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2021 > Neuro > Flashcards

Neuro Flashcards

1
Q

LL Neuro Schpiel

A

Today I examined ____ lower limb.

Pertinent findings were weakness in XXX with tone/reflexes/co-ordination/sensory findings of ____.

These findings are in keeping with an upper/lower/mixed motor neuron pattern consistent with a lesion at the XXXX.

My differentials are ….

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2
Q

Schpiel (Gait)

A

Today I was asked to examine ____ gait, which was ____.

Given these findings I went on to examine lower limb neuro, co-ordination/cerebellar/Parkinson’s.

My findings were ___ consistent with ____ and my differentials are _____.
-

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3
Q

Predominant sensory peripheral neuropathy causes

A
  • Diabetes
  • ETOH
  • Hypothyroidism
  • Uraemia
  • Sarcoidosis
  • Paraneoplastic
  • B12 deficiency
  • Infections, e.g., leprosy, HIV, Lyme disease
  • Amyloidosis
  • Drugs (isoniazid, metronidazole, hydralazine, disulfiram, chloroquine, pyridoxine, colchicine, flecanide).
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4
Q

Predominant motor peripheral neuropathy causes

A
  • CIPD/GBS
  • Drugs (Dapsone)
  • Porphyria
  • Lead
  • Diptheria
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5
Q

Pes Cavus (inherited neuropathy) causes

A
  • CMT
  • Friedrich ataxia
  • Muscular dystrophy
  • Cerebral palsy
  • Spinal cord tumour
  • Poliomyelitis
  • Syringomyelia
  • HSP
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6
Q

Axonal loss signs

A

(Diabetes, ETOH, malignancy)

  • Distal reflex loss
  • Distal proprioception/vibration loss
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7
Q

Demyelinating loss signs

A

(HIV, drugs, MS)

  • global areflexia
  • decreased proprioception/vibration
  • preserved pin-prick
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8
Q

Proximal limb weakness causes

A

Proximal myopathy:

  • steroids, ETOH, statins
  • diabetes, diabetic amyotrophy
  • thyrotoxicosis
# IBM (quads)
# Polymyositis/dermatomyositis
# Mitochondrial myopathies
# Hereditary causes - muscular dystrophies, fascioscapulohumeral dystrophy
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9
Q

Distal myopathy causes

A
  • Myotonic dystrophy - facial and distal limb weakness, myotonia
  • IBM (distal in UL)
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10
Q

Lower limb weakness differentials

A 
# Mix of UMN & LMN with no sensory findings:
- MND, cerebral palsy, lacunar infarct

UMN in upper and lower limbs, bilaterally:

  • High cervical stenosis
  • MS
  • Arnold chiari malformation

LMN lesion in UL and UMN lesion in LL

  • Syringomyelia
  • Cervical lesions

Sensori-motor peripheral neuropathies:

  • Inherited: CMT
  • Acquired: Diabetes, CIDP

Neuromuscular disease:

  • Myasthenia
  • Lambert Eaton
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11
Q

Foot drop causes

A

Weak tibialis anterior

Common peroneal lesion - loss of eversion, sensory loss over lateral calf/dorsum of foot

L4/L5 root weakness - loss of eversion and inversion, expect dermatome sensory findings, may have hip abduction weakness

Bilateral peripheral neuropathy - all movements weak in glove/stocking sensory loss and areflexia.

UMN pattern:

  • bilateral spastic paraparesis - spinal cord lesion, bilateral stroke, MND
  • One leg weak - cortical infarct/lesion, Brown-Sequard
  • Hemiparesis - Upper and lower limb weakness same side - ? stroke

Sciatic nerve lesions - loss of eversion/inversion and ankle jerk.

Anterior horn cell disease - polio

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12
Q

Other neuro spiel

A
  • It is best to mention abnormalities as patterns rather than coming up with a diagnosis first up, e.g.,:
  • UMN vs LMN or a combination
  • Cerebellar dysfunction +/- other signs
  • Peripheral neuropathy (sensory/motor)

You can then mention a list of possible diagnoses.

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13
Q

Neuro Cases

A
  • Polyneuropathy - others (pure motor, sensorimotor - 21%
  • Muscular dystrophy - myotonic - 14%
  • CN lesions including pituitary tumours - 13%
  • Multiple Sclerosis - 12%
  • Myopathy/myositis - 12%
  • Polyneuropathy - CMT - 7%
  • MND - 7%
  • Parkinson’s disease/PSP/Huntington’s
  • Stroke - 7%
  • Polyneuropathy - Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP)
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14
Q

Ability to stand on toes?

A

S1

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15
Q

Ability to stand on heels?

A

L4,5 –> foot drop

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16
Q

Romberg test

A

Steady with eyes open, unsteady with eyes closed:

  • posterior column
  • peripheral neuropathy
  • vestibular function

Unsteady with eyes open & closed:
- cerebellar

*Unlikely to be related to cerebellar function in exam

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17
Q

Diplegic/paraparetic gait causes (5):

A
  • SC lesion
  • Cerebral palsy
  • Bilateral strokes
  • HSP
  • MS
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18
Q

CP Lesion (foot drop)

A

CP CAN invert whereas L4/L5 or Sciatic lesions unable to invert.
CP, L4-5 or sciatic lesions CAN’T evert.

Ankle jerk preserved

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19
Q

Unilateral high stepping gait (unilateral foot drop) causes:

A

Distal weakness:

  • L5 lesion
  • CPN lesion
  • Sciatic neuropathy - patient can walk on toes but not heel of affected side
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20
Q

Bilateral high stepping gait (bilateral foot drop) causes:

A
  • Lumbosacral polyradiculopathy
  • MND
  • Distal polyneuropathy e.g., CMT (patient can’t walk on heels or toes), CIDP
  • MD
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21
Q

High stepping gait of sensory neuropathy (sensory ataxic gait) causes:

A

Maybe wide-based, clumsy, slapping down of feet + Romberg’s:

  • Peripheral sensory neuropathy
  • Syphilis
  • Subacute combined degeneration of the spinal cord
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22
Q

UL/LL Neuro *Don’t forget:

A

1) Scars, back, neck
2) Catheters
3) Peri-anal sensation, anal tone

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23
Q

Gerstmann’s syndrome (Dominant) - 4

A

1) Agraphia
2) Acalculia
3) Finger agnosia
4) Left-Right Confusion

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24
Q

Subcortical lesion:

  • Internal capsule
  • Basal Ganglia (Globus pallidus & Putamen)
  • Thalamus
A
  • Absent cortical signs
  • Face, arm & leg equally affected
  • Unusual movements (basal ganglia)
  • Dense sensory loss (thalamus), maybe associated with hemiplegia
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25
Q

Brainstem lesion (5)

A
  • Crossed hemiplegia, cranial nerve or cerebellar signs on side of brainstem affected opposite to hemiplegia
  • Nystagmus horizontal, vertical
  • INO (Internuclear ophthalmoplegia)
  • Gaze palsy looking to side of lesion (pontine gaze centre controls gaze towards itself)
  • Sensory findings: crossed sensory loss, 5th nerve (pain & temp) opposite to body sensory loss (spinothalamic)
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26
Q

Cortical signs (4)

A
  • Aphasia
  • visuospatial neglect
  • gaze deviation
  • visual field defects

*always absent in subcortical/lacunar strokes

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27
Q

Lacunar syndrome (5)

A
  • Pure motor stroke/hemiparesis (most common lacunar syndrome: 33–50%)
  • Ataxic hemiparesis (second most frequent lacunar syndrome)
  • Dysarthria/clumsy hand (sometimes considered a variant of ataxic hemiparesis, but usually still is classified as a separate lacunar syndrome)
  • Pure sensory stroke
  • Mixed sensorimotor stroke
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28
Q

SC Lesion

A
  • usually bilateral
  • sparing of face, cranial nerves (rarely 5th nerve long tract affected)
  • horner’s high spinal lesion, sympathetic chain down to T1, T2
  • sensory level
  • bladder, bowel dysfunction
  • if unilateral look for Brown Sequard- hemitransection of the SC:
  • ipsilateral spastic hemiparesis, loss of vibration & proprioception
  • contralateral loss of temperature & pin-prick
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29
Q

CN 2 (4)

A

Optic Nerve:

1) Acuity (done first)
2) Fields
3) Pupil response
4) Fundi

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30
Q

Bi-temporal heminopsia (tunnel vision) causes:

A

1) Pituitary adenoma
2) Craniopharyngioma
3) Neoplastic - meningioma
4) Vascular origin is an aneurysm of the anterior communicating artery

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31
Q

CN 3 Palsy

A

Oculomotor

1) Ptosis
2) Inferolateral displacement of the ipsilateral eye (SR, IR. MR, IO)
3) Pupil

*PCOM Aneurysm - CTA
- MRI - stroke (ischemia), tumour, demyelination, GCA, infectious

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32
Q

Argyll Robinson Pupil

A
  • Accommodates but does not react.
  • bilateral small pupils that reduce in size on a near object (i.e., they accommodate), but do not constrict when exposed to bright light (i.e., they do not constrict when exposed to light).
  • highly specific sign of neurosyphilis
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33
Q

RAPD (MG)

A
  • observed during the swinging-flashlight test where upon the patient’s pupils dilate when a bright light is swung from the unaffected eye to the affected eye. The affected eye still senses the light and produces pupillary sphincter constriction to some degree, albeit reduced.
  • most common cause is a lesion of the optic nerve (between the retina and the optic chiasm) due to glaucoma, or severe retinal disease, or due to multiple sclerosis.
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34
Q

Common causes of CN palsies (4)

A

1) Diabetes
2) Aneurysm
3) A vascular event
4) Mass lesion

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35
Q

Complex ophthalmoplegia (4)

A

1) Graves
2) MG
3) Mitochondrial myopathies - Chronic progressive external ophthalmoplegia
4) Occulopharyngeal l dystrophy

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36
Q

Stroke facial nerve

A
  • spares forehead

- paralysis of contralateral lower face

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37
Q

Pseudobulbar palsy causes:

A
  • Bilateral UMN Lesion

- Causes: MND, MS, multiple strokes, trauma, BS tumour

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38
Q

Bulbar palsy causes:

A
  • Bilateral LMN Lesion

- Causes: MND, MG, GBS, Infarcts in medulla, Polio, Arnold Chiari malformation

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39
Q

Dysphasia types (4)

A
  • Receptive - can’t comprehend what you’re saying and have a problem with repeating what you’re saying: Wernicke’s area - posterior section of the superior temporal gyrus, dominant cerebral hemisphere
  • Expressive (motor aphasia): Brocca’s area - inferior frontal gyrus of the dominant hemisphere
  • Nominal dysphasia: can’t reliably be localised
  • Conductive: arcuate fascicles - deep white matter bundle connecting the posterior temporoparietal junction with the frontal cortex. *can’t repeat statements or name objects but can follow commands.
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40
Q

Dysarthria (3)

A
  • Cerebellar (scanning speech: slow, jerky, slurred and often explosive, broken up into syllables
  • UMN
  • pyramidal (spastic) dysarthria: slow, laboured, patient trying to squeeze words out
  • extrapyramidal e.g., PD: motonous, bradykinesia, muscular rigidity
  • apraxic speech: pre-frontal motor dysfunction, difficulty constructing speech
  • LMN
  • nasal, flaccid (MG, MND with LMN signs, bulbar palsies)
  • facial muscle weakness –> slurred speech
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41
Q

Posterior Column Lesions causes

A

1) Sub-acute combined degeneration of the cord - B12 deficiency - diet, malabsorption
2) Tabes dorsalis - syphilis
3) Friedrich’s taxia
4) Spinocerebellar ataxia
5) Paraneoplastic DRG-opathies

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42
Q

Syringomyelia

A
  • ko’s the Spinothalamic tract

- spares the DCML

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43
Q

PD extra tests:

A

1) measure postural BP (autonomic dysfunction)
2) assess cognitive function (MMSE)
3) assess handwriting (micrographia)

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44
Q

Parkinsonism

A

1) BK with at least one of:
- tremor
- rigidity
- postural instability

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45
Q

PD

A
  • Neurodegenerative disease caused by disruption of dopminergic neurotransmission in the basal ganglia. Loss of dopaminergic neurons in the substantia nigra.
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46
Q

CMT description

A
  • Symmetrical distal motor and sensory neuropathy.

- Hyporeflexia

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47
Q

Bulbar palsy signs:

A
  • Upper and lower facial weakness
  • Palatal paralysis
  • Wasted and flaccid tongue with prominent fasiculations
  • Nasal quality speech
48
Q

Pseudobulbar palsy signs:

A
  • Emotional lability (laughing/crying)
  • Stiff (spastic) tongue with no fasiculations
  • *Brisk jaw reflex
49
Q

UMN and LMN ddx

A
  • MND (ALS)
  • Syringomyelia
  • Cervical myelopathy
50
Q

Cerebellar lesion will result in IPSILATERAL signs.

A

Cerebellar lesion will result in IPSILATERAL signs.

51
Q

Friedreich’s ataxia signs:

A
  • Pes Cavus
  • pryamidal and dorsal column signs in legs
  • depressed ankle jerks
  • extensor plantars
52
Q

Cerebellar syndrome causes:

A
  • Demyelination (MS)
  • Alcohol cerebellar degeneration
  • Posterior fossa SOL
  • Brainstem lesions
  • Friedreich’s ataxia
  • Hypothyroidism
  • Vitamin E deficiency
  • Spinocerebellar degneration
  • VHL syndrome
  • MSA

Drugs:

  • phenytoin
  • Lithium
  • Carbamazapine
  • CTx agents
53
Q

Myotonic dystrophy (trinucleotide repeat CTG expansion)

A
  • myopathic/expressionless facies
  • frontotemporal balding
  • bilateral ptosis but can be unilateral
  • distal wasting and weakness, i.e., distal myopathy
  • high steppage gait
  • overcome eye closure
  • clench fist and open
54
Q

Associated conditions with MD:

A
  • diabetes
  • cardiomyopathy - HF
  • valvular heart disease - MVP
  • arrhthymias - AF, SVT, VT
  • conduction defects - PPM
  • hypogonadism: gynaecomastia, testicular atrophy
  • goitre
55
Q

Peripheral neuropathy types:

A
  • sensory (large fibre - DCML, small fibre - STT) - sensory loss in a stocking distribution
  • motor (distal wasting and weakness, depressed reflexes)
  • sensori-motor
56
Q

Motor neuropathy signs:

A
  • LMN pattern of weakness - wasting, weakness (distal to proximal, length dependent axonal degeneration), hyporeflexia and down-going plantars
57
Q

Sensory neuropathy distribution:

A
  • stocking distribution in the legs and glove distribution in the arms.
  • distal-to-proximal axonal degneration.
58
Q

Sensori-motor polyneuropathy causes:

A
  • ETOH
  • Diabetes
  • Hypothyroidism
  • Uraemia
  • Sarcoidosis
  • Vasculitis
  • Paraneoplastic
  • CIDP/GBS
  • Hereditary motor and sensory neuropathies
59
Q

Demyelinating polyneuropathy causes

A
  • CIDP
  • MM
  • MGUS
  • HMSN (CMT)
  • HNPP
  • Multifocal motor neuropathy
  • HIV
60
Q

Peripheral neuropathy Ix

A
  • FBE
  • ESR
  • UEC
  • LFT
  • Glucose/HbA1c
  • TFT
  • B12, folate
  • SPEP
  • Autoimmune profile
  • NCS
  • CSF analysis
  • Nerve biopsy
  • Genetic testing
61
Q

Common causes of CP injury:

A

External compression:

  • short braces
  • plaster cast
  • tourniquets
  • leg crossing
  • prolonged pressure due to positioning during surgery
  • schwanoma

Trauma:

  • direct trauma to nerve
  • fibula fracture
  • following TKR

Causes of mononeuritis multiplex

62
Q

Flaccid foot drop causes:

A

Muscle:

  • MD
  • Trauma

NMJ: MG

LMN: MND

LS plexus: pelvic pathology

Cauda equina: tumour

L5 nerve root: L4/5 disc prolapse

CP palsy

Sciatic nerve palsy: trauma, hip surgery

63
Q

Friedreich’s ataxia (pes cavus (PN) plus cerebellar ataxia)) signs:

A
  • cerebellar syndrome
  • pes cavus
  • pyramidal distribution of weakness
  • depressed reflexes with extensor plantar responses
  • peripheral neuropathy - loss of proprioception and vibration sense
64
Q

High-arched palate causes:

A
  • Friedrich’s ataxia
  • Marfan’s syndrome
  • Turner’s syndrome
  • Tuberous sclerosis
65
Q

Pyramidal weakness

A
  • characteristic of UMN damage
    LL: flexion is weaker than extension, ankle dorsiflexion, eversion.
    UL: extension is weaker than flexion
66
Q

DDx of depressed knee and ankle jerks with extensor plantar responses:

A

Combo of conditions:

  • peripheral neuropathy and stroke
  • peripheral neuropathy and cervical myelopathy
  • cervical and lumbar spondylosis
  • Subacute combined degeneration of the cord (B12 deficiency)
  • Tabes dorsalis
  • Lesion of the conus medullaris
  • Friedreich’s ataxia
  • MND
67
Q

Multiple Sclerosis signs:

A
  • eye (optic atrophy, RAPD)
  • brainstem (INO, facial sensory loss, facial weakness)
  • cerebellar (ataxia, dysarthria)
  • pyramidal
  • dorsal column signs.
68
Q

Causes of spastic paraparesis:

A
  • MS
  • Cord compression - tumours
  • Trauma
  • MND
  • Syringomyelia
  • Anterior spinal artery occlusion
  • Subacute combined degeneration of the cord
  • Tabes Dorsalis
  • Friedrich’s ataxia
  • Cervical myelopathy
  • HSP
  • Transverse myelitis:
  • bacterial infections: Lyme disease, mycoplasma, TB and syphilis
  • Viral infections: HSV, VZV, CMV, EBV, HIV, HAV, influenza and echovirus
  • Demyelination (MS and NMO)
  • Radiation myelopathy
  • Vasculitis
69
Q

Cervical Myelopathy - most commonly caused by canal stenosis - degen change/trauma, tumours.

A

UL: absence of bicep and supinator reflexes coupled with DCML signs
LL: spastic paraparesis with DCML signs

70
Q

Unilateral ptosis causes

A
  • CN 3 palsy - Eye movements
  • Horner’s syndrome *sympathetic chain - meiosis
  • MG/LEMS
  • Myopathy - myotonic dystrophy - usually bilateral
  • Congenital
71
Q

Bilateral ptosis causes

A
  • MG
  • Myotonic dystrophy
  • Tabes dorsalis
  • Bilateral Horner’s syndrome, e.g., syringomyelia
  • Chronic progressive external ophthalmoplegia
  • Miller Fisher Syndrome
72
Q

Causes of central Horner’s syndrome (first order neurone):

A
  • Demyelination
  • BS or SC tumour
  • BS or SC haemorrhage or infarction
  • Syringomyelia
  • Basal meningitis (syphilis, TB, carcinoma, lymphoma)
  • Basal skull tumours
  • Neck trauma
73
Q

Causes of peripheral Horner’s syndrome (second order neurone):

A
  • Pancoast tumour
  • Cervical rib
  • Neurofibromatosis
  • Neck surgery
  • CTS surgery
  • Lymphadenopathy
  • Aneurysms or dissection (aorta, subclavian or common carotid)
74
Q

Causes of peripheral Horner’s syndrome (third order neurone):

A
  • Internal carotid artery dissection
  • Carotico-cavernous fistula
  • Herpes Zoster
75
Q

Four types of dysarthria

A

1) Cerebellar disease
2) MND (pseudobulbar or bulbar palsy)
3) PD
4) Syringomyelia (bulbar palsy)

76
Q

Hemiparesis case add ons:

A
  • Perform complete neuro exam (UL/LL/CN)
  • Assess visual field defects (HH)
  • Assess patient’s speech (particularly with R) hemiparesis-L) dominant hemisphere)
  • Measure BP
  • Assess pulse (AF)
  • Auscultate for carotid bruits
  • Check urinalysis (glycosuria)
  • As if the patient is R) or L) handed
77
Q

Causes of Hemiparesis:

A
  • Stroke (ischaemic, haemorrhagic, thrombosis)
  • Tumour
  • Demyelination
  • Abscess
  • Post-ictal (Todd’s paresis)
  • Functional
78
Q

Cortical lesion signs

A
  • aphasia
  • neglect
  • apraxia
  • HH
  • seizures
79
Q

BS lesion signs:

A
  • Cerebellar
  • Eye movements/Horner’s
  • Crossed signs: R) CN III or VII cranial never palsy plus L) hemiplegia)
80
Q

PCA stroke

A
  • Brainstem cerebellar signs as well as HH and memory problems

PCA supplies: occipital cortex, hippocampus and thalamus.

81
Q

MCA lesion vs ACA lesion:

A

MCA lesion affects: unilateral UL and face

ACA lesion affects: unilateral LL

82
Q

Causes of Chorea

A

Inherited:

  • Huntington’s disease
  • Wilson’s disease
  • Spinocerebellar ataxia

Acquired:

  • SLE
  • PRV
  • Thyrotoxicosis
  • Hypo PTH with hypocalaemia
  • Dopamine antagonists
  • Stroke
83
Q

Polio

A
  • LMN signs (often unilateral) with the absence of sensory signs in a patient with hypoplastic limbs
84
Q

Acute flaccid paralysis causes:

A

Infection:

  • Viral
  • Polio
  • Enterovirus
  • Coxsackie
  • Japanese encephalitis
  • Bacterial
  • Botulism
  • Diptheria
  • Lyme disease

Neuropathy:

  • GBS
  • AIP
  • Lead poisoning

Spinal disease

  • Acute transverse myelitis
  • Spinal cord compression
  • Spinal cord infarction
85
Q

Brainstem dysfunction signs:

A
  • Ophthalmoplegia
  • Conjugate gaze palsy
  • Pupil involvement
  • Nystagmus (esp vertical)
  • Crossed signs, i.e., sensory and/or motor dysfunction affecting the limbs on one side and the face/bulbar muscles on the other side
  • Ataxia
  • Bilateral pyramidal signs, e.g., extensor plantars or quadriparesis
  • Respiratory or autonomic involvement
86
Q

VSIP

A
  • Vascular
  • SOL
  • Inflammatory
  • Paraneoplastic
87
Q

Lateral medullar syndrome (4) - Posterior inferior cerebellar artery - secondary to vertebral artery stenosis or dissection.

A
  • Ipsilateral Horner’s syndrome
  • Ipsilateral cerebellar signs
  • Ipsilateral V (STT), IX, X and X nerve signs
  • Contralateral STT (below the lesion)
  • Sensory of V
88
Q

Power scale:

A

0 - no contraction
1 - flicker or trace of contraction
2 - active movement with gravity eliminated
3 - active movement against gravity
4 - active movement against gravity and resistance
5 - normal power

89
Q

UMN Signs (3)

A
  • Hyper-reflexia
  • Spasticity
  • Up-going plantar reflexes
90
Q

LMN Signs (4)

A
  • Hyporeflexia
  • Fasiculations
  • Decreased tone/flaccid
  • Atrophy
91
Q

Horner’s signs (3)

A
  • Ptosis
  • Meiosis
  • Anhidrosis
92
Q

Binocular diplopia ddx (6)

does it go away with EITHER eye?

A
  • supranuclear
  • nuclear
  • infranuclear
  • nerve
  • muscle
  • NMJ
93
Q

Monocular diplopia ddx (4)

does it go away with one eye?

A
  • refractive error
  • corneal disease
  • cataract
  • dry eye
94
Q

Myopathy (6)

A
  • Usually proximal weakness
  • Usually no sensory deficit
  • Reflexes preserved until late
  • Fasiculations absent
  • Contractures present
  • May be associated with myocardial dysfunction or muscle tenderness
95
Q

Neuropathy (6)

A
  • Distal weakness
  • Concomitant sensory symptoms + signs
  • Reflexes lost early
  • +/- fasiculations
  • No contractures
  • Not associated with myocardial dysfunction nor muscle tenderness
96
Q

NCS - Axonal pattern

A
  • Decreased amplitude
97
Q

NCS - Demyelination

A
  • Decreased conduction velocity
  • Increased latency
98
Q

Horizontal diplopia

A
  • CN 3 or 6

*due to disease of the medial or lateral rectus muscle, the neuromuscular junction, or the nerves supplying these muscles

99
Q

Vertical diplopia

A
  • CN 4

Causes: congenital, microvascular disease, or trauma

100
Q

Diagonal diplopia

A
  • CN 3 or 4

*reflects dysfunction of both vertical and horizontal muscles, suggests dysfunction of the oculomotor nerve (involving some combination of the inferior rectus, superior rectus, and inferior oblique muscles).

101
Q

PRES (reversible posterior leukoencephalopathy syndrome)

A
  • Headache, confusion, visual symptoms, seizures
102
Q

Multiple sclerosis

A
  • Periventricular
  • Cortical/juxtacortical
  • Infratentorial
  • Spinal cord
103
Q

McDonald’s criteria

A
  • Demonstration of CNS lesions in both space (PV, JC, IF, SC) AND time.
104
Q

LEMS

A
  • SCC lung Cx
  • *EMG: incremental response
  • Anti-voltage gated calcium channel
105
Q

MG

A
  • Anti AcHr-Ab, MUSK ab
  • Tensilon test
  • EMG - jitter/decrementation
  • CT Thorax - thymoma
106
Q

CN 4

A
  • SO *Controls intorsion of the eye in down-gaze
107
Q

Where is the lesion? (8)

A

1) Cortical - vision/speech, neglect
2) Subcortical - lacunar - pure motor, sensory
3) Brainstem - Opthalmoplegia has to be BS
4) SC - sensory level + UMN until L-S spine
5) Nerve root - brachial plexus
6) Peripheral nerve - dermatome - radiculopathy, plexopathy
7) Muscle - myopathy
8) NMJ

108
Q

Stroke (6)

A

1) Location
2) ? Cause - carotid/thromboembolic disease/small vessel disease (older - T2DM, HTN, Hcol, smoker)
3) Loop, Holter, TTE - ? PFO closure (younger)
4) Rx - aspirin/clopidogrel
5) Impact on function from stroke
6) Return back to work and Driving Ax

109
Q

Medial Medullary Syndrome

A
  • Ipsilateral INO
  • Contralateral DCML
  • Contralareral hemiparesis
  • Ipsilatreral 3, 4, 6 and 12

Anterior spinal atery

110
Q

7 Classical features of Parkinsonian Gait

A
  1. Stooped and rigid posture
  2. Difficulty with initiation
  3. Narrow-based (not a pathological feature)
  4. Shuffling and festinating
  5. Reduced arm swing
  6. Clock-face turning
  7. Freezing of gait
111
Q

Spasticity

A
  • Velocity and degree dependent
112
Q

Rigidity

A
  • Velocity and degree independent
113
Q

Long term issues of MS (9)

A
  • Pain (spasticity)
  • Immobility (ataxia)
  • Numbness
  • Continence - urinary retention, self-IDC, constipation
  • Ataxia
  • Fatigue
  • Cognitive issues
  • Employment
  • QOL
114
Q

Ophthalmoplegia possibilities (6):

A
  • CN Palsy - Diabetes, Aneurysm, HIV, syphilis
  • Graves
  • MS
  • MG
  • Mitochondrial - MELAS (Mitochondrial encephalomyopathy, lactic acidosis and stroke-like episode)
  • Miller-Fisher Variant CIDP
115
Q

Miller-Fisher Variant CIDP (3)

A
  • Ophthalmoplegia
  • Ataxia
  • Areflexia
  • Anti-GM1, GD3, GQ1b
116
Q

Stroke causes (5)

A
  • Cardio-embolic (20%)
  • Large artery disease (20%)
  • Subcortical (25%)
  • Cryptogenic (30%(
  • Vasculitis, genetic, VST (5%)
117
Q

MS Sx Rx options (4):

A
  • Motor disability: gait aids, PT, OT, spasticity, NDIS
  • Bladder: anti-cholinergics, mirabegron, botox, continence clinic
  • Pain: neuropathic, spasticity, botx, baclofen, CBD-THC
  • Mood/anxiety Rx

2021 (34 decks)

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