26. Limb Weakness Flashcards Preview

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Flashcards in 26. Limb Weakness Deck (25)
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1

How does the time course help you narrow down differentials for limb weakness?

Sudden: trauma, fractures, vascular insults
Subacute: Demyelination (GBS, MS) slowly expanding haematoma
Chronic: MND, slow growing tumour

2

What should you ask of someone who has presented with limb weakness?

Exact time of onset? thrombolysis window 4.5 hrs
Speech / vision disturbances? problem more likely to be in brain
Headache? SAH, hemiplegic migraine, SOL
Recent trauma? SAH
Seizures/ LOC? Stroke mimics e.g. Todd's paresis (post-seizure)
Neck or back pain? disc prolapse/ GBS
RF for stroke? hx of stroke, AF, smoking, FH, HTN, DM, dyslipidaemia

3

What signs would you see in a UMN lesion?

Increased tone
Hyper-reflexia
Upgoing plantars
Sometimes clonus

4

What language defects should you look out for with limb weakness?

Receptive dysphasia: Wernicke's (temporal), speaks fluently but can't comprehend language
Expressive dysphasia: Broca's (frontal), comprehends language but can't speak fluently

5

What would you suspect if a patient is responding to cues on one side?

Lesion in parietal cortex

6

What eye signs should you look out for in someone with limb weakness?

Complete blindness in 1 eye: optic nerve lesion
Homonymous hemianopia: lesion between optic chiasm + visual cortex on contralateral side
Deviation: if deviates to weak side= brain stem lesion. If deviates away from weakness= cortical lesion

7

Difference between ACA and MCA infarct?

ACA: weakness in the lower limb more than upper
MCA: weakness in upper limb more than lower

8

What are first line investigations for a stroke? Why?

CT head: exclude haemorrhagic stroke
FBC: reveal cause of arterial occlusion (polycythaemia/ thrombocytosis) or haemorrhage (thrombocytopenia)
Blood glucose: exclude hypoglycaemia
Blood clotting: if on warfarin + exclude haemophilia
ECG: for AF

9

How do you manage stroke acutely?

Antiplatelets e.g. aspirin
Admit to stroke unit
VTE prophylaxis e.g. LMWH

10

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 patent foramen ovale

11

What are some medical complications of stroke and how can you reduce them?

Pressure ulcers: regular movement
Aspiration pneumonia: Swallowing assessment + NG tube if needed.
VTE: LMWH

12

How do you assess disability in stroke patients?

GCS
Swallow
Speech + language
Visual fields
Gait

13

What is seen in LMN lesions?

Decreased tone
Hyporeflexia
Fasciculations
Wasting

14

Give 2 time frames and 2 causes of limb weakness when the pathology is in the brain

Sudden: Ischaemic stroke, TIA
Subacute: MS, Haematoma

15

Give 3 time frames and causes of limb weakness when the pathology is in the spinal cord

Sudden: Spinal disc prolapse
Subacute: MS
Gradual: Spinal canal stenosis

16

Give 2 time frames and causes of limb weakness when the pathology is in the nerve roots

Sudden: Spinal disc prolapse
Subacute: GBS

17

Give 2 time frames and causes of limb weakness when the pathology is in the peripheral nerve/ nerve plexus

Sudden: Acute limb ischaemia
Gradual: Diabetes

18

Give 2 time frames and causes of limb weakness when the pathology is in the neuromuscular junction

Subacute: Botulism
Gradual: Myasthenia gravis

19

Give a time frame and cause of limb weakness when the pathology is in the muscle

Gradual: Myositis

20

What signs would you see in a LMN lesion?

Hypotonia
Hyporeflexia
Fasciculations sometimes
Wasting

21

Which columns are spared in an anterior spinal artery infarct? Which sensory modalities are therefore preserved?

Dorsal columns
Light touch, vibration, proprioception

22

How do UMN facial weakness and LMN facial palsy differ?

UMN has sparing of forehead wrinkling + blink

23

Describe locations where and characteristics of clots can form due to blood stasis. What drugs are used for preventing these? What adverse outcomes do they prevent?

Deep veins/ fibrillating atria
Rich in fibrin + erythrocytes
Drugs that inhibit fibrin mesh formation (anticoagulants) e.g. Warfarin, RIvaroxaban
Venous thromboembolism + atrial clots

24

Give an example of where clots can form due endothelial activation of platelets, what allows this? What drugs are used for preventing these? What adverse outcomes do they prevent?

E.g. upon atherosclerotic plaque rupture
Rich in platelets
Drugs that inhibit platelet activation (antiplatlets) e.g. Aspirin, Clopidogrel
MI's + primary ischaemic strokes

25

Distinguish between the suffixes -paresis and -plegia. What does the prefix para- mean?

-paresis: weakness (can still move)
-plegia: complete paralysis
Para-: Lower limbs