Neurology Flashcards
(113 cards)
1
Q
What does clasp knife spasicity suggest?
A
Pyramidal disease in upper motor neurone lesion
2
Q
What does cog wheel rigidity suggest?
A
Extrapyramidal disease
Elicited by slowly pronating and supinating the patient’s wrist.
3
Q
What is the muscle tested in shoulder ABduction?
A
Supraspinatus and Deltoid
4
Q
What is the muscle tested in Shoulder ADduction?
A
Petoralis Major, Latissimus Dorsi
5
Q
What is the muscle tested in Elbow Flexion?
A
Biceps and brachioradialis
6
Q
What is the muscle tested in Elbow Extension?
A
Triceps
7
Q
What is the muscle tested in Finger ABduction?
A
interossei
8
Q
What is the muscle tested in Finger ADduction?
A
Interossei
9
Q
What is the nerve root tested in shoulder ABduction?
A
C5
10
Q
What is the nerve root tested in Shoulder ADduction?
A
Multiple, mainly C7
11
Q
What is the nerve root tested in Elbow Flexion?
A
C5, C6
12
Q
What is the nerve root tested in Elbow Extension?
A
C7
13
Q
What is the nerve root tested in Wrist Flexion?
A
C7 and C8
14
Q
What is the nerve root tested in Wrist Extension?
A
C7
15
Q
What is the nerve root tested in finger ABduction and ADduction?
A
T1
16
Q
What is the grading scale for power?
A
Medical Research Council Muscle Strength Scale
0: No visible Movements
1: Flicker of Movement on Active Contraction
2: Active movement with gravity eliminated
3: Active Movement against gravity but not against resistance
4: Active movement against gravity and resistance, but not normal strength
5: Normal
17
Q
What does difficulty with past pointing and intention tremor suggest?
A
Cerebellar Disease
18
Q
What does difficulty in dysdiadocokinesis suggest?
A
Cerebellar Disease
19
Q
What are you testing in supinator reflex?
A
C5 & C6
20
Q
What are you looking for in supinator reflex?
A
The contraction of the brachioradialis muscles- finger and elbow flexion
21
Q
What are you testing in bicep reflex?
A
C5 & C6
22
Q
What are you looking for in bicep reflex?
A
Contraction of the bicep muscles
23
Q
What are you testing in triceps reflex?
A
C7
24
Q
What are you looking for in triceps reflex?
A
Contraction of the tricep muscle
25
Where do you test dermatomes?
Picture
26
What nerve tract are you testing with proprioception?
Dorsal Column
27
What tuning fork in Neuro vibration sense?
128-Hz
28
What sensory modality are you testing with tuning fork?
Vibration- Dorsal Column
29
What is the muscle tested in Hip Flexion?
Iliosoas
30
What is the muscle tested in Hip extension?
Gluteus Maximus
31
What is the muscle tested in Knee Flexion?
Hamstrings
32
What is the muscle tested in Knee Extension?
Quadriceps
33
What is the nerve root tested in Hip Flexion?
L1 & L2
34
What is the nerve root tested in Hip Extension?
L5 & S1
35
What is the nerve root tested in Knee Flexion?
L5 & S1
36
What is the nerve root tested in Knee Extension?
L3 & L4
37
What is the muscle tested in Dorsiflexion?
Tibialis Anterior
38
What is the muscle tested in Plantar flexion?
Calf Muscles
39
What is the nerve root tested in Dorsiflexion?
L4 & L5
40
What is the nerve root tested in Plantar Flexion?
S1
41
Where do you assess Sensation on lower limb?
PIC
42
What are you testing in knee reflex?
L3 & L4
43
What are you looking for in knee reflex?
Knee Extension and quadricep muscle contraction
44
What are you testing in Ankle reflex?
L5 &S1
45
What are you looking for in ankle reflex?
Plantar flexion and contraction of the calf muslce.
46
What is a normal Babinski response?
Down going plantars.
47
What does the inability to tandem walk suggest?
Cerebellar disease
48
What does Romberg's Test test for?
Sensory Ataxia
49
What are reflexes?
Monosynaptic responses to muscle fibre stretch, mediated via the spinal cord with inhibitary input from higher neurones.
In UMN lesions the inhibitory input from higher neurones is reduced and so reflexes are increased.
50
Pattern of Signs in an UMN lesion
Tone- Increased tone or spasticity, clonus
Power- Reduced: Mainly in arm extensors and leg flexors
Pronator Drift
Reflexes: Hyperreflexia
Inspection: No muscle wasting or fasiculaitons
51
Difference between Tone and Spasticity.
Spasticity is velocity dependent: tone decreases with velocity
52
Where is the lesion in an UMN relative to the signs?
Contralateral Side
53
Pattern of Signs in an LMN lesion
Tone: Hypotonia
Power: Reduced
Reflexes: Diminished/ Absent
Inspection: Muscle Wasting and fasiculaitons
54
Where is the lesion in an LMN relative to the signs?
Ipsilateral side
55
Differentials for UMN lesions
Stroke, MS
56
DDx for LMN lesions
Radiculopathy, Peripheral Neuropathy, Mononeuropathies
57
Features of Cerebellar Disease
```
Dysdiadokinesia
Ataxia and Hypotonia
Horizontal Nystagmus
Intention Tremor with Pass Pointing
Staccato or Slurred Speech
Heel Shin Ataxia
Wide based, unsteady ataxic gait- pt falls to side of lesion
```
58
How do you assess whether a tremor is an action tremor or not?
Rule out any muscle activation
Take the pts arms and support them in your arms.
A truley cerebellar tremor will disappear.
59
What are the causes of cerebellar disease?
1. Space Occupying Lesions ( Tumours, Abcescess, Bleeds)
2. Multiple Sclerosis
3. Chronic Alcohol Abuse
4. Anti- Epileptic Drugs e.g Phenytoin
60
What is the speed of a Parkinsonian Tremor?
4-7Hz
61
What happens in Parkinsons to Speech and Handwritin?
There is a slowing down of speech and micrographia
62
What is the extrapyramidal system?
The basal ganglia and it's connections; especially those to do with movement.
The extrapyramidal system is charged with modulation and initiation of movement.
63
What is Parkinson's Disease?
Progressinve Neurodegenerative disorder characterised by Lewy Bodies, neuronal loss and degeneration of the substantia nigra
Diagnosis is clinical, but some patients have L-Dopa or apomorphine challenges.
PET of MRI scanning is sometimes done to exclude other diagnoses
64
Causes of Parkinsonism
Parkinson's Disease: Idiopathic
65
Treatment of Parkinson
...
66
How do you demonstrate Fatuigability in myasthenia Gravis?
Ask the patient to gaze upwards for a few minutes.
| Pts with MG will get increased Ptosis
67
How would you complete your exam in a patient with suspected myasthenia gravis?
1. Look for Thymectomy Scar
2. Assess for signs of other AI disease
3. Assess speech (get dyarthria and poor swallowing due to weak bulbar muscles)
4. Check eyes: Get Ophthalmoplegia, ptosis and diplopia due to weak eye muscles.
68
How do pts with Myasthenia Gravis tend to present?
With diplopia, typically worse when tired.
69
How do you diagnose Myasthenia Gravis?
Clinical Diagnosis
Can use tensolin test. Give edrophonium (short active ACh) and get a rapid improvement in symptoms
70
What specialist investigations do you do for Myasthenia Gravis?
BLood test: Anti-Ach Antibodies
Tensolin Test
EMG- reduced amplitude of evoked potentials with repetative stimulation
71
What is Myasthenia Gravis?
Auto Immune disorder affective the neuromuscular junction. Antibodies block the action of post-synaptic acetylcholine receptors
72
What do you need to distinguish Myasthenia Gravis from?
Lambert-Eaton Syndrome
- Occular and bulbar muscles are not affected
- Second wind phenonemon
73
How do you treat Myasthenia Gravis?
Medical: Cholinesterase Inhibitors, Immunosuppressants and corticosteroids (But be careful as pts are at risk of myasthenia crises if there is a coexisting infection-some crises are drug induced)
Surgical: Thymectomy for Thymomas
74
Typical Examination Findings for Multiple Sclerosis.
UMN: Increased tone, Clonus, Brisk Reflexes, Weakness.. Bilateral.
Neuro-opthalmology:
Internuclear Ophthalmoplegia
Optic Nerve Damage
Cerebellar Signs: Ataxia, Dysarthria
Cranial Nerve Palsy: Facial Nerve
Sensation altered in a variable fashion. Altered temperature sensation, Trigeminal neuralgia, Lhermitts phenomenon-electric shock sensation down arms and legs on neck flexion.
May have catheter-neurogenic bladder dysfunction
75
DDx in pt with suspected MS
Spinal Cord LEsion: Tumour or trauma causing spastic paraparesis
76
Investigating Multiple Sclerosis
MRI Brian and Spinal Cord: First line investigation, reveals plaques or multiple white matter lesions, particularly in the brainstem and periventricular areas.
Electrophysiology: Prolonged Visual Evoked Potentials
CSF: High Protein, Raised WCC, Electrophoresis shows oligoclonal bands.
77
What is Multiple Sclerosis?
Neurological Disorder of unknown cause resulting in multiple areas of plaques of demyelination in the brain and spinal cord, disseminated in time and space.
There is a female predominance.
Characteristically begins in early adult hood: Clinical course can be broadly broken down to progressive and relapsing remitting.
78
What factors give poor prognosis in MS?
Male
Increased Age
Motor Symptoms
High Number of Relapses with incomplete remissions
79
How would you treat MS
This patient will require an MDT approach
The focus of the treatment is to prevent disability and its progression.
High dose steroids: Aid recovery and promote remission during acute relapses but do not affect long term prognosis
Beta-Interferon has been shown to delay progress of disability, reduce relapse rates and reduce disease activity.
Urinary catheteriastion- neurogenic bladder dysfunction.
Physio and OT- aid mobility and limit disability.
Muscle relaxants: Baclofen for painful spasticity
Pt and Family Self Help group referral
80
4 Groups of Cranial Nerves
1. Olfactory
2. Ophthalmology: II, III, IV, VI
3. Cerebellopontine Angle Nerves: V, VII, VIII
4. Bulbar Nerves: IX, X, XI, XII
81
What is a turned out eyelid called?
Ectropion
82
What is a turned in eyelid called?
Entropion
83
Causes of Entropion
1. Congenital
2. Age related
3. Infection
4. Trauma
84
Causes of Ectropion
Normally the Lower Lid
Styes (Hordeolum)- acute focal infection, usually staphyloccocal involving the glands of Zeis or meibomian glands
85
SE of Entropion
Redness and irritation due to inversion of eyelashes with excessive lacrimation
86
SE of ectropion
Corneal Exposure, lacrimation, scarring of the conjunctiva and eventually vision loss.
87
What is the causes of proptosis?
Increased volume in the fixed volume orbital cavity forcing the orbit forward
88
What are the causes of proptosis?
1. Inflammatory
2. Infection
3. Vascular pathology
In Graves disease: AI reaction in orbital tissues which become infiltrated with inflammatory tissue and matter
89
What does iritis look like?
Mudded iris, often with pupil constriction
90
When do pupils constrict?
1. Light
2. Extremes in age: Old and infancy
3. Sleep
91
When do pupils dilate?
1. Fear
2. Excitement
3. Poor light
92
What happens in the accommodation reflex
Pupils constrict and converge
93
Pathological cause of a Small Pupil.
Miosis
1. Argyll Robinson
2. Horner's Syndrome
3. Iritis
94
Argyll Robinson pupil
Small, irregular pupil.
| Doesn't react to light but accommodates
95
Horner's Syndrome
Miosis
Ptosos
Anhydrosis on affected side
Due to lesion in the sympathetic chain.
Pupil reacts normally to light and accommodation
96
Iritis
Poor reaction to light and accommodation
97
Pathological cause of large pupil (Mydriasis)
1. Holmes-Aidie Pupil
| 2. 3rd Nerve Palsy
98
Holes-Adie Pupil
Congenital, Slow, incomplete reaction to light. Accommodation is slow/ Normal.
Holmes Adie Syndrome if loss of deep tendon reflexes
99
CN3 Lesion
Interruption of parasympathetic chain, no reaction to light or accommodation. BUT normal side still reacts consensually
100
Aeitiology of Arcuate Scotoma
Glaucoma
101
Aeitiology of Central Scotoma
Macular Degeneration
102
Aeitiology of Unilateral Deficit
PIC
Arterial Occulsion
Branch Retinal Vein Occlusion
Retinal Detachment
103
Superior Homonomous L/R sided quadrantinopia
Right sided means left temporal lesion
104
Inferior Homonomous L/R sided quadrantinopia
Right sided means left parietal lesion
105
Homonomous Hemianopia
Right field deffect means Left OPtic radiation or visual cortex
106
Bitemporal hemianopia
Lesion a optic Chiasm
107
Loss of vision in one eye
Optic nerve lesion
| Complicated lesion of Chiasm
108
What are the branches of the Facial Nerve?
To Zanzibar by Motor Car
Temporal, Zygomatic, Buccal, Marginal Mandibular, Cervical
109
Causes of facial nerve palsy
1. Bells Palsy
2. Infective: Ramsay Hunt Syndrome, Lyme Disease, TB
3. Brain Lesons: in brainstem and cerebellopontine angle
4. Others: ENT, Trauma, etc
1. Bells Palsy: Classically described as idiopathic but can be viral. Typically Facial Weakness is the only sign.
2. Ramsay-Hunt Syndrome: Reactivation of Herpes Zoster in the geniculate ganglion--> altered taste and vesicles in the external auditory meatus
3. Brainstem= Tumours, MS, CVA
4. Cerebellopontine Angle= Meningioma, Acoustic Neuromas
5. ENT: Otitis Media, Cholesteatoma, Parotid Tumours
6. Trauma: Base of skull fracture, barotrauma whilst diving
others include: DM, Guillain-Barre Syndrome
110
What is Bells Phenomenon?
On attempted closure of the eye the eye rolls up
It is due to weak orbicularis oculi muscles resulting in difficulty in closing eyes
111
Key features of Bells Palsy
```
Unilateral- Facial Droop
Bells Phenomenon: Weak Orbicularis Oculi
Inability to raise eyebrow: Weak frontalis muscle
Inability to frown
Smooth Nasolabial Fold
```
112
How do you localise a facial nerve palsy
1. Ask about changes in hearing- Hyperacusis suggests lesion distal to the stapedius branch
2. Ask about changes in lacrimaiton and taste- Major branch of facial nerve, Chorda Tympani goes through facial canal of petrous temporal bone.
113
Treatment of Bells Palsy
Steroids- within 6 days
? Aciclovir
Eye protection
