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The One Deck To Rule Them All > Neuro: General (Motor + Sensory disorders) > Flashcards

Neuro: General (Motor + Sensory disorders) Flashcards

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1
Q

Allodynia (pain from stimuli that shouldn’t be painful)
Flushing
Unusual hair growth
Hx of trauma

A

Complex regional pain syndrome

  • 3F:1M

Type 1: no lesion
Type 2: underlying lesion on nerve

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2
Q

Used to diagnose complex regional pain syndrome

A

Budapest Diagnostic Criteria

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3
Q

Management of complex regional pain syndrome

A

Physiotherapy

Neuropathic analgesia

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4
Q

Clinician has the patient extend their neck and turn their head to the side that is being tested. The patient then holds their breath and the radial pulse is palpated.

Tests for thoracic outlet syndrome

A

Adson’s test

Positive if change in pulse/ no pulse

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5
Q

Inability to control facial movements

A

Pseudobulbar palsy

  • seen in PSP
  • Parkinson’s
  • MS
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6
Q

Muscle wasting of the hands

Paraesthesia

A

Thoracic outlet syndrome (TOS)

  • 90% of TOS
  • neurogenic
  • Compression of brachial plexus
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7
Q

Painful arm swelling

A

Thoracic outlet syndrome (TOAS)

  • 10%
  • vascular
  • Subclavian artery/vein
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8
Q

Flushing
Sweating
Extreme HTN

A

Autonomic dysreflexia

  • symptoms above level of spinal injury
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9
Q

Causes of Autonomic dysreflexia

A 
Faecal impaction (constipation)
Urinary retention
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10
Q

Intervertebral disc prolapses are more common to herniate

A

Laterally - due to weaker ligaments

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11
Q

Causes of peripheral neuropathy

A

ABCDE

Alcohol
B12 deficiency 
Cancer
CKD
Diabetes
Drugs (isoniazid)
Every vasculitis
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12
Q

Predominantly motor-loss neuropathy

A
  • Guillain-Barre syndrome
  • Porphyria
  • Lead poisoning
  • Hereditary Sensorimotor Neuropathies (HSMN)
    - Charcot-Marie-Tooth
  • Chronic inflammatory demyelinating polyneuropathy
  • Diptheria
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13
Q

Predominantly sensory-loss neuropathy

A 
Diabetes "glove + stocking loss"
Uraemia
Leprosy
Alcoholism
Vitamin B12 deficiency
Amyloidosis
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14
Q

Dyskinesia

A

Dystonia
Chorea
Athetosis

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15
Q

Involuntary contraction of muscles

A

Dystonia

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16
Q

Irregular unpredictable movements

A

Chorea

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17
Q

Involuntary writhing of fingers etc

A

Athetosis

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18
Q 
Muscle weakness 
Decreased tone
Decreased reflexes
Muscle wasting
Fasiculations
Affects full face
A

Lower motor neuron (LMN) lesion

  • most things decreased
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19
Q 
Muscle weakness
Increases tone
Increased reflexes (brisk)
Muscle mass maintained
Spasticity
Upgoing plantars
Forehead sparing
A

Upper motor neuron (UMN) lesion

  • most things increased
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20
Q

Causes of UMN lesions

A

Stroke

Tumour

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21
Q

Genetics for Huntington’s Chorea

A

Autosomal dominant
Tri-nucleotide disorder

Anticipation: Earlier age of onset = increased severity for later generations

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22
Q

Age 30s
Uncontrolled movements
Falls
Difficulty speaking

A

Huntington’s Chorea

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23
Q 
Symmetrical fine tremor
Worsens on intentional movements 
Disappears on rest
Improves with alcohol 
Can affect vocal cords
A

Benign essential tremor

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24
Q

Management of benign essential tremor

A

Propranolol

Primidone

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25
``` Subacute onset Behavioural changes Speech impairment Visual impairment Motor impairment Ataxia Weakness ```
Progressive multifocal leukoencephalopathy (PML)
26
Widespread demyelination due to infection of oligodendrites by John cunningham virus (JC Virus)
Progressive multifocal leukoencephalopathy (PML)
27
Investigations for PML
CT: Lesions MRI: High-signal demyelinating white matter lesions
28
Impaired balance (prone to falls) Vertical gaze palsy Symmetrical onset
Progressive Supranuclear Palsy (PSP) - Parkinson plus condition - Levodopa can sometimes help
29
A collection of CSF (in fluid filled cyst "syrinx) within the spinal cord that compresses the spinothalamic tract fibres (decussating at anterior white commissure of spine)
Syringomyelia
30
``` Cape-like loss of temperature (neck + arms) - accidental burns Preserved: - light touch - Proprioception - Vibration Spastic weakness (upper limbs) Paraesthesia Neuropathic pain Bowel + bladder dysfunction ```
Syringomyelia - age 20-40s
31
Causes of Syringomyelia
Arnold-chiari malformation Trauma Tumours Idiopathic
32
Complications of Syringomyelia
Syringobulbia (fluid filled cavity in medulla) Scoliosis Horner's syndrome
33
Investigations for syringomyelia
Full spine + brain MRI
34
``` Months onset Pain (neck/ upper + lower limbs) Loss of motor function Decreased sensory function Decreased dexterity in hands Urinary/ faecal incontinence ```
Degenerative cervical myelopathy (DCM)
35
An involuntary flexion movement of the thumb and or index finger when the examiner flicks the fingernail of the middle finger down. The reflexive pathway causes the thumb to flex and adduct quickly Tests for Degenerative Cervical myelopathy
Hoffman's sign
36
Risk factors for Degenerative Cervical myelopathy (DCM)
Smoking (effects discs) Genetics Occupation- Labourer (high axial load)
37
Investigations for Degenerative cervical myelopathy
MRI Cervical spine
38
Management for degenerative cervical myelopathy
Decompressive surgery
39
OA of the spine leading to compression of the cord
Cervical spondylosis
40
Neck pain + stiffness LMN signs at level of compression UMN signs below lesion
Cervical spondylosis
41
Damage to posterior spinal artery
Posterior cord syndrome
42
Loss of proprioception Loss of vibration Loss of two-point discrimination Loss of light touch
Posterior cord syndrome
43
Acute onset | Loss of pain + temperature sensation
Anterior cord syndrome - caused by ischaemia in spinal cord
44
Damage to half of the spinal cord
Brown-sequard syndrome
45
Paralysis Ipsilateral: Loss of proprioception Contralateral: Loss of pain Loss of temperature
Brown-sequard syndrome
46
Spontaneous continuous lower limb movements Parasthesia Akathisia (inability to sit still) - worse at night/ sitting still
Restless leg syndrome = clinical diagnosis associated with: - FHx - Iron deficiency anaemia - Uraemia - DM - Pregnancy
47
Management for restless leg syndrome
Stretching Dopamine agonists (Pramipexole, Ropinirole) Benzodiazepines Gabapentin
48
Balance with eyes closed Test for proprioception
Romberg's test
49
``` Damage to posterior (dorsal) column: - loss of proprioception - loss of light touch - loss of vibration Damage to lateral column: UMN signs Damage to peripheral nerves: LMN signs ```
Subacute combined degeneration of the spinal cord (SADC)
50
Cause of subacute degeneration of the spinal cord
Vitamin B12 deficiency
51
Management for Subacute degeneration of the spinal cord
Vitamin B12 + then maybe folate - if you give folate first it may precipitate SADC
52
``` Pes cavus (high foot arches) Distal muscle wasting Decreased reflexes Weakness in lower limb Peripheral sensory loss ``` = LMN signs + sensation loss
Charcot Marie Tooth "Hereditary sensorimotor neuropathy) - Autosomal dominant - PMP-22 gene (codes for myelin) Type 1: Demyelinating pathway Type 2: Axonal pathway
53
Paraesthesia + loss of sensation spreading up from feet Back + leg pain Progressive (ascending) symmetrical weakness of all limbs Decreased reflexes - No UMN signs
Guillian-Barre syndrome
54
Causes of Guillian-Barre syndrome
Campylobacter jejuni Cytomegalovirus (CMV) Epstein-barr virus Inflammatory peripheral neuropathy - B cells produce antibodies to peripheral nerve cells
55
Investigations for Guillian-Barre syndrome
LP: Increased protein, normal WBC Nerve conduction studies: - Decreased motor nerve conduction velocity - Increased F wave latency EMG: Increased action potential duration + amplitude
56
Management for Guillian-Barre syndrome
IV Immunoglobins
57
``` Muscle weakness (improves on exercise) - Proximal muscles legs > arms - Intraocular muscles (diplopia) - Levator muscles (ptosis) - Oropharyngeal muscles (dysarthria + dysphagia) Waddling gait (limb girdle weakness) Decreased reflexes ```
Lambert-eaton myasthenia syndrome - autoimmune
58
Investigations for Lambert-eaton myasthenia syndrome
EMG: Incremental response to repetitive stimulation - relaxes improve after strong contraction (post-titanic potentiation) Voltage-gate-calcium-channel Antibodies
59
Causes of Lambert-eaton myasthenia syndrome
Small-cell lung cancer (smoking)
60
Management of Lambert-eaton myasthenia syndrome
Amifampridine
61
Types of Cerebral palsy
``` Spastic (70%) - Hemiplegia - Diplegia - Quadriplegia Dyskinetic Ataxic Mixed ```
62
Abnormal tone Delayed motor milestones Abnormal gait Feeding difficulties Associated with: - learning difficulties (60%) - epilepsy (30%) - Squints (30%) - Hearing impairment (20%)
Cerebral Palsy
63
Causes of cerebral palsy
``` Antenatal (80%) - cerebral malformation - congenital infection (CMV, Rubella, Toxoplasmosis) Intrapartum (10%) - birth trauma Intraventricular haemorrhage (10%) Meningitis Trauma ```
64
Management of cerebral palsy
Diazepam Baclofen Botulin toxin type A (Botox) Surgical dorsal rhizotomy
65
``` Proximal muscle weakness (worse from exercise + at night) - head + neck - arms > legs Extra-ocular muscle weakness (diplopia) - worse when reading Ptosis Dysphagia ```
Myasthenia gravis - autoimmune - insufficient functioning acetylcholine receptors
66
Associated with: - thymoma tumours (difficulty breathing), 15% - pernicious anaemia - thyroid disorders - RA - SLE - Thymic hyperplasia (60%)
Myasthenia gravis
67
Investigations for myasthenia gravis
Acetylcholine receptor antibodies (85%) CK: Normal Specific: tensilon test: positive - IV Edrophonium induces muscle weakness temporarily CT: Thymoma of thorax Single fibre electromyography EMG: Decreased response to repetitive stimulation
68
Management of myasthenia gravis
1. Reversible acetylcholinesterase inhibitors (long-acting): - Pyridostigmine - Neostigmine Immunosuppression: - Prednisolone - Azathioprine, cyclosporin, mycophenolate Surgery (thymectomy) Monoclonal antibody tx: Rituximab
69
Myasthenia crisis can be caused by
``` Beta blockers Pencilamine Lithium Phenytoin Abx (Gentamicin, macrolides, quinolones, tetracyclines) ```
70
Management of myasthenia crisis
Plasmapheresis | IV immunoglobins
71
``` Gradual onset muscle weakness (hands + shoulders) Eye muscles spared Respiratory muscles weakened Facial muscles weakened - slurred speech - swallowing difficulties No sensory deficit ```
Motor Neurone Disease (MND) - clinical diagnosis - associated with fronto-temporal dementia - 50% dead in 1 year
72
Types of MND
Amylotropic Lateral Sclerosis (ALS) - most common (50%) Primary Lateral Sclerosis (PLS) Progressive Muscular Atrophy Progressive Bulbar Palsy
73
UMN + LMN signs (arms + legs) Upper limbs: Weakness + decreased reflexes Lowe limbs: Increased tone + increased reflexes Fasiculations
Amylotrophic Lateral Sclerosis (ALS) - Chromosome 21 (superoxide dismutase)
74
LMN signs | - affects distally before proximally
Progressive muscular atrophy Has best prognosis
75
Palsy of tongue + facial muscles Fasiculations Difficulty chewing/ swallowing
Progressive bulbar palsy Has worst prognosis
76
UMN Signs
Primary lateral sclerosis
77
Investigations for MND
EMG: increased action potential duration + amplitude
78
Management for MND
Riluzole - prevents stimulation of glutamate receptors (slows progression) Non-invasive breathing support at night
79
Lethargy (75%) + Mostly UMN signs Optic problems - optic neuritis - optic atrophy - uhthoff's phenomenon (vision worse on increased temperature) - internuclear ophthalmoplegia Sensory - pins/ needles - numbness - trigeminal neuralgia - lhermitte's sign (parasethesia on neck flexion) Motor - spastic weakness (legs) Cerebellar - ataxia - tremor Urinary Incontinence Sexual dysfunction intellectual deterioration
Multiple sclerosis (MS) Autoimmune Demyelination in the CNS 3F:1M Age: 20-40
80
Risk factors for MS
``` Female Further from equator (latitude) EBV White Vit D deficiency ```
81
Types of MS
``` Relapsing-remitting (60-85%) Primary Progressive (10%) - common in elderly Secondary Progressive - has progressed from primary progressive ```
82
Investigations for MS
LP: Oligocolonal bands in CSF - intrathecal synthesis of IgG Contrast MRI: Periventricular plaques Hypotense lesions perpendicular to corpus callous (Dawson fingers)
83
Management for MS to decrease relapse rate
Beta-interferon therapy Glaticamer acetate (immuno-modulating drug) Natalizumab (monoclonal antibody) Fingolimod (sphingosine 1-phosphate receptor modulator)
84
Management for MS Acute relapses
Methylprednisolone (5 days) | Monoclonal antibodies
85
Side effect of monoclonal antibodies
Risk of JCV infection + PML
86
Management of Spasticity in MS
1. Baclofen + gabapentin 2. Diazepam Dantrolene Tizanidine
87
Management of Oscillopsia in MS
Gabapentin
88
Management of fatigue in MS
Amantadine
89
TRAP Tremor (4-6 hz, worse at night, asymmetrical) Rigidity (lead-pipe) Akinesia Postural instability (stooped posture + forward tilt) Postural hypotension Shuffling gait + small steps when turning Bradykinesia (slow movement) Decreased facial expressions + drooling (reduced swallow) Quiet monotonous speech Decreased sense of smell ``` Arms don't swing when walk Micrographia (small writing) Hypomimia (facial masking, low expression) Depression (40%) REM Sleep problems ```
Parkinson's disease - starts unilateral and becomes bilateral
90
Investigations for Parkinson's
DAP Scan: looks for dopamine receptors in basal ganglia (reduction = neuropathic Parkinson's) Discolouration of substantia nigrans - due to loss of nerve cells
91
Contraindicated in Parkinson's
Prochlorperazine Haloperidol - risk of neuroleptic malignant syndrome
92
Management of sleepiness in Parkinson's
Modafinil
93
Management of postural hypotension in Parkinson's
Midodrine | - acts on peripheral alpha-adrenergic receptors to increase arterial resistance
94
Management of drooling in Parkinson's
Glycopyrronium Bromide
95
Management for Motor symptoms in Parkinson's
Motor symptoms affect QofL? Yes: 1. Levodopa (effectiveness decreases over time) + Decarboxylase inhibitor - Carbidopa - Benserazide Used to prevent peripheral metabolism of levodopa to dopamine No: 1. Dopamine agonist (non-ergot derived) - Ropinorole - Apomorphine 2. Levodopa 3. MOAI (B) - Selegiline - Rasagiline Second line add ons: - Dopamine agonists - MOAIs - COMT Inhibitors - Entacapone - Tolcapone
96
4 examples of dopamine receptor agonists
Non-Ergot derived: - Ropinorole - Apomorphine Ergot derived: - Bromocriptine - Cabergoline
97
Side effects of ergot derived dopamine receptor agonists - cabergoline - bromocriptine
Pulmonary, cardio + retroperitoneal fibrosis
98
Management of tremor in Parkinson's
Procyclidine
99
Side effects of metoclopramide (dopamine antagonist)
Drug induced parkinsonism | - bilateral tremors
100
Management of drug induced parkinsonism
Anti-muscarinics (block cholinergic receptors) Procyclidine Benzotropine Trihexyphenidyl
101
4 types of Parkinson Plus syndromes
Progressive Supranuclear Palsy (PSP) Multisystem Atrophy Corticobulbar degeneration Lewy Body dementia
102
Types of Multi system atrophy
MSA- P (predominantly Parkinson's) | MSA- C (predominantly cerebellar)
103
``` Parkinsonism Autonomic disturbance - erectile dysfunction - postural hypotension - atonic bladder Cerebellar disease ```
Multi System Atrophy | - Parkinson Plus condition

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