Neurology Flashcards
Difference between Dysphasia, Dysarthria and Dysphonia
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)
Types of Dysphasia
- Receptive Dysphasia (Wernicke’s Area of the Parietal + Temporal Lobe) - inability to UNDERSTAND spoken (auditory dysphasia) or written word (alexia)
- fluent speech but disorganised - Expressive Dysphasia (Broca’s Area of the Frontal Lobe) - inability to EXPRESS/ VERBALISE
- non-fluent/frustrated speech - Nominal Dysphasia - INABILITY TO NAME OBJECTS
- circumlocution = long winded method of describing word - Conductive Dysphasia - difficulty REPEATING + NAMING OBJECTS (arcuate fasciculus lesion linking Broca + Wernicke’s)
- intact understanding and obeys commands
Causes of Dysarthria
How do you identify dysarthria?
NO DISORDER OF CONTENT OF SPEECH
Difficulty with ARTICULATION
- UMN lesion of cranial nerves (7, 9, 10, 11, 12)
- Extrapyramidal lesions (Parkinson’s Disease) - monotonous speech
- Cerebellar Lesions (affects rhythm of speech –> Staccato)
Repetition of Words is the primary test
- West Register Street
- Baby Hippopotamus
- No ifs, ands or buts
Pseudobulbar Palsy VS Bulbar Palsy
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
Causes of Dysphonia
- Recurrent Laryngeal Nerve Palsy (surgery/trauma/lung cancer)
- Laryngeal disease (URTI or vocal cord tumour)
DOMINANT Parietal Lobe Signs (Gertsmanns Syndrome)
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)
NON-DOMINANT Parietal Lobe Signs
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
Frontal Lobe Signs
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
Temporal Lobe Signs
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)
Occipital Lobe Signs
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)
Causes of UMN Lesions
- Vascular - Thrombotic, embolic or haemorrhage stroke/infarction of the brain or spinal cord
- Infective - meningitis / encephalitis or abscess
- Compressive Lesion - Neoplasm / Tumour / Meningioma / Syringomyelia
- Demyelinating Disease - MS
- Traumatic - TBI or Fracture Skull / Vertebrae
Causes of LMN Lesion
- Myopathy
- NMJ
- Peripheral Nerve
- Nerve Root
- Anterior Horn Cell
Pyramidal Tract vs Extra-pyramidal Tract
Pyramidal = Corticospinal Tract - controls the muscles
Extra-pyramidal = Motor Modulation System - Basal Ganglia + Cerebellar
Causes of Peripheral Neuropathy
- Drugs - Amiodarone, Chemotherapy (Taxanes, Vincristine + Platinum), Isoniazid
- Toxins - ETOH, Urea, Heavy Metals (lead)
- Metabolic - Diabetes, Hypothyroidism
- Inflammatory - Sarcoidosis, amyloidosis, GBS (AIDP), CIDP
- Infection - Leprosy, HIV
- Vitamin Deficiency / Excess - B12 deficiency, B6 excess/deficiency
- Malignancy - Paraneoplastic (Lung Ca), Lymphoma, Leukaemia
- Hereditary / Genetic - CMT, Hereditary Motor and Sensory Neuropathy
- Connective Tissue Disease - SLE
- Vasculitis - PAN
- Trauma - compression or traction
What is Mononeuritis Multiplex?
What are the causes?
Multifocal peripheral nerve lesions
Acute: Diabetes, Connective Tissue Disease (RA or SLE), Vasculitis (PAN)
Chronic: Sarcoid, Acromegaly, HIV, Leprosy, Lyme Disease, Cancer, CIDP