Oxford Clinicals I Flashcards
Describe the upper motor neurone lesion signs
Hyperreflexia, no muscle wasting, increased tone that is velocity dependent and non-uniform.
+/- clonus (- 3 rhythmic downward beats of the foot is normal, but more will suggest an UMN lesion)
A positive Babinski sign and a positive Hoffman’s reflex
Describe the lower motor neurone lesion signs
Hypotonia and flaccidity.
Muscle wasting and fasciculations of the affected muscles
Negative Babinski sign
What is MRC classification? Describe.
MRC classification is muscle weakness grading.
Grade 0: No muscle contraction
Grade 1: Flicker of contraction
Grade 2: Some active movement
Grade 3: Active movement against gravity
Grade 4: Active movement against resistance
Grade 5: Normal power (allowing for age)
What does Extrapyramidal signs mean?
What are the positive and negative signs?
“Extra-pyramidal” denotes CNS motor phenomena relating to the basal ganglia.
Extra-pyramidal lesions cause poor initiation and maintenance of movement.
Negative symptoms include bradykinesia or akinesia and loss of postural reflexes.
Positive symptoms include chorea, athetosis, ballismus and dystonia.
What does occlusion of posterior cerebral artery result in?
Occlusion of the posterior cerebral artery leads to contralateral homonymous hemianopia (often with macula sparing).
Which part of the brain does the anterior cerebral artery supply?
The anterior cerebral artery supplies the frontal and medial part of the cerebrum.
What are the symptoms of occlusion to the anterior cerebral artery?
- Weak numb contralateral leg, and can also affect the arms, but to a lesser degree
- no effects on the face.
Bilateral infarction can cause akinetic mutism
What are the symptoms of occlusion to the middle cerebral artery?
Occlusion to the middle cerebral artery:
- contralateral hemiparesis
- Hemisensory loss (especially face and arm)
- Contralateral homonymous hemianopia due to involvement of the optic radiation
- Cognitive changes including dysphasia with dominant hemisphere lesions, and visuo-spatial disturbance with non-dominant lesions
Which 3 conditions should be ruled out when patients present with menigitism: acute, severe headache felt over most of the head accompanied with neck stiffness
If headache is acute, severe and felt over most of the head and accompanied by neck stiffness, must exclude:
- Meningitis: fever, photophobia, stiff neck, purpuric rash, coma
- Encephalitis: fever, odd behaviour, fits, or decreased consciousness
- Subarachnoid haemorrhage: sudden-onset, “worst headache ever”, stiff neck, decreased consciousness.
Sinusitis and acute glaucoma can cause headache. Describe the headache.
In sinusitis: acute headache. Dull, constant ache over frontal or maxillary sinuses, with tenderness +/- postnasal drip.
Pain is worse on bending over
Acute glaucoma: acute headache. Typically affects elderly, long-sighted people. Constant aching pain around one eye which
What is the differential diagnosis for recurrent acute headaches?
- Migraine
- Cluster headache
- Trigeminal Neuralgia
- Recurrent Mollaret’s Meningitis
What is menigitism?
Acute, severe headache which is felt over most of the head, accompanied with neck stiffness.
Giant Cell Arteritis causes headaches of subacute onset or chronic headaches?
Giant cell arteritis causes headaches of subacute onset.
What type of headache is this:
bilateral, non-pulsatile headache that is accompanied with scalp tenderness.
No vomiting nor senitivity to head movements.
Relieved with massage or anti-depressants.
Tension headache
What type of headache is this:
Typically worse on waking, lying, bending forward, or coughing.
Also vomiting, papilloedema, seizures, false localising signs, or odd behaviour
Chronic headache resulting from raised intracranial pressure.
Always do an imaging to exclude a space-occupying lesion.
Lumbar puncture is contraindicated until after imaging.
