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Neuro Flashcards

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1
Q

Different kinds of neurological examination?

A

Upper limb, lower limb, cranial nerves, DANISHP, GALS

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2
Q

What makes the CNS?

A

Brain, spinal cord, brainstem

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3
Q

What is the function of the brainstem

A

Control respiratory drive, cranial nerve function, houses beginning of spinal cord

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4
Q

What makes the PNS?

A

Outside of the brain and spinal cord: cranial nerves, spinal nerves and their roots and branches, peripheral nerves and neuromuscular junctions

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5
Q

Where does the PNS start?

A

anterior horn cells

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6
Q

What is PNS functionally divided into?

A

Somatic nervous system (control of body wall- skin (sensory), skeletal muscles (motor)) and autonomic nervous system

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7
Q

What is the motor control system crudely split into?

A

pyramidal (corticospinal+corticobulbar) tract, extrapytamidal tracts (incl. basal ganglia), cerebellum

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8
Q

Function of the pyramidal tract?

A

skilled, intricate, organised movements

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9
Q

How does defective pyramidal tract present?

A

loss of voluntary movement, bradykinesia, rigidity, tremor, chorea

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10
Q

Function of the extrapyramidal tract?

A

fast, fluid, involuntary movements

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11
Q

How does defective extrapyramidal tract?

A

bradykinesia, rigid, tremor, chorea

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12
Q

How does defective cerebellum present?

A

Dysdidokinesia, Ataxia, Nystagmus, Inattention tremor, Slurred speech, Hypotonia, Past pointing

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13
Q

Sensory tracts in the spine?

A

spinothalamic, dorsal columns

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14
Q

Motor tracts in the spine?

A

corticospinal, corticobulbar tracts

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15
Q

Cardinal signs of UMN lesions?

A

hypertonia, upgoing plantars, hyperreflexia, weakness (vague and present in LMN lesions as well)

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16
Q

Cardinal signs of LMN lesions?

A

hypotonia, hyporeflexia, wasting, fasciculations

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17
Q

Is the sensory cortex mainly posterior/anterior?

A

posterior

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18
Q

Is the motor cortex mainly posterior/anterior?

A

anterior

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19
Q

Function of frontal lobe?

A

executive functions: reasoning, planning, complex. Broca’s area

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20
Q

Function of occipital lobe?

A

visual processing

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21
Q

Function of temporal lobe?

A

language, Wernicke’s, auditory stimuli, memory, speech

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22
Q

Function of parietal lobe?

A

movement, orientation, recognition

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23
Q

Neurological symptoms to ask about in Hx?

A

weakness, memory, sensation, involuntary movements, low GCS

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24
Q

What do unilaterla symptoms suggest? Bilateral?

A

uni: brain pathology, bi: spine pathology

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25
What kind of pathology would cause acute neuro symptoms?
traumatic, bleeds
26
What kind of pathology would cause chronic neuro symptoms?
inflammatory, genetic
27
3 primary causes of peripheral neuropathy?
diabetes, B12 deficiency, alcohol
28
Main way of differentiating meningitis and encephalitis?
encephalitis presents with confusion
29
Primary causes of encephalitis?
herpes, post-infectious/autoimmune, voltage gated channelopathies?
30
Syndromes affecting spinal cord?
MS, Brown Sequard, Myelopathy, MSCC
31
Which cranial nerves arise from the brainstem? Which come from the cerebrum?
3-12 from brainstem, 1/2 from cerebrum
32
Where does the olfactory nerve run?
from nose->past cribiform plate->olfactory bulb->frontal/temporal lobes
33
How do you test olfactory nerve?
scratch and sniff cards/smelling salts- each one in isolation
34
Causes of bilateral anosmia?
Parkinson's, nasal trauma, smoking, congenital ciliary dysmotility syndromes, Aura before migraine/epilepsy
35
Causes of unilateral anosmia?
Mucus blocekd nostril, head trauma, subfrontal meningioma
36
Where does the sensory information optic nerve run?
retina->optic nerve->optic chiasm->optic tract->lateral geniculate->striate cortex
37
How do you test acuity for optic nerve? How do you correct for refractory error?
From 6m ask to read Snellen Chart (with glasses if needed). Repeat the test with pinhole to correct for refractory error
38
If can't use Snellen chart what do use instead?
counting fingers->hand movements->perception to light->no perception to light
39
If NPL, what could be the cause? How do you test?
Cataracts, no red reflex
40
Causes of visual loss in the cornea?
Glaucoma (acute angle closure), herpetic keratitis (emergency from HSV1), blepharitis (usually bacterial/scalp dandruff), corneal abrasion (trauma)
41
What forms the anterior chamber of the eye? What's it filled with?
Inner surface of the cornea to the iris, filled with aqueous humour
42
What anterior chamber problems can cause visual loss?
Iritis, hyphaema (blood pooling in eye due to trauma), hypopyon (leukocytic exudate poolin in eye, from corneal ulcer or Behcets for example)
43
Problems affecting lens?
Cataracts e.g. from congenital rubella syndrome, acquired
44
Problems affecting vitreous humour/chamber?
Haemorrhage (diabetic retinopathy, trauma, retinal tear/detachment), vitritis
45
Problems affecting retina?
Central retinal artery/vein occlusion, macula degeneration, retinal detachment, macular oedema, hypertensive retinopathy
46
How would you detect retinal artery occlusion?
Cherry red spot (pale retina with red spot at point of occlusion)
47
What causes a stormy sunset appearance on fundoscopy?
Central retinal vein occlusion
48
What causes retinal detachment?
Tear in the retina which allows vitreous humour behind it- vitreous membrane detachment, inflammatory, trauma
49
Causes of visual loss due to optic nerve?
Optic neuritis (MS), ischaemic optic neuropathy (like temporal arteritis), papilloedema
50
Causes of visual loss affecting optic chiasm?
Pituitary tumour , meningioma, craniopharyngioma
51
Causes of visual loss affecting optic tract?
Stroke, tumour, abscess
52
Causes of visual inattention?
Stroke, head injury
53
Where is the lesion in monocular blindness? Causes?
Distal to optic chiasm: damage to the eye/blood supply/optic nerve
54
Causes of tunnel vision?
glaucoma, retinal damage
55
Causes of bitemporal hemianopia?
pituitary adenoma/macroadenoma, craniopharyngoma, suprasellar meningioma
56
Causes of enlarged blindspot?
papilloedema
57
Cause homonymous hemianopia?
Behind optic chiasm: stroke, tumour
58
Causes of superior homonymous quadrantonopia?
Lesion in temporal lobe white matter
59
Causes of inferior homonymous quadrantonopia?
Lesion in parietal lobe white matter
60
Muscle controlling pupil constriction?
Sphincter pupillae in iris
61
Muscle controlling pupil dilation?
dilator pupillae in iris
62
Light reflex pathway?
Retinal fibres->Pretectal nucleus->Edinger-Westphal nuclei->preganglionic fibres->ciliary ganglion->postganglionic fibres->sphincter pupillae
63
What is RAPD?
rapid afferent pupillary defect: initial dilation of both pupils when light shone in affected eye
64
What is the accomodation reflex?
Coordinated changes in vergence, miosis, lens shape (accomodation)
65
Path of accomodation reflex?
CN II (afferent arm of reflex)->superior centres (interneuron)->CNIII (efferent arm of reflex)
66
Path of pupil dilation by sympathetic system?
1st neuron (Hypothalamus->centre of Budge)-> 2ns neuron (apical pleura->superior cervical ganglion in neck)->3rd neuron (superior cervical ganglion to sphincter pupillae)
67
Causes of RAPD?
optic neuropathy (optic neuritis, compressive lesions), gross retinal pathology (central retinal vein occlusion, retinal detachment), optic chiasm and tract lesions (infarcts, demyelination)
68
Triad of Horner's syndrome?
ptosis, anhydrosis, miosis
69
What is light-near dissociation?
absent/delayed light reflex but normal accomodation reflex
70
What are these nerves respectively named?
Oculomotor, trochlear, abducens
71
Motor functions of CN III?
All extrinsic eye muscles except lateral rectus and superior oblique: levator palpebrae superioris, superior rectus, medial rectus, inferior rectus, inferior oblique
72
2 nuclei of CN III?
Oculomotor nucleus and Edinger-Westphal nuclei
73
Autonomic function of CN III?
parasympathetic supply to sphincter pupillae of iris/ciliary muscles
74
Motor function of CN IV?
contralateral superior oblique
75
What is unique about CN IV?
thinnest CN, longest course, only CN to arise from dorsal brainstem
76
Function of CN VI?
Ipsilateral rectus muscle
77
What centre controls horizontal eye movements?
horizontal gaze centre in pontine paramedian reticular formation.
78
What centre controls vertical eye movements?
vertical gaze centre in the rostal interstitial nucleus of the median longitudinal fasciculus
79
Clinical features of CN III palsy?
ptosis, down and out, opthalmoplegia in all directions other than lateral/inferior
80
What would mydriasis in a CN III palsy suggest?
As the nerves for constriction are quite superficial, this helps to distinguish 'compressive' from medical palsies
81
Causes of CN III palsy?
Main 2: Microvascular, intracranial aneurysms. Other: trauma, tumours, demyelination, vasculitis, congenital
82
Clinical features of CN IV palsy?
vertical diplopia, slight external rotation of affected eye, hypertropia
83
Causes of CN IV palsy?
mainly due to head trauma, then microvascular disease. Other: congenital, others
84
Clinical features of CN VI palsy?
inability to abduct the affected eye, diplopia
85
Causes of CN VI palsy?
microvascular lesions most common. other: meningeal infection, aneurysm, inflammatory processes
86
3 areas that a lesion can occur leading to combined nerve palsies?
cavernous sinus, orbit, superior orbital fissure
87
Definition?
An autoimmune T-cell mediated hypersensitivity reaction leading to demyelination of the CNS
88
Epidemiology?
More common in women (3:1), temperate climates, average age of onset 20-40 years
89
Aetiology- genetic factors?
HLA-DR2, HLADRB1*15
90
Aetiology- environmental factors?
sunlight, vitamin D deficiency associated
91
Presenting symptoms- sensory?
tingling and numbness
92
Introduction- how much should patient be exposed?
top off or vest
93
What can you ask patient to do whilst you inspect them?
pronator drift
94
What features are characteristic of LMN lesions on inspection?
wasting and fasciculations
95
What does spastic posturing suggest on inspection?
UMN lesion
96
What scars might you see on inspection?
musce biopsy or nerve biopsy

Finals Revision (9 decks)

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