Neurology Flashcards

1
Q

Difference between Dysphasia, Dysarthria and Dysphonia

A

Dysphasia - inability to produce or understand spoken language in the ABSENCE of paralysis

Dysarthria - Difficulty with articulation, but NO disorder of content of speech

Dysphonia - alteration of sound of voice (huskiness or decreased volume)

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2
Q

Types of Dysphasia

A
  1. Receptive Dysphasia (Wernicke’s Area of the Parietal + Temporal Lobe) - inability to UNDERSTAND spoken (auditory dysphasia) or written word (alexia)
    - fluent speech but disorganised
  2. Expressive Dysphasia (Broca’s Area of the Frontal Lobe) - inability to EXPRESS/ VERBALISE
    - non-fluent/frustrated speech
  3. Nominal Dysphasia - INABILITY TO NAME OBJECTS
    - circumlocution = long winded method of describing word
  4. Conductive Dysphasia - difficulty REPEATING + NAMING OBJECTS (arcuate fasciculus lesion linking Broca + Wernicke’s)
    - intact understanding and obeys commands
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3
Q

Causes of Dysarthria

How do you identify dysarthria?

A

NO DISORDER OF CONTENT OF SPEECH
Difficulty with ARTICULATION

  1. UMN lesion of cranial nerves (7, 9, 10, 11, 12)
  2. Extrapyramidal lesions (Parkinson’s Disease) - monotonous speech
  3. Cerebellar Lesions (affects rhythm of speech –> Staccato)

Repetition of Words is the primary test

  • West Register Street
  • Baby Hippopotamus
  • No ifs, ands or buts
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4
Q

Pseudobulbar Palsy VS Bulbar Palsy

A

Pseudobulbar (SUPRANUCLEAR) = UMN weakness (infarction of bilateral internal capsule/cortices) resulting in a SPASTIC Dysarthria (as though patient trying to squeeze words out from tight lips), paralysis of the facial muscles and difficulty chewing and swallowing
- INCREASED JAW JERK

Bulbar (NUCLEAR) = bilateral LMN (peripheral nerve lesion - at the brainstem) resulting in nasal speech + dysphagia/dysarthria
- ?Motor Neurone Disease, Brain stem lesions, GBS

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5
Q

Causes of Dysphonia

A
  1. Recurrent Laryngeal Nerve Palsy (surgery/trauma/lung cancer)
  2. Laryngeal disease (URTI or vocal cord tumour)
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6
Q

DOMINANT Parietal Lobe Signs (Gertsmanns Syndrome)

A

AALF

AGRAPHIA - can’t write
ACALCULIA - can’t do mathematics
LEFT-RIGHT DISORIENTATION - can’t tell left hand from right hand
FINGER AGNOSIA - inability to name fingers

LOWER QUADRANTINOPIA (Pee Down)

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7
Q

NON-DOMINANT Parietal Lobe Signs

A

Neglect - visual and sensory
Construction and Dressing Apraxia - difficulty drawing clock face/pentagons + difficulty dressing
Astereognosis - can’t name objects in the hand
Agraphesthesia - inability to recognise numbers or letters drawn on the palm of the hand

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8
Q

Frontal Lobe Signs

A

Personality Change - Disinhibition

PRIMITIVE REFLEXES

  • snout
  • pout
  • palmomental
  • grasp

ANOSMIA

OPTIC NERVE ATROPHY / PAPILLOEDEMA (Foster Kennedy = frontal lobe tumour and compression of the Optic Nerve on ipsilateral side resulting in atrophy, but papilloedema on contralateral side from raised ICP)

GAIT APRAXIA

Expressive Dysphasia (BROCA’S AREA)

Concrete Explanation of Proverbs (A Rolling Stone Gathers No Moss, The Grass is Always Greener on the Other side)

LOSS OF MICTURITION CONTROL

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9
Q

Temporal Lobe Signs

A

MEMORY Impairment:
SHORT TERM - remember 3 objects
LONG TERM - dates of events (Year WW2 ended - 1945, Christmas Day), names of family members, DOB

UPPER QUADRANTINOPIA (Tee Up, Pee Down)

Receptive Dysphasia (WERNICKE’S AREA)

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10
Q

Occipital Lobe Signs

A

Homonymous Hemianopia - half of the visual field is completely lost

(Bilateral Occipital Lobe infarction (basilar artery stroke) = ANTON’S SYNDROME - cortical blindness with confabultation)

Alexia (inability to read - but retains ability to write)

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11
Q

Causes of UMN Lesions

A
  1. Vascular - Thrombotic, embolic or haemorrhage stroke/infarction of the brain or spinal cord
  2. Infective - meningitis / encephalitis or abscess
  3. Compressive Lesion - Neoplasm / Tumour / Meningioma / Syringomyelia
  4. Demyelinating Disease - MS
  5. Traumatic - TBI or Fracture Skull / Vertebrae
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12
Q

Causes of LMN Lesion

A
  1. Myopathy
  2. NMJ
  3. Peripheral Nerve
  4. Nerve Root
  5. Anterior Horn Cell
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13
Q

Pyramidal Tract vs Extra-pyramidal Tract

A

Pyramidal = Corticospinal Tract - controls the muscles

Extra-pyramidal = Motor Modulation System - Basal Ganglia + Cerebellar

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14
Q

Causes of Peripheral Neuropathy

A
  1. Drugs - Amiodarone, Chemotherapy (Taxanes, Vincristine + Platinum), Isoniazid
  2. Toxins - ETOH, Urea, Heavy Metals (lead)
  3. Metabolic - Diabetes, Hypothyroidism
  4. Inflammatory - Sarcoidosis, amyloidosis, GBS (AIDP), CIDP
  5. Infection - Leprosy, HIV
  6. Vitamin Deficiency / Excess - B12 deficiency, B6 excess/deficiency
  7. Malignancy - Paraneoplastic (Lung Ca), Lymphoma, Leukaemia
  8. Hereditary / Genetic - CMT, Hereditary Motor and Sensory Neuropathy
  9. Connective Tissue Disease - SLE
  10. Vasculitis - PAN
  11. Trauma - compression or traction
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15
Q

What is Mononeuritis Multiplex?

What are the causes?

A

Multifocal peripheral nerve lesions

Acute: Diabetes, Connective Tissue Disease (RA or SLE), Vasculitis (PAN)

Chronic: Sarcoid, Acromegaly, HIV, Leprosy, Lyme Disease, Cancer, CIDP

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16
Q

Causes of Spinal Cord Compression

A
  1. Vertebral - trauma, disc prolapse, spondylolithesis, tumour, infection
  2. Extradural - Infection - abscess, Malignancy - lymphoma, metastases
  3. Dural - meningioma, neurofibroma
  4. Intramedullary - Tumour - glioma, ependymoma, syringomyelia, haematomyelia
17
Q

Causes of Myopathy

A
PACEPODS
Polymyositis or Dermatomyositis
Alcohols + AIDS (HIV)
Cancer
Endocrine - cushing's, hyper-/hypo-thyrodism, acromegaly, hypo-pituitarism
Periodic Paralysis - hyepr-kalemia, hypo-kalaemia
Osteomalacia
Drugs - steroids, statins
Sarcoidosis
18
Q

Dystrophia Myotonica Clinical Features

A
Frontal Baldness
Bilateral Ptosis
Expressionless face
Atrophy of SCM
Weakness of Neck Flexion
Percussion Myotonia of the hand
Gynaecomastia
Testicular Atrophy
Cardiomyopathy
Diabetes (BSL + Urine)