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Will's Clinical Exam > Talley Neuro > Flashcards

Talley Neuro Flashcards

1
Q

Loss of facial pain/temperature but preserved light touch

A

Medullary or upper cervical fifth nerve lesion

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2
Q

Horner’s Syndrome

A
  1. Carcinoma of lung apex (Squamous Cell)
  2. Neck mass - Thyroid malignancy, trauma
  3. Carotid arterial lesion - aneurysm or dissection
  4. Brain stem lesion - vascular disease, syringobulbia, tumour
  5. Retro-orbital lesions
  6. Syringomyelia (rare)
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3
Q

Light Reflex

A

Constriction - No cortical involvement. Involves optic nerve and tract, Edinger-Westphal nucleus and efferent parasympathetic fibres

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4
Q

Accomodation

A

Cortex –> Convergence of the pupil with accomodation. Parasympathetic fibres in third nerve

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5
Q

Absent light reflex but intact accommodation

A
  1. Midbrain lesion (Argyll Robinson pupil)
  2. Ciliary ganglion lesion
  3. Parinaud’s syndrome
  4. Bilateral anterior visual pathway lesions (bilateral afferent pupil deficits)
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6
Q

Absent convergence but inact light reflex

A
  1. Cortical lesion (cortical blindness)
  2. Midbrain lesion (rare)
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7
Q

Causes of Constriction

A
  1. Horner’s Syndrome
  2. Argyll Robertson pupil
  3. Pontine lesion (often bilateral but reactive to light)
  4. Narcotics
  5. Pilocarpine drops
  6. Old age
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8
Q

Causes of dilatation

A
  1. Mydriatics, atropine poisoning or cocaine
  2. Third nerve lesion
  3. Adie’s pupil
  4. Iridectomy, lens implant, iritis
  5. Post-trauma, deep coma, cerebral death
  6. Congenital
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9
Q

Tunnel vision

A

Glaucoma, papilloedema

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10
Q

Central scotomata

A

Optic nerve head to chiasmal lesion
- Demyelination
- Toxic
- Vascular
- Nutritional

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11
Q

Unilateral field loss

A

Optic nerve lesion
- Vascular
- Tumour

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12
Q

Lower Quadrant Homonymous Hemianopia

A

Parietal lobe

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13
Q

Upper Quadrant Homonymous Hemianopia

A

Temporal Lobe

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14
Q

Aide’s Syndrome

A

Lesion in efferent parasympathetic pathway

Signs
- Dilated pupil
- Decrease or absent reaction to light (direct and consensual)
- Slow or incomplete reaction to accommodation with slow dilation afterwards
- Decreased tendon reflexes
- Commonly in young women

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15
Q

Argyll Robinson Pupil causes

A

Lesion of the iridodilator fibres in the midbrain:
- Syphilis
- Diabetes Mellitus
- Alcoholic midbrain degeneration (rarely)
- Other midbrain lesions

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16
Q

Argyll Robinson Pupil signs

A
  • Small, irregular, unequal pupil
  • No reaction to light
  • Prompt reaction to accommodation
  • If tabes associated, decreased reflexes
17
Q

Causes of optic neuropathy

A
  • Multiple Sclerosis
  • Toxins - ethambutol, chloroquine, nicotine, alcohol
  • Metabolic (B12)
  • Ischaemia
  • Familial (Leber’s disease)
  • Infective (EBV)
18
Q

Third nerve palsy features

A
  • Complete ptosis (or partial ptosis)
  • Divergent strabismus (eye ‘down and out’)
  • Dilated pupil unreactive to direct or consensual light and unreactive to accommodation
19
Q

Differential for eye movement abnormality not explained by CN lesion

A

Neuromuscular myopathy
Ocular myopathy (mitochondrial myopathy) - do not worsen with repetition or maintenance

20
Q

Third Nerve Palsy Aetiology

A

Central
- Vascular
- Tumour
- Demyelination
- Trauma
- Idiopathic

Peripheral
- Compressive lesion
- Aneurysm, tumour causing raised ICP, nasopharyngeal carcinoma, basal meningitis
- Infarction
- Trauma
- Cavernous sinus lesion

21
Q

Sixth Nerve Palsy Features

A

Failure of lateral movement
Affected eye is deviated inwards in severe lesions
Diplopia - Horizontal, outermost image from affected eye, maximal looking to affected side

22
Q

Sixth Nerve Palsy Causes

A

Bilateral - Trauma, Wernicke’s, Raised ICP, Mononeuritis Multiplex

Unilateral:
Central - Vascular, tumour, Wernicke’s encephalopathy, multiple sclerosis
Peripheral - Diabetes, trauma, idiopathic, raised ICP

23
Q

Causes of Horizontal Nystagmus

A

Vestibular - Fast phase away from side of lesion
Cerebellar - Nystagmus to the side of the lesion
INO - Nystagmus in abducted (contralateral) eye with failure of adduction in the affected eye.

24
Q

One and a half syndrome

A

MLF and abducens nucleus on same side affected - only horizontal movement the eye can make is abduction of the contralateral side

25
Q

Causes of Vertical Nystagmus

A

Brain steam lesion
- Upbeat nystagmus = lesion in floor of the fourth ventricle
- Downbeat nystagmus suggests foramen magnum lesion
Toxic - Alcohol, phenytoin

26
Q

Supranuclear palsy

A

Loss of upward and/or downward gaze
- Both eyes affected
- Pupils often unequal
- No diplopia
- Reflex eye movements intact

27
Q

Fifth Nerve Palsy

A

Central (Pons, medulla, upper cervical cord)
- Vascular, tumour, syringobulbia, MS

Peripheral (posterior fossa)
- Aneurysm, tumour (acoustic neuroma), chronic meningitis

Trigeminal ganglion (Petrous temporal bone)
- Meningioma, fracture of the middle fossa

Cavernous sinus (associated third, fourth and sixth nerve palsies)
- Aneurysm, thrombosis, tumour

Other
- Sjogren’s syndrome, SLE, toxins, idiopathic

Will's Clinical Exam (5 decks)

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