Neuro Flashcards
(83 cards)
1
Q
Median nerve palsy (carpal tunnel is common cause)
A
Thenar eminence wasting Thumb ABduction (reduced power) LOAF = motor innervation of median nerve Lateral 2 lumbricals Opponens pollicis Abductor pollicis brevis Flexor pollicis brevis
2
Q
Phalen test
A
Wrist held in flexion for 60 seconds causing parasthesia
3
Q
Tinel test
A
Repeatedly percuss over carpal tunnel
4
Q
Ulnar nerve palsy
A
Hypothenar eminence wasting
Partial claw hand of little and ring finger
Finger ABduction (reduced power)
Usually caused by damage to elbow (funny bone)
5
Q
Froment’s sign
A
Straight thumb and index finger pinching paper and try and keep hold as you pull away; would flex DIP if positive showing weak ADductor pollicis
6
Q
Radial nerve palsy (or C7 radiculopathy)
A
Wrist drop
Reduced power extending wrist and fingers
NB C7 sensation though is index and middle fingers so would had motor deficit of radial nerve and median nerve sensation loss
7
Q
Carpal tunnel syndrome causes
A
Idiopathic Pregnancy RA Hypothyroidism Diabetes Acromegaly
8
Q
Radial nerve palsy causes
A
Humeral shaft #
Saturday night palsy (compression of radial nerve when sleeping causing dead arm)
9
Q
T1 lesion causes
A
Causes:
Cervical spondylosis
Pancoast tumour
Plexus trauma/birth trauma (Klumpke’s)
10
Q
T1 lesion features
A
Total claw hand
Wasting of small muscles in hand
Sensory loss in medial forearm
Horner’s syndrome may co-exist
11
Q
Supinator catch
A
Early sign of hypertonia in upper limb, difficulty pronating/supinating
12
Q
Erb’s palsy
A
Lesion of C5-6
Atrophy of the deltoid, biceps, and brachialis muscles
Medially rotated arm with extended and pronated forearm with flexed wrist
13
Q
Klumpke’s palsy
A
C8-T1 lesion
Claw hand occurs
Wasting on small muscles in hand
14
Q
Shoulder ABduction
A
C5 (axillary)
15
Q
Elbow flexion
A
C5/C6 (musculocutaneous)
16
Q
Elbow and finger extension
A
C7 (radial)
17
Q
Wrist extension
A
C6 (radial)
18
Q
Finger flexion
A
C8 (medial + ulnar)
19
Q
Thumb ABduction
A
T1 (median)
20
Q
Finger ABduction
A
T1 (ulnar)
21
Q
Biceps jerk
A
C5/6 (same as elbow flexion)
22
Q
Triceps jerk
A
C7 (same as elbow extension)
23
Q
Supinator jerk
A
C5/6 (biceps does so same as elbow flexion)
24
Q
Extrapyramidal lesion
A
Rigid tone Normal power Normal reflexes Plantars down Co-ordination down (THINK PARKINSON'S)
25
Spinothalamic pathology
Syringomyelia = expansion of spinal cord central canal due to CSF blockage
Anterior spinal artery occlusion
MS
26
Dorsal columns pathology
Tabes dorsalis
Folate/B12 deficiency (SDSC)
MS
27
Spinothalamic
Pain
Temp
Crude touch
28
Dorsal columns
Vibration
Propriaception
Fine touch
29
Syringomyelia
Loss of pain and temp in cape-like distribution over arm and shoulder
LMN signs in upper limbs and spastic paraparesis of lower limbs
Dorsal column signs develop in late syringomyelia
If affects brainstem called syringobulbia
30
Flexion of upper limb
C5 - elbow flexion (musculocutaneous = makes sense as biceps innervated by this)
C8 - finger flexion (median and ulnar)
31
Extension of upper limb
C6 - wrist extension (radial)
| C7 - elbow extension and finger extension (radial)
32
Hip flexion
L1/2
33
Hip extension and knee flexion
L5/S1
34
Knee extension
L3/4
35
Ankle dorsiflexion
L4 (peroneal)
36
Hallux extension
L5 (peroneal)
37
Ankle plantarflexion
S1 (tibial)
38
Knee jerk
L3/4 (same as knee extension)
39
Ankle jerk
S1 (same as ankle plantarflexion)
40
Peripheral neuropathy DDx
```
DM (sensory mainly)
B12/folate deficiency (called subacute degeneration of spinal cord)
Alcohol
Thiamine deficiency (Wernicke's)
Uraemia (sensory mainly)
SLE
Guillain-Barre (motor mainly)
Charcot-Maries-Tooth
Lead poisoning (motor mainly)
Amyloidosis
Paraneoplastic
```
41
Unilateral leg weakness DDx
UMN: stroke, tumour, MS
LMN: root lesion, nerve lesion
42
Subacute degeneration of spinal cord
```
B12/folate deficiency
Features:
UMN - Spastic paraparesis & upgoing plantars
LMN - reduced reflexes
+ dorsal columns loss
```
43
Mixed LMN and UMN
MND (e.g. ALS Amyotrophic lateral sclerosis)
| SDSC
44
Bilateral leg weakness DDx
UMN (spastic) - bilateral strokes; acute spinal cord compression (eg disc prolapse, trauma, tumor, MS); syringomyelia (LMN signs in upper limb)
LMN (flaccid) - Guillain Barre; lead poisoning; Charcot-Marie-Tooth
45
Positive Romberg's (dizziness when eyes shut)
Dorsal columns loss: tabes dorsalis; SCDC; MS
| Sensory peripheral neuropathy
46
MND features
UMN: spasticity, brisk reflexes
LMN: weakness, wasting, fasciculation
47
Foot drop
```
Common peroneal nerve palsy
Stroke
L4/L5 nerve root lesion
MND
Charcot-Marie-Tooth
```
48
Olfactory lesion
Trauma
Frontal lobe tumour
Meningitis
49
Bitemporal hemianopia
Pituitary adenoma
| Internal carotid artery aneurysm
50
Homonymous hemianopia
Anything behind chiasm
| Stroke/tumour/abscess
51
Trigeminal lesion
Trigeminal neuralgia (idiopathic)
Acoustic neuroma
Herpes zoster
52
Facial lesion
LMN: Bell's, malignant parotid tumour, Ramsay Hunt (herpes), sarcoid (usually bilateral)
UMN: stroke, tumour
53
Hearing loss
```
Excessive noise
Conductive loss
Meniere's
Furosemide
Gentamicin
```
54
Bulbar balsy (LMN)
```
MND
Diptheria
Polio
Myasthenia gravis
Guillain Barre syndrome
Syringobulbia
```
55
Pseudobulbar palsy (UMN)
MND
Bilateral stroke
MS
56
Cavernous sinus thrombosis
III, IV, VI lesion (mainly VI)
V - pain (ophthalmic)
Corneal reflex lost
Headache, periorbital oedema, proptosis (exopthalmus)
57
CN III palsy
Down and out eye
Ptosis
Dilated pupil if complete (not diabetes)
58
Opthalmoplegia
```
Myasthenia gravis
Cranial nerve palsy (III, IV, VI)
Grave's
Wernicke's
Progressive supranuclear palsy
```
59
Internuclear opthalmoplegia (INO)
Disorder of conjugate lateral gaze due to lesion in medial longitudinal fasciculus (MLF), which ADducts that eye
Means that if you have LEFT LESION, your LEFT EYE cannot ADduct and so you cannot look to the RIGHT
60
Causes of INO
MS (esp in young pt)
Stroke
Lyme disease and TCA overdose
61
Bulbar palsy (LMN) features
Tongue appearance:
Flaccid
Wasted
Fasciculating
Tremulous lips as well as drooling and dysphonia
62
Pseudobulbar palsy (UMN) features
Tongue appearance:
Spastic
Contracted
Emotionally labile as well as drooling and dysphonia
63
Parkinson's
```
TRAP
Tremor
Rigidity
Akinesia (bradykinesia initially)
Postural instability
```
64
Parkinson's DDx
Benign essential tremor
| Wilson's (with psych illness, hepatotoxicity and Kayser-fleischer rings)
65
Parkinson-plus syndromes
Multi-system atrophy (autonomic failure)
Corticobasal degeneration (alien hand syndrome and apraxia)
Progressive supranuclear palsy (ocular features including vertical gaze failure)
Lewy-body dementia
66
Parkinson's Rx
```
L-dopa
Dopamine agonist - ropinerole
Anticholinergics - procyclidine
COMTi - entacapone
MAO-Bi - selegiline
Glutamate antagonists - amantadine
Sleep commonly affected and mirtazapine works best
```
67
Causes of cerebellar disease
```
Stroke: vertebrobasilar
Tumour at cerebello-pontine angle
MS
Congenital (e.g. Arnold-Chiari)
Friedrich's ataxia
Alcohol abuse
Thiamine deficiency
Anti-epileptic medication (phenytoin)
```
68
Wernicke's triad
Acute confusion
Ataxia
Ophthalmaplegia (especially upgaze)
69
Dysarthria Differentials
```
Facial nerve palsy CNVII
Bulbar palsy eg MND
Pseudobulbar palsy eg MS
MG
Cerebellar disease
```
70
Lateral Medullary syndrome
posterior inferior cerebellar artery (PICA) infarct
DANVAH = dysphagia, ataxia, nystagmus, vertigo, anaesthesia, Horner's
[] ipsilateral: ataxia, nystagmus, dysphagia, facial numbness, cranial nerve palsy e.g. Horner's
[] contralateral: limb sensory loss
71
Weber's syndrome
ipsilateral III palsy
| contralateral weakness
72
Abulia
Pathological laziness, seen with anterior cerebral artery infarct (with this face spared usually)
73
Cerebellopontine angle syndrome
Causes: acoustic neuroma, meningioma, astrocytoma and mets (e.g. breast)
Effect: ipsilateral CN 5, 6, 7, 8 palsies (pons) and cerebellar signs
74
Subclavian steal syndrome
subclavian artery stenosis proximal to origin of vertebral artery leading to syncope/headache raising arms and BP difference >20 between arms
75
Anterior spinal artery/Beck's syndrome
Supplies ventral 2/3 spinal cord caused usually by aortic aneurysm or dissection / surgery
Symptoms: paresis with impaired pain and temperature sensation but preserved dorsal columns as these antero-lateral
76
Locked-in syndrome
Everything paralysed but eye muscles
Causes = ventral pons infarct from basilar artery or central pontine demyelination
77
Millard-Gulber syndrome
Pontine infarct
| 6 and 7 CN palsy and contralateral hemiplegia
78
Parkinson's plus
Progressive supranuclear palsy
Corticobasal degeneration
Multi system atrophy (shy drager)
Lewy body dementia
79
Hearing loss conductive causes
```
WIDENING
Wax or foreign body
Infection: otitis media, OME
Drum perforation
Extra: ossicle discontinuity – otosclerosis, trauma
Neoplasia: carcinoma
INjury: e.g. barotrauma
Granulomatous: Wegener’s, Sarcoid
```
80
Hearing loss sensorineural causes
```
DDIVINITY
Developmental - Alport's; TORCH
Degenerative - Presbyacusis
Infection - VZV, measles
Vascular - internal auditory artery
Inflammation - vasculitis, sarcoid
Neoplasm - cerebellopontine angle tumour
Injury - trauma / noise
Toxins - gentamicin, frusemide
LYmph - Perilymphatic fistula
```
81
Action tremor causes
BEATS
Benign essential tremor
Endocrine: thyroxicosis, ↓glucose, phaeo
Alcohol withdrawal (or caffeine, opioids…)
Toxins: β-agonists, theophylline, valproate, PHE
Sympathetic: physiological tremor may be
enhanced: e.g. in anxiety
82
Bell's sign
Eyes move up on trying to close eyelid in bell's palsy
83
Miller Fisher sydrome
Variant of GBS
Triad of:
Ophthalmoplegia + sensory ataxia + areflexia
