26. Limb Weakness Flashcards
How does the time course help you narrow down differentials for limb weakness?
Sudden- trauma, fractures, vascular insults
Subacute- Demyelination; Guillaune barre, slowly expanding haematoma
Chronic- motor neurone disease, slow growing tumour
What should you ask of someone who has presented with limb weakness?
Exact time of onset? thrombolysis window 4.5 hrs
Any speech disturbance or vision disturbance? if so problem is more likely to be in the brain
Headache? SAH
Recent trauma? SAH
Seizures of LOC? Stroke mimics like todd’s paresis
Neck or back pain? spinal pathologies like disc prolapse
RF for stroke? like smoking, family hx, hypertension, diabetes, dyslipidaemia
What are the main differences on examination between UMN lesions and LMN leisons?
UMN:Increased toneHyper-reflexia, Upgoing plantars, sometimes clonus
LMN:Decreased tone, Hyporeflexia, Fasciculations, Wasting
What language defects should you look out for with limb weakness?
Receptive dysphasia- wernicke’s lesion, patient speaks fluently but cannot comprehend language
Expressive dysphasia- broca’s lesion, patient comprehends language but can’t follow instructions
What would you suspect if a patient is responding to cues on one side?
Lesion in parietal cortex
What eye signs should you look out for in someone with limb weakness?
Complete blindness- optic nerve lesion
Homonymous hemianopia- lesion between optic chiasm and visual cortex
Deviation- if eyes deviate to the weak side, suggests brain stem lesion. If they deviate away from weakness, suggests cortical lesion
Difference between ACA and MCA infarct?
ACA will cause weakness in the lower limb more than upper and MCA is the opposite
What are first line investigations for a stroke?
CT head, FBC- reveal cause of arterial occlusion, blood glucose- rule out hypoglycaemia as cause for limb weakness, blood clotting and ECG
How do you manage stroke acutely?
Antiplatelets like aspirin, admit to stroke unit, VTE prophylaxis
What second line investigations will a patient with a stroke need?
Carotid doppler- exclude carotid artery atheromas
Echo- identify cardiac source of emboli like atrial thrombus or patient foramen ovale
What are some medical complications of stroke and how can you reduce them?
Pressure ulcers- regular movement
aspiration pneumonia- due to difficulty swallowing.
Swallowing assessment and NG tube if needed.
VTE
How do you assess disability in stroke patients?
GCS, assess swallow, assess speech and lnguage, visual fields and gait
