pastest neuro Flashcards
what muscles does the radial nerve supply?
Muscles supplied by the radial nerve B Brachioradialis E Extensors S Supinator T Triceps
how does mysthaenia gravis usually present?
bulbar weakness (fatigueability) (ptosis / double vision / dysphagia / easy fatigueability of neck movements)
can be precipitated by stresses on the body
generally repeated weakness on repeated testing of a muscle NOT on first movement (still a fair bit of ACh knocking about the synapses)
guillain barre syndrome - how does it present?
ascending fashion - lower extremities first
describe a typical presentation of lupus (if there is one…)
arthralgias
myalgias
malar photosensitive rash
PMR - how does it usually present
frank weakness in proximal muscles
pain - generalised myalgia
state the different types of dementia and how they might present:
frontotemporal - Pick’s (frontal lobe features) - often late middle age with SIGNIFICANT personality change
multi-infarct dementia - stepwise fashion
Normal pressure hydrocephalus - urinary incontinence and gait abnormalities + cognitive decline
Sporadic CJD - RAPIDLY progressive onset of dementia + myoclonic jerks / gait abnormalities / cerebellar syndromes
Alzheimer’s disease is a diagnosis made after exclusion of other causes of dementia (non-reversible)
fungal meningitis - what are the two main causative organisms?
Fungal meningitis
C Cryptococcus (associated with HIV infection)
C Candida
Progressive peripheral polyneuropathy with hyporeflexia suggests…?
Guillain-Barre syndrome
The tremor seen in Parkinson’s disease is a…
a unilateral tremor that improves with voluntary movement
The tremor seen in Parkinson’s disease is a…
a unilateral tremor that improves with voluntary movement
what visual field defect does a primary open angle glaucoma cause?
Unilateral peripheral visual field loss
how do you remember the visual field defect in a patient with an extensive stroke causing paresis etc..
homonymous hemianopia is always on the same side as the paresis.
what is lateral medullary syndrome
which vessel is often affected to cause this?
quick phase of nystagmus towards the affected side
ipsilateral ataxia of upper and lower limbs
drooping of palate on eliciting gag reflex ipsilateral to lesion ( cos of involvement of vagus nerve)
may be assoc with dysphagia and dysphonia because of the above…
THINK MEDULLARY SYNDROME - IPSILATERAL
medullary syndrome is caused by blockages in the PICA artery - posterior inferior cerebellar
what symptoms might be associated with an:
- anterior choroidal artery blockage
- labyrinthine artery blockage
think - what does it supply?
- ant choroidal supplies optic tract / choroid plexus (produces csf) / cerebral peduncle / some of the thalamus / the posterior limb of the internal capsule
occlusion therefore = contralateral hemiparesis/ sensation loss / homonymous hemianopia with loss of contralateral hemianopia
- right labyrinthine arteries - branch from AICerebellarArtery - ischaemia may = unilateral deafness / vertigo
Bell’s palsy:
- 4 causes?
- Management of bell’s palsy?
- how would you clinically differentiate between a UMN and LMN lesion?
- STROKE - commonest cause of facial nerve palsy!!! - key to differentiate between LMN and UMN
acoustic neuroma
idiopathic
Parotid infiltration (remember facial nerve (? branch) passes through parotid…
Herpes Zoster (Ramsey Hunt syndrome)
Mononeuritis multiplex - ?MS - check…? - 10 days oral prednisolone if an early presentation (within 72 hours? - check…)
reassure that most will resolve spontaneously (not all though…)
Obvs aciclovir if evidence of herpes zoster - severe pain etc… - LMN lesions cause a total hemifacial palsy
UMN lesions have sparing of the forehead and the upper eyelid
- which nerve is most commonly damaged in a humeral shaft fracture?
- which nerve is most commonly damaged in a humeral neck fracture?
- which nerve is most commonly damaged in a medial epicondylar fracture?
- radial nerve
- axillary nerve
- ulnar nerve
- name 3 common clinical features of Pick’s disease..
2. what might be seen on an MRI or a CT head in Pick’s disease?
think of it’s other name…
repetitive behaviour hoarding / criminal behaviour disinhibition aggresion anxiety emotional disturbance echolalia - repeating examiner's words echopraxia - imitating the examiner's actions
NB - patients tend to perform well on cognitive tests
- frontotemporal lobe degeneration
build up of Pick’s bodies (spherical aggregations of tau proteins in neurons
what are the key features of multisystem atrophy (a nice triad…)
and what is its eponymous name
- autonomic dysfunction
- ataxia
- parkinsonism
Shy-Drager syndrome..
what would be a typical presentation of CJD?
rapidly progressive dementia
hallucinations
may also lead to personality changes…
