The approach to a neurology patient Flashcards
Cause of sudden onset
-Recurrent?
Vascular or trauma or -epilepsy or migrain
Cause of hour to days onset
Inflammation e.g MS
Infection
Cause of days-weeks onset
Inflammation/ rapid mass lesions
Cause of months onset
Slower mass elsion
Cause of years onset
Degenerative
Cause of since early life onset
Congenital
How to categorise regions-
Cerebral hemispheres Brainstem Spinal cord Nerve roots or peripheral nerves Muscles
How would a hemispheric pathology present
Contralateral hemi motor and sensory signs
Upper motor neuron signs (weakness, hyperactive reflex, tremor, increased muscle rigidity)
Cognitive signs (aphasia/neglect)
Presentations of upper motor neurone legions
Secondary changes in excitability–>
-Increased tone; clonus; brisk reflexes; extensor plantar (upward movement of toe when underneath of foot is stroked)
Presentation of upper motor neurone legions
Show effects of loss of nerve input to muscle–>
-Wasting; low tone; fasciculations; loss of reflexes
Where are the weaknesses worse in upper motor neurone patterns
Extensors of arms (shoulder abduction, triceps, wrist and finger ext)
Flexors of legs (hip flexion+ knee flexion and ankle dorsiflexion)
Where will weakness in lower neurone patterns occur in peripheral neuropathy
IN distal hands and legs
where will weakness in lower neurone patterns occur in nerve roots
Specific areas
Where will weakness in lower neurone patterns occur in focal peripheral nerves
Specific areas of hands and feet
Signs of brainstem signs
Abnormal eye movements/ vertigo
+
Upper motor neuron unilateral or bilateral weakness
+- crossed sensory sign (e.e. one side of ur face has sensory loss compared to the other half of ur body)
+-Weakness of swallowing and speech
+-Cerebellar signs
+-horner’s sign (decreased pupil size, drooping eyelid)
