Neurology Station Flashcards
Muscles innervated by the ulnar nerve in the hand
Flexor digiti minimi
Abductor digit minimi
Oppenens digiti minimi
Palmar brevis
Adductor pollicis
1/2 Flexor pollicis brevis
Lumbricals 3 & 4
Plamar & dorsal interossei
Muscles innervated by the ulnar nerves in the arm
Flexor carpi ulnaris
1/2 Flexor digitorum profundus
Muscles innervated by the median nerve in the hand
Flexor pollicis brevis
Abductor pollicis brevis
Opponens pollicis
Lumbricals 1 & 2
Muscles innervated by the median nerve in the forearm
Pronator teres
Flexor carpi radialis
Palmaris longus
Flexor digitorum superficialis
Flexor digitorum profundus (1/2)
Flexor pollicis longus
Pronator quadratus
Muscles innervated by the musculocutaneous nerve
Biceps brachii
Brachialis
Coracobrachialis
Features of an ulnar palsy
Ulnar claw
Hypothenar atrophy
Intrinsic hand muscle atrophy
LOW: Weakness of the hypothenar muscles, the adductor pollicis, lumbricals 4 & 5 and the interossei muscles
HIGH: Above plus FCU and medial half of FDP will be weak
Parasthaesia of the medial aspect of the hand
Muscles innervated by the radial nerve in the arm
Triceps brachii
Anconeus
Brachioradialis
Extensor carpi radialis longus
Extensor carpi radialis brevis
Extensor carpi ulnaris
Extensor digitorum
Extensor digiti minimi
Extensor pollicis longus
Extensor pollicis brevis
Extensor indicis
Abductor pollicis longus
Features of a radial nerve palsy
Wrist drop
Wasting of posterior compartment and tricep
LOW: wrist extensors, finger extensors, brachioradialis, supinator will be weak
HIGH: above plus triceps brachii will also be weak
Sensory: parasthaesia over posterior forearm and for sum of hand
Charcot-Marie-Tooth (HSMN) most common types
CMT1: AD inheritance, demyelination, most common mutation is PMP22 duplication
CMT2: AD inheritance, axonal, most common cause is MFN2 gene mutation
Causes of motor-dominant sensorimotor polyneuropathy
Acute: GBS, botulism
Chronic: CIDP, paraproteinaemic polyneuropathy, diabetic amyotrophy (more proximal), CMT, lead toxicity, porphyria
Causes of a sensory-dominant sensorimotor polyneuropathy
Endocrine & metabolic:
Diabetes mellitus
Vitamin B12 deficiency
Folate deficiency
Vitamin B1 deficiency
Uraemia
Hypothyroidism
Toxins:
Alcohol
Drugs - isoniazid, vincristine, cisplastin, phenytoin, amiodarone
Infections:
HIV, leprosy, syphilis
Vasculitis:
GPA, EGPA, MPA (ANCA positive)
RA, SLE, Hep B & C
Differential of a mononeuritis multiplex
Primary vasculitis:
GPA, EGPA, MPA (ANCA-positive)
Secondary vasculitis
RA, SLE, Hep B & C
Sjögren’s syndrome
Diabetes
Paraneoplastic
Causes of thickened nerves
Leprosy
Neurofibromatosis
Amyloidosis
Acromegaly
Causes of a cerebellar syndrome
Acute: stroke, MS
Chronic: alcohol, SOL in posterior fossa, paraneoplastic, hypothyroidism, drugs (phenytoin toxicity), MSA
Rare: Friedrich’s ataxia, ataxia telangiectasia
What is Kennedy disease?
Motor neuron disease (bulbar and limbs)
X-linked recessive
CAG repeat in AR gene
Very slow progression (over decades)
Perioral fasciculations
Other features: androgen insensitivity, metabolic syndrome
Differential of MND
Cervical spondylosis with a combined myelopathy and radiculopathy
Multifocal motor neuropathy
Kennedy’s disease
Genetics of Fredriech’s ataxia
Autosomal recessive
GAA repeat expansion (intronic) in the FXN gene on chromosome 9
Friedreich’s Ataxia - Clinical picture
Neurological
- cerebellar signs
- peripheral neuropathy
- dorsal columns may be affected
- mixed UMN and LMN signs
- optic atrophy
- sensorineural hearing loss
Other
- HOCM
- diabetes
- High-arched palate
- kyphoscoliosis
Huntington disease genetics
Autosomal dominant inheritance
CAG expansion (>35 repeats) in the HTT gene on chromosome 4
Anticipation
Features of Huntington’s disease
Motor
- chorea
- motor impersistence
- Parkinsonism
- slow saccades, loss of OKN
Cognitive
- bradyphrenia
- memory loss
- executive dysfunction
Psychiatric
- anxiety
- depression
- psychosis
- OCD
Differential for complex ophthalmoplegia
Myasthenia gravis
Grave’s disease
Miller-Fisher variant of GBS
Cavernous sinus pathology
Mitochondrial cytopathy
Differential for mixed UMN + LMN signs
MND
Subacute combined degeneration of the cord (Vit B12 deficiency)
Cervical spondylosis with myelopathy and radiculopathy
Friedriech’s ataxia
Neurofibromatosis genetics
Autosomal dominant inheritance
NF1: NF1 mutation on chromosome 17
NF2: NF2 mutation on chromosome 22
Clinical manifestations of neurofibromatosis is
NF1: cutaneous neurofibromas (2+), café au lait spots (6+, >15 mm), axillary/inguinal freckling, Lisch nodules, optic gliomas
NF2: vestibular schwannomas, meningiomas, ependymomas
Associations:
Renal artery stenosis (2%)
Pheochromocytoma (2%)
Complications:
Epilepsy
Intellectual impairment
Clinical manifestations of tuberous sclerosis
Facial adenoma sebaceum (angiofibromata)
Periungal fibromas
Shagreen patch (lumbar region)
Ash leaf macules (on trunk)
CNS: Epilepsy, intellectual impairment
Resp: cystic lung disease
Renal: PCKD, angiomyolipomata, RCC
Eyes: retinal phakomas (white patches)
Genetics of tuberous sclerosis
Autosomal dominant inheritance
Mutation in TSC1 (ch 9) or TSC2 (ch 16)
Differential for bilateral ptosis
- Myasthenia gravis
- Myotonic dystrophy
- Oculopharyngeal muscular dystrophy
- Mitochondrial disease e.g. Kearns-Sayres
