Flashcards in Interactive cases - neurology Deck (39)
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?
- hereditary/ congenital
what are the steps in the neurological exam?
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
- 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?
- 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?
- inhibit the descending inhibitory tracts leading to brisk reflexes
what symptoms would you get with a lesion compression of the spinothalamic tract?
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?
- 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
what is Progressive Supranuclear Palsy?
- Parkinsonian features AND an up gaze abnormality
what is Lewy body dementia?
- Alzheimer's features
- parkinsonian features
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
- Depressibe pseudo-dementia
what is the AMTS score? what does it assess?
7. Recognise Dr name
8. Prime Minister
9. Second WW
10. count backwards from 20 to 1
Asses confusion level