to the middle of the patient - testing visual fields Shine light in one pupil - testing for direct and consensual reflexes
69
What reflexes (2) are you observing when testing pupillary reflex?
Direct reflex - response to light in the eye you shine light in Consensual Reflex - response to light in other eye
70
How do you determine the presence of an optic nerve lesion and which side is affected?
Where direct reflex is lost this is the side with the lesion: When light is shone in eye - no direct reflex When light is shone is other eye - consensual reflex maintained
71
What is the difference in effects between an optic lesion and occulomotor lesion?
Optic nerve lesion: Where direct reflex is lost this is the side with the lesion: When light is shone in eye - no direct reflex When light is shone is other eye - consensual reflex maintained Occulomotor lesion: Present in eye where there is no direct or consensual reflex but where the opposite eye demonstrates both direct and consensual reflexes
72
What nerves supply extra occular muscles?
III, IV and VI
73
What are the 7 extra occular muscles?
``` Levator Palpebrae superioris Superior oblique Inferior oblique Superior rectus Medial rectus Lateral rectus Inferior rectus ```
74
Which cranial nerves supply the extra-occular muscles and which nerve supplies which individual muscle?
III - Sup, Med, Inf. rectus, sphincter pupillae, inferior oblique and Levator Palpebrae superioris IV - Superior oblique VI - Lateral rectus
75
What is the effect of a palsy of cranial nerve IV?
Diplopia - looking down and in
76
What is the effect of a palsy of cranial nerve VI?
Diplopia - looking laterally
77
What are the branches of the trigeminal nerve?
V1, 2, 3
78
What type of nerve is the trigeminal nerve (motor or sensory)?
Motor and sensory
79
What is the pseudo-chemical equation used to memorise the innervation of the extra-occular muscles?
LR6(SO4)3
80
How is the trigeminal nerve tested?
Sensory - Light touch bilateral across 3 areas with cotton wisp and corneal reflex Motor - Jaw jerk
81
What are the potential causes of a trigeminal nerve palsy (UMN and LMN)?
UMN - Ischaemia, tumour, MS | LMN - acoustic neuroma, cavernous sinus lesion
82
What type of nerve is the facial nerve (motor or sensory)?
Sensory and motor
83
What is the sensory component of the facial nerve?
Taste to the anterior 2/3rds via chorda tympani
84
What is the function of the motor component of the facial nerve?
Muscles of facial expresion, and secretomotor function to lacrimal submandibular and sublingual salivary glands
85
How do you test the facial nerve?
Primarily testing of motor function as smell (olfactory) provides most of taste senses. Forced opening of closed eyes Squeezing of puffed cheeks Opening of pursed lips
86
What are the primary functions of the vestibulocochlear nerve?
Hearing and balance
87
How do you test vestibulocochlear nerve function?
Whispering into each ear | Checking balance or presence of nystagmus or vertigo
88
What is the function of cranial nerve IX?
Sensory to tonsillar fossa and pharynx Taste to the posterior 1/3rd of the tongue and parasympathetic innervation of the parotid glands
89
How do you test cranial nerve IX functionality?
Gag reflex by touching tonsillar fossa
90
What is the function of cranial nerve X
Vagus - motor function to pharynx, larynx and soft palate
91
How do you test cranial nerve X functionality?
Ask patient to say ahh - visualise uvula and soft apalte and initiate gag reflex
92
How do you detect the presence of a deficit in function of cranial nerve X?
Soft palate will lie lower on side of lesion Uvula will point away from side of lesion
93
How do you test cranial nerve XI functionality?
Shrug test against resistance and turning head against resistance.
94
What is the function of cranial nerve XII?
Motor function to the tongue (anterior 2/3rds)
95
What is the sign of a deficit in function of cranial nerve XII?
Tongue deviation to a side (which ever side the deviation lies is where the lesion is)

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