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Clinical lists GI > Neuro > Flashcards

Neuro Flashcards

1
Q

Which dominant lobe do right handed people have ?

A

Left in 94%

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2
Q

Which dominant lobe do left handed people have ?

A

Left in 50%

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3
Q

Where is Broca’s area?

A

Inferior frontal gyrus

STRIFE - Inferior frontal expressive

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4
Q

What does a lesion in Broca’s cause?

A

Expressive non fluent aphasia

Normal comprehension

Shorts sentences

Frustration at the defecit

Paraphrasic errors

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5
Q

Where is the lesion in conductive aphasia?

A

Arcuate fasiculus

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6
Q

What deficits occur in conductive aphasia ?

A

Poor repetition

Intact comprehension

Fluent speech

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7
Q

Dominant parietal lobe deficits?

A

Gerstmann syndrome

  1. Acalculia
  2. Left right disorientation
  3. Finger agnosisa
  4. Agraphia
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8
Q

Non dominant or Non localising parietal lobe deficit (8)?

A
  1. Dressing apraxia - Pyjama top
  2. Constructional Apraxia - Copying a picture
  3. Visual Neglect
  4. Sensory neglect,
  5. Hemispatial neglect - clock face
  6. Anosognosia,
  7. Asterognosia - recognising objects in hands
  8. Graphasthesia - recognising letters or numbers on the skin
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9
Q

MCA syndrome deficits?

A
  1. Hemiparesis and sensory loss of face and arm>leg
  2. Visual field loss
  3. Dominant parietal lobe (usually left sided lesion) - aphasia
  4. Non dominant parietal lobe- neglect
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10
Q

ACA syndrome deficits ?

A
  1. Hemiparesis and sensory loss leg > arm
  2. Urinary incontinence
  3. Apraxia
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11
Q

Where Wernicke’s area?

A

Superior temporal gyrus

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12
Q

What does a lesion in Wernicke’s area cause?

A

Fluent receptive aphasia

Normal prosody of speech

Paraphrasic errors

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13
Q

Left field inferior quadrantinopia, where is the lesion

A

Right, parietal lobe

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14
Q

Right field superior quadrantinopia, where is the lesion

A

Left, temporal lobe

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15
Q

Causes of motor predominant peripheral neuropathy ?

A

Nerve

Metabolic - Alcohol, Diabetes, lead

Inflammatory - Multifocal motor neuropathy with conduction block

Acute intermittent porphyria

GBS e.g AIDP

Idiopathic

CMT

MAGIC

Muscle

  • IBM
  • Myotonic dystrophy

MND

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16
Q

Causes of sensory predominant peripheral neuropathy (6)?

A
  1. Nutritional/metabolic - Diabetes Vitamin - B12 deficiency,
  2. Toxins - alcohol
  3. Drugs - Amiodarone, Nitrofuratoin, Chemotherapy agents
  4. Malignancy associated - paraneoplastic, paraprotienaemia
  5. Infection - HIV
  6. Hereditary - hereditary sensory neuropathy (CMT)
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17
Q

Causes of Mononeuritis Multiplex?

A
  1. Diabetes
  2. CT disease - PAN, SLE, RA
  3. Infiltrative - sarcoid, amyloid
  4. Acromegaly
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18
Q

Causes of fasciculations?

A
  1. MND
  2. Polio
  3. Kennedy Disease
  4. Benign idiopathic fasiculations
  5. Motor root compression
  6. Peripheral neuropathy
  7. Primary myopathy
  8. Thyrotoxicosis
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19
Q

Causes of Central Horner’s syndrome (3)?

A

Central

  • Lateral Medullar
  • Lateral Pons
  • Cervicothoracic spinal cord
    • V -Infarct
    • SOL
    • Demyelination
    • Synringobulbia
    • Trauma
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20
Q

Causes of Preganglionic Horner’s syndrome(3)?

A

Anatomy

  • Sympathetic chain
  • Brachial plexus
  • Common Carotid

Causes

  • Tumour - pancoast/thyroid
  • Trauma - base of neck, klumpke
  • Cervical rib
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21
Q

Causes of Postganglionic Horner’s syndrome(3)?

A

Anatomy

  • Internal carotid
  • Cavernous sinus
  • Sup orbital fissure

Causes

  • Thrombosis
  • Dissection/Aneurysm
  • Infection
  • Cluster headache/Migraine
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22
Q

Causes of proximal myopathy ?

A
  • Drugs *
    • Steroids
    • Statins
    • Alcohol
  • Metabolic
    • Cushings
    • Hypothyroidism
    • Acromgealy
    • Osteomalacia
  • Inflammatory
    • Dermatomyositis
    • Polymyositis
  • Hereditary
    • Duchennes
    • Becker’s
    • Facioscapularhumeral dystrophy
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23
Q

Horner’s syndrome deficits?

A

Miosis (constricted pupil)

Partial ptosis

Anihidrosis - central = everywhere, pre ganglionic = face, post ganglionic = no

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24
Q

CN 3 deficits (6)?

A
  1. Complete ptosis
  2. Affected eye no direct or consensual response
  3. Unaffected eye will have consensual response
  4. Loss of accommodation
  5. Down and out (Divergent strabismus)
  6. myadriasis - dilated pupil (loss of parasympathetic)
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25
Q

Causes of CN 3 deficit?

A
  • Diabetes
  • Hypertension
  • Compression
    • Subarachnoid space
    • Posterior communicating artery aneurysm
    • Orbit
    • Cavernous sinus

CN nucleus - would cause bilateral ptosis

Occulomotor fasicles (get either contralteral tremor(red nucleus), contralateral hemipareis(cerebral peduncle), ipsilateral ataxia (cerebellar peduncle)

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26
Q

Causes of mixed peripheral neuropathy (6)?

A
  1. Endocrine Nutritional -Diabetes Mellitus, Vitamin B12 deficiency,
  2. Toxins - Chronic kidney disease, Alcohol
  3. Drugs -Alcohol -Gold -Cisplatin -Thalidomide - amiodarone - nitrofurantoin
  4. Infective - HIV
  5. Malignancy associated - Paraneoplastic, paraprotein
  6. Hereditary - CMT

RARE

  1. CT disease -RA -PAN -SLE -Churg Strauss -Cryoglobulinaemia
  2. Infiltrative -Amyloid -Sarcoid
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27
Q

Causes of complex opthalmoplegia (4)?

A
  • Graves Disease ○ Exopthalmus
  • MG ○ Ptosis ○ Fatiguability
  • Miller fisher Variant ○ Areflexia, ataxia and complex opthalmoplegia
  • Mitrochondrial ○ CPEO chronic progressive external opthalmoplegia ○ Don’t often complain diplopia
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28
Q

Causes of unilateral constricted pupil ?

A
  • • Horner’s
  • • Argyll Robinsons (Iridodolator fibres in midbrain) (Accommodate but don’t react)
    • Sypillis
    • Diabetes Meillitus
    • Rarely Alcohol
    • Other midbrain
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29
Q

Causes of uniltaeral dilated pupil ? (6)

A
  • Third nerve
  • Adie Pupil
  • Iridectomy, iritis, lens implant
  • Congenital
  • Trauma

Mydriatics

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30
Q

Bilateral Ptosis?

A

Eye end plate

  • • Senile ptosis
  • • Congential

Muscle

  • • Myotonic dystrophy
  • • Fascioscapulohumeral dystrophy
  • • Mitochondrial Myopathy
  • Limb Girdle dystrophy

NMJ

  • • MG

Nerve

  • Bilateral horner
  • Bilateral CN 3

Brain stem

  • CN3 nucleus expect Trochlear signs
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31
Q

Causes of CN 6 palsy ?

A

Pons, Fasicle, Subarachnoid space, Petrous temporal bone, Cavernous sinus, orbit.

○ Tumour

○ Vascular

○ Wernicke’s

○ MS

• Peripheral

  • Cavernous Sinus (+ V)
  • Diabetes
  • Trauma
  • Idiopathic
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32
Q

Causes of CN 7 palsy ?

A

Pons

Cerebellopontine angle

Petrous temporal bone

Parotids

UMN

  • Vascular
  • Tumour

LMN

  • Pontine Often with V and VI
    • Vascular
    • Tumour
    • MS
    • Syringobulbia
  • Cerebellopontine angle
    • Acoustic neuroma
    • Meningioma
  • Petrous Temporal bone affecting nerve
    • Bell’s palsy
    • Ramsay Hunt Syndrome
    • Otitis media
    • Fracture
    • Parotid
    • Tumour
    • Sarcoid
33
Q

Causes of bilateral cerebellar disease? (10)

A
  1. • Drugs
    • Phenytoin
    • Alcohol
  2. Hereditary
    • Frederick’s ataxia
    • Spinocerebellar ataxia
  3. Paraneoplastic syndrome
  4. Tumour
  5. MS
  6. Trauma - punch drunk
  7. Infarction
  8. Arnold chiari malformation
  9. Hypothyroidism
34
Q

Causes of unilateral cerebellar disease? (5)

A
  1. • Tumour
  2. Trauma
  3. Demyelinating
  4. Ischemia
  5. Paraneoplastic
35
Q

Features of CMT?

A

Demyelinating due to mutation in myelin gene , Can be AR or AD or X linked depending on type

The classic features include

  • variable foot deformity (hammer toes, pes cavus),
  • atrophy,
  • distal weakness,
  • decreased deep tendon reflexes
  • sensory loss(stocking).

NCS consistent with demyelination

36
Q

Features of Frederich’s ataxia?

A

Due to loss of function of Frataxin gene, with expanded trinucleotide repeat. Autosomal recessive

Exam

  • Deformity - Pes cavus, Hammer toes, Kyphoscoliosis
  • Distal wasting
  • Motor weakness, initially affecting feet and legs but then progressing to hands then arms
  • Loss of reflexes and Extensor plantar
  • Bilateral cerebellar signs
  • Peripheral neuropathy - Primarily affects dorsal columns with loss of vibration and proprioception

Proceed

  • Nystagmus
  • Voice - cerebellar dysarthria
  • Cardiomyopathy (ECG abnormalities in > 50%)
  • Optic atrophy - loss of visual acuity
  • Diabetes
37
Q

Types of Paraphasic errors (3)?

A
  1. Semantic - word is swapped for word with obvious association cat and dog
  2. Phonemic - sound is swapped cat and mat
  3. Neologism - Non existent word cat and yat
38
Q

Lesion in conjugate gaze palsy?

A

Contralateral frontal lobe or ipsilateral pons

39
Q

CN 3 pupil is …

A

Dilated Myadriasis

40
Q

Horner’s pupil is …

A

Small , miosis

41
Q

What is in the cerebellopontine angle?

A

CN V, VII, VIII

42
Q

Investigation of proximal myopathy ?

A

History

Chronicity

Exposure to drugs or toxins

Bloods

  • Inflammatory markers
  • EUC - Creatinine
  • Creatinine Kinase
  • Myositis Immunoblot

Investigation

  • Electromyography
    • Neuropathic and myopathy
    • Fibrillations
    • Jitter
  • MRI
    • Oedema
    • Necrosis
  • Biopsy
43
Q

Causes of proximal myopathy ?

A

Muscle

Acquired

  • Drugs
  • Steroid
  • Statins
  • Alcohol

Infection

  • HIV

Inflammatory

  • Polymyositis
  • Dermatomyositis

Hereditary

  • Myotonic dystrophy
  • Muscular dystrophy - men
  • Mitochronical myopathy
  • Storage disease
  • Congenital myopathy

Neuromuscular junction

  • MG
  • LEMS

Anterior horn cell

  • MND

Root

  • Cauda equina
44
Q

Investigation of peripheral neuropathy ?

A

History

  • Chronicity
  • Drugs list toxins

Bloods

  • CBE - unexplained anaemia - malignancy or megaloblastic
  • Evdience to ETOH - GGT, AST:ALT, macrocytosis
  • EUC - uraemia
  • HbA1c
  • Vitamin Deficiency
  • SPE

NCS

  • Axonal vs demylinating

LP

  • Elevated protein
45
Q

Bilateral Spastic paralysis findings?

A

Spastic gait - circumduction

Hypertonicity

Clonus

Bilateral weakness (pyramidal)

Hyperreflexia + extensor plantars

Sensory level

46
Q

Spastic paraparesis cause?

A

Vascular

  • Ant Spinal cord

SOL

Demyelinating

  • Transverse myelitis - MS, NMO, post infective

Hereditary

  • Frederich’s ataxia
  • Familial spastic paraparesis

Infection

  • HIV

Nutrition

  • Subacute combined degeneration of the cord

Trauma

  • Disc prolapse
  • Pathological fracture
47
Q

Ix of Spastic paraparesis ?

A
  • ESR
  • B12
  • HIV serology
  • CT/MRI
  • CSF - protein, pcr, oligoclonal bands
48
Q

Hereditary spastic paraparesis signs?

A
  • Mild pes cavus
  • Hypertonicity
  • Hyper-reflexia
  • Extensor plantars
  • Loss of power
  • Mild sensory loss
49
Q

weakness, absent ankle jerks, extensor plantars?

A

Single pathology

  • Subacute combined degeneration of the cord - loss of dorsal columns
  • Frederich’s ataxia - ataxia, loss of dorsal columns
  • Tabes dorsalis - loss of dorsal columns
  • MND
  • Conus medularis

Dual pathology

50
Q

Ix of MND?

A

NCS

  • Exclude other pathology
  • Usually normal
  • May have reduced compound motor action potentials if severe

EMG

  • Features of acute and chronic denervation (fibrillations, large amplitude long diartion action potentials)

MRI

  • Exclude other diagnosis
51
Q

Axonopathy NCS?

A

Low amplitude

Prolonged latency

Conduction block

52
Q

MND features?

A

Combination of LMN and UMN signs

  • Fasiculations
  • Wasting
  • Spasticity, hyper-reflexia
  • Weakness
  • Normal sensation

Proceed

  • Speech
  • Lower CN exam - mixed UMN and LMN signs
  • Peak flow to assess lung involvement
53
Q

Cervical Myelopathy features?

A

UMN signs below, LMN at site (e.g. reduced reflexes)

Sensory level

54
Q

Demyelinating NCS?

A

Decrease velocity

Normal amplitude

Slow F wave

55
Q

Neuropathic EMG?

A

Insertional jitter

Large polyphasic motor units

56
Q

Myopathic EMG?

A

If inflammatory - jitter, spontaneous activity

Small polyphasic units

57
Q

Monotonic EMG

A

Dive bomber

58
Q

MG EMG?

A

Single motor fibre - jitter

Decrement

59
Q

Bulbar palsy causes?

A

MND

GBS

Synringomyelia

mg

Neurosarcoid

60
Q

Lateral Medullary Syndrome signs?

A
  • The 4 ‘side’ (lateral) structures and the associated deficits are:
  • Spinocerebellar pathway:
    • ipsilateral ataxia of the arm and leg
  • Spinothalamic pathway:
    • contralateral alteration of pain and temperature affecting the arm, leg and rarely the trunk
  • Sensory nucleus of the 5th cranial nerve:
    • ipsilateral alteration of pain and temperature on the face in the distribution
  • Sympathetic pathway:
    • ipsilateral Horner’s syndrome, that is partial ptosis and a small pupil (miosis)
61
Q

Lateral medullary syndrome artery ?

A

Vertebral and posterioinferior cerebellar artery

62
Q

Medial Medullary syndrome?

A
  • Motor pathway (or corticospinal tract):
    • contralateral weakness of the arm and leg
  • Medial Lemniscus:
    • contralateral loss of vibration and proprioception in the arm and leg
  • Motor nucleus and nerve:
    • ipsilateral loss of the cranial nerve 12
63
Q

Pseudobulbar palsy causes?

A

MS

MND

Bilateral cerebrovascular disease e.g. both internal capsules

64
Q

Features of fascioscapulohumeral dsytrophy?

A
  • Ptosis
  • Wasting of SCM
  • Winging of scapula
  • Loss of power in triceps and biceps
  • Absent biceps and triceps jerk
  • Proceed
    • Hearing loss
    • Retinal telangiectasia
    • OSA
65
Q

Ulnar nerve palsy at wrist ?

A
  • wasting small muscles of hand
  • Ulnar claw - hyperextension at MCP and flexion at DIP and PIP of 4/5th fingers
  • Froment sign
  • Weakness of ulnar flexor digitorum profundus,
  • Loss of sensation of medial 1/5 fingers
66
Q

Ulnar nerve palsy Lesion above cubital fossa ?

A

flexor carpi ulnaris(flexes and ABducts hand at wrist) and flexor digorotum profundus (flexes DIP) is paralysed.

Ulnar paradox - claw looks less severe , The flexor digitorum profundus is paralysed, and there will not be any flexion at the distal IP joints of the ring and little fingers. Now the ulnar claw only consists of hyperextension at the MCP joints and flexion at the proximal IP joints. This produces a much less evident claw hand.

67
Q

Common peroneal nerve lesion >

A

Wasting of tibalis anterior

Foot drop

Weak dorsiflexion and Everison

Normal ankle jerk

68
Q

Radial Nerve palsy at axilla?

A
  • loss of
    • Forearm flexion and supination
    • Wrist extension
    • digital extension
    • loss of dorsal sensation of arm and hand
69
Q

Radial nerve palsy at forearm just below elbow?

A

Loss of

  • Finger extension
  • Thumb extenion and ABduction
  • Partial wrist drop
  • Sensation normal
70
Q

INO features?

A

Loss of ADduction of eye with nystagmus in other eye

71
Q

Lesion location in INO

A

Medial longitudinal fasiculus

72
Q

Causes of INO?

A

Young MS

Old Vascular

Rarer- Tumour (pontine glioma), drugs - phenytoin and carbamazepine,

73
Q

One and a half features?

A

No horizontal movement of one eye,other eye is only capable of ABduction with nystagmys. Vertical eyemovements normal

74
Q

Lesion in one and a half?

A

Medial longitudinal fasiculus and parapotine retciular formation

75
Q

Brown Sequard features?

A

Ipsilateral Monoplegia or hemiplegia

Ipsilateral loss of vibration and proprioception

Contralateral loss of spinothalamic tract

76
Q

Cauda equina features?

A
  • Flaccid paralysis
  • loss of knee and ankle jerks
  • Saddle sensory loss
  • Down going plantars
77
Q

Causes of Demylinating peripheral neuropathy?

A
  • CIDP
  • MFNCB
  • Paraproteinaemic
  • POEMS
  • Amiodarone
  • HIV
  • Hepatitis
78
Q

Features of Limb Girdle dystrophy?

A
  • Inherited myopathy - young person
  • Scapula winging
  • Symmetrical proximal weaknness affecting proximal linmb girdles and face
  • Normal reflexes, tone, sensation
79
Q

Radial nerve in spiral groove?

A

Loss of

  • Extension of hand, fingers,
  • Supination
  • Sensation arm and hand

Clinical lists GI (7 decks)

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