Limb weakness (oxford clin cases)

Question 1

What pathology does acute (sudden onset) limb weakness indicate?

Answer 1

Trauma or vascular problems (eg stroke/TIA)

Question 2

What pathology does subacute (hours to days) limb weakness indicate?

Answer 2

Multiple sclerosis
Guillian barre syndrome
Slowing expanding haematoma

Question 3

What pathology does chronic (weeks to months) limb weakness indicate?

Answer 3

Slow growing tumour

Progressive degeneration eg motor neurone disease

Question 4

What are common causes of sudden onset limb weakness that originate in the brain?

Answer 4

Ischaemic stroke
TIA
Haemorrhagic stroke
Hypoglycaemia

Question 5

What are common causes of sudden onset limb weakness that originate in the spinal chord?

Answer 5

Spinal disc prolapse

Spinal cord infarction

Question 6

What are common causes of sudden onset limb weakness that originate in the peripheral nerve?

Answer 6

Peripheral nerve ischaemia

Question 7

What are common causes of subactute onset limb weakness that originate in the brain?

Answer 7

Multiple sclerosis
Haematoma
Tumor

Question 8

What are common causes of subactute onset limb weakness that originate in the spinal chord?

Answer 8

Multiple sclerosis

Tumor

Question 9

What are common causes of gradual onset limb weakness that originate in the muscle?

Answer 9

Myasthenia gravis

Question 10

If someone has limb weakness, what other symptoms will make you think its a problem in the brain rather than in the spine or peripheral nervous system?

Answer 10

Deficits in speech or vision

Question 11

If someone has speech deficit/visual problems alongside limb weakness where is the problem most likely to be?

Answer 11

Brain

Question 12

What type of headache will a stroke/TIA present with?

Answer 12

It is unlikely there will be headache

Question 13

What does a unilateral headache preceding the limb weakness indicate?

Answer 13

Hemiplegic migraine

Question 14

What does a gradual onset headache preceding limb weakness indicate?

Answer 14

Intercranial mass (slowing expanding haemorrhage?)

Question 15

What symptoms are not typical of stroke and would make you think something else is going on?

Answer 15

Seizure
Loss of conciousness
Headache

Question 16

What are the 3 main risk factors for stroke?

Answer 16

Previous stroke or TIA
Atrial fibrillation
Atherosclerotic risk factos (hyperlipidaemia, smoking, diabetes mellitus, hypertension, smoking, family hx)

Question 17

If a patient is ignoring half of their sensory world where should you suspect there may be a lesion?

Answer 17

Parietal lobe

Question 18

If there is complete blindness in one eye where does this suggest there may be a lesion?

Answer 18

Optic nerve

Question 19

If there is homonymous hemianopia where might there be a lesion?

Answer 19

Between the optic chiasm and visual cortex

Question 20

What is homonymous hemianopia?

Answer 20

Loss of visual field in the same regions in both eyes

Question 21

Where is there likely to be a lesion if the eye deviated away from the lesion?

Answer 21

Cortex

Question 22

Where is there likely to be a lesion if the eye deviated towards the lesion?

Answer 22

Brain stem

Question 23

Where will an infarction in the spinal column spare the dorsal column?

Answer 23

An anterior infarction

Question 24

What lesion does parasthesia or loss of sensory modality in the limb indicate?

Answer 24

Peripheral lesion or nerve root lesion

Question 25

What sensory modalities is the spinothalamic tract responsible for?

Answer 25

Pain and temperature

Question 26

What sensory modalities is the dorsal column responsible for?

Answer 26

Light touch Vibration Proprioception

Question 27

What region of the motor cortex is associated with the lower limb?

Answer 27

The most medial part

Question 28

What region of the motor cortex is associated with the upper limb?

Answer 28

More medial aspects

Question 29

What is the blood supply to the medial aspect of the motor cortex?

Answer 29

Anterior cerebral artery

Question 30

What is the blood supply to the lateral aspects of the motor cortex?

Answer 30

Middle cerebral artery

Question 31

After someone has a stroke, what are some complications they are at risk of and why?

Answer 31

Pressure ulcers- if they are not mobilised quickly and are lying in bed in one position Aspiration pneumonia- patients often struggle to swallow and can therefore aspirate food which can give them pneumonia

Question 32

What different aspects are considered when analysing disability in someone after they have had a stroke?

Answer 32

``` Swallowing Visual fields Gait Speech and language Use GCS ```

Question 33

What drugs are patients commonly put on for long term management after they have a stroke?

Answer 33

Statin ACE inhibitor/ something to reduce their blood pressure Clopidrogrel/ some type of blood thinner

Question 34

How does treatment for a haemorrhagic stroke differ from treatment for an ischaemic stroke?

Answer 34

If a stroke is haemorrhagic, aspirin should not be given immediately as the blood does not need to be thinned. Furthermore when prescribing prohyliactiv medication, blood thinners like clopidrogrel do not need to be given

Question 35

What is the treatment for haemorrhagic stroke?

Answer 35

ABCD, then check and stabilise INR

Question 36

What second line investigations are done in a specialist stroke unit?

Answer 36

VTE/PE prophylaxis Bedsore/ulcer prevention Nutritional assesment (inc swallow)

Question 37

What are the 2 main treatments for an ischaemic stroke? How is it decided which should be used?

Answer 37

Aspirin or thrombolysis Thrombolysis can only be performed if the patient arrives with 4.5 hours of onset of the stroke, a specialist will review the patient and decide if its beneficial to thrombolyse them to break up the clot that is causing the stroke

Question 38

What are risks of thrombolysis as a treatment for ischaemic stroke?

Answer 38

Haemorrhage

Question 39

What is immediately done when someone comes in with a suspected stroke and why?

Answer 39

Non contrast CT head | This is to rule out haemorrhagic stroke

Question 40

What is the first line investigation to look for carotid artery stenosis?

Answer 40

Doppler ultrasound

Question 41

What is the difference between anticoagulants and anitplatelets

Answer 41

``` Anticoagulants= affect the clotting cascade Antiplatelets= affect platelet aggregation ```

Question 42

When are anticoagulants used and when are antiplatelets used?

Answer 42

Antiplatelets are used when clots form for reasons besides atrial fibrillation because they prevent platelet aggregation and atrial fib occurs due to issues with the clotting cascade Anticoagulants are used for prevention of DVT, PE etc/ things that occur due to atrial fibrillation