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Flashcards in Neurology Deck (45):
1

Bamford stroke classification?

Unilateral weakness or sensory defect, homonymous hemianopia, higher cerebral dysfunction
TACS: 3/3
PACS: 2/3
POCS: 1 of cerebeller or brainstem signs, LOC, homonymous hemianopia
LACS: 1 of unilateral weakness/sensory loss, pure sensory, unilateral hemiparesis

2

Management of ischaemic stroke?

Aspirin 300mg
<4.5 hours thrombolysis with alteplase

3

What lies either side of the central sulcus?

Pre central gyrus (primary motor cortex)
Post central gyrus (primary sensory cortex)

4

Key functions of each of the 4 areas of the cortex?

Frontal lobe: primary motor cortex, personality, executive functions
Parietal lobe: primary sensory cortex, integration of sensory info
Occipital lobe: primary visual cortex
Temporal lobe: primary auditory cortex, smell, memory, language

5

What makes us the brainstem?

Mid brain, pons, medulla

6

What is the function of the cerebellum?

Receives info from sensory systems and spinal cord and coordinates voluntary movements (balance, posture, coordination, speech)

7

Where is the basal ganglia located?

Deep in cerebral hemisphere

8

Function of the basal ganglia?

Made up of separate nuclei that all have independent functions
Overall receives info from the cortex, processed and sent back to the cortex via the thalamus
Facilitate movement and inhibit competing movements

9

Where does spinal cord terminate?

L2 to become cauda equina

10

What makes up the PNS?

31 spinal nerves 12 cranial nerves
Two divisions: autonomic nervous system (involuntary control), somatic nervous system (voluntary control)

11

What makes up grey and white matter and how are they organised in brain and spinal cord?

Grey matter: cell bodies
White matter: myelinated fibres
In brain gray matter to outside
In spinal cord grey matter to inside

12

What are the different parts of the vertebral column?

C1 to C7 (8 cervical)
T1 to T12 (12 thoracic)
L1 to L5 (5 lumbar)
S1 to S5 (5 sacral)
Coccyx (1 coccyx)

13

What information does the ventral root carry?

Efferent fibres (motor)

14

What information does the dorsal root carry?

Afferent fibres (sensory)

15

Structure of spinal nerve entry point to the spinal cord?

Dorsal and ventral ramus
Spinal nerve
Dorsal and ventral root
Dorsal and ventral horn

16

What are the two main tracts in the motor system?

Extrapyramidal (do not pass through pyramid in medulla, involved in INVOLUNTARY muscle control) and pyramidal (pass through pyramid in medulla, involved in VOLUNTARY muscle control)

17

What are the two main tracts in the pyramidal system?

Corticospinal
Corticobulbar

18

What are the main ascending/sensory tracts in the spinal cord and the functions of each?

Dorsal column: fine touch, vibration, proprioception DECUSSATES AT MEDULLA
Spinothalamic tracts: crude touch, pressure, pain, temperature DECUSSATES AT SPINAL LEVEL

19

Key difference between UMN and LMN?

UMN are first order neurones and part of the CNS they synapse to interneurones or straight to LMNs that exit the spinal cord or brainstem and travel to muscle fibres (PNS)

20

Do all spinal nerves carry LMNs?

Yes

21

Do all cranial nerves carry LMNs?

No, not all CNs have a motor component

22

What are the 5 key aspects of neurological exam?

Bulk, tone, power, reflexes, sensation

23

What is the difference between spasticity and rigidity?

Spasticity is seen in pyramidal lesions and is velocity dependant (increased tone when suddenly moving the muscle)
Rigidity is seen in extrapyramidal lesions (PD) and is not velocity dependant (increased tone during fast and slow movement)

24

What is meant by tone?

The state of contraction by a muscle

25

7 key steps to upper limb neuro exam?

1- Inspection/bulk (SWIFT)
2- Pronator drift
3- Tone (shoulder, elbow, wrist)
4- Power (Shoulder, elbow, wrist, fingers, thumb)
5- Reflexes (Biceps - C5/6, triceps C7, brachioradialis/supinator C5/6)
6- Sensation (light touch, pin prick, vibration -128hz, proprioception)
7- Coordination: nose to finger, dysdiadokinesis

26

What are the upper limb dermatomes?

C3/4, C5, C6, C7, C8, T1

27

What does a positive pronator drift indicate?

UMN lesion

28

Where is an UMN?

Above the ventral horn
Brain or spinal cord

29

Where is an LMN lesion?

Below the ventral horn
Nerve root, peripheral nerve, NMJ, muscle)

30

What are the 7 key aspects of lower limb exam?

1- Inspect/bulk (SWIFT)
2- Gait (normal, heel toe, walk on tip toes (plantar felxion), walk on heels(dorsiflexion)), Rhombergs
3- Tone (leg roll, leg flop, ankle clonus)
4- Power (Hip x4, knee, ankle x4, EHL)
5- Reflexes (knee L4, ankle S1, babinski)
6- Sensation (light touch, pin prick, vibration (128hz), proprioception)
7- Coordination (heel to shin)

31

What is a positive rhombergs and what does it suggest?

Patient standing with feet together and arms by side, eyes closed
If excessive swaying or loss of balance positive test
Indicates loss of proprioception and that ataxia is sensory in nature

32

What is ataxia?

Loss of motor coordination (affecting balance, coordination and speech)
Usually cerebellar in origin
Can be sensory

33

What is a positive babinski and what does it suggest?

Toes extend up
UMN lesion

34

Dermatomes in lower limb?

L2, L3, L4, L5, S1

35

What can cause abnormalities in nose to finger test?

Past pointing classically seen in cerebellar lesions
Difficulty due to sensory ataxia or arm weakness

36

What can cause abnormalities in dysdiadokinesis?

Cerebeller lesions, PD, sensory ataxia

37

What can cause abnormalities in heel to shin test?

Cerebeller lesions, sensory ataxia or muscle weakness

38

10 stages of Cerebellar exam?

1- Gait (normal and heel to toe)
2- Rhombergs (if positive sensory ataxia)
3- Speech (British constitution, Baby hippopotamus - slurred)
4- Nystagmus (H)
5- Upper arm tone (hypotonia)
6- Finger to nose (past pointing, intention tremor)
7- Rebound phenomenan (absent)
8- Dysdiadokinesia (unable to perform rapid movement)
9- Lower limb reflexes (hyporeflexia)
10- Heel to shin test (uncoordinated)

39

What are the 4 hallmarks of parkinsonism?

Tremor
Rigidity
Akinesia/bradykinesia
Postural instability

40

What are the 4 key EPSE?

Dystonia (spasms)
Parkinsonism (TRAP)
Akathesia (restlessness)
Tardive dyskinesia (involuntary repetitive movements e.g. lip smacking)

41

Management of stroke?

CT head to identify if haemorhagic or ischaemic
Ischaemic <4.5hrs symptoms thrombolysis (alteplase), aspirin 300mg PO/PR OD for 14 days 24hrs after thrombolysis or asap if no thrombolysis
Haemorrhagic: neurosurgery, reverse anticoagulation

42

Management of stroke?

CT head to identify if haemorhagic or ischaemic
Ischaemic <4.5hrs symptoms thrombolysis (alteplase), aspirin 300mg PO/450mg PR OD for 14 days 24hrs after thrombolysis or asap if no thrombolysis
Haemorrhagic: neurosurgery, reverse anticoagulation

43

When should a statin be given?

At night

44

What are the 7 parts of the ROSIER score?

(recognition of stroke in emergency room)
LOC/syncope
Seizure
Facial weakness
Arm weakness
Leg weakness
Speech changes
Visual field defect

45

Identifying retinitis pigmentosa on fundoscopy?

Pigment deposits