Pattern Recognition (revision) Flashcards
Describe hyperkinetic movement disorders
Dystonia Tics Myoclonus Chorea Tremor
Describe hypokinetic movement disorders
Parkinsons; rigidity and bradykinesia
What is the pattern of weakness in MND?
UMN and LMN signs
Absence of sensory symptoms
+/- frontotemporal dementia
Inflammatory muscle disorders
Poly/deramatomyositis Inclusion body myositis Vasculitis RA Sjogren's
Endocrine muscle disorders
Hypothyroidism Cushing's Electrolyte disturbances Hypophosphatemia Hypocalcemia Hypernatraemia/ hyponatraemia
Drugs/toxins causing muscle disorders
Illicit drugs; cocaine, heroin Alcohol Corticosteroids Colchicine Antimalarial drugs Stains Penicillamine
Infections causing muscle disorders
Viral; influenza, parainfluenza, coxsackie, HIB, CMG, echovirus, adenovirus, EBV
Bacteria
Fungal
Parasitis
Rhabdomyolysis causing muscle disorders
Crush trauma Seizures Alcohol absuse; hyperkinetic state with delirium tremens Exertion Vascular surgery Malignant hyperthermia
Which muscle, nerve and nerve root are responsible for shoulder abduction?
M: deltoid
N: axillary
NR: C5
Which muscle, nerve and nerve root are responsible for elbow extension?
M: triceps
N: radial
NR: C7
Which muscle, nerve and nerve root are responsible for finger extension?
M: extensor digitorum
N: radial
NR: C7
Which muscle, nerve and nerve root are responsible for index finger abduction?
M: 1st dorsal interosseous
N: Ulnar
NR: T1
Which muscle, nerve and nerve root are responsible for hip flexion?
M: iliopsoas
N: femoral
NR: L1,2
Which muscle, nerve and nerve root are responsible for knee flexion?
M: hamstrings
N: sciatic
NR: S1
Which muscle, nerve and nerve root are responsible for ankle dorsiflexion?
M: tibialis anterior
N: common fibular and sciatic
NR: L4,5
Which muscle, nerve and nerve root are responsible for great toe dorsiflexion?
M: EHL
N: common fibular
NR: L5
Main deep tendon reflexes and oot innervation
Biceps/ supinator: C5,6
Triceps: C7,8
Knee: L3,4
Ankle: S1,2
What does a glove and stocking sensory loss indicate?
Length dependent neuropathy
What does a sensory level sensory loss indicate?
Spinal cord lesion
What does a hemianesthesia sensory loss indicate?
Contralateral cerebral lesion
What is a dissociated sensory loss indicate?
Loss of spinothalamic but preserved DCML; anterior spinal artery syndrome, brown sequard or syringomyelia
Extrapyramidal symptoms
Bradykinesia Rigidity Resting tremor Shuffling gait Stooped posture Hypomimia Hypophonia Reduced arm swing Impaired postural reflexes Asymmetry in PD, symmetry in DI
Main function of frontal lobe
Executive function
Prefrontal cortex connects to the basal ganglia, limbic system, thalamus and hippocampus
Frontal lobe dysfunction
Personality disorder Disinhibition Paraparesis Paratonia Frontal gait dysfunction Cortical hand Seizures Incontinence Visual field defects - homonymous hemianopia Expressive dysphagia - broca's area Anosmia
Temporal lobe dysfunction
Episodic memory dysfunction Agnosia Receptive aphasia; wernicke's area Superior quadrantanopia Auditory dysfunction; as hearing is bilateral deafness is NOT a cerebral feature Limbic dysfunction Temporal lobe epilepsy
Parietal lobe dysfunction
Inferior homonymous quadrantanopia Visuospatial dysfunction Gerstmann's syndrome Dyspraxia Inattention Denial
What is gerstmann’s syndrome?
Dominant lobe; dysgraphia, left-right disorientation, finger agnosia, acalculia
Treatment protocol for PD
Symptomatic; levodopa or dopamine agonist
MDT including speech and language, OT, PT, exercise
Deep brain stimulation
Drugs used in PD
Levodopa; crosses BBB Dopamine agonists; acts on D2 receptors MAO-B inhibitors; improve symptoms in those with mild disease Anticholinergics for tremor Amantadine; blocks NMDA receptors
Imaging in stroke
MRI T1/T2 and FLAIR for old lesions and lesions of non-vascular origin
T2 to identify bleeds and microbleeds
CT: hyperintense; bleed. Ischaemic; loss of lentiform nucleus, poor grey white matter differentiation, loss of insular ribbon
Corticospinal tract origin and parts
Origin: primary motor cortex of precentral gyrus
Lateral (primary decussation) = voluntary motor control of limbs and digits
Anterior corticospinal (segmental decussation) = voluntary motor control of trunk and maintains posture
Corticobulbar tracts origin and function
Origin: primary motor cortex in precentral gyrus
Function: muscles of face, head and neck
Which CN do NOT have a bilateral innervation to their nuclei?
CN 12
Lower part of 7; if there is forehead sparing this is an UMN lesion of facial nerve
Rubrospinal tract origin and function
Origin: red nucleus of midbrain
Function: excites flexors and inhibits extensors of upper body
Reticulospinal tract origin and function
Origin: pons/medulla
Function: excites extensors
Which motor tract is in charge in decorticate rigidity?
Lesion above midbrain
Rubrospinal tract; flexion of upper limbs
Which motor tract is in charge in decerebrate rigidity?
Lesion below midbrain
Reticulospinal tract; extension
DCML function and route
Function; fine touch, pressure and vibration
Decussates in medulla to contralateral medial lemniscus to reach the primary somatosensory cortex in the postcentral gyrus of the parietal lobe
Difference between gracile fasciculus and cuneate fasiculus
Gracile; legs, below T6
Cuneatus; arms; above T6
Gracile medial to cuneate in spinal cord
Spinothalamic tract function and pathway
Function: pain and temp
Decussates segmentally in spinal cord to reach opposite primary somatosensory cortex
Extradural haemorrhage: Location Origin Presentation Symptoms Ix Imaging findings
L: skull and dura
O: middle meningeal artery
Px: injury to pterion
Sy: unconscious then lucid interval then unconscious
Ix: CT
Findings: hyperdense biconvex lens appearance
Chronic subdural haemorrhage Location Origin Presentation Symptoms Ix Imaging findings
L: dura and arachnoid
Origin: cerebral bridging veins
Px: older patients due to low impact trauma
Sy: progressive headache and confusion
Ix; CT
Findings: hypodense crescent shaped appearance
SAH Location Origin Presentation Symptoms Ix Imaging findings
L: arachnoid and pia
Origin: arterial; commonly berry aneurysm
Px: severe head injuries or ruptured berry
Sy: thunderclap headache, meningeal irritation (neck stiffness, photophobia), loss of consciousness
Ix: CT initially. Definitive diagnosis is CTA
Findings; hyperdense in SA space. Commonly star shaped
Symptoms of cerebral herniation
Extensor response
Cushing’s triad; hypertx, brady, agonal breathing
Uncal herniation = blown pupil
Where can you find the dual venous sinuses?
Outer and inner dura
Expressive dysphasia
Brocas area
Receptive dysphasia
Wernicke’s area
Nystagmus, intention tremor and dysarthria
Cerebellum
Temperature control
Hypothalamus
Oculomotor nucleus
Midbrain
Most common cause of hydrocephalus in children
Aqueduct stenosis - non-communicating hydrocephlus
Sy of aqueduct stenosis?
Growth in head circumference
Eyelids retracted; sunsetting eyes
Upward gaze impaired
Failure to thrive
What GCS indicates comatomse?
8 or less
