Upper and lower limb neurology OSCE Flashcards
What is carried through the spinal thalamic tracts?
- Pain
- Temperature
- Crude touch
What is carried through the dorsal columes?
- Light touch
- Vibration
- Proprioception
What pathology of the spine that would cause disruption to the spinal thalamic tract?
- Syringomyelia
What pathology of the spinal cord would cause pathology of the dorsal columes?
- Tabes dorsalis (syphilis)
- SCDC (subacute degeneration of the cord)
Syringomyelia what are the characteristics?
- Expansion of spinal cord central canal due to CSF blockage. (Chiari malformation)
- Spinalthalamic fibres principally affected
- Loss of pain & temnperature sensation in the cape like distribution over arms shoulder and upper body
- Lower motor neuron signs in upper limb and upper motor neuron signs in lower limb (spastic paraparesis) of lower limb
- Dorsal column signs develop as canal further expands
- Syringobulbia if syrinx extends into brainstem
What is erbs palsy?
C5 - C7 damaged during birth.
How would a patients arm be held in erbs palsy?
Waiters tip position
- Shoulder ADducted
- Arm internally rotated
- Forearm pronated
What is Klumpke’s palsy?
C8-T1 damaged during birth
What are findings on a patient with Klumpke’s
- Sensory loss on medial forearm
- Complete claw hand
- Wasting of the small muscles of the hand
- Horners syndrome may co-exist
Causes of Paraparesis (bilateral leg weakness) that is acute and progressive.
Acute & Progressive - very unlikely in OSCEs
- Acute spinal cord progression (UMN)
- Cauda equina (LMN)
- Gullian Barre Syndrome (LMN)
Causes of spastic paraparesis. (Bilateral UMN signs)
- Sagittal sinus lesion
- Parasagital meningioma
- Bilateral stroke
- Syringomyelia (with upperlimb involvement)
- Cord trauma (e.g. Road traffic accident)
- Cord compression
- Extradural tumour
- Disc prolapse
- Spondylosis
- Osteophytes
- Intrinsic cord disease
- Tumour
- Vascular myelopathy
- Multiple sclerosis
Causes of flaccid paraparesis - Bilateral LMN signs
- Polio
- Mostly motor peripheral neuropathy
- Gulliane barre
- Lead poisoning
- Charcot Marie Tooth
- Mixed peripheral neuropathy
- Diabetic
- Uraemic
- Vitamin deficiency (B12, folate, thiamine)
- Paraneoplastic
- Alcohol
Causes of unilater leg weakness
UMN - Stroke - Tumour - MS LMN - Root lesion - Nerve
What is SCDC (B12 / Folate deficiency)?
And how does it present
Subacute combined degenration of the cord
present with
- Spastic paraparesis
- Upgoing plantars
- Reduced knee jerks
- Loss of ankle jerks
- Dorsal column loss
- Loss of vibratory, joint position sense & Sensory ataxiaWhat is amyotrophic lateral sclerosis and what are the signs?
A type of MND and is the most common MND
LMN signs
- weakness
- wasting
- Fasciculation
UMN signs
- Spasticity
- Brisk reflexes
What are the causes of foot drop?
- Common peroneal nerve palsy
- Stroke
- L4/L5 root lesion
- MND
- Charcot-Marie-Tooth syndrome
What do you if there is upper motor lesion signs in the lower limbs with unaffected upper limb?
- Sensory assessment of thorax to ascertain level
Causes of a T1 lesion
- Cervical spondylosis
- Pancoast tumour
- Plexus trauma / Birth injury (klumpke’s palsy)
Clinical features of T1 lesion
- Total claw hand (loss of all lumbricals
- Wasting small muscles of the hand
- Pain / Sensory loss in the medial forearm
- Horner’s syndrome may co-exist
Causes of carpal tunnel syndrome
- Idiopathic (majority of cases)
- Pregnancy
- RA
- Hypothyroidism
- Diabets
- Acromegaly
What is saturday night palsy?
- Compression of the radial nerve against the humerus by falling asleep with your arm over the back of the chair.
How would a person with saturday night palsy present?
- wrist drop
- Numbnees on the radial spot on the dorsum of the hand
- Triceps may be spared and you know why LOL
