Patterns of Neurological Presentation Flashcards
describe focal weakness
in distribution of peripheral nerve or spinal root
hemi-distribution
pyramidal distribution
describe non-focal weakness
generalized
predominantly proximal or distal
if truly generalized - including bulbar motor function otherwise quadri or tetraparesis
upper motor neurone?
between brain and spinal cord level
lower motor neurone?
between spinal cord and tissue site
describe motor signs of UMN lesion
corticospinal distribution of weakness
increased deep tendon and pathological reflexes
decreased superficial reflexes
sphincter function can be impaired
increased muscle tone (flexed arms, extended legs)
can have muscle hypertrophy
Babinski reflex?
type of pathological reflex
upgoing plantar
drawing a pin along sole of foot causes hyperextension of big toe and fanning of other toes
pattern of sensory loss in UMN lesion?
central pattern
motor signs of LMN lesion?
generalized, predominantly proximal, distal or focal distribution of weakness (no involvement of corticospinal innervated muscles)
normal reflexes (deep reflexes can be decreased)
sphincter function usually normal
normal/decreased muscle tone
muscle wasting
pattern os sensory loss in LMN lesion?
can have no sensory loss
can have glove and stocking, peripheral nerve or root distribution
general UMN pattern?
increased tone
brisk reflexes
pyramidal/corticospinal weakness (weak arm extensors and leg flexors)
general LMN pattern?
wasting fasciculation decreased tone decreased or absent reflexes flexor plantars
general pattern of muscle disease?
wasting (usually proximal)
decreased tone
decreased or absent tendon reflexes
general pattern of NMJ disease?
fatiguable weakness
normal/decreased tone
normal reflexes
no sensory symptoms
general pattern of functional weakness?
no wasting normal tone normal reflexes erratic power non-anatomical loss
what can cause UMN lesions?
acute stroke syndromes
SOLs
spinal cord problems
how can location of UMN lesion be determined?
hemispheric = contralateral pyramidal weakness in face, arm, leg
parasagittal frontal lobe = paraparesis
spinal cord = pyramidal weakness below level of lesion
what can cause LMN symptoms from anterior horn cells?
MND
spinal muscular atrophy
how does LMN peripheral nerve involvement present?
symmetrical (usually length dependant) polyneuropathy with weakness and sensory symptoms
mononeuropathy as a result of nerve compression or mononeuritis multiplex which occurs in diabetes or vasculitis
what causes NMJ disease?
acetylcholine receptor (or musk) antibody mediated myasthenia gravis inhibition of acetylcholinesterase by organophosphate poisoning or interfere with presynaptic calcium channel function in lambert eaton paraneoplastic syndrome
which tumour is associated with myasthenia gravis?
thymoma
4 examples of sensory loss patterns and what causes them?
stocking and glove = length dependant neuropathy
sensory level = spinal cord
hemianaesthesia = contralateral cerebral lesion or with no other signs - non-organic disorder
dissociated sensory loss with lost spinothalamic but preserved dorsal column sensation = hemicord damage (e.g brown sequard)
4 cerebellar signs?
broad based, unsteady gait
intention tremor/ataxia
dysdiadochokinesis
nystagmus and dysarthria
extrapyramidal/parkinsonism symptoms?
bradykinesia, rigidity, resting tremor, impaired gait and posture
hypomimia
hypophonia
impaired postural reflexes
asymmetrical in PD, symmetrical in drug induced or atypical PD
extrapyramidal/parkinsonism gait?
reduced arm swing, stooped posture, small steps, festination, turning en bloc
what problems occur with temporal lobe dysfunction?
memory
agnosia
language disorders (Wernicke’s and broca’s)
visual fields (upper homonymous quadrantanopia)
auditory
limbic
temporal lobe epilepsy
what problems occur with parietal lobe dysfunction?
visual field (lower homonymous quadrantanopia) sensory gerstmann's syndrome dyspraxia inattention denial
treatment protocol for parkinsons?
symptomatic treatment with levodopa/dopamine agonist
OT,PT exercise etc
deep brain stimulation for some patients
cardinal features of PD?
resting tremor rigidity bradykinesia postural instability usually asymmetrical
