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Flashcards in Neurological weakness Deck (13)

What can lower motor neurone disorders cause?

Weakness, wasting, reduced muscle tone, visible spontaneous contractions (fasciculations).
peripheral neuropathy (e.g., diabetes, B12); specifically of facial nerve: Bell’s palsy (affects whole side of face).


What can upper motor neurone disorders cause?

Weakness, no wasting, increased muscle tone, no fasciculations. eg. stroke, multiple sclerosis, tumour


Does the duration of the weakness give any clues as to the pathology?

minutes-hours = vascular
days-weeks = inflammation/infection
weeks-months = tumour
months-years = degeneration


What are the neurological tests you can do to test if muscles are working (as cranial nerves control these and give an idea to neurological capacity)

-face,mouth, VII–facial nerve. Test=smile
- jaw, chewing, V-trigeminal nerve. Test =open your mouth
- tongue, XII hypoglossal nerve. Test: stick out your tongue (it will point to your weak side)
- swallowing, X - vagus. Test: swallow, cough, “aah” (uvula points away from weak side)
[IX - glossopharyngeal] Test: can you feel this?


What is bulbar palsy?

bilateral impairment of function of cranial nerves V, VII, X and XI due to LOWER motor neuron lesion in the medulla
(or bilateral lesions of lower cranial nerves outside brainstem).
Symptoms – dysphagia (difficulty in swallowing), difficulty chewing,
nasal regurgitation, dysarthria (slurring of speech), choking on liquids
Signs – nasal speech (lacking in modulation and difficulty with all consonants), tongue atrophy with fasciculations, dribbling of saliva, weakness of soft palate (ask the patient to say “aah”)


What is Pseudobulbar palsy?

bilateral impairment of function of cranial nerves V, VII, X and XI due to UPPER motor neuron lesion affecting the cortical pathways to the medulla.
Symptoms – dysphagia, dysarthria, difficulty chewing, choking
+ labile affect, uncontrollable laughing or crying Signs – speech is slow, thick and indistinct, tongue is small & stiff.


What's a neuromuscular disease?

Myasthenia gravis


What's a muscular disease?

muscular dystrophy


What are the symptoms and signs of raised intracranial pressure?

 symptoms: nausea, headache
 General signs: vomitting, possible ↓GCS  Signs relating to BP:
bradycardia, increased systolic BP widened pulse pressure
 Others: Cheyne-Stokes breathing, papilloedema, dilated pupil/pupils


What can cause raised intracranial pressure?

 Brain parenchyma  Interstitial fluid  Meninges  CSF


What are the consequences of raised intracranial pressure?

1. Coning: Brainstem compression:
Damage to vital respiratory and cardiac centres, can be fatal
2. Extradural haematoma
3. Subarachnoid haemorrhage


What's a stroke?

Sudden onset neurological signs / symptoms
Last for >24 hours
Due to a vascular cause 85% infarction (embolism / thrombosis) 15% haemorrhage


What are the sources of emboli for a cerebral infarction?

Left atrium
Mural thrombus
Cardiac valves
Atherosclerosis (aorta and carotid)