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P3A Med > Neurology Clinical Syndromes > Flashcards

Neurology Clinical Syndromes Flashcards

1
Q

What is proximal myelopathy?

A

Symmetrical weakness of proximal upper and/or lower limbs

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2
Q

What is a myasthenic syndrome?

A

A group of conditions characterised by fatigable muscle weakness, caused by an inherited disorder affecting the junction between the nerve and the muscle

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3
Q

What is a mononeuropathy?

A

Nerve disorder resulting from focal involvement of a single nerve trunk and usually caused by local lesions.

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4
Q

What is a peripheral neuropathy?

A

Refers to the conditions that result when nerves that carry messages to and from the brain and spinal cord from and to the rest of the body are damaged or diseased

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5
Q

What is a radiculopathy?

A

Radiculopathy describes a range of symptoms produced by the pinching of a nerve root in the spinal column

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6
Q

What is an anterior horn cell syndrome?

A

Disease of the anterior horn cells, causing the lower motor neuron signs of weakness, wasting (atrophy), and fasciculations. These signs may be seen alone or in combination with upper motor neuron signs (hyper-reflexia, Babinski reflex) in the case of ALS. Sensory disturbances are absent.

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7
Q

What is a myelopathy?

A

Injury to the spinal cord caused by severe compression

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8
Q

What is a vertebral pain syndrome?

A

Lower back pain?

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9
Q

What is a cerebellar syndrome?

A

A condition which presents with a lack of coordination, such as past-pointing, caused by damage to the cerebellum.

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10
Q

What is parkinsonism?

A

Any condition that causes a combination of the movement abnormalities seen in Parkinson’s disease — such as tremor, slow movement, impaired speech or muscle stiffness — especially resulting from the loss of dopamine-containing nerve cells (neurons)

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11
Q

What is chorea?

A

A movement disorder that causes involuntary, random muscle movements

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12
Q

What are lobe syndromes?

A

Says on tin.

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13
Q

What is parasellar syndrome?

A

A condition characterized by episodic orbital pain, with inflammation of the cavernous sinus

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14
Q

What is epilepsy?

A

A central nervous system (neurological) disorder in which brain activity becomes abnormal, causing seizures or periods of unusual behavior, sensations, and sometimes loss of awareness

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15
Q

What are the signs of a raised ICP?

A

Swollen optic disk…

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16
Q

What is MS?

A

Autoimmune disease causing demyelination of the CNS

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17
Q

What is meningeal irritation?

A

Irritation of the meninges, surprisingly

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18
Q

What is stroke?

A

Sudden onset of neurological symptoms due to decreased cerebellar perfusion.

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19
Q

What is an acute confusional state?

A

Delirium - an abrupt change in the brain that causes acute mental confusion

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20
Q

What is dementia?

A

A general term for loss of memory, language, problem-solving and other thinking abilities that are severe enough to interfere with daily life

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21
Q

What is somatization?

A

It is the generation of physical symptoms of a psychiatric condition such as anxiety

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22
Q

What are lateralising signs?

A

These are signs that helps you to localise a CNS pathology to a particular area of the brain eg. bradykinesia and dyskinesis allows a localisation of a lesion or pathology to the basal ganglia in the brain. Other well known lateralizing signs are ataxia, hyperreflexia etc

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23
Q

How do we take a history from a patient who can’t give us a history?

A

Collateral history, general appearance, vital signs, mini-neurological examination

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24
Q

What comprises the mini-neurological examination?

A

Pupils, GCS, lateralising signs

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25
Q

What comprises the neurological examination?

A

Core examination (gen app, vital signs, gait, fundoscopy (papilloedema/optic atrophy), long tract signs (upper motor neuron signs), vibration sense (128Hz) + signs associated with the two or three clinical syndromes shortlisted from the history, i.e., a hypothesis-based approach

26
Q

What is the most common cause of proximal myopathy?

A

Commonest underlying disease entity is iatrogenic, secondary to corticosteroid use

27
Q

What is Lambert-Eaton Syndrome?

A

Who knows

28
Q

What is a defining aspect of radiculopathy?

A

The pain must radiate.

29
Q

A patient presents with a numb thumb, and an inability to flex his biceps. What is the diagnosis?

A

C6 radiculopathy.

30
Q

A patient presents with a numb little finger, and an inability to flex his triceps. What is the diagnosis?

A

C7 radiculopathy.

31
Q

A pt presents with lack of sensation on the top of their foot and big toe, and they can’t dorsiflex their foot. What is the diagnosis?

A

L5 radiculopathy.

32
Q

A pt presents with lack of sensation on the side of their foot and small toe, and they can’t plantarflex their foot. What is the diagnosis?

A

S1 radiculopathy.

33
Q

What signs would you see early on in diabetic peripheral neuropathy?

A

Touch, pain and temperature sensation and proprioception in lower limbs in a glove and stocking distribution.
Loss of ankle jerks and, later, knee jerks.

34
Q

When would you be worried about mononeuropathy?

A

UMN symptoms in upper limb

35
Q

Give four examples of mononeuropathy. Two chronic, two acute.

A

Carpal tunnel, ulnar neuropathy at elbow, axillary neuropathy, radial nerve palsy?

36
Q

How do you screen for myelopathy?

A

Look for the UMN signs: Spastic gait, Hypertonia, Hyper-reflexia, Babinski, Clonus, Cross-adductors, Hoffman’s sign, Loss of fine finger movements (‘treacle hands’), Deltopectoral reflex

37
Q

What is a lateralising sign?

A

A lateralising sign reflects a problem with one hemisphere versus the other

38
Q

What is the commonest cause of myelopathy?

A

Disc-osteophyte cord compression

39
Q

How does proximal myopathy present?

A

Proximal weakness. Myalgia if inflammatory. Normal reflexes. Normal sensation.

40
Q

Give typical signs of myasthenic syndrome.

A

Ask the patient to count up to 50. As the patient nears 50 their voice becomes less audible as they are fatiguing.

41
Q

Describe the pathophysiology behind myasthenic syndromes.

A

Usually autoimmune diseases, resulting from binding of autoantibodies to components of the neuromuscular junction, most commonly the acetylcholine receptor

42
Q

Describe the pathophysiology behind mononeuropathies.

A

Focal involvement of a single nerve trunk and usually caused by local lesions, for example due to trauma/entrapment

43
Q

How do mononeuropathies present?

A

Pain, weakness, paraesthesia, sensory loss

44
Q

How do myopathies and neuropathies differ?

A

Motor + sensory in neuropathy, motor in myopathy

45
Q

How does radiculopathy present?

A

Unilateral neck, shoulder, or arm pain approximating to a dermatome. There may be accompanying changes in sensation or weakness in related muscles. NB: pain or paraesthesia radiating into the arm is a nonspecific sign for nerve root pain.

46
Q

What signs may you find with radiculopathy?

A

There may be postural asymmetry with the patient flexing their head to decompress the nerve root. Neck movement may be restricted.

47
Q

How does anterior horn cell syndrome present?

A

MND is mostly a sporadic disease of middle and elderly life. Limb weakness if limb onset, slurred speech if bulbar onset, UMN/LMN signs, breathlessness if respiratory onset.

48
Q

What is the pathophysiology behind MND?

A

It causes lower motor neurone (LMN) and upper motor neurone (UMN) dysfunction, leading to a mixed UMN/LMN picture of muscular paralysis, usually with LMN signs predominating.

49
Q

What symptoms do you see with spinal cord compression?

A

Insidious progression, gait disturbance, clumsy or weak hands, or loss of sexual, bladder, or bowel function

50
Q

What signs do you see with myelopathy?

A

Lhermitte’s sign: flexion of the neck causes an electric shock-type sensation that radiates down the spine and into the limbs.
Upper motor neurone signs in the lower limbs (Babinski’s sign: up-going plantar reflex, hyperreflexia, clonus, spasticity).
Lower motor neurone signs in the upper limbs (atrophy, hyporeflexia).
Sensory changes are variable, with loss of vibration and joint position sense more evident in the hands than in the feet.

51
Q

Give four causes of myelopathy.

A

Trauma, tumours, slipped disk, epidural/subdural haematoma, RA, infection

52
Q

What symptoms do you see in cerebellar syndrome?

A

Clumsiness, feeling unsteady, dysarthria (slurred words), vertigo

53
Q

Give key signs of cerebellar syndrome.

A

Cerebellar ataxia, dysmetria (past pointing), tremor, dysdiadokinesia, pronator drift, dysarthria (slurred words)

54
Q

What is the underlying pathology of cerebellar syndrome?

A

Infarct, trauma, infection, alcoholism, tumour, MS

55
Q

What symptoms do you see in parkinsonism?

A

Resting tremor, bradykinesia, rigidity

56
Q

Give key signs of parkinsonism

A

Stooped posture, waddling gait, reduced arm swing,

57
Q

Describe the pathophysiology behind PD.

A

The basal ganglia are a group of structures situated in the middle of the brain. They is responsible for coordinating habitual movements such as walking or looking around, controlling voluntary movements and learning specific movement patterns. Part of the basal ganglia called the substantia nigra produces a neurotransmitter called dopamine. Dopamine is essential for the correct functioning of the basal ganglia. In Parkinson’s disease, there is a gradual but progressive fall in the production of dopamine.

58
Q

How do you distinguish between Parkinson’s tremor and essential tremor?

A

Parkinson’s tremor worsens at rest, essential improves at rest

59
Q

What symptoms/signs do you see with chorea?

A

Involuntary muscle movements, milkmaid’s grip, speech problems

60
Q

Name causes of chorea.

A

HD, stroke, post rheumatic fever

P3A Med (9 decks)

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