Neurology Examination findings and Differentials Flashcards
Causes of a scissoring gait
UMN only
- Bleed/Ischaemia
- Demyelination
- SLE - transverse myelitis
- Syringomyelia
- Brain/Spinal cord tumour
- Cerebral palsy
- Herditary spastic paraparesis
UMN and LMN
- Motor Neuron Disease
Station 5: Young patient with spastic gait, What else would you examine?
Top differential: Demyelination e.g. MS
Eyes: visual acuity, RAPD, painful eye movement, diplopia, INO
Sensation
Cerebellar
Other: catheter
Station 5: spastic gait
UMN signs: reflexes, clonus, upping plantars
Sensory Level
Jaw jerk/dysarthria
INO, visual acuity, RAPD
Scars
Catheter
Wasting/fasciculations
Motor Pathway
1st order neuron: Nuclei exist in the Motor Cortex (last gyrus of frontal lobe); the axons collect and bundle into the corona radiate and descend into the internal capsule (the internal capsule exists between the basal ganglia and thalamus); the axon bundles then enter the brain stem and become the pyramidal tract; fibres to limbs cross over in the medulla, fibres to trunk stay straight; when they enter the spinal cord limb fibres run as the lateral cortisol spinal tracts and trunk fibres run as anterior corticospinal tract; First order neurone terminates at a specific segment and synapses with nuclei of the…
2nd motor neurone: Nuclei of the 2nd neurone is the anterior horn cell; axons leave via the motor root and join the sensory root to make the spinal root; plexus; peripheral nerves; neuromuscular junction; muscle
Causes of hemiparesis
Intracranial: cerebral infarct, SOL, demyelination
Brain stem: posterior circulation event, demyelination
Spinal cord: trauma, tumour, abscess, AV malformation, haemorrhage
Causes of radiculopathy
Disc herniation
Spondylosis with osteophyte formation
Spinal stenosis
Nerve sheath tumour (schwannomas/neurofibroma)
Epidural abscess
Epidural met
Guillaune-barre syndrome
Herpes zoster/Borrelia/CMV
Causes of brachial plexopathy
Brachial neuritis - check for winging of the scapula
Infiltration from breast or lung cancer - check Horner’s syndrome
Radiation induced
Cervical rib
Causes of purely motor peripheral neuropathy
Acute intermittent porphyria
Lead poinsoning
(Acute inflammatory demyelinating polyneuropathy)
Parkinsonian gait with absence of signs in face and upper limbs
Vascular Parkinsonism
Parkinsonian gait with frontal overactivity and axial rigidity
Progressive Supranuclear Palsy
Neuropathic gait (high stepping gait) - causes
Common peroneal palsy
L5 radiculopathy
Charcot-Marie-Tooth
Diabetes
Vasulitis
Sarcoid
Paraproteinaemia
Amyloid
GBS
MND
Myopathic gait (waddling gait, can’t stand from chair) - causes
Proximal Myopathy
Ankle-foot Orthoses
Foot drop
Pes Cavus
Charcot-Marie-Tooth
Other causes?
Unable to walk on toes/heels
Distal power issue
Symptoms of Horner’s
Ptosis
Miosis - constriction
Anhydrosis
Describe the pathway of the cervical sympathetic pathway
- Hypothalamus to T1
- T1 to the superior cervical ganglion
- Superior Cervical ganglion to the eye and eyelid: 3rd nerve fibres to the superior/inferior tarsus muscle - ptosis; Nasociliary branch of 5th nerve to the pupil
Causes of Horner’s Syndrome
Hemisphere Lesions: infarct or bleed
Brainstem Lesions: MS, pontine glioma
Cervical cord lesion: syringomyelia
T1 root: pancoast tumour, cervical rib, aneurysm of subclavian artery/aortic arch
Carotid artery dissection
Congenital horner’s
Hemiparesis due to spinal cord lesion - examination findings
Sensory level
Anterior horn cell damage - wasting/fasciculation at that level
Ipsilateral loss of vibration/joint position
Contralateral temp/pinprick
Spastic paraparesis (both legs)
Tone: Hypertonia
Reflexes: hyper-reflexia, ankle clonus, upgoing plantars
Sensation: sensory level
Flaccid paraparesis
Inspection: wasting, fasciculations
Tone: hypotonia
Reflexes: diminished, down going plantars
Sensations: absence of sensory signs (GBS, CIPD, motor neuropathy, MND)
