Neurology Flashcards
Describe the features of a common peroneal nerve lesion
High stepping gait Normal Tone Wasting of anterior tibialis Weakness of dorsiflexion, eversion and EHL Sensory loss lateral lower leg Preserved reflexes
What problem do the following findings suggest?
Normal Tone
Wasting of anterior tibialis
Weakness of dorsiflexion, eversion and EHL
Sensory loss lateral lower leg
Preserved reflexes
Common peroneal nerve palsy
Describe the features of an L4/5 root or plexus lesion
Normal tone
Weakness of dorsiflexion, inversion and eversion
Normal reflexes
May also be weakness of hip abduction
What problem do these findings suggest? Normal tone Weakness of dorsiflexion, inversion and eversion Normal reflexes May also be weakness of hip abduction
L4/5 root or plexus lesion
What are the possible causes of an L4/5 root or plexus lesion?
Prolapsed intervertebral disc
Cauda equina tumour
Obstetric injury to the lumbosacral trunk
List the muscles, peripheral nerves and nerve roots for the following movements:
1) ankle dorsiflexion
L4/5
Tibialis anterior
Common peroneal nerve
List the muscles, peripheral nerves and nerve roots for the following movements:
2) hip flexion
L1/2
Iliopsoas
femoral
List the muscles, peripheral nerves and nerve roots for the following movements:
3) ankle inversion
L5/S1
Tibialis posterior
sciatic
List the muscles, peripheral nerves and nerve roots for the following movements:
4) Knee extension
L3/4
quads
femoral
List the muscles, peripheral nerves and nerve roots for the following movements:
5) Hip extension
L5/S1
Gluteus maximus
Inferior gluteal
List the muscles, peripheral nerves and nerve roots for the following movements:
6) Plantar flexion
S1/S2
gastrocnemius
Sciatic
List the muscles, peripheral nerves and nerve roots for the following movements:
7) knee flexion
L5/S1
Hamstrings, biceps femoris
sciatic
List the muscles, peripheral nerves and nerve roots for the following movements:
8) Hip abduction
L4/L5/S1
gluteus medius
superior gluteal nerve
List the muscles, peripheral nerves and nerve roots for the following movements:
9) Ankle eversion
L5/S1
Peroneus longus, brevis
Common peroneal
List the muscles, peripheral nerves and nerve roots for the following movements:
10) Hip adduction
L2-4
Adductor longus
Obturator nerve
What is suggested by:
- bilateral distal weakness of legs
- Areflexia
- Glove and stocking sensory loss
Peripheral neuropathy
What is suggested by:
- loss of ankle reflex
- extensive sensory loss lower limbs
- possible weakness of the hamstrings
Sciatic nerve lesion
What clinical findings would you expect in a peripheral neuropathy?
- bilateral distal leg weakness
- glove and stocking distribution sensory loss
- Areflexia
What are the possible causes of a sciatic nerve lesion?
Trauma, tumour, vasculitis or pressure
What would you expect to find in a sciatic nerve lesion?
Extensive lower limb sensory loss (mainly posterior)
Loss of S1/2
Depending on the site, weakness of the hamstrings
What would you expect to find in a L5/S1/S2 root or plexus lesion?
Loss of ankle reflex weakness of foot movements with normal knee/hip saddle anaesthesia No anal wink Urinary incontinence
What would weakness of foot movements, wasting, fasciculations, hyper reflexia and normal sensation make you consider?
Anterior horn cell disease due to MND
What would be the possible causes of isolated weakness of all foot movements but normal knee and hip power?
1) Peripheral neuropathy
2) Sciatic nerve lesion
3) L5/S1/S2 root or plexus problem
4) Anterior horn cell disease due to MND
How do you work out the cause of a Horner’s syndrome clinically?
- If absent corneal reflex: orbital or retro-orbital lesion
- Lack of sensation over ipsilateral face and contralateral arm, hoarse voice: brain stem infarct/lateral medullary syndrome
- ipsilateral arm weakness/hyporeflexia: brachial plexus avulsion or pan coast’s tumour
what are the causes of a 3rd nerve palsy?
Central causes:
- stroke or haemorrhage involving in the ipsilateral midbrain at the level of the superior colliculus
- meningitis
- demyelination
Peripheral causes:
- Compression of the oculomotor nerve via a tumour
- Aneurysm of the post communicating artery
- ischaemia or infarction of the oculomotor nerve
What is a bulbar palsy?
LMN lesion of 9, 10, 11 and 12 at the medullary bulb.
Tongue is wasted with fasciculations, nasal speech
what are the causes of a bulbar palsy?
MND, myasthenia gravis, GBS, syringobulbia, neurosyphilis, neurosarcoidosis, poliomyelitis
What is and what are the causes of a pseudo bulbar palsy?
UMN lesion of cranial nerves 9, 10, 11 and 12
Stiff and slow tongue, brisk jaw jerk, hot potato speech
Causes: CVA (bilateral internal capsular lesions), MS, MND, PSP, brainstem lesions
