OSCE Stop Neuro

Question 1

What is the differential for a proximal weakness? (normal sensation)

Answer 1

Congenital MIND

• Congenital (mitocondrial)
• Metabolic (Cushing’s disease hypothyroidism)
• Inflammatory (Dermato/polymyositis, includions body myositis)
• Neuromuscular ( myasthenia gravis, Lambert-Eaton myasthenic syndrome)
• Dystrophies (Becker’s FSHD, limb girdle)

Question 2

What are the differentials for a Bilateral UMN (pyramidal weakness)

Answer 2

3Ms

• MS
• MND (normal sensation
• Myelopathy (sensory level) - SOL, cervical myelopathy, disc prolapse, trauma, transverse myelitis, syringomyelia, congenital

-Others - Brainstem stroke, hereditary spastic paraplegia

Question 3

What are the differentials for a bilateral LMN lesion (distal weakness) with abnormal sensation distally (i.e. sensorimotor polyneuropathy?

Answer 3

VITDIM

• Vasculitis - SLE, RA, PAN
• Infection - herpes zoster, HIV, leprosy, syphilis
• Toxins - ALCOHOL, TB drugs, metronidazole/nitrofurantoin, vincristine/ cisplatin, amiodarone
• DIABETES MELLITUS
• Inherited - Charcot-Marie-Tooth disease
• Metabolic - B12 deficiency, B1 deficiency

Question 4

What are the differentials for a bilateral LMN lesion (distal weakness) with normal sensation (i.e. distal motor neuropathy)?

Answer 4

Guillian Barre Syndrome
CIDP
Lead poisoning
Porphyria
Myotonic dystrophy
Inclusion body myositis (proximal in legs but distal in arms
Progressive muscular atrophy

Question 5

What are the differentials for mononeuritis multiplex?

Answer 5

Vasculitis - GPA (Wegners), EGPA (Churg-Strauss), polyarteritis nodosa, microscopic polyangiitis

Autoimmune - RA, SLE, cryoglobulinaemia, Sjogrens sarcoidosis

Question 6

What are the differentials for combined UMN and LMN signs

Answer 6

MND

Dual Pathology

Cervical radiculomyelopathy

Question 7

What gives absent ankle (+/- knee) jerks and extensor plantars?

Answer 7

Subacute combined degeneration of the cord
Syphilitic Tabo-Paresis
Friedreich’s ataxia
MND

Question 8

What causes multiple cranial nerve lesions 3-6?

Answer 8

Cavernous sinus thrombosis

Question 9

What causes multiple cranial nerve lesions 5-8 plus cerebellar signs?

Answer 9

Cerebellopontine angle lesion

Question 10

What causes multiple cranial nerve lesions CN 9-10?

Answer 10

+12 = pseudobulbar/ bulbar palsy

+11 = jugular foramen syndrome

+Horner’s syndrome + cerebellar + sensory disturbance (ipsilateral face, contralateral body) = lateral medullary (Wallenberg syndrome)