presentations

Question 1

signs of upper motor neuron disease?

Answer 1

increased tone or spasticity
brisk reflexes
upgoing plantar responses

pyramial/corticospinal pattern of weakness -> weak extensors in arm + weak flexors in leg

Question 2

signs of lower motor neuron disease?

Answer 2

muscle wasting
reduced tone
fasciculations (twitches)
reduced reflexes

Question 3

signs of muscle disease?

Answer 3

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

Question 4

signs of neuromuscular junction disease?

Answer 4

fatiguable weakness
normal or decreased tone
normal reflexes
no sensory symptoms !

Question 5

how would a hemispheric upper motor lesion present?

Answer 5

contralateral weakness in face, arm, leg

*think homunuculus

Question 6

how would a parasagittal frontal lobe lesion upper motor lesion present?

Answer 6

paraparesis - partial paralysis of both legs

Question 7

what does hemianaesthesia with no other signs suggest?

Answer 7

contralateral cerbral lesion

Question 8

dissociated sensory loss

Answer 8

loss with lost spinothalamic (temperature/pain) but preserved dorsal column (vibration, light touch, proprioception) suggests hemicord damage

eg anterior spinal artery syndrome, brown-sequard syndrome

Question 9

what is the difference between hyper / hypokinetic symptoms? dysfunction in what part of the brain causes this?

Answer 9

basal ganglia, extrapyramidal

hypo = rigidity, bradykinesia (slow movements) -> parkinsonism

hyper = spasms, involuntary movements(chorea), ticks

Question 10

ataxia indicates damage to what part of the brain?

Answer 10

cerebellum

coordination, balance, speech, swallowing

Question 11

signs of cerebellar dysfunction?

Answer 11

gait - broad based + unsteady
intention tremor, ataxia in arms (finger nose), legs (knee-heel)

dysdiadochokinesis - clumsy fast alternating movements
nystagmus
dysarthria - slurred speech

Question 12

extrapyramidal / parkinsonism (motor symptoms)

Answer 12

bradykinesia
resting tremor
small shuffling gait

reduced arm swing
stooped posture

asymmetry in PD, symmetrical in drug induced or atypical

Question 13

frontal lobe dysfunction presentation

Answer 13

personality dysfunction
contralateral weakness - deficit in primary cotex
paraparesis
paratonia
present grasp reflex
magnetic gait
seizures
incontinence
visual field defects - optic chiasm beneath frontal lobe
anosmia
wernickes dysphasia (u can speak but may not be grammatically correct) - damage to brocas area

Question 14

temporal lobe dysfunction presentation

Answer 14

memory dysfunction - esp episodic
agnosia - inability to recognise or identify (visual/sensory)
language disorders - Wernickes
visual field defects - contralateral homonymous quadrantanopia
auditory dysfunction - Heschl’s gyrus
limbic dysfunction - depression

Question 15

parietal lobe dysfunction presentation

Answer 15

visual field defect - contralateral inferior homonymous quadrantanopia
contralateral weakness + sensory loss - primary somatosensory
sensory problems - visual + sensory
dyspraxia
lack of attention
denial

dominant lobe affected = Gerstmanns syndrome - cant write, do maths, identify fingers, or tell left from right

non-dominant = neglect (no awareness o one side of the body) dressing apraxia

Question 16

what is Gerstmanns syndrome? dysfunction to what part of the brain can cause this?

Answer 16

1. agraphia - can’t write
2. acalculia - can’t do math calculations
3. finger agnosia - can’t name, discriminate or identify fingers
4. left-right disorientation - can’t tell left from right

left parietal lobe in region of angular gyrus

Question 17

occipital lobe dysfunction presentation

Answer 17

contralateral homonymous hemianopia
visual hallucinations

Question 18

what visual deficit is seen in a parietal vs temporal lobe lesion?

Answer 18

temporal = contralateral superior quadrantopia

parietal = contralateral inferior quadrantopia

Question 19

how can you distinguish between dominant vs non-dominant parietal lobe dysfunction?

Answer 19

dominant lobe affected = Gerstmanns syndrome - cant write, do maths, identify fingers, or tell left from right

non-dominant = neglect (no awareness o one side of the body) dressing apraxia

(most people left dominant as right handed)