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OSCEs > UMN lesions vs LMN lesions > Flashcards

UMN lesions vs LMN lesions Flashcards

1
Q

What signs indicate UMN lesion?

A
  • Increased tone
  • Spasticity
  • Weakness
  • Brisk reflexes, upgoing Babinski
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2
Q

What signs indicate LMN lesion?

A
  • Wasting and fasciculation
  • Decreased tone
  • Weakness
  • Reduced reflexes
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3
Q

What are the potential causes of unilateral UMN lesions (pyramidal weakness)?

A

Brain → Cord

  • Intracranial: stroke, SOL → hemisensory loss
  • Brainstem: stroke, SOL → may be crossed signs
  • Spinal cord: MS, infarct/haemorrhage, SOL, disc prolapse, trauma, syringomyelia, congenital → sensory level/segmental sensory loss
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4
Q

What are the potential causes of bilateral UMN lesions (pyramidal weakness)?

A

3 Ms

  • MS
  • Motor neurone disease → normal sensation
  • Myelopathy: cord compression (e.g. due to cervical myelopathy, SOL, disc prolapse, paraspinal infection), trauma, transverse myelitis, syringomyelia, congenital → sensory level/segmental sensory loss

Others:

  • Brainstem stroke
  • Hereditary spastic paraplegia
  • Cerebral palsy
  • HTLV-1
  • Syphilis
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5
Q

What are the features of radiculopathy?

A

Dermatomal sensory loss

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6
Q

What are the causes of radiculopathy?

A
  • Disc herniation/ degenerative disc disease
  • Spondylosis
  • OA with osteophytes
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7
Q

What is the general feature of plexopathies?

A

Vast dermatomal sensory loss

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8
Q

What are the causes of brachial plexopathy?

A
  • Brachial neuritis
  • Trauma (dislocated shoulder)
  • Congenital (Erb’s palsy, Klumpke’s)
  • Thoracic outlet syndrome
  • Neoplastic infiltration/compression
  • Radiotherapy
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9
Q

What are the causes of lumbosacral plexopathy?

A
  • Trauma
  • Congenital
  • Neoplastic infiltration/compression
  • Radiotherapy
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10
Q

What are the potential causes of median nerve palsy?

A
  • Carpal tunnel syndrome
  • Distal radius fracture
  • Penetrating forearm injuries
  • Pronator teres syndrome
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11
Q

What are the potential causes of carpal tunnel syndrome?

A
  • Idiopathic
  • Pregnancy
  • Obesity
  • Local pressure
  • Hypothyroidism
  • Acromegaly
  • Diabetes
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12
Q

What are the potential causes of ulnar nerve palsy?

A
  • Compression at elbow/cubital tunnel
  • Fractures
  • Guyon’s canal/ulnar tunnel syndrome
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13
Q

What are the potential causes of radial nerve palsy?

A
  • Trauma/compression at axilla (crutches, Saturday night palsy, stabbing)
  • Fracture to mid-humerus
  • Elbow fracture/dislocation/ganglion
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14
Q

What are the potential causes of axillary nerve palsy?

A
  • Shoulder dislocation

- Fracture at surgical neck of humerus

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15
Q

What are the potential causes of common peroneal nerve palsy?

A
  • Plaster cast compression

- Trauma

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16
Q

What are the potential causes of bilateral LMN lesions (distal weakness) associated with abnormal sensation?

A

Sensorimotor polyneuropathy: ABCDE

  • Alcohol
  • B12/thiamine (B1) deficiency
  • Charcot-Marie-Tooth, Carcinomas
  • Diabetes, drugs (TB drugs, metronidazole, nitrofurantoin, vincristine, cisplatin, amiodarone)
  • Every vasculitis (SLE, RA, polyarteritis nodosa) and some infections (HSV, HIV, leprosy, syphilis)
17
Q

What are the potential causes of bilateral LMN lesions (distal weakness) associated with normal sensation?

A

Distal motor neuropathy

  • Chronic inflammatory demyelinating polyneuropathy
  • Myotonic dystrophy
  • Inclusion body myositis (proximal in legs, distal in arms)
  • Progressive muscular atrophy
  • Lead poisoning
  • Porphyria
18
Q

What are the potential causes of acute flaccid paralysis?

A
  • GBS
  • Some rare infections (e.g. rabies, polio, West Nile virus)
  • Cauda equina
  • Spinal cord shock
19
Q

What are the potential causes of proximal weakness and normal sensation?

A

DENIM:
- Dystrophies: Becker’s/Duchenne, limb girdle, fascioscapulohumeral
- Endocrinological: Cushing’s syndrome, hyper/hypothyroidism, diabetic amyotrophy (lower limbs)
- Neuromuscular: MG, Lambert-Eaton syndrome
- Inflammatory: dermato-/polymyositis, inclusions body myositis
Metabolic/congenital/ mitochondrial myopathies

20
Q

What are the causes of mononeuritis multiplex?

A
  1. Vasculitis:
    - granulomatosis with polyangiitis
    - eosinophilic granulomatosis
    - polyarteritis nodosa
    - microscopic polyangiitis
  2. Autoimmune:
    - RA
    - SLE
    - Cryoglobulinaemia
    - Sjogren’s syndrome
  3. Infectious:
    - Lyme disease
    - HIV
    - Leprosy
  4. Others:
    - Diabetes mellitus
    - Amyloidosis
    - Sarcoidosis
21
Q

What are the causes of mixed UMN and LMN signs?

A
  • MND (no sensory deficit)
  • Dual pathology: cervical myelopathy + polyneuropathy)
  • Myeloradiculopathy
  • Subacute combined degeneration of the cord (symmetrical UMN signs with absent reflexed, impaired posterior columns function, peripheral sensory neuropathy)

OSCEs (45 decks)

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