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MI clinical exam and diagnosis > Neurology > Flashcards

Neurology Flashcards

1
Q

What does DAMNIT-VP stand for?

A 
D: degenerative
A: anomalous
M: metabolic
N: neoplastic, nutritional
I: infectious, inflammatory, immune, iatrogenic, idiopathic
T: traumatic, toxic
V: vascular
P: parasitic
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2
Q

What is the approach to solving neurological problems

A
  1. describe abnormalities
  2. localize
  3. charaacterize onset and progression
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3
Q

What is the approach to solving neurological problems

A
  1. describe abnormalities
  2. localize
  3. characterize onset and progression
  4. generate differential diagnoses
  5. use ancillary tests to rule in or rule-out each differential on your list
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4
Q

What are the three divisions of the brain (in this course)

A

forebrain
brainstem
cerebellum

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5
Q

What are the 4 important regions of the spinal cord?

A

C1-C5
C6-T2
T3-L3
L4-S2

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6
Q

What are the 4 important regions of the spinal cord?

A

C1-C5
C6-T2
T3-L3
L4-S2

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7
Q

What is a lower motor neuron?

A

a neuron that directly innervates the muscle

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8
Q

What are the components of a lower motor neuron?

A
  1. nerve cell bodies in ventral grey matter
  2. nerve roots
  3. peripheral nerve
  4. neuromuscular junction
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9
Q

What are lower motor neuron signs? (5)

A
  1. decreased muscle tone
  2. severe muscle atrophy
  3. weak and diminished reflexes
  4. gait typically weak
  5. short strides with feet under body
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10
Q

What are lower motor neuron signs? (5)

A
  1. decreased muscle tone
  2. severe muscle atrophy
  3. weak and diminished reflexes
  4. gait typically weak
  5. short strides with feet under body
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11
Q

What is the cauda equina?

A

the nerve roots arising from the terminal part of the spinal cord–course caudally within the vertebral canal to exit the canal as a spinal nerve caudal to the vertebral body of same number

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12
Q

What does C6-T2 contain?

A

The neres of the brachial plexus innervating forelimb muscles

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13
Q

What does C6-T2 contain?

A

The nerves of the brachial plexus innervating forelimb muscles

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14
Q

What nerves/muscle/reflex does L456 contain/control/mediate

A

femoral nerve, quadraceps muscle, patellar reflex

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15
Q

What nerves/muscles/reflex does L6-S2 contain/control/mediate

A

sciatic nerve, flexor muscles of rear leg, withdrawal reflex

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16
Q

What does S1-S3 control?

A

anus, bladder

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17
Q

What does S1-S3 control?

A

anus, bladder

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18
Q

What are UMN responsible for?

A

initiation and continuatio nof movement and regulation of normal tone in extensor muscles of limbs

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19
Q

What is proprioception?

A

the ability to sense where the limbs are in space

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20
Q

Where do the long tracts cross the midline and what are the implications?

A

just above the brainstem. Lesions in the forebrain

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21
Q

Where do the long tracts cross the midline and what are the implications?

A

just above the brainstem. Lesions in the forebrain an diencephalon will cause UMN on the contralteral forelimb and rear limb while lesions of the brainstem or spinal cord will cause UMN signs in the limbs on the same side

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22
Q

What are UMN signs?

A
  1. paresis/paralysis
  2. loss of proprioception
  3. loss of coordination
  4. increased extensor tone
  5. increased reflexes
  6. basewide stance
  7. excessive limb abduction during turning
  8. long strides
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23
Q

What tracts are more superficial? more deep

A

proprioception–superficial, most susceptible to injury

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24
Q

What tracts are more superficial? more deep

A

proprioception–large, superficial, most susceptible to injury
motor–medium, deeper–less susceptible to injury
deep pain–small, wiry–very resistant to injury

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25
Q

What is the order of loss with a lesion compression the UMN tracts in the spinal cord

A
  1. conscious proprioception
  2. voluntary motion
  3. deep pain sensation
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26
Q

Distinguish UMN and LMN signs

  1. muscle tone
  2. spinal reflexes
  3. motor function
  4. muscle atrophy
  5. gait
  6. lesion
A
  1. UMN: normal or increased LMN: decreased
  2. UMN: normal or increased LMN: decreased
  3. UMN: spastic
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27
Q

Distinguish UMN and LMN signs

  1. muscle tone
  2. spinal reflexes
  3. motor function
  4. muscle atrophy
  5. gait
  6. lesion
A
  1. UMN: normal or increased LMN: decreased
  2. UMN: normal or increased LMN: decreased
  3. UMN: spastic paresis to paralysis caudal to lesions LMN: flaccid paresis to paralysis at site of lesion
  4. UMN: muscle atrophy mild from diffuse LMN: severe neurogenic muscle injury
  5. UMN: delayed protraction, stiff spastic long stride, ataxic, exessive abduction of limbs during turning; LMN: weak, unable to suppport weight short strided apperas lame, may bunny-hop
  6. UMN: above spinal cord segments; LMN: at spinal cord segments or nerve roots or peripheral nerves
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28
Q

What does change in mentation suggest?

A
  1. decreased levels of consciousness may occur during metabolic disturbance or disease of cerebrum
  2. change in mentation suggests lesion in cerebrum
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29
Q

What can weakness or paresis be caused by ?

A
  1. metabolic disturbances
  2. muscle disease
  3. LMN disease
  4. UMN disease–gait very different than LMN
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30
Q

What can weakness or paresis be caused by ?

A
  1. metabolic disturbances
  2. muscle disease
  3. LMN disease
  4. UMN disease–gait very different than LMN
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31
Q

What is ataxia or incoordination an indication of?

A

UMN disease. caused by lesion in cerebellum, vestibular system of general proprioceptive sensory tracts

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32
Q

What can circling be caused by?

A

lesions in the forebrain or ccestibular system.

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33
Q

What is ataxia?

A

loss of coordination of muscular function

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34
Q

What is spinal cord/brainstem proprioceptive ataxia?

A

animals lose awareness of where limbs are in space and have a wide brased stance, long strides, excessive abduction of limbs during turning and exaggerated limb movements. tend to scuff or knuckle

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35
Q

What is vestibular ataxia?

A

animals with vestibular lesions have a profound loss of balance with head tilt and wide based crouched stance with a tendency to lean, drift, fall or roll to the side. often accompanied by abnormal nystagmus. normal conscious proprioception if peripheral but may have deficits if is a brain stem lesions

36
Q

What is cerebellar ataxia?

A

inability to control rate, range and force of movement. animals have wide based stanec, sway from side to side and exaggerated (hypermetric) limb movements with normal strength. Knuckling, hopping remain normal. hypermetria of all 4 limbs results in goosestepping and may have intention tremor of head.

37
Q

What is cerebellar ataxia?

A

inability to control rate, range and force of movement. animals have wide based stanec, sway from side to side and exaggerated (hypermetric) limb movements with normal strength. Knuckling, hopping remain normal. hypermetria of all 4 limbs results in goosestepping and may have intention tremor of head.

38
Q

What are postural reactions?

A

complex series of responses that maintain an animal in an upright position

39
Q

what is postural reaction testing?

A

used to determine if an animal can recognize the position of their limbs in space (conscious proprioception)

40
Q

What are four postural reaction tests?

A
  1. proprioception (knuckling, placing)
  2. hopping
  3. wheelbarrowing
  4. hemi-walking
41
Q

What is the main purpose of assessing postural reactions?

A

being able to decide if each limb is neurologically normal or abnormal. if abnormal can use spinal reflexes and muscle tone/atrophy to definitively characterize each limb as having UMN or LMN disease

42
Q

What is the grading for spinal reflexes

A 
0-absent
1-diminished
2-normal
3-increased
4-clonus
43
Q

What is the grading for spinal reflexes

A 
0-absent
1-diminished
2-normal
3-increased
4-clonus
44
Q

What is the stimulus, response and SC segments of the thoracic limb withdrawal

A

pinch toe
withdraw limb
C6-T2

45
Q

What is the stimulus, response and SC segments of the patellar reflex?

A

tap patellar tendon
extend stifle
L456

46
Q

What is the stimulus, response and SC segments in the rear limb withdrawal

A

pinch toe

flex stifle and hock

47
Q

What is the stimulus, response and SC segments in the rear limb withdrawal

A

pinch toe

flex stifle and hock

48
Q

What is the stimulus, response and SC segments in the sciatic reflex?

A

tap on nerve between greater trochanter and ischium
flex stifle and hock
L6-7, S1-2

49
Q

What occurs with lesions in L4-S3?

A

LMN signs of rear limbs, diminished perineal sensations and reflexes
loss of sciatic nerve function
loss of perineal sensation and reflexes

50
Q

What occurs with lesions in S1-S3

A

normal patellar reflexes
loss of sciatic nerve function
loss of perineal sensation and reflexes

51
Q

What is seen in animals with muscle disease, incomplete postsynaptic NMJ blockade or severe metabolic disorders

A

generalized weakness with normal postural reactions, normal reflexes, no ataxia

52
Q

What is the panniculus/cutaneous trunci reflex used for?

A

to further localized severe spinal cord lesions in T3-L3. travels from the skin up spinal cord to C8-T1. If disrupted between stimulus and T1 then no twitch. Where you get a twitch is approx site of lesion

53
Q

Neck pain is common in what?

A

patients with meningitis

54
Q

How is superficial pain assessed?

A

by pinching skin with a hemostat

55
Q

how is deep pain assessed?

A

apply hemostat to nail base

56
Q

What happens if olfactory nerve is affected?

A

loss of ability to smell

57
Q

what happens if optic nerve is affected?

A

loss of vision, menace repsonse and pupillary light reflex

58
Q

what happens if occulomotor nerve is affeced?

A

dilated pupil, loss of pupillary light reflex

59
Q

what happens if trochlear nerve is affected

A

dorsomedial eye rotation

60
Q

What happens if the trigeminal nerve is affected?

A

dropped jaw (if bilateral motor) atrophy of tem

61
Q

What happens if the trigeminal nerve is affected?

A

dropped jaw (if bilateral motor) atrophy of temporalis and masseter muscles analgesia of face, nasal mucosa

62
Q

what happens if the abducent nerve is affected

A

medial strabismus, impaired lateral gaze

63
Q

What happens if the facial nerve is affected?

A

lip, eyelid, ear droop, can’t blink or retract lip

64
Q

What happens if the vestibulocochlear nerve is affected?

A

ataxia, head tilt, nystagmus, deafness

65
Q

What happens if the vestibulocochlear nerve is affected?

A

ataxia, head tilt, nystagmus, deafness

66
Q

what happens if the glossopharyngeal nerve is affected?

A

dysphagia, loss of gag reflex

67
Q

what happens if the vagus nerve is affected?

A

laryngeal paralysis, dysphagia, loss of gag reflex

68
Q

what happens if the accessory nerve is affected?

A

atrophy over trapezius, sternocephalicus, brachiocephalicus muscles

69
Q

what happens if the hypoglossal nerve is affected?

A

loss of tongue strength

70
Q

What are signs seen with central AND peripheral vestibular disease

A
  1. incoordination
  2. head tilt toward side of lesion
  3. falling/rolling toward side of lesion
  4. +/- ventral strabismus on side of lesion
  5. vomiting, salivation
  6. spontaneous nystagmus (fast phase away from lesion
  7. nystagmus may intensify with changes in body position
71
Q

What are signs seen with central AND peripheral vestibular disease

A
  1. incoordination
  2. head tilt toward side of lesion
  3. falling/rolling toward side of lesion
  4. +/- ventral strabismus on side of lesion
  5. vomiting, salivation
  6. spontaneous nystagmus (fast phase away from lesion
  7. nystagmus may intensify with changes in body position
72
Q

differentiate nyastagmus with peripheral and central vestibular disease

A

peripheral: horizontal or rotary
central: horizontal, rotary or vertical

73
Q

differentiate changes in nyastagmus with position changes (peripheral vs cental)

A

peripheral: no changes in nystagmus direction
central: direction may change direction as head position changes

74
Q

differentiate postural defects with peripheral and central vestibular disease

A

peripheral: postural reactions, proprioception normal
central: abnormal postural reactions and proprioception may be seen on side of lesion

75
Q

differentiate concurrent signs of other nerves with peripheral and central vestibular disease

A

peripheral: may have concurrent horners, cranial nerve 7 paralysis with involvement of middle/inner ear, other cranial nerves normal
central: multiple cranial nerve deficits are common

76
Q

What lesions can results in horner’s syndrome?

A
  1. central causes (rare): intracranial or cervical spinal cord lesion
  2. preganglionic: spinal cord T1-T3 lesion, brachial plexus avulsion, nerve root tumor, cranial mediastinal mass, cervical soft tissue neoplasia/trauma, skull base trauma
  3. postganglionic: otitis media/internal, neplasia in middle ear, retrobulbar injury, neoplasia
77
Q

Lesions in the forebrain cause

A
  1. seizures
  2. altered behavior
  3. altered mentation
  4. gait usually normal
  5. pacing or circling to side of lesion
  6. contralateral-blindness (normal pupils and light reflex), subtle deccrease in skin/nasal/facial sensation
    +- subtal postural reaction, proprioceptive defects on opposite side
    +- changes in appetite, thirst, temp, electrolyte and water balance
78
Q

Lesions in brainstem cause

A
  1. altered mental status (depression, stupor or coma)
  2. ipsilateral UMN hemiparesis or tetraparesis and ataxia
  3. postural reaction deficits ipsilateral limbs with normal or increased reflexes
  4. multiple ipsilateral cranial nerve deficits (3-12)
79
Q

With nyastagmus in vestibular system lesions, is the fast phase toward or away from the lesion?

A

away

80
Q

What do lesions in the cerebellum cause

A
  1. normal mental status
  2. cerebral ataxia: hypermetria
  3. normal strength
81
Q

What do lesions in the cerebellum cause

A
  1. normal mental status
  2. cerebral ataxia: hypermetria
  3. normal strength
  4. normal knuckling and hopping (hypermetic?)
  5. normal spinal reflexes
  6. ipsilateral menace response may be lost
  7. possible paradoxical vestibular syndrome: head tilt to opposite lesions, CP deficites on side of lesion
82
Q

What do lesions in the cerebellum cause

A
  1. normal mental status
  2. cerebral ataxia: hypermetria
  3. normal strength
  4. normal knuckling and hopping (hypermetic?)
  5. normal spinal reflexes
  6. ipsilateral menace response may be lost
  7. possible paradoxical vestibular syndrome: head tilt to opposite lesions, CP deficites on side of lesion
83
Q

What causes peracute, nonprogressive signs?

A
  1. external trauma
  2. hemorrhage/infact
  3. internal trauma (disk, fracture)
84
Q

What causes subacute progressive signs?

A
  1. infectious inflammatory disease
  2. noninfectious inflammatory disease
  3. rapidly growing tumors (lymphoma, metastatic neoplasia)
85
Q

What causes chronic progressive signs?

A
  1. most tumors

2. degenerative disorders

MI clinical exam and diagnosis (10 decks)

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