Neurology Flashcards
Which cranial nerves would cause diplopia?
III, IV, VI
- Diplopia
- Bilaterial ptosis
- Slurred speech
- Dysphagia
- Sluggish pupillary response to light
- Descending symmetrical muscle weakness
- Multiple skin abscess on arms and legs
Where is the problem and what is the cause?
Neuromuscular junction (SC/IM drug use => wound botulism)
What are the ddxs for descending muscle weakness (LMN)?
- Myasthenia Gravis
- Miller-Fisher syndrome (descending variation of GB)
- Botulism
What are the abnormal cerebellar signs of coordination?
- Ataxia
- Nystagmus
- Dysdiadochokinesia
- Intention tremor
- Speech - slurred, scanning
Gives 2 examples of mononeuropathy
- Carpal tunnel syndrome
* Meralgia paraesthetica
Give an example of a polyneuropathy and outline it?
Lambert-Eaton syndrome (Myasthenia Gravis variation)
• paraneoplastic (small-cell carcinoma)
• antibodies against pre-synaptic calcium channels
• gait difficulty before eye signs
• improves with muscle use
- Numbness and tingling in hands and feet
- T1DM on basal/bolus insulin
- Decreased sensation to pin prick in glove and stocking distribution (polyneuropathy)
What would you prescribe?
Duloxetine - for peripheral neuropathy, most likely due to diabetes
Where might the abnormal proteins come from in amyloidosis?
- Excess light chains in myeloma
* Chronic infection or inflammation e.g. rheumatoid arthritis
34 year old woman • Weakness in legs • Blurred vision • Pain on eye movement • Increased tone • Decreased power • Brisk reflexes • Reduced pin prick sensation • Optic disc not clear on fundoscopy
Cause of blurred vision and why?
Papillitis (optic neuritis)
- Young woman
- Inflammatory - in CNS (as it’s UMN)
- Pain
60 year old man
• Pain and paraesthesia on anterolateral thigh
• T2DM
• On metformin
• High HbA1C and BMI
• Decreased pin prick sensation on anterolateral thigh
Diagnosis and most appropriate next step in management?
- Meralgia paraesthetica
- Compression of lateral femoral cutaneous nerve by inguinal ligament
• Lose weight, avoid tight garments
If meralgia paraesthetica is PERSISTENT, what is the next step?
- Carbamazepine
* Gabapentins
Which nerve supplies the abductor pollicis brevis?
Median nerve
What can cause compression and consequential sciatica?
- Disc herniation
- Spinal canal stenosis
(lumbosacral)
55 year old man • Confusion • Chest pain • High HR • Recently moved house • Normal temp • ST depression
Most likely cause of confusion?
Toxic/metabolic - CO poisoning, non-specific ECG changes
- No headache - not vascular
- Normal temp and normal WCC - no infection
- No evidence of inflammation
- Recurrent falls
- Tremor at rest
- Rigidity
- Forgetful
- Limited upgaze
Diagnosis?
Progressive supranuclear palsy (Steele-Richardson syndrome)
- Parkinsonian features
- Up-gaze abnormality
