Neurology exam Flashcards
(124 cards)
1
Q
Causes of Horner’s syndrome
A
Carcinoma of lung apex- squamous cell Thyroid malignancy, trauma Carotid aneurysm/dissection Brainstem lesion- vascular disease, tumour Retro-orbital lesion Syringomyelia
2
Q
One-and-a-half syndrome
A
Horizontal gaze palsy when looking to 1 side
Impaired adduction on looking to other side
Exotropia (turning out) of eye opposite side of lesion
Causes- stroke, plaque of MS, tumour in dorsal pons
When combined with lesion of ipsilateral facial nerve causing LMN weakness –> eight-and-a-half syndrome
3
Q
If suspecting Horner’s syndrome (partial ptosis + miosis)
A
- Test for anhydrosis
- Exclude lateral medullary syndrome - nystagmus, ipsilateral CN V, IX and X, ipsilateral cerebellar signs, contralateral pain and temp loss over trunk/limbs
- Check for hoarse voice, clubbing and finger abduction for C8/T1 lesion
- -> perform respiratory exam if signs present - Examine neck for lymphadenopathy, thyroid carcinoma, carotid aneurysm/bruit
- Check for dissociated sensory loss for syringomyelia
4
Q
Causes of anosmia (CN I)
A
Bilateral- URTI, meningioma of olfactory groove, ethmoid tumours, head trauma, meningitis, hydrocephalus, Kallmann’s syndrome, COVID
Unilateral- meningioma of olfactory groove, head trauma
5
Q
Light reflex
A
Via optic nerve and tract (no cortical involvement)
6
Q
Accommodation reflex
A
Originates in cortex, associated with convergence
Relayed via parasympathetic fibres in CN III
7
Q
Causes of absent light reflex but intact accommodation reflex
A
Midbrain lesion- Argyll Robertson pupil
Ciliary ganglion lesion- Adie’s pupil
Parinaud’s syndrome
Bilateral anterior visual pathway lesion
8
Q
Causes of absent convergence but intact light reflex
A
Cortical lesion
Midbrain lesion
9
Q
Causes of pupil constriction
A
Horner's syndrome Argyll Robertson pupil Pontine lesion Narcotics Pilocarpine drops Old age
10
Q
Causes of pupil dilatation
A
Mydriatics, atropine poisoning, cocaine 3rd nerve lesion Adie's pupil Iridectomy, iritis Post-trauma Cerebral death Congenital
11
Q
Tunnel vision
A
Glaucoma
Papilloedema
12
Q
Enlarged blind spot
A
Optic nerve head enlargement
13
Q
Central scotomata
A
Optic nerve head to chiasmal lesion- demyelination, toxic, vascular
14
Q
Unilateral field loss
A
Optic nerve lesion- vascular, tumour
Retinal vein occlusion
15
Q
Bitemporal hemianopia
A
Optic chiasma lesion- pituitary tumour, sella meningioma
16
Q
Homonymous hemianopia
A
Optic tract to occipital cortex
17
Q
Upper quadrant (superior) homonymous hemianopia
A
Temporal lobe lesion (PITS)
18
Q
Lower quadrant (inferior) homonymous hemianopia
A
Parietal lobe lesion (PITS)
19
Q
Adie’s syndrome
A
Lesion in efferent parasympathetic pathway
- Dilated pupil
- Decreased/absent reaction to light (direct and consensual)
- Slow/incomplete reaction to accommodation
- Decreased tendon reflexes
Typically young women
20
Q
Argyll Robertson pupil
A
Lesion of iridodilator fibres in midbrain
Causes- syphilis, DM, alcoholic midbrain degeneration
Features- small irregular pupil, no reaction to light, prompt reaction to accommodation, decreased reflexes (if associated with tabes)
21
Q
Papilloedema
A
Optic disc swollen without venous pulsation Normal early acuity and colour vision Large blind spot Peripheral constriction of visual fields Usually bilateral
Causes- space-occupying lesion, hydrocephalus, idiopathic intracranial HTN, HTN grave IV, central retinal vein thrombosis, cerebral venous sinus thrombosis, high CSF protein level (GBS)
22
Q
Causes of optic atrophy
A
Chronic papilloedema or optic neuritis Optic nerve pressure/division Glaucoma Ischaemia Familial- Friedreich's ataxia, retinitis pigmentosa
23
Q
Causes of optic neuropathy
A
MS Toxic- ethambutol, chloroquine, nicotine, alcohol Metabolic- vitamin B12 deficiency Ischaemia- DM, atheroma Familial- Leber's disease Infectious mononucleosis
24
Q
Causes of cataract
A
Old age Endocrine- DM, steroids Hereditary- myotonic dystrophy Glaucoma Irradiation Trauma
25
Causes of ptosis
Normal pupils- senile ptosis, myotonic dystrophy, facioscapulohumeral dystrophy, ocular myopathy, thyrotoxic myopathy, myasthenia gravis, botulism, congenital, fatigue
Constricted pupils- Horner's syndrome, tabes dorsalis
Dilated pupils- 3rd nerve lesion
26
3rd nerve palsy
Dilated pupil unreactive to light or accommodation
Complete ptosis
Divergent strabismus- 'down and out'
Causes- central (vascular, tumour, demyelination, trauma), peripheral (compressive lesion eg. PICA aneurysm, infarction, cavernous sinus lesion)
27
CN III (oculomotor nerve)
Supplies superior rectus, inferior rectus, inferior oblique, medial recurs
28
CN IV (trochlear nerve)
Supplies superior oblique muscle --> intorts eye
29
6th nerve palsy
Failure of lateral movement- eye is deviated inwards (esotropia) if severe
Horizontal diplopia to affected side
Causes
- Bilateral = trauma, Wernicke's encephalopathy, raised ICP, mononeuritis multiplex
- Unilateral = vascular, tumour (cavernous sinus, retro orbital), demyelination, diabetes, vasculitis/GCA, trauma, idiopathic, raised ICP, paraneoplastic, myasthenia gravis
30
Causes of nystagmus
Jerky
- Horizontal = vestibular lesion (away from lesion side), cerebellar (towards lesion side), INO (abducting eye)
- Vertical = brainstem lesion (upbeat = lesion in floor of 4th ventricle vs. downbeat = foramen magnum lesion), toxic (phenytoin, alcohol)
Pendular - retinal, congenital
31
Supranuclear palsy
Loss of vertical upward/downward gaze
- affects both eyes
- no diplopia
- reflex eye movements intact
- pupils often unequal
32
Parinaud's syndrome
Loss of vertical upward gaze
Causes
- Central = pinealoma, MS, vascular lesions
- Peripheral = trauma, DM, idiopathic, raised ICP
33
CN V (trigeminal) palsy
Causes
- Central = vascular, tumour, syringobulbia, MS
- Peripheral = aneurysm, tumour (acoustic neuroma), chronic meningitis
- Cavernous sinus aneurysm, thrombosis, tumour
- Other = Sjogren's, SLE, toxins
34
CN VII (facial) nerve palsy
UMN- contralateral weakness, spares frontalis muscle --> vascular, tumour
LMN- ipsilateral facial weakness of all muscles --> pontine stroke, posterior fossa tumour, Ramsay Hunt, Bell's palsy, parotid (tumour, sarcoid)
Bilateral = GBS, bilateral parotid disease
35
Causes of sensorineural deafness
```
Degeneration
Trauma
Toxic- aspirin, alcohol
Infection
Tumour- acoustic neuroma
Brain stem lesion
```
36
Causes of conductive hearing loss
Wax
Otitis media
Otosclerosis
Paget's disease of bone
37
CN IX (glossopharyngeal) + X (vagus) palsy
```
Central = vascular (lateral medullary infarction), tumour, syringobulbia, MND
Peripheral = aneurysm, tumour, chronic meningitis, GBS
```
38
CN XII (hypoglossal) palsy
```
UMN = vascular, MND, tumour, MS
LMN = vascular, MND, syringobulbia, aneurysm, tumour, trauma
```
39
Causes of multiple cranial nerve palsies
Cavernous sinus lesion
Retroorbital lesion
Paraneoplastic
Nasopharyngeal carcinoma
Chronic meningitis
GBS
Brain stem lesions
Arnold-Chiari malformation
Trauma
Myopathies, NM disease
```
40
Dominant parietal lobe evaluation
Acalculia- mental arithmetic
Agraphia- inability to write
Left-right dissociation- put right hand onto left ear
Finger agnosia- inability to name individual fingers
41
Non-dominant parietal dysfunction
Dressing apraxia
42
Fluent aphasia
Receptive, conductive or nominal (Wernicke's) = temporal gyrus in dominant lobe
- Unaware of aphasia
- Naming objects done poorly
- Difficulty repeating words
- Impaired comprehension in receptive
- Difficulty reading in conductive and receptive
- Impaired writing in conductive (dysgraphia) vs. abnormal content (receptive)
43
Non-fluent aphasia
Expressive (Broca's) = frontal lobe
- Aware of aphasia --> frustrated
- Poor naming of objects
- Impaired repetition
- Normal comprehension
- Dysgraphia can be present
- Hemiparesis (arm > leg)
44
Dysarthria
Disorder of articulation with no disorder of content of speech
- consider cerebellar or lower cranial nerve lesion
- in cerebellar --> slurred, scanning (irregular, staccato)
- in pseudobulbar palsy --> slow, hesitant, hollow-sounding speech with harsh strained voice
45
Causes of pronator drift
Downwards- UMN weakness (due to muscle weakness)
Upwards- cerebellar lesion (due to hypotonia)
Any direction- posterior column loss (loss of joint position sense)
46
Muscle power grading
0- complete paralysis
1- flicker of contraction
2- movement with no gravity
3- movement against gravity only
4- movement against gravity with some resistance
5- normal power
47
LMN lesion
Weakness
Wasting
Decreased/absent reflexes
Fasciculation
48
UMN lesion
Spasticity
Clonus
Increased reflexes, extensor plantar response
Weakness more marked in UL abductor/extensor muscles and LL flexor muscles
49
Causes of peripheral neuropathy
Axonal (length dependent 75%)- diabetes, compression, alcohol, uraemia, heavy metal toxicity, Vit B12 deficiency, paraneoplastic
Demyelination (20%)- GBS/CIDP, metabolic (leukodystrophies), medications (amiodarone, TNF-antagonists, tacrolimus), infection, hereditary (CMT)
Cell body death (5%)- idiopathic, Sjogren's, paraneoplastic, drugs (cisplatin, doxorubicin), Fabry's
50
Causes of motor neuropathy
CIDP
MND- LMN variant
Hereditary motor and sensory neuropathy- Charcot Marie Tooth
Acute intermittent porphyria
DM
Lead poisoning
Multifocal motor neuropathy
51
Causes of sensory neuropathy
Diabetes
Carcinoma/paraneoplastic
AIDP
Vasculitic neuropathy
Vitamin B6 intoxication, Vit B12 deficiency
Sjogren's syndrome
Syphilis
52
Causes of painful peripheral neuropathy
DM
Alcohol
Vitamin B12/B1 deficiency
Carcinoma
Porphyria
Arsenic/thallium poisoning
53
Nerve conduction findings for demyelinating disease
Velocity <75%
Distal latency >130%
Normal amplitude
54
Nerve conduction findings for axonal disease
Amplitude <50%
| Velocity >70%
55
Causes of mononeuritis multiplex
Separate involvement of >1 peripheral nerve
Acute- diabetes, PAN, SLE, RA
Chronic- joint-deforming arthritis, sarcoidosis, acromegaly, leprosy, carcinoma, idiopathic
56
Causes of thickened nerves
```
Hereditary motor and sensory neuropathy
Acromegaly
CIDP
Amyloidosis
Leprosy
```
57
Causes of fasciculation
MND
Benign idiopathic fasciculation
Motor root compression
Malignant neuropathy
Spinal muscular atrophy
58
Charcot-Marie-Tooth disease (hereditary motor and sensory neuropathy)
Autosomal dominant
Features- pes cavus (short high-arched feet with hammer toes), distal muscle atrophy, absent reflexes, sensory loss in limbs, thickened nerves, optic atrophy, Argyll Robertson pupils
59
Complete lesion of brachial plexus
LMN signs affecting whole arm
Sensory loss
Horner's syndrome (if proximal lesion in lower plexus)
60
Upper trunk lesion (Erb palsy)
C5-6
Loss of shoulder movement and elbow flexion
Hand in 'waiter's tip' position
Sensory loss over lateral aspect of arm and forearm, over thumb
61
Lower trunk lesion (Klumpke palsy)
C8-T1
Claw hand with paralysis of all intrinsic muscles
Sensory loss along ulnar side of hand and forearm
Horner's syndrome
62
Cervical rib syndrome
Weakness and wasting of small muscles of hand- claw hand
Sensory loss over medial aspect of hand and forearm
Unequal radial pulses and BP
Subclavian bruit and loss of pulse on arm manoeuvring
Palpable cervical rib in neck
63
Radial nerve lesion
C5-C8
Wrist and finger drop
Loss of elbow extension (if above spiral groove)
Sensory loss over anatomical snuff box and dorsal radial 3.5 digits
64
Median nerve lesion
C6-T1
Hand of benediction- unable to make fist
Weakness of thumb opposition, abduction and flexion
Wasting of thenar eminence
Loss of sensation of lateral 3.5 digits on palmar aspect
Tinel's/Phalen's positive
65
Causes of carpal tunnel syndrome
```
Idiopathic
Pregnancy
Endocrine disease- hypothyroidism, acromegaly
Arthropathy- RA
Trauma/overuse
```
66
Ulnar nerve lesion
C8-T1
Claw hand- unable to open fist
Wasting of hypothenar eminence
Weak finger abduction and adduction, wrist flexion
Froment's sign- unable to grasp paper between thumb and forefinger
Sensory loss over medial 1.5 digits (dorsal and palmar aspects)
67
Femoral nerve lesion
```
L2-4
Weakness of knee extension
Slight hip flexion weakness
Preserved adductor strength
Loss of knee jerk
Sensory loss involving inner aspect of thigh and leg
```
68
Sciatic nerve lesion
Weakness of knee flexion
Loss of power of all muscles below knee causing foot drop (cannot stand on toes or heels)
Knee jerk intact
Loss of ankle jerk and plantar response
Sensory loss along posterior thigh and total loss below knee
69
Common peroneal nerve lesion
L4-S1
Foot drop, loss of foot eversion
Ankle reflex present
Sensory loss over dorsum of foot
69
Causes of foot drop
Common peroneal nerve palsy
Sciatic nerve palsy
Lumbosacral plexus lesion
L4/5 nerve root lesion
Peripheral motor neuropathy
Distal myopathy
MND
Precentral gyrus lesion
70
Spinal cord compression changes
LMN signs at level of lesion
UMN signs below lesion
71
Subacute combined degeneration of cord
Vitamin B12 deficiency
- symmetrical posterior column loss --> ataxic gait
- symmetrical UMN signs in LL with absent ankle reflexes, exaggerated/absent knee jerk
- peripheral sensory neuropathy
- optic atrophy
- dementia
72
Causes of extensor plantar response + absent ankle jerk
```
Subacute combined degeneration of cord
Conus medullaris lesion
Combination of UMN lesion with cauda equina compression/peripheral neuropathy
Syphilis
Friedreich's ataxia
DM
Adrenoleukodystrophy
```
73
Brown-Sequard syndrome
Motor- UMN signs below hemisection on ipsilateral side, LMN signs at level of hemisection on ipsilateral side
Sensory- pain and temperature loss on contralateral side, vibration + proprioception loss on ipsilateral side
Causes- MS, angioma, glioma, trauma, myelitis, post-radiation myelopathy
74
Causes of spinothalamic loss (pain and temperature)
```
Syringomyelia
Brown-Sequard syndrome
Anterior spinal artery thrombosis
Lateral medullary syndrome
Peripheral neuropathy
```
75
Cause of dorsal column loss (vibration + proprioception)
```
Subacute combined degeneration
Brown-Sequard
Spinocerebellar degeneration
MS
Tabes dorsalis
Sensory neuropathy
Peripheral neuropathy
```
76
Syringomyelia
Loss of pain + temperature over neck, shoulder, arms (cape like)
Amyotrophy of arms- weakness, atrophy, areflexia
UMN signs in LL
77
Causes of proximal muscle weakness
Myopathy
Neuromuscular junction disorder- MG
Neurogenic- Kugelberg-Welander disease, MND
78
Causes of myopathy
Inflammatory- polymyositis/dermato, inclusion body myositis, vasculitis
Endocrine- Cushing's, thyroid
Metabolic- lipid/glycogen disorder, mitochondrial disorder, rhabdo
Infection- viral (HIV, hepatitis, EBV, influenza)
Toxic- EtoH, cocaine, medications (steroids, statins, fibrates, antimalarials)
Congenital dystrophies- Duchenne's/Beckers, myotonic, FSH, limb girdle
79
Causes of proximal myopathy + peripheral neuropathy
Paraneoplastic syndrome
Alcohol
Connective tissue disease
80
Duchenne's muscular dystrophy
Affects only males
Calves and deltoids are hypertrophied early, weak later
Early proximal weakness
Tendon reflexes preserved in proportion to muscle strength
Severe progressive kyphoscoliosis
Heart disease- dilated CM
CK markedly elevated
Becker's = similar but later onset, less severe
81
Limb girdle muscular dystrophy
Shoulder/pelvic girdle affected
Onset in 3rd decade
Face and heart usually spared
82
Tests for myopathy
```
CK
EMG
ECG- for Duchennes, myotonic dystrophy
Muscle biopsy
Echocardiogram
```
83
Types of gait
Hemiplegic- foot plantarflexed and leg swung in lateral arc, unilateral, flexed elbow, extended knee/hip
Paraparetic- scissor gait e.g.cerebral palsy
Parkinsonian- stooped position, head down, festination, freezing, shuffling, reduced arm swing, slow turn
Cerebellar- wide-based gait, drunken appearance
Posterior column lesion/sensory- slapping of feet on broad base, positive Romberg's
Distal weakness/neuropathic- high stepping gait, drop foot, can be bilateral
Proximal weakness/myopathic- waddling gait, positive Trendelenburg
84
Friedreich's ataxia
Young person with
- cerebellar signs bilaterally
- posterior column loss in limbs
- UMN signs in limbs
- peripheral neuropathy
- optic atrophy
- pes cavus
- cardiomyopathy
- DM
85
Causes of spastic and ataxia paraparesis
UMN + cerebellar signs combined
- Spinocerebellar degeneration
- MS
- Spinocerebellar ataxia
- Arnold-Chiari malformation
- Syringomyelia
- Infarction
86
Causes of Parkinson's
```
Idiopathic
Drugs- methyldopa
Post-encephalitis
Toxins
Wilson's disease
```
87
Types of tremor
Parkinsonian- resting, asymmetric
Essential- rapid, accentuated by stress, bilateral and symmetric, affects head/speech
- Causes- meds (amiodarone, steroids, lithium, thyroxine), toxins
Intention (cerebellar)- increases towards target
Cerebellar outflow tract tremor (red nucleus)- abduction-adduction movements of upper limbs with flexion-extension of wrists e.g. MS, brain injury
88
Causes of chorea
```
Huntington's disease
Sydenham's chorea
Senility
Wilson's disease
Drugs- OCP, phenytoin
Vasculitis
Thyrotoxicosis
Polycythaemia
```
89
Wasting to abductor pollicis brevis (APB)
Median nerve lesion
90
Wasting to abductor digiti minimi and 1st dorsal interossei
Ulnar nerve lesion
91
Wasting of 1 hand and weakness of finger extensors/flexors + triceps
C7, C8, T1 root or plexus lesion
92
Investigations to request for MND
EMG --> evidence of denervation (fasciculations, fibrillation potentials)
NCS --> exclude multifocal motor neuropathy with conduction block
MRI of brain and spinal cord --> should be normal
Modified barium swallow --> check for aspiration
PFTs
93
Hereditary spastic paraparesis
```
Length-dependent degeneration of corticospinal tract in thoracic spinal cord + dorsal column
Spastic gait- stiff, feet turned in
UMN signs in LL
Bilateral LL weakness
Dorsal column impairment
Bladder dysfunction
Romberg's positive
```
94
Guillain-Barre syndrome
Bilateral symmetric weakness- likely ascending
Absent reflexes
Can affect ocular muscles
Paraesthesias in feet and hands
LP- albuminocytologic dissociation (high protein, normal WCC)
95
Myasthenia gravis
```
Fatiguable weakness
Ptosis
Diplopia worse on sustained gaze
Weakness of facial muscles
Myasthenic snarl
Dysarthria
Bovine cough
Weakness of tongue
Proximal limb girdle weakness
Single fibre EMG- abnormal jitter
Repetitive nerve stimulation- decreased response to stimuli
```
96
Midline cerebellar lesion signs
```
Affects vermis
Romberg's positive
Wide-based gait
Truncal ataxia
LL dysmetria (abnormal heel shin test)
Horizontal gaze-evoked nystagmus (towards side of lesion)
Saccadic intrusions
Vertigo
```
97
Hemispheric cerebellar lesion signs
```
Dysdiadochokinesis
UL/LL dysmetria (past pointing)
Limb ataxia
Intention tremor
Ataxic dysarthria (alternating loudness, fluctuating pitch)
```
98
Cervical myelopathy signs
```
LMN signs at level of lesion
UMN signs in LL
Sensory changes
No fasciculations
Check neck for surgical scar
```
99
Anatomy of LMN
Anterior horn cell --> nerve root/nerve --> plexus --> peripheral nerve --> NMJ --> muscle
100
MND signs
```
Presence of UMN + LMN signs
Asymmetric limb weakness
Split hand syndrome- lateral aspect more wasted compared to medial
Dysarthria
Dysphagia
Pseudobulbar palsy
Fasciculations
```
101
Pseudobulbar palsy
Syndrome of bilateral UMN lesions of CN IX, X and XII
Causes- bilateral CVAs in internal capsule, MS, MND, high brainstem tumours, head injury
Increased/normal gag reflex
Spastic tongue
Increased jaw jerk
Slow, hesitant, hollow-sounding speech with harsh strained voice "Donald duck"
102
Bulbar palsy
LMN lesion of CN IX, X and XII
Causes- MND, syringobulbia, GBS, brainstem CVA, subacute meningitis
Absent gag reflex
Wasted tongue with fasciculations
Absent/normal jaw jerk
Nasal speech with imprecise articulation
103
Cerebellar speech
Slurred, staccato quality
104
If foot drop present, test for inversion/eversion
Inversion normal in common peroneal nerve
Inversion absent in L5 radiculopathy
Eversion lost in both
105
If foot drop present, test ankle jerk
If absent --> S1 lesion
If present --> common peroneal nerve lesion
If increased --> UMN cause or MND
106
Unilateral cerebellar disease causes
```
Space occupying lesion- tumour, abscess
Ischaemia
Paraneoplastic syndrome
MS
Trauma
```
107
Bilateral cerebellar disease causes
```
Drugs- phenytoin
Friedreich's ataxia
Hypothyroidism
Paraneoplastic syndrome
MS
Trauma
Alcohol
Large space occupying lesion, cerebrovascular disease
```
108
Causes of pes cavus
Longstanding peripheral neuropathy
- Friedreich's ataxia/spinocerebellar degeneration
- Hereditary motor and sensory neuropathy (CMT)
- Neuropathies in childhood
- Idiopathic
109
Cranial nerve anatomy
I, II --> cerebrum
III, IV --> midbrain
V, VI, VII, VIII --> pons
IX, X, XI, XII --> medulla
110
Cranial nerves in cavernous sinus
III, IV, VI, first branch of V
111
Multiple sclerosis exam findings
Inspect- gait aids
CN exam- optic neuritis (fundoscopy- blurring of optic disc, pallor), RAPD, INO, facial palsy, loss of balance/sensorineural deafness, speech/swallowing difficulty
Cerebellar exam- nystagmus, intention tremor, dysarthria
UL + LL- hypertonia, hyperreflexia, decreased power/spasticity, clonus, abnormal sensation
Ix- MRIB + spinal cord with contrast --> T2 hyperintense white matter plaques, CSF, VEP
112
Causes of INO
Ipsilateral loss of adduction + horizontal nystagmus of contralateral eye
= Lesion of medial longitudinal fasciculus
Causes = MS, brainstem lesion/infarct, head trauma
113
Causes of wasted hand
Brachial plexus injury
Carpal tunnel syndrome
Peripheral nerve injury
MND- split hand syndrome
Syringomyelia
Congenital- CMT, myotonic dystrophy, inclusion body myositis
Nutritional/disuse
114
Myotonic dystrophy signs
Face- frontal baldness, triangular facies, temporalis/masseter wasting, partial ptosis, dysarthria
Neck flexion weakness
Grip myotonia
Difficulty opening eyes after closure
Reduced/absent reflexes
Thenar eminence tap
Forearm muscle wasting
Generalised weakness in arms and legs
Peripheral sensory neuropathy
Foot drop
115
FSH dystrophy signs
Expressionless facies
Muscle weakness in face, shoulders and distal legs (tibialis anterior)
No ophthalmoplegia
Winged scapula, difficulty raising arms
Spared wasting of forearms
Protuberant in lower abdomen- Beevor's sign
116
Cortical signs
Speech- aphasia
Focal motor weakness- face/arm (MCA) vs. leg (ACA)
Cortical sensory deficit- stereognosis, 2 point discrimination
Eyes- visuospatial neglect, visual field defect, gaze deviation to affected hemisphere
Higher function- agraphia, apraxia, acalculia
117
Subcortical signs
Face-arm-legs equally affected
Pure motor- lacunar lesion
Pure sensory- thalamic lesion
Mixed motor and sensory- thalamus and internal capsule
118
Brainstem lesion
INO/nystagmus
Cranial nerve palsies
Ataxia
Altered consciousness
Contralateral motor deficit- crossed limb signs
Autonomic features
119
Horner's syndrome
Ptosis, miosis + anhydrosis
120
Causes of proximal myopathy
Endocrine- Cushing's syndrome, hypothyroidism, acromegaly
Inflammatory- polymyositis, dermatomyositis, scleroderma, MCTD
Drugs- statin, alcohol
NMJ- MG, LEMS
Dystrophies- muscular dystrophy
121
Causes of motor + sensory neuropathy
AIDP/CIDP
Vasculitic neuropathy
122
Plexus lesion
Ipsilateral
Single limb with LMN signs
Painful
Not attributable to single peripheral nerve/spinal level
123
Conus medullaris lesion
Bilateral LL UMN weakness
Bowel/bladder dysfunction
