Flashcards in General Neuro Deck (45):
What does hemiballismus mean?
Wild flinging limb movements due to lesion in sub thalamic nucleus- typically due to infarction
What nerves traverses the cavernous sinus?
Cranial nerve 3, 4, v1, v2, and 6
What fibers cause itch
What are four causes of autonomic dysfunction?
Diabetes, Parkinson's disease, multiple system atrophy, amyloidosis
What space does an acoustic neuroma occupy?
Cerebellar pontine angle so can also involve a 7th nerve palsy
How do you assess muscle weakness from 1-5?
5= full motor power
4= patient is able to lift limb up against gravity and against resistant
3= patient is able to lift limb up against gravity but not against resistance.
2= patient is unable to lift limb up against gravity but can still move the limb
1= no movement of the limb at all. `
Pathology in what 4 structures can cause dysmetria?
1. Sensory cortex, 2. thalamus, 3. cerebellum, 4. cervical spine
what can cause a positive romberg test?
1. vitamin B12 deficiency
2.neurosyphillis or other pathologies affecting the dorsal column
3. peripheral neurpathy
5. Fredriech ataxia
4 signs of Horner's syndrome
1. Unilateral constricted pupil
2. Decreased sweating on the same side
3. Partial ptosis
4. Subtle enopthalmas
what is the Hallpike's manoeuvre?
For BPPV. Rotate the patient’s head 45 degree to the side of the troubling ear then quickly get the patient to lie down on the bed with their head hanging off the bed. Ask them to keep their eyes open and look for nystagmus. If nystagmus is present- then BPPV is diagnosed. Generally the patient would not already have nystagmus before the manoeurve
what are the two types of nystagmus?
central and peripheral
what does it mean by 'beating' in nystagmus?
beating refers to the 'quick' phase in nystagmus. There is always are quick and a slow phase. if the eye beats up when the examiner asks the patient to look up, then it's called an upbeat nystagmus. The slow lag phase however is the pathological part of the process.
what is characteristic of lateral medullary syndrome, aka wallenberg syndrome? what causes the symptoms?
There is a loss of pain and temperature sensation on the contralateral (opposite) side of the body and ipsilateral (same) side of the face. This crossed finding is diagnostic for the syndrome. DUE to PICA infarction
What do you think when you see a patient with constricted pupils?
Sympathetic overdrive + opioids
Characteristics of Argyll Robertson pupils?
constricted pupils that do not respond to light (pupil reaction) but responds to accommodation. Associated with neurosyphilis, MS
what can cause horner's syndrome?
• Cerebral infarction
• Lateral medullary syndrome
• Brainstem lesion
• Apical lung tumour or TB Pancoast's tumour
• Brachial plexus trauma
• Following laryngeal/thyroid surgery
• Cluster headaches
• Carotid dissection
A stroke patient comes in with unilateral widespread hemiparesis. Where do you think is the infarct?
Internal capsule. So not cortical or brainstem
what are the 4 causes of seizures you need to exclude from an alcoholic?
1. hypoglycaemia (reduced gluconeogenesis due to end stage liver disease)
2. electrolyte disturbances
3. Subdural post head trauma
4. alcohol withdrawal
what are the 10 consequences of alcoholism?
1. Liver cirrhosis --> portal hypertension
2. Korsakoff's psychosis
4. Cerebellar ataxia
7. Cardiac myopathy (alcohol induced)
8. peripheral neuropathy
9. proximal myopathy
10. psychosocial aspect (crime, drink driving etc)
how do we distinguish a traumatic LP from a SAH LP?
traumatic LP refers to damage of some blood vessels when doing the LP leading to blood in the CSF. The blood is usually in the first vial of CSF. In SAH, the last vial will still contain blood
The spinal cord can be compressed by what type of lesions?
Extradural, intramedullary or intradural
what are the 5 most common pathological causes of spinal cord compression? *think categories
tumour, degeneration, infection, haematoma and developmental problems
what are the most common conditions of spinal cord compressions
extradural compression by tumour
intradural meningioma or schwannoma
intramedullary compression by astrocytoma
Clinical signs of cervical myelopathy
Lower motor neuron signs in upper limbs
UMN spastic paraparesis in lower limbs
in an older person, what causes cervical myelopathy?
degenerative canal stenosis
when might we consider doing surgery for cervical myelopathy?
when the patient presents with neurological symptoms such as sciatica or neurological claudication. So for moderate or severe disease
what direction is the surgery for a laminectomy
what direction is the surgery for a disectomy?
what are some clinical characteristics of the pain associated with spinal cord compression?
diffuse, dull burning pain
girdle pain radiating around chest wall
what causes spinal canal stenosis?
hypertrophy of facets and ligamentum flavum, disc prolapse
what do you think when the radiologist says- an 'intradural, extra medullary, well defined lesion on the spinal cord?
schwannoma, dermoid cyst or metastases
what are the 2 main underlying pathologies of trigeminal neuralgia
1. Compression (usually by an aberrant loop of superior cerebellar artery)
2. Demyelination (esp if the patient has MS)
what do we mean by myelopathy? what do we usually see with myelopathies?
disorder of the spinal cord. UMN signs like increased tone, hyperreflexia, weakness, +/- sensory signs
Describe meniere's disease
Sudden onset vertigo, hearing loss, tinnitus, sensation of fullness in the ear.
what is tumarkin otolithic crisis?
Associated with Meniere's disease:
-Patient feels like they are going to fall as the world appears tilted. They try to regain balance and this causes them to fall. No LOC but can involve headstrike
presentation of tranverse myelitis?
subacute paraparesis with a sensory level, accompanied by severe pain in the neck or back at the onset.
what is the outcome of tranverse myelitis?
May progress to MS
May recover completely
May have lasting deficit
what is tranverse myelitis?
acute monophasic demyelination of the spinal cord
what is NMO? what is it due to?
neuromylitis optica aka Devic's disease
transverse myelitis + optic neuritis
antibody to aquaporin 4
what is another name for acoustic neuroma
what is the inheritance pattern for neurofibromatosis 1 and 2
what are some signs and symptoms of NF1?
Café au lait spots
Freckles in groin region
Lisch nodules in the eye
what is a hallmark diagnostic feature of NF2
bilateral acoustic neuromas
what is the difference between hepatic encephalopathy and wernicke's encephalopathy?
and how are they treated?
Hepatic- due to too much ammonium circulating in the bloodstream --> treated with lactulose
Wernicke's - due to thiamine deficiency --> treated with thiamine