Pattern Recognition

Question 1

when does upper motor neurone weakness occur

Answer 1

acute stroke syndromes
SOL
spinal cord lesions

Question 2

if there was an issue in a hemisphere, what areas would you expected to be showing weakness

Answer 2

CONTRALATERAL pyramidal weakness in face, arm, leg

Question 3

if there was an issue in a parasagittal frontal lobe, what would you expect to see

Answer 3

paraparesis

Question 4

if there was a lesion in the spinal cord, what would you expect to see

Answer 4

pyramidal weakness below the level of the lesion

cervical: arms and legs
Thoracolumbar: legs

Question 5

what is the peripheral nerve involvement pattern - symmetrical

Answer 5

Symmetrical polyneuropathy with weakness and sensory symptoms: frequent complication of diabetes, toxin (alcohol) or metabolic insults

Question 6

what is the peripheral nerve involvement pattern - mononeuropathy

Answer 6

nerve compression (carpal or tarsal tunnel syndrome, ulnar neuropathy, radial neuropathy)

or mononeuritis multiplex (asymmetric polyneuropathy), which occurs in the context of diabetes or vasculitis

Question 7

what part of the neuromuscular junction is affected in Lambert-Eaton paraneoplastic syndrome

Answer 7

presynaptic calcium channel

Question 8

what are the patterns of sensory loss and what do they suggest

Answer 8

Stocking (and later glove) implies length dependent neuropathy

Sensory level implies a spinal cord lesion

Haemianaestheisa suggests contralateral cerebral lesion, or with no other signs a non-organic disorder

Dissociated sensory loss

Question 9

what does dissociated sensory loss suggest

Answer 9

Disscociated sensory loss with lost spinothalamic (temperature / pain) but preserved dorsal column (vibration, light touch, proprioception) suggests hemicord damage (anterior spinal artery syndrome, Brown-Sequard syndrome, syringomyelia)

Question 10

how is intention tremor/ataxia assessed

Answer 10

in the arms by finger-nose test and in the legs by knee-heel testing