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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
Q

state some causes of autonomic neuropathy ?

A

DM
􏰀 HIV
􏰀 SLE
􏰀 GBS, LEMS

26
Q

what are some features of autonomic neuropathy?

A 
Postural hypotension
􏰀 ED, ejaculatory failure
􏰀 ↓ sweating
􏰀 Constipation / Nocturnal diarrhoea
􏰀 Urinary retention
􏰀 Horner’s
27
Q

what are two tests to check for autonomic neuropathy ?

A

BP: Postural drop > 20/10mmHg
ECG: variation >10bpm ̄c respiration

28
Q

what investigations can be done for peripheral neuropathy ?

A 
􏰀 LFTs, U+E, glucose, ESR, B12
􏰀 TFTs B1, ANA, ANCA
􏰀 Genetic tests: e.g. PMP22 in CMT
􏰀 Nerve conduction studies
􏰀 EMG
29
Q

where abouts do peripheral neuropathies affect in the body?

A

Distribution is symmetrical and widespread

􏰀Distal weakness and sensory loss (glove + stocking)

30
Q

what is the commonest cause of Charcot-Marie-Tooth disease?

A

HMSN1

31
Q

what is the pathophysiology of HMSN1?

A

demyelination

32
Q

what is the pathophysiology of HMSN2?

A

axonal degeneration

33
Q

what mutuation causes HMSN1?

A

AD mutation in the peripheral myelin protein 22 gene

34
Q

when is the onset of HMSN?

A

puberty

35
Q

what nerve is most affected by HSMN?

A

common peroneal

36
Q

what motor dysfunction does HSMN cause ?

A

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
Q

what investigations can be done for HSMN?

A

Genetic tests: PMP22 gene mutation

Nerve conduction studies: ↓ conduction speed in HSMN1

38
Q

what is the management for charcot maire tooth disease?

A

Supportive
􏰁 Physio
􏰁 Podiatry
􏰁 Orthoses

39
Q

what are the three classifications of guilian barre syndrome ?

A

AIDP: Acute autoimmune demyelinating polyneuropathy
􏰀AMAN: Acute motor (± sensory) axonal neuropathy
􏰀Miller-Fisher:

40
Q

what three things does miller fisher have?

A

Ophthalmoplegia + ataxia + areflexia

41
Q

what features does guillian barre syndrome have?

A

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
Q

what is the cause of guillain barre syndrome ?

A

Abs cross-react to gangliosides

- from bacteria, virus or vaccine

43
Q

what three investigations can be done for guillian barre syndrome ?

A 
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
Q

what is the management of guillian barre syndrome ?

A

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
Q

what is the prognosis of guillian barre syndrome ?

A

85% complete recovery

46
Q

what three investigations can be done for MND?

A 
Brain/cord MRI: exclude structural cause
􏰁 Cervical cord compression → myelopathy
􏰁 Brainstem lesions
􏰀 LP: exclude inflammatory cause
􏰀 EMG: shows denervation
47
Q

state the features of paralytic polio?

A

Asymmetric LMN paralysis

􏰁 No sensory involvement

48
Q

what part of the spinal cord does polio affect?

A

Affects anterior horn cells

Y2 Neurology (52 decks)

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