Neurology Flashcards
(155 cards)
1
Q
stroke definition
A
rapid onset neuro deficit of vascular origin
2
Q
Glabellar tap
A
confirmatory test of Parkinson’s
if tap patients forehead, eyes blink
3
Q
MSA symptoms
A
autonomic dysfunction
cerebellar dysfunction
rigidity > tremor
4
Q
PSP symptoms
A
vertical gaze palsy
postural instability
speech disturbance
5
Q
corticobasilar degeneration
A
unilateral parkinsonism
aphasia
alien limb phenomenon
6
Q
Parkinsonism Vs Parkinson’s
A
Parkinsonism: symmetrical, rapid progression, poor response to levodopa
Parkinson’s: asymmetrical, progressive nature, good response to Levodopa
7
Q
Parkinsonism symptoms
A
vascular (strokes)
idiopathic
AI encephalitis
Infective (Syphollis, HIV, CJD)
Congential e.g. Wilson’s
Drugs (antipsychotics)
8
Q
MS definition
A
AI demyelinating disorder of CNS, multiple plaques in separate time and space
9
Q
MG management
A
- long acting ACh-esterase inhibitors e.g. neostogmine
- immunosuppression: azothioprine
10
Q
ALS
A
mixed UMN/LMN
11
Q
PLS
A
UMN
12
Q
PMA
A
LMN
13
Q
PBP
A
bulbar
14
Q
investigations in MND
A
MRI brain +/- spinal cord
EMG
LP
15
Q
unilateral vs bilateral UMN lesion gait
A
UL = circumducting gait
BL = scissoring gait
16
Q
spasticity vs rigidity
A
spasticity = pyramidal
rigidity = extra-pyramidal
17
Q
pyramidal tracts
A
corticospinal tracts
corticobulbar tracts
18
Q
causes of cerebellar syndrome
A
- vascular: vertebrobasiliar stroke
- infection: encephalitis/abscess
- trauma: raised ICP
- AI: MS/ paraneoplastic
- Metabolic: ethanol/poisons
- Neoplastic: posterior fossa tumour
- congenital: spinocerebellar ataxia
19
Q
fast phase nystagmus
A
cerebellar = towards lesion
vestibular = away from lesion
20
Q
nystagmus maximal looking
A
cerebellar = towards lesion
vestibular = away from lesion
21
Q
zones of cerebellum and function
A
- spinocerebellum: movement and posture
- neocerebellum: motor planning
- vestibulocerebellum: balance and vision
22
Q
spinocerebellum problem presentation
A
truncal ataxia
23
Q
neocerebellum problem presentation
A
dysmetria
intention tremor
24
Q
vestibulocerebellum problem presentation
A
diplopia
nystagmus
25
Wallenberg's syndrome symptoms (My PANDAS)
Miosis (Horner's)
nYstagmus
Ptosis (Horner's)
Anhidrosis (Horner's)
Nystagmus
Dysphagia (ipsliateral)
Ataxia
Sensory loss of limb (contralateral)
26
3 causes of Marcus Gunn pupil
MS
Glaucoma
Retinal disease
27
Weber's syndrome
midbrain strokes
ipsilateral 3rd nerve palsy
contralateral hemiplegia
28
autonomic dysreflexia
usually spinal injuries above T6
lack if splanchnic outflow from T6-T12
29
causes of syringomyelia
affects spinothalamic tracts
- Chiari malformations
- Trauma
- Tumours
- Idiopathic
30
symptoms of syringomyelia
loss of sensation to pain and temp, especially in hands
progressive limb weakness and stiffness
31
management of synringomyelia
shunting
32
pre-ganlionic Horner's sx
anhidrosis of face
33
central Horner's sx
anhidrosis of face and trunk
34
post-ganglionic Horner's sx
no anhidrosis
35
central causes of Horner's
stroke
syringomyelia
sclerosis (multiple)
wallenburg's lateral meduallary syndrome
36
Pre-ganglionic causes of Horner's
Tumour (pancoast)
Thyroidectomy
Cervical Rubs
37
Post-ganglionic causes of Horner's
carotid artery dissection
cavernous sinus thrombosis
cluster headache
38
symptoms of degenerative cervical myelopathy
- pain in neck and limbs
- loss of ANS function
- loss of digital dexterity
- loss of sensory function and numbness
39
testing cerebellar dysfunction in upper limbs
tone
pronator drift
rebound phenomenon
coordination
40
cause of painful 3rd nerve palsy
posterior communicating artery aneurysm
41
ptosis and large pupil
3rd nerve palsy
42
ptosis and normal pupil
MG
43
ptosis and small pupil
Horner's
44
UMN motor pathway
motor cortex to anterior horn cell
45
LMN motor pathway
anterior horn cell to motor unit
46
if UMN signs, where could lesion be?
brain
brainstem (midbrain, pons, medulla)
spinal cord
47
if UMN/LMN signs, where could lesion be?
anterior horn cell
48
if sensory signs, where could lesion be?
DRG
49
if motor symptoms, where could lesion be?
NMG or muscle
50
what are the different sensory pathways?
proprioception
vibration sense
touch
pain and temp
51
posterior circulation stroke symptoms
diplopia
dysarthria
dizziness
dysphagia
52
lateral medullary syndrome symptoms
ipsilateral Horner's
ipsilateral sensory alteration of pain and temp
ipsilateral cerebellar ataxia
contralateral alteration of pain and temp (spinothalamic tract)
53
important parts to remember about status epilepticus
check BM
if poor nutrition/alcohol abuse - give Pabrinex
54
absence seizure EEG
3Hz
55
atonic sx and EEG
Sx: loss of tone
EEG: spikes
56
myoclonic sx and EEG
sx: jerking
EEG: spikes
57
investigations in epilepsy
eye witness account
examination
bloods
ECG, EEG
MRI brain
58
important parts of epilepsy management
safety advice: showers rather than bath, stop driving, inform DVLA
start treatment after 2 clearly unprovoked seizures >24 hrs apart
59
ALS symptoms
wasting and fasciculations
brisk reflexes and upgoing plantars
dyarthria and dysphagia
60
Bulbar palsy symptoms
dysarthria and dysphagia
limb involvement later
61
progressive muscular atrophy
pure LMN
62
primary lateral sclerosis
pure UMN
63
mimics of MND
syringomyelia
benign fasciculation syndrome
multifocal motor neuropathy
64
management of GBS
admit, early stages are unpredictable
spirometry
cardiac monitor
DVT prophylaxis
IVIg/plasma exchange
65
causes of predominantly sensory neuropathy
diabetes
thiamine def
malignancy
leprosy
amyloid
uraemia
66
causes of predominantly motor neuropathy
GBS
porphyria
diptheria
botulism
lead
67
Parkinson's disease features
gait
mask like face
bradykinesia
reduced arm swing
rigidity
asymmetric resting tremor
postural instability
tremor
autonomic dysfunction
68
MS differentials
neurosarcoidosis
neuromyelitis optica spectrum disorders
69
fundoscopy tips
- use R hand to examine R eye
- use L hand to examine L eye
70
MRC grading
0: no contraction
1: flicker or trace of contraction
2: active movement, with gravity eliminated
3: active movement against gravity
4: active movement against gravity and resistance
5: normal power
71
reflex nerve root
- biceps (C5, C6)
- supinator (C5, C6)
- triceps (C7)
- knee (L3-4)
- ankle (L5-S1)
72
dorsal columns function
fine touch
vibration
proprioception
73
lateral spinothalamic tract function
pain
temperature
74
lateral corticospinal tract function
motor
75
parietal lobe function
sensory cortex
body organisation
76
temporal lobe function
memory
77
patterns of motor deficits: corticol lesions
- hyperreflexia proximally in arm or leg
- unexpected patterns (e.g. all movements in hand/foot)
78
patterns of motor deficits: internal capsule/corticospinal lesions
- contralateral hemiparesis
79
patterns of motor deficits: lesion with decrease cognition/homonyous hemianopia
cerebral hemisphere
80
patterns of motor deficits: cord lesions
- quadriparesis/paraparesis
- motor and reflex level = LMN signs at level, UMN signs below
81
patterns of motor deficits: peripheral neuropathies
distal weakness
82
peripheral neuropathy with one nerve involved and causes
mononeuropathy
(trauma/entrapment)
83
peripheral neuropathy with several nerves involved and causes
mononeuritis multiplex
(vasculitis/DM)
84
UMN lesions affect what cells
motor cells in pre-central gyrus to anterior horn cells
85
UMN lesion signs
pyramidal weakness
no wasting
spasticity (inc tone +/- clonus)
hyperreflexia
upgoing plantar
86
LMN lesions affect what cells
anterior horn cells to peripheral nerves
87
LMN lesion signs
wasting
fasciculation
flaccid/ dec tone
hyporeflexia
down going plantars
88
primary muscle lesions signs
symmetrical loss
reflexes lost later
no sensory loss
fatiguability in MG
89
sensory deficits pattern: distal sensory loss cause
neuropathy
90
sensory deficits pattern: sensory level cause
cord lesion
hemi-cord lesion = Brown-Sequard
91
sensory deficits pattern: dissociated sensory loss and cause
e.g. cervical cord lesion (Syringomyelia)
selective loss of pain and temp
(conservation of proprioception and vibration)
92
muscle weakness differentials if caused by problem with cerebrum/ brainstem
- vascular (infarct/haemorrhage)
- inflammation (MS)
- SOL
- infection (enceph, abscess)
93
muscle weakness differentials if caused by problem with cord
- vasc (ant spinal artery infarction)
- inflammation (MS)
- injury
94
muscle weakness differentials if caused by problem with anterior horn
MND
Polio
95
muscle weakness differentials if caused by problem with roots/plexus
- spondylosis
- CES
96
muscle weakness differentials if caused by problem with motor nerves
- mononeuropathy e.g. compression
- polyneuropathy e.g. GBC
97
muscle weakness differentials if caused by problem with NMJ
GB
LEMS
Botulism
98
muscle weakness differentials if caused by problem with muscle
toxins = steroids
myositis
inherited (DMD)
99
hand wasting differentials if caused by problem with cord
MND
Polio
Syringomyelia
100
hand wasting differentials if caused by problem with Roots
(C8,T1)
compression e.g. spondylosis
101
hand wasting differentials if caused by problem with brachial plexus
compression (cervical ribs, Pancoast)
Klumpke's
102
hand wasting differentials if caused by problem with Neuropathy
mononeuritis = DM
compressive mononeuropathy = median/ulnar
103
hand wasting differentials if caused by problem with muscle
- disuse (RA)
- compartment syndrome
- distal myopathy
- cachexia
104
gait disturbance with basal ganglia problem and causes
festinating/shuffling
- PD
- Parkinsonism (MSA, PSP, Lewy body dementia)
105
gait disturbances with UMN bilateral lesion and cause
spastic, scissoring
- cord (compression, trauma, syringomyelia)
- bihemispheric (CP, MS)
106
gait disturbances with UMN unilateral lesion and cauuse
spastic circumducting
- hemisphere lesion: CVS, MS, SOL
- hemicord: MS, tumour
107
gait disturbances with LMN bilateral lesion and cause
bilateral foot drop
- polyneuropathy: CMT, GBS
- cauda equina
108
gait disturbances with LMN unilateral lesion and cause
foot drop - high stepping gait
- anterior horn: polio
- radicular: L5 root lesion
- sciatic/common peroneal nerve: trauma, DM
109
TACS diagnostic requirements
all 3 of:
1. Hemiparesis (contralateral)
2. Homonymous hemaniopia (contralateral)
3. Higher corticol dysfunction (dysphagia, neglect)
110
PACS vs TACS
PACS only needs 2/3
111
cause of lacunar stroke
small infarcts around basal ganglia, internal capsule, thalamus, pons
112
symptoms of lacunar stroke
absence of:
higher corticol dysfunction
homonymous hemianopia
brainstem signs
113
stroke secondary prevention
clop 75mg started after 2 weeks
(initially 300mg aspirin)
114
stroke extra management points
MDT
safe eating
neuro rehab
DVT prophylaxis
sores
115
subdural appearance on CT head
crescentic haematoma over one hemisphere
116
extradural appearance on CT head
lens shaped haematoma
117
Kernig's sign
straightening leg with hip at 90 degrees = pain
118
Brudzinki's sign
lifting head = lifting of legs
119
when to give dexamethasone in meningitis?
bacterial
120
definition of epilepsy
recurrent tendency to spontaneous, intermittent abnormal electrical activity in brain
121
causes of epilepsy
idiopathic
acquired:
- vascular (CVA, SOL)
- corticol scarring (trauma, infection)
122
neuro obs
GCS
pupils
HR
BP
RR
SpO2
Temp
123
important to remember with CN6 palsy
false localising sign
124
what is neuroprotective ventilation?
hyperventilate
125
what worsens the Parkinson's tremor?
worsened by distraction
126
what are the features of Parkinsons?
- tremor (worse at rest)
- rigidity (inc tone = lead pipe, rigidity + tremor = cog wheeling)
- bradykinesia (slow initiation of movement, hypomemetic face)
- reduced arm swing
127
what Parkinson's meds to start if young and fit?
start with Da agonists, MOA-B inhibitors, L-DOPA
128
What Parkinson's meds to start if biologically frail +/- co-morbidities?
L-DOPA, MOA-B inhibitors
129
benefit of COMT inhibitors
lessen end of dose effect
130
Lhermitte's sign
neck flexion = electric shock in trunk/limbs
131
treatment of MS
IFN-beta
Natalizuman
132
cord compression signs
LMN signs at level
UMN signs below level
acute: tone and reflexes reduced
133
what is spondylosis?
degeneration due to trauma or ageing
134
symptoms of cervical spondylosis
neck stiffness
arm pain
motor/sensory upper limb disturbances according to compression level
135
symptoms of lumbar spondylosis
low back pain
sciatica
136
what are the most commonly compressed nerve roots
L5/S1
137
L5 root compression symptoms
weak toe extension
foot drop
weak inversion
decreased sensation on inner dorsum
138
S1 root compression symptoms
weak plantar flexion and eversion
loss of ankle jerk
calf pain
139
systemic causes of facial nerve palsy
GBS
sarcoid
DM
140
definition of mononeuritis multiplex
2+ peripheral nerves affected
141
median nerve (C6-T1)
- location
- motor function
- sensory loss
- wrist: carpal tunnel/trauma
- motor function: LLOAF muscles, thenar wasting
- sensory loss: radial 3.5 fingers
142
ulnar nerve (C7-T1)
- location
- motor function
- sensory loss
- elbow trauma (e.g. supracondylar fracture)
- motor: claw hand, hypothenar wasting
- sensory: ulnar 1.5 fingers
143
radial nerve (C5-T1)
- location
- motor function
- sensory loss
- damaged at wrist (low), humerus (high) and axilla (very high)
Motor:
- low = finger drop
- high = wrist drop
- v high = triceps paralysis, wrist drop
sensory: snuff box
144
phrenic nerve (C3-C5)
- location
- motor function
- neoplastic (lung Ca, myeloma), mechanical (cervical spondylosis), infective (HIV, TB)
- motor: orthopnoea and raised hemidiaphragm
145
Lateral cutaneous nerve of thigh (L2-3)
- location
- sensory loss
- entrapment under inguinal ligament
- sensory: meralgia paraesthetica (anterolateral burning thigh pain)
146
sciatic nerve (L4-S3)
- pelvic tumours, pelvic fractures
- motor: hamstrings, all muscles below knee
- sensory: below knee laterally and foot
147
common peroneal nerve (L4-S1)
- location
- motor function
- sensory loss
- fibular head trauma/sitting cross legged
- motor: foot drop, weak ankle dorsiflexion and eversion
- sensory: below knee laterally
148
Tibial nerve (L4-S3)
- motor function
- sensory loss
- motor: can't plantar flex, poor toe flexion
- sensory: sole of foot
149
GBS management
Airwary
Analgesia
Autonomic (may need catheter)
Antithrombotic (TEDS, LMWH)
150
Charcot-Marie-Tooth symptoms
peroneal muscular atrophy
Hereditary motor and sensory neuropathy
151
MND diagnostic criteria
El Escorial
152
where is lesion in ALS
loss of motor neurones in cortex and anterior horn
153
symptoms of myopathy
- gradual onset
- symmetrical proximal weakness
- preserved tendon reflexes
154
NF1 symptoms
CAFE NOIR
Cafe au lait spots
Axillary freckling
Fibromas (Neuro)
Eye (Lisch nodules)
Neoplasia (CNS, phaeo)
Orthopaedic (Kyphoscolisosi)
dec IQ and epilepsy
Renal (inc BP)
155
causes of peripheral neuropathy
ABCDE
Alcohol
B12 deficiency
Cancer and Chronic Kidney Disease
Diabetes and Drugs (e.g. isoniazid, amiodarone)
Every vasculitis
