Revision course

Question 1

UMN vs LMN

Answer 1

UMN- to anterior horn cell—Tone up, Power down, Reflex brisk/up
LMN-from anterior horn cell onwards-Power down, decreased tone, reflex down, fasciculation, wasting

Question 2

Sensory pathways

Answer 2

Spinothatlamic tract-pain and temp-crosses at points it exits
Other tract- cross at the medulla higher up- vibration and proprioception, pin prick
Spinal cord stops at L1/2—after that its all LMN

Question 3

Stroke, tia and blood supply

Answer 3

TIA- sx of stroke <24h-can be 15mins
Stroke -rapid onset of local neurology- due to ischemia or heamorrgahe
Blood-ACA, MCA, PCA, and posterior- Basilar, communicating,

Anterior- ACA/MCA- hemiparesis, cortical signs (aphasia, apaxia, visual field)-face arm and leg
Posterior-diplopia, dizziness, nausea, dysphagia — CROSSED findings (face vs limbs)

Neuro homonculus- Foot->legs-> arms-> hand-> face->tongue
Tongue on the side- and more MCA
Feet in central-more of a ACA

Question 4

Neuro homonculus

Answer 4

Neuro homonculus- Foot->legs-> arms-> hand-> face->tongue
Tongue on the side- and more MCA
Feet in central-more of a ACA

Question 5

Homonymous hemianopia pathways

Answer 5

Contralateral damage of the occipital region- as it crosses over at the chiasm-
STROKE SIGN

Question 6

occipital stroke eye changes

Answer 6

If you have an occipital stroke– lose CONTRALATERAL homonymous hemianopia-can see one side (same side in both eyes)

unlike- before chiasm- eye issue
chiasm- bitemporal hemianopia
issues in the tracts to the occipital lobe-quadrianopia (TEMPORAL- SUperior, Parietal->inferior

in PACES- just want to tell- nerve, chiasm or after

Question 7

Best management of stroke

Answer 7

acute-
CT HEAD AND CONTACT STROKE team
thrombolysis (4.5h) and throbectomy (6h)+ Aspirin 300mg

long term
Clopidogrel is the best anticoagulant to use–
but it depends on causes (if AF-DOAC/APIXABAN, carotid stenosis (>70% w/ SX), etc)

also need to image the carotids-doppler or CT- and consider removing w/ endartrectomy
COnsider other RF- HTN, Diabetes-and treat

causes are important- cause thats how you treat (CHAD-VASC2 is important to know clopido vs DOAC)
dissections, GCA, Heamatological disorders (Sickle Cell, LPS)

Question 8

Cerebellar stoke

Answer 8

Ataxia, nystagmus (fast phasing beat towards issue)
intetion tremor on same side
Unsteady gait
Dysdidokinesia
Speech changes
Hypotonia

DANISH

IPSILATERAL

Question 9

Brainstem stroke

Answer 9

Crossed findings-posterior circulation
Cranial nerves and Limb nerves dont cross in same area-

Contralateral limbs, ipsilateral face (fully)

+ dizzyness, nausea,

Question 10

Brainstem stroke

Answer 10

Crossed findings-posterior circulation
Cranial nerves and Limb nerves dont cross in same area-

Contralateral limbs, ipsilateral face (fully)

with crossed signs- usually numbness this time (face ipsi, limbs contralateral)

Question 11

Vertebral artery dissections

Answer 11

important cause of young people stroke–
its lateral medullary syndrome/PICA-vertebral arteries issues-

crossed SENSORY signs- face and limbs paresthesia
+ vertigo+ataxia (very posterior)
Horners syndrome can present

Question 12

What is horners, causes

Answer 12

Ptosis, meisosis, anhidrosis, enopthalmos

blockage of sympathetic chain-
starts in brainstem- why can happen in PICA
Pass via carotid-carotid dissection
Pass via lung- pancost tumour, 1st rib

Question 13

SAH ix

Answer 13

Can present with only headache and no neuro

CT head is the start- but not always as it can not show up 98% if done within 12h– see bright areas (bleeding).but after a week 50% sensitive

2nd- LUMBAR puncture for blood degradation products-xanthochromia-best within 12h-2w is very reliable
need to cover from light!
also do other LP measurments as usual

Question 14

SAH ix

Answer 14

Can present with only headache and no neuro

CT head is the start- but not always as it can not show up 9– see bright areas (bleeding)

2nd- LUMBAR puncture for blood degradation products-best within 12h-1w

Question 15

Status epilepticus

Answer 15

5mins seize or 2 without recovery

O2, ressus, protect airway, glucose, bloods, pabrinex if alcohol
IV acesss-> IV lorazepam 2 doses
PR diazepam/buccal midazolam also

-> phenytoin/levitaceram/sodium valporate if not recovering

-> if not ITU and General anesthetic

Question 16

Seizure definition and presentations

Answer 16

discharge of electrical activity-

generalised or focal
epilepsy is just the tendency to have seizures- 2> with 24h different

children–
absence/atonic- childhood seizures (need specific EEG changes)
Juvenile - Myoclonic- Jerks

Generalised-
Tonic clonic

Focal- one limb, area-jacksonian march
either simple (no loss of awareness)
or complex (with loss of awareness)

usually last a few seconds, and has a drowsy period afterwards (post ictal), and pre-ictal + period they dont remeber
eyewitness is most crucial

biting tongue, pee, smacking limb

Question 17

Epilepsy Ix and Mx

Answer 17

Eye witness always
MRI, EEG, ECG

mx-
safety- no baths, no driving (Contact DVLA->2 seizures=cant drive until 1y seizure free. Only 1 seizure- 6m no drive. Provoked seizure- case by case)
start management if no visible cause
generalised- sodium valp male, Lamotrigine female
Focal- lamotrigine

Question 18

Chord compression sx, ix and mx

Answer 18

Bilateral leg weakness and pain
upgoing plantars, brisk reflex
Numbness in legs up (progressess up as compression is left)
Urinary incontinence, bowel

-> UMN signs tell you the block is higher and need MRI whole spine-crucial
assox with cancer,

NO CAUDA EQUINA— thats LMN (and would be lumbar MRI-probs MRI whole spine)

Ix- MRI WHOLE SPINE -usually above the sensory level
Mx- immediate neurosurgery refer and

Question 19

Spinal hemicord syndrome sx

Answer 19

Brown sequard sequence
Half the cord is lost-so lose only some tracts

Paralysis (motor) and Loss of vibration/proprioception (dorsal tract) on one side
loss of pain and temp on other side (spinothalamic)

Question 20

Motor Neuron disease sx and ix, mx

Answer 20

PURE motor weakness-anterior horn cell issue
with UMN and LMN signs (usually UMN but with fasciculations)

usually 60y/o

ALS is most common (70%)-month to years
Bulbar Palsy (20%)-dysarthria/phagia-limbs later

ix- muscle conduction is usually best
can do MRI brain for ddx (Spondylitic neck, Syringomeglia)

mx-v little
rulazole maybe helps a few months
and supportive- like NG/Peg tube, NIVentilation

Question 21

GBS sx, ix, mx

Answer 21

GBS- post viral illness-fully LMN
Weakness and paresthesia, Distal>proximal, usually legs>arms
Gloves n stock distribution
down reflexes, down plantars,
fasciculation and wasting
can get ANS issues
rare millerfischer variant-eye, ataxia, no limbs

ix-other neuropathy causes-
Bloods
LP– high protein is GBS. WCC raised-> not GBS

Mx-IVIG/Plasma exchange are usually reserved for later/motor sx- will resolve on their own
support- cardiac monitor for dysarrythmia
DVT prophylaxis
Spirometry measure
rarely MRI- if not clear

Question 22

Neuropathies

Answer 22

Pure sensory- diabetes, alcohol, b12/folate, cancer medication, cancer
Pure Motor- GBS, lead, Porypheria

also mono vs poly
mono- carpal tunnel
Poly-acute or chronic
acute- axonal, demyelinating
Chronic-axonal, demyelinating

axonal- decreased amplitude but speed fine
demyelinating- speed slower but amplitude fine

Question 23

Myasthenia gravis

Answer 23

AID in NMJ
fatiguability weakness
especially dysarhtria, ptosis, diplopia, opthalmoplegia
triggered via infections/drugs (bblocks)
assox with THymoma

ix- clincal hx and exams
AChR Ab are 80% +ve
Nerve conduction study will say in NMJ
Tensilon test
Ice test-put ice on the ptosis- improve

Mx- Pysostigmine
acute-plasma exchange/ivIG
longterm- steroids, other immunosupressants (azathioprine etc)
check for Thymoma

Question 24

Parkinsons Sx, Ix and Mx

Answer 24

Resting tremor, bradykinesia, Postural instability, Rigidity,
hypomemisaia
Parkisonian gait/shuffling gait
then later ANS (hypotense, urinary)

can be caused by parkisons (asymetric), PSP (symetrical and falls early), MSA (ANS features first Hypotense, Urinary)
other than parkinsons-poor response to levodopa
Drug- symetrical

ix- response to levodopa
DAT-scan (normal in drugs, abnormal in park +)

Mx- Levodopa
Younger-dopamine agonist -Ropiridole

SE
issue with impulse control (more dopamine agonist)
confusion, hypotension
Nausea and vomiting (settles in weeks)
drowsy
long term- dyskinesia, hallucinations, psychosis)

Question 25

MS sx,ix,mx

Answer 25

AID -> central demyelination, brain/cord
focal neurology isolated in time and space- >2 events
Optical neuritis very common start
Bladder incontinence, numbness etc

Ix-MRI with contrast-show lesions all around
Bloods,LP-oligoband only in CNS for mimics
NEW -McDonald criteria- need to exclude ddx to diagnose MS-based on the 2 attacks differentiated in time/space OR imaging /LP (w/ 1 sx attack)-> earlier diagnoses

Mx-
relapse-check for infections, if none->Steroids to lower length (not improve MS)
DMARD-dymethyl fumarate, interferon, Fingolimod
Stem cell transplant

Question 26

MS ddx

Answer 26

bilateral Optic neuritis-neuromyelitic spectrum disorder
Neurosarcoidosis
Acute disseminated encephelomyelitis (post infection neuro lesions)

Question 27

What is Rapid afferent peripheral d