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The One Deck To Rule Them All > Neuro: General (Motor + Sensory disorders) > Flashcards

Neuro: General (Motor + Sensory disorders) Flashcards

1
Q

Allodynia (pain from stimuli that shouldn’t be painful)
Flushing
Unusual hair growth
Hx of trauma

A

Complex regional pain syndrome

  • 3F:1M

Type 1: no lesion
Type 2: underlying lesion on nerve

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2
Q

Used to diagnose complex regional pain syndrome

A

Budapest Diagnostic Criteria

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3
Q

Management of complex regional pain syndrome

A

Physiotherapy

Neuropathic analgesia

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4
Q

Clinician has the patient extend their neck and turn their head to the side that is being tested. The patient then holds their breath and the radial pulse is palpated.

Tests for thoracic outlet syndrome

A

Adson’s test

Positive if change in pulse/ no pulse

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5
Q

Inability to control facial movements

A

Pseudobulbar palsy

  • seen in PSP
  • Parkinson’s
  • MS
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6
Q

Muscle wasting of the hands

Paraesthesia

A

Thoracic outlet syndrome (TOS)

  • 90% of TOS
  • neurogenic
  • Compression of brachial plexus
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7
Q

Painful arm swelling

A

Thoracic outlet syndrome (TOAS)

  • 10%
  • vascular
  • Subclavian artery/vein
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8
Q

Flushing
Sweating
Extreme HTN

A

Autonomic dysreflexia

  • symptoms above level of spinal injury
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9
Q

Causes of Autonomic dysreflexia

A 
Faecal impaction (constipation)
Urinary retention
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10
Q

Intervertebral disc prolapses are more common to herniate

A

Laterally - due to weaker ligaments

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11
Q

Causes of peripheral neuropathy

A

ABCDE

Alcohol
B12 deficiency 
Cancer
CKD
Diabetes
Drugs (isoniazid)
Every vasculitis
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12
Q

Predominantly motor-loss neuropathy

A
  • Guillain-Barre syndrome
  • Porphyria
  • Lead poisoning
  • Hereditary Sensorimotor Neuropathies (HSMN)
    - Charcot-Marie-Tooth
  • Chronic inflammatory demyelinating polyneuropathy
  • Diptheria
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13
Q

Predominantly sensory-loss neuropathy

A 
Diabetes "glove + stocking loss"
Uraemia
Leprosy
Alcoholism
Vitamin B12 deficiency
Amyloidosis
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14
Q

Dyskinesia

A

Dystonia
Chorea
Athetosis

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15
Q

Involuntary contraction of muscles

A

Dystonia

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16
Q

Irregular unpredictable movements

A

Chorea

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17
Q

Involuntary writhing of fingers etc

A

Athetosis

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18
Q 
Muscle weakness 
Decreased tone
Decreased reflexes
Muscle wasting
Fasiculations
Affects full face
A

Lower motor neuron (LMN) lesion

  • most things decreased
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19
Q 
Muscle weakness
Increases tone
Increased reflexes (brisk)
Muscle mass maintained
Spasticity
Upgoing plantars
Forehead sparing
A

Upper motor neuron (UMN) lesion

  • most things increased
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20
Q

Causes of UMN lesions

A

Stroke

Tumour

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21
Q

Genetics for Huntington’s Chorea

A

Autosomal dominant
Tri-nucleotide disorder

Anticipation: Earlier age of onset = increased severity for later generations

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22
Q

Age 30s
Uncontrolled movements
Falls
Difficulty speaking

A

Huntington’s Chorea

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23
Q 
Symmetrical fine tremor
Worsens on intentional movements 
Disappears on rest
Improves with alcohol 
Can affect vocal cords
A

Benign essential tremor

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24
Q

Management of benign essential tremor

A

Propranolol

Primidone

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25
Q 
Subacute onset 
Behavioural changes
Speech impairment
Visual impairment
Motor impairment
Ataxia
Weakness
A

Progressive multifocal leukoencephalopathy (PML)

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26
Q

Widespread demyelination due to infection of oligodendrites by John cunningham virus (JC Virus)

A

Progressive multifocal leukoencephalopathy (PML)

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27
Q

Investigations for PML

A

CT: Lesions
MRI: High-signal demyelinating white matter lesions

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28
Q

Impaired balance (prone to falls)
Vertical gaze palsy
Symmetrical onset

A

Progressive Supranuclear Palsy (PSP)

  • Parkinson plus condition
  • Levodopa can sometimes help
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29
Q

A collection of CSF (in fluid filled cyst “syrinx) within the spinal cord that compresses the spinothalamic tract fibres (decussating at anterior white commissure of spine)

A

Syringomyelia

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30
Q 
Cape-like loss of temperature (neck + arms)
   - accidental burns
Preserved: 
- light touch
- Proprioception 
- Vibration 
Spastic weakness (upper limbs)
Paraesthesia 
Neuropathic pain
Bowel + bladder dysfunction
A

Syringomyelia

  • age 20-40s
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31
Q

Causes of Syringomyelia

A

Arnold-chiari malformation
Trauma
Tumours
Idiopathic

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32
Q

Complications of Syringomyelia

A

Syringobulbia (fluid filled cavity in medulla)
Scoliosis
Horner’s syndrome

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33
Q

Investigations for syringomyelia

A

Full spine + brain MRI

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34
Q 
Months onset
Pain (neck/ upper + lower limbs)
Loss of motor function 
Decreased sensory function 
Decreased dexterity in hands 
Urinary/ faecal incontinence
A

Degenerative cervical myelopathy (DCM)

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35
Q

An involuntary flexion movement of the thumb and or index finger when the examiner flicks the fingernail of the middle finger down. The reflexive pathway causes the thumb to flex and adduct quickly

Tests for Degenerative Cervical myelopathy

A

Hoffman’s sign

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36
Q

Risk factors for Degenerative Cervical myelopathy (DCM)

A

Smoking (effects discs)
Genetics
Occupation- Labourer (high axial load)

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37
Q

Investigations for Degenerative cervical myelopathy

A

MRI Cervical spine

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38
Q

Management for degenerative cervical myelopathy

A

Decompressive surgery

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39
Q

OA of the spine leading to compression of the cord

A

Cervical spondylosis

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40
Q

Neck pain + stiffness
LMN signs at level of compression
UMN signs below lesion

A

Cervical spondylosis

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41
Q

Damage to posterior spinal artery

A

Posterior cord syndrome

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42
Q

Loss of proprioception
Loss of vibration
Loss of two-point discrimination
Loss of light touch

A

Posterior cord syndrome

43
Q

Acute onset

Loss of pain + temperature sensation

A

Anterior cord syndrome

  • caused by ischaemia in spinal cord
44
Q

Damage to half of the spinal cord

A

Brown-sequard syndrome

45
Q

Paralysis
Ipsilateral: Loss of proprioception
Contralateral: Loss of pain
Loss of temperature

A

Brown-sequard syndrome

46
Q

Spontaneous continuous lower limb movements
Parasthesia
Akathisia (inability to sit still)
- worse at night/ sitting still

A

Restless leg syndrome

= clinical diagnosis

associated with:

  • FHx
  • Iron deficiency anaemia
  • Uraemia
  • DM
  • Pregnancy
47
Q

Management for restless leg syndrome

A

Stretching
Dopamine agonists (Pramipexole, Ropinirole)
Benzodiazepines
Gabapentin

48
Q

Balance with eyes closed

Test for proprioception

A

Romberg’s test

49
Q 
Damage to posterior (dorsal) column: 
    - loss of proprioception 
    - loss of light touch
    - loss of vibration 
Damage to lateral column: UMN signs
Damage to peripheral nerves: LMN signs
A

Subacute combined degeneration of the spinal cord (SADC)

50
Q

Cause of subacute degeneration of the spinal cord

A

Vitamin B12 deficiency

51
Q

Management for Subacute degeneration of the spinal cord

A

Vitamin B12 + then maybe folate

  • if you give folate first it may precipitate SADC
52
Q 
Pes cavus (high foot arches)
Distal muscle wasting
Decreased reflexes 
Weakness in lower limb
Peripheral sensory loss

= LMN signs + sensation loss

A

Charcot Marie Tooth
“Hereditary sensorimotor neuropathy)

  • Autosomal dominant
  • PMP-22 gene (codes for myelin)

Type 1: Demyelinating pathway
Type 2: Axonal pathway

53
Q

Paraesthesia + loss of sensation spreading up from feet
Back + leg pain
Progressive (ascending) symmetrical weakness of all limbs
Decreased reflexes

  • No UMN signs
A

Guillian-Barre syndrome

54
Q

Causes of Guillian-Barre syndrome

A

Campylobacter jejuni
Cytomegalovirus (CMV)
Epstein-barr virus

Inflammatory peripheral neuropathy
- B cells produce antibodies to peripheral nerve cells

55
Q

Investigations for Guillian-Barre syndrome

A

LP: Increased protein, normal WBC
Nerve conduction studies:
- Decreased motor nerve conduction velocity
- Increased F wave latency
EMG: Increased action potential duration + amplitude

56
Q

Management for Guillian-Barre syndrome

A

IV Immunoglobins

57
Q 
Muscle weakness (improves on exercise)
   - Proximal muscles legs > arms
   - Intraocular muscles (diplopia)
   - Levator muscles (ptosis)
   - Oropharyngeal muscles (dysarthria + dysphagia)
Waddling gait (limb girdle weakness)
Decreased reflexes
A

Lambert-eaton myasthenia syndrome

  • autoimmune
58
Q

Investigations for Lambert-eaton myasthenia syndrome

A

EMG: Incremental response to repetitive stimulation
- relaxes improve after strong contraction (post-titanic potentiation)

Voltage-gate-calcium-channel Antibodies

59
Q

Causes of Lambert-eaton myasthenia syndrome

A

Small-cell lung cancer (smoking)

60
Q

Management of Lambert-eaton myasthenia syndrome

A

Amifampridine

61
Q

Types of Cerebral palsy

A 
Spastic (70%)
   - Hemiplegia
   - Diplegia
   - Quadriplegia
Dyskinetic
Ataxic
Mixed
62
Q

Abnormal tone
Delayed motor milestones
Abnormal gait
Feeding difficulties

Associated with:

  • learning difficulties (60%)
  • epilepsy (30%)
  • Squints (30%)
  • Hearing impairment (20%)
A

Cerebral Palsy

63
Q

Causes of cerebral palsy

A 
Antenatal (80%)
    - cerebral malformation 
    - congenital infection (CMV, Rubella, Toxoplasmosis)
Intrapartum (10%)
    - birth trauma 
Intraventricular haemorrhage (10%)
Meningitis
 Trauma
64
Q

Management of cerebral palsy

A

Diazepam
Baclofen
Botulin toxin type A (Botox)
Surgical dorsal rhizotomy

65
Q 
Proximal muscle weakness (worse from exercise + at night)
  - head + neck
  - arms > legs 
Extra-ocular muscle weakness (diplopia)
     - worse when reading
Ptosis
Dysphagia
A

Myasthenia gravis

  • autoimmune
  • insufficient functioning acetylcholine receptors
66
Q

Associated with:

  • thymoma tumours (difficulty breathing), 15%
  • pernicious anaemia
  • thyroid disorders
  • RA
  • SLE
  • Thymic hyperplasia (60%)
A

Myasthenia gravis

67
Q

Investigations for myasthenia gravis

A

Acetylcholine receptor antibodies (85%)
CK: Normal
Specific: tensilon test: positive
- IV Edrophonium induces muscle weakness temporarily
CT: Thymoma of thorax
Single fibre electromyography
EMG: Decreased response to repetitive stimulation

68
Q

Management of myasthenia gravis

A
  1. Reversible acetylcholinesterase inhibitors (long-acting):
    - Pyridostigmine
    - Neostigmine

Immunosuppression:

  • Prednisolone
  • Azathioprine, cyclosporin, mycophenolate

Surgery (thymectomy)

Monoclonal antibody tx: Rituximab

69
Q

Myasthenia crisis can be caused by

A 
Beta blockers
Pencilamine
Lithium
Phenytoin
Abx (Gentamicin, macrolides, quinolones, tetracyclines)
70
Q

Management of myasthenia crisis

A

Plasmapheresis

IV immunoglobins

71
Q 
Gradual onset muscle weakness (hands + shoulders)
Eye muscles spared
Respiratory muscles weakened 
Facial muscles weakened 
  - slurred speech
  - swallowing difficulties 
No sensory deficit
A

Motor Neurone Disease (MND)

  • clinical diagnosis
  • associated with fronto-temporal dementia
  • 50% dead in 1 year
72
Q

Types of MND

A

Amylotropic Lateral Sclerosis (ALS) - most common (50%)
Primary Lateral Sclerosis (PLS)
Progressive Muscular Atrophy
Progressive Bulbar Palsy

73
Q

UMN + LMN signs (arms + legs)
Upper limbs: Weakness + decreased reflexes
Lowe limbs: Increased tone + increased reflexes
Fasiculations

A

Amylotrophic Lateral Sclerosis (ALS)

  • Chromosome 21 (superoxide dismutase)
74
Q

LMN signs

- affects distally before proximally

A

Progressive muscular atrophy

Has best prognosis

75
Q

Palsy of tongue + facial muscles
Fasiculations
Difficulty chewing/ swallowing

A

Progressive bulbar palsy

Has worst prognosis

76
Q

UMN Signs

A

Primary lateral sclerosis

77
Q

Investigations for MND

A

EMG: increased action potential duration + amplitude

78
Q

Management for MND

A

Riluzole
- prevents stimulation of glutamate receptors (slows progression)

Non-invasive breathing support at night

79
Q

Lethargy (75%) + Mostly UMN signs

Optic problems

  • optic neuritis
  • optic atrophy
  • uhthoff’s phenomenon (vision worse on increased temperature)
  • internuclear ophthalmoplegia

Sensory

  • pins/ needles
  • numbness
  • trigeminal neuralgia
  • lhermitte’s sign (parasethesia on neck flexion)

Motor
- spastic weakness (legs)

Cerebellar

  • ataxia
  • tremor

Urinary Incontinence
Sexual dysfunction
intellectual deterioration

A

Multiple sclerosis (MS)

Autoimmune
Demyelination in the CNS
3F:1M
Age: 20-40

80
Q

Risk factors for MS

A 
Female
Further from equator (latitude)
EBV
White
Vit D deficiency
81
Q

Types of MS

A 
Relapsing-remitting (60-85%)
Primary Progressive (10%)
  - common in elderly
Secondary Progressive 
  - has progressed from primary progressive
82
Q

Investigations for MS

A

LP: Oligocolonal bands in CSF
- intrathecal synthesis of IgG

Contrast MRI: Periventricular plaques
Hypotense lesions perpendicular to corpus callous (Dawson fingers)

83
Q

Management for MS to decrease relapse rate

A

Beta-interferon therapy
Glaticamer acetate (immuno-modulating drug)
Natalizumab (monoclonal antibody)
Fingolimod (sphingosine 1-phosphate receptor modulator)

84
Q

Management for MS Acute relapses

A

Methylprednisolone (5 days)

Monoclonal antibodies

85
Q

Side effect of monoclonal antibodies

A

Risk of JCV infection + PML

86
Q

Management of Spasticity in MS

A
  1. Baclofen + gabapentin
  2. Diazepam
    Dantrolene
    Tizanidine
87
Q

Management of Oscillopsia in MS

A

Gabapentin

88
Q

Management of fatigue in MS

A

Amantadine

89
Q

TRAP

Tremor (4-6 hz, worse at night, asymmetrical)
Rigidity (lead-pipe)
Akinesia
Postural instability (stooped posture + forward tilt)
Postural hypotension

Shuffling gait + small steps when turning
Bradykinesia (slow movement)
Decreased facial expressions + drooling (reduced swallow)
Quiet monotonous speech
Decreased sense of smell

Arms don't swing when walk
Micrographia (small writing) 
Hypomimia (facial masking, low expression)
Depression (40%)
REM Sleep problems
A

Parkinson’s disease

  • starts unilateral and becomes bilateral
90
Q

Investigations for Parkinson’s

A

DAP Scan: looks for dopamine receptors in basal ganglia (reduction = neuropathic Parkinson’s)

Discolouration of substantia nigrans
- due to loss of nerve cells

91
Q

Contraindicated in Parkinson’s

A

Prochlorperazine
Haloperidol

  • risk of neuroleptic malignant syndrome
92
Q

Management of sleepiness in Parkinson’s

A

Modafinil

93
Q

Management of postural hypotension in Parkinson’s

A

Midodrine

- acts on peripheral alpha-adrenergic receptors to increase arterial resistance

94
Q

Management of drooling in Parkinson’s

A

Glycopyrronium Bromide

95
Q

Management for Motor symptoms in Parkinson’s

A

Motor symptoms affect QofL?

Yes:
1. Levodopa (effectiveness decreases over time)
+ Decarboxylase inhibitor
- Carbidopa
- Benserazide
Used to prevent peripheral metabolism of levodopa to dopamine

No:

  1. Dopamine agonist (non-ergot derived)
    - Ropinorole
    - Apomorphine
  2. Levodopa
  3. MOAI (B)
    • Selegiline
    • Rasagiline

Second line add ons:

  • Dopamine agonists
  • MOAIs
  • COMT Inhibitors
    • Entacapone
    • Tolcapone
96
Q

4 examples of dopamine receptor agonists

A

Non-Ergot derived:

  • Ropinorole
  • Apomorphine

Ergot derived:

  • Bromocriptine
  • Cabergoline
97
Q

Side effects of ergot derived dopamine receptor agonists

  • cabergoline
  • bromocriptine
A

Pulmonary, cardio + retroperitoneal fibrosis

98
Q

Management of tremor in Parkinson’s

A

Procyclidine

99
Q

Side effects of metoclopramide (dopamine antagonist)

A

Drug induced parkinsonism

- bilateral tremors

100
Q

Management of drug induced parkinsonism

A

Anti-muscarinics (block cholinergic receptors)
Procyclidine
Benzotropine
Trihexyphenidyl

101
Q

4 types of Parkinson Plus syndromes

A

Progressive Supranuclear Palsy (PSP)
Multisystem Atrophy
Corticobulbar degeneration
Lewy Body dementia

102
Q

Types of Multi system atrophy

A

MSA- P (predominantly Parkinson’s)

MSA- C (predominantly cerebellar)

103
Q 
Parkinsonism 
Autonomic disturbance 
  - erectile dysfunction 
  - postural hypotension 
  - atonic bladder
Cerebellar disease
A

Multi System Atrophy

- Parkinson Plus condition

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