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NEURO > NMS > Flashcards

NMS Flashcards

1
Q

right fourth and fifth digit, a right sided foot drop and a left sided facial weakness.

diagnosis

A

mononeuritis multiplex

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2
Q

what is mononeuritis multiplex

A

simultaneous or sequential involvement of individual non-contiguous nerve trunks.

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3
Q

features of mononeuritis multiplex

A

acute or subacute loss of sensory and motor function of individual nerves. The pattern of involvement is asymmetric, however, as the disease progresses, deficit(s) becomes more confluent and symmetrical, making it difficult to differentiate from polyneuropathy.

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4
Q

predominantly motor loss of peripheral neuropathy

A

Guillain-Barre syndrome
porphyria
lead poisoning
hereditary sensorimotor neuropathies (HSMN) - Charcot-Marie-Tooth
chronic inflammatory demyelinating polyneuropathy (CIDP)
diphtheria

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5
Q

predominantly sensory loss of peripheral neuropathy

A 
diabetes
uraemia
leprosy
alcoholism
vitamin B12 deficiency
amyloidosis
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6
Q

alcoholic neuropathy features

A

secondary to both direct toxic effects and reduced absorption of B vitamins
sensory symptoms typically present prior to motor symptoms

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7
Q

vit B12 deficiency features

A

subacute combined degeneration of spinal cord

dorsal column usually affected first (joint position, vibration) prior to distal paraesthesia

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8
Q

what is chiari 1 malformation

A

herniation of the cerebellar tonsils throught the formaen magnum

disturbs the CSF - causing non-communicating hydrocephalus (uncommon) or syringomyelia (common)
- headache

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9
Q

what is syringomyelia

A

dilation of a CSF space within the spinal cord

occurs within the cervical and thoracic segments and causes compression of the spinothalamic tracts decussating in the anterior white commisure

loss of sesation of pain, temperature and non-discriminative touch

cape-like distrubution of the sensory loss

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10
Q

characteristic features of GBS

A

rapidly progressive peripheral neuropathy with lower motor neurone signs (hyporeflexia),

progressive weakness of all four limbs.

  • the weakness is classically ascending i.e. the lower extremities are affected first, however it tends to affect proximal muscles earlier than the distal ones
  • reflexes are reduced or absent
  • sensory symptoms tend to be mild (e.g. distal paraesthesia) with very few sensory signs
  • PAIN - back/leg pain in the initial stages of the illness
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11
Q

other features of GBS

A
  • there may be a history of gastroenteritis
  • respiratory muscle weakness
  • cranial nerve involvement e.g. diplopia
  • autonomic involvement: e.g. urinary retention, diarrhoea
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12
Q

Ix for GBS

A

lumbar puncture

  • > rise in protein
  • > normal white blood cell count (albuminocytologic dissociation) + protein

nerve condution studies may be performed

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13
Q

what is GBS

A

immune-mediated demyelination of the peripheral nervous system often triggered by an infection (classically Campylobacter jejuni).

characterised by

  • paraesthesia
  • weakness
  • hyporeflexia

More common in men
Europe

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14
Q

Tx for GBS

A

-> intravenous immunoglobulin (IVIG) – a treatment made from donated blood that helps bring your immune system under control

plasma exchange (plasmapheresis) – an alternative to IVIG where a machine is used to filter your blood to remove the harmful substances that are attacking your nerves

treatments to reduce symptoms such as painkillers
treatments to support body functions, such as a machine to help with breathing and/or a feeding tube

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15
Q

what is Miller Fisher syndrome

Sx

A

proximal variant of GBS

antiboides angainst the ganglioside GQ1b

Sx
opthalmoplegia
areflexia
ataxia
BUT NOT WEAKNESS
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16
Q

RFs of GBS

A
  • history of GI/Resp infection 1-3 weeks prior to the onset of weakness
  • vaccinations
  • malignancies
  • pregnancy: decreases during pregnancy but increases in the months after delivery
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17
Q

Examination of GBS

A
  • hypotonia
  • demonstrable altered sensation or numbness
  • reduced or absent reflexes
  • fasciculations
  • facial weakness - asymmetrical
  • autonomic dysfunction - fluctuations of heart rate and arryhthmias
  • respiratory muscle paralysis
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18
Q

DDx of GBS

A

barin - stroke, braisntem compression, encephalitis

spinal cord: cord compressions, polymyelitis, transverse myelitis

peripheral nerve: vasculitis, lead poisoning, porphyria

NMJ: MG, botulism

muscle: hypokalemia, polymyositis

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19
Q

complications of GBS

A

respiratory failure

persistent paralysis
hypotension/hypertension
thromboembolism, pneumonia, skin breakdown
cardiac arryhthmia
ileus
aspiration pneumonia
urinary retention
psychiatric problems - anxiety, depression
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20
Q

what is vasculitic neuropathy

A

Patchy motor and sensory loss; pain and dysaesthesia.

Underlying primary vasculitic or rheumatological syndrome

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21
Q

Ix of vasculitic neuropathy

A

NCT may reveal clinically asymptomatic lesions.

Nerve ± muscle biopsy

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22
Q

acute intermittent porphyria clinical features

Ix

A

distal motor neuropathy, HTN, tachycardia

blood and urine analysis

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23
Q

diphtheria

A

oropharyngeal weakness at onset
pharyngeal membrane

NCT axonal neuropathy; serology

24
Q

symptoms of MG

A

EYES
extraocular muscles
- ptosis
- pupils unaffected

BULBAR involvement - dysphagia, dysphonia, dysarthria

limb weakness
- proximal and symmetrical

resp

weaker thruout day

face weakness

limbs and trunk are less affected

no ANS involvement

muscle atrophy rare but disuse atrophy possible

abnormalities to thymus 
ass with autoimmune
RA 
SLE
Graves
Pernicious anaemia
25
Q

complications of MG

A

resp failure

myasthenic crisis - drooling, weak neck, slack facial muscles

26
Q

Ix for MG

A

tensilon test

EMG

27
Q

what is myasthenic crisis

A 
Slack facial muscles 
Weak neck
Drooling
Nasal speech
Generally weak 
Unsafe swallow
28
Q

cholinergic crisis?

A

Looks similar to myasthenic crisis.
Excess of acetylcholinesterase inhibitors
excessive stimulation of striated muscle - flaccid paralysis
Respiratory failure
Miosis and the SLUDGE syndrome
(ie, salivation, sweating, lacrimation, urinary incontinence, diarrhea, GI upset and hypermotility, emesis) also may mark cholinergic crisis-not inevitably present

29
Q

what is tensilon test

A

allows MG patient to move muscles normally

30
Q

cautions for tensilon test

A

Caution – asthma, MI, bradycardia

Cardiac monitoring

31
Q

normal functions of the frontal lobe

A
  • > primary motor cortex: precentral gyrus, opposite side of the body
  • > coordinating and planning complex movements
  • > frontal eye field -> eye movements to the contralateral side
  • > Broca’s area - motor or expressive centre of speech
  • > personality, emotional expression, initiative and the ability to plan
  • > inhibition of voiding of the bladder and bowel
32
Q

Sx from lesions of the frontal lobe

A

contralateral weakness - mono/hemiparaesis and facial weakness in an UMN pattern

gait apraxia - slow, shuffling, upright and wide based

conjugate eye deviation - both eyes look towards the side of the lesion and away from the side of the weakness

focal seizures -clonic movements of the contralateral lower face, arm and leg - away from the side of the lesion

expressive dysphasia - non-fluent, hesitant speech

personality & behavioural change 
- social disinhibition
loss of initiative and interest
- inability to solve problems
- impaired concentration and attention

anosmia

primitive reflexes - grasping, sucking, pouting rooting and palmomental

incontinence of urine/faeces

33
Q

function of parietal lobe

A

primary somatosensory cortex - postcentral gyrus

language (dominant hemisphere)

use of numbers

non- dominant hemisphere - allows awareness of the body and its surroundings, appropriate movement of the body and constructional ability

visual pathways - inferior quadrantanopias

34
Q

Sx from lesions of the parietal lobe

A

contralateral sensory loss - impairment of joint position and two point discrimination
- recognise objects by form and texture

visual disturbacnes

35
Q

syndromes of the dominant parietal lobe

A

wernicke’s receptive ‘fluent’ dysphasia - imparied comprehension of speech and written language

gerstmann’s syndrome - cant differentiate between left and right sides of the body, impairment of calculation/writing

bilateral ideomotor adn ideational apraxia

36
Q

syndromes of the non-dominant parietal lobe

A

contralateral sensory inattention

constructional apraxia - cant draw simple tings

dressing apraxia

topographical disorientation -> unfamiliar with normal places

37
Q

function of temporal lobe

A

wernicke’s area - comprehension of written and spoken language

auditory and vestibular cortices

limbic system - olfactory and gustatory cortices -> medial temporal lobe - memory, learning

38
Q

define pyramidal weakness

proximal weak

A

LOP in the extensor muscles in the arms and the flexors in the legs

UMN lesions involving ht epyramidal tract

proximal

  • affecting shoulders, hips, trunk, neck and sometimes face
  • characteristics - myopathy and NMJ (MG)

distal

  • hands and feet
  • peripheral motor neruopathy
39
Q

clinical features of a UMN lesion

A

spasticity - clasp knife, clonus

tendon reflexes are brisk
positive babinski sign

40
Q

what is tetraparaesis

A

weakness in all four limbs

  • brainstem
  • high cervical cord
  • – cervical spondylosis
  • – MS
  • – traumatic cord lesions
41
Q

types of LMN lesion

A

anterior horn cell
spinal nerve
plexus
peripheral nerve

42
Q

characteristics of LMN lesions

A
  • decreased tone
  • focal pattern of weakness and wasting
  • fasciculations
  • pain and sensory disturbance - nerve roots, plexi and peripheral nerves
  • reduced tendon reflexes and flexor plantar responses
43
Q

focal pattern of weakness and wasting in LMN

  • anterior horn
  • radiculopathy
  • plexopathies
  • peripheral neuropathies
  • NMJ disorders
  • myopathies
A

anterior horn cell disease

  • generalised weakness, wasting
  • mimmin peripheral nerve lesion

radiculopathies
- weakness and wasting in the respective myotomes

plexopathies
- weakness and wasting in the plexus region

peripheral neuro

  • mono - single peripheral nerve
  • multiple mononeuropathies - many single nerves
  • polyneuropathy - longest anxon in all nerves affected -SYMMETRICAL , GLVIE AND SOCK SENSATIONS

NMJ
- MG

myopathies - symmetrical wasting of proximal muscles

44
Q

types of peripheral neuropathy

A

mononeuropathy - ie median nerve
multiple mononeuropathy - mononeuritis complex
polyneuropathy - vit B12, Diabetic neuropathy, drugs isoniazid

45
Q

disorders of the NKJ

A

MG
Eaton-Lmabert
iatrogenic

46
Q

features of myopathy

A

limb weakness bilateral and proximal
cant stand from sitting, climbing stairs
dysphagia, respiratory muscle weakness
myalgia esp after exercise

47
Q

what is tremor

A

ivoluntary and rhythmic

  • disappear during sleep
  • fine - low amplitude
  • coarse - high amplitude
48
Q

define intention tremor

A

tremor that increases throughout the movement

49
Q

define physiological tremor

A

present during waking
bilateral worse on maintaining a posture
fine and fast

50
Q

define pathological tremor

A

occurs at rest or with movement slower coarse

asymmetrical

51
Q

what is resting termor

A

coarse ‘pill-rolling’ tremor

  • disappears during voluntary movement
  • asymmetrical
52
Q

what is essential tremor

A

coarser
AD
the tremor may worsen terminally but not throughout
temporary improvment with alchol

Mx
beta-blockers, anticholinergics, primidone

53
Q

what is a kinetic tremor types

A

occurs during movement

cerebellar tremor - coarse often slow

absent a t rest

54
Q

what is chorea

A

involuntary movements, abrupt and jerky

causes
huntingotns
SLE
HIV
thyroid
55
Q

Mx of huntington

A

dopamine blocking or depleting but results in parkinsons

CAG chromosome 4

NEURO (30 decks)

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