Weakness and dyskinesia Flashcards
What are the signs of cord compression?
BL leg weakness (arm suggests cervical invovlement)
Back pain
Bladder/anal sphincter involvement - hesitency, frequency, painless retention (later presentation)
Normal - above lesion
LMN - level of lesion
UMN - below lesion
Tone an reflexes often reduced in acute compression
What are the causes of cord compression?
Metastases - breast, lung, prostate, thyroid, kidney
Infection, tumour, disc prolapse
What are the Ddx to cord compression?
GBS, MS, transverse myelitis, trauma
What investigation should be done to confirm cord compression?
MRI
What is the treatment for cord compression?
Dexamethasone - malignancy
Laminectomy
What are the signs of conus medullaris lesions?
UMN/LMN mixed signs Leg weakness Urinary retention Constipation Back pain Sacral sensory loss ED
What are the signs of cauda equina lesions?
Back pain Radicular pain down legs asymmetrical areflexic paralysis in legs Decreased sphincter tone
What are some causes of UL foot drop?
DM Common peroneal nerve injury Stroke Disc prolapse MS
What are some causes of leg weakness without sensory loss?
MND
Polio
Parasagittal meningioma
What are some causes of chronic spastic parapesis? (stiff, weak)
MS Tumour MND Syringomyelia Hereditary
What are some causes of chronic flaccid parapesis? (floppy, weak)
Peripheral neuropathy
Myopathy
What are some causes of absent knee jerks/plantar extensors?
Cervical and lumbar disc disease conus medullaris lesions MND Myelorediculopathy Friedrich's ataxia
What is a spastic gait?
Stiff
Circumduction of legs
Scuffing of shoes
Cause: UMN lesion
What is an extrapyramidal gait?
Flexed posture, shuffling feet, slow start, postural instability
Cause: Parkinson’s
What is an apraxic gait?
‘gluing to floor’
Wide based unsteady gait
Tendency to falls
Cause: hydrocephalus, multi-infarct states
What is an ataxic gait?
Wide
Falls
Unable to walk heel to toe
Cause: cerebellar lessions (MS, alcohol, phenytoin), proprioceptive sensory loss (B12 deficiency)
What is a myopathic gait?
Waddling
Unable to climb steps
Cannot stand from sitting
Cause: Hip girdle weakness
Whta is a psychogenic gait?
Unusual gait but doesn’t seem to follow set gait patterns
What is a rest tremor?
Stops on voluntary movement
Cause: Parkinson’s
What is an intention tremor?
Irregular, large amplitude, worse at the end of purposeful acts (pointing)
Cause: Cerebellar damage (MS, stroke)
What is a postural tremor?
Absent at rest, present with maintained posture, may persist on movement
Cause: benign essential tremor, thyrotoxicosis, anxiety, b-agonists
What is a re-emergent tremor?
Postural tremor developing after a delay of 10s
Case: Parkinson’s
What is chorea?
Non-rhythmic, jerky purposeless movement
Grimacing, raising shoulders, finer flexion
Cause: Huntingdon’s, Syndenham’s chorea
Maden worse by levo-dopa
What are tics?
Brief, repeated, stereotyped movements
Tourettes: give clonazepam (or haliperidol if severe -> tardive dyskinesia)
