Patterns of Neurological Presentation

Question 1

describe focal weakness

Answer 1

in distribution of peripheral nerve or spinal root
hemi-distribution
pyramidal distribution

Question 2

describe non-focal weakness

Answer 2

generalized
predominantly proximal or distal
if truly generalized - including bulbar motor function otherwise quadri or tetraparesis

Question 3

upper motor neurone?

Answer 3

between brain and spinal cord level

Question 4

lower motor neurone?

Answer 4

between spinal cord and tissue site

Question 5

describe motor signs of UMN lesion

Answer 5

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

Question 6

Babinski reflex?

Answer 6

type of pathological reflex
upgoing plantar
drawing a pin along sole of foot causes hyperextension of big toe and fanning of other toes

Question 7

pattern of sensory loss in UMN lesion?

Answer 7

central pattern

Question 8

motor signs of LMN lesion?

Answer 8

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

Question 9

pattern os sensory loss in LMN lesion?

Answer 9

can have no sensory loss

can have glove and stocking, peripheral nerve or root distribution

Question 10

general UMN pattern?

Answer 10

increased tone
brisk reflexes
pyramidal/corticospinal weakness (weak arm extensors and leg flexors)

Question 11

general LMN pattern?

Answer 11

wasting
fasciculation
decreased tone
decreased or absent reflexes 
flexor plantars

Question 12

general pattern of muscle disease?

Answer 12

wasting (usually proximal)
decreased tone
decreased or absent tendon reflexes

Question 13

general pattern of NMJ disease?

Answer 13

fatiguable weakness
normal/decreased tone
normal reflexes
no sensory symptoms

Question 14

general pattern of functional weakness?

Answer 14

no wasting
normal tone
normal reflexes
erratic power
non-anatomical loss

Question 15

what can cause UMN lesions?

Answer 15

acute stroke syndromes
SOLs
spinal cord problems

Question 16

how can location of UMN lesion be determined?

Answer 16

hemispheric = contralateral pyramidal weakness in face, arm, leg
parasagittal frontal lobe = paraparesis
spinal cord = pyramidal weakness below level of lesion

Question 17

what can cause LMN symptoms from anterior horn cells?

Answer 17

MND

spinal muscular atrophy

Question 18

how does LMN peripheral nerve involvement present?

Answer 18

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

Question 19

what causes NMJ disease?

Answer 19

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

Question 20

which tumour is associated with myasthenia gravis?

Answer 20

thymoma

Question 21

4 examples of sensory loss patterns and what causes them?

Answer 21

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)

Question 22

4 cerebellar signs?

Answer 22

broad based, unsteady gait
intention tremor/ataxia
dysdiadochokinesis
nystagmus and dysarthria

Question 23

extrapyramidal/parkinsonism symptoms?

Answer 23

bradykinesia, rigidity, resting tremor, impaired gait and posture
hypomimia
hypophonia
impaired postural reflexes
asymmetrical in PD, symmetrical in drug induced or atypical PD

Question 24

extrapyramidal/parkinsonism gait?

Answer 24

reduced arm swing, stooped posture, small steps, festination, turning en bloc

Question 25

what problems occur with temporal lobe dysfunction?

Answer 25

memory
agnosia
language disorders (Wernicke’s and broca’s)
visual fields (upper homonymous quadrantanopia)
auditory
limbic
temporal lobe epilepsy

Question 26

what problems occur with parietal lobe dysfunction?

Answer 26

visual field (lower homonymous quadrantanopia)
sensory 
gerstmann's syndrome
dyspraxia
inattention
denial

Question 27

treatment protocol for parkinsons?

Answer 27

symptomatic treatment with levodopa/dopamine agonist
OT,PT exercise etc
deep brain stimulation for some patients

Question 28

cardinal features of PD?

Answer 28

resting tremor 
rigidity
bradykinesia
postural instability
usually asymmetrical