Examination - Neurological Flashcards
(35 cards)
What is the main differential of an abnormal gait with a flexed arm?
Hemiplegia
What are the 4 cardinal features of upper motor neurone hemiplegia?
- increased tone
- > 5 beats of clonus
- hypereflexia
- +ve Babinski reflex
What type of gait is seen in hemiplegia with a flexed arm and extended leg?
Circumductive
What signs indicate bulbar involvement of stroke?
CN9, 10, 11, 12
pseudobulbar - UMN - increased gag reflex and jaw jerk
bulbar - LMN - reduced gag reflex and jaw jerk
How is power graded?
0 = none 1 = flicker 2 = moves with gravity 3 = moves against gravity 4 = reduced power against resistance 5 = normal
How are strokes classified?
Bamford classification
- Total anterior circ stroke = hemiplegia, homonymous hemianopia, higher cortical dysfunction (unlikely to have in OSCE)
- Partial anterior circ stroke = 2 of the 3
- Lacunar circ stroke = hemimotor or hemisensory stroke only
- Posterior circ stroke
What is the main differential for an abnormal slow shuffling gait?
Parkinsonism
What are some of the signs of parkinsonism?
Bradykinesia Rigidity Shuffling gait Resting tremor pill-rolling Cogwheel rigidity Glabellar tap +ve (Parkinsons patients will blink repeatedly) - always ask permission Reduced arm swing
Features are usually worse on one side
Why would you want to measure the lying and standing BP in a patient with parkinsonism?
To rule out multisystem atropy
Why would you want to assess the eye movements in a patient with parkinsonism?
to rule out progressive supranuclear palsy
Why would you want to assess higher cognitive function in a patient with parkinsonism?
to rule out Lewy-Body dementia or Parkinsons dementia
What are the causes of parkinsonism?
- Idiopathic Parkinsons disease
- Multisystem atrophy - postural hypotension
- Progressive supranuclear palsy - palsy of vertical eye movements
- Lew-body dementia - dementia onset <12 months after parkinsonism
- Corticobasal degeneration - apraxia, acalculia, myoclonus
- Drug-induced - Hx of antipsychotics
How is Parkinsons disease treated?
Symptom control (do not alter disease progression)
- L-dopa
- Co-beneldopa -
- Pergolide
- Apomorphine
- Selegiline
- Entacapone
- Procyclidine
What is the main differential of an abnormal gait that is broad and unsteady with poor heel to toe balance?
Cerebellar syndrome
What are the features of cerebellar syndrome?
DANISH Dysdiadokinesis Ataxia Nystagmus Intention tremor Slurred speech Hypotonia
Where is the cerebellar lesion localised when there is truncal ataxia with minimal limb signs?
Cerebellar vermis
Where is the cerebellar lesion localised when there is ipsilateral limb signs with less truncal involvement?
Cerebellar hemisphere
What is the most likely cause of the cerebellar syndrome if the patient is younger, female with spasticity and internuclear opthalmoplegia?
Multiple sclerosis
What is the most likely cause of the cerebellar syndrome if the patient is older with atrial fibrillation, CABG scarring and tar staining?
Stroke
What is the most likely cause of the cerebellar syndrome if the patient has a comorbidity of chronic liver disease?
Alcoholism
What is the most likely cause of the cerebellar syndrome if the has coarse facial features and gingivial hypertrophy?
Phenytoin use
Where is the lesion that causes internuclear opthalmoplagia?
Medial longitudinal fasciculus - failure of conjugate gase so eyes do not move in synchrony
How does internuclear opthalmoplegia present on examination?
Ipsilateral failure of adduction and contralateral nystagmus when in abduction
How is multiple sclerosis treated?
Methylprednisolone to shorten the duration of acute attacks.
Baclofen for muscle spasm.
Disease modifiers [reduce the frequency and duration of flare-ups]: interferone-beta, galtriamer, alemtuzumab
