Patterns of Neurological Presentation Flashcards
what type of movement disorders are caused by problems of the corticospinal / pyramidal tract?
pyramidal / UMN features
- pyramidal weakness
- spasticity
what type of movement disorders are caused by problems of the basal ganglia?
EXTRAPYRAMIDAL
hyperkinetic MD
- dystonia
- tics
- myoclonus
- chorea
- tremor
hypokinetic (rigidity, bradykinesia)
- parkinsonism
- parkinsons disease
what type of movement disorders are caused by problems of cerebellum?
ataxia
weakness may be focal or non-focal, what is the difference between these?
focal - in distribution of peripheral nerve or spinal root, hemi-distribution, pyramidal distribution
non-focal - generalised, predominantly proximal or distal, if truly generalised it includes bulbar motor function otherwise quadri or tetraparesis
in UMN lesion, what pattern of sensory loss is seen compared to LMN?
UMN - central pattern
LMN - none, glove, stocking, peripheral nerve or root distribution
what is the difference between deep tendon reflexes, superficial reflexes and pathological reflexes in UMN lesion vs LMN?
UMN - increased deep tendon, decreased superficial and increased pathological
LMN - normal or decreased deep tendon, normal superficial and pathological
how is the sphincter function affected in UMN lesion vs LMN?
UMN = sometimes impaired
LMN = usually normal (unless for example cauda equina lesion)
how is muscle tone and bulk affected in UMN and LMN lesions?
UMN = increased tone, sometimes muscle hypertrophy
LMN = normal / decreased tone, muscle wasting
what are the main upper motor neurone signs?
increased tone hyper-reflexia extensor plantar responses spastic gait exaggerated jaw-jerk slowed movements
what are the main lower motor neurone signs?
muscle wasting
weakness
fasciculations
absent or reduced deep tendon reflexes
what is an upper motor neurone pattern of weakness?
increased tone
brisk reflexes
pyramidal / corticospinal pattern of weakness (weak extensors in arm, weak flexors in legs)
what is a lower motor neurone pattern of weakness?
wasting, fasciculation, decreased tone, decreased or absent reflexes, flexor plantars (normal)
what are the signs of muscle disease?
wasting (usually proximal), decreased tone, decreased or absent tendon reflexes
what are the signs of neuromuscular junction disease?
fatiguable weakness, normal or decreased tone, normal tendon reflexes
no sensory symptoms
what are the signs of functional weakness?
no wasting, normal tone, normal reflexes, erratic power, non-anatomical loss
UML pattern of weakness usually occurs with stroke, SOLs and spinal cord problems and can usually be determined by body segments involved and accompanying signs - what signs suggest a hemispheric, parasagittal frontal lobe and spinal cord lesion?
hemispheric = contralateral pyramidal weakness in face, arm and leg
parasagittal frontal lobe lesion = paraparesis
spinal cord = pyramidal weakness below level of lesion (cervical = arms and legs, thoracolumbar = legs)
what conditions can cause lower motor neurone pattern of weakness?
motor neurone disease
spinal muscular atrophy (lead poisoning, poliomyelitis)
how does peripheral nerve involvement normally present?
symmetrical polyneuropathy with weakness and sensory symptoms (diabetes, alcohol, metabolic insults)
mononeuropathy (nerve compression) or mononeuritis multiplex (asymmetric polyneuropathy) which occurs in diabetes or vasculitis
give examples of conditions which are neuromuscular junction disorders?
myasthenia gravis
organophosphate poisoning
lambert-eaton paraneoplastic syndrome
what are the different patterns of sensory loss and what type of disorder do these indicate?
stocking - length dependent neuropathy
sensory level - spinal cord lesion
haemianaesthesia - contralateral cerebral lesion
dissociated sensory loss with lost spinothalamic but preserved dorsal column - hemicord damage
what are the signs of a cerebellar disorder?
gait - broad based and unsteady
intention tremor / ataxia (assessed by finger-nose test and knee-heel test)
dysdiadochokinesis - clumsy fast alternating movements
nystagmus and dysarthria are additional features
what is the role of the frontal lobe?
generates novel strategies and has executive functions
enables self criticism and trying again
what are the many signs which can be associated with frontal lobe dysfunction?
personality dysfunction paraparesis paratonia grasp reflex frontal gait dysfunction (magnetic gait) cortical hand seizures incontinence visual field defects expressive dysphasia (brocas area) anosmia
what are the signs of temporal lobe dysfunction?
memory dysfunction (esp episodic memory)
agnosia (visual and sensory modalities in particular)
language disorders (wernickes)
visual field defects (congruous upper homonymous quadrantanopia)
auditory dysfunction (heschel’s gyrus)
limbic dysfunction
temporal lobe epilepsy
what are the signs of parietal lobe dysfunction?
visual field defect (congruous lower homonymous quadrantanopia)
sensory dysfunction (visual and sensory modalities)
gerstmanns syndrome (disease of dominant angular gyrus - dysgraphia, left-right disorientation, finger agnosia, acalculia)
dyspraxia
inattention
denial
what are the symptoms of a lacunar stroke?
no visual field defect
no new higher cortical or brainstem dysfunction
pure motor hemiparesis or pure sensory deficit of one side of the body, or sensorimotor hemiparesis or ataxia hemiparesis (dysarthric clumsy hand syndrome or ipsilateral ataxia with crural hemiparesis)
at least 2 of the 3 areas (face, arm and leg) should be involved
what are the symptoms of posterior circulation stroke?
one of:
- cranial nerve palsy
- unilateral or bilateral motor or sensory deficit
- disorder of conjugate eye movements
- cerebellar dysfunction
- homonymous hemianopia
- cortical blindness
what are the symptoms of total anterior circulation stroke?
hemiplegia and homonymous hemianopia contralateral to lesion
AND
either aphasia or visuospatial disturbances
+/- sensory deficit contralateral to the lesion
what are the symptoms of partial anterior circulation syndrome?
one or more of unilateral motor or sensory deficit, aphasia or visuospatial neglect (with or without homonymous hemianopia)
motor or sensory deficit may be less extensive than in lacunar syndromes
