Neurology Flashcards
Cranial nerve exam
General inspection - look and feel for scars/shunts
Close eyes, tell me what you smell?
Acuity
Fields
Movements
Sacades
Pupils
Fundoscopy
Face sensation
Masseter
Forehead, eyes, smile
Corneal reflex
Stick tongue out, test power, Examine tongue - fasciculations
Say AH
Gag reflex
Shrug shoulders, turn your head against my hand
Ptosis
General Inspection
One eye closed, other normal - MG or CN III palsy
Ptosis + large pupil + down and out - CNIII
Ptosis + small pupil - Horners
Bilateral - myopathy or MG
Proptosis and ptosis in one eye - orbital tumour or vascular anomaly
Differentials for complex opthalmoplegia
Multiple nerve lesions:
MS / demyelination
Mononeuritis multiplex
Cavenous sinus syndrome
Muscles:
Throid eye disease
NM Junction: MG
Miller fisher, Kearns-Sayer, botulism
Causes of anosmia
Upper respiratory tract infection
Meningioma of olfactory groove
Ethmoid tumours
Head trauma - cribiform plate fracture
Meningitis
Hydrocephalus
Congenital - Kallmann’s syndrome (hypogonadatrophic hypogonadism)
Dementia
Causes of absent light reflex but intact accomodation
and
intact light with loss of convergence
- Midbrain lesions
- Ciliary ganglion lesion (Adies)
- Parinaud Syndrome
- Bilateral anterior visual pathway lesions (bilat RAPDs)
and
- Cortical blindness
Causes of pupillary constriction
- Horners
- Argyll Robertson
- Pontine lesion
- Narcotics, pilocarpine drops
- Old age
Causes of pupillary dilatation
Mydriatics, atropine, cocaine
CNIII lesion
Adie’s pupil
Iridectomy, lens implant, iritis
Post trauma, deep coma, cerebral death
Congenital
Adie’s syndrome
Dilated pupil
Loss of direct and consentual light reflex
Slow accomodation
Decreased tendon reflexes
lesion in the efferent parasympathetic pathway
young women
Argyll Robertson Pupil
Signs:
small irregular, unequal pupil
no reaction to light
prompt reaction to accomodation
+/- decreased reflexes with Tabes
Cause:
Syphilis
Diabetes
Alchoholic or other midbrain degenerartion/lesion
Papilloedema vs papililitis
Papiloedema
usually bilateral
Swollen optic disc no venous pulsation
Normal acuity and colour vision
Large blind spot & concentric constriction of peripheral fields
Papillitis
sudden onset unilaterl
swollen optic disc
poor acuity with red desaturation
large central scottoma
pain on eyemovement
Causes of papillloedema
- Space occupying lesion
- Hydrocephalous
- IIH
- HTN grade IV
- Central retinal vein thrombus, or venous sinus thrombus
- Elevated CSF protein (ie GBS)
Causes of optic atrophy
- Chronic papilloedema
- Optic nerve compressions/divission
- Glaucoma
- Ischaemia
- Familial - retinitis pigmentosa, Leber’s, Frederich’s ataxia
Causes of optic neuropathy
- MS
- Toxic - EtoH, ethambutol
- Metabolic - vit B12 deficiency
- Ischaemia - DM, temporal arteritis, atheroma
- Familial - Leber’s disease
- Infective - EBV
Causes of cateract
Age
Endocrine - DM, steroids
Hereditary / congenital - dystophia myotonica
Occular disease - glaucoma
Irradiation
Trauma
Causes of ptosis (normal pupils)
Senile
Myotonic dystrophy
Fascioscapulohumeral dystrophy
Occular myopathy ie mitochondrial
Thyrotoxic myopathy
Myesthenia gravis
Botulism, snake bite
Ptosis + contricted pupil
Ptosis + dilated pupil
Horner’s
Tabes dorsalis
CNIII lesion
Clinical features of a third nerve palsy
Ptosis
Divergent strabismus (down and out)
Dilated pupil, unreactive to direct or consentual light with no accomodation reflex
rule out 4th nerve lesion by tilting head to the side of the lesion and looking for intorsion if intact
Causes of CNIII lesion
Compressive lesion - PCOM
infarction - DM, arteritis (pupil spared)
tumour causing raised ICP (pupil early)
demyelination
naropharyngeal carcinoma
cavernous sinus lesions
Clinical features of a CNVI palsy
Failure of abduction
Diplopia - maximal on looking to the affected side
examine fundus for papillodema
Causes of CNVI palsy
Raised ICP
tumour
trauma
vascular lesions
diabetes/other vascular
mononeuritis multiplex
inflammatory - MS
infective - subacute meningitis
Wernicke’s
Which muscle does CNIV supply?
Superior oblique - intorts the eye
Which muscle does CNVI supply?
lateral rectus - abducts
Causes of Horner’s syndrome
Orbital/retrorbital
Lateral medullary infarct - PICA
Neck - carotid dissection, malignancy
Apical tumour
Speech exam
Hello my name is Sophie, thank you for agreeing to be examined today.
What’s your full name? Are you left or right handed?
Is English your first language? Do you normally wear glasses to read?
Cookie Jar
Repeat: “No ifs and or butts”
Read command
Name objects - watch, pen
Write a sentence
Verbal command 3 step
Puh Puh Puh
Tah Tah Tah
Kah Kah Kuh
Cough
Either:v isual fields/neglect, look for a hemiparesis, acalculia, fingeragnosia.
->AF, bruits, BP, diabetic
or
Lower cranial nerves
Cerebellar exam
Parkinson’s
Urinalysis - gylcosuria or haematuria
