Neurology (Quesmed) Flashcards
What are the differentials for Autonomic Dysfunction (Dysfunction of the Involuntary Nervous System- things that happen whether we want them to or not- vasoconstriction, sensation etc.)?
Autonomic Neuropathies
Neurodegenerative Diseases (Parkinson’s, Multiple System Atrophy, Autonomic Failure)
Drug Induced Autonomic Dysfunction- Antihypertensives, Anticholinergics, Tricyclic Antidepressants
What are the causes of Autonomic Neuropathies?
Diabetes (Most Common)
HIV, Lyme Disease, Chagas Disease
Autoimmune Diseases (like SLE)
AMYLOIDOSIS
What are some of the common signs of Autonomic Dysfunction?
Dizziness
Feeling FULL early (Early Satiety) + Nausea + Bloating= Gastroparesis
Postural Hypotension (on standing)
What are the 2 types of Brachial Plexus Injuries?
Erb’s Palsy (C5-6)
- Dermatomal Sensory Loss
- Weakness of the Intrinsic Muscles of the hand
- Associated with Shoulder Dystocia and Traumatic Childbirth
Klumpke’s Palsy (C8-T1)
- Dermatomal Sensory Loss
- Weakness of the Intrinsic Muscles of the Hand
- T1 Involvement can lead to Horner’s Syndrome
- Claw Hand
What should be suspected if a patient presents with Horner’s Syndrome and Erb’s/ Klumpke’s Palsy?
SQUAMOUS CELL LUNG CARCINOMA- Pancoast Tumour
What can a mid-humeral fracture result in?
A Damaged RADIAL NERVE
This leads to WRIST DROP due to the EXTENSOR MUSCLES BEING WEAKENED
What is Brown-Sequard Syndrome?
It is the Anatomical Disruption of Nerve Fibre Tracts in one half of the spinal cord
So injury of one side of spinal cord leads to symptoms on that side
What are the signs of Brown-Sequard Syndrome?
Ipsilateral Hemiplegia
Ipsilateral loss of Proprioception and Vibration
Ipsilateral HYPERreflexia and HYPERtonia
CONTRALATERAL Loss of Pain and Temperature (2-3 segments below the level of the lesion)
What are the causes of Brown-Sequard Syndrome?
Cord Trauma (Penetrating Injuries (KNIFE/ GUNSHOT) are the most common)
Neoplasms
Disk Herniation
Demyelination
Infective/ Inflammatory Lesions
Epidural Haematomas
What is the management of Brown-Sequard Syndrome?
Surgical Intervention if PHYSICAL CAUSE
1) Retained Foreign Objects
2) CSF Leakage
3) Infection or signs of Extrinsic Spinal Cord Compression
Medical Management if CHEMICAL/ MICROSCOPIC CAUSE
1) Infective/ Inflammatory causes
2) Demyelinating causes
What is Bulbar Palsy?
Which Cranial Nerves are affected?
It is a “Lower Motor Neurone” Lesion affecting Cranial Nerves 9,10 and 12
This causes impairments in SPEECH and SWALLOWING
What are the signs of bulbar Palsy?
If PSEUDOBULBAR- SPASTIC TONGUE with NO FASCICULATIONS
Absent or Normal JAW JERK REFLEX
Absent GAG REFLEX
Flaccid, Fasciculating Tongue
Nasal Quiet Speech
Signs of the cause (Lower Limb Fasciculations if Motor Neurone Disease)
What are the causes of Bulbar Palsy?
Motor Neurone Disease (the Progressive Bulbar Palsy Variant)
1) Myasthenia Gravis
2) Guillain-Barre Syndrome
Brainstem Stroke (Lateral Medullary Syndrome)
Syringobulbia
How is Progressive Bulbar Palsy (Motor Neurone Disease) diagnosed?
EMG shows DIFFUSE DENERVATION
What are the signs of Cerebellar Syndrome?
DANISH
Dysdiachokinesia (Inability to perform rapid alternating hand movements)
Ataxia (unsteady gait)
Nystagmus (involuntary eye movements)
Intention Tremor (Seen in the finger-nose test)
Slurred Speech
Hypotonia
Cerebellar Vermis- Ataxia (few signs in limbs)
Cerebellar Hemisphere- signs in Ipsilateral Limb
What are the causes of Cerebellar Syndrome?
VITAMIN C (usually Strokes or Multiple Sclerosis)
Vascular causes (Strokes- Ischaemic or Haemorrhagic) that affect the Posterior Circulation)
Infective Causes (LYME Disease)
Inflammatory Causes (Multiple Sclerosis)
Traumatic Causes (trauma to Posterior Fossa)
Metabolic Causes (Alcoholism)
Iatrogenic Causes- PHENYTOIN and CARBAMAZEPINE
Neoplastic Causes- Tumours
Congenital/ Hereditary- Friedrich’s Ataxia/ Spinocerebellar Ataxia
How do you differentiate between Cerebellar and Sensory Ataxia?
Romberg’s sign positive (measure of PROPRIOCEPTION) (can’t stand with eyes closed but can without)- SENSORY
Romberg’s sign negative- CEREBELLAR
They need to SEE to STAND= SENSORY
What is Cervical Spondylosis (Cervical Osteoarthritis)?
It is an Osteodegenerative Disease of the Cervical Spine- due to wear and tear
It is a common and underdiagnosed cause of Falls in the Elderly
(usually seen in 50-59 year olds)
What are the signs of Cervical Spondylosis?
Suspect in Neck Pain/ Lhermitte’s following Osteoarthritis
Suspect in Progressive Upper Limb Weakness and 70 year olds- after OSTEOARTHRITIS
LACK of Bladder/ Bowel issues- unless very SEVERE
Neck pain, Arm Weakness, Following Osteoarthritis in the Elderly basically
Neck Pain, Headache, Interscapular Pain
Radiculopathy (due to compression of NERVE ROOTS/ injury of nerve roots at the site of the Foraminal Exit)- leading to FLACCID UPPER LIMB PARESIS
Myelopathy- due to the dynamic stretch of the spinal cord over impinging Spinal Osteophytes (Injury to spinal cord caused by COMPRESSION of SPINAL CORD itself)
Variable Sensory Changes (like the Lhermitte Phenomenon)- Pain on Neck Flexion
Spastic Paraparesis
- Variable involvement of the upper limbs depending on site of lesion and degree of Radiculopathy
How can you differentiate between Motor Neurone Disease and Cervical Myelopathy?
Motor Neurone Disease has NORMAL SENSATION
Cervical Myelopathy does not (because it is compressed so sensation is also affected)
When does Multiple Sclerosis present age-wise?
20-40 years of age (so UNLIKELY in children in people over middle-aged)
What is the key sign of Mononeuritis Multiplex?
Why does it occur?
Asymmetrical, Painful, Progressive, Multifocal Neuropathy of SENSORY and MOTORNERVES
Of MULTIPLE NERVE AREAS
Weakness, Atrophy, Cramping, Hyporeflexia
It is ASYMMETRICAL
It occurs due to an autoimmune reaction to a protein on motor neurone cells
More local than Multiple Sclerosis, which is symmetrical
What are the signs of Cubital Tunnel Syndrome?
It affects the ULNAR NERVE and Medial Half of the hand
Lateral Half- Carpal Tunnel Syndrome
What is Charcot-Marie-Tooth Syndrome (HEREDITARY SENSORIMOTOR NEUROPATHY- HSMN)?
What is the inheritance?
When does it usually present?
It is a HEREDITARY MOTOR and SENSORY NEUROPATHY
It is the MOST COMMON group of Genetic Peripheral Neuropathies
The most common gene associated is the !!!!Autosomal Dominant mutation of the PMP22 gene
There are 2 types-
1) Type 1= Demyelinating (more common)
2) Type 2= Axonal
The disorder affects both the Sensory and Motor Nerves of the Peripheral Nervous System- though MOTOR NERVES are MORE affected
Patients usually present in PUBERTY with !!!!!!!!!! symptoms affecting the feet which progresses to involve the hands