Neuro Flashcards

Question

Causes of Mixed UMN and LMN signs

Answer 1

1) Cervical radiculopathy 2) MND 3) Subacute degenration of the cord 4) Syringomyelia 5) Conus meddlaris compression- as per classic cauda equina. Will have sphincter disturbance, sensory level and weakness assocaited Plus saddle anaesthesia.

Answer 2

Wasting of arm muscles- if C5-C6 then of biceps and supinators If c8-t1 then small msucles of hands Brisk reflexes belown lesion Pain localised to neck in radicular pattern Sensory loss localised to radicular patten

Answer 3

``` Mixed picture Will can have reduced or spastic tone Reduced power Brisk or absent reflexes Fasciculations- diagnostic ``` Sensation will remain intact Subtypes include- Amyotrophic lateral sclrosis- Classic picture affects UMN and LMN of limbs and bulbar system If only bulbar then is progressive bulbar palsy primary lateral sclerosis- Only UMN signs Progressive muscular atrophy- only LMN signs Dx- is by EMG demonstrating widespread denervation Mx- Supportive MDT in put for symptom control and optomisation PT/OT/SALT- may need PEG Riluzole will prolong lifespan by 3 months May need NIV if T2RF due to neuromusclar weakness

Answer 4

Fluid filled cyst in central spinal cord- linked to tumours and arnold chiari malformation Signs - Loss of pain and temperature sensory loss but but not touch or vibration or position. Described as cape like as affects arms and thorax but not legs May have scars from burns and cuts not recognised Wasting and weakness of small muscles of hands Brisk lower limb reflexes and upgoing plantars May have Horner's syndrome

Answer 5

Signs Brisk knee jerks, absent ankles Symmetrical sensory neuropathy. May be burning and lose touch, vibration and potision sense Reduced lower limb power Positive romberg's sign May be anaemic May have optic atropy or dementia due to B12 deficinecy Check abdomen for splenomegaly or previos surgery- e.g in crohn's Causes- Poor oral intake, Pernicious anaemia, ETOH intake and nitrous oxide abuse

Answer 6

UMN lesion= spares forehead due to bilateral innervation LMN lesion= forehead will also be paralysed ``` Unilateral= Bell's Palsy Ramsey Hunt syndrome Stroke Demyelination SOL (CPA lesion) Nerve infiltration e.g sarcoid ``` ``` Bilateral= Bilateral Bell's palsy Sarcoid AI e.g GBS Muscular dystrophy esuch as myotonic or fascioscapulohumeral Infection such as Lyme ```

Answer 7

Polyneuropathy- diffuse involvement of peripheral nerves Mononeuropathy- involves on nerve Mononeuritis multiplex- focal involvement of 2 or more neves. Rsdiculopsrhy- single spinal nerve root Plexopathy- involvement of brachial or lumbosacral plexus.

Answer 8

Burning tingling pain radiating down limb Weakness and senroy loss in myotomal distribution Loss of reflexes and moeot strength Chronic rsdiculopsrhy- can result in atrophy and fasciculations. T1 radiculopathy- causes Horner's ``` Causes- Disc herniation Cervical/lumbar spondylosis Spinal stenosis Compression by tumour Inflammation Infections. ```

Answer 9

Burning tingling pain radiating down limb Weakness and senroy loss in myotomal distribution Loss of reflexes and moeot strength Chronic rsdiculopsrhy- can result in atrophy and fasciculations. T1 radiculopathy- causes Horner's ``` Causes- Disc herniation Cervical/lumbar spondylosis Spinal stenosis Compression by tumour Inflammation Infections. ```

Answer 10

Muscle weakness and atrophy from c5-t1 Reduced tendon reflezesensory loss often of axillary nerve. ``` Causes neuralgic amyotrophy Neoplastic eg breast and lung cancer Radiation induced Thoracic outlet syndrome Iatrogenic after surgery ``` NB c8 lesion will cause weakness of flexor policcis Longus and extensor pollicis brevis whi h ulnar lesion won't do

Answer 11

Supplies LOAF, long finger flexors and sensation to lateral 2/3rds of palm and 3.5 fingers. Causes Carpel tunnel syndrome linked to other pathologies E.G Ra and acromegaly and pregnenacy And diabetes and hypothyroid Trauma Surgical injury ``` Clinical signs Wasting of thenar eminence Weakness of APB, oppons pollicis and lumbrical. Sensory loss over relaxsnf region. Provoked by Tinel's and phalens test. ```

Answer 12

``` Signs wasting of dorsal interossei Wasting of hypothenar eminence Clawing of 4-5th fingers Generalized weakness of hannd Sensoey impairment oflvsd little and ulnar ring finger ``` ``` Innervates hypothenar muscles Medial 2 lumbrical Interossei Adductor pollicis Medial wrist flexors ``` ``` Causes Compression at the elbow e.g bone, prolonged elbow flexion and op compression Bony deformity at evlow- fractures and RA and pagets Idiopathic Variable anatomy Diabetes Vasculitis Leprosy ```

Answer 13

Signs- weakness of wrist extension Weaknes of finger extension. If wrist is pasicly extended CNA then straighten fingers Weakness of finger abduction and adductio. If weakness of tricep relfex think lesion in axilla or c7 radiculopsrhy- Causes- injury at elbow by fracture of dislocation At humeral shaft fracture At axilla due to traumatic compression fromx rutches or Saturday night palsy. NB an intact trcieps reflex suggests lesion below spiral groove.

Answer 14

Signs- High stepping gait Wasting of muscle on lateral lower leg Weakness of dorsiflexion and eversion of foot Sensory impairment over anterolateral aspect of lower leg ``` Causes- compression Direct trauma Diabetes Mononeuritis multiplex Leprosy will have palpable thickening of nerve. ```

Answer 15

``` Sensori-Motor= Diabetes Nutritional (B12) deficiency) ETOH Drugs e.g isoniazid, metronidazole, chemotherapy agents and phenytoin Hypothyroidism, renal failure Infections e.g HIV and leprosy and syphillis Vasculitis Hereditary- Charcot marie tooth disease ``` Motor predominence= Inflammatory e.g AIDP, CIDP, MGUS associated. Lead poisoing Diabetic amyitrophy Inherited e.g spinal muscular atrophy Sensory- Paraneoplastic, Fredrich's ataxia, chemotherapy

Answer 16

Glove and stocking sensory impairment Muscular atrophy of affected areas Reduced reflexes Autonomic dysfunction with postural hypotension, impotence, GI changes and urinary inontinence. Small fibre neuropathy affects temp and pin prick Large fibre affects soft touch, vibration and proprioception But often both affected

Answer 17

History and complete neurological exam (All 3 parts) Urine dip Bloods for FBC, ESR, B12, Folate, HBa1c, tftS, u+E and LFTs ``` Can then move onto nerve conduction studies and EMG to characterise affected nerves Vasculitis screen Eletrophoresis CXR HIV ``` May do antineuronal antiboodies eg anti hu and anti Yo for paraneoplastic CT-CAP for cause if above all negative.

Answer 18

AR progressive ataxia. Most common inheritied ataxia in UK. Inherited with Triplet repeat due to mutation on fraxin gene. Is a spinocerebellar disese- symptoms hinted in the name! Affects dorsal column Neurologically develop a form of spastic paraparesis Often have a wheelchair or walking aid present. Will have increased tone Reduced power in pyramidil distribution. Absent ankle reflexes but upgoing plantars/clonus is characteristic Also reduced coordination of hands and legs And cerebellar speech Sensation- reduced dosral column ``` Other features of Fredrich's ataxia Pes cavus Kyphoscoliosis Deafness with hearing aids T1DM- so look for CBG pin pricks Arrythmias and hypertrophic cardiomyopathy - so pacemaker may be present ``` Ix to cover neurological symptoms, risk fo daiebtes and cardiovascular risk too Management will need to be MDT with relavent specialists and allied health professionals involved.

Answer 19

In contrast to Fredrich's ataxia this is a polyneuropathy! Is AD inheritance Subtypes include demyelinating and axonal. On examination will find; Wasting of distal lower limb but preserved thigh muscles (causign inverted champagne bottle apperance) Pes cavus Weakness in ankle dorsiflexion and toe extension Variable degree of stocking distrubution sensory loss Gait will be high stepping Also wasting of hadn muscles Palpable lateral popliteal nerve

Answer 20

Nerve foot- plexus- nerve- NMJ- Muscle Nerve root= MND or polio In between have cauda equina and compression Plexus= Trauma, tumour or abscess affecting lumosarcral plexus but note often unilateral ``` Nerve- Several causes Inflammation e.g GBS or CIDP Infections e.g HIV Toxins- Lead Metabolic- Porphyria and diabetic neuropathy Congenital- Charcot Marie Tooth ``` NMJ- Myasthenia gravia Botulinism Organophospahte poisoning ``` Muscle-Congenital myopathy- Myotonic dystrophy, Duchenne/becker's Inflammtory- Poly/dermomyositis Endocrine- Hypothyroid, Cushing's ETOH Electrolyte disurbances ```

Answer 21

See spinal diseases. These show rough guide Aka- break down is 1) MS 2) Cord compression (Sensory level) 3) Vascular cord injury (Sensory level) 4) Trauma 5) Cerbral palsy Also can think of Fredrich's ataxia Hereditary spastic paraparesis Tropical spastic parapresis And also syringomyelia

Neuro Flashcards

(45 cards)