Neurology lectures Flashcards
Types of symptoms according to level of lesion (8)
1) Intramuscular: Weakness
2) Neuromuscular junction: Quick fatigueability
3) Peripheral nerve lesion: muscle weakness and sensation disorder at Area Nervina of that nerve, most peripheral nerves are mixed so mostly its motor and sensory
4) Polyneuropathy: Diffuse lesions of peripheral nerves in metabolic and other diseases; motor, sensory or both with vegetative changes and gait problems
5) Plexus: Muscle weakness and hypotonia as well as sensory deficit in large area not corresponding to Area Nervina of one nerve
6) Radicular lesion:
- Dorsal: Sensory loss of one dermatome
- Ventral: Motor loss of one myotome
- Frequent: L5: cant stand on tips of feet
S1: cant stand on heel
7) Cauda equina: Severe assymetric pain, areflexia, weakness, sphincter disturbances
8) Conus syndrome: L1-L2 similar to Cauda equina but NO PAIN, instead sexual dysfunction and perianogenital sensory loss
Difference paraesthesia and dysesthesia?
Paresthesia: No stimulus causes some sensation
Dysesthesia: Non-painful stimulus causes pain
Paresis vs plegia
Hemiplegia/paresis vs paraplegia/paresis
Paresis: Decreased strength
Plegia: Loss of strength
Hemi: One lateral side
Para: Lower limbs
Central cord syndrome/Synringomyelia?
Change of central canal leading to growth
Affects mainly spinothalamic decussating fibres thus sensory problems (esp. rough touch, temperature)
Anterolateral syndrome?
Peripheral paresis at level of lesion
Central paresis below level of lesion
Heat, cold and pain affected
Preserved tactile and deep sensation
Brown sequard syndrome:
Hemisection of spinal cord
Central paresis below lesion on same side of body
Deep sensation loss on same side
Superficial sensation loss contralaterally
Posterior column syndrome
Ataxia, areflexia, loss of propioception, loss of deep and tactile sensation
How do you identify level of lesion?
Paraparesis of lower limb C8-L2
Paresis of upper limb: C5-C8
Central quadriparesis without affection of cranial nerves: C1-C4
Parts of general screening neurological examination? (21)
5 on face -Conc, Behaviour, Orientation, Memory - Speech (Aphasia or Dysarthria) - Visus - Eyes (Nystagmus, Pupils, Strabism, Diplopia) - Facial (Expressions and symmetry) 7 for upper limb - Upper muscles tonus (Rigidity-Spasticity) - Upper muscle strength - Biceps reflex (C5) - Triceps reflex (C7) - Pronation sign - Mingazzini sign - Cerebellar ataxia (Finger to nose) 7 for lower limb - Lower muscle tonus - Lower muscle strength - Patellar reflex (L3) - Achilles reflex (S1) - Mingazzini sign - Babinski sign (in pyramidal damage positive) - Cerebellar ataxia (Heel-Knee-Shin-Test) 2 more - Sensory testing (Touch face, upper limb, lower limb) - Stance and gait (In three stances, wide, close, close with eyes closed; if problem with third one = Romberg sign positive)
Whats alternating hemiparesis/plegia?
Contralateral motor/sensory problems in limbs/axial
Ipsilateral motor problems for muscles innervated by cranial nerves
Caused by brainstemlesion that destroy corticospinal tract before crossing and cranial nerves which do not cross (except IV)
Bulbar syndrome?
Impairment of IX-XII due to lower motor neuron lesions in Medulla oblongata or in cranial nerves directly
Symptoms:
Atrophy & Fasciculations of tongue
Bulbar speech (nasal, slurred, dropped palate)
Problems swallowing
Pseudobulbar syndrome?
Difference to bulbar: Tongue without atrophy Masseter reflex intact emotional incontinence (uncontrolled laughter/crying) Often in Binswanger
Peripheral N. facialis lesion
N. facialis innervates face motor and lacrimal/salivary glands
Symptoms: Whole affected side not moveable
Cant close eyes
No wrinkles, less nasolabial fold
No nasopalpebral/corneal reflex
Central N. facialis lesion
Doesnt affect upper part of face because its innervated also by fibres from the contralateral side (someone said from limbic system)
Pontocerebellar angle significance
VII and VIII pass through here
Meningeomas and Schwannomas etc. here can quickly cause Vertigo, Hearing loss, Facial paresis
