Week 18 - Nervous System Flashcards by Lucy Gallagher

What type of motor neuron lesion causes hyperreflexia?

Upper motor neuron lesion

How well did you know this?

Not at all

Perfectly

What is Parkinson’s disease?

Progressive reduction in dopamine in the basal ganglia leading to disorders of movement

How well did you know this?

Not at all

Perfectly

What is the typical patient of Parkinson’s?

Man around aged 70
Gradual onset of symptoms

How well did you know this?

Not at all

Perfectly

What is the classic triad of symptoms for Parkinson’s?

Resting tremor
Rigidity
Bradykinesia

How well did you know this?

Not at all

Perfectly

What is myasthenia gravis?

Autoimmune condition affecting NMJ
Causes muscle weakness that gets progressively worse with activity and improves with rest

How well did you know this?

Not at all

Perfectly

How do you elicit fatigability of muscles?

Repeated blinking -> ptosis
Prolonged upward gazing -> exacerbate diplopia
Repeated abduction of 1 arm -> unilateral weakness

How well did you know this?

Not at all

Perfectly

What is the typical patient of motor neuron disease?

60 year old man with an affected relative

How well did you know this?

Not at all

Perfectly

What are 4 common signs of lower motor neuron disease?

Muscle wasting
Reduced tone
Fasciculations
Reduced reflexes

How well did you know this?

Not at all

Perfectly

What are 3 common signs of upper motor neuron disease?

Increased tone/spasticity
Brisk reflexes
Upgoing plantar reflexes

How well did you know this?

Not at all

Perfectly

What drug can extend survival and slow progression of MND?

Riluzole

How well did you know this?

Not at all

Perfectly

What are the common causes of death in MND?

Respiratory failure
Pneumonia

How well did you know this?

Not at all

Perfectly

What is multiple sclerosis?

Autoimmune condition involving demyelination in central nervous system

How well did you know this?

Not at all

Perfectly

What is a typical patient of MS?

Young adult
More likely women

How well did you know this?

Not at all

Perfectly

What are key features of optic neuritis?

Enlarged central blind spot (central scotoma)
Pain with eye movement
Impaired colour vision
Relative afferent pupillary defect

How well did you know this?

Not at all

Perfectly

When is optic neuritis seen?

Multiple sclerosis

How well did you know this?

Not at all

Perfectly

What is ataxia?

Problem with coordinated movement

How well did you know this?

Not at all

Perfectly

What is sensory ataxia and in what test is it positive?

Loss of proprioception
Results in a positive Rombergs test = lose balance when standing with eyes closed

How well did you know this?

Not at all

Perfectly

What lesion causes sensory ataxia?

Lesion in the dorsal columns of the spine

How well did you know this?

Not at all

Perfectly

Which parts of the visual field do not cross at the optic chiasm and which do?

Lateral aspects of vision don’t cross
Medial aspects of vision do cross

How well did you know this?

Not at all

Perfectly

Which tract transports information about vibration, proprioception and fine touch?

Dorsal column

How well did you know this?

Not at all

Perfectly

What information is carried in the dorsal column?

Sensory
- Proprioception
- fine touch
- vibration

How well did you know this?

Not at all

Perfectly

What are the 2 regions of the dorsal column and where do they carry information from?

Fasciculus gracilis = more medial, info from below T6-T8
Fasciculus cuneatus = more lateral, info from above T6-T8 but below the head

How well did you know this?

Not at all

Perfectly

What information is carried by the spinothalamic tract?

Sensory
- crude touch
- pressure
- pain
- temperature

How well did you know this?

Not at all

Perfectly

What tract transmits info on pain, temperature, crude touch and pressure?

Spinothalamic

How well did you know this?

Not at all

Perfectly

At what level do nerve fibres cross over in the spinothalamic tract?

At the level the spinal nerve enters

What type of tract is the corticospinal tract?

Motor - pyramidal

What is the function of a pyramidal tract?

Conscious control of muscles from the cerebral cortex to the muscles of the body and the face

What is the function of extrapyramidal tracts?

Unconscious, reflexive or responsive control of muscles from various brain stem structures

What 3 major cortical areas does the corticospinal tract communicate with?

Primary motor cortex Premotor cortex Supplementary motor cortex

Where do nerves of the corticospinal tract converge after leaving the cortical areas?

Internal capsule

At what point does the lateral corticospinal tract cross over?

Medulla

At what point do neurons of the anterior corticospinal tract cross over?

At the level the spinal nerve root enters This will be in cervical or upper thoracic spinal cord

Where do UMNs of the corticospinal tract synapse with LMNs?

Ventral horn of the spinal cord

What is the main management of an acute attack of MS?

High dose steroid therapy 500mg methylprednisolone oral for 5 days Or 1g methylprednisolon oral for 3-5 days

What is the long term management of MS?

Disease modifying agents - manage demyelination process Injectable = beta interferon Oral = dimethyl fumarate Monoclonal antibodies = alemtuzumab

What happens to visual evoked potentials in demyelination?

Decreased amplitude and prolonged latency

What drugs can help control spasticity in MS?

Baclofen and gabapentin

What drugs can help neuropathic pain in MS?

Amytriptyline Gabapentin

What are normal levels for WBCs, RBCs, protein, glucose and pressure in a lumbar puncture?

WBC = 0-5 cells/uL RBCs = 0-5 /uL Protein = 0.15-0.45 g/L (<1% of serum conc) Glucose = 2.8-4.2 mmol/L (>60% serum conc) Pressure = 10-20 cm H2O

What is clinically isolated syndrome?

Unexplained episode of neurological dysfunction Features are suggestive of MS but do not meet diagnostic criteria More likely to get MS in next 5 years

What is relapsing-remitting MS?

No progression between attacks Unpredictable attacks of neurological dysfunction (>24hrs) followed by recovery

What is secondary progressive MS?

Initially presents as relapsing remitting Then gets progression With or without attacks

What is primary progressive MS?

Steady progression of disease from onset No attacks

What are the causes of MS?

Low vit D EBV Smoking Obesity

What types of plaques are seen in relapsing remitting MS?

Acute active plaques Many macrophages

What types of plaques are seen in progressive MS?

Chronic

What are the 3 most common symptoms on presentation of MS?

Limb numbness / tingling Limb weakness Cerebrellar symptoms

What is Uhtoffs phenomenon? When is it seen?

Worsening of symptoms on exercise or in warm environments MS

What is Lhermittes phenomenon? When is it seen?

Lightening shock pain down spine on flexion of the neck secondary to cervical cord plaque formation MS

How can you characterise a previous episode of optic neuritis on a Fundoscopy?

Optic disc pallor Blurring of optic disc

What happens with the relative afferent pupillary defect when light is shone in eye affected by optic neuritis?

Pupil of healthy eye will constrict when light is shone in it as will contra lateral pupil In effected eye when light is shone it will not constrict

Which cranial nerve is optic neuritis affecting?

Optic nerve (II)

What is seen in MS when lesions affect cranial nerves III, IV, VI)?

Double vision (diplopia) Nystagmus

What is nystagmus?

Repeated involuntary movement of the eye

What do lesions in MS affecting CN V do?

Cause facial Parasthesia and or weakness in muscles of mastication

What can lesions in MS affecting CN VII do?

Weakness of facial muscles Mimics stroke (can still move eyebrows as just UMN)

What do lesions in MS affecting CN VIII do?

Loss of balance and sensorineural deafness

What do lesions in MS affecting CN IX, X and XII do?

Loss of motor function to tongue and pharynx causing speech and swallowing problems

What do lesions in MS affecting CN XI do?

Loss of motor function to sternocleidomastoid and trapezius resulting in neck weakness and hypertonic

What are the results of an LP in bacterial meningitis?

Cloudy WBCs = elevated (>100/uL) Protein = elevated (>0.5g/L) Glucose = low (<40% serum) Pressure = elevated [>25)

What do these LP results show? Cloudy WBCs = elevated (>100/uL) Protein = elevated (>0.5g/L) Glucose = low (<40% serum) Pressure = elevated [>25)

Bacterial meningitis

What LP results are seen for viral meningitis?

Clear WBCs = elevated (>100/uL) Protein = elevated (>0.5g/L) Glucose = normal (>60% serum) Pressure = normal or elevated

What does this LP result show? Clear WBCs = elevated (>100/uL) Protein = elevated (>0.5g/L) Glucose = normal (>60% serum) Pressure = normal or elevated

Viral meningitis

What LP results are seen in tuberculosis meningitis?

Opaque, forms a fibrin web when settled WBCs = elevated Protein = elevated (1-5g/L) Glucose = low Pressure = elevated

What do these LP results show? Opaque, forms a fibrin web when settled WBCs = elevated Protein = elevated (1-5g/L) Glucose = low Pressure = elevated

Tuberculosis meningitis

What LP results are seen in fungal meningitis?

Clear/cloudy WBCs = elevated Proteins = elevated Glucose = low Pressure = elevated

What do these LP results show? Clear/cloudy WBCs = elevated Proteins = elevated Glucose = low Pressure = elevated

Fungal meningitis

What LP results are seen in subarachnoid haemorrhage?

Blood stained initially, with xanthochromia (yellowish) >12 hours later WBCs = elevated (WBC:RBC 1:1000) Proteins = elevated Glucose = normal Pressure = elevated

What does this LP show? Blood stained initially, with xanthochromia (yellowish) >12 hours later WBCs = elevated (WBC:RBC 1:1000) Proteins = elevated Glucose = normal Pressure = elevated

Subarachnoid haemorrhage

What LP results are seen in MS?

Clear WBCs = 0-20 cells/uL Protein = mildly elevated (0.45-0.75g/l) Glucose = normal Pressure = normal Electrophoresis = oligoclonal bands present

What do these LP results show? Clear WBCs = 0-20 cells/uL Protein = mildly elevated (0.45-0.75g/l) Glucose = normal Pressure = normal Electrophoresis = oligoclonal bands present

Multiple sclerosis

What LP results are seen in Guillain-Barré syndrome?

Clear WBCs = normal Protein = mildly elevated (>5.5g/L) Glucose = normal Pressure = normal

What do these LP results show? Clear WBCs = normal Protein = mildly elevated (>5.5g/L) Glucose = normal Pressure = normal

Guillain-Barré syndrome