Neurology 2 Flashcards
(52 cards)
At which level do the nerve roots stop exiting the spinal cord above the vertebrae and instead exit below?
C7
*remember C7 has above and below creating a C7 nerve root and C8 nerve root
What are the motor symptoms of radial compression:
Weakness in:
- Wrist extension
- finger extension
- Elbow flexion mid pronation (Brachioradialis)
*usually lack of pain
There are two main sites that one can develop ulnar nerve palsy, where are these?
Medial epicondyle of the humerus / cubital tunnel
Guyon canal
*paradoxically gets worse the more distal the lesion
List some drugs which commonly cause length dependent polyneuropathy:
Amiodarone
Cisplatin
Isoniziade
Alcohol
List some causes of length dependent peripheral neuropathy?
Diabetes
Alcohol
Nutrition
Immune
Drugs
HIV
Paraneoplastic
Critical illness
What investigations should be done into peripheral neuropathy and why?
FBC
- MCV - B12? Alcohol?
HbA1c/ OGTT
U&Es
- electrolyte imbalance
TFTs
- can cause peripheral neuropathy
B12/ Folate
Electrophoresis
- myeloma
- if proximal and peripheral signs then:
- LP
- EMG/ nerve conduction studies
Name a finding seen on nerve conduction studies which suggest demyelination?
Temporal dispersion
What complication of cervical myelopathy can make surgery very difficult?
Ossification of the posterior longitudinal ligament
What is the definitive management of lumbar radiculopathy? (sciatica)
Lumbar microdiscectomy
List some signs seen on clinical examination which would suggest the cause of vertigo is centrally caused?
Negative head impulse test
Bidirectional Nystagmus
Vertical skew (nystagmus vertically)
- other signs
- ataxia
- passed pointing
- changes to speech
List some causes of Horner’s syndrome listing whether they are central (1st order neuron), preganglionic (2nd order neuron) or post ganglionic (3rd order neuron):
1st order:
- Stroke (Weber’s syndrome)
- Brainstem tumour
- MS
2nd order:
- Pancoast tumour
- Thyroidectomy
- Trauma
- Cervical rib
3rd order:
- Carotid artery dissection
- Cavernous sinus thrombosis
- Posterior communicating artery aneurysm
- cluster headache
What clinical sign can help localise where the lesion is in Horner’s syndrome and why?
Anhidrosis
If lack of sweating is present it localises the lesion to either the:
- brainstem (1st order neurons)
- Preganglionic (2nd order)
this is because these nerves are the only ones that branch off to supply the sweat glands. In other words - the 3rd order neurons to the eye are not associated with the sweating
If a patient presents with signs and symptoms suggestive of a posterior stroke, but the CT negative what does this mean?
Which vessel is typically affected?
CT is not sensitive for posterior strokes therefore is not reliable.
MRI is more sensitive
Posterior Inferior Cerebellar Artery
- most commonly affected causing lateral medullary syndrome
What is the acute sign seen on CT following an ischemic stroke?
Hyperintense vessel sign
- can see the clot in the vessel
Why is it so important to make sure that a person with Parkinson’s disease received their medication at the correct dose at correct time?
Avoid development of
- Parkinson’s Hyperreflexia syndrome
Sudden withdrawal of medication can lead to acute dystonia and neuroleptic malignant syndrome
What other areas of management must be considered in someone with Parkinson’s other than medication?
Bone health
Exercise
Psychology/ support
Advance care planning
How is Lewy body dementia differentiated between Parkinson’s associated dementia?
If dementia is onset is within 12 months then this suggests Lewy body dementia
in other words
- early onset dementia
What is the main side effect of Enzyme inhibitors such as COMT, used in Parkinson treatment?
Diarrhea
What are the Parkinson plus syndrome and list some features of them:
Progressive Supranuclear Palsy:
- Postural instability
- Vertical gaze palsy
- Truncal rigidity
Multisystem Atrophy:
- Early autonomic signs (hypotension, incontinence, falls)
- Cerebellar signs
Corticobasal degeneration
- Akinetic limb loss affecting one limb
- progressive aphasia
- Sensory loss
Lewy body dementia
- Early onset dementia
- fluctuates in cognition
Vascular parkinson’s
- Predominant lower limb symptoms >3 years
What are some of the red signs with Parkinson’s disease that may make you query diagnosis:
Rapid impairment requiring wheelchair within 5 years
No progression of motor symptoms over 5 years
Marked bulbar dysfunction within 5 years
Severe autonomic dysfunction
UMN signs
Dystonic Anterocollis within 10 years
In suspected bacterial meningitis the first step in management is IV antibiotics. what additional antibiotics should be given to those >60 years old? and what additional symptoms/ features may be seen?
Amoxicillin
- cover Listeria monocytogenes
Listeria monocytogenes usually has:
- prodromal headache of 2-3 days
- Low sodium - hyponatremia
- confusion
**babies <3 months are also given amoxicillin to cover for listeria
Give some differentials for raised intracranial pressure in a young person:
Tumour
Venous cerebral sinus thrombosis
Idiopathic intracranial hypertension (would not cause a seizure)
What are the presenting symptoms and How do you diagnosis a venous cerebral sinus thrombosis? and what are some risk factors, and what is the treatment?
Headache Vomiting Seizure Papilloedema Periorbital oedema
CT venography/ MRI venography
- Oral contraceptive
- pro-coagulative/ thrombophilia
- nephrotic syndrome
- Pregnancy
- Dehydration
- Mastoiditis/ Sinusitis/ Otitis
Treatment:
- Anti-coagulation
Highlight the symptoms you would expect from a seizure affecting particularly lobes:
Frontal:
- motor
- Personality
Temporal
- Automatisms
- dejavu
Parietal:
- sensory
Occipital
- visual (explosion of light or colour)
