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RW FY1 > Neurology COPY > Flashcards

Neurology COPY Flashcards

1
Q

Secondary prevention of stroke

A

Anti-platelet therapy (LIFELONG)

  • (1) Clopidogrel (1st line by RCP)
  • (2) Aspirin AND Dipyridamole (1st line by NICE)

EXCEPTION: AF and Stroke

  • Initial 14 days post-stroke –> Aspirin
  • Secondary prevention –> Warfarin or DOAC (Apixaban)
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2
Q

Postural tremor

Most pronounced by arms are outstretched

Relieved at rest

Affects Hands and Arms

No other neurological signs (No Parkinsonism)

Diagnosis? Treatment?

A

Benign essential tremor

If functional impairment –> (1) Propranolol

If no functional impairment –> Observation

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3
Q

Fever

Headache

Progressive focal neurology

Seizures

Meningismus

CN nerve palsies

Papilloedema

Diagnosis? Ix? Tx?

A

Cerebral abscess

Ix: MRI Head (with Contrast) –> Ring-enhancing lesion

Tx

  • Antibiotics
  • AED
  • +/- Dexamethasone
  • +/- Surgical decompression and evacuation
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4
Q

Causes of cerebellar syndrome

A

SMART

  • Stroke
  • MS
  • Alcohol
  • Rare
    • FriedRich’s ataxia
  • Trauma

PASTERIES

  • Posterior fossa tumour
  • Alcohol
    • B1 (Thiamine) deficiency
    • B12 deficiency
  • Multiple Sclerosis
  • Trauma
  • Rare
  • Inherited
    • Friedrich’s ataxia
  • Epilepsy medication
    • Phenytoin
  • Stroke
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5
Q

Signs of cerebellar lesion

A
  • Dysdiadochokinesia (inability w rapid alt movements) + Dysmetria (past pointing)
  • Ataxia
    • Wide based gait
    • Drunken gait
  • Nystagmus
  • Intention tremor (shaking fingers with nose-finger test)
  • Slurred, staccato speech
  • Hypotonia
  • Rebound phenomenon
  • Pronator drift
  • Pendular reflexes
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6
Q

Sx of Lateral Medullary Syndrome

Cause?

A

Caused by Posterior circulation stroke

DANVAH (Ipsilateral signs - exception contralateral for loss of pain to limbs)

  • Dysphagia
  • Ataxia + Cerebellar signs (ipsilateral)
  • Nystagmus
  • Vertigo
  • Anaesthesia to Pain
    • Ipsilateral for Face
    • Contralateral for Limbs
  • Horner’s syndrome
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7
Q

Friedrich’s Ataxia vs Charcot-Marie Tooth disease

A
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8
Q

Bilateral cerebellar signs (DANISH)

Pes cavus

UMN + LMN signs

Sensory loss

Kyphoscoliosis

Decreased visual acuity

Associated with HOCM and Diabetes

Diagnosis? Cause? Ix? Tx?

A

Friedrich’s ataxia

Autosomal recessive (GAA trinucleotide expansion in Frataxin gene)

Ix: Genetic testing

Tx:

  • Conservative only
    • Physiotherapists
    • Orthoses
    • Mobility aids
  • Medical and Surgical
    • Treat complications
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9
Q

Cerebellopontine angle syndrome - Sx

A

Signs

  • CN 5-8 palsy
  • Cerebellar signs

Causes = Acoustic neuroma

Tip: CN 5-8 (angle = 5, syndrome = 8)

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10
Q

Alzheimer’s disease - Sx, Ix, Tx

A

4A

  • Amnesia
    • Short term memory loss
    • Disorientiation
  • Aphasia
    • Difficulty finding words
  • Agnosia
  • Apraxia

Ix: MMSE / MoCA

Tx

  • Bio
    • AChE inhibitor
      • Donepazil (oral)
      • Rivastigmine (transdermal)
    • Memantine
  • Psycho
  • Social
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11
Q

Sx of

AD

LBD

VD
Pseudodementia

Delirium

Pick’s disease

A
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12
Q

Fever

Altered mental state / Confusion

Seizures

Rash

+/- Meningismus

No headache

Diagnosis? Tx?

A

Encephalitis

High-dose IV Aciclovir (empirical Tx for all cases)

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13
Q

Most common causes of meningitis

A
  • Viral = most common
  • Bacterial
    • Streptococcus pneumonia (most common bacterial)
    • Neisseria meningitides (2nd most common bacterial)
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14
Q

Triad of meningism

A

Headache

Neck stiffness

Photophobia

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15
Q

Viral vs Bacterial meningitis on CSF analysis

A
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16
Q

C/I to LP

A

Cushing’s triad: relative bradycardia, hypertension, irregular breathing

Papilloedema

Dilated pupil (↑ ICP –> blown pupil)

Focal neurological signs

Signs of cerebral herniation

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17
Q

Tx for bacterial meningitis

A

In community

  • If non-blanching rash –> IV Benzylpenicillin
  • Then, refer to A&E

In hospital

  • Antibiotics
    • IV Ceftriaxone
  • +/- Dexamethasone
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18
Q

Types of epilepsy

A
  • Generalised
    • Consulsive
      • Tonic
      • Clonic
      • Tonic-Clonic
      • Myoclonic
    • Non-convulsive
      • Absence
      • Atonic
  • Focal / Partial
    • Consciousness not impaired (simple)
    • Consciousness impaired (complex)
    • Partial with secondary Generalisation
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19
Q

Partial seizures - localising Sx

A
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20
Q

Tx for epilepsy

A
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21
Q

S/E of AEDs

A
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22
Q

Tuberous sclerosis - Cause, Sx

A
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23
Q

Tx of status epilepticus

A

Oh My Lord Phone the Anaesthetist

  • Oxygen
  • Buccal Midazolam (wait 10min, up to 2) = 1st line in the community
  • IV Lorazepam (wait 5min, up to 2)
  • IV Phenytoin
  • Rapid induction anesthesia (Propofol)
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24
Q

Causes of CN7 palsy

A

LMN CN7 palsy

  • Bell’s palsy (idiopathic)
  • Ramsay-Hunt syndrome (HSV infection)

UMN CN7 palsy

  • Stroke
  • MS
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25
Q

Tx for Bell’s palsy

A

High dose oral Prednisolone (given within 72 hours)

+ Eye protection (artificial tears, tape)

If Ramsay-Hunt syndrome –> +/- Aciclovir

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26
Q

Large amplitude, unilateral chorea

Involuntary movement

Diagnosis? Cause? Treatment?

A

Hemiballismus

Lesion in contralateral basal ganglia

Tx: Dopamine antagonists

Self-resolves within months

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27
Q

Headache

Tight band around head

Gradual onset

Worse with stress

No N&V

Normal neurological examination

Diagnosis? Treatment?

A

Tension headache

Tx: Analgesia OTC

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28
Q

Episodes of headache

Unilateral, sharp orbital pain

Acute onset

Repeated attacks

Last 15-180min

Autonomic features (Rhinorrhoea, Partial Horner’s syndrome)

Diagnosis? Tx? Prevention?

A

Cluster headaches

Acute

  • 100% Oxygen
  • +/- Sumatriptan s.c. or nasal

Preventative

  • Verapamil (CCB)
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29
Q

Zigzag lines or Paresthesia beforehand

Unilateral, Throbbing headache

Photophobia + Phonophobia

Nausea & Vomiting

Diagnosis? Tx?

A

Migraine

Acute

  • Sumitriptan + Analgesia

Prevention

  • β blockers (Propranolol)
  • or Topiramate (AED)
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30
Q

Facial pain in CN V distribution

Episodic (up to 100 episodes daily)

Sudden onset, sharp pain

Trigged by touching face

No rash

Diagnosis? Cause? Tx?

A

Trigeminal neuralgia

Causes = Vascular compression (90%) or MS

Tx: Carbamazepine

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31
Q

Progressive lower limb weakness

Progressive lower limb spasticity

Pes cavus

Scissoring gait

Bilateral UMN signs

↑ tone in legs bilaterally

↓ power in legs bilaterally

↑ reflexes bilaterally

↓ sensation to pinprick to a level

Diagnosis? Tx?

A

Hereditary spastic paraparesis

Tx: PT/OT + Orthotics + Muscle relaxants +/- Surgery

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32
Q

Horner’s syndrome - Triad, Ix

A

Ptosis, Miosis, Anhidrosis

Ix: Topical cocaine eye drops

Normal ==> pupil dilation

Horner’s syndrome ==> no effect

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33
Q

Chorea

Restlessness

Motor impersistence (cannot hold tongue sticking out)

Loss of fine motor coordination

Impaired tandem walking

Slowing of saccade eye movements

Cognitive impairment

Behavioural / personality changes

Diagnosis? Ix? Tx?

A

Huntington’s disease

Autosomal dominant trinucleotide repeat disorder (CAG)

Genetic testing: > 36 CAG repeats

MRT: Caudate + Striatal atrophy

Symptomatic treatment only

Treat chorea ==> Tetrabenazine

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34
Q

Triad of normal pressure hydrocephalus

A

Wet (urinary incontinence)

Wobby (gait –> falls)

Wacky (dementia)

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35
Q

Definition of Anterior circulation stroke

A

2/3 = Partital

Total = 3/3

  • Higher cortical dysfunction
    • L hemisphere ==> Dysphasia
    • R hemisphere ==> Visual inattention or Neglect
  • Hemiparesis or Sensory deficit
  • Homonymous hemianopnia
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36
Q

Strokes

ACA

MCA

PCA

Midbrain stroke

PICA

AICA

Retinal artery

Basilar artery

A

I

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37
Q

Lacunar syndrome

A

Stroke in small perforating artery of MCA

1/4

  • Pure sensory stroke
  • Pure motor stroke
  • Sensorimotor
  • Ataxic hemiparesis
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38
Q

Tx of ischaemic stroke

A
  • Onset < 4.5 hours
    • IV Thrombolysis (Alteplase or tPA)
    • +/- Thrombectomy
      • if within 6 hours of symptom onset
      • or up to 24 hours if limited infarct core on CT/MRI
    • Aspirin
      • ​Started after 24 hours
      • For 14 days
  • Onset > 4.5 hours
    • Aspirin or Clopidogrel (for 14 days)
  • Post-stroke care
    • Stop Aspirin after 14 days ==> switch to Lifelong Clopidogrel
      • ​Exception: AF and Stroke ==> anticoagulation (Warfarin, Apixaban)
    • + Statin
    • +/- Carotid endartectomy
      • If > 50% stenosis
      • Modify cardiovascular risk factors
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39
Q

Tx of haemorrhagic stroke

A

ABCDE

URGENT CT scan ==> confirm haemorrhagic stroke

Surgical evacuation of haematoma

  • +/- Coil or Clip bleeding aneurysm
  • +/- Ventricular drainage

Manage ICP

Post-stroke care ==> modify cardiovascular risk factors

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40
Q

Tx of TIA

A

Onset of TIA < 7 days

  • URGENT referral to TIA clinic (within 24 hours)
  • If symptoms resolved –> Aspirin 300mg

Onset of TIA > 7 days

  • Referral to TIA clinic (within 7 days)

Post-TIA care

  • Clopidogrel (lifelong)
    • Atorvastatin
  • +/- Carotid endartectomy (if >50% occlusion)
  • Modify cardiovascular risk factors
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41
Q

Extradural vs Subarachnoid vs Subdural

Cause

Onset

Symptoms

Vessel

CT changes

A
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42
Q

CT shows

Lemon-shaped haematoma

Does not cross suture line

A

Extradural haemorrhage

Surgical decompression and evacuation of haematoma

+/- AEDs

+/- ABx

+/- Lower ICP

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43
Q

CT scan shows

Hyperdense area

Located at base of skull (within basal cisterns)

Ix if -ve CT?

A

Subarachnoid haemorrhage

Ix:

(1) CT
(2) If -ve CT –> Lumbar puncture after > 12 hours ==> Xanthochromia (straw-coloured CSF)

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44
Q

Tx for subarachnoid haemorrhage

A
  • ABCDE
  • Nimodipine (CCB –> prevents cerebral artery vasospasm)
  • Laxatives (prevent straining)
  • Surgery
    • Endovascular coiling
    • Surgical clipping
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45
Q

CT changes in subdural haemorrhage

A

Concave haemorrhage

Hyperdense (in acute SDH)

Hypodense (in chronic SDH)

NOT limited by suture lines

46
Q

Tx of subdural haemorrhage

A

If SDH < 10mm

  • Conservative
    • Serial imaging to monitor resorption

If SDH > 10mm or midline shift > 5mm

  • Surgical
    • Burr hole
    • Craniotomy
    • Hemicraniectomy
47
Q

Acute onset

Headache

Painful ophthalmoplegia

Proptosis

Trigeminal nerve lesion (V1, V2)

—> no sensation, loss of corneal reflex

Horner’s syndrome (Ptosis)

Diagnosis?

A

Cavernous sinus thrombosis

CN 3-6 (not V3)

CN3, CN4, CN V1, CN V2, CN6

48
Q

Tx of MND

A
  • Riluzole (prolongs survival)
  • Symptomatic treatments
    • If respiratory symptoms –> BiPAP
49
Q

Optic neuritis vs Papilloedema

A
50
Q

Marcus-Gunn pupil

aka

A

Marcus-Gunn pupil

= Relative Afferent Pupillary Defect (RAPD)

51
Q

MS presentations

A

Optic neuritis - painful, blurred vision, RAPD

Transverse myelitis - UMN signs, Paraesthesia below lesion, Lhermitte’s phenomenon

Cerebellar Sx - DANISH

Brainstem Sx - Ataxia, Diplopia, Bulbar pathology

52
Q

Ix for MS

A

MRI (GAD-enhanced): demyelinating plaques = GOLD STANDARD

CSF electrophoresis: unmatched oligoclonal IgG bands

Evoked potentials: delayed conduction velocity (demyelination)

53
Q

Tx of MS

A

Acute

  • (1) IV Methylprednisolone
  • (2) Plasma exchange

Once stable

  • DMARDs
    • Injectables (B-IFN s.c.)
    • Oral (Fingolimod)
    • Biologics (IV Alemtuzumab)
  • Symptomatic relief
54
Q

M gravis

Ix

A

Anti-nAChR antibody (M gravis)

Anti-VGCC antibody (Lamert-Eaton syndrome)

Tensilon test: AChE –> improves clinical features

Nerve conduction studies: repeated stimulation –> decrease in APs

Single-fibre EMG: “jitter”

55
Q

Tx of Myasthenic crisis

A

Acute myasthenic crisis

  • Measure FVC
    • If low FVC –> Intubation + Ventilation
  • IVIG or Plasma exchange
  • +/- Prednisolone

Once stable

  • (1) Anticholinesterase inhibitors (Neostimgmine)
  • (2) Prednisolone
56
Q

Sx of M gravis

A

Muscle

  • Muscle weakness worsens with repetitive use (= Fatiguabiiity)
    • Affects eyes –> moves down
    • Proximal muscle weakness (Arms > Legs)

Ocular

  • Progressive Ptosis
  • Diplopia

Bulbar

  • Facial weakness –> Myasthenic snarl
  • Slurred speech
  • Dysphagia

MG crisis –> Acute respiratory failure

57
Q

GBS

  • cause
  • Sx
A

Post-infection (Campylobacter jejuni) –> antibodies react with myelin

Sx

  • Acute onset
  • Ascending motor and sensory peripheral neuropathy
    • Ascending symmetrical limb weakness
      • Distal muscle weakness (Legs > Arms)
      • LMN signs (flaccid paralysis, areflexia)
      • LMN Facial nerve palsy
    • Ascending paraesthesia
      • Impaired sensation in multiple modalities
    • Type 2 respiratory failure
  • Albuminocytological dissociation
58
Q

Miller-Fisher

What is it?

Triad

Ix

A

Subtype of GBS

  • Ophthalmoplegia
  • Ataxia
  • Areflexia

Ix: +ve anti-ganglioside antibodies (against myelin)

59
Q

Guillain-Barre syndrome

aka

A

GBS =

Acute inflammatory demyelinating polyneuropathy

60
Q

Ix for GBS

A

LP ==> Albuminocytological dissociation (↑ CSF protein BUT Normal WCC) = Diagnostic

Spirometry = most important Ix

  • If FVC < 1.5 L –> ITU for ventilation
61
Q

Tx for GBS

A

(1) IVIG
(2) Plasma exchange

+ Serial spirometry

+ Serial ECGs

+ DVT prophylaxis

Avoid steroids in GBS

62
Q

Cause of death in GBS

A

Type 2 respiratory failure (serial spirometry to measure FVC)

Tachyarrhythmia (serial ECGs)

63
Q

Generalised weakness (starting in hands, feet and face)

Temporalis wasting

LMN signs (muscle wasting, areflexia)

Myotonia (contract, cannot relax)

Normal sensory examination

Diagnosis? Cause? Tx?

A

Myotonic dystrophy

Autosomal dominant trinucleotide repeat disorder

Physiotherapy, Mobility aids

If respiratory muscle weakness –> +/- NIPPV

64
Q

Sx of Neurofibromatosis Type 1

A

CLANS

  • Cafe au lait spots (number > 5, size > 15mm)
  • Lisch nodules
  • Axillary freckling
  • Neurofibromas
  • Sphenoid wing dysplasia
65
Q

Sx of Neurofibromatosis Type 2

A

Bilateral acoustic neuromas

  • Bilateral sensorineural deafness
  • Tinnitus
  • Facial nerve palsy
  • Absent corneal reflex

Cerebellar signs

66
Q

Complications of Neurofibromatosis

A

HTML

Hypertension (renal artery stenosis, phaeo)

Thoracic kyphosis

Learning difficulities

Malignant transformation (NF Type 1, neurufibroma ==> malignant PNS tumour)

67
Q

Ix for Parkinson’s disease

A

Trial of Levodopa: improvement in symptoms

DAT scan if atypical features

68
Q

Tx for Parkinson’s disease

A

Treat motor symptoms

  • L-DOPA + DOPA decarboxylase (Sinemet = combo)
  • Dopamine agonists (Apomorphin)
  • MOA-B inhibitor (Selegiline, Rasagiline)
  • COMT inhibitor (Entacapone)
  • Anticholinergics (Procyclidine) - useful for tremor
  • Deep brain stimulation

Treat non-motor features

  • Postural hypotension ==> Fluids +/- Salt +/- Fludrocortisone
  • Drooling ==> Anticholinergic
  • Antidepressants
69
Q

S/E of L DOPA

A

S/E of L-DOPA

Tip: DOPAMINE

  • Dyskinesia
  • On-Off Phenomena
  • Psychosis
  • ABP ↓
  • Mouth dryness
  • Insomnia
  • Nausea and Vomiting
  • Excess daytime sleepiness
70
Q

Sx of Parkinson’s disease

A
  • Resting tremor (pill-rolling, asymmetrical, improve with movement, worse with stress)
  • Bradykinesia
  • Rigidity (Lead pipe rigidity, Cogwheel rigidity)
  • Postural instability
  • Parkinsonian gait (reduced arm swing, stooped posture, shuffling gait, festination, freezing, gait ignition difficulties, falls)
  • Masked facies
  • Soft monotonous voice
  • Micrographia
  • Autonomic dysfunction ==> Postural hypotension
  • Neuropsychiatric ==> Depression, Dementia
  • Sleep ==> REM sleep behaviour disorder
71
Q

Parkinson’s plus syndromes + Sx

A

Multiple System Atrophy

  • Autonomic dysfunction (postural hypotension, urinary retention)
  • Cerebellar Sx
  • Parkinsonism

Corticobasal degeneration

  • Alein limb phenomenon
  • Unilateral Parkinsonism

Progressive supranuclear palsy

  • Supranuclear gaze palsy (vertical gaze plasy)
  • Parkinsonism

Dementia with Lewy Bodies

  • Visual hallucinations
  • Fluctuating cognition
  • Early dementia
  • Parkinsonism

Vascular PD

  • Sudden onset
  • Parkinsonism
72
Q

Obese

Female

Headache

Visual changes

Normal neurological findings

+/- Papilloedema

Diagnosis? Ix? Tx?

A

Idiopathic intracranial hypertension

LP: very high opening pressure (diagnostic)

Tx:

  • Conservative
    • Weight loss
  • Medical
    • (1) IV Acetazolomide (reduce CSF production)
    • (2) Topiramate
    • (3) Repeat LPs
  • Surgical
    • +/- VP Shunt
73
Q

Signs of papilloedema

A

Papilloedema

  • Venous engorgement (1st sign)
  • Loss of venous pulsation
  • Blurring of optic disc margins
  • “Doughnut”-shaped opacity around optic disc
74
Q

Restless leg syndrome - Tx

A

Conservative

  • Walking
  • Stretching

Medical

  • Dopamine agonists (Ropinirole)
75
Q

Presentations of Thiamine deficiency

A

B1 (Thiamine) deficiency

Wernickes - ACE (= Dry Beri Beri)

  • Ataxia
  • Confusion
  • Eye signs
    • Nystagmus
    • Ophthalmoplegia (CN3 palsy, CN6 palsy)
  • Peripheral sensory neuropathy

Korsakoff’s

  • ACE
  • + Amnesia (anterograde +/- retrograde)
    • Cannot remember new things
  • + Confabulations
  • +/- Psychosis

Wet Beri Beri

  • Heart failure
  • Oedema
76
Q

Summary of mononeuropathies

A
77
Q

Erb’s palsy

Cause? Dx?

A

Traction to baby’s head/neck during delivery

Damage to C5/C6

Waiter’s tip (elbow extended and pronated, wrist flexted)

Sensory loss in C5/C6 dermatomes

78
Q

Klumpke’s palsy

A

Clumsy Klumpke’s fell from a tree

Break fall from tree / Pulling baby’s arm

Damage to C8/T1

Complete claw hand (all intrinsic hand muscles affected)

Hyperextension of MCPJ

Flexion of DIPJ and PIPJ

Loss of sensation in C8 and T1 dermatomes

79
Q

Long thoracic nerve palsy

Cause? Sx?

A

Breast cancer surgery (masectomy)

Lymph node sampling

Loss of innervation to serratus anterior

==> winging of scapula

80
Q

Axillary nerve palsy

Cause? Sx?

A

Anterior shoulder dislocation

Fracture of surgical neck of Humerus

Loss of shoulder abduction (and external rotation)

Deltoid atrophy

Patch of numbess over Deltoid (Regimental patch)

81
Q

Radial nerve palsy

Cause? Sx? Tx?

A

Humeral shaft fracture

Compression (crutches, armrest, handcuffs)

Wrist drop

Loss of sensation over dorsum of 3.5 digits

+/- Posterior Arm

+/- Posterior Forearm

Tx: Splint (reduce risk of carpal tunnel)

82
Q

Median nerve supplies

A

Forearm muscles (majority)

Intrinsic hand muscles (some) = LOAF

Lateral 2 lumbricals

Opponens pollicis

Abductor pollicis

FPB

83
Q

Ulnar nerve palsy

Cause? Sx? Tx?

A

Supracondylar elbow fracture

Self harm at wrist

Ulnar claw (hyper-extend MCP and flex DIP and PIP in 4th and 5th digit)

Wasting of hypothenar eminence

Froment’s sign +ve

Loss of sensation in medial 1.5 palmar and dorsal aspect of digits/palm

Tx: Splint, PT, OT, Analgesia +/- Surgical decompression or repair

84
Q

explain why

Ulnar paradox = “closer to the paw, the worse the claw”

A

When the ulnar nerve is damaged at the elbow

==> loss of ulnar half of flexor digitorum profundus

==> reduced unopposed flexion at the IPJ

==> less marked clawing

85
Q

DDx Ulnar nerve palsy and Dupuytren’s contracture

A

Dupuytrens = flexion of MCP, PIP + DIP

Ulnar mononeuropathy = flexion of PIP + DIP & hyper-extension of MCP

86
Q

Borders of carpal tunnel

A

Roof = Flexor retinaculum

Floor = Carpal

Radial side = Scaphoid

Ulnar side = Pisiform

87
Q

Causes of carpal tunnel syndrome

A

DRPARO

  • Diabetes mellitus
  • Rheumatoid arthritis
  • Pregnancy
  • Acromegaly
  • Repetitive strain injury
  • Obesity
88
Q

Median nerve palsy - Sx

A

Compression (ganglion cyst, vibrating tools)

Trauma

Causes of Carpal Tunnel syndrome

Hand of Benediction (when formning a fist)

Ape Hand deformity

Thenar wasting

Loss of power of thumb abduction

Loss of sensation in median nerve distribution

89
Q

Carpal tunnel syndrome

Sx

Tx

A

Numbness / Tingling in distribution of Median nerve

Improved by shaking

Worse in morning

Thenar wasting

Loss of thumb abduction

Conservative

  • Wrist splint (70% success rate)
  • PT/OT
  • Modify ADLs

Medical

  • Analgesia
  • Corticosteroid injections

+/- Surgery

  • Surgical decompression of Carpal Tunnel (cut flexor retinaculum)
90
Q

Diabetic

Burning pain on anterolateral thigh

Normal motor

Diagnosis? Cause? Tx?

A

Lateral Cutaneous Nerve of the Thigh

Compression

Diabetes

Tx:

  • Wear loose clothing
  • (1) Lidocaine patches
  • (1) Corticosteroids
  • (2) Surgical nerve compression
91
Q

Shooting, lower back pain –> leg

High stepping gait (foot drop)

↓ Power, ↓Reflexes, ↓ Sensation

Straight leg raise +ve

Diagnosis? Cause? Tx?

A

Sciatic nerve palsy / Sciatica / Lumbar radiculopathy

Disc herniation (90%)

Management

  • Conservative
    • Physiotherapy
  • Medical
    • Analgesia
  • +/- Surgical
    • Indications
      • Pain > 6 weeks
      • Complications (loss of bladder/bowel function)
    • Lumbar nerve decompression (Laminectomy, Discectomy)
92
Q

Foot drop

Loss of ankle dorsiflexion and eversion

Normal reflexes

↓sensation in dorsum of foot and lateral leg

Diagnosis?

A

Common peroneal nerve injury

Tx: Ankle foot othosis

+/- Surgery

93
Q

Common peroneal nerve injury vs L5 radiculopathy

A

Common peroneal nerve injury (LMN) [most common cause]

  • Tip: Common peroneal nerve injury ==> ↓ ankle eversion
  • Motor
    • Weakness of ankle dorsiflexion + eversion
    • BUT Normal ankle inversion
  • Sensory
    • Loss of sensation over anterolateral leg and dorsum of foot

L5 radiculopathy (LMN)

  • Tip: L5 radiculopathy ==> ↓ ankle inversion
  • Motor
    • Weakness of ankle dorsiflexion + inversion +/- eversion
    • Weakness of hip abduction
  • Sensory
    • Loss of sensation in 1st webspace of foot (L5)
94
Q

Loss of ankle plantarflexion (inability to tiptoe)

Loss of toe flexion

Loss of sensation of Ankle and Sole of Foot

Diagnosis? Cause? Tx?

A

Tibial nerve palsy

Tarsal tunnel syndrome (OA, RhA, Trauma)

Tx:

  • Conservative
    • Orthotics / Braces
    • Physiotherapy
  • Medical
    • NSAIDs
  • Surgical
    • If tarsal tunnel syndrome –> dissection of flexor retinaculum
95
Q

Causes of sensory neuropathy

A

Diabetic neuropathy

GBS

Charcot-Marie-Tooth syndrome

Alcohol

Vitamin B12 deficiency

Vitamin B1 deficiency

Drugs (Isoniazid)

Tabes dorsalis (neurosyphilis)

96
Q

1st line Tx for neuropathic pain

A

Pregabalin

Gabapentin

Duloxetine

Amitriptyline

97
Q

Causes of UMN lesion

Causes of LMN lesion

A

UMN lesion

  • Stroke
  • MS
  • Motor neurone disease (UMN + LMN)

LMN lesion

  • Peripheral motor neuropathy (e.g. peroneal nerve palsy –> foot drop)
  • Polio
  • Guillain Barre syndrome (peripheral motor and sensory neuropathy)
  • Charcot-Marie-Tooth disease
  • Motor neuron disease (UMN + LMN)
98
Q

UMN vs LMN signs

Examination findings

Ix

A

Nerve Conduction Studies + EMG

  • UMN → normal nerve conduction but ↓interference pattern + firing rate
  • LMN → abnormal nerve conduction | recruitment of large motor units
99
Q

Charcot-Marie Tooth disease

aka

Sx

Ix

A

Charcot Marie Tooth disease = Hereditary motor and sensory peripheral neuropathy

Autosomal dominant

Length dependent disorder

Sensory

  • Pes cavus
  • Loss of sensation ==> Distal > Proximal
    • Loss of fine touch (stocking distribution)
    • Loss of pain and temperature
    • Loss of proprioception
      • Sensory ataxia (slapping of feet due to lack of proprioception)

LMN signs ==> Distal > Proximal

  • ↓ Distal muscle strength (symmetrical)
    • High stepping gait (foot drop)
  • Distal muscle atrophy
    • Claw hand
    • Champagne bottle leg
  • ↓ Reflexes

Ix: Nerve conduction studies (demyelination or axonal loss - depends on type)

100
Q

Causes of mononeuritis multiplex

A

Causes of mononeuritis multiplex

  • Vasculitis (Polyarteritis nodasa) - most common
  • Rheumatoid arthritis
  • SLE
  • Sjogren’s syndrome
  • Sarcoidosis
101
Q

Ipsilateral loss of proprioception and vibration sensation

Contralateral loss of pain and temperature sensation

Ipsilateral spastic paresis below lesion (UMN)

Diagnosis?

A

Brown Sequard syndrome

Spinal cord hemisection

102
Q

Bilateral loss of proprioception and vibration sensation

Bilateral limb ataxia

Then, Bilateral loss of fine touch (distally)

Bilateral spastic paresis (UMN + LMN)

Diagnosis?

A

Subacute combined degeneration of the spinal cord

Tx: Vitamin B12

103
Q

Bilateral spastic paresis (UMN + LMN signs)

Bilateral loss of proprioception and vibration sensation

Bilateral limb ataxia

+ Cerebellar Sx (DANISH)

Pes cavus

Diagnosis?

A

Friedrich’s ataxia

104
Q

Back pain (sciatic pain shooting down legs)

Saddle anaesthesia

Poor anal tone

Urinary incontinence

Leg weakness

Diagnosis? Ix? Tx?

A

Cauda Equina Syndrome

Ix: MRI (Spine)

Surgery –> Decompressive laminectomy

+/- High dose steroids???

105
Q

Anterior cord syndrome

Posterior cord syndrome

Sx

A

Anterior cord syndrome

  • Loss of pain and temperature (spinothalamic)
  • Loss of motor function (corticospinal)

Posterior cord syndrome

  • Loss of fine touch, vibration and proprioception (dorsal columns)
106
Q

Acute cord compression

Sx

A
  • Back pain
  • BELOW the lesion
    • Loss of fine touch and proprioception
    • Loss of pain and temperature
    • UMN signs
  • AT THE LEVEL of the lesion
    • LMN signs
  • Autonomic features
    • Constipation
    • Incontinence
    • Urinary retention
      • Above T12 –> Bladder spasticity
      • Below T12 –> Bladder flaccidity
107
Q

Spinal cord injury

Trigger (urinary retention, constipation)

Hypertension

Without relative increase in HR

Flushing

Sweating

Diagnosis? Cause?

A

Autonomic dysreflxia

Only occurs if spinal cord injury ABOVE T6 level

108
Q

Spinal cord injury

VERY LOW HR

VERY LOW BP

Diagnosis?

A

Neurogenic shock

Only spinal cord lesions ABOVE T6

109
Q

Sensory disturbance in cape-like distribution (pain, temp +/- touch)

Progressive weakness in hands

Wasting of small muscles of hands

Autonomic features

Diagnosis? Tx?

A

Syringomyelia

Tx:

  • VP shunt
  • Treat underlying pathology
    • e.g. If Chiari malformation –> surgical decompression at Foramen Magnum
110
Q

Progressive (months)

Neck pain

Motor weakness (UMN below level, LMN at level)

Loss of sensation

Loss of digital dexterity

Hoffman reflex

Diagnosis? Ix?

A

Cervical spondylosis (OA of the spine –> osteophytes –> radiculopathy)

Ix: MRI (Cervical Spine)

Tx:

  • (1) Analgesia
  • (2) Surgical nerve decompression
111
Q

Sx + Ix and Tx of spinal disc herniation

A

Spinal disc herniation

  • Dermatomal loss
  • Myotomal loss
  • Lumbar region –> Sciatica
  • Cauda equina –> Cauda Equina Syndrome

Ix: MRI Spine

Tx:

  • Conservative –> Physiotherapy
  • Medical –> Analgesia
  • Surgical –> +/- Discectomy
112
Q

What level does the spinal cord end

A

L1-L2

RW FY1 (15 decks)

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