Neurological Cases in Medicine AS Flashcards
(38 cards)
HOW DO YOU ASSESS GCS?
EYES 4
VERBAL RESPONSE 5
MOTOR RESPONSE 6
MINIMUM IS 3
LIST THE COMPONENTS OF THE AMTS test for confusion.
- DOB
- AGE
- TIME
- YEAR
- PLACE
- RECALL (WEST REGISTER STREET)
- RECOGNISE DOCTOR/NURSE
- PRIME MINISTER
- SECOND WW
- COUNT BACKWARDS FROM 20 TO 1
What are the UMN signs?
Increased tone/spasticity and reflexes
Upgoing plantars
Decreased power
What are the LMN signs?
Decreased tone(flaccid) and reflexes
Decreased power
What anatomy must you consider in neurological diagnosis?
Brain + spinal cord
Nerve roots
Peripheral nerves
NMJ
What are the general causes of neurological pathology?
- Vascular
- Infection
- Inflammation/autoimmune
- Toxic/metabolic
- Tumour/malignancy
- Hereditary/congenital
- Degenerative
Describe these visual field defects.
Describe these visual field defects.
- III, IV, VI - diplopia
- IX, X - slurred speech and dysphagia
- This is a problem affecting NMJ
- This is a LOWER MOTOR NEURONE LESION
Botulism - when addict run out of venous sites for injection they innject under skin. This man needed . Dx: myasthenia gravis (but no lesions).
Not brain - no hemiparesis. Affecting extraocular muscles as well as speech and swallowing.
Describe the disribution of these lesions:
- Cerebral cortex
- Spinal cord
- Nerve roots (radiculopathy)
- Mononeuropathy
- Polyneuropathy
- hemisensory loss
- level (e.g. umbilicus)
- dermatomes
- specific area
- glove and stocking districbution
What is hydroxocobalamin?
Vit B12a - dietary supplement
What would you say in front of patient… HIV? Ca?
HIV - “retroviral disease”
Cancer = “mitotic disease”
What would you prescribe?
Codeine/duloxetine/hydroxocobalamin/paracetamol/morphine
duloxetine
What are the causes of peripheral neuropathy?
(Less likely vascular)
Infection
Inflammation/autoimmune
Toxin/metabolic
Tumour/malignancy
What are the toxic/metabolic causes of peripheral neuropathy?
Young woman - lesion likely in spinal cord
Blurred margins of optic disc - papilloedema or papillitis…
- Might also complain of pain - papillitis (reduced visual acuity, blurred vision, pain)
- Less likely papilloedema because she is young - and doesn’t reduce visual acuity
Two lesions
- Optic nerve - optic neuritis (papillitis) - blurred dic margins/vision, pain on eye movement
- Spinal cord - corticospinal/spinothalamic tracts - spastic paraparesis - vascular/infection/inflammation (demyelination e.g. transverse myelitis), toxic/metabolic, tumour/malignancy
What is TB affecting spinal cord called?
Pott disease
What characterises MS?
Two lesions
Separated in time/space
Lose weight
Describe meralgia paraesthetica. How do you treat it?
Describe innervation of the hand.
What is radiculopathy? Use lumbosacral as an example.
Disease of nerve roots
E.g. lumbosacral - pain in buttock, radiating down leg below the knee = “sciatica”
What is the cause of radiculopathy?(2)
Compression
- Disc herniation
- Spinal canal stenosis
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