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Flashcards in Localisation Deck (57)
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1
Q

What are the two important questions to ask in neurology?

A

Where is the localisation and what is causing it

2
Q

A patient has bilateral weakness. What origin can you exclude?

A

brain

3
Q

How to describe pattern of distribution?

A

Uni or bilateral
Proximal or distal
Sensory or motor

4
Q

What is the pattern of distribution of GBS?

A

distal and bilateral

5
Q

What is the pattern of distribution in myasthenia gravis?

A

bilateral and PROXIMAL e.g. pelvic and shoulder girdle

6
Q

How does myasthenia present and progress?

A

Starts in the eyes. Double vision, ptosis
Speech- dysphonic, dysarthria (slurred speech)
Swallowing- dysphagia
Facial muscles- droop
Neck muscles- droopy head
(MG rarely presents with limb weakness)

7
Q

Why is it important to localise the origin of lesion causing weakness when requesting an image

A

The larger the area of spinal cord you image, the lower resolution and therefore lower quality of image. If you can deduct that the lesion is likely to be lumbar or thoracic then request MRI Lumbar/sacral or MRI thoracic. If you think it could be L1/L2 then it is worthwhile requesting thoracic as well.

8
Q

If there is dysfunction in bladder and bowel, where is the problem?

A

spinal cord

9
Q

Patient with no sensation over patch of anterior thigh. Which nerve is likely to be impaired?

A

lateral cutaneous nerve= branch of lumbar plexus. Only provides sensory innervation

10
Q

A patient with common peroneal nerve injury will present with which symptoms?

A

controls dorsiflexion, therefore damage causes foot drop. Derived from sciatic nerve and bifurcates into superficial and deep peroneal nerve

11
Q

Symptoms of patient with sciatica lesion?

A

Nerve roots L4-S3
Innervates the muscles of the posterior thigh (biceps femoris, semimembranosus and semitendinosus) and the hamstring portion of the adductor magnus (remaining portion of which is supplied by the obturator nerve). NO cutaneous function. Sciatica means that there is irritation or a problem with the sciatic nerve that usually emanates from the low back, from the nerve roots in the spine. In most cases of sciatica, the pain extends down past the knee,

12
Q

Which conditions present with glove and stocking syndrome?

A

Focal sensory loss (in the absence of CNS pathology) suggests a peripheral neurological problem. A glove and stocking pattern of sensory loss suggests an axonal polyneuropathy. Nerve root lesions cause sensory loss in a dermatomal pattern. Numbness in a single nerve territory suggests trauma or entrapment neuropathy. Multiple areas of numbness in non-contiguous areas point to mononeuritis multiplex. Loss of reflexes occur with neuropathic lesions either affecting sensory or motor fibres.

13
Q

Where is the limit of glove and stocking pattern distribution?

A

mid thigh and above the elbow (think of long gloves and long stockings)

14
Q

Below which spinal nerve would you expect to not have involvement of the arms?

A

T3 and below (Arms T1-T2)

15
Q

If patient has tingling/painful band around chest, where is the lesion?

A

T5

16
Q

Patient has a brainstem lesion. What symptoms will patient have potentially?

A

Any symptoms associated with CN III-XII due to origin of cranial nerves

17
Q

Does the cauda equina contain central or peripheral nerves?

A

peripheral, termination of spinal cord at L1/L2

18
Q

Patient with bilateral leg weakness and UMN signs, which section of the spinal cord would you like to request?

A

thoracic (lesion could be L1/L2 but would include bladder and bowel symptoms).

19
Q

Patient with weakness in arms and legs bilaterally and confusion. Where is the lesion?

A

Could be two lesions! Bilateral weakness due to spinal cord lesion and confusion due to brain lesion.

20
Q

Patient with right arm and leg weakness, with left face weakness. Where is the lesion?

A

Brainstem (if face involvement then must be brainstem)

21
Q

Does the anterior horn comprise motor and sensory innervation?

A

pure motor- motor neurone disease

22
Q

Neuro presenting complaint is immediate in onset. What could be the cause?

A

vascular or trauma

23
Q

Neuro presenting complaint has occurred over hours/days. What could be the cause?

A

infection or inflammation

24
Q

Neuro presenting complaint has arisen over months. What could be the cause?

A

Space occupying lesion

25
Q

Neuro presenting complaint has arisen over years. What is the category of cause?

A

degenerative disease

26
Q

What questions should you ask in the presenting complaint of neuro patient

A

Speed of onset
Exacerbating/improving factors
Continuous/intermittent (does it improve on its own)

27
Q

Which aspects of social history should you ask about in neuro patient?

A
nutritional deficiencies
job/activities- pesticides, contact sports
Urban/rural- Lyme's disease
STI
Smoking
Rec drugs
Rx drugs
Travel
28
Q

What is the best way to assess for spasticity in upper limb?

A

spastic catch

29
Q

What is the best way to assess for rigidity?

A

wrist movement

30
Q

Which dermatome supplies the area of the nipple

A

T4

31
Q

Which dermatome supplies the level of the umbilicus

A

T10

32
Q

Name two diseases that affect anterior horn cells

A

motor neuron disease

polio

33
Q

Which conditions/factors affect peripheral nerves?

A

diabetes
alcohol
GBS
vasculitis

34
Q

Define ataxia

A

inability to coordinate voluntary muscular movements- coordination, balance, speech

35
Q

Which spinal nerve innervates biceps?

A

C5/C6

36
Q

Supinator?

A

C6

37
Q

Triceps?

A

C7

38
Q

Knee?

A

L2/L3

39
Q

Ankle?

A

S1/S2

40
Q

Where does the corticospinal tract decussate?

A

medulla

41
Q

How to illicit fasciculations?

A

flick muscle belly

42
Q

Lesion to internal capsule will result in what clinical picture?

A

hemiplegia- face/arm/leg

43
Q

Lesion in the thalamus will result in what clinical picture?

A

hemi-sensory disturbance

44
Q

Why is bulbar named as such?

A

medulla translates to bulb. Therefore the cranial nerve nuclei that are located there are described as such

45
Q

If you see crossed signs in face and limbs, where is the lesion?

A

brainstem!!

46
Q

Lesion to midbrain can lead to which symptoms?

A

oculomotor disorder- double vision

47
Q

Lesion to pons can causes which symptoms?

A

facial weakness, sensory disturbance, vertigo, deafness

48
Q

Lesion to medulla can lead to which symptoms?

A

dysphagia, dysarthria, dysphonia, weakness/wasting of tongue

49
Q

Spinal cord traumatic injury to C4. What clinical signs will you see?

A

spastic tetraparesis
UMN signs
Loss of sensation below suprasternal notch
Breathing affected (C3,C4,C5 keeps diaphragm alive)

50
Q

RTA complete transection of T5. What clinical signs will you observe

A

Spastic paraparesis
UMN
Sensory loss below costal margin and nipples
Breathing not affects

51
Q

How to ask about bowel and urinary symptoms if you are worried about cauda equina

A

can you feel your bottom when you wipe your bum

can you feel urine passing through and can you sense when you are finished?

52
Q

What does a positive Romberg sign indicate?

A

sensory ataxia

loss of vibration and proprioception- dorsal column issue

53
Q

Name two pathologies which selectively affect posterior columns

A

vit B12 deficiency
Vit E deficiency
Friedreich’s ataxia

54
Q

Is motor neuron disease more common in men or women?

A

men

55
Q

What is the clinical presentation of motor neuron disease?

A

asymmetrical limb weakness

bulbar symptoms

56
Q

What is a serious complication of motor neurone disease

A

bulbar/respiratory dysfunction

57
Q

Does motor neuron disease involve sensory symptoms?

A

no it is pure motor