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Flashcards in Neuro Deck (20)
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1

UMN

Increased tone
Increased reflexes
Decreased power
Extensor plantars

2

UMN Bilateral causes

MS
Cord compression
Cord prolapse
Cord trauma

3

UMN Unilateral causes

Stroke
MS
SOL
Cord prolapse

4

Mixed UMN and LMN features

MND
Ataxia
Subacute combined degeneration of spinal cord - B12
Taboparesis (3tiary syphilis)

5

Acute stroke

Rapid onset focal neurological defect of vascular origin lasting >24hrs

Ischaemic 80%
Haemorrhagic 20%

DDx: HEad injury, Inc./Dec. Glucose, SOL, infection, Drugs

Tx: Thrombolysis if

6

Stroke regions: Total anterior circulation (TACS)

Carotid / MCA and ACA

Hemiparesis and/or hemisensory deficit
Homonymous hemianopia
Higher cortical dysfunction - aphasia(dominant), neglect and apraxia (non-dominant)

7

Stroke regions: Partial anterior circulation (PACS)

Carotid / MCA and ACA

2/3 of TACS symptoms
Homonymous hemianopia
Higher cortical dysfunction

8

Stroke regions: Posterior circulation (POCS)

Vertebrobasilar territory

Cerebellar syndrome
Brainstem syndrome
Homonymous hemianopia

9

Stroke regions: Lacunar (LACS)

Infarct around basal ganglia, internal capsule, thalamus and pons

Pure motor
Pure sensory
Mixed
Dysarthria
Ataxic hemiparesis

10

Non-acute stroke management

MDT
Eating - ng tube, ensure no aspiration
Neurorehab
DVT prophylaxis
Sores

11

Multiple Sclerosis

A chronic inflammatory condition of the CNS characterised by multiple plaques of demyelination disseminated in time and space

12

MS features

Sensory: dys/paraesthesia, dec vibration sense, trigeminal neuralgia
Motor: Spastic weakness, transverse myelitis
Eye: Diplopia, Optic neuritis, Bilateral INO
Cerebellum: Ataxia, scanning dysarthria, falls
GI: Swallowing disorders, constipation
Sexual/GU: ED + anorgasmia, retention, incontinence

13

MS management

MDT

Methylpred 1g IV for 3 days - acute attack

Prevent relapse:
Disease modifying - IFN-B, Glatiramer
Biologics - Alemtuzumab (anti CD52)

Symptoms:
Modafinil - fatigue
SSRI - depression
Amitryptylline, gabapentin - pain
Physio, botulinum - spasticity
Oxybutynin - incontinence
Sildenafil - ED
Clonazepam - tremor

14

Motor Neuron Disease - types

Amyotrophic lateral sclerosis: 50%
Corticospinal tracts - UMN + LMN signs, fasiculations

Progressive bulbar palsy: 10%
CN 9-12 - bulbar palsy

Progressive muscular atrophy: 10%
Anterior horn cell lesion - LMN only
Distal to proximal
Better prog than ALS

Primary lateral sclerosis: 30%
Loss of Betz cells in motor cortex - UMN mainly
Marked spastic leg weakness and pseudobulbar palsy
No cognitive decline

15

Balbar palsy

Nasal speech lacking in modulation and difficulty with all consonants

Tongue is atrophic and shows fasciculations.

Dribbling of saliva.
Weakness of the soft palate, examined by asking the patient to say aah.

The jaw jerk is normal or absent.

The gag reflex is absent.

In addition, there may be lower motor neuron lesions of the limbs.

The ocular muscles are spared and this differentiates it from myasthenia gravis.

16

LMN signs

Fasiculations
Hypotonia
Hyporeflexia
Wasting

17

LMN - bilateral, symmetrical and distal

HMSN - Charcot Marie tooth
Paraneoplastic
Lead poisoning
GBS, Botulism

18

LMN - bilateral, symmetrical and proximal

Inherited: Muscular dystrophy
Inflammation: Polymyositis, dermatomyositis
Endocrine: Cushings, Acromegaly, Thyrotoxicosis, Osteomalacia
Drugs: Alcholo, steroids, statins
Malignancy: paraneoplastic

19

LMN - unilateral

Old polio - single limb and no sensory signs
Segmental (nerve roots), peripheral (mononeuropathy) - localised to group of muscles with same supply

20

Foot drop causes

Neuromuscular disease;
Peroneal nerve (common, i.e., frequent) —chemical, mechanical, disease;
Sciatic nerve—direct trauma, iatrogenic;
Lumbosacral plexus;
L5 nerve root (common, especially in association with pain in back radiating down leg);
Cauda equina syndrome, which is cause by impingement of the nerve roots within the spinal canal distal to the end of the spinal cord;
Spinal cord (rarely causes isolated foot drop) —poliomyelitis, tumor;
Brain (uncommon, but often overlooked) —stroke, TIA, tumor;
Genetic (as in Charcot-Marie-Tooth Disease and hereditary neuropathy with liability to pressure palsies);
Nonorganic causes.