Neurology Flashcards
1
Q
What are two causes of a spontaneous non traumatic intra parenchyma loss haemorrhage?
What does it look like on imaging ?
A
Amyloid deposits
HTN
anti-coag
On CT they look like hyper dense round elliptical masses
2
Q
what nerve root is needed for the biceps muscle?
A
C6
3
Q
What nerve route is needed for the triceps muscle?
A
C7
4
Q
What does L5 do?
A
Dorsiflexion and big toe
5
Q
What does S1 do?
A
Plantar flexion
6
Q
Why can nerves not regenerate after being damaged?
A
They can no longer create GF which is needed for regeneration.
7
Q
Are motor fibres in the anterior or posterior horn?
A
Anterior Horn
8
Q
If you had anterior horn syndrome how would you present?
A
You would have a motor deficit
But sensory would be intact
9
Q
What are 3 locations that strokes can occur?
A
Cerebral
Vertebral
Retinal
10
Q
What would the clinical presentation be if you had an anterior stroke?
A
- Weakness in legs
- Sensory loss in legs
- Gait apraxia and Truncal Ataxia
- Incontience
11
Q
How would a stroke in the middle cerebral artery present?
A
- Contralateral arm and leg weakness.
- Contralateral arm and leg sensory loss
- Aphasia and Dysphagia
- Hemianopia
12
Q
How would a stroke in the PCA present?
A
Contralateral homonymous hemianopia
cortical blindness
Visual agnosia
13
Q
From what time of presentation of sx can you give thrombolysis?
A
4.5 hours
14
Q
What long term therapy will you have to prescribe to someone who has just has a stroke?
A
After 24 hours of presentation start them on clopidogrel
Also start on aspirin
Good HTN control and cholesterol control.
15
Q
What is the name given to the stroke classification chart used?
A
Bamford
16
Q
What are the 4 types of stroke mentioned in the Bamford stroke classification?
A
Total anterior classification stroke
Partial anterior stroke
Lacunar syndrome
Posterior circulation syndrome.
17
Q
What is the criteria for a Total anterior circulation stroke classification?
A
- Homonymous hemianopia
- Unilateral weakness
- Speech disorder
Need all 3
18
Q
What is the criteria for a partial anterior circulation stroke?
A
- Homonymous hemianopia
- Unilateral weakness
- Speech disorder
Need 2
19
Q
What is needed in the classification of a lacunar syndrome stroke?
A
One of the following
Pure motor
Pure sensory
Ataxic hemiparesis
Pure sensory/motor
20
Q
What diagnostic criteria is needed to diagnose posterior circulation syndrome?
A
One of the following:
- CN palsy
- Eye movement disorder
- Cerebellar dysfunction
- Isolated homonymous hemianopia
- B/l motor/sensory impairment
21
Q
What is the management of a tension headache?
A
- NSAIDs: aspirin and ibuprofen
BE AWARE of med overuse headaches
22
Q
How do you treat an acute episode of a cluster headache?
A
Oxygen
Sumatriptan
23
Q
How do you treat chronic cluster headaches?
A
CCB verapamil
24
Q
What is the presentation of GCA?
A
Scalp tenderness (severe headache) particularly when brushing hair
Jaw claudication
Sudden painless vision loss
Malaise lethargy and fever
25
How do you diagnose GCA?
Look at ESR (raised)
Do temporal artery biopsy
26
How do you treat simple GCA?
How do you treat GCA with eye involvement?
You give high dose steroids + PPI
if there is eye involvement do an IV steroid
27
Where can mononeuropathies occur ? two places
Cranial Nerves
Individual peripheral nerves
28
What is the term given to when 2 or more peripheral nerves are affected?
Mononeuritis Multiplex
29
What are some conditions part of Mononeuritis Multiplex?
Wegners
Amyloid
Rheumatoid arthritis
Diabetes
Polyarteritis nodosa
L eprosy
C ancer
30
What is the cervical root of the nerve (median nerve) compressed in carpal tunnel syndrome?
C6 to T1
31
What time of day is carpal tunnel syndrome generally worse at?
Night
Have to dangle Hand over bed to relieve the pain
32
What muscles are innervated by the median nerve?
LLOAF
Lateral 2 lumbar I also
Opponens Pollicus
Abductor pollicus brevis
Flexor pollicus brevis
33
What cervical root is the ulnar nerve from?
C7 to T1
34
how would an ulnar nerve palsy present?
Weak medial 2 lumbricals : creates a claw hand
Weak little finger
Medial wrist flexors
Interossei can’t do a good luck sign
35
What are some symptoms of Alzheimer’s Dementia?
Agnosia
Short term memory loss
Decline in language
Apraxia
Decline in visual spatial skills
36
What score out of 30 is classed as normal in MMSE?
Above 25
37
What is a mild cognitive impairment on the MMSE?
18-24
38
How do you manage dementia?
Anti acetyl cholinesterase inhibitors
Donepezil
Rivastigmine
39
What is Myasthenia Gravis?
This is an autoimmune condition against the ACh receptors in neuromuscular junction
40
What is the main cause of myasthenia gravis in
A. Men
B . Females
A. Thymic Atrophy or Tumours
B. Thymic Hyperplasia secondary to other AI conditions
41
How would someone with myasthenia gravis present?
Muscle fatigue particularly after strenuous tasks
Normally affects speech and facial expression
Can easily has ptosis and Diplopoda
Respiratory depression can occur
42
How to diagnose myasthenia gravis?
EMG and NCS will be reduced
Antibodies: anti-MUSK and anti-AChr
CT of thymus
Count to 50
Constantly look up- see if there is any lag.
43
What is the treatment for myasthenia gravis?
Anti cholinesterase such as pyridostigmine
+ Immuno supression with prednisolone and immunosuppressive like methotrexate
44
What is a myasthenia crisis?
How do you treat one?
This is when you get Resp muscle involvement and Resp distress occurs
You treat it with plasmapheresis and IV Ig
45
What causes Wernicke’s korsakoff syndrome?
Thiamine deficiency
46
3 causes of thiamine deficiency?
Starvation
Anorexia
Alcoholism
47
What is the pathophysiology behind Wernicke’s encephalopathy?
Haemorrhages and secondary gliosis in the periventricular and peri aqueductal grey matter
48
What is the tetrad behind Wernicke’s syndrome?
Nystagmus
Acute confusion
Opthalmoplegia (mostly due to a 6th nerve palsy)
Ataxia
49
What are two specific symptoms of Korsakoff Syndrome?
Confabulation
| Retrograde amnesia: inability to learn and repeat simple tasks.
50
What vitamin is thiamine?
B1
51
What is the pathophysiology behind Korsakoff psychosis?
Haemorrhages and secondary gliossi within the periventricular and peri aqueductal grey matter
You get disconnection of the mammillothalmic pathway
52
How does Korsakoff psychosis present?
1. Working memory is impaired
2. Retrograde + Antegrade amnesia
3. Confabulation
53
Where are brain tumours more common anatomically in:
A. Children
B Adults
Children: posterior fossa
Adults: supratentorial
54
What is the most common type of brain cancer?
What is the most common subdivision of this?
Glioma
Astrocytoma
55
What are the 4 grades of the WHO brain cancer scale?
1. Pilocytic astrocytoma: benign common in children.
2. Diffuse astrocytoma: pre malignant
3. Anaplastic astrocytoma
4. Glioblastoma Multiforme (GBM)
56
Do IDH-1 positive or negative tumours have a better prognosis?
Positive
57
What is a common presentation for a patient with oligodendromas ?
Seizures
58
What are 4 common symptoms of a brain tumour?
Headache worse on waking , coughing and bending forward
N+V can relieve headache
Drowsiness
Seizures
Papilloedema
59
What imaging do you do on a suspected brain tumour?
CT head
60
What is the treatment for a brain tumour?
Dexamethasone
Chemotherapy: Temozolamide +/- Radiotherapy
Surgery
Secondary epilepsy: Carbamazepine
61
3 common cancers that metastasise to the brain?
```
Renal
Bowel Ca
SCLC
NSCLC
Breast
```
62
What gene is associated with MND?
SOD-1 gene
63
Where in the body can MND affect?
Anterior horn off spinal canal
Brain
64
What are the main differences between MND and :
1. MS
2. Myasthenia Gravis
1. MS: you get sensory impairment and sphincter involvement
| 2. Myasthenia Gravis: you get eye involvement
65
If MND causes bulbar involvement what CN are involved?
CN 9 CN 10 CN 11 CN 12
66
What are the 4 types of MND?
ALS
Progressive Muscular Atrophy
Progressive Bulbar Palsy
Primary Lateral Sclerosis
67
How does the MND ALS normally present?
1. LMN and UMN signs.
2. Fasiculations + wasting- you will see Split Hand sign
3. Foot and Wrist Drop
4. Up going planters, brisk reflexes and hypertonia
68
How does Progressive Muscular Atrophy present?
LMN
Weakness
Fasciulations
69
How does Progressive Bulbar Palsy present?
1. CN 9, 10, 11 and 12 are involved
2. Choking, regurgitate and dysphagia and dysarthria
3. Fasiculating tongue
70
What is the presentation of Primary Lateral Sclerosis?
Loss of Betz cells
Spastic Leg weakness
UMN signs
Pseudobulbar palsy
71
What do you need for a diagnosis of MND?
Affects 3nor more regions LMN + UMN
Slowness seen on EMG
72
What is the treatment for MND?
Anti glutamatergic: Riluzole
Anti spasm: baclofen
Anti cholinergic: for drooling like amitriptyline
73
What is Bell’s palsy?
A LMN facial palsy
74
What two conditions increase your risk of Bell’s Palsy?
Diabetes
Pregnancy
75
What is the pathophysiology of Bell’s Palsy?
Ischaemic compression of the facial nerve
Commonly caused by HSV and VZV
76
How does Bell’s Palsy present?
Ipsilateral Facial Weakness
Ipsilateral numbness or pain
Loss of taste
Hypersensitive to noise
Drooling
Speech difficulties and loopsided smile
Ptsosis of ipslateral side
77
How would you diagnose Bell’s Palsy ?
Diagnosis by exclusion. Thus exclude the following
- Viral cause: VZV, HSV, Lyme disease
- MRI scan
- NCS
78
What is the management of Bell’s Palsy?
1. Present within 72 hours give prednisolone
| 2. Protect the eye
79
Is trigeminal neuralgia more common in males or females?
Females
80
What triggers trigeminal neuralgia?
1. Eating
2. Talking
3. Washing
4. Shaving
81
How does trigeminal neuralgia present?
1. Unilateral severe electric shock pain
| 2. Precipated by an inoculus stimuli
82
How many attacks of trigeminal neuralgia do you need before getting a diagnosis?
1. At least 3 attacks
83
How do you treat Trigeminal Neuralgia- first and second line?
1. Carbamazepine
| 2. Gamma Knife Surgery
84
What is the inheritance of Neurofibromatosis?
Autosomal Dominant
85
How does
- NF-1
- NF-2 present?
NF-1 bone deformities, cafe au last spots, short statue, large head and freckling of groin
NF-2: benign and slow growing tumours in ears: acoustic neuromas or optic nerve gliomas
86
In normal pressure hydrocephalus what signs might you see?
Papilloedema
UMN signs
Brisk reflexes
Ataxia
87
How do you treat someone with normal pressure hydrocephalus?
1. Carbonic a hydrate inhibitors
| 2. Surgical insertion of shunt
88
An abnormality of what neurotransmitter causes narcolepsy?
Hypocretin
89
To have Cataplexy what other condition do you need to have ?
Narcolepsy
90
What are 4 symptoms of narcolepsy?
- Excessive Daytime Sleepiness
- Cataplexy
- Hypnagogic hallucinations
- Sleep paralysis
Can also have autonomic symptoms like: night sweats, fainting spells and ED
91
What are 3 ways to manage a patient with narcolepsy?
1. NO DRIVING
2. Good sleep hygiene + strategic daytime naps
3. Medication like Modafinil
92
How do you diagnose Narcolepsy?
1. Epsworth Sleepiness Scale
2. Sleep Studies
3. MRI or LP (see low hypocretin)
93
What is the pathophyisiology of PD?
You get breakdown of the substantia Nigra. Causes a reduction in dopamine available.
Less dopamine means that the thalamus will be inhibited and thus causing decreased movements
94
What two substances are Lewy bodies made from?
Ubiquitin
Syn nuclein
95
What is a good diagnosis to do in someone with suspected PD?
DAT Scan
96
What are 3 non idiopathic causes of epilepsy?
```
Ion disturbance
Alcohol withdrawal
Sudden withdrawal of medications
Meningitis
SAH
Brain tumours
```
97
What is the name given to the weakness after a seizure ?
Todd’s Palsy
98
What will you see on EEG in a patient with an absence seizure?
3 Hz
99
If you have a temporal lobe epilepsy what symptoms would you expect?
Memory
Emotion
Speech
Lip smacking and funny smells
100
What symptoms would be only seen in frontal lobe epilepsy?
Motor symptoms like
Post ictal Todd’s Palsy and Jacksonian March
101
What symptoms will you get with a parietal lobe?
Tingling and Numbness
102
Give 5 investigations you would want to do in someone with epilepsy?
EEG
ECG, electrolytes, glucose, tox screen, calcium, U&E and LFT
MRI
Video subsequent attacks
103
What is the management of status epilepticus?
1. Rectal Diazepam
| 2. IV phenytoin
104
What is the treatment 1st and 2nd line for:
Generalised Tonic Clonic
Absence
Partial/Focal Seizures
Generalised: Sodium Valproate then Lamotrigone
Absence: Sodium Valproate then Lamotrigone
Partial: Carbamazepine then Sodium Valproate.
105
How many seizures do you need to have to get a diagnosis of epilepsy?
>2
106
What causes Huntington’s Disease?
A lack of GABA inhibitory neurotransmitter
107
What is the pathophysiology of Huntington’s Disease?
1. Lack of GABA
2. Decreased inhibition of Dopamine. SO more Dopamine is available
3. Increased thalamic stimulation -> leading to excessive movements
108
What is the clinical presentation of Huntington’s Disease (4 things)
1. Chorea (only stops when asleep)
2. Depression and mood changes. Normally has a prodrome of this
3. Dysphagia and Dysarthria
4. Dementia
109
What are two investigations you would like to do in someone with suspected Huntington’s disease?
Genetic Testing
CT/MRI: caudate nucleus atrophy and increased size of frontal horns.
110
What is the management of Huntington’s Disease?
1. Anti-psychotic as psychosis is common
2. Benzodiazepines: lorazepam
3. Anti-depressant: sertraline
111
What cells are attacked in Multiple Sclerosis?
1. Oligodendrocytes of CNS
| 2. T cell mediated response
112
Where are 4 places where demyelination may occur >?
Perivenular
Brain ventricles
Brain stem
Corpus Callosum
113
Name 5 symptoms of MS:
Optic neuritis *eye pain + loss of colour vision*
Pins and needles
Generalised weakness
Sphincter (urinary incontienance)
Sexual dysfunction
114
What are some
Cerebellar Symptoms and Brainstem symptoms of MS?
Cerebellar: Ataxia, speech and balance
Brainstem: Diplopoda, vertigo and facial numbness
115
How do you diagnose MS?
MRI head + Spine : periventricular, perivenular and multiple scattered plaques
LP: oligoclonal Ig G bands
2 or more CNS lesions that are disseminated in time and space.
116
How do you treat an acute relapse of MS?
IV methyl pred
117
How to treat chronic or maintenance MS?
SC interferon IB + IA n
DMARDs: dimethylfumarate
Baclofen or Botox infection
118
What are the three parts of the cerebellum?
Lingual
Vermis
Flocculonodula
119
What is the most important layer of the cerebellum?
Purkinjine Layer
120
What is the aetiology behind Cerebellar disease?
```
Toxins (alcohol)
Genetics (freidrich’s ataxia)
MS
CVS
Trauma
```
121
What are 5 ways cerebellar disease can present?
```
Dysdiakinesia
Dysphagia
Dysarthria
Intention tremor
Ataxia
Nystagmus
Clumsiness
```
122
What is the best imaging to for the cerebellum ?
MRI
123
What is a good definition of cerebral palsy?
Non progressive lesion. Pernament and non changing.
124
What is the most common variety of cerebral palsy?
Bilateral spastic cerebral palsy
125
What are 3 RF of cerebral palsy?
1. Preterm birth
2. Low birth
3. Multiple babies
4. Maternal illness
126
Up to what age can cerebral palsy occur up to?
2 years old
127
How does spastic cerebral palsy present ?
1. Increased tone
2. Scissoring Gait
3. All 4 limbs affected
4. Poor head control
128
What is a RF for presentation of cerebral palsy post birth?
Agpar Score (low <5)
Delayed Developmental milestones
Feeding difficulties
Hypotonia and Spasticity
129
What medication can be given to improve spasticity?
Baclofen
130
What are the 3 presentations of Horner’s Syndrome?
Miosis
Partial Ptosis
Hemifacial anhidrosis
131
What are 3 causes of Horner’s Syndrome?
```
CVS accidents
MS
Apical tumours: like pan coast tumour
HZ virus
Temporal arteritis
```
132
What 3 investigations might you want to do in someone with Horner’s syndrome?
CT head
CXR exclude lung cancer
CT angiogram
133
What artery is involved in an extra dural haematoma?
Middle Meningeal artery
134
What are 4 symptoms of extra dural haematoma?
1. Loss of consciousness followed by a lucid interval then another drop in consciousness
2. Severe headache, nausea and vomiting, confusion and seizures.
135
What are two investigations you would like to do in an extra dural haematoma?
Skull X Ray
CT head
136
WHat is the management of extra dural haematoma?
IV mannitol
| Neurosurgery
137
What normally causes a Sub dural haematoma?
A rupture in the bridging vein
138
What two populations are sub dural haematomas common in?
Alcoholics
| Elderly
139
How long is the period of time between injury and presenting of a SDH?
Normally a couple of weeks or months.
Can have chronic sub durals
140
what will be shown on CT head if a person has a sub dural haematoma?
Crescent shape collection
141
Management of a Sub dural haematoma?
1. IV mannitol
| 2. Burr Hole surgery
142
What type of artery is a berry aneurysm?
Saccular artery
143
What are 3 conditions that increase the chance of SAH?
PKD/
Coarctation of aorta
Erhlers Danlos syndrome
144
What will you see if you look at the eyes of someone with a SAH?
Papilloedema
Retinal Viteral Bleeds
Fixed dilated pupils
145
What other symptoms (than headache) do you get in SAH?
Collapse
Head and neck stiffness
Nausea and Vomiting
Visual changes
146
What will you see on LP if a person has a SAH?
Xanthochromia
147
How do you treat a SAH ?
CCB like nifedipine
Surgery: endo vascular coiling
IV fluids
148
What are two common pathogens of meningitis in newborns?
E. coli
Group B strep
149
What are 3 of the causative agent in adults for meningitis?
1. Strep pneumoniae
2. H influenzae
3. N menigitides
150
What are 6 signs/symptoms of meningitis?
Headache
Neck stiffness
Fever
Photophobia
Nausea and Vomiting
Altered consciousness
Sepsis? Non blanching rash
151
What is Brudzinski’s Sign?
This is when you lift a patient’s head and in response they draw up their legs
152
What is Kernig’s Sign?
Inability to straighten leg when the hip is flexed.
153
If you took the following LPs from these patients what would you see:
1. Bacterial
2. Viral
3. Chronic
1. Bacterial: turbid colour, high protein and high neutrophils, low glucose
2. Viral: high lymphocytes and normal protein and glucose
3. Chronic bacteria: raised lymphocytes, raised protein and low glucose
154
what abx do you give to contacts of someone with meningitis?
Ciprofloxacin STAT PO
155
If someone had meningitis and presented to GP. What abx would you give them?
IV benzlpencillin
Vs IV cefotaxime in hospitals
156
How do you treat meningitis in hospital?
IV cefotaxime
In community give IV benzyl penicillin.
157
What are 4 common viral causes of encephalitis?
EBV
CMV
HSV
VZV
158
What two lobes are affected in encephalitis?
Frontal and temporal
159
How does encephalitis present?
Headache
Fever
Altered consciousness
You will also see fatigue, personality changes and possible seizures
160
How do you diagnose encephalitis?
1. MRI head
2. EEG
3. LP high lymphocytes and do viral PCR on this
161
What investigations would you like to do in someone with suspected non epileptic attack disorder?
EEG
MRI head
Video tape of the seizure
You need a full ECG, blood glucose and BP assessment
Full psych assessment
162
How many NEAD seizures do you need to have to get a diagnosis?
1. You need more than 2 over 24 hours.
163
Do all patients with spinal stenosis develop symptoms?
NO
164
What are is the pathophysiology behind spinal stenosis?
Loss of joint space
This then causes you to get root ischaemia and neurogenic claudication.
165
How does cervical spinal stenosis present?
You get pain
Reduced ROM
Muscle weakness in upper limbs (struggle with motor things)
166
How do you treat cervical spine stenosis?
1. Physio
| 2. NSAIDs
167
How does lumbar stenosis normally present?
1. Back pain or buttock
2. Numbness or weakness in legs
3. Incontience
4. Burning or cramping pain.
168
How do you treat lumbar stenosis?
NSAIDs
Physio
And Steroids
Then not ok? You need surgery
169
What is Guilin barre syndrome?
It is an acute inflammatory ascending demyelinating polyneuropathy
170
What is the No.1 cause of GBS?
What are two other causes?
MAIN cause: Campylobacter jejuni
Other causes are CMV and EBV
171
How does GBS typically present?
You get it generally 1-3 weeks post infection.
You get an ascending muscle weakness
Reflexes are absent early
Note you normally don’t get numbness
Can go to the respiratory muscles!!! MAY NEED VENTILATING
172
What are some of the autonomic symptoms associated with GBS?
1. Sweating
2. Raised BP
3. Raised Pulse
173
How do you diagnose GBS?
1. You do NCS
2. LP may show raised protein
3. Routine spirometry so that FVC can be plotted. To see if there is any Resp involvement.
174
How do you treat GBS?
1. IV Ig
2. LMWH
3. Still no improvement? Plasmapheresis
175
What is a squint?
Abnormality of coordinated eye movement
176
What do the following mean in relation to squints?
Esotropia
Exotropia
ESO : when the eyes point in
EXO: when the eyes point out
177
Who are non paralytic squints common in ?
Who are paralytic squints common in?
Children
Adults
178
What are two diagnostic tests you can use for squints?
Cover Test
Corneal reflection test (if asymmetry they have a squint)
179
If you had a 3rd nerve palsy how would it present?
The eye would be down and out
Ptosis of the eyelid
Fixed dilated pupil
180
What is the eye like in a 4th nerve palsy?
Up and out!
Generally have their head tilted
CAN”T LOOK DOWN
181
What is a 6th nerve palsy? How does it present
Diplopia in horizontal plane
Likely to have eye medially
182
What is the function of the superior oblique?
Intorsion
eyelid depression
183
What is the function of the inferior oblique?
Extorsion
Eyelid elevation
184
Explain the difference between TIA and Stroke?
In a TIA you get ischaemia
In a Stroke you get infarction
185
Give 5 RF for a TIA?
```
HTN
Hyperlipidaemia
Diabetes
Smoking
Age
Past TIA
Other heart disease
```
186
What artery do 90% of TIAs occur in?
ACA
187
Give 3 symptoms of a TIA?
1. Hemiparesis
2. Amaurosis Fugax
3. Contralateral leg weakness or numbness
188
What artery are affected in 10% of TIAs?
Posterior circulation arteries
189
Give 5 ways that a posterior circulation TIA may present?
1. Double vision
2. Vertigo
3. Choking
4. Ataxia
5. Transient global amnesia
190
What scoring system to use to quantify the risk of having a stroke after a TIA?
ABCD2 score
Age >60
BP >140/90
Clinical feature: unilateral weakness, speech disturbance
Diabetes
Duration <1 hour 1 point >1 hour 2 points
191
What does a score of 6 and a score of 4 mean in relation to the ABCD2 scoring system?
Score 4: specialist in 24 hours
| Score 6: strongly predicts stroke. Review immediately
192
What meds should you start someone who had a TIA on?
Aspirin + Dipyridamole
Clopidogrel
Simvastatin
ACE inhibitor
193
What does the frontal lobe normally control? 2 things
Behaviour
| Personality
194
Give 4 functions of the frontal lobe?
1. Behaviour
2. Personality
3. Speech (Broca’s) + writing
4. Voluntary movements on contralateral side
195
is thought process affected In frontal lobe syndrome?
YES
| Intellectual functioning, thought process and memory are all affected
196
What are 3 blood tests you would want to do in a patient with suspected frontal lobe syndrome?
Syphilis
Thyroid
B12
197
Give 3 symptoms of frontal lobe disorder?
```
Loss of attention
Personality change
Normal memory
Decreased spontaneous activity
Change of affect
```
198
If you get spinal cord compression do you get UMN or LMN signs?
UMN signs
199
What are 3 causes of spinal cord compression?
Malignancy (vertebral body neoplasm)
Disc herniation
Disc prolapse
200
What are 5 symptoms/signs of a spinal cord compression? Aka myelopathy?
Back pain
Progressive weakness of the legs and UMN signs (spasticity and hyper reflexia)
Anal sphincter/ bladder involvement. Can cause painless retention
Sensory loss below the level of the lesion
Can cause arm weakness in cervical cord lesion.
201
If a patient had a spinal cord compression at the following levels would you get a LMN or a UMN sign
1. At the level of the spinal cord compression
2. Below the level of the spinal cord compression
1. At the level of the spinal cord compression: LMN signs
| 2. Below the level of the spinal cord compression: UMN signs
202
What is the gold standard investigation of choice for spinal cord compression?
MRI spine
203
Treatment of spinal cord compression?
IV dexametasone
| Surgical decompression
204
What CN are involved in a Bulbar Palsy?
9 to 12
205
Disease of what part of the brain leads to dysarthria?
The medulla
206
What is the difference between phonation and articulation:
phonation: production of sounds as a result of vocal cords
Articulation: contraction of structural muscles
207
What are 3 causes of a bulbar (CN9-12) palsy?
MS
MND
Stroke
208
What are 4 symptoms of a bulbar palsy?
1. Dysarthria
2. Speech is quiet
3. Drooling
4. LMN lesion of the tongue: issues talking and swallowing
209
What is the difference between bulbar palsy and pseudobulbar palsy?
Bulbar Palsy: LMN
Pseudobulbar palsy: UMN
210
Is bulbar or pseudobulbar more common?
Pseudobulbar palsy
211
3 causes of pseudobulbar palsy?
1. MND
2. MS
3. Stroke
212
What is the presentation of pseudobulbar palsy?
1. Slow tongue movements
2. Slow speech
3. Increased jaw jerk + reflexes
4. Mood incongruence
213
What is the best investigation for bulbar and pseudo bulbar palsies?
CT
214
What is the best treatment for:
A. Bulbar Palsy
B. Pseudo-bulbar palsy
A. Bulbar Palsy: this is when you get drooling and LMN involvement can be useful to give any anti-cholinergic (hyoscyamine)
B. Pseudo Bulbar Palsy: you get increased tone and spasticity so can be helpful to use: baclofen
215
Give the 4 main different types of groups causing myopathies?
1. ) Inherited: duchesses muscular dystrophy
2. ) Non inflammatory: thyroid, DM and Cushings
3. )Infection: polio or Lyme
4. ) Steroid or alcohol
216
How does a patient with myopathy present?
You get weakness in the shoulders and the pelvic girdle
Motor delay in children
Myalgia is common in inflammatory myopathies
217
Are reflexes gone or maintained in a myopathy?
They are maintained
218
What are two tasks that someone with a myopathy might find hard?
Shaving
| Going up stairs
219
What tests would you do on a patient with suspected myopathy? (Name 4)
1. ) Creatinine Kinase + serum myoglobin
2. ) ECG may show Hypokalaemia (increased PR internal and wide QRS)
3. Muscle biopsy
4. EMG
220
What two things do you use to treat hypokalaemia?
IV K+
| Spironolactone
221
What are two types of bacteria that can cause a brain abscess?
Staph
| Strep
222
What cervical root makes up a radial nerve?
C5 to T1
223
What 4 muscles does the radial nerve supply?
```
BEST
Brachioradialis
Extensors
Supination
Triceps
```
224
How would a lateral cutaneous nerve entrapment present?
Anterior lateral burning thigh pain
225
How would a compression of a sciatic nerve present differently to compression of the lateral cutaneous nerve?
Sciatic: you would get loss of sensation below knee laterally + causes foot drop
Lateral cutaneous nerve: presents with antero lateral burning thigh pain
226
Where does the common peroneal nerve originate from?
The sciatic nerve @ a site just above the knee
227
What is the presentation of a common peroneal nerve compression?
Foot drop
Weak ankle dorsiflexion + Eversion
Can cause a sensory loss over the dorsal
228
If you damage your tibial nerve what movement will you be unable to do?
Stand on your toes
229
4 ways a nerve can malfunction
Demyelination
Infarction
Infiltration
Compression
230
CAUDA Equina syndrome: where does the damage occur?
The cauda equina is formed from nerve roots caudal to the end of the spinal cord at L1/L2
231
What are 3 causes of cauda equina syndrome?
Herniation of the lumbar discs
Tumour or metastasis
Trauma
Infection
232
How would cauda equina present?
You will get reduced perianal sensation
Loss of sphincter tone
ED + urinary and foecal incontience
Bilateral sciatica
Legs will be flaccid and areflexic
233
What is the investigation of choice in cauda equina?
MRI !
