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Flashcards in Interactive cases - neurology Deck (39)
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where can the lesion be in neurology?

- brain/ brainstem (cranial nerves)/ cerebellum (ataxia)
- spinal cord (paraparesis)
- nerve roots
- peripheral nerves
- NM junction


what are the different possible pathologies?

- vascular
- infection
- inflammation/AI
- toxic/metabolic
- tumour/malignancy
- hereditary/ congenital
- degenerative


what are the steps in the neurological exam?

- Inspection
- Tone
- Power
- Reflexes
- Coordination
- Sensation
- Gait
- Back


in general what are the UMN lesion signs?

- general inc activity
- less power
- inc tone (spasticity)
- inc reflexes


in general what the LMN lesion signs?

- general dec activity
- less power
- dec reflexes


what is Frank's sign?

- diagonal earlobe crease extending from tragus across the lobule to the rear edge of the auricle
- indivative of CV disease and diabetes


pt with diplopia and slurred speech/dyphasia. What could it be?

CN 3,4,6: diplopiaN 9,10,11: slurred speech, dysphagia
- unusual combo of cranial nerve involvement = pathology unlikely to be in brainsteam
- more likely to be NM problem (myasthenia gravis, botulism)


how do the MoA of myasthenia gravis and botulism differ?

MG: antibodies that block nicotinic ACh receptor
Botulism: inhibit release of ACh


what are coordination signs and what are they likely to indicate?

indicate cerebellar pathology
- ataxia
- nystagmus
- dysdiadochokinesia
- intention tremor
- slurred and scanning speech


what are the causes of cerebellar lesions?

- Vascular: bleed into cerebellar fossa
- Infective: TB, VZV, cerebellitis
- Inflammation: MS
- Tumour: primary or metastasis
- Toxic/metabolic: alcohol, phenytoin


what is the abnormal sensation distribution with the different anatomical areas?

- Cerebral cortex: hemisensory loss
- Spinal cord: at level e.g. umblicus
- Nerve roots (radiculopathy): dermatomes
- mononeuropathy: specific area
- polyneuropathy: glove and stocking


what is glove and stocking distribution?

lose feeling in whole hand


what are the causes of polyneuropathy?

- Infection: HIV
- Inflammation: vasculitis, CTD, inflammatory demyelinating neuropathy
- toxic/metabolic: drugs, alcohol, B12 def, diabetes, hypothyroidism, uraemia, amyloidosis
- Tumour/malignancy: paraneoplastic syndrome
- hereditary sensory motor neuropathy


what are the 2 possible causes of optic disc blurring?

- Papilledema: from raised ICP (not painful, does not cause blurred vision)
- Papillitis: associated with blurred vision. painful due to inflammation at head of CN2


what are signs characteristic of of MS?

- papillitis
- LMN signs
both signs of systemic demylination


what are the signs of papillitis/optic neuritis?

- blurred optic disc margins
- blurred vision
- pain on eye movement


what symptoms would you get with a lesion compression of the corticospinal tract?

- weakness
- inhibit the descending inhibitory tracts leading to brisk reflexes


what symptoms would you get with a lesion compression of the spinothalamic tract?

reduced sensation


what are the differential diagnoses for spastic paraparesis?

- Vascular: ant. spinal artery thrombosis
- Infectious: Pott's disease (TB of spine)
- Inflammation: transverse myelitis
- Toxic: sub acute combined degeneration of the cord (Vit B12 def)


what is the def of MS?

- 2 identifiable lesions
- lesions separated in time and space


what is meralgia paresthetica?

condition characterized by tingling, numbness, burning pain in outer part of thigh
peripheral nerve pathology


what is the treatment?

- reassure
- avoid tight clothes
- lose weight
- if persistent: gabapentin, carbamazepine


what is the sensory innervation of the hand?

C6 - thumb
C7 - middle finger
C8 - little finger


what is radiculopathy? what is it caused by?

- disease of nerve roots
- caused by compression due to disc herniation and spinal cord stenosis


what is Parkinson's disease?

disease of dopaminergic neurones and the substantia nigra
- tremor
- rigidity
- bradykinesia


what is Progressive Supranuclear Palsy?

- Parkinsonian features AND an up gaze abnormality


what is Lewy body dementia?

- Alzheimer's features
- parkinsonian features
- hallucinations


what are the differentials for confusion?

- Vascular e.g. SAH
- Infection e.g. meningitis
- Inflammation e.g. cerebral vasculitis
- Toxic/ metabolic e.g. hypoglycaemia, CO poisoning
- Tumour
- Post-ictal
- Dysphasia
- Dementia
- Depressibe pseudo-dementia


what is the AMTS score? what does it assess?

1. DOB
2. Age
3. Time
4. Year
5. Place
6. Recall
7. Recognise Dr name
8. Prime Minister
9. Second WW
10. count backwards from 20 to 1
Asses confusion level


what is GCS and what does it assess?

Eyes (4)
Verbal Response (5)
Motor Response (6)
asseses consciousness level