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Gen med - neuro > Neuropathies > Flashcards

Neuropathies Flashcards

1
Q

What is syringomyelia(syrinx)

A

Syringomyelia (‘syrinx’ for short) describes a collection of cerebrospinal fluid within the spinal cord.

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2
Q

Causes of syringomyelia

A

A chiari malformation(strong association)
Trauma
Tumours
Idiopathic

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3
Q

Classical presentation of a syrinx

A

‘Cape-like’(neck and arms) loss of sensation to temperature but preservation of light touch, proprioception and vibration.

Other symptoms and signs include spastic weakness (predominantly of the upper limbs), paraesthesia, neuropathic pain, upgoing plantars and bowel and bladder dysfunction

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4
Q

What might a syrinx cause if untreated

A

Scoliosis over a matter of years

May cause hornet’s syndrome due to compression of sympathetic chain but this is rare

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5
Q

Function of CNIII

A

Eye movement (MR, IO, SR, IR)
Pupil constriction
Accomodation
Eyelid opening

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6
Q

Presentation of CNIII palsy

A

ptosis
‘down and out’ eye
dilated, fixed pupil

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7
Q

Function of CNIV

A

Eye movement (SO)

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8
Q

Presentation of CNIV palsy

A

Palsy results in defective downward gaze → vertical diplopia

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9
Q

Function of CNV

A

Facial sensation

Mastication

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10
Q

Presentation of trigeminal nerve lesions

A 
trigeminal neuralgia
loss of corneal reflex (afferent)
loss of facial sensation
paralysis of mastication muscles
deviation of jaw to weak side
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11
Q

Function of CNVI

A

Eye movement (LR)

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12
Q

Presentation of CNVI palsy

A

Palsy results in defective abduction → horizontal diplopia

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13
Q

Function of CNVII

A

Facial movement
Taste (anterior 2/3rds of tongue)
Lacrimation
Salivation

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14
Q

Presentation of CNVII lesions

A

flaccid paralysis of upper + lower face
loss of corneal reflex (efferent)
loss of taste
hyperacusis

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15
Q

Function of CNVIII

A

Hearing

Balance

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16
Q

Presentation of CNVIII palsy

A

Hearing loss
Vertigo, nystagmus
Acoustic neuromas are Schwann cell tumours of the cochlear nerve

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17
Q

Function of CNIX

A

Taste (posterior 1/3rd of tongue)
Salivation
Swallowing
Mediates input from carotid body & sinus

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18
Q

Presentation of CNIX lesions

A

Lesions may result in;
hypersensitive carotid sinus reflex
loss of gag reflex (afferent)

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19
Q

Function of CNX

A

Phonation
Swallowing
Innervates viscera

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20
Q

Presentation of CNX lesions

A

Lesions may result in;
uvula deviates away from site of lesion
loss of gag reflex (efferent)

21
Q

Function of CNXI

A

Head and shoulder movement

22
Q

Presentation of CNXI lesions

A

Lesions may result in;

weakness turning head to contralateral side

23
Q

Function of CNXII

A

Tongue movement

24
Q

Presentation of CNXII palsy

A

Tongue deviates towards side of lesion

25
Q

Corneal reflex - afferent and efferent limb

A

Aff - Ophthalmic(v1)

Eff - Facial

26
Q

Jaw jerk reflex - aff and eff limb

A

Aff - Mandibular nerve(V3)

Eff - Mandibular nerve(V3)

27
Q

Gag reflex - nerve limbs

A

Aff - IX

Eff - X

28
Q

Carotid sinus reflex - nerve limbs

A

Aff - IX

Eff - X

29
Q

Pupillary light reflex - nerve limbs

A

Aff - II

Eff - III

30
Q

Lacrimation - nerve limbs

A

Aff - V1

Eff - VII

31
Q

What is a benign essential tremor

A

Associated with older age

Characterised by fine tremor affecting all voluntary muscles(most notable in hands)

32
Q

Features of benign essential tremor

A 
Fine tremor
Symmetrical
More prominent on voluntary movement
Worse when tired, stressed or after caffeine
Improved by alcohol
Absent during sleep
33
Q

Causes of tremor

A 
Parkinson’s disease
Multiple sclerosis
Huntington’s Chorea
Hyperthyroidism
Fever
Medications (e.g. antipsychotics)
34
Q

Mx of benign essential tremor

A

Does not need treatment if not causing functional or psychological problems

Propranolol (a non-selective beta blocker)

Primidone (a barbiturate anti-epileptic medication)

35
Q

Typical features of neuropathic pain

A 
Burning
Tingling
Pins and needles
Electric shocks
Loss of sensation to touch of the affected area
36
Q

Questionnaire used to assess neuropathic pain

A

DN4 questionnaire

They are then scored out of 10 for their pain. A score of 4 or more indicates neuropathic pain.

37
Q

Mx of neuropathic pain

A

Amitriptyline
Duloxetine
Gabapentin
Pregabalin

38
Q

1st line mx of neuropathic pain in trigeminal neuralgia

A

Carbamazepine

39
Q

Other options for mx of neuropathic pain

A

Tramadol ONLY as a rescue for short term control of flares
Capsaicin cream (chilli pepper cream) for localised areas of pain
Physiotherapy
Psychological input

40
Q

What is complex regional pain syndrome

A

Areas are affected by abnormal nerve functioning causing neuropathic pain and abnormal sensations. It is usually isolated to one limb.

Often it is triggered by an injury to the area.

41
Q

Presentation of complex regional pain syndrome

A

The area can become very painful and hypersensitive even to simple inputs such as wearing clothing. It can also intermittently swell, change colour, change temperature, flush with blood and have abnormal sweating.

42
Q

Mx of complex regional pain syndrome

A

Treatment is often guided by a pain specialist and is similar to other neuropathic pain.

43
Q

Effects of radial nerve damage

A

Wrist drop
Sensory loss to small area between dorsal aspect of the 1st and 2nd metacarpals
paralysis of triceps

44
Q

Effects of median nerve damage

A

paralysis and wasting of thenar eminence muscles and opponens pollicis (ape hand deformity)
sensory loss to palmar aspect of lateral (radial) 2 ½ fingers

unable to pronate forearm
weak wrist flexion
ulnar deviation of wrist

45
Q

Median nerve root

A

median nerve is formed by the union of a lateral and medial root respectively from the lateral (C5,6,7) and medial (C8 and T1)

46
Q

Radial nerve root

A

C5-T1

47
Q

Common peroneal nerve root

A

L4-S2

48
Q

Features of common perineal nerve lesion

A

Foot drop
weakness of foot dorsiflexion
weakness of foot eversion
weakness of extensor hallucis longus
sensory loss over the dorsum of the foot and the lower lateral part of the leg
wasting of the anterior tibial and peroneal muscles

Gen med - neuro (12 decks)

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