Neurology Flashcards
A-What is Syringomyelia?
B-Where is it most common?
C-What is the most common cause of Syringomyelia?
A-Syrinx= tube. So its the formation of a tube at the centre of the spinal cord that’s expansile & contains fluid.
B-Cervical area or C8-T1.
C-Anything that obstructs the flow of CSF. Most common is= chiari malformation (the herniation of the cerebellum (cerebellum tonsilar herniation) through foramen magnum because of abnormal skull shape that doesnt accommodate for space which can be acquired through trauma OR congenital).
A-How does Syringomyelia presents?
B-What if the syrinx expands to the brainstem?
C-What if it expands to the dorsal column?
A-Expansile character= destroys the spinothalamic tract (pain & temp + crude touch) + incidious onset then rapid progression of symptoms.
Presentation: Cape-like bilateral pain & temp. If it expands further to the anterior horn cells= weakness & atrophy of the hands.
B-Horner’s syndrome & CN palsies. will be called Syringobulbia.
C-Proprioception/vibration/light touch will start to get affected.
Lumbar Spine stenosis:
What is it & what are the causes?
Narrowing of the spinal canal (space that cord runs through).
Most common cause: degenerative changes (e.g. facet joint oesteoarthritis forms osteophytes and articular cartilage erosion which mechanically compress & narrows the canal). Other causes: Tumors, disc prolapse.
A-Symptoms & signs of Lumbar spine stenosis?
B-Diagnosis?
C-Mx?
A-POSITIONAL element of lowerback/buttock/lower limb pain (better when sitting, walking uphill, leaning forward as the canal enlarges & relieves the stenosis. Worst when walking). Numbness & paresthesia.
B-MRI spine
C-Weight loss, NSAIDs, PT, Decompressive laminectomy.
Prolapsed Intervertebral Disc (slipped disc):
A- What happens in pathophysiology?
B-Which position does herniation occur?
C-Risk factors?
D-Common sites?
A-Tear in annulus fibrosus= nucleus pulposes bulges out= impinges on a spinal nerve.
B-Postero-lateral (posterior long. ligament prevent direct posterior herniation which will impact the spinal cord rather than nerve).
C-Heavy lifting, sport trauma, disc degeneration, idiopathic.
D-L4/L5 or L5/S1
A-What’s Beck’s Syndrome (Anterior spinal artery occlusion/syndrome)?
B-Signs & Symptoms?
A-Infarct of anterior 2/3 of the spinal cord. Causes= Aortic pathology e.g. Aneurysm or dissection
B-1) Loss of pain & temp (spinothalamic=anterior cord) below the lesion
2) loss of bilateral motor command: UMN below the lesion, LMN at the level of the lesion
Brown-Sequard Syndrome:
A-How does this condition develop?
B-Signs & Symptoms?
A-Insult to one lateral half of the spinal cord (Hemisection)
B-1) Ipsilateral loss of all sensation at the level of lesion
2) Ipsilateral loss of proprioception & vibration below the lesion.
3) Contralateral loss of pain & temp below the lesion.
4) Ipsilateral loss of LMN at the level of lesion (flacid paralysis)
5) Ipsilateral UMN signs below the lesion
6) if lesion above T1= horner’s syndrome (Oculosympathetic pathway)
When you are presented with signs of LMN, what would you want to exclude for differentials?
That its a neuropathy rather than myopathy (primary muscle disease)
Primary Muscle Disease:
1-Symmetrical weakness usually proximal (e.g. getting dressed, brushing teeth)
2-Late loss of reflexes compared to neuropathy
3-No sensory loss
What disorders might cause a mixture of UMN and LMN signs?
Motor Neuron Disease: its a neurological condition of unknown cause which can present with both UMN and LMN signs.
e.g. Amytrophic lateral sclerosis (50% of patients), primary lateral sclerosis, progressive muscular atrophy, progressive bulbar palsy.
What are the specific patterns of motor loss in the following: 1-Cortical lesions 2-Internal capsule 3-Corticospinal tract 4-Cord lesions 5-Peripheral neuropathies
1-Cortical lesions: unexpected pattern of weakness of all movemments of hands or foot, normal or reduced tone, high reflexes proximally (suggest UML not LMN)
2-Internal capsule and 3-Corticospinal tract: contralateral hemiparesis (if occurs with epilepsy, reduced cognition or homonymous hemianopia= lesion is in cerebral hemisphere)
3-Cord Lesion: Paraparesis, Quadriparesis, tetraplegia. If it’s UMN then signs below lesion. If LMN the sign at the level of the lesion.
4-Peripheral Neuropathies (include polyneuropathies & mononeuropathies): Polyneuropathies have distal weakness e.g. Foot Drop, Wrist Drop (e.g. GBS).
B-Mononeuropathy: Trauma or entrapment e.g. Carpel Tunnel.
What patterns can weakness present as?
UMN Lesions:
Damage to the motor pathways (corticospinal tracts also sometimes called pyramidal tract) anywhere from motor nerve cells in the precentral gyrus of the frontal cortex> internal capsule> brainstem>cord>synapse with anterior horn cells in cord.
LMN Lesions:
Damage of the motor pathways anywhere from anterior horn cells in the cord>nerve roots> plexi>peripheral nerves.
What are the signs of UMN Lesions?
1-UMN lesions affect MUSCLE GROUPS (not individual muscles)
2-Pyramidal pattern weakness:
Upper limb flexed with weakness of: shoulder abduction>adduction, Elbow extension>flexion, wrist dorsiflexion>volar flexion, finger abduction>adduction.
Lower limb extended with weakness of: Knee flexion>extension, Ankle dorsiflexion>plantar flexion, foot eversion>inversion.
Foot plantar is flexed and supinated (inverted)
Circumductive gait
3-No muscle wasting
4-loss of skilled fine finger movements
5-Spasticity in stronger muscles (arm flexors and leg extensors)- High tone thats velocity dependent and non-uniform)= CLASP KNIFE
6-Hyperreflexia
7-+Ve Babinski sign
8-Clonus (>3 rhythmic downwards beats)
9-+Hoffman’s reflex- brief flexion of thumb and index finger in a pincer movement following a flick to the middle finger.
What are the signs of LMN Lesions?
1-Distribution of weakness corresponds to those muscles supplied by cord segment, nerve root, plexus, or peripheral nerve.
2-wasting and fasciculations (spontaneous involuntary twitching) of affected muscles.
3-Hypoflaccidity/hypotonia
4-Reduced/absent reflexes
5-Plantars remain flexor
What are some pathological Gait abnormalities?
1-Antalgic Gait: Due to pain in 1 area, tends to put one leg down for a shorter time than the other creating an assymmetrical gait.
2-Ataxic (broad-based gait): Due to Cerebellar Lesion or Alcohol. Unable to walk Heel-To-Toe.
3-Shuffling (Festinating Gait/Gait Apraxia): extra-pyramidal disease.
4-Tilted Gait: Inner Ear disorder
5-High-Stepping Gait: Foot-Drop— a person will lift their foot far above the ground in order to avoid catching their toes on the ground while walking. They will also have difficulty walking on their heels.
What’s Parkinson’s Disease definition?
Neurodegenerative disease. Degeneration of dopaminergic neurons in the substantia Nigra. More common in men age 65. - Able to see lewy bodies as hallmark of parkinson’s in Substantia Nigra.
What are the cardinal TRIAD symptoms of PD?
1-Tremor: Resting tremor which is worst on one side, can be bilateral or even involve the legs. Pin-rolling. Its worst when arm isnt being used or patient is anxious.
2-Bradykinesia: short, shuffling steps with reduced arm swinging. Difficulty initiating movement, hypokinesia.
3- Rigidity: lead pipe & cogwheeling (due to superimposed tremor).
- Asymmetry as characteristic of PD symptoms.
Other motor symptoms of PD?
Mask-like facies
Flexed posture
Micrographia
Causes of PD?
1-Idiopathic PD- 70%
2- Parkinsonian plus: MSA (Multiple System Atrophy), PSP (Progressive Supranuclear Palsy), CBS (CorticoBasal Syndrome)
3-Dementia with lewy bodies
4-Drug-Induced Parkinsonism (rapid-onset): Neuroleptics: Haloperidol, Risperidone, Anti-Emetics: Metoclopramide, Prochlorerazine (NOT domperidone)
5-Toxication: Manganese or copper (wilson’s), carbon monoxide
6-Post-Infectious: flu, HIV, encephalitis
7-Trauma: boxing (dementia -pugilistica)
8-Vascular: DM or HTN
9-Genetics
When Investigating PD via Hx, you want to ask the triad + other motor symptoms + non-motor symptoms:
What are the non-motor symptoms?
Non-Motor symptoms:
1-Visual Hallucinations 2-Mood: depression & dementia & psychosis 3-Postural hypotension (autonomic dysfunction) 4- REM sleep disturbances 5-Restless leg syndrome 6-Constipation (autonomic dysfunction) 7-Urinary: frequency & urgency 8-Fatigue 9- Back & Neck pain 10- Loss of sense of smell 11- Dribbling of saliva
*If cognitive dysfunction (dementia) starts early (usually late) then it might be lewy body dementia than PD.
