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NEUROLOGY 2 Flashcards

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1
Q

Why are brain tumours not benign or malignant?

A

Even benign tumours if they continue to grow can cause adverse effects of any space occupying lesion

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2
Q

What are high and low grade tumours?

A

High - rapid growing, aggressive

Low - slow growing but may/may not be able to be treated

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3
Q

Main causes of space occupying lesions? (6)

A 
Tumour - primary or metastatic
Aneurysm
Abscess
Chronic subdural haematoma
Granuloma
Cyst
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4
Q

Main types of primary brain tumours? (5)

A

Gliomas - Astrocytoma, Ependymoma, Oligodendroglioma, Glioblastoma multiforme
Meningioma

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5
Q

Signs of increased ICP? (6)

A 
Headache worse on waking, lying down, coughing
Vomiting
Papilloedema
Decreased GCS
Seizures
Focal neurology
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6
Q

What 3 primaries do brain metastases usually come from?

A

Breast
Lung
Melanoma

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7
Q

Tests for SOLs?

A

CT/MRI
Possible biopsy
Avoid LP until diagnosed as coning risk

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8
Q

Management of brain tumours? (6)

A

If benign remove if accessible
If malignant accessible - excise, chemo-radiotherapy
If inaccessible - chemo-radiotherapy
If hydrocephalus/oedema - ventriculo-peritoneal shunt, dexamethasone/mannitol
Anticonvulsants
Temozolomide for glioblastomas

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9
Q

How do SOLs exert their effects? (3)

A

1) Direct mass effect - local function impaired; symptoms depend on site; 2) Secondary effects - raised ICP/shift of intracranial structures; 3) Provoke focal > generalized seizures

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10
Q

What are astrocytomas?

A

Tumours of astrocytes - support cells, blood brain barrier cells
Low grade - pilocytic
High grade - glioblastoma multiforme

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11
Q

What are oligodendrogliomas?

A

Tumours of oligodendrocytes - myelin producing cells

Slow growing

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12
Q

What are meningiomas?

A

Tumours of arachnoid mater, slow growing

Penetrate venous sinuses

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13
Q

What is MND?

A

Motor neurone disease
Cluster of degenerative diseases characterised by selective loss of neurons in the motor cortex, cranial nerve nuclei and anterior horn cells

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14
Q

How to distinguish MND from MS, MG?

A

MND has no sensory loss or sphincter disturbance unlike MS

MND never affects eye movements unlike MG

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15
Q

What are the types of MND?

A

ALS (amyotrophic lateral sclerosis)
Progressive bulbar palsy
Progressive muscular atrophy
Primary lateral sclerosis

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16
Q

What is ALS?

A

50% of MND
Loss of motor neurons in motor cortex and anterior horn of the cord
Weakness and upper motor neuron signs
Lower motor neuron wasting/fasciculation

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17
Q

What is progressive bulbar palsy?

A

Only affects cranial nerves 9-12
LMN lesion of tongue - flaccid, fasciculating
Quiet/hoarse speech

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18
Q

What is progressive muscular atrophy?

A

Anterior horn cell lesion only, no UMN signs

Affects distal muscles then proximal

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19
Q

What is primary lateral sclerosis?

A

Loss of Betz cells in motor cortex
Mainly UMN signs
Marked spastic leg weakness
Pseudobulbar palsy - UMN lesion of swallowing/talking muscles

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20
Q

Classic presentation of MND?

A 
>40 years old
spastic gait
Foot drop, proximal myopathy
Weak grip
Shoulder abduction
Aspiration pneumonia
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21
Q

What are some UMN signs?

A

Spasticity
Brisk reflexes
Upgoing plantas

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22
Q

What are some LMN signs?

A

Wasting
Fasciculation
Weakness i.e. of swallowing

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23
Q

Diagnosis of MND?

A

Clinical
Brain/cord MRI to exclude structural causes
LP to exclude inflammatory causes

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24
Q

Prognosis of MND?

A

Fatal within 2-4 years

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25
Treatment of MND? (5)
MDT approach - palliative nurse, physio, OT, SALT Riluzole (antiglutamatergic) prolongs life by 3 months NG tube/PEG Analgesia for joint pain Non-invasive ventilation for sleep apnoea
26
Which types of MND have the best and worse prognosis?
Best - progressive muscular atrophy | Worst - progressive bulbar palsy
27
What causes MND?
Unknown | Associated with some gene mutations - SOD1, C9orf72, TARDBP
28
What is MS?
Multiple sclerosis | Chronic autoimmune T cell mediated inflammatory disorder of the CNS
29
Pathology of MS?
Discrete plaques of demyelination occur at multiple CNS sites From T cell mediated immune response in white matter Demyelination heals poorly - relapsing and remitting Prolonged demyelination causes axonal loss - progressive
30
Where is MS more common?
Temperate northern areas i.e. Britain, Scandinavia | Migrants take risk with them, children acquire risk of where they settle
31
Possible risk factors for MS? (4)
Country you live in Lack of exposure to sunlight/vitamin D Possibly viral infections such as EBV, HHV6 if exposed at critical times in development Presents between 20 and 40
32
Types of MS? (3)
Relapsing remitting (90%) - attacks of symptoms followed by complete/incomplete recovery, on average 1 relapse a year Secondary progressive - late stage, gradually worsening disability, normally follows 30-40yrs of relapsing remitting Primary progressive - least common, gradually worsens with no remission
33
Presentation of MS? (4)
``` Usually monosymptomatic Unilateral optic neuritis - pain on eye movement, decrease in vision Numbness/tingling in limbs Leg weakness Brainstem/cerebellar - diplopia/ataxia ```
34
What is Uhtoff's phenomenon?
Decreased vision gets worse in heat i.e. in a hot bath, on exercise
35
Other symptoms of MS? (7)
``` Decreased vibration sense Trigeminal neuralgia Spastic weakness Swallowing disorders Cognitive decline Erectile dysfunction Incontinence ```
36
How is MS diagnosed? (4)
Lesions disseminated in time and space, unattributable to other causes MRI for plaque detection CSF shows oligoclonal bands of IgG not present in serum Delayed visual, auditory, sensory evoked potentials
37
How is MS treated? (5)
``` Decrease stress Give vitamin D if deficient Methylprednisolone for 3 days to shorten relapses Interferons decrease relapses Alemtuzamab acts against T cells ```
38
Palliation for MS? (3)
Baclofen/diazepam for spasticity Botulinum toxin for tremor Tolterodine for urinary symptoms
39
What is epilepsy?
Tendency to spontaneous, intermittent, abnormal electrical activity in part of the brain manifesting as seizures
40
What are convulsions?
Motor signs of electrical discharges
41
What is a prodrome?
Change in mood or behaviour that precedes the seizure, may last hours or days
42
What is the aura?
Part of the seizure which the patient is aware of and may precede its other manifestations May be an experience of deja vu, strange smells or flashing lights
43
Give some post ictal symptoms? (6)
``` Headache Confusion Myalgia Sore tongue Weakness Dysphasia ```
44
Cause of epilepsy?
2/3 idiopathic, may be familial Cortical scarring - head injury, developmental problems, SOL, stroke, vascular malformations Sarcoidosis SLE
45
Give some non epileptic causes of seizures? (6)
``` Trauma Stroke Haemorrhage Increased ICP Alcohol/benzo withdrawal Metabolic disturbance - low oxygen, hypo/hypernatraemia, hypo/hypercalcaemia, hypo/hyperglycaemia Infection - meningitis, encephalitis ```
46
Triggers of epileptic seizures? (6)
``` Alcohol Stress Infection Certain sounds Flickering lights Reading/writing ```
47
Investigations of seizures? (5)
``` Bloods (infection) Drugs screen LP EEG CT/MRI ```
48
Advice to give in epilepsy?
Dangers of swimming, driving | Avoid driving until seizure free for >1 year - tell DVLA
49
What are partial (focal)seizures?
Focal onset seizures with features referable to a part of one hemisphere More related to structural problem
50
How are partial seizures classified?
Simple partial seizure Complex partial seizure Partial seizure with secondary generalisation
51
What is a simple partial seizure? (2)
Unimpaired awareness, with focal motor/sensory/autonomic or psychic symptoms No post ictal symptoms
52
What is a complex partial seizure? (5)
``` Impaired awareness May have an aura Most arise from temporal lobe Automatisms - lip smacking, wandering Post ictal confusion common if temporal, rapid recovery if frontal ```
53
What is a partial seizure with secondary generalisation? (2)
Seizure starts focally as simple/complex partial seizure | Spreads causing secondary generalised seizure which is typically convulsive
54
What are primary generalised seizures?
Simultaneous onset of electrical discharge throughout the cortex with no localising features referable to only one hemisphere
55
How are generalised seizures classified?
``` Absence seizures - petit mal Tonic clonic seizures - grand mal Myoclonic seizures Atonic seizures Infantile spasms ```
56
What are absence seizures? (2)
Brief <10s pauses, such as stopping talking mid sentence then carries on after Presents in childhood
57
What are tonic clonic seizures? (4)
Loss of consciousness Limbs stiffen (TONIC) Limbs jerk (CLONIC) Post ictal confusion and drowsiness
58
What are myoclonic seizures? (3)
Sudden jerk of a limb, trunk or face Patient may be thrown suddenly to ground Have one violently disobedient limb
59
What are atonic seizures?
Sudden loss of muscle tone causing a fall, no loss of consciousness
60
What are features of a temporal partial seizure? (7)
``` Automatisms - lip smacking, fumbling Abdominal rising sensation/pain Dysphasia Memory phenomena - deja vu, jamais vu Emotional disturbance Hallucinations of smell/taste/hearing Delusional behaviour ```
61
What are features of a frontal partial seizure? (5)
Motor features - posturing (involuntary flexion or extension), movements of head/eyes, peddling of the legs Jacksonian march - spreading focal motor seizure with retained awareness Motor arrest Behavioural disturbances Dysphasia
62
What are features of a parietal partial seizure?
Sensory disturbance - tingling, numbness | Motor symptoms
63
What are features of an occipital partial seizure?
Visual phenomena - spots,flashed, lines
64
What is Todd's palsy?
Transient neurological deficit (paresis) after a seizure Face, arm or leg weakness Aphasia or gaze palsy Lasts from 30min to 36hr
65
When are medications offered for epilepsy?
After the 2nd fit | After the 1st fit if high risk of recurrence - i.e. focal deficit, structural abnormality
66
What is used to treat generalised tonic clonic seizures?
1st line - Sodium valproate or Lamotrigine | 2nd line - carbamazepine
67
What is used to treat absence seizures?
Sodium valproate or lamotrigine
68
What is used to treat tonic, atonic and myoclonic seizures?
Sodium valproate of lamotrigine | Carbamazapine may make worse
69
What is used to treat partial seizures? +/- secondary generalisation
1st line - carbamazepine 2nd line - sodium valproate, lamotrigine Others - levetiracetam, phenytoin, gabapentin
70
How should medications be prescribed in epilepsy? (3)
Build up dose over 2/3 months until seizures controlled or side effects are too bad or max dose If ineffective/not tolerated switch to next line Withdraw 1st drug when established on the 2nd Dual therapy rare
71
What is medications for epilepsy don't work?
Neurosurgical resection if cause such as tumour,sclerosis Vagal nerve stimulation MDT management - relaxation training, epilepsy nurse
72
Reccommendations for pregnant women with epilepsy?
Take folic acid | Avoid sodium valproate - use lamotrigine, can breastfeed
73
How does lamotrigine work? 3 side effects
Sodium channel blocker | Maculopapular rash, hypersensitivity i.e. photo, double/blurred vision
74
How does sodium valproate work? 3 side effects
Sodium channel blocker, potentiates GABA | Weight gain, ataxia, teratogenic
75
How does carbamazepine work? 3 side effects
Increases refractory period of sodium channel Potentiates GABA Leucopaenia, double/blurred vision, drowsy
76
What is status epilepticus?
Seizures lasting >30min or repeated seizures without regaining consciousness
77
Complications of status epilepticus?
Death Permanent brain damage Risk increases with length of seizure
78
When should status epilepticus be treated?
Seizures over 5 min, try to terminate before 20 min
79
Treatment of status epilepticus? (7)
Maintain airway, intubate if needed, oxygen IV access and take blood Slow IV bolus lorazepam 2nd dose lorazepam if no response in 10 min If no response, phenytoin infusion If no response, diazepam infusion General anaesthesia last resort
80
What is NEAD?
Non epileptic attack disorder
81
How to distinguish NEAD from epilepsy?
``` Non-neuroanatomically accurate convulsions Wild shaking or completely still Arms flexing and extending Pelvic thrusting, arched back Wax and wane Eyes closed firmly Move away from you May be aware, won't lose sats etc Recovery quick, emotionally distressed Background of MUS, abuse ```
82
What is mononeuropathy?
Lesion of an individual peripheral or cranial nerve
83
What usually causes mononeuropathies?
Local causes such as trauma, entrapment
84
What is mononeuritis multiplex?
2 or more peripheral nerves affected, causes tend to be systemic
85
Causes of mononeuritis multiplex?
Wegeners, AIDS, Rheumatoid, Diabetes, Sarcoidosis
86
What is the commonest mononeuropathy?
Carpal tunnel syndrome
87
What is carpal tunnel syndrome?
Compression of the median nerve causing pain and paraesthesia in the hand
88
What is the carpal tunnel?
Passageway in the wrist containing 9 tendons and the median nerve, covered with the flexor retinaculum
89
What does the median nerve supply?
LOAF - lumbricals, opponens pollicis, abductor pollicis brevis, flexor pollicis brevis Sensory innervation to palmar side of thumb, index, middle fingers
90
Spinal roots of median nerve?
C6-T1
91
Causes of carpal tunnel syndrome?
``` Myxoedema Enforced flexion Diabetic neuropathy Idiopathic Acromegaly Neoplasms Tumours - benign Rheumatoid arthritis Amyloidosis Pregnancy Sarcoidosis ```
92
Symptoms of carpal tunnel syndrome? (6)
``` Aching pain in hand worse at night Paraesthesia in tumb, index, middle finger Pain relieved by shaking hand Sensory loss Weakness of abductor pollicis brevis Wasting of thenar eminence ```
93
Tests for carpal tunnel syndrome? (3)
Neurophysiology Phalens test - maximal wrist flexion may elicit symptoms Tinels test - tapping the nerve over the wrist induces tingling
94
Treatment of carpal tunnel syndrome? (3)
Splinting Local steroid injection Decompression surgery
95
What is the ulnar nerve root?
C7-T1
96
Cause of ulnar nerve mononeuropathy?
Elbow trauma
97
Presentation of ulnar nerve mononeuropathy?
Weakness of the ulnar side wrist flexors, interossei so can't cross fingers, and medial 2 lumbricals = claw hand, weak little finger abduction Sensory loss of ulnar 1.5 fingers
98
What is the radial nerve root?
C5-T1
99
Cause of radial nerve mononeuropathy?
Compression against humerus
100
Presentation of radial nerve mononeuropathy?
Can't extend wrist and fingers Muscles - brachioradialis, extensors, supinator, triceps Sensory loss lateral dorsum of hand, anatomical snuffbox
101
What is the root of the brachial plexus?
C5-T1
102
Cause of brachial plexus damage?
Trauma Radiotherapy Heavy rucksack Thoracic outlet compression
103
Presentation of damaged brachial plexus?
Pain/paraesthesia and weakness, variable distribution
104
What is the root of the phrenic nerve?
C3,4,5 keep the diaphragm alive
105
Cause of damaged phrenic nerve?
Lung cancer, cervical spondylosis/trauma, thoracic surgery, HIV, TB
106
Presentation of damaged phrenic nerve?
Orthopnoea with raised hemidiaphragm on x ray
107
What is the root of the lateral cutaneous nerve of the thigh?
L2-L3
108
What is meralgia parsaesthetica?
Anterolateral burning thigh pain from entrapment under the inguinal ligament
109
What is the root of the sciatic nerve?
L4-S3
110
What causes damage to the sciatic nerve?
Pelvic tumours or fractures to pelvis or femur
111
Presentation of damaged sciatic nerve?
Foot drop - affects hamstrings and all muscles below the knee Loss of sensation below the knee laterally
112
What is the root of the common peroneal nerve?
L4-S1
113
What causes damage to the common peroneal nerve?
Trauma | Sitting cross legged
114
Presentation of damaged common peroneal nerve?
Foot drop Weak ankle dorsiflexion/eversion Sensory loss over dorsum of foot
115
What is the root of the tibial nerve?
L4-S3
116
Presentation of damaged tibial nerve?
Inability of plantarflexion, foot inversion, toe flexion | Sensory loss over sole of foot
117
What are the cranial nerves?
12 nerves that emerge directly from the brain/brainstem
118
Name the cranial nerves
``` I - olfactory II - optic III - oculomotor IV - trochlear V - trigeminal (opthalmic maxillary mandibular) VI - abducens VII - facial VIII - vestibulocochlear IX - glossopharyngeal X - vagus XI - accessory XII - hypoglossal ```
119
How does CNI lesion present?
Anosmia
120
Causes of CNI lesion? (3)
Trauma URTI Meningitis
121
How does CNII lesion present?
Low visual acuity Visual field defect Pupil defect - size, symmetry, light reaction, accommodation
122
Causes of CNII lesion? (6)
``` MS GCA Optic chiasm compression Stroke Raised ICP Diabetes ```
123
How dies CNIII lesion present?
Eyes go down and out due to unopposed CNIV/VI action
124
Causes of CNIII lesion?
MS Diabetes GCA Posterior communicating artery aneurysm
125
How does CNIV lesion present?
Diplopia on looking down
126
Causes of CNIV lesion?
Rare - orbit trauma
127
How does a CNVI lesion present?
Horizontal diplopia on looking out
128
Causes of a CNVI lesion? (3)
MS Wernickes Pontine stroke
129
How does a CNV lesion present?
Open jaw deviates to side of lesion Trigeminal neuralgia Cluster headache
130
Causes of CNV lesion? (3)
Stroke Trigeminal neuralgia Herpes zoster
131
How does CNVII lesion present?
Facial droop, weakness | Loss of taste in anterior 2/3 tongue
132
Causes of CNVII lesion? (3)
Bells palsy - unilateral LMN lesion Skull fracture Stroke
133
How does CNVIII lesion present?
Abnormal Webers/Rinnes test - hearing problems | Dizziness
134
Causes of CNVIII lesion?
Noise damage Acoustic neuroma Herpes zoster
135
How does CNIX lesion present?
Loss of taste posterior 1/3 of tongue | Absent gag reflex
136
How does CNX lesion present?
Absent gag reflex Raised BP, HR Hoarse voice
137
Cause of CNIX/X/XI lesions?
Trauma Brainstem lesions Neck tumour
138
How does CNXI lesion present?
Can't shrug shoulders or turn neck against resistance
139
How does CNXII lesion present?
Tongue deviates to side of lesion | Tongue fasciculation
140
What causes CNXII lesion?
Rare - polio, stroke, tumour, bulbar palsy, trauma
141
What is the difference between mononeuropathy and radiculopathy?
Mononeuropathy affects nerve itself | Radiculopathy affects nerve root
142
What is a radiculopathy?
Pinched nerve root causing radicular pain (pain along dermatome)
143
Presentation of radiculopathy?
Dermatomal pain - sharp/shooting Dull reflexes Numbness, tingling, pain
144
What nerve roots are usually affected in radiculopathy in upper and lower limbs?
Commonly from cervical spine Upper C6 C7 Lower L5 S1
145
Causes of radiculopathy?
Degenerative disc disease Osteoarthritis Facet joint hypertrophy or degeneration Ligament hypertrophy
146
What is sciatica?
Leg pain from lower back, often caused by spinal disc herniation compressing nerve root
147
Compression of which nerve roots can cause sciatica? (ie what are the roots of the sciatic nerve)
L4, L5 | S1, S2, S3
148
How is sciatica treated?
Spontaneous resolve for a lot of disc herniations NSAIDs Discectomy
149
What is peripheral neuropathy?
Condition of peripheral or cranial nerves causing motor/sensory symptoms
150
Difference between mononeuropathy, mononeuritis multiplex and polyneuropathy?
Mononeuropathy is neuropathy affecting only 1 nerve MM is 2 or more separate nerves in disparate areas Polyneuropathy is multiple nerves involved in roughly the same areas on both sides of the body
151
Classification of peripheral neuropathy?
Course - Acute or chronic Function - Sensory, motor, autonomic or mixed Pathology - demyelination, axonal degeneration, both
152
Causes of mostly motor peripheral neuropathies? (3)
Guillain Barre Lead poisoning Charcot Marie Tooth syndrome
153
Causes of mostly sensory peripheral neuropathies? (3)
Diabetes mellitus Renal failure Leprosy
154
Medication causes of peripheral neuropathies?
``` Alcohol Isoniazid Phenytoin Metronidazole Nitrofurantoin Cisplatin Vincristine ```
155
Metabolic causes of peripheral neuropathies?
Diabetes Renal failure Hypothyroid Hypoglycaemia
156
Vasculitis causes of peripheral neuropathies?
Polyarteritis nodosa Rheumatoid arthritis Wegeners granulomatosis
157
Malignant causes of peripheral neuropathy?
Polycythaemia rubra vera | Paraneoplastic syndrome
158
Inflammatory causes of peripheral neuropathy?
Guillain Barre syndrome | Sarcoidosis
159
Infective causes of peripheral neuropathy?
Leprosy HIV Syphilis Lyme
160
Nutritional causes of peripheral neuropathy?
``` Low B1 Low B12 Low vit E Low folate High B6 ```
161
Symptoms of sensory neuropathy? (5)
``` Numbness Paraesthesia Burning Glove and stocking distribution affecting extremities first Signs of trauma on hands ```
162
Symptoms of motor neuropathy? (6)
``` Weak/clumsy hands Difficulty walking Falls, stumbles Difficulty breathing Wasting/weakness in distal muscles of hands/feet causing foot or wrist drop Reduced/absent reflexes ```
163
Symptoms of autonomic neuropathy?
``` Constipation/urinary retention - parasympathetic Erectile dysfunction - parasympathetic Ejaculatory failure - sympathetic Postural hypotension - sympathetic Sweating - sympathetic Horners syndrome - sympathetic ```
164
Tests in peripheral neuropathy? (6)
``` Bloods inc TSH, B12, glucose Plasma antibodies, electrophoresis CXR Urinalysis Possible LP or specific genetic tests Nerve conduction to distinguish axonal from demyelinating ```
165
Management of peripheral neuropathy? (6)
Treat cause Physio and OT Foot care Immunoglobulin i.e. for GBS Steroids/immunosuppressants for vasculitis Amitriptyline, gabapentin, pregabalin for pain
166
How does cord compression usually present?
Weak legs
167
Symptoms of cord compression? (3)
Spinal/nerve root pain may precede Leg weakness, possible less severe arm weakness Bladder and anal sphincter involvement - late sign - hesitancy, frequency, retention
168
Pattern of symptoms in cord compression?
Normal above the level of the lesion LMN signs at the level UMN signs below the level
169
Causes of cord compression? (3)
Secondary malignancy in the spine Infection - epidural abscess Disc prolapse
170
Investigations of cord compression? (4)
MRI spine Biopsy/surgical exploration if mass Screening bloods - infection markers, B12, syphilis, serum electrophoresis CXR
171
Treatment of cord compression?
If malignancy - dexamethasone, radio/chemotherapy, decompressive laminectomy If infection, decompress and antibiotics
172
Difference between cauda equina and higher spinal cord lesions?
Cauda equina - leg weakness is flaccid and areflexic, not spastic and hyperreflexic
173
What is cauda equina syndrome?
Compression of the nerves that form the cauda equina (from L2 down)
174
Causes of cauda equina syndrome?
Same as cord compression - metastases, infection, disc prolapse Lumbar disc disease and lumbosacral nerve lesions
175
Symptoms of cauda equina syndrome? (5)
Back pain and radicular pain down legs Asymmetrical, atrophic, areflexic paralysis of the legs Sensory loss in root distribution - perineum Sexual dysfunction Decreased sphincter tone
176
Investigations for cauda equina?
MRI spine
177
Management of cauda equina syndrome?
Urgent surgical decompression | Antiinflammatory agents/antibiotics if needed
178
What is anterior cord syndrome?
Complete motor loss below the lesion Loss of pain and temperature perception Sensation preserved
179
What causes anterior cord syndrome?
Ischaemia of the anterior spinal artery - loss of function of the anterior 2/3 of the spinal cord
180
What is Brown Sequard syndrome?
Damage to one half of the spinal cord resulting in paralysis and loss of proprioception on the ipsilateral side, and loss of pain and temperature contralaterally
181
What are the 3 sensory (ascending) tracts of the spinal cord?
Dorsal column-medial lemniscus tract - proprioception and vibration Anterolateral system - pain and temperature Spinocerebellar pathways - unconscious proprioception
182
What are the tracts in the DCML system?
The gracile fasciculus and the cuneate fasciculus
183
What are the tracts in the ALS system?
Spinothalamic Spinoreticular Spinotectal
184
What are the tracts in the spinocerebellar system?
Posterior, anterior and rostral spinocerebellar | Cuneocerebellar
185
What are the 2 motor (descending) tracts of the spinal cord?
Pyramidal tracts - voluntary movement | Extrapyramidal tracts - involuntary movement
186
What are the tracts in the pyramidal system?
Corticospinal | Corticobulbar
187
What are the tracts in the extrapyramidal system?
Tectospinal Vestibulospinal Recticulospinal Rubrospinal
188
What is myelopathy?
Injury to the spinal cord due to severe compression that may result from trauma, stenosis, disc herniation, neoplasm
189
What may cause a brain abscess?
Infection - ear, sinus, dental Skull fractire Congenital heart disease/endocarditid Bronchiectasis
190
Signs of brain abscess? (6)
``` Increased ICP Fever Increased WCC Seizures Coma Signs of sepsis ```
191
Investigations of brain abscess?
CT/MRI - ring enhancing lesion Bloods - WCC, ESR Biopsy
192
Treatment of brain abscess?
Treat increased ICP | ANTIBIOTICS
193
What is myopathy?
Disease of muscle fibres where they do not function properly, resulting in weakness
194
Difference between myopathy and neuropathy?
Myopathy more gradual onset, symmetrical, PROXIMAL weakness Effect specific muscle groups Preserved reflexes Neuropathy more likely if paraesthesiae, bladder problems, distal weakness,rapid onset
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What can cause myopathies?
``` Muscular dystrophy (i.e. Duchenne) Drugs - statins, steroids, alcohol Myotonic Inflammatory Metabolic (glycogen/lipid storage disease) ```
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What are myotonic disorders?
Cause tonic muscle spasm i.e. dystrophia myotonica
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What are inflammatory myopathies?
Inclusion body myositis - aggregates of protein | Polymyositis and dermatomyositis
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Dermatome of clavicles?
C3-4
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Dermatome of lateral arm/forearm?
C6-7
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Dermatome of medial side of arm?
T1
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Dermatome of thumb?
C6
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Dermatome of middle finger?
C7
203
Dermatome of little finger?
C8
204
Dermatome of nipples?
T4
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Dermatome of umbilicus?
T10
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Dermatome of inguinal ligament?
L1
207
Dermatome of anterior and inner leg?
L2-3
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Dermatome of medial side of big toe?
L5
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Dermatome of posterior and outer leg?
L5, S1-2
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Dermatome of lateral margin of foot and little toe?
S1
211
Dermatome of perineum?
S2-4

3A REVISION (17 decks)

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