Clinical

Question 1

Upper motor neuron problem key symptoms

Answer 1

Weakness
Increased tone and reflexes
1/2 body affected or spinal cord motor level
Extensor plantar response

Question 2

Lower motor neuron problem

Answer 2

Weakness
Decreased tone and reflexes
Nerve root or peripheral nerve distribution
Flexor plantar response

Question 3

Mononeuropathy

Answer 3

Due to a lesion in an individual peripheral nerve
Sensory loss in skin within the nerve’s distribution
Weakness in the muscles innervated by the peripheral nerve

Question 4

Example of mononeuropathy

Answer 4

Carpal tunnel syndrome

Question 5

Mononeuritis multiplex

Answer 5

Disease of multiple separate peripheral nerves

Question 6

Peripheral polyneuropathies

Answer 6

Due to disease of peripheral nerves
Can have motor and sensory involvement, or motor or sensory involvement alone
Generally insidious onset

Question 7

Radiculopathy

Answer 7

Lesion in a single nerve root
Sensory loss in the skin supplied by that nerve root
Weakness in muscles and loss of reflexes supplied by that nerve root

Question 8

Anterior spinal cord injury

Answer 8

Spares posterior columns

Loss of spinothalamic sensation

Question 9

Central spinal cord injury

Answer 9

Spares posterior columns and maybe power

Central canal can expand, leading to a profound loss of pain sensation

Question 10

Hemicord injury

Answer 10

Different modalities on each side, lose pinprick sensation on one side and vibration and strength on the other

Question 11

Multiple sclerosis

Answer 11

Autoimmune disorder of the central nervous system including spinal cord, white matter tracts in the brain and the optic nerve
Subacute onset
Disease of oligodendrocytes leading to loss of myelin sheath

Question 12

Cerebellar function

Answer 12

Coordination of motor system to allow precision motor movements
Coordination of motor response to allow accurate timing of coordinated movements

Question 13

Cerebellar afferents

Answer 13

From spinal cord, vestibular nuclei via inferior olivary nucleus and pontine nuclei

Question 14

Cerebellar efferents

Answer 14

To upper motor neurons via thalamus and lower motor neurons via vestibular nuclei, reticular formation and red nuclei

Question 15

Ataxia

Answer 15

Uncoordinated movement

Can be limbs, orobuccal (speech/swallowing), truncal or gait related

Question 16

Cerebellar disease associated symptoms

Answer 16

Visual symptoms
Vertigo
Nausea and vomiting
Nystagmus
Dysarthria
Limb ataxia

Question 17

Intention tremor

Answer 17

Shaking before a movement is commenced

Question 18

Dysmetria

Answer 18

Past pointing

Question 19

Truncal and gait ataxia

Answer 19

Broad based gait, swaying to either side, irregular steps, exaggerated, heel-toe walking

Question 20

Cardinal clinical features of Parkinson’s

Answer 20

Rest tremor
Bradykinesia
Rigidity
Postural abnormalities

Question 21

Diagnosis of Parkinson’s

Answer 21

Tw or more cardinal features
Progressive course
Response to Levodopa
No alternative cause for the patient’s symptoms

Question 22

Lewy bodies

Answer 22

Aggregates of alpha-synuclein in substantia nigra causing degeneration of dopaminergic neurons

Question 23

Key characteristics of Parkinson’s

Answer 23

Asymmetrical
Insidious onset
Decrement of movements
Arrest of movement

Question 24

Honeymoon response

Answer 24

6–8 years of Levodopa treatment in Parkinson’s due to cells still being able to respond. After this length of time, these cells die and can’t regenerate.

Question 25

Alpha-synucleinopathies

Answer 25

Parkinson's Dementia with Lewy bodies Multiple systems atrophy

Question 26

Surgical treatment of Parkinson's

Answer 26

``` Stereotactic thalalotomy (for tremor) Stereotactic pallidotomy Transplantation of dopamine-producing tissue Deep brain stimulation ```

Question 27

Late complications of Parkinson's

Answer 27

Cognitive abnormalities Emotional disturbances Postural hypotension Fluctuations