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Year 4 Semester 2 > Neurology > Flashcards

Neurology Flashcards

1
Q

What does the dorsal column pathway include?

A

Proprioception
Vibration
Finetouch

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2
Q

What does the spinothalamic pathway include?

A

Pain

Temperature

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3
Q

What is the parasympathetic NS?

A

Rest and digest

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4
Q

What is the sympathetic NS?

A

Fight or flight

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5
Q

What does the autonomic NS include?

A

Parasympathetic NS

Sympathetic NS

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6
Q

Excitatory neurotransmitters?

A 
Glutamate
Acetylcholine
Noradrenaline
Serotonin
Dopamine
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7
Q

Inhibitory neurotransmitters?

A

GABA

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8
Q

Primary headache syndromes?

A 
Migraine
Tension-type headache
Cluster headache
Medication overuse headache
Benign cough headache
Benign exertion headache
Hypnic headache
'Ice pick' headache
Coital/sex headache
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9
Q

Migraine criteria?

A

> 5 attacks
4-72 hours
≥ 2 of: unilateral, pulsating, moderate/severe pain. avoidance of routine physical activity
Nausea and/or vomiting OR photophobia/phonophobia

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10
Q

Migraine prophylaxis?

A

B-blockers e.g. propanolol
Anti-epileptics e.g. topiramate, sodium valproate
Anti-depressants e.g. amitryptyline

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11
Q

Migraine treatment?

A

Aspirin 900 mg
Anti-emetics e.g. metoclopramide
Triptans

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12
Q

Tension-type criteria?

A

≥ 10 episodes
30 mins-7 days
≥ 2 of: bilateral, non-pulsating, mild/moderate pain, not aggravated by routine physical activity
No nausea/vomiting

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13
Q

Cluster headache criteria?

A 
≥ 5 attacks
Severe/very severe unilateral
15-180 mins
Ipsilateral conjunctival injection, lacrimation, nasal congestion, rhinorrhoea, eyelid oedema, forehead/facial sweating, mitosis/ptosis, sense of restlessness/agitation
Frequency 1-8 per day
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14
Q

Cluster headache treatment?

A

High flow oxygen
SC triptan
Avoid triggers

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15
Q

Cluster headache prophylaxis?

A

Corticosteroids
Verapamil
Lithium

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16
Q

Secondary headache types?

A

Vascular: subarachnoid haemorrhage, intracerebral haemorrhage, subdural haematoma, stroke, intracranial venous thrombosis, carotid/vertebral direction, GCA cerebral venous thrombosis
Infection: meningitis, encephalitis
Pressure: raised ICP, low ICP
Ocular: glaucoma, optic neuritis, eye strain
Facial pain: trigeminal neuralgia
Other: hypercapnia, drugs (e.g. anti-hypertensives)

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17
Q

Red flags for headaches?

A 
Explosive onset/very severe at onset
Recent significant change in pattern
Altered mental status
Onset with exertion, cough, sexual activity
Age > 50 years
Immunosuppression
Neurological abnormalities
Decreased LOC
Meningismus, fever
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18
Q

New, acute headache?

A

Intra-cranial infection
Intra-cranial haemorrhage
First presentation of benign intermittent headache

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19
Q

Recent, subacute headache?

A

Raised ICP
GCA
Transient benign headache

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20
Q

Longer-standing, chronic headache?

A

Primary headache syndrome

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21
Q

Headache alone?

A

Benign cause

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22
Q

Headache and nausea, vomiting, photo/phono-phobia?

A

Serious cause- meningitis, encephalitis

Migraine

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23
Q

Headache and fever, infectious features?

A

Meningitis

Encephalitis

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24
Q

Headache and neurological features?

A

Migraine

Serious cause

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25
Headache examination and investigations?
``` History Infection features: temp, rash Blood pressure URT examination Neurological examination Cervical spine Bloods: ESR Lumbar puncture: pressure, white cells (infection, inflammation), bilirubin (subarachnoid haemorrhage), xanthrochromic (subarachnoid haemorrhage) ```
26
Causes of blackouts?
Syncope Epileptic seizure Functional/non-epileptic seizure Hypoglycaemia
27
Features of an epileptic seizure?
``` Long duration Confusion Long recovery Cyanosis Tongue biting Jerking Can have stiffness May have a warning ```
28
Features of syncope
``` Short duration Quick recovery Pallor Can have some jerking May/may not have a warning ```
29
Blackout investigations?
May not need any ECG Some syncope cases: ambulatory ECG, tilt-table testing Some epilepsy cases: EEG, cerebral imaging
30
Blackout definition?
Episodes of loss of consciousness
31
Funny turns definition?
Discrete episode(s) due to some sort of brain event
32
Funny turn causes?
TIA Epileptic seizure Migraine Other: dissociation/depersonalisation/derealisation, anxiety/panic attacks, hypoglycaemia, sleep-related turns
33
Coma definition?
State of unconsciousness where a person: - Cannot be awakened - Fails to respond normally to painful stimuli, light, sound - Lacks normal sleep-wake cycle - Does not initiate voluntary actions
34
Common causes of coma?
Focal brain lesions: - Haemorrhagic stroke - Intracranial mass lesions- tumour, abscess Diffuse disorders: - Post cardiac/respiratory arrest - Overdose - Subarachnoid haemorrhage - Metabolic disturbances- hypoglycaemia, hepatic failure, renal failure - Infection- meningitis, overwhelming sepsis - Post-epileptic seizure - Non-convulsive status epilepticus
35
Neurological assessment for coma?
``` History General examination Pupil examination Eye movements GCS CT brain Drug levels Lumbar puncture ```
36
Immediate coma management?
Airways: open, stabilise cervical spine Breathing: ventilate, intubate Circulation: pulse, perfusion, BP, correct hypovolaemia, correct arrhythmias, large bore IV access Treat hypoglycaemia
37
Ongoing coma supportive care?
Monitor Empty stomach contents DVT prophylaxis Maintain blood gas and electrolyte homeostasis Urinary catheterisation Regular turning/air mattress to avoid pressure sores
38
Concussion definition?
Traumatic brain injury that alters the way your brain function. Effects are usually temporary but can include headaches, problems with concentration, balance, co-ordination. The brain requires time to recover
39
Mechanisms of brain injury?
Contact: coup and centrecoup, causes fractures and contusions Inertial: acceleration and deceleration Strain: deformity when mechanical force is applied Differential movements
40
Brain hernias?
``` Uncal herniation Central transtentorial herniation Subfalcine herniation Extracranial herniation Upwards cerebellar herniation Tonsillar herniation https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=2ahUKEwj4zb2HvOnhAhWD3eAKHfMJC_QQjRx6BAgBEAU&url=https%3A%2F%2Fen.wikipedia.org%2Fwiki%2FBrain_herniation&psig=AOvVaw0O1pUWRy8GBLvxUUHda2Qh&ust=1556220710633814 ```
41
Delirium definition?
``` Acute onset Fluctuating course Inattention Disorganised thinking and/or altered LOC There is a precipitating cause ```
42
Dementia definition?
Due to disease of the brain Chronic/progressive Disturbance of multiple higher comical functions Conscious not changed Cognitive functions result in functional impairment Progressive Irreversible (in most cases)
43
Frontal lobe functions?
``` Executive function Adaptive behaviour Personality- especially motivation, inhibition Impulse control Planning and initiation Behaviour sequencing Social behaviour Language production- in Broca's area ```
44
Temporal lobe functions?
Memory | Language comprehension- in Wernicke's area
45
Parietal lobe functions?
Visuospatial skills | Praxis
46
Occipital lobe functions?
Vision
47
Alzheimer's pathogenesis?
Beta amyloid plaques and tau tangles
48
Alzheimer's features?
``` Gradual onset Cognitive impairment Progressive Visuospatial function affected early Defects: short-term memory, language, praxis, visuospatial, executive functioning ```
49
Alzheimer's stages?
First 2-3 years post diagnosis Moderately severe (3-6 years) Severe (6-10 years)
50
Alzheimer's management?
Cholinesterase inhibitors for symptoms
51
Vascular dementia features?
After stroke | Step wise deterioration
52
Vascular dementia management?
``` Optimise vascular risk Stop smoking Reduce cholesterol BP control AF treatment ```
53
Dementia with Lewy Bodies features?
Fluctuates Visual hallucinations Parkinsoniam Can appear as delirium initially
54
Dementia with Lewy Bodies management?
Avoid antipsychotics | Cholinesterase inhibitors for symptoms
55
Frontotemporal dementia features?
45-65 year old onset Different types Overlaps with MND
56
Frontotempotal dementia management?
Non available
57
Dementia management?
Symptoms in Alzheimers and DLB: cholinesterase inhibitors Treat exacerbating issues: remove sedation, treat depression Post-diagnostic support for family etc. Social support Power of Attorney recommendation Support for carers
58
Epilepsy defintion?
Manifestation of abnormal paroxysmal neuronal discharges Recurrent spontaneous seizures After ≥ 2 seizures
59
Types of epilepsy?
Focal onset Generalised onset Unknown onset
60
Sub-types of focal onset epilepsy?
Focal aware Focal impaired awareness Focal to bilateral tonic-clonic
61
What causes focal onset epilepsy?
Acquired after damage
62
What causes generalised onset epilepsy?
Usually genetic
63
Sub-types of generalised onset epilepsy?
``` Absence Tonic-clonic Myoclonic Atonic Infantile spasms ```
64
Focal seizure management?
Carbamazepine | Lamotrigine
65
Generalised tonic-clonic management?
Sodium valproate | Lamotrigine
66
Absence management?
Sodium valproate | Ethosuximide
67
Myoclonic management?
Sodium valporate
68
Tonic or atonic management?
Sodium valporate | Lamotrigine
69
What is epileptic surgery for?
Focal epilepsy | Symptomatic focal- temporal, frontal, occipital lobe
70
Status epilepticus definition?
> 30 minutes of continuous seizure activity or a series of seizures without full resolution between
71
How to manage status epilepticus?
``` ABCDE assessment Benzodiazepine IV If unable PR/buccal Repeat benzodiazepine Phenytoin IV- need cardiac monitoring and notify ICU/anaesthetist ```
72
Features of parkinsonism?
Bradykinesia Rigidity Tremor Postural instability
73
Causes of Parkinsonism?
Drug-induced Idiopathic Parkinson's disease Other primary degenerative disease Miscellaneous conditions
74
Pathogenesis of idiopathic Parkinson's disease?
Lewy bodies Substantia nigra neuronal death Related loss of neuromelanin
75
Can treatment cause disease modification/prophylaxis in Parkinsons?
No
76
Parkinsons medication?
``` Direct dopamine agonists- ropinorole Levodopa Selegeline (alternative to DDAs) Amantadine (weak dopamine agonist) Anti-cholinergic drugs ```
77
Long term problems with Parkinsons medications?
``` Treatment is only symptomatic Drug toxicity CNS plasticity Reduced efficacy Shorter durations of response Fluctuations in disability Unpredictable and variable response Emergence of involuntary movements- chorea, athetosis, dystonia Confusion, hallucinations, dementia ```
78
Difference between stroke and TIA?
Stroke > 24 hours TIA < 24 hours Stroke due to: cerebral ischaemia or haemorrhage TIA due to: inadequate cerebral/ocular blood supply
79
Fixed risk factors for stroke and TIA?
``` Age M > F Race Previous vascular event Hereditary High fibrinogen Cholesterol- high LDL ```
80
Modifiable risk factors for stroke and TIA?
``` Hypertension Smoking High hip to waist ratio Hyperlipidaemia Diabetes mellitus Alcohol Depression Heart disease- AF Oestrogen containing drugs Polycythae,oa ```
81
Stroke causes?
80% ischaemic 15% haemorrhage 5% unknown
82
Presentation of a vascular lesion in stroke?
``` Sudden onset No warning Maximal at onset Body parts affected simultaneously Gradual improvements over time Repeated events Hemispheric pattern of deficit LOC is uncommon ```
83
How to investigate a stroke/TIA if presentation is ≤ 7 days?
CT scan
84
How to investigate a stroke/TIA if presentation is ≥ 7 days?
MRI scan
85
Mimics of stroke/TIA?
``` Sepsis Syncope Seizure Spreading migraine aura Functional ```
86
How to diagnose a stroke/TIA?
Localise the lesion- symptoms, neurological signs, imaging confirmation
87
Types of stroke?
Total anterior circulation stroke Partial anterior circulation stroke Lacunar stroke Posterior circulation stroke
88
How does a total anterior circulation stroke present?
All of: Unilateral weakness of face, arm and leg Homonymous hemianopia Higher cerebral dysfunction
89
How does a partial anterior circulation stroke present?
2 of: Unilateral weakness of face, arm and leg Homonymous hemianopia Higher cerebral dysfunction
90
How does a posterior circulation stroke present?
1 of: Cranial nerve palsy and a contralateral motor/sensory deficit Bilateral motor/sensory deficit Conjugate eye movement disorder Cerebellar dysfunction Isolated homonymous hemianopia or cortical blindness
91
How does a lacunar stroke present?
``` 1 of: Pure sensory stroke Pure motor stroke Sensori-motor stroke Ataxic hemiparesis ```
92
Which stroke types are usually caused by carotid disease?
Total anterior and partial anterior
93
Which stroke types have higher recurrence?
Partial anterior and posterior circulation
94
Which stroke type has the highest chance of death?
Total anterior
95
What increases risk of stroke following a TIA/minor stroke?
``` Older age Hypertension Clinical features- weakness, speech Longer duration Diabetes mellitus Positive imaging ```
96
Ischaemic stroke management?
Hyperacute: Thrombolysis CLOT retrieval Neurosurgical decompression ``` Acute: Stroke unit Supportive care- fluids, feeding Prevention and management of complications e.g. DVT prevention if immobile Manage co-morbidities ``` Rehabilitation ``` Secondary prevention: Exercise Smoking cessation Healthy weight Diet BP control Antiplatelets Statin Anticoagulation if in AF PFO closure if needed Carotid endarterectomy ```
97
Haemorrhagic stroke management?
Hyper-acute: Sometimes BP lowering ``` Acute treatment: Stroke unit Supportive care- fluids, feeding Prevention and management of complications e.g. DVT prevention if immobile Manage co-morbidities ``` ``` Secondary prevention: Exercise Smoking cessation Healthy weight Diet BP control Avoid antiplatelets Avoid anticoagulation ```
98
What is the thrombolytic drug used?
Alteplase 1 mg/kg
99
Contraindications to thrombolysis after stroke?
Minor surgery in last 14 days GI/urinary tract bleeding in last 21 days History of ICH, intracranial malignancy or intracranial AVM Symptoms suggestive of subarachnoid haemorrhage BP > 185 systolic or > 110 diastolic INR > 1.7 Hyperglycaemia > 20 Hypoglycaemia < 3
100
What is MS?
Inflammatory disease affecting all of the CNS
101
Types of MS?
Relapse-remitting (+ secondary progressive) Fulimant Primary progressive
102
Common nerves affected in MS?
Optic nerve -> optic neuritis Medial longitudinal fascicularis -> internuclear ophthalmoplegia Corpus callous -> often asymptomatic Spinal cord
103
MS presentation?
Visual:: optic neuritis, optic atrophy, Uhthoff's phenomenon, internuclear ophthalmoplegia Sensory: pins and needles, numbness, trigeminal neuralgia, Lhermitte's syndrome Motor: spastic weakness (legs), transverse myelitis Cerebellar: ataxia, tremor Other: urinary incontinence, sexual dysfunction, intellectual deterioration
104
Features contraindicatory to MS?
``` Diminished/lost reflexes Patterns of weakness that fit a single root/nerve/very variable Lots of pain Seizures Reduced consciousness Respiratory compromise ```
105
Investigations in suspected MS?
Exclude other diagnoses Routine bloods MRI brain and spine Consider LP if brain scan is normal
106
How to diagnose MS?
≥ 2 attacks with ≥ 2 objective clinical lesions | if there is lower clinical presentation you need MRI, SCF evidence
107
Types of treatment for MS?
Symptomatic Acute relapse treatment Disease modifiers
108
Symptomatic treatment for MS?
``` Physiotherapy Ani-spasmodics Neuropathic pain treatment Aids Fatigue Spasticity: baclofen, danrolene, tizanide, physiotherapy, botox Bladder dysfunction: unstable bladder (oxybutynin, tolterodine), uncoordinated bladder (self catheterisation) Erectile dysfunction: sildenafil ```
109
Acute relapse treatment for MS?
Oral steroids- 500 mg methylprednisolone
110
Disease modifying treatment for MS?
Beta-interferon: avonex, rebid, betaferon, extavia Glatiramer acetate Natalizumab
111
Is there any treatment for progressive MS?
No licensed treatment | Potential neuroprotective treatment- lamotrigine/phenytoid
112
What is myasthenia gravis?
Disorder of neuromuscular junction
113
Myasthenia gravis presentation?
``` Fatiguable weakness Diurnal variation Diplopia (double vision) Dysarthria Ptosis Dysphagia Dyspnoea Neck weakness ```
114
What exacerbates the features of myasthenia gravis?
``` Pregnancy Hypokalaemia Infection Over-treatment Change of climate Emotion Exercise Gentamicin Opiates Tetracycline Quinine Beta blockers ```
115
Investigations in suspected myasthenia gravis?
Neuroimmunology- anti-AChR antibody, anti-MUSK antibody Bloods: TFTs, B12 CT mediastinum Electromyography
116
What types of treatment options are there for myasthenia gravis?
Symptomatic Surgical Immunosuppression
117
Symptomatic treatment for myasthenia gravis?
Anti-cholinesterase
118
Surgical treatment for myasthenia gravis?
Thymectomy
119
When to consider surgery for myasthenia gravis?
Generalised myasthenia gravis < 50 years AChR antibody positive
120
Immunosuppression treatment for myasthenia gravis?
Corticosteroids Azathioprine Alternatives: methotrexate IV immunoglobulin or plasmapheresis
121
What medications to avoid in myasthenia gravis?
``` Gentamicin Clarithromycin Beta blockers Sedative drugs Calcium channel blockers Aminoglycoside antibiotics and erythromycin Benzodiazepines Curare-type muscle relaxants ```
122
Presentation of Lambert-Eaton myasthenia syndrome?
Subacute proximal weakness Gait difficulty Sensory and autonomic disturbances, especially dry mouth Bulbar and ocular muscles are rarely affected
123
Treatment of Lamber-Eaton myasthenia syndrome?
Symptomatic: 3,4-diaminopyridine Immunosuppression and plasmapheresis Treat underlying tumour
124
What is a myopathy?
Primary disorder of muscle with gradual onset symmetrical weakness
125
Acquired causes of myopathy?
``` Inflammatory Endocrine Associated with systemic illness Drug induced Toxic ```
126
Hereditary causes of myopathy?
``` Muscular dystrophies Myotonias Channelopathies Metabolic myopathies Mitochondrial myopathies ```
127
Signs in favour of a myopathy?
``` Gradual onset of symmetrical proximal weakness Specific muscle groups affected Preserved tendon reflexes No paraesthesia or bladder problems No fasciculation ```
128
Myopathy symptoms?
Cramp Contractures Myotonias- impaired muscle relaxation after forceful voluntary contraction
129
Investigations if suspect a myopathy?
Bloods- ESR, CK, AST, LDH EMG Muscle biopsy Genetic testing
130
What is muscular dystrophy?
A group of genetic diseases with progressive degeneration and weakness of specific muscle groups
131
How do muscular dystrophies present?
Unusually firm muscles (infiltration by fat/connective tissue) Marked variation in size of individual muscle fibres on histology
132
Types of muscular dystrophy?
Duchenne's muscular dystrophy Becker's muscular dystrophy Fascioscapulohumeral muscular dystrophy
133
What is a myotonic disorder?
Causes stiffness, limitation of movement, sometimes weakness and tonic muscle spasm Contractions usually provoked by cold and direct muscle stimulation
134
What is radiculopathy?
Nerve root compression
135
What is myelopathy?
Compression of the spinal cord
136
Causes of radiculopathy?
Acute disc Spondylosis Tumours Inflammatory conditions e.g. shingles
137
Presentation of radiculopathy?
Pain- in nerve root distribution, disc prolapse, mechanical causes e.g. coughing, spinal tenderness Weakness and reflex changes- in nerve root distribution Sensory loss- in nerve root distribution
138
What is myeloradiculopathy?
Presence of UMN signs or sensory signs below the level of the radiculopathy in cervical spine
139
What is polyradiculopathy?
Compression of more than one nerve root
140
Causes of polyradiculopathy?
Lumbar canal stenosis | Inflammatory e.g. Guillain-Barré syndrome, inflammatory meningitis, sarcoidosis, neoplastic process in the spinal fluid
141
Presentation of C5 radiculopathy?
Weak deltoid and supraspinatus Reduced supinator jerks Numb elbow Pain in neck/shoulder and radiating down front of arm the elbo
142
Presentation of C6 radiculopathy?
Weak biceps and brachioradialis Reduced biceps jerk Numb them and index finger Pain in shoulder radiating down arm below elbow
143
Presentation of C7 radiculopathy?
Weak triceps and finger extension Reduced triceps jerk Numb middle finger Pain in upper arm and dorsal forearm
144
Presentation of T1 radiculopathy?
Was in all intrinsic hand muscles Horner's syndrome Pain in upper anterior and medial arm
145
Presentation of L2 radiculopathy?
Weak hip flexion and adduction | Pain across upper thigh
146
Presentation of L3 radiculopathy?
``` Weak knee extension and hip abduction Reduced knee jerk Numb from mid thigh to just below knee Positive femoral stretch test Pain across lower thigh ```
147
Presentation of L4 radiculopathy?
``` Weak knee extension Reduced knee jerk Numb on medial portion of lower leg Positive femoral stretch test Pain across lower thigh ```
148
Presentation of L5 radiculopathy?
Weak toe dorsiflexion and eversion Numb anterior lower leg down to foot and lateral lower leg Positive sciatic stretch test Pain across lateral shin to dorm of foot and great toe
149
Presentation fo S1 radiculopathy?
Was ankle plantarflexion, toe inversion, knee flexion Reduced ankle jerk Positive sciatic stretch test Pain across posterior calf to lateral foot (sole) and little toe
150
Investigations in suspected radiculopathy?
MRI of relevant spinal level EMG CSF examination- in multiple radiculopathy or if evidence of systemic illness
151
Treatment of lumbar disk disease (radiculopathy)?
Rest then mobilise Education to avoid injury Consider surgery if: radicular pain continues, neurological deficit
152
Treatment of cervical disk protrusions (radiculopathy)?
Often improves spontaneously or with conservative treatment Conservative treatment: physiotherapy, soft collar, traction Consider surgery if: pain persists or marked radicular weakness
153
Treatment of benign compressive tumours (radiculopathy)?
Surgical decompression
154
Presentation of acute cauda equina compression?
``` Altering/bilateral root pain in legs Saddle anaesthesia Loss of anal tone Bladder/bowel/sexual changes Distal sensory loss in feet ```
155
Treatment of cauda equina syndrome?
Disk prolapse -> MRI and neurosurgeons Malignancy -> high dose steroids, radiotherapy, oncologists Treatment: urgent surgical decompression
156
Treatment of lumbar canal stenosis (polyradiculopathy)?
Surgical decompression
157
Red flags for back pain?
``` < 20 years > 55 years Acute onset in elderly people Constant/progressive pain Nocturnal pain Worse pain on being supine Fever, night sweats, weight loss PMH of malignancy Abdominal mass Thoracic back pain Morning stiffness Bilateral or alternating leg pain Neurological disturbance Sphincter disturbance Current/recent infection Immunosuppression Leg claudication or exercise related leg weakness/numbness ```
158
What nerve roots contribute to the median nerve?
C6-T1
159
What is median nerve compression associated with?
``` Pregnancy Rheumatoid arthritis Hypothyroidism Diabetes Acromegaly Myeloma Idiopathic ```
160
Presentation of median nerve compression at the wrist?
Carpel tunnel syndrome Weakness of abductor policies brevis Sensory loss over radial 3.5 fingers
161
Presentation of median nerve compression due to anterior interosseous nerve lesions?
Weakness of flexion of distal phalanx of the thumb and middle finger
162
Treatment for carpel tunnel syndrome?
Splinting Local steroid injection Consider decompression surgery
163
Two causes of mononeuropathy?
Axonal injury | Focal demyelination/conduction block
164
Causes of axonal injury mononeuropathies?
``` Vasculitis Diabetes mellitus Sarcoidosis Leprosy HIV CMV Lyme Hepatitis C ```
165
Causes of focal demyelination/conduction block mononeuropathies?
Chronic inflammatory demyelinating polyradiculopathy- MADSAM, MMN Multiple compression neuropathies- hypothyroidism, diabetes mellitus Hereditary neuropathy with liability to pressure palsy (HNPP) Lymphoma Severe burns Sickle cell disease
166
What nerve roots contribute to the ulnar nerve?
C7-T1
167
Presentation of ulnar nerve compression
Weakness/wasting of medial wrist flexors, interossei, medial lumbricals Hypothenar eminence wasting Weak 5th digit abduction and 4th and 5th DIP flexion Sensory loss over medial 1.5 fingers and ulnar side of hand Froment's sign
168
Treatment of ulnar nerve compression?
Rest Avoid pressure Soft elbow splinting (if symptoms continue) Hand splint- to prevent clawing Surgery- if chronic associated with weakness/failure of splinting
169
Which nerve roots contribute to the radial nerve?
C5-T1
170
Presentation of radial nerve compression?
Wrist and finger drop with elbow fixed and arm pronated | Sensory loss is variable
171
Treatment of radial nerve compression?
Most resolve spontaneously | Lively splint may help to improve hand function during recovery
172
Which nerve roots contribute to the phrenic nerve?
C3-C5
173
Presentation of phrenic nerve compression?
Orthopnoea | Raised hemidiaphragm on CXR
174
Which nerve roots contribute to the common peroneal nerve?
L4-S1
175
Presentation of common perineal nerve compression?
Foot drop Weak ankle dorsiflexion/eversion Sensory loss over dorsal foot
176
Which nerve roots contribute to the tibial nerve?
L4-S3
177
Presentation of tibial nerve compression?
Inability to stand on tiptoe (loss of plantar flexion) Inability to invert the foot or flex the toes Sensory loss over sole
178
What is mononeuritis multiplex?
Involvement of ≥ 2 peripheral nerves in a mononeuropathy
179
Causes of mono neuritis multiplex?
Diabetes mellitus Connective tissue disorders e.g. RA, SLE Vasculitis Rare: sarcoidosis, amyloid, leprosy
180
What is polyneuropathy?
Motor and/or sensory disorder of multiple peripheral or cranial nerves, usually symmetrical and widespread. Often worse distally
181
Broad causes of polyneuropathy?
Acquired Hereditary Demyelinating Axonal
182
Acquired causes of polyneuropathy?
``` Dysmetabolic- diabetes Drugs- amiodarone, antibiotics, anti-retrovirals, chemotherapy, phenytoin Mechanical or compressive Cancer Immune related Toxins- alcohol, NO Infectious ```
183
Hereditary causes of polyneuropathy?
``` Hereditary motor and sensory neuropathy Hereditary neuropathy with liability to pressure palsies Familial brachial plexopathy Familial amyloidosis Prophyria MND ```
184
Demyelinating causes of polyneuropathy
``` Immune related- Guillain Barré syndrome Multiple compression neuropathies Drugs Lymphoma Severe burns Hereditary e.g.Charcot Marie Tooth 1, HNPP Sickle cell disease ```
185
Axonal causes of polyneuropathy?
``` Dysmetabolic- diabetes Immune/infectious- HIV, CMV, Lyme, Hepatitis C, leprosy Hereditary- Charcot Marie Tooth Post infectious- Guillain Barré syndrome Sarcoidosis Drugs and toxins e.g. alcohol Cancer Vasculitis ```
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Which type of polyneuropathy can you treat?
Demyelinating ones
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Which type of polyneuropathy can you not treat?
Axonal damage ones
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Investigations into polyneuropathies?
``` Bloods: glucose, ESR, CRP, U&Es, LFTs, vitamin B12, folate Serum protein electrophoresis ANA, ANCA Chest X-ray HIV serology Others: vitamin E, vitamin A, genetic testing, lyme serology, serum ACE, serum amyloid Nerve conduction studies Electromyography ```
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Causes of sensory polyneuropathy?
Diabetes mellitus CKD Leprosy Alcohol
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Presentation of sensory polyneuropathy?
``` Numbness Pins and needles Paraesthesia Glove and stocking distribution Difficulty handling small object Signs of trauma e.g. finger burns Joint deformation Diabetic and alcohol are painful ```
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Cause of diabetic neuropathy?
Axonal degeneration
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Patterns of diabetic neuropathy?
Distal symmetrical neuropathy Asymmetrical proximal neuropathy Autonomic neuropathy Mononeuropathies and radiculopathies
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Causes of motor polyneuropathy?
Guillain Barré syndrome Lead poisoning Charcot-Marie Tooth syndrome Alcohol
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Presentation of motor polyneuropathy?
``` Often progressive Weak or clumsy hands Difficulty walking- stumbling, falls Difficulty breathing Signs of LMN lesion ```
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Guillain Barré syndrome mechanism for motor neuropathy?
Acute inflammatory demyelinating polyneuropathy
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Presentation of motor neuropathy due to Guillain Barré syndrome?
``` Acute Varying severity A few weeks after infection a symmetrical ascending muscle weakness starts Sensory symptoms in legs and arms at onset Examination findings minimal May have pain in back, buttock, thigh Muscle weakness affects legs > arms Arreflexia ```
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Treatment for motor neuropathy due to Guillain Barré syndrome?
Monitor vital capacity, if < 1 -> ventilation Monitor for evidence of autonomic dysfunction Monitor: pressure areas Venous thrombosis prophylaxis Chest and limb physiotherapy Supportive care for paralysed patients Shortening the disease course- plasma exchange, IV immunoglobulin
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Causes of autonomic polyneuropathy?
``` Diabetes mellitus Guillain Barré syndrome Sjögren's syndrome HIV Leprosy SLE Toxic Genetic Paraneoplastic ```
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Presentation of autonomic polyneuropathies?
Sympathetic: postural hypotension, decreased sweating, ejaculatory failure, Horner's syndrome Parasympathetic: constipation, nocturnal diarrhoea, urine retention, erectile dysfunction, Holmes-Adie pupil
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Effects of alcohol and drugs?
``` Intoxication Dependence Withdrawal/DTs Seizures ARBD Wernicke's encephalopathyKorsakoff's Pellagra Blackouts Central pointine and extrapontine myelinolysis Marchiafava-Bignami disease Hepatic encephalopathy Neuropathy Ataxia ```
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Treatment of alcohol dependence?
Antabuse Acamproate Naltrexone Baclofen
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What two systems are within the UMN?
Cortico-spinal system | Cortico-bulbar system
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Function of the cortico-bulbar system?
Controls the cranial LMNs
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Function of the cortico-spinal system?
Control the spinal LMNs
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What is the portico-spinal system also called?
The pyramidal system
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Third nerve palsy presentation?
Eye down and out Ptosis Mydiasis (pupil dilated)
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Sixth nerve palsy presentation?
Esotropia (one/both eyes turn in) | Diplopia (double vision)
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Seventh nerve palsy (Bell's palsy) presentation?
One sided facial droop

Year 4 Semester 2 (3 decks)

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