Neuro

Question 1

Causes of monoparesis in Upper Limb

Answer 1

UMNL - small infarct motor cortex (lacunar infarct)
LMNL - brachial plexus – Cervical rib Pancoast tu (C8-T1 radiculopathy)
Combined median & ulnar nerve palsy

Question 2

Causes of monoparesis in Lower Limb

Answer 2

UMNL - small infarct motor cortex (lacunar infarct)
Brown-Sequard $ (Lesion below T1)

LMNL - L5-S1 radiculopathy
Common peroneal N palsy
Sciatic N palsy
Poliomyelitis (no sensory)

Question 3

Causes of hemiparesis (UMNL only)

Answer 3

Cerebral or brainstem – CVA (Ischemic (arterial)-thrombotic/embolic, v/sitis (venous)-Cerebral Venous Sinus Thrombosis (CVST) Hemorrhage- ICH/SAH, SDH, EDH)
Demyelination (Multiple sclerosis)
SOL (Tumor, abscess)

Question 4

UMNL in Lower limb examination (Sensory level)

Answer 4

SC compression (trauma, tumor, haematoma, abscess, AV malformation, prolapsed disc, Inf – pott’s spine)
- Transverse myelitis, SC tumor

Question 5

UMNL in Lower limb examination (Dorsal column sign)

Answer 5

Friedrich ataxia
Subacute combined degeneration of SC
Taboparesis
Multiple sclerosis
Cervical myelopathy (can also cause sensory level)

Question 6

UMNL in Lower limb examination (Dissociative sensory loss)

Answer 6

Anterior spinal artery occlusion

Question 7

UMNL in Lower limb examination (Normal sensory)

Answer 7

UMN type of Motor Neuron Disease (MND)
Hereditary spastic paraplegia
Parasagittal meningioma (cortical sensory loss+)
Syringomyelia (LMN weakness & dissociate sensory loss in upper limb)

Question 8

LMNL in Lower Limb examination (Sensory- glove and stocking)

Answer 8

Sensorimotor peripheral neuropathy (Charcot-marie-tooth, CIDP, DM, alcohol, Hypothyroid, paraneoplastic, drugs)

Question 9

LMNL in Lower Limb examination (Sensory - dorsal column)

Answer 9

Tabes dorsalis

Question 10

LMNL in Lower Limb examination (Normal sensory)

Answer 10

LMN type of MND
Motor dominant peripheral neuropathy
(GB, CIDP, lead, porphyria, diphtheria, drugs)
Spinal muscular atrophy
Multifocal motor neuropathy (asymmetrical)
Old poliomyelitis (usually unilateral)
NMJ - Myasthenia gravis (generalized weakness)
Myopathy - proximal - Polymyositis, Dermatomyositis Alcohol Muscular dystrophy-Duchenne/Becker Endocrine – Thyroid, Cushing, DM Periodic paralysis Osteomalacia Drug - steroid, fibrate, statin Paraneoplastic
- distal - Myotonic dystrophy Inclusion body myositis Other distal myopathies

Question 11

Conditions associated with UMNL + LMNL (Absent ankle jerk + EPR)

Answer 11

• Combination of conditions (most common)
  (cervical myelopathy+peripheral neuropathy, cervical&lumbar spondylosis)
  
  • Subacute combined degeneration of the cord (B12 deficiency)
  • Taboparesis
  • Conus medullaris lesion
  • Friedreich’s ataxia
  • Motor neurone disease