Flashcards in DPD: Amir Sam Neuro cases Deck (30)
Which sites may a lesion causing a neurological pathology be found?
What may cause neurological pathology broadly speaking?
State what would be affected by pathology of each of the cranial nerves
I: sense of smell
II: VA, VF, pupils, fundoscopy
III, IV, VI: diplopia
V: sensation, corneal reflex
VII: facial palsy
IX, X: Speech, swallowing
XI: Sternocleidomastoid, trapezius
XII: tongue movements
Describe the tone, power and reflexes seen in upper motor neurone lesions
Tone: Increased (spasticity)
Reflexes: Increased (brisk), upgoing plantar
Describe the tone, power and reflexes seen in lower motor neurone lesions
Tone: Decreased (flaccid)
List 3 examples of UMN conditions
Using the acronym, list the cerebellar signs
Slurred/ staccato speech
How would you locate the lesion based on the distribution of abnormal sensation?
Cerebral cortex: Hemisensory loss
Spinal cord: reduced up to certain Level
Nerve roots (Radiculopathy): Dermatome
Mononeuropathy: Specific area
Polyneuropathy: Glove + stocking
Considering the broad causes of pathology, what can cause peripheral neuropathy?
Inflammation/ AI: Vasculitis, CTD, inflammatory demyelinating neuropathy
Toxic/ Metabolic: DM, Alcohol, B12 deficiency
Tumour/ Malignancy: Paraneoplastic feature
Give 3 features of papillitis (optic neuritis at head of optic nerve)
Blurred optic disc margins
Pain on eye movement
What features are suggestive of MS?
Separated in time + space
Give 4 differentials for apparent confusion and decreased AMTS
Post-ictal (post seizure)
Depressive pseudo dementia
Describe the GCS
4 = Spontaneous
3 = Opens in response to voice
2 = Opens in response to painful stimuli
1 = Does not open
5 = Oriented
4 = Confused
3 = Words
2 = Sounds
1 = No sounds
6 = Obeys commands
5 = Localizes pain
4 = Withdraws to painful stimuli
3 = Abnormal flexion
2 = Extension
1 = No movements
List the 10 components of AMTS
Recall (West Register Street)
Recognize doctor + nurse
Date of 2nd WW
Count backwards from 20 to 1
Give 3 signs of meningitis
Give 4 signs of a migraine
What indicates SAH? What should yo do?
Sudden onset headache
What makes you suspect GCA as cause of headache? What measurement may be found? What should you do?
Urgent steroids e.g. prednisolone
How do you manage a patient presenting with stroke within 4.5 hours of onset?
If no haemorrhage- Thrombolysis
How do you manage a patient presenting with stroke after 4.5 hours of onset?
CT head (exclude haemorrhage)
Aspirin (300mg, swallow assessment)
Maintain hydration, oxygenation
How do you manage a patient presenting with TIA?
Don't treat BP acutely (unless >220/120)
Risk factor modification
In the context of reduced pinprick sensation what may Duloxetine be used to treat?
Peripheral neuropathy in diabetics
What is Meralgia paraesthetica? What are the symptoms of this?
Compression of lateral femoral cutaneous nerve
Pain + parasthesia on anterolateral thigh
How is Meralgia paraesthetica treated?
Avoid tight garments
If persistent: Carbamazepine or Gabapentin
List 5 risk factors for Meralgia paraesthetica
What symptom would arise from lumbosacral nerve root compression? What is this also known as?
Pain in the buttock radiating down the leg to below the knee
Give 2 causes of lumbosacral nerve root compression
Spinal canal stenosis
Give 6 differentials for confusion and decreased consciousness
Toxic/ Metabolic: Drugs, LFTs, Vit déficiences, Endocrinopathies
What 4 differentials must be excluded for headache presentation in the ED?
Meningitis: Neck stiffness, Kernig's
SAH: Sudden onset
GCA: High ESR, >50
Migraine: Throbbing, photophobia