CCC Neurology Flashcards
What is the order of examination (e.g. inspection palpation percussion for abdo etc.) for upper and lower limb examination?
Inspection Tone Power Reflexes Coordination Sensation Gait Back
Present in this way and present one word after each e.g. Tone reduced
How might botulism present?
Disrupts NMJ so would get widespread reduced tone and reflexes, sluggish responses but also skin popping due to infection.
How do cerebellar pathologies present?
Dysdiadochokinesia - rapidly alternating movement Ataxia Nystagmus Intention tremor - finger nose test Speech slurred
How do signs of sensation show us where a lesion may be?
Hemisensory loss - cerebral cortex Level - spinal cord Nerve roots - dermatomes Specific area - mononeuropathy Glove and stocking - polyneuropathy
How do we treat peripheral neuropathy (presenting glove and stocking distribution)?
Duloxetine and treat causes
What can cause peripheral neuropathy?
Toxic - diabetes, B12 deficiency, alcohol, drugs, hypothyroid, uraemia, amyloidosis
Infection - HIV
Inflammation - vasculitis, CTD, inflammatory demyelination neuropathy
Tumour - paraneoplastic, paraproteinaemia
Hereditary (can cause pes cavus, arched foot)
What is papilitis?
Optic neurve neuritis
- Blurred optic disc margins
- Blurred vision
- Pain on eye movements
Different to uveitis because that is of eye, causes eye pain and redness.
What is spastic paraparesis?
Changes to the spinal cord that causes gradual weakness.
It can present in eyes as papilitis.
Important to decide its cause e.g. toxin, infection, inflammation, vascular, malignancy. So if papilitis present can be infection. But could be MS if no signs of inflammation, but perhaps genetic instead etc. If unilateral then could be stroke.
Signs of papilledema?
Enlarged blindspot.
What is meralgia paraesthetica?
Compression of lateral femoral cutaneous nerve. Presents with pain and loss of fine touch in one area specifically - shows not in brain or spine but indeed in one specific nerve. This can be applied across the body to other nerves, saying compression of x nerve is fine. Sensory innervation of hand common, learn this.
Needs to avoid tight garments, lose weight (for this compression e.g. carpal tunnel needs splint). Carbamazepine or gabapentin.
What is radiculopathy?
Disease of nerve roots.
Pain in buttock that radiates down.
Can be caused by disc herniation or spinal canal stenosis.
Parkinsonian features?
Dopaminergic neurones in substantia nigra - tremor, rigidity, bradykinesia
Lewy body dementia has some symptoms with hallucinations and alzheimer’s features.
What is myasthenia gravis?
Chronic, autoimmune condition causing gradual weakness, ptosis, SOB, voice changes, waddling gait, easier tiring etc. as antibodies destroy nerve communication.
Causes of chronic confusion?
Post-ictal - after seizure
Dysphasia - receptive or expressive and has other features of stroke or TIA
Dementia - vascular, alcoholic, alzheimer’s, inherited e.g. huntington’s
Depression - pseudodementia e.g. elderly, withdrawn with precipitating factor
Causes of acute confusion?
Hypoglycaemia
Vascular - bleed with headache or collapse
Infection - temp, intra or extracranial symp
Inflammation
Malignancy
Toxic - drugs, vitamin def, endocrinopathies, LFTs, U&Es
