Neurology

Question 1

Describe the features of a common peroneal nerve lesion

Answer 1

High stepping gait
Normal Tone
Wasting of anterior tibialis
Weakness of dorsiflexion, eversion and EHL
Sensory loss lateral lower leg
Preserved reflexes

Question 2

What problem do the following findings suggest?
Normal Tone
Wasting of anterior tibialis
Weakness of dorsiflexion, eversion and EHL
Sensory loss lateral lower leg
Preserved reflexes

Answer 2

Common peroneal nerve palsy

Question 3

Describe the features of an L4/5 root or plexus lesion

Answer 3

Normal tone
Weakness of dorsiflexion, inversion and eversion
Normal reflexes
May also be weakness of hip abduction

Question 4

What problem do these findings suggest?
Normal tone
Weakness of dorsiflexion, inversion and eversion
Normal reflexes
May also be weakness of hip abduction

Answer 4

L4/5 root or plexus lesion

Question 5

What are the possible causes of an L4/5 root or plexus lesion?

Answer 5

Prolapsed intervertebral disc
Cauda equina tumour
Obstetric injury to the lumbosacral trunk

Question 6

List the muscles, peripheral nerves and nerve roots for the following movements:
1) ankle dorsiflexion

Answer 6

L4/5
Tibialis anterior
Common peroneal nerve

Question 7

List the muscles, peripheral nerves and nerve roots for the following movements:
2) hip flexion

Answer 7

L1/2
Iliopsoas
femoral

Question 8

List the muscles, peripheral nerves and nerve roots for the following movements:
3) ankle inversion

Answer 8

L5/S1
Tibialis posterior
sciatic

Question 9

List the muscles, peripheral nerves and nerve roots for the following movements:
4) Knee extension

Answer 9

L3/4
quads
femoral

Question 10

List the muscles, peripheral nerves and nerve roots for the following movements:

5) Hip extension

Answer 10

L5/S1
Gluteus maximus
Inferior gluteal

Question 11

List the muscles, peripheral nerves and nerve roots for the following movements:

6) Plantar flexion

Answer 11

S1/S2
gastrocnemius
Sciatic

Question 12

List the muscles, peripheral nerves and nerve roots for the following movements:

7) knee flexion

Answer 12

L5/S1
Hamstrings, biceps femoris
sciatic

Question 13

List the muscles, peripheral nerves and nerve roots for the following movements:

8) Hip abduction

Answer 13

L4/L5/S1
gluteus medius
superior gluteal nerve

Question 14

List the muscles, peripheral nerves and nerve roots for the following movements:

9) Ankle eversion

Answer 14

L5/S1
Peroneus longus, brevis
Common peroneal

Question 15

List the muscles, peripheral nerves and nerve roots for the following movements:
10) Hip adduction

Answer 15

L2-4
Adductor longus
Obturator nerve

Question 16

What is suggested by:

• bilateral distal weakness of legs
• Areflexia
• Glove and stocking sensory loss

Answer 16

Peripheral neuropathy

Question 17

What is suggested by:

• loss of ankle reflex
• extensive sensory loss lower limbs
• possible weakness of the hamstrings

Answer 17

Sciatic nerve lesion

Question 18

What clinical findings would you expect in a peripheral neuropathy?

Answer 18

• bilateral distal leg weakness
• glove and stocking distribution sensory loss
• Areflexia

Question 19

What are the possible causes of a sciatic nerve lesion?

Answer 19

Trauma, tumour, vasculitis or pressure

Question 20

What would you expect to find in a sciatic nerve lesion?

Answer 20

Extensive lower limb sensory loss (mainly posterior)
Loss of S1/2
Depending on the site, weakness of the hamstrings

Question 21

What would you expect to find in a L5/S1/S2 root or plexus lesion?

Answer 21

Loss of ankle reflex
weakness of foot movements with normal knee/hip
saddle anaesthesia
No anal wink
Urinary incontinence

Question 22

What would weakness of foot movements, wasting, fasciculations, hyper reflexia and normal sensation make you consider?

Answer 22

Anterior horn cell disease due to MND

Question 23

What would be the possible causes of isolated weakness of all foot movements but normal knee and hip power?

Answer 23

1) Peripheral neuropathy
2) Sciatic nerve lesion
3) L5/S1/S2 root or plexus problem
4) Anterior horn cell disease due to MND

Question 24

How do you work out the cause of a Horner’s syndrome clinically?

Answer 24

• If absent corneal reflex: orbital or retro-orbital lesion
• Lack of sensation over ipsilateral face and contralateral arm, hoarse voice: brain stem infarct/lateral medullary syndrome
• ipsilateral arm weakness/hyporeflexia: brachial plexus avulsion or pan coast’s tumour

Question 25

what are the causes of a 3rd nerve palsy?

Answer 25

Central causes:
- stroke or haemorrhage involving in the ipsilateral midbrain at the level of the superior colliculus
- meningitis
- demyelination
Peripheral causes:
- Compression of the oculomotor nerve via a tumour
- Aneurysm of the post communicating artery
- ischaemia or infarction of the oculomotor nerve

Question 26

What is a bulbar palsy?

Answer 26

LMN lesion of 9, 10, 11 and 12 at the medullary bulb.

Tongue is wasted with fasciculations, nasal speech

Question 27

what are the causes of a bulbar palsy?

Answer 27

MND, myasthenia gravis, GBS, syringobulbia, neurosyphilis, neurosarcoidosis, poliomyelitis

Question 28

What is and what are the causes of a pseudo bulbar palsy?

Answer 28

UMN lesion of cranial nerves 9, 10, 11 and 12
Stiff and slow tongue, brisk jaw jerk, hot potato speech
Causes: CVA (bilateral internal capsular lesions), MS, MND, PSP, brainstem lesions