Neurology

Question 1

Motor Neurone Disease: Presentation

Answer 1

1. Upper Motor Neurone Signs:
   - Brisk reflex
   - Upgoing plantar
2. Lower Motor NEurone Signs:
   - Fasciculations
3. No sensory involvement

Question 2

Myositis:

Myositis affects the ______, resulting in tenderness, wasting and ________ but no _________ motor neurone signs.

Answer 2

1. Muscle
2. Fasciculations
3. Upper

Question 3

Upper Motor Neurone Signs

Answer 3

• Increased muscle tone (spasticity)
• Increased reflexes
• Muscle weakness (weak leg flexors, weak arm extensors)
• Upgoing plantar response Babinski
• Sustained clonus

Question 4

Lower Motor Neurone Signs

Answer 4

• Decreased muscle tone
• Arreflexia
• Muscle wasting (atrophy) of muscles supplied by the affected motor nerve
• Fasciculations

Question 5

Babinksi’s Sign: what is a positive sign and what is its significance?

Answer 5

Upgoing plantar reflex and is a sign of upper motor neurone lesion

Question 6

Hoffman’s Sign: What is a positive sign and what is it’s significance?

Answer 6

Hold the DIP of 3rd or 4th finger and flick nail - positive sign is an unintentional flexion of terminal phalanx of thumb on same hand.

Upper Motor neurone sign

Question 7

Causes of raised Intracranial Pressure (ICP) [4]

Answer 7

1. SoL (tumour, haematoma, abscess, cyst)
2. Cerebral Oedema (2o to trauma)
3. Increase BP in the CNS (Vasodilators e.g. GTN, increase CO2 during sleep due to hypoventilation)
4. Increase CSF volume: (hydrocephalus)
   a. Obstruction of CSF drainage (tumour)
   b. Dysfunction of arachnoid cells
   c. Increase in CSF production by choroid plexus

Question 8

SIgns and Symptoms of Raised ICP

Answer 8

• Headache
• Nausea and vomiting
• Worse in the morning and lying down
• Papilloedema
• Cushing’s Response (HTN, Bradycardia, Irregular breathing - see headache notes)
• CN VI palsy