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Y3 Charis > Neuro - symptoms + signs > Flashcards

Neuro - symptoms + signs Flashcards

1
Q

Meningitis - symptoms + signs

A
  • Non-specific features
  • fever, headache, N+V, lethargy, irritability, muscle/joint pains, refusing food, respiratory symptoms
  • Stiff neck
  • Non-blanching/purpuric rash
  • Back ridgidity
  • Photophobia
  • Altered mental state
  • Kering’s sign - pain + resistance on passive knee extension with hips fully flexed
  • Brudzinski’s sign - hips flex on bending the head forward
  • Paresis, focal neurological defcits (incl cranial nerve involvement, abnormal pupils)
  • Seizures, LOC
  • Shock (tachy, hypotension, resp distress, poor urine output, increased cap refill time, altered mental state, leg pain, cold hands + feet, unusual colour)
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2
Q

Subdural haemorrhage signs and symptoms

A 
Fluctuating consciousness
Confusion
Personality changes
Symptoms of increased ICP
Can present as UMN signs (e.g. pronator drift)
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3
Q

Main difference between meningitis + encephalitis

A

In meningitis consciousness is not impaired where is in encephalitis it is usually always affected

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4
Q

Anterior cerebral artery stroke symptoms + signs

A

Contralateral hemiparesis lower limb>upper limb
Behavioural changes

https://doctorlib.info/anatomy/clinical-neuroanatomy-28/clinical-neuroanatomy-28.files/image227.jpg

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5
Q

Middle cerebral artery stroke symptoms + signs

A

Contralateral hemiparesis upper limb/face>lower limb
Contralateral hemisensory loss (makes sense because somatosensory cortex in the parietal lobe is affected)

Apraxia (bc parietal lobe is affected - involved in bringing together + combining information needed to perform skillfull actions)

Receptive/expressive aphasia (involvement of Wernicke’s + Broca’s areas)
Broca’s area - expressive aphasia, broken speech
Wernick’s area - receptive aphasia
(optic radiation contains tracts that carry information from the lateral geniculate nucleus to the primary visual cortex in 2 loops: Meyer’s + Baum’s)

Quadrantanopia
Superior optic radiation (Baum’s loop) - parietal lobe, causes contralateral inferior quadrantopoia
Inferior optic radiation (Meyer’s loop) - temporal lobe, causes contralateral superior quadrantopoia

Hemineglect (parietal lobe)
Facial weakness

https://doctorlib.info/anatomy/clinical-neuroanatomy-28/clinical-neuroanatomy-28.files/image227.jpg

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6
Q

Posterior cerebral artery stroke symptoms + signs

A

Contralateral homonymous hemianopia
(often damage to the occipital lobe/visual cortex leads to macular sparring - large macular representation, dual blood supply (PCA, MCA))

Visual agnosia (damage to the visual association cortex)

https://doctorlib.info/anatomy/clinical-neuroanatomy-28/clinical-neuroanatomy-28.files/image227.jpg

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7
Q

Brainstem damage in stroke

A

Reduction in consciousness
Cranial nerve pathology
IPSILATERAL SIGNS

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8
Q

Cerebellar stroke

A

DANISH

Dydiadochochenesia
Ataxia
Nystagmous
Intention tremor
Slurred speech
Hypotonia

IPSILAERAL SIGNS

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9
Q

Total anterior circulation stroke (TACS) vs Partial anterior circulation stroke (PACS)

A

Contralateral motor or sensory deficit
Homonymous hemianopoia
Higher cortical dysfunction (e.g. aphasia)

TACS - all 3 of them
PACS - any 2 of them

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10
Q

Posteror circulations stroke

A

Any of:
Isolated homonymous hemianopoia
Brainstem signs
Cerebellar ataxia

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11
Q

Lacunar stroke (LACS)

A

Any of
Pure motor deficit
Pure sensory deficit
Sensorimotor deficit

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12
Q

Cauda equina presentation

A

LMN symptoms (nerve roots affected and not the CNS so no UMN signs as in spinal cord compression)
Perianal anaesthesia
Bladder retention
leg weakness

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13
Q

Lacunar infarct affecting the

o Affecting the internal capsule/pons

A

Internal capsule - Pure motor, pure sensory, mixed motor + sensory signs

Pons - dizziness/vertigo, ataxia

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14
Q

Lacunar infarct affecting the

o Affecting the thalamus

A

loss of consciousness, hemisensory deficit

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15
Q

Lacunar infarct affecting the

o Affecting the basal ganglia

A

Dyskinesias

hemichorea, hemiballismus, parkinsonism

Intact cognition/consciousness

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16
Q

Lacunar infarct affecting the

o Multiple lacunar infarcts

A 
Vascular dementia
Urinary incontinence
Gait apraxia
Shuffling gait
Normal or excessive arm-swing
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17
Q

Normal pressure hydrocephalus signs - popular SBA

A

Hakim’s triad (weird walking water)

  • Urinary incontinence
  • Dementia
  • Gait disturbance (ataxia, shuffling)(also cognitive impairement, hyperreflexia)
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18
Q

Hydrocephalus symptoms + signs

Acute onset

A 
Papilledema
Headache
Vomiting
Impaired upward gaze
Sunset eyes
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19
Q

Hydrocephalus symptoms + signs

Gradual onset

A
  • Unsteady, slow, cautious gait
  • Unsteady gait (Levodopa-unresponsive gait apraxia (spasticity in legs))
  • Large head
  • Unilateral/bilateral 6th nerve palsy (2o to raised ICP)
  • Double vision
  • CN palsies
  • Cognitive impairement
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20
Q

Multiple sclerosis symptoms + signs MS

A 
CNS so UMN signs
Visual
- Blindness/hemianopoia
- Optic neuritis
- Scotoma
- Symmetrical HORIZONTAL jerking nystagmus
- LR weakness - may cause double vision
- Eye pain commonly exacerbated on eye movement as the inflamed optic nerve sheath is stretched
- INO (intranuclear ophthalmoplegia)

Face

  • Bell’s palsy
  • Trigeminal neuralgia
  • Paroxysmal dysarthria

Ears

  • Deafness
  • Unsteadiness

Autonomic system

  • Bladder - urgency, frequency, incontinence, impaired bladder emptying
  • Sexual problems - impotence
  • Loss of thermoregulation - excess sweating

Cognitive

  • Visual + auditory attention affected
  • Loss of memory

Perineum + genital numbness, altered sphincter function –> characteristic feature of MS

intention tremor, ataxia, dysmetria - cerebellar signs
Lhermitte’s sign = electric shock sensations
MS with cervical posterior column involvement
Sudden neck flexion causes electric-shock sensations to the limbs

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21
Q

Motor neurone disease symptoms MND

A

MND=ALS

  • UMN + LMN dysfunction

Oculomotor + sphincter functions spared!!

Limb onset more most common (usually upper limbs)

  • Pt drop objects, can’t manipulate objects with one hand
  • Wasting of intrinsic muscles
  • Fasciculations

Lower limb problems

  • Foot drop
  • Gait disorder
  • Difficulty rising from low chairs + climbing stairs (+ wasting, fasciculation, change in tone + reflexes unlike MG)

Progressive ASYMMETRICAL weakness of bulbar, limb, thoracic, abdominal muscles
Onset can also be bulbar (20%) - slurring of speech, emotional lability, dysphagia, wasting + fascisulation of tongue
Onset can rarely be respiratory - dyspnoea, orthropnoea, hypoventilation overnight (unrefreshing sleep, early morning headahces)

NO sensory involvement

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22
Q

Course of disease in myasthenia gravis

A

Starts in the eyes with weakness to the extrinsic ocular muscles and LPS

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23
Q

Myasthenis gravis symptoms

A
  • Muscle weakness that increases with exercise and improves with rest
  • Fatiguable muscles
  • Ptosis (but pupils are spared unlike in Horner’s syndrome where there is miosis)
  • Double vision
  • Oropharungeal/appendicular weakness
    Dysphagia, dysarthria
    Reading aloud may provoke dysarthria of nasal speech after 3 mins

Proximal limb weakness
- difficult in getting out of chairs, climbing stairs but no muscle wasting, no fasciculations, normal tone, normal reflexes, normal sensation unlike MND

  • SOB

NO sensory signs
Weakness is greater in proximal muscles (rather than distal as in GBS) + commonly involves spinal nerves

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24
Q

Median nerve damage symptoms

A
  • Wasting of the thenar muscles
  • Lack of ability to abduct + oppose the thumb
  • Weakness in forearm pronation + wrist + finger flexion
  • Sensory loss in thumb, index, middle finger + radial aspect of ring finger
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25
Q

Ataxic gait

what is it a sign of?
Where is it seen?

A

Cerebellar sign

Seen in Wernicke’s encephalopathy

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26
Q

Hemiplegic gait sign

A

Typically following a stroke

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27
Q

Shuffling gait sign

A

PD

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28
Q

Scissor gait sign

A 
Cerebral palsy
cord lesions (e.g. MS)

results from increased spasticity in both legs

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29
Q

Choreiform gait sign

A

Huntington’s

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30
Q

Wernicke’s encephalopathy triad

A
  • Ophtalmoplegia
  • Confusion
  • Ataxia
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31
Q

Wernicke’s encephalthy triad vs NPH triad vs encehalitis

A

Wernicke’s encephalopathy

  • Eye signs - ophthalmoplegia, nystagmus, diplopoia
  • Confusion
  • Ataxia (due to cerebellar damage)

NPH triad (Hakim’s triad)

  • Urinary incontinence
  • Dementia
  • Gait disturbance (ataxia, shuffling)

Encephalitis

  • Fever
  • Headache
  • Altered mental status
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32
Q

Basal skull fracture signs

A

haemotympanum
panda eyes
CSF leakage from ear or nose
Battle’s sign

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33
Q

Guillaine Barre syndrome symptoms GBS

A 
PNS so LMN signs
Weakness, paraesthesia and hyporeflexia 
Progresses acutely
SYMMETRICAL
I fasciculation
T flaccid tone
P ascending pattern of progressive SYMMETRICAL weakness starting at the lower extremities affects proximal before distal muscles
R hyporeflexia or absent
S neuropathic pain, back pain, sensory abnormalities usually mild

Autonomic symptoms - decreased sweating, decreased heat intolerance, tachycardia, HTN, postural hypotension, ileus, urinary retention
Face - Facial weakness - facial droop, facial nerve palsy, Dysphasia, dysarthria
Extra-ocular muscle weakness - Diplopoia
Bulbuar dysfunction causing oroharyngeal weakness - Dysphagia

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34
Q

Trigeminal neuralgia symptoms + signs

A
  • Paroxysms of Sudden, Unilateral, Stabbing/electric-shock like pain
  • Most common in 2nd + 3rd divisions of the trigeminal nerve
  • Does not interfere with sleep
  • Following an episode of pain there is a refractory phase of several minutes during which there will not be another paroxysm of pain even if the triggering stimulus recurs
  • Autonomic symptoms - lacrimation +/- redness of eye
  • Progressive increase in frequency, duration, severity of attacks
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35
Q

Encephalitis symptoms

A

o Meningism (photophobia, neck stiffness, headache)

Followed by:
o	Altered state of consciousness
o	Seizures
o	Personality changes
o	Cranial nerve palsies
o	Speech problems
o	Motor + sensory deficits 
o	Focal neurological signs  (hemianopia, aphasia, hemiparesis, ataxia, brisk tendon reflexes, babinski's signs, CN deficits) 
o	Increased ICP
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36
Q

Triad of encephalitis

A
  • Fever
  • Headache
  • Altered mental status
    Cognitive dysfunction
    Memory disturbances
    Psychiatric + behavioural manifestations
    (hallucinations, withdrawal apathy, personality changes)
37
Q

What do we mean by meningism?

A

o Photophobia
o Neck stiffness
o Headache

38
Q

BPPV symptoms + signs

A

• Vertigo
Sudden onset
Severe
Brief duration - <30s
Episodic
Rapid resolution if the head is kept still
Brief latent period 5s-20s between the provocative movement + the experience of vertigo

  • Specific provoking positions - looking up, bending down, getting up, turning head, rolling over in bed to one side
  • Symptoms worse in the mornings
  • Nausea, imbalance, light-headedness

• Positive Dix-Hallpike/Nylen-Barany manoeuvre – posterior canal BPPV
o Positive test – reproduction of vertigo + nystagmus
o Nystagmus
- Torsional – L ear has a clockwise torsional nystagmus response, R ear has an anti-clockwise response, horizontal nystagmus suggests horizonal canal BPPV
- Reversible with seating
- Fatigable with repeat testing
- Occurs with 1-5s latency
- Lasts <30s

• Positive supine lateral head turn – lateral canal BPPV
o Positive test – vertigo + nystagmus
o Horizontal nystagmus without torsional component
o When head is rotated towards the affected side the nystagmus will beat towards the ground (geotropic + be more intense)

  • Normal neurological examination
  • Normal otological examination
39
Q

Meniere’s triad

A 
- Vertigo   m to h
   N+V
   attacks tend to cluster in groups 
- Unilateral Hearing loss
- Unilateral Tinnitus

Not provoked by positional changes

40
Q

Meniere symptoms + signs

A

Triad

  • Vertigo m to h N+V attacks tend to cluster in groups
  • Unilateral Hearing loss
  • Unilateral Tinnitus
  • Unilateral aural fullness
  • Positive Romberg’s test
  • Fukunda’s stepping test
    o Turning towards the affected side when asked to march in place with eyes closed
41
Q

Type 1 neurofibromatosis symptoms + signs

NF

A
  • Painless mobile lumps under the skin (SC neurofibromatomas may be tender to touch + cause tingling in the distribution of the affected nerve)
  • Cafe au lait spots - back, buttocks, thighs
  • Lisch nodules on iris
  • Spinal scoliosis
  • RAS
  • Phaeochromocytomas
  • Large neurofibromas can develop in the abdominal cavity + press against nearby organs and impair their function (e.g. kidneys, constipation, abdominal pain)
  • Optic gliomas (15%) – visual acuity loss, abnormal colour vision, visual field loss [most common presentation is asymmetrical visual fields]
  • Disruption of bone maintenance and reduced bone mineral density – possibility of osteoporosis
  • Most common additional manifestations: LEARNING DISABILITIES, optic pathway gliomas, diffuse plexiform neurofibromas, dystrophic SCOLIOSIS, sphenoid wing dysplasia, renovascular hypertension, malignant nerve sheath tumours, SHORT STATURE
  • Also risk of seizures, bone dysplasia, Congenital heart disease (PS, HTN), Pheochromocytoma, RAS
42
Q

Type 2 neurofibromatosis symptoms + signs

A
  • BILATERAL acoustic neuromas (acoustic neuromas can occur in individuals that don’t have neurofibromatosis but in neurofibromatosis type II they tend to occur bilaterally) – tinnitus, gradual hearing loss on both sides, +/- loss of balance, facial weakness due to vestibular schwannomas –> SENSORINEURAL HEARING LOSS
  • Intracranial meningiomas
  • Spinal gliomas – pain, numbness, weakness (compression of the spinal cord)
  • Paraspinal schwannomas
  • Cataracts (Posterior subcapsular lenticular opacities)
  • Hamartomas in the retina
  • Absence of café-au-lait spots

symptomatic by age 20

43
Q

Huntington’s symptoms

A 
Chorea
Athetosis - writhing movements of hands, early in course of disease pt can mask involuntary movements by incorporating them into socially acceptable movements .e.g. twiddling thumbs
Ataxia
Loss of coordination + balance
Deficit in fine motor coordination 
Dysarthria, dysphagia

Cognitive decline
Impaired work or school performance
Personality changes - irritability, impulsativity, temper outbursts, loss of enthusiasm or involvement in previously engaging activities, self-neglect, depression
Dementia

44
Q

Parkinson’s disease cardinal features PD

A
  • Bradykinesia
  • Rigidity - Lead pipe, cogwheel rigidity
  • Postural instability - seen late, lack of ability to voluntarily adjust position in response to postural disturbance
  • Resting tremor - 3-4 hz, pill rolling, can be induced by concentration, absent with activity
45
Q

Parkinson’s disease symptoms PD

A
  • Tremor at rest (can be induced by concentration, absent with activity, Low frequency – 3-4 Hz, pill rolling)
  • Rigidity - Lead pipe, cogwheel rigidity
  • Bradykinesia
  • Postural instability - seen late, lack of ability to voluntarily adjust position in response to postural disturbance

5Ms

  • Hypomimic face/masked facies
  • Monotonous speech/hypophonia
  • Micrograpia
  • Misery - depression
  • Memory loss - dementia
  • Marche a petit pas*
  • Stooped posture
  • Shuffling gate
  • Difficulty rising from a sitting position + starting to walk
  • Small shuffling steps, unsteadiness on turning (taking several steps to turn), difficulty in stopping*

Neuropsychiatric: hallucinations, anxiety, confusion, stupor, impulsivity, depression, cognitive decline, dementia, paranoia, visuospatial dysfunction

Autonomic + Vegetative: bladder, bowel, hypotension, Impotence, dysarthria, dysphagia, drooling, rash, anosmia

Sleep: restless legs, REM sleep disorder, nightmares

46
Q

Parkinson’s disease signs

A

4 cardinal signs

  • Bradykinesia
  • Rigidity - Lead pipe, cogwheel rigidity
  • Postural instability - seen late, lack of ability to voluntarily adjust position in response to postural disturbance
  • Resting tremor - 3-4 hz, pill rolling, can be induced by concentration, absent with activity
  • Lack of arm swing when walking
47
Q

SAH symptoms

A
  • Thunderclap headache
    Peaks within 1-5mins
    Lasts more than 1h
  • N+V
  • Photophobia
  • Non focal neurological signs
  • Depressed/loss of consciousness or confusion – caused by blockage of the normal CSF circulation by blood in the subarachnoid space
  • Isolated pupillary dilation with loss of light reflex may indicate bran herniation as a result of rising intracranial pressure
  • if blood irritates the meninges - signs of meningismus present (neck stiffness, photophobia)
48
Q

Symmetrical or asymmetrical symptoms
MND
GBS

A

MND - asymmetrical

GBS - symmetrical

49
Q

Difference between

Vasovagal syncope
Arrhythmias
Strokes-Adam attack
Epilepsy

A

Vasovagal (reflex)

  • Precipitating factor
  • Sweating
  • Nausea
  • Pale
  • Dizzy
  • Narrowing of visual fields
  • May twitch + be incontinent
  • Seconds
  • Quick recovery on sitting

Arrhythmias (cardiac)

  • Chest pain
  • Palpitations
  • Seconds
  • Quick recovery on sitting
Strokes-Adam attack (cardiac - transient arrhythmias cause a drop in CO and LOC, underlying problem - complete heart block or sinoatrial disease)
- Pale
- Seconds
- Facial flush
(treatment is pacemaker)

Epilepsy

  • Aura or no warning
  • <3 mins
  • Tongue biting
  • Twitching
  • Incontinence
  • Slow recovery
  • Post-ictal Confusion/Headache/Myalgia
50
Q

Difference between an aura + a prodrome

A

Aura

  • part of the seizure
  • can last up to a few minutes
  • strange smells, flashing lights, deja vu etc
  • suggests that the epilepsy is focal

Prodrome

  • not part of the seizure
  • can last up to a few hours
  • change in the patient’s experience or mood
51
Q

What is Tood’s paresis?

A
  • Syndrome assosciated with weakness or paralysis of part/all the body
  • Happens after focal-onset seizure
52
Q

Focal seizure - Frontal lobe epilepsy symptoms + signs

A
  • Motor symptoms
  • Jacksonian march - muscular spasm spreads from distal part of the limb to a larger area of the body
  • Post-ictal flaccid weakness (Todd’s paralysis)
  • Disinhibition –> Involuntary actions
53
Q

Focal seizure - parietal lobe epilepsy

A

Sensory disturbances (pain, tingling, numbness)

54
Q

Focal seizures - occipital lobe epilepsy

A

Visual disturbances (spots, lines, flashes)

55
Q

Focal seizures - temporal lobe epilepsy

A
  • Aura (epigastric discomfort)
  • Automatisms (playing with fingers, lip smacking)
  • Hallucinations
  • Olfactory hallucinations

also called complex partial seizures

56
Q

Exertional syncope sign of

A

AS, HOCM

HOCM - L ventricular outflow obstruction due to asymmetrical septal hypertrophy - occludes the outflow tract during systole

57
Q

What is the Miller-Fischer syndrome and what are the signs and symptoms?

A

Variant of GBS

Triad of

  • Ophthalmoplegia
  • Areflexia
  • Ataxia

but no muscle weakness

58
Q

Brown sequard syndrome

What is it

describe the symptoms

A

Occurs when the spinal cord is injured on one side much more than the other

Lateral corticospinal tract crosses over in the medulla (motor)
Dorsal columns cross over in the medulla (sensation, vibration, proprioception)
Spinothalamic tract crosses over in the spinal cord (pain+temperature)

Therefore

  • Ipsilateral loss of motor function, sensation, vibration, proprioception
  • Contralateral loss of pain + temperature
59
Q

Crossing + function of

Lateral corticospinal tract
Anterior corticospinal tract
Dorsal columns cross
Spinothalamic tract crosses

A

Lateral corticospinal tract crosses over in the medulla (motor to distal digits, limbs)
Anterior corticospinal tract crosses over in the spinal cord
(motor to proximal muscles of the trunk)
Dorsal columns cross over in the medulla (sensation, vibration, proprioception)
Spinothalamic tract crosses over in the spinal cord (pain+temperature)

60
Q

Difference and similarities between spinal cord compression + cauda equina syndrome

A

Spinal cord compression

  • LMN at lesion
  • UMN below lesion
  • Leg weakness
  • Urinary incontinence retention
  • Sensory level
  • In acute injury there may initially be LMN signs

Cauda equina sydrome

  • LMN
  • Perianal anaesthesia
  • Leg weakness
  • Bladder retention
61
Q

Radiculopathy symptoms + signs

A

• Motor
o LMN symptoms for the muscles innervated by this spinal root

• Sensory
o Dermatomal pattern
o Pain, numbness

62
Q

Spinal cord compression symptoms + signs

A
  • Acute onset – trauma
  • Chronic onset – osteoporosis, tumours

• Motor
o Limb weakness (hemiplegia/paraplegia)
o LMN symptoms at the level of the lesion
o UMN symptoms below the level of the lesion

• Sensory
o Sensory loss below a specific level
o Back pain

• Autonomic
o Constipation
o Urinary incontinence/retention
o Erectile dysfunction

63
Q

Cauda equina symptoms

A
  • LMN symptoms
  • Perianal anaesthesia
  • Bladder retention
  • Leg weakness
64
Q

Cushing’s reflex/triad

What is it sign of?

A

Bradycardia
HTN
Irregular breathing

Sign of increased ICP

65
Q

Mononuclear visual loss

A

optic nerve lesion

66
Q

Homonymous hemianopoia

A

Lesion in the occipital lobe

67
Q

Bitemporatal hemianopoia

A

Lesion in the optic chiasm

68
Q

Fatiguability - where is the lesion

A

NMJ

69
Q

Syringomyelia symptoms + signs

A

o Syrinx starts in cervical cord
o Spinothalamic tract is affected – bilateral loss of pain + temperature along the back and arms
o Dorsal roots not affected – vibration, proprioception, fine touch not affected
o LMN signs at the level of the syrinx (arms)
o UMN below the syrinx (legs)
o Paralysis, weakness
o MRI spine
o If fluid cavity is in the brainstem – syringobulia  vocal cord paralysis, ipsilateral tongue wasting, trigeminal sensory loss

70
Q

What is weird about myoclonic seizures?

A

o Pt often remains conscious + alert throughout

brief shock like jerk of a muscle or muslce groups

71
Q

Complex partial seizures also called temporal lobe epilepsy describe

A

Focal seizures

  • Impairement of consciousness
  • Patient may still be awake
  • Aura (epigastric discomfort)
  • Automatisms (playing with fingers, lip smacking)
  • Hallucinations
  • Olfactory hallucinations
  • Abnormal posture may be adopted due to dystonia
  • Patient doesn’t remember the events after the attack
  • often derived from temporal lobes
72
Q

What are Jacksonian seizures?

A

Focal motor seizure
Simple partial seizure spreads from the distal part of the limb to the rest of the ipsilateral side of the body

Can lead to paralysis of involved limbs for several hours

Subtype of SPS (simple partial seizure)
Electrical activity causes a tingling sensation to march across a region of the body from one group of distal muscles to the other
This is often accompanied by automatisms, muscle cramping, hallucinations, head turning

73
Q

Spinal stenosis symptoms + signs

A

Spinal stenosis
Pain relieved when sitting/leaning forwards
Caused by narrowing of the spinal canal due to spondylosis

Presents with: a)back pain + b) sciatica

Pain worse when spine is extended  going downhill, walking
Pain better when spine is flexed  going uphill, sitting

74
Q

Lateral medullary syndrome symptoms + signs

A
  • Ipsilateral sensory deficits of the face + CN
  • Contralateral sensory deficits of the trunk + the extremities
  • Sudden onset vomiting + vertigo
  • Diminished gag reflex
  • Palatal paralysis
  • Nystagmus
  • Horner’s syndrome
  • Broad based ataxic gait

Caused by occlusion of the posterior inferior cerebelar artery

75
Q

How does a head injury present?

A

Agitation
Headaches
Vomiting
Dizziness

76
Q

Which is most commonly affected in MS?

cone cells
or
rod cells

A

Cone cells (colour vision + high acuity central vision) – myelinated, therefore more commonly affected

Rod cells (dark vision + peripheral vision) – non-myelinated, less commonly affected

77
Q

Difference between

Essential tremor/familial tremor
PD tremor
Cerebellar tremor

A

Essential tremor/familial tremor
Absent at rest
Appear on action
6-12 Hz
Fine amplitude
May be ameliorated by alcohol or beta blockers
No other parkinsonian symptoms are present

PD tremor
Present at rest, exacerbated by concentration
Disappear on action
3-7 Hz
Coarse amplitude
Commonly affects the distal limbs asymmetrically

Cerebellar tremor
Increases in magnitude throughout the movement to be maximal on approaching the target
4-6 Hz
Associated with other cerebellar signs (DANISH)

78
Q

cavernous sinus pathology

A

complete ophthalmoplegia of the affected side + loss of forehead sensation on the affected side

The cavernous sinuses of either side communicate with one another - thrombosis + fistula formation can cause symptoms on the other side as well

79
Q

Damage in

Wernicke’s area
Broca’s area

A

Wernicke’s area – inability to understand language, able to produce fluent, non-sensical speech [Temporal lobe]
Broca’s area – ability to understand language, inability to produce fluent speech (broken speech) [Frontal lobe]

80
Q

Central pontine myelinolysis is a result of….

signs + symptoms

A

Raising the Na too quickly in a hyponatraemic patient
Damage to the myelin sheath of the neurones that make up the pons

Acute paralysis, dysarthria, dysphagia

81
Q

Lumbar spinal stenosis

what makes it worse
what makes it better

A

pain in the lower limbs
Worse when walking/standing for long periods of time
Eased by bending forwards to widen the spinal canal

82
Q

stroke affects _____ side of face

brainstem lesions affect _______ side of face

A

stroke affects contralateral side of face

brainstem lesions affect ipsilateral side of face

83
Q

How do you elicit Hoffman’s sign and what does it represent?

A

Positive Hoffman’s sign

Flick the distal phalanx of the middle finger - thumb contracts
This indicates an UMN lesion

84
Q

Cerebellar problem vs proprioceptive problem

A

Cerebellar problem - patients can’t stand with their feet together even if their eyes are open

Proprioceptive loss - patients can stand with their feet together if they have their eyes open but lose their balance once they close their eyes (positive Romberg’s test)

85
Q

What does the Romberg’s test test?

A

Proprioception

86
Q

Ventricular septal defect VSD symptoms + signs

A

Pansystolic murmur
Cyanosis
Clubbing
Raised JVP often occurs

87
Q

Haemorrhagic stroke presents…

A

Suddenly with a thunderclap headache

88
Q

Lacunar strokes can present with

A

Unilateral motor disturbance affecting the face, arm or leg or all 3
Complete one sided sensory loss
Ataxia hemiparesis

Y3 Charis (35 decks)

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