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Neuro Flashcards

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1
Q

Ulnar claw

A

Mild extension at 4th and 5th MCPJ and relative flexion of the fingers

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2
Q

Which muscle differentiates a C8/ T1 lesion from ulnar lesion? Ie not a radiculopathy but an ulnar neuropathy

A

Abductor policis brevis - median nerve

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3
Q

Hoffmans sign

A

Hold DIPj and flick the finger
Thumb and index finger flex

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4
Q

Causes of peripheral neuropathy

A

Metabolic: Diabetes
Hypothyroid
Uraemia
Vitamin B1/ 6/ 12 deficiency

Toxic: chemo, alcohol

Inflammatory: CIDP, sarcoidosis, vasculitis, RA

Paraneoplastic: lung cancer, paraproteinaemia

Predominantly sensory: DM, alcohol, drugs, vit b deficiency
Predominantly motor: GBS and botulism acutely, lead toxicity, porphyria, HSMN ie CMTD

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5
Q

Why do we do nerve conduction studies for peripheral neuropathy?

A

Determine if it is demyelinating or axonal
Demyelinating = more likely to be inflammatory condition ie CIDP

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6
Q

Why is nerve conduction studies useful in HSMN?

A

HSMN type 1 is demyelinating
Type 2 is axonal
(HSMN also known as Charcot Marie tooth)

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7
Q

Inheritance of CMTD

A

Type 1 is autosomal dominant

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8
Q

how to differentiate a posterior stroke from a middle cerebral artery stroke with visual field defects

A

They both have homonomous hemianopia but a posterior stroke has macular sparing

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9
Q

How to differentiate a middle cerebral stroke from trigeminal neuropathy?

A

Test sensation on the neck - trigeminal neuropathy will have intact sensation on neck
Corneal reflex will be intact in hemispheric damage

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10
Q

How to differentiate cerebella versus sensory ataxia?

A

Cerebellar ataxia will have nystagmus and dysarthria
Sensory ataxia will have impaired sensation, particularly proprioception and vibration. They will also have pseudo athetosis in the upper limbs. Removing the visual input exacerbate the ataxia

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11
Q

What causes both central and peripheral sensory ataxia

A

B12 deficiency

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12
Q

lower motor neuron signs and peri oral fasciculations

A

Kennedys disease
Bulbar dystrophy
X linked
Very slow to progress

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13
Q

MND drug

A

Riluzole

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14
Q

Cerebellar ataxia and peripheral neuropathy

A

Alcohol

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15
Q

RAPD also known as

A

Marcus Gunn

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16
Q

Features that might be associated with retinitis pigmentosa that indicate it is part of a syndrome

A

Sensorineural deafness
Ataxia

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17
Q

If suspecting Parkinson’s what other tests should you do during the exam and why?

A

Opening finger and thumb
Check for gaze paresis = progressive supranuclear palsy
Ataxia = multi systems atrophy
Also offer to assess function ie buttons, hand writing

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18
Q

Parkinson’s like but affecting lower limbs predominantly

A

Vascular PD

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19
Q

Which hemisphere is language centre?

A

Left
So aphasia associated with RSW

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20
Q

Which nerve palsy in raised ICP?

A

6th

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21
Q

Friedrichs ataxia genetics

A

Triplet repeat
Recessive
Frataxin gene

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22
Q

Friedrichs features

A

Young adult, wheelchair or ataxic gate
Pes Cavus
Bilateral cerebella ataxia
(Nystagmus, Dysarthria)
Leg wasting with absent reflexes but bilateral upgoing planters
Posterior column signs i.e. loss of vibration and proprioception

Plus
Kyphoscoliosis optic atrophy, high arched palette, sensory neural deafness HOCM diabetes dementia

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23
Q

Causes of upgoing planters with absent knee jerks

A

Friedrichs ataxia
Sub acute combined degeneration of the cord
Motor neuron disease
Taboparesis
Conus medullaris lesions
Combined upper and lower pathology i.e. cervical spondylosis with peripheral neuropathy

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24
Q

What is spastic paraparesis?

A

Increased tone and reflexes bilaterally with pyramidal weakness

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25
Causes of spastic paraparesis
Demyelination i.e. MS Cord compression Trauma MND ie anterior Horn cell differential Cerebral palsy Stroke
26
Differentials for spastic paraparesis plus a sensory level
Cord compression Cord infarction Transverse myelitis
27
Spastic paraparesis with dorsal column loss
Demyelination Friedrichs ataxia SACD of cord Syphilis Cervical myelopathy
28
Spastic paraparesis and spinothalamic loss
Syringomyelia And anterior spinal artery infarction
29
Spastic paraparesis and cerebellar signs
MS Friedrick ataxia and Arnold Chiari malformation
30
Spinothalamic tract
Pain temperature Decussates at spinal level
31
Dorsal column tract
Proprioception, vibration and fine touch. Decussates at the medulla
32
Corticospinal
Movement of limbs/motor neurons and spinal cord. Decussates at the pyramids in the medulla
33
Charcot Marie tooth disease what is it
Inherited peripheral neuropathy, Autosomal dominant mostly but there are lots of types Motor more than sensory
34
Features of CMTD
Distal wasting of limbs (inverted champagne bottle) Claw hand pes Cavus weak ankle Dorsi flexion and toe extension i.e. foot drop with high stepping gait stocking distribution of sensory loss scoliosis reduced reflexes
35
Why is EMG helpful in CMTD?
Help to differentiate between axonal/demyelinating to help direct genetic testing of family
36
Polio what is it
Enterovirus transmitted by Faeco-oral route affecting the motor neurons in the anterior horn and brain stem
37
MDT for Huntington’s
Dieticians important as increased basal metabolic rate Neuro psych
38
Myasthenia gravis what is it
Acquired autoimmune condition with antibodies against the postsynaptic neuromuscular junction characterised by painless muscle fatigue and associated with thymus and other autoimmune diseases
39
Triggers for myasthenia gravis
Aminoglycosides, surgery and tapering Meds, starting steroids
40
Myasthenia gravis crisis
Need to do vital capacity at bedside. Give IVIG sometimes plasmapharesis is needed
41
Causes of bilateral cerebellum syndrome and how to tell
1) MS - INO/ RAPD/ UMN weakness/ optic atrophy 2) paraneoplastic - cachexia, clubbing, tar staining 3) SOL or b/l POCS - weakness, visual field defect, papilloedema
42
Causes of unilateral cerebellum syndrome
MS POCS/haemorrhagic SOL in posterior Fossa
43
Mainly sensory causes of peripheral neuropathy
Alcohol B12/ B1/ folate deficiency Diabetes Uraemia Chemotherapy Isoniazid CIDP Sarcoid RA Paraneoplastic
44
Causes of predominantly motor peripheral neuropathy
GBS CMTD Porphyria Botulism Lead toxicity
45
Causes of mononeuritis Multiplex
Diabetes SLE RA Vasculitis Infection i.e. HIV Malignancy
46
How does EMG study differ for axonal versus demyelinating conditions?
Axonal shows reduced amplitude. Demyelinating shows reduced velocity
47
Causes of demyelinating peripheral neuropathy
CIDP and GBS
48
Surgical sieve for myelopathy causes
Trauma i.e. disc protrusion Malignancy Infections – abscess HIV Autoimmune MSOSLE Nutritional – B12 and copper deficiency
49
Radial nerve innovation and palsy
C5 to T1 Sensation loss over posterior arm/ forearm/ radial 3 1/2 fingers Weakness of posterior Absent triceps and Braco reflex At rest wrist drop
50
Auxiliary nerve palsy
C5-6 Numbness over deltoid, weakness of deltoid, arm adducted and internally rotated
51
Median nerve palsy
C5 – T1
52
Ulnar nerve palsy
C8-T1 Weak wrist flexion, abd/adduction of fingers (claw hand)
53
MG clinical tests to confirm
Fatiguable ptosis - worse after looking up for a while Complex ophthalmoplegia - not affecting one particular CN Shoulder abduction strength - exercise it then recheck and expect it to be weaker Ice on ptosis can resolve the ptosis
54
MG crisis management
A-E Forced vital capacity Involve ITU early
55
Important cause of mortality in Friedrichs ataxia
Arrhythmias and cardiomyopathy
56
Cerebellar ataxia causes
Acute - vascular stroke haemorrhage, infection ie varicella or autoimmune or demyelinating (then offer no RAPD or optic atrophy) Chronic - alcohol or nutritional deficiencies or genetic, surgery, previous trauma
57
Peripheral neuropathy + Cerebellar signs =
Alcohol cause of both
58
Lateral medullary syndrome - what is it?
Wallenberg Posterior inferior Cerebellar artery or vertebral artery Lateral part of medulla
59
Lateral medullary syndrome signs
Ipsilateral- Cerebellar signs + loss of gag reflex, hornets and reduced pain and temperature sensation in trigeminal distribution on face Contra lateral - loss of pain and temperature sensation over trunk and limbs
60
MND only affecting upper limbs
Primary lateral sclerosis
61
What is MND?
Progressive axonal degeneration of motor neurons in motor cortex and corticospinal tract, anterior horn cells or spinal cord and brain stem
62
MRI findings in multiple sclerosis
Hyper intense lesions on T2 weighted imaging
63
Non-pharmacological management for multiple sclerosis
Stop smoking Vitamin D Exercise MDT i.e. physio and occupational therapy Mental health Bladder management
64
Commenest presentation of multiple sclerosis
Optic neuritis Reduce visual acuity Reduce colour perception Horizontal gaze palsy Paraesthesia pain spasticity hyperreflexia Bladder dysfunction Sexual dysfunction
65
Causes of central visual loss
Macular degeneration could be diabetic or ARMD Retinal vein occlusion Hypertensive retinopathy causing macular oedema Optic neuritis Cataract
66
Causes of peripheral visual loss
Retinitis pigmentosa Glaucoma Chiasmal lesion
67
Broad causes of gradual visual loss
Compressive cause Inherited Degenerative Toxic Nutritional
68
Describe INO
Failure of the ipsilateral eye to adduct with nystagmus on abduction of the other eye which indicates a lesion in the MLF indicating INO
69
Why do we check velocity dependent tone?
In spasticity the rapid movements make the hypertonia more obvious because it is velocity dependent
70
Spastic paraparesis differentials (broadly)
Trauma Ischaemia Inflammation Infection Neoplasia Nutritional/ metabolic
71
Clinical signs of spastic paraparesis
wheelchair or walking aids Disuse atrophy and contractures if chronic Increased tone and ankle clonus Generalised weakness Hyperreflexia and upgoing planters Gate is scissoring
72
Additional signs during examination of spastic legs
Examined for a sensory level suggestive of a spinal lesion. Look at the back for scars or spinal deformity. Look for features of multiple sclerosis e.g. cerebella signs endoscopy for optic atrophy. Ask about bladder symptoms and look for presence of urinary catheter. Offer to test anal tone
73
Causes of cord compression
Disc prolapse, Malignancy Infection e.g. abscess or TB Trauma
74
L2/3
Hip flexion
75
L3/4
Knee extension
76
L4/5
Foot Dorsey flexion
77
L4/5
Foot Dorsey flexion
78
L5/S1
Knee flexion Hip extension
79
L5/S1
Knee flexion Hip extension
80
S1/2
Foot plantar flexion
81
Brown sequard
Asymmetrical spastic paraparesis and contralateral spinothalamic dysfunction Aka spinal cord dysfunction
82
Myelopathy means
Spinal cord compression
83
Signs of syringomyelia
Weakness and wasting of small muscles of the hand A reflexia in upper limbs. Dissociated sensory loss in upper limbs and chest: loss of pain and temperature (spinothalamic) with preservation of joint position and vibration sense (dorsal columns) Scars from painless burns Charcot joints of the elbow and shoulder Parador weakness in lower limbs with upgoing planters Kyphoscoliosis Horner syndrome. If searing extends into brain stem there may be cerebella and lower cranial nerve signs
84
What is syringomyelia?
Caused by progressively expanding fluid filled cavity (syrinx) within the cervical cord typically spanning several levels
85
What is usually spared in syringomyelia?
Dorsal columns so joint position and vibration sense
86
What is lost at the level of the lesion in syringomyelia? What signs below the level of the syrinx?
Decussating spinothalamic neurones producing segmental pain and temperature loss at level of the syrinx Anterior Horn cells producing segmental lower motor neuron weakness at the level of the syrinx Corticospinal tract producing UMN weakness below the level of the syrinx Usually spares dorsal columns
87
Syringomyelia association conditions
Arnold chiari malformation Spina bifida
88
Most important causes of Charcot joint?
Hip & knee - tabes dorsales Foot & ankle- DM Elbow & shoulder - syringomyelia
89
C5/6
Elbow flexion and supination
90
C7/8
elbow extension
91
T1
Finger adduction

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