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Y2 Neurology > Y4 Nerve Palsy > Flashcards

Y4 Nerve Palsy Flashcards

1
Q

does intracranial sinus thrombosis have sudden or progressive onset?

A

progressive onset over couple of weeks

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2
Q

does bells palsy have sudden onset or progressive onset ?

A

very sudden onset

- wake up one morning with it

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3
Q

state the features of bells palsy ?

A

Complete, unilateral facial weakness in 24-72h
􏰁 Failure of eye closure → dryness
􏰁 Bell’s sign: eyeball rolls up on attempted closure 􏰁 Drooling, speech difficulty
􏰀 Numbness or pain around ear
􏰀 ↓ taste (ageusia)
􏰀 Hyperacusis: stapedius palsy

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4
Q

what nerve palsy causes bells palsy ?

A

facial nerve

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5
Q

is bells palsy UMN and LMN condition ?

A

LMN

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6
Q

is the forehead spared in bells palsy ?

A

no

- forehead is paralysed

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7
Q

what three investigations should be done for bells palsy ?

A

Serology: Borrelia or VZV Abs
􏰀 MRI: SOL, stroke, MS
􏰀 LP

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8
Q

what is the manegment of bells palsy ?

A

Give prednisolone w/i 72hrs
􏰁 60mg/d PO for 5/7 followed by tapering

􏰀 Valaciclovir if zoster suspected
􏰁 Otherwise antivirals don’t help

􏰀 Protect eye

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9
Q

what is the cause of bell palsy ?

A 
idiopathic 
viral cause (HSV1)
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10
Q

what is the prognosis of bells palsy ?

A

Incomplete paralysis: recovers completely w/i wks

􏰀 Complete: 80% get full recovery

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11
Q

what are two complications of bells palsy ?

A

Synkinesis:

􏰀 Crocodile tears:

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12
Q

what is crocodile tears?

A

eating stimulates unilateral lacrimation, not salivation

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13
Q

what is synkinesis ?

A

e.g. blinking causes up-turning of mouth

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14
Q

facial palsy with bilateral symptoms could be caused by?

A

Bilat symptoms: Lyme, GBS, leukaemia, sarcoid, MG 􏰀

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15
Q

facial palsy with UMN symptoms could be caused by?

A

UMN signs: sparing of frontalis and orbicularis oculi

􏰁 Due to bilateral cortical representation

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16
Q

what is Ramsay Hunt syndrome (RHS)?

A

Ramsay Hunt syndrome (RHS) is a complication of shingles. It is the name given to describe the symptoms of a shingles infection affecting the facial nerve.

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17
Q

what are the features of ramsay hunt syndrome ?

A

Preceding ear pain or stiff neck
􏰀 Vesicular rash in auditory canal ± TM, pinna, tongue,
hard palate (no rash = zoster sine herpete)
􏰀 Ipsilateral facial weakness, ageusia, hyperacusis,
􏰀 May affect CN8 → vertigo, tinnitus, deafness

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18
Q

what is the management of ramsay hunt syndrome ?

A

If Dx suspected give valaciclovir and prednisolone w/i first 72h

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19
Q

what are the main causes of a peripheral sensory neuropathy ?

A

􏰀 Alcohol
􏰀 B12
􏰀 CRF and Ca (paraneoplastic) 􏰀 DM
􏰀 Every vasculitis

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20
Q

what nerve fibre does B12 deficiency affect?

A

Large Myelinated Fibres (A􏰆)

21
Q

what symptoms of B12 deficiency cause?

A

􏰀 Loss of proprioception → ataxia

􏰀 Pins and needles

22
Q

what nerve fibre does alcohol abuse affect?

A

Small Unmyelinated Fibres (C)

23
Q

what symptoms of alcohol abuse cause?

A

Loss of pain and temperature sensation

􏰀 Painful dysesthesia: e.g. burning, hyperalgesia

24
Q

what are the main causes of motor neuropathy ?

A

GBS (+ botulism)
􏰀 HMSN / CMT (Charcot-Marie-Tooth disease) - genetic
􏰀 Paraneoplastic
􏰀 Lead poisoning

25
state some causes of autonomic neuropathy ?
DM 􏰀 HIV 􏰀 SLE 􏰀 GBS, LEMS
26
what are some features of autonomic neuropathy?
``` Postural hypotension 􏰀 ED, ejaculatory failure 􏰀 ↓ sweating 􏰀 Constipation / Nocturnal diarrhoea 􏰀 Urinary retention 􏰀 Horner’s ```
27
what are two tests to check for autonomic neuropathy ?
BP: Postural drop > 20/10mmHg ECG: variation >10bpm ̄c respiration
28
what investigations can be done for peripheral neuropathy ?
``` 􏰀 LFTs, U+E, glucose, ESR, B12 􏰀 TFTs B1, ANA, ANCA 􏰀 Genetic tests: e.g. PMP22 in CMT 􏰀 Nerve conduction studies 􏰀 EMG ```
29
where abouts do peripheral neuropathies affect in the body?
Distribution is symmetrical and widespread | 􏰀Distal weakness and sensory loss (glove + stocking)
30
what is the commonest cause of Charcot-Marie-Tooth disease?
HMSN1
31
what is the pathophysiology of HMSN1?
demyelination
32
what is the pathophysiology of HMSN2?
axonal degeneration
33
what mutuation causes HMSN1?
AD mutation in the peripheral myelin protein 22 gene
34
when is the onset of HMSN?
puberty
35
what nerve is most affected by HSMN?
common peroneal
36
what motor dysfunction does HSMN cause ?
Foot drop → high stepping gait 􏰀 Weak ankle dorsiflexion and toe extension 􏰀 Absent ankle jerks 􏰀 Symmetrical muscle atrophy: mainly distal 􏰁 Peroneal muscles → “Champagne Bottle” 􏰁 Hand and arm muscles → “Claw Hand” 􏰀 Pes cavus (high-arched feet)
37
what investigations can be done for HSMN?
Genetic tests: PMP22 gene mutation | Nerve conduction studies: ↓ conduction speed in HSMN1
38
what is the management for charcot maire tooth disease?
Supportive 􏰁 Physio 􏰁 Podiatry 􏰁 Orthoses
39
what are the three classifications of guilian barre syndrome ?
AIDP: Acute autoimmune demyelinating polyneuropathy 􏰀AMAN: Acute motor (± sensory) axonal neuropathy 􏰀Miller-Fisher:
40
what three things does miller fisher have?
Ophthalmoplegia + ataxia + areflexia
41
what features does guillian barre syndrome have?
Growing Weakness - 􏰀 Symmetrical, ascending flaccid weakness / paralysis - 􏰀 LMN signs: areflexia, fasciculations may occur􏰀 Proximal > distal (trunk, respiratory, CNs [esp. 7]) - 􏰀 Progressive phase lasts 􏰅 4wks Breathing and Bulbar Problems Back Pain 􏰀 Back / limb pain is common Sensory disturbance - Paraesthesia in extremities - Sensory ataxia in Miller-Fisher Autonomic Neuropathy
42
what is the cause of guillain barre syndrome ?
Abs cross-react to gangliosides | - from bacteria, virus or vaccine
43
what three investigations can be done for guillian barre syndrome ?
``` Immune 􏰀 Serology for anti-ganglioside Abs 􏰀 Evidence of infection: e.g. stool sample Demyelinating Nerve Conduction Studies 􏰀 Slow conduction velocities Protein in CSF 􏰀 Protein often > 5.5g/L ```
44
what is the management of guillian barre syndrome ?
Supportive 􏰀 Airway / ventilation: ITU if FVC < 1.5L 􏰀 Analgesia: NSAIDs, gabapentin 􏰀 Autonomic: may need inotropes, catheter 􏰀 Antithrombotic: TEDS, LMWH Immunosuppression 􏰀 IVIg 􏰀 Plasma exchange Physiotherapy 􏰀 Prevent flexion contractures
45
what is the prognosis of guillian barre syndrome ?
85% complete recovery
46
what three investigations can be done for MND?
``` Brain/cord MRI: exclude structural cause 􏰁 Cervical cord compression → myelopathy 􏰁 Brainstem lesions 􏰀 LP: exclude inflammatory cause 􏰀 EMG: shows denervation ```
47
state the features of paralytic polio?
Asymmetric LMN paralysis | 􏰁 No sensory involvement
48
what part of the spinal cord does polio affect?
Affects anterior horn cells

Y2 Neurology (52 decks)

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