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Neurology > Weakness and dyskinesia > Flashcards

Weakness and dyskinesia Flashcards

1
Q

What are the signs of cord compression?

A

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

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2
Q

What are the causes of cord compression?

A

Metastases - breast, lung, prostate, thyroid, kidney

Infection, tumour, disc prolapse

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3
Q

What are the Ddx to cord compression?

A

GBS, MS, transverse myelitis, trauma

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4
Q

What investigation should be done to confirm cord compression?

A

MRI

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5
Q

What is the treatment for cord compression?

A

Dexamethasone - malignancy

Laminectomy

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6
Q

What are the signs of conus medullaris lesions?

A 
UMN/LMN mixed signs 
Leg weakness
Urinary retention 
Constipation
Back pain 
Sacral sensory loss
ED
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7
Q

What are the signs of cauda equina lesions?

A 
Back pain 
Radicular pain down legs 
asymmetrical 
areflexic paralysis in legs 
Decreased sphincter tone
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8
Q

What are some causes of UL foot drop?

A 
DM
Common peroneal nerve injury 
Stroke
Disc prolapse
MS
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9
Q

What are some causes of leg weakness without sensory loss?

A

MND
Polio
Parasagittal meningioma

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10
Q

What are some causes of chronic spastic parapesis? (stiff, weak)

A 
MS
Tumour
MND
Syringomyelia
Hereditary
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11
Q

What are some causes of chronic flaccid parapesis? (floppy, weak)

A

Peripheral neuropathy

Myopathy

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12
Q

What are some causes of absent knee jerks/plantar extensors?

A 
Cervical and lumbar disc disease
conus medullaris lesions
MND
Myelorediculopathy
Friedrich's ataxia
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13
Q

What is a spastic gait?

A

Stiff
Circumduction of legs
Scuffing of shoes

Cause: UMN lesion

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14
Q

What is an extrapyramidal gait?

A

Flexed posture, shuffling feet, slow start, postural instability

Cause: Parkinson’s

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15
Q

What is an apraxic gait?

A

‘gluing to floor’
Wide based unsteady gait
Tendency to falls

Cause: hydrocephalus, multi-infarct states

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16
Q

What is an ataxic gait?

A

Wide
Falls
Unable to walk heel to toe

Cause: cerebellar lessions (MS, alcohol, phenytoin), proprioceptive sensory loss (B12 deficiency)

17
Q

What is a myopathic gait?

A

Waddling
Unable to climb steps
Cannot stand from sitting

Cause: Hip girdle weakness

18
Q

Whta is a psychogenic gait?

A

Unusual gait but doesn’t seem to follow set gait patterns

19
Q

What is a rest tremor?

A

Stops on voluntary movement

Cause: Parkinson’s

20
Q

What is an intention tremor?

A

Irregular, large amplitude, worse at the end of purposeful acts (pointing)

Cause: Cerebellar damage (MS, stroke)

21
Q

What is a postural tremor?

A

Absent at rest, present with maintained posture, may persist on movement

Cause: benign essential tremor, thyrotoxicosis, anxiety, b-agonists

22
Q

What is a re-emergent tremor?

A

Postural tremor developing after a delay of 10s

Case: Parkinson’s

23
Q

What is chorea?

A

Non-rhythmic, jerky purposeless movement

Grimacing, raising shoulders, finer flexion

Cause: Huntingdon’s, Syndenham’s chorea

Maden worse by levo-dopa

24
Q

What are tics?

A

Brief, repeated, stereotyped movements

Tourettes: give clonazepam (or haliperidol if severe -> tardive dyskinesia)

25
Q

What is myoclonus?

A

Sudden involuntary focal/general jerks

Cause: metabolic problems, neurodegenerative conditions, myoclonic epilepsies, benign (give clonazepam/valproate), asterixis

26
Q

What are some causes of asterixis?

A 
Liver/kidney failure
Hyponatraemia
Hypercapnia
Gabapentin 
Thalamic stroke (UL)
27
Q

What are the causes of tardive syndromes?

A

Dopamine agonists - anti-psychotics, anti-emetics

28
Q

What is tardive dyskinesia?

A

Mouth/tongue/trunk/choreiform movements

Licking lips, grimacing, chewing

29
Q

What are the signs of Wallerian degeneration?

A

Distal axonal degeneration
24-36 hours following injury.

Myelin sheath degenerates and is phagocytosed

Neurology (9 decks)

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