Neurosciences

Question 1

What are typical Upper Motor Neurone Symptoms? (4)

Answer 1

• Muscle Weakness
• Spasticity
• Hyperreflexia
• Resistance to movement

Question 2

Common tracts in the brainstem? (4)

Answer 2

• Corticospinal tract -> motor tract
• Spinothalamic tract -> sensory tract (pain and temperature sensation)
• Dorsal column -> sensory tract (discriminatory touch, conscious proprioceptive information)
• Spinocerebellar tract -> unconscious proprioceptive information

Question 3

Which are the motor spinal tracts? (2)

Answer 3

• Pyramidal (corticospinal e.g. voluntary movement)

- Extra Pyramidal (e.g. non-voluntary movement: balance, muscle tone, posture and reflexes)

Question 4

What is MND?

Answer 4

Motor Neurone Disease: progressive degeneration of the motor neurones

Question 5

What are the 3 main variants of MND?

Answer 5

1. ALS (amyotrophic lateral sclerosis): upper and lower motor neurone signs
2. PLS (primary lateral sclerosis): upper motor neurone signs
3. PMA (progressive muscular atrophy): lower neurone signs

Question 6

What is a classic onset of MND?

Answer 6

Usually loss of power of a limb e.g. clumsy hand

Question 7

What gives you a poor prognosis?

Answer 7

• Later age
• Bulbar involvement
• Short diagnostic interval
• ALS/PMA Variant

Question 8

Management of MND?

Answer 8

• NIV (can improve life expectancy to up to 1yr)
• MDT
• Medication
• PEG

Question 9

What is hydrocephalus?

Answer 9

Abnormal accumulation of CSF in the ventricular system of the brain.

Question 10

What are common symptom of hydrocephalus?

Answer 10

• Abnormal gait
• Urinary incontinence
• Progressively impaired cognition
• Nausea and vomiting

Question 11

What is CJD?

Answer 11

Creutzfeldt-Jakob Disease

Abnormal prion proteins (part of the nervous system) collect in the brain leading to brain atrophy.

Question 12

Main symptoms of CJD?

Answer 12

• 1/3rd = fatigue, sleep problems, reduced appetite
• 1/3rd = neurological problems such as behavioural changes, memory loss and confusion
• 1/3rd = focal signs such as cerebellar ataxia, aphasia,, visual disturbance and some motor weakness

Question 13

What is an upper motor neurone lesion?

Answer 13

Lesion of the neural pathway in the anterior horn of the spinal cord or motor nuclei of the cranial nerves.

Question 14

What is a lower motor neurone lesion?

Answer 14

Lesion of the nerve fibres which travel from the anterior horn to associated muscles.

Question 15

What is Myasthenia Gravis and what is its main presentation (motor/sensation/reflex)?

Answer 15

Lesion to the neuromuscular junction.
Symptoms:
- Motor fatiguability, sensation intact, normal or decreased reflexes

Question 16

What is peripheral polyneuropathy of alcoholism and its main presentation (motor/sensation/reflex)?

Answer 16

Lesion to the peripheral nerves.
Symptoms:
- Motor weakness and atrophy more distal than proximal (sometimes with fasciculations), sensory deficits often in glove/stocking distribution, decreased relexes

Question 17

What is muscular dystrophy and its main presentation (motor/sensation/reflex)?

Answer 17

Lesions to the muscles themselves.
Symptoms:
- Motor weakness proximal>distal (fasciculations are rare), sensation intact, normal or decreased reflexes

Question 18

What is GBS and its main presentation (motor/sensory/reflex)?

Answer 18

Person’s autoimmune system attacks its own peripheral nervous system via demyelination in an ascending pattern.
Symptoms:
- Symmetrical proximal and distal motor weakness but often begins proximally in feet, sensory loss symmetrically (paraesthesia in feet > hands is often the first symptom), absent or decreased reflexes

Question 19

What is MS and its main presentation (motor/sensory/reflex)?

Answer 19

Multiple Sclerosis is the demyelination of the central nervous system (brain and spinal cord) by the person’s autoimmune system. (most commonly unilateral)
Symptoms:
- Muscle weakness, spasms (spasticity), tremors, ataxia
- Numbness, Pins and Needles, Paraesthesia
- Dysarthria, Nystagmus, Intention tremor
- Symptoms vary and depend on the location of the plaques
- Fatigue, double vision, loss of balance, loss of coordination, altered cognition

Question 20

What are the 4 main types of MS?

Answer 20

1. Relapse-Remitting (most common)
2. Secondary progressive (initially like relapse-remitting but over time turns into a constant deterioration)
3. Primary progressive (constant deterioration)
4. Progressive - relapsing (one constant attack with worsening bouts superimposed)