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FRACP Clinical > Neurology > Flashcards

Neurology Flashcards

(106 cards)

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1
Q

CN 3 palsy features

A
  • eye down and out, pupil dilated

- failure of addiction, elevation, depression, and ptosis of eyelid

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2
Q

CN IV palsy features

A
  • head tilt
  • can’t intort eye
  • on adduction, eye elevates
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3
Q

Causes of CN IV palsy

A
  • head injury

- DM

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4
Q

Causes of CN VI palsy

A

Location: CN6 nucleus in pons

  • HTN
  • DM
  • raised ICP
  • pontine stroke or bleed
  • nasopharyngeal cancer
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5
Q

Features of INO

A
  • one eye fails to adduct, the other eye: nystagmus
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6
Q

Causes of INO

A
  • lesion of median longitudinal fasciculus
  • unilateral INO: stroke
  • bilateral INO: MS
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7
Q

Decreased visual acuity, with RAPD

A

Lesion at anterior visual system: eye or retina or optic nerve

  • optic neuropathy:
    - inflammatory: optic neuritis
    - infiltrative: sarcoidosis, lymphoma
    - trauma
    - compression
    - ischemia: GCA
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8
Q

Cause of bitemporal hemianopia

A

Optic chasm lesion

- pituitary tumor; look for signs of hypopituitarism or acromegaly

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9
Q

Causes of homonymous hemianopia

A

Location of lesion: behind optic chiasm

  • stroke
  • tumor
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10
Q

Homonymous hemianopia with sparing of central vision. Where is the lesion?

A

Occipital lobe

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11
Q

Upper homonymous quadrantanopia: where is the lesion?

A

Temporal lobe optic radiation

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12
Q

Lower homonymous hemianopia: where is the lesion?

A

Parietal love optic radiation

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13
Q

Peripheral nystagmus beats away or towards lesion?

A

Away from side of lesion

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14
Q

Vertical nystagmus central or peripheral?

A

Central duh

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15
Q

Horner syndrome causes:

A

1st order: tumor, stroke: brain stem, hypothalamus
2nd order: apical lung tumor, mediastinal tumor
3rd order: skull base lesions, trauma

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16
Q

Causes of 3rd nerve palsy

A
  • posterior communicating artery aneurysm
  • chronic meningitis
  • raised ICP
  • cavernous sinus lesion (would involve CN V)
  • DM
  • HTN
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17
Q

How to test median nerve function?

A
  • thumb abduction
  • thumb flexion
  • index finger flexion
  • median nerve distribution sensation
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18
Q

What are features of ulnar nerve lesion?

A

Loss of:

  • finger abduction
  • little finger flexion
  • ulnar nerve distribution sensation
  • claw hand 4th, 5th fingers
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19
Q

What are features of radial nerve lesion?

A

Loss of:

  • finger extension
  • wrist extension
  • elbow E (triceps), if lesion above spiral groove
  • brachioradialis
  • sensation anatomical snuff box
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20
Q

How to test C5-C6 nerve root?

A
  • deltoid: shoulder abduction
  • biceps and brachioradialis
  • biceps and supinator jerks
  • C5/C6 dermatome
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21
Q

How to test C7-C8 nerve root?

A

Finger flexion and extension
Triceps: elbow extension
Triceps jerk
C7-C8 dermatome

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22
Q

What are differentials for mainly motor neuropathy?

A
  • GBS / CIDP
  • hereditary: CMT
  • DM
  • lead poisoning
  • polio
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23
Q

What are differentials for sensory neuropathy?

A
  • DM
  • malignancy ?paraneoplastic
  • b12 deficiency
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24
Q

What are causes of peripheral neuropathy?

A
  • metabolic: DM, hypothyroidism
  • hereditary
  • alcohol
  • GBS
  • drugs/toxins: isoniazid, cisplatin, phenytoin
  • rheum: RA, SLE, Vasculitis
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25
What are causes of mononeuritis multiplex?
- DM - connective tissue disease: SLE, RA - compressive neuropathy - sarcoidosis
26
What are the features of CMT?
- pets cavus - distal muscle atrophy - absent reflexes - minimal to no sensory loss - thickened nerves
27
Causes of hand wasting?
``` Nerve: - median, ulnar nerve lesions - plexus lesion Anterior horn cell disease: - MND - polio Myopathy: - myotonic dystrophy Spinal cord: - syringomyelia, cervical spondylosis, tumour ```
28
How to differentiate the causes of foot drop?
- Peroneal nerve: lose Dorsi F and eversion only - L5 radiculopathy: lose Dorsi F, eversion, AND inversion - sciatic nerve: foot can't do anything, loses plantar flexion too
29
Feature of sciatic nerve lesion?
L4/L5/S1/S2 - weak knee F - loss of power below knees - absent ankle jerk, no plantar response - sensory loss posterior thigh and below knee
30
Spinal cord lesion causes?
- cord compression: spondylosis, abscess, tumour - transverse myelitis - MS - intrinsic cord lesion: infarction, syrinx
31
What are features of subacute combined degeneration of cord (B12 deficiency)?
- upper motor neuron signs in lower limbs (increased tone, UMN pattern weakness, upgoing plantar) - but absent ankle jerks and sometimes loss of knee jerk. - sensory neuropathy: vibration, proprioception
32
What are the features of cord hemisection (Brown Sequard)?
Motor: - Ipsilateral UMN signs below lesion - ipsilateral LMN signs AT level of lesion Sensory: - ipsilateral loss of vibration, position - contralateral loss of pain, temperature
33
What are causes of Brown-Sequard?
- MS - glioma - trauma - myelitis - post radiation myelopathy
34
What are some causes of muscle weakness?
Myopathy: - polymyositis, Dermatomyositis - endocrine: hypo/hyperthyroidism, Cushings, hypopituitarism - drugs: steroids - hereditary: muscular dystrophy (only in males) NMJ: myasthenia, lambert-eaton Neurogenic: MND, polyradiculopathy (I.e. spinal stenosis, leptomeningeal disease, tumors, diabetic amyotrophic)
35
What tests for myopathy?
- CK - EMG - muscle biopsy
36
What are side effects of dopamine agonists in Parkinson's?
- impulsivity: gambling, hyper sexuality, shopping - headache - nausea/vomiting - fatigue
37
What are some causes of Horner's syndrome?
- apical lung mass or infection - neck: thyroid mass, trauma - carotid artery aneurysm - brainstem lesions
38
Clinical features of Horner's syndrome?
- ptosis - pupil constricted - loss of sweating forehead - hoarse voice
39
What is lateral medullary syndrome and what are the clinical features?
Stroke or lesion at lateral medulla - nystagmus to side of lesion - ipsilateral pain loss - ipsilateral cerebellar signs - contralateral pain/sensory loss in limbs
40
What are causes of optic neuropathy?
- MS - metabolic: B12 deficiency - DM - temporal arteritis - infiltrative: lymphoma, sarcoidosis
41
What causes a 3rd CN Palsy with sparing of the pupil?
- diabeetus - arteritis - MG - can mimic CN palsy
42
What are causes of CN3 palsy?
- posterior communicating artery aneurysm - tumour: raised ICP - DM - Trauma - cavernous sinus lesion
43
What nerve lesion causes Abductor Pollicus Brevis (APB) wasting?
Median nerve
44
What nerve lesion causes Abductor Digiti Minimi (ADM) and 1st dorsal interosseous wasting?
Ulnar nerve
45
What lesion causes thumb abductor weakness?
Median nerve at carpal tunnel
46
What lesion causes thumb abductor, thumb flexion, and index finger weakness?
Median nerve at elbow
47
What lesion causes isolated finger abduction weakness
Ulnar nerve at elbow
48
What causes wasting, weak finger extensors, finger flexors, and triceps?
C7, C8, T1 root or plexus lesion
49
What causes flaccid paralysis of entire arm, with wasting, areflexia, sensory loss to one arm?
Avulsion of all roots of brachial plexus (i.e. trauma)
50
What causes wasting of one hand, loss of reflexes in arm, and dissociated sensory loss (loss of pinprick, but normal light touch) in half cape distribution?
Lesion of cervical and upper thoracic cord (syringomyelia, tumours)
51
What causes wasting of both hands, and spastic weakness in legs?
C8-T1 cord lesion: trauma, tumour
52
What causes generalised muscle weakness and wasting, fasiculations, hyper-reflexia, and normal sensation?
Motor neuron disease
53
What causes distal wasting and weakness of all 4 limbs, areflexia, and a glove/stocking sensation loss?
Peripheral neuropathy i.e. DM, inherited
54
What causes distal wasting, weakness of all four limbs, hyporeflexia, baldness, ptosis and cataracts
Myotonic dystrophy
55
What causes weakness of brachioradialis, wrist extension, finger extension? Normal triceps power. With loss of brachioradialis reflex, and sensory loss of snuff box?
Radial nerve lesion at spiral groove
56
What causes weak triceps, finger extensors, and finger flexors? Loss of triceps reflex?
C7-C8 root or plexus lesion
57
What causes increased tone, generalised weakness of muscles of upper limb in deltoid, triceps, wrist E, finger E? Hypereflexia of UL?
Corticospinal lesion
58
What causes weakness of detloid only? Biceps and brachioradialis power normal. Sensation loss over deltoid.
Axillary nerve lesion.
59
What causes : - weakness of deltoid, biceps, and brachioradialis? Absent biceps and brachioradialis reflex. - Triceps reflex increased - Increased lower limb reflexes
C5-C6 cord lesion
60
What causes: - weakness of deltoid, biceps, and brachioradialis - absent biceps and brachioradialis reflex - normal triceps and leg reflexes
C5-C6 root or plexus lesion
61
What causes: - weakness of all muscles in one arm - absent reflexes - C5 to T1 sensory loss
Brachial plexus lesion
62
What causes: - weakness of all muscles in one arm - hyperreflexia
UMN/hemiparesis
63
What causes: - proximal weakness both arms and both legs - normal or reduced reflexes - normal sensation
- polymyositis/dermatomyositis | - Myasthenia Gravis
64
What causes: | - selective proximal weakness of arms and legs
- muscular dystrophy - spinal muscular atrophy - inclusion body myositis
65
Where is the lesion: - weakness hip F, knee E - normal hip add - absent knee jerk
- femoral nerve lesion
66
Where is the lesion: - weakness hip F, knee E, hip adduction - absent knee jerk
L2/3/4 root or plexus lesion: tumour, amyotrophy
67
Where is the lesion: - unilateral weakness Hip F, Knee F, Dorsi F, eversion - increased tone and reflexes
UMN/corticospinal lesion
68
Where is the lesion: - bilateral weakness hip F, knee F, ankle dorsi F, eversion - increased tone and reflexes
spinal cord lesion
69
Where is the lesion: - proximal weakness - normal or reduced reflexes
- myopathy: muscular dystrophy/polymositis | - myasthenia gravis
70
Where is the lesion: - proximal weakness - absent reflexes
- spinal muscular atrophy | - GBS
71
Where is the lesion: | - weak dorsi F and eversion
- common peroneal nerve lesion (with lateral lower leg sensation loss)
72
Where is the lesion: | - weak dorsi F, eversion, inversion
- L4/5 root or plexus lesion
73
Where is the lesion: | - weak dorsi F, eversion, inversion, and plantar F
- sciatic nerve lesion | DDx: trauma, vasculitis, tumour
74
Where is the lesion: - distal weakness both legs - areflexia - glove/stocking sensory loss
``` - peripheral neuropathy (DDx: - metabolic: DM, hypothyroidism - hereditary - alcohol - GBS - drugs/toxins: isoniazid, cisplatin, phenytoin - rheum: RA, SLE, Vasculitis) ```
75
Where is the lesion: - wasting, fasiculations - hyper-reflexia - normal sensation
- MND
76
Where is the lesion: - weak hip F, knee F, dorsi F, eversion - tone increased - brisk reflexes
- UMN/corticospinal
77
Where is the lesion: - bilateral weakness hip F, knee F, dorsi F, eversion - tone increased - brisk reflexes
- spinal cord lesion
78
What does a positive Romberg's mean?
- ataxia from loss of proprioception/sensation, such as: diabetic neuropathy, sensory neuropathy, spinocerebellar degenration, subacute combined degeneration of cord, MS - NOT cerebellar ataxia
79
What does unilateral high stepping gait suggest?
- unilateral foot drop
80
What does bilateral high stepping gait suggest?
- bilateral foot drop: DDX: 1) peripheral neuropathy i.e. CMT 2) MND
81
What does wide based and high stepping gait suggest?
sensory ataxia | DDx: diabetic neuropathy, sensory neuropathy, spinocerebellar degenration, subacute combined
82
Causes of waddling gait
- weakness of hip abduction - DDx: myopathy, OA hips - Trendelenberg "sound side sags"
83
DDx of circumduction gait
- hemiparesis: stroke
84
DDx of bilateral circumducting gait
- spastic paraparesis/scissoring gait | DDx: cerebral palsy, hereditary spastic paraplegia, MS, cervical spondylosis
85
What does a Parkinson's gait look like?
- small shuffling steps - turning takes several steps - normal/narrow based gait - decreased arm swing - positive pull test
86
Shuffling small steps, several steps to turn, broad based gait
- NPH | - dementia
87
What causes broad based irregular/ataxic gait?
- cerebellar disturbance | - stagger to side of lesion
88
What causes facial weakness, with sparing of frontalis and eyelid closure?
UMN/stroke contralateral cerebral hemisphere
89
What causes weakness of all muscles on one side of face?
``` LMN DDx: - Bell's Palsy (sensation normal) - lesion of facial nucleus (has CN VI palsy as well) - acoustic neuroma - infection within facial nerve canal ```
90
Bilateral facial weakness
- GBS - myotonic dystrophy - MG - Bilat UMN: multi-lacunar stroke or MND
91
In facial weakness, if pupils spared, usually means muscle or NMJ problem
...
92
What are the features of CMT?
- Pes cavus (high arches, hammer toes) - Distal muscle atrophy (champagne bottle legs) - Absent reflexes - No or only slight snesory loss - Thickened nerves - optic atrophy (RAPD)
93
What are some causes of foot drop?
- common peroneal nerve palsy - sciatic nerve palsy - Lumbosaccral plexus lesion - L4/5 nerve root lesion - peripheral motor neuropathy - distal myopathy - MND
94
Shoulder abduction: - Muscle: ?? - Nerve root: ?? - Peripheral nerve: ??
Muscle: deltoid Nerve Root: C5/C6 Peripheral Nerve: axillary nerve
95
``` Elbow E: Which: - Muscle - Nerve Root - Peripheral Nerve ```
Muscle: Triceps Nerve Root: C7/C8 Peripheral Nerve: radial
96
``` Elbow F: Which: - Muscle - Nerve Root - Peripheral Nerve ```
Muscle: Biceps Nerve Root: C5/C6 Peripheral Nerve: musculocutaneous
97
``` Wrist E: Which: - Muscle - Nerve Root - Peripheral Nerve ```
Muscle: extensor carpi ulnaris Nerve Root: C7/C8 Peripheral Nerve: branch of radial
98
``` Wrist F: Which: - Muscle - Nerve Root - Peripheral Nerve ```
Muscle: flexor carpi radialis Nerve Root: C6/C7 Peripheral Nerve: median
99
``` Finger E: Which: - Muscle - Nerve Root - Peripheral Nerve ```
Muscle: extensor digitorum Root: C7/C8 Nerve: Radial
100
``` Finger abduction: Which: - Muscle - Nerve Root - Peripheral Nerve ```
Muscle: dorsal interossei Root: C8/T1 Nerve: Ulnar
101
What are the features of myotonic dystrophy?
``` Inspection: - frontal baldness - triangular facies - wasting of temporalis, masseter, sternomastoid - partial ptosis Neck: - weak neck flexion Upper limbs: - grip myotonia (shake hands) - percussion myotonia (tap over thenar eminence) - wasting and weakness (esp. forearm) - usually only mild sensory loss Chest: - gynecomastia Testicular atrophy Urinalysis: glycosuria Cardiomyopathy ```
102
What are the features of lateral medullary syndrome?
Occlusion of PICA or branches of vertebral artery; lateral medulla infarcts: - vomiting/vertigo/nystagmus - ipsilateral cerebellar signs - ipsilateral dimished gag reflex - ipsilateral Horner's - ipsilateral face loss of pain/temp - contralateral loss of pain/temperature
103
What are some causes of Parkinsonism?
- idiopathic PD - drugs drugs drugs (metopclopramide, antipsychotics) - Wilson's disease - Parkinson's Plus: PSP, MSA
104
What are causes of UMN facial weakness?
- brain: infarct, tumour, bleed | - pons: MS, MND, infarct, tumour
105
What are causes of LMN facial weakness?
``` Most common: Bell's palsy Cerebello-pontine angle: - acoustic neuroma - meningioma - tumour, mets Facial nerve canal: - Bell's - zoster (Ramsay Hunt) - tumour, trauma Parotid: sarcoidosis ```
106
What is the differential for bilateral proximal muscle weakness?
- neuropathy - myopathy - MND - MG/Lambert Eaton

FRACP Clinical (11 decks)

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