Causes of upward gaze palsy
- Progressive supranuclear palsy
- Grave’s ophthalmopathy
- MG
- Miller Fisher syndrome
- Muscular dystrophy
- Chronic progressive external ophthalmoplegia
D.D of 3 nerve palsy
- Mononeuritis multiplex: DM
- Brainstem lesion: tumor, infarction, Hge, demyelination
- cavernous sinus lesion: tumor, infection, thrombosis, aneurysm
- Posterior communicating artery aneurysm
- Superior orbital fissure lesion: trauma,
Tumor, granuloma - Subacute meningitis
Causes of LMN facial palsy
- Bell’s palsy
- Ramsay Hunt syndrome
- Parotid tumor
- Middle ear infection
- Pontine infarction
- Pontine tumor
- DM
How would you differentiate between UMN and LMN facial palsy
- Bell’s phenomenon ( LMN)
- Sparing of the upper part of the face ( UMN)
Causes of bilateral facial palsy
- GBS
- Sarcoidosis
- Lyme disease
- HIV
In which part of facial nerve does Bell’s palsy happen? Why?
- Happens in labyrinthine part of the facial canal
- The canal is very narrow in this part and any swelling of the nerve may lead to nerve compression
What is the cause of Bell’s palsy?
HSV
Complications of Bell’s palsy
- Corneal dryness and ulcer
- Persistent weakness
- Contracture
How would you differentiate between UMNL and LMNL of the hypoglossal nerve?
UMNL: leads to spastic tongue
LMNL: leads to atrophy and fasciculation of the affected side
Causes of hypoglossal nerve palsy ?
- Cerebral lesions
- ischemic stroke - Carotid
- carotid aneurysm - Lesions in the medulla
- medullary infarction
- hemorrhage
- tumor
- syringobulbia
- demyelination
- bulbar palsy : MND - Lesions in the base of skull
- metastatic carcinoma
- nasopharyngeal carcinoma
- meningioma
Other causes that give subacute combined degeneration that mimic B12 deficiency?
- Copper deficiency
- Vit E deficiency
- Folate deficiency
- HIV vacuolar myelopathy
How long do you expect for Neurological manifestations of B12 deficiency improve after Iv B12 ?
3 - 6 months
What precautions should be taken when giving large doses of B12 ?
Monitor Potassium level for Hypokalemia
If Hb normal, can exclude B12 deficiency as a cause of neurological manifestation?
No,
Neurological manifestations can occur even in the absence of anemia
Neurological complications of B12 deficiency?
- Cognitive dysfunction
- Dementia
- Depression and mood changes
- Optic atrophy
- Sensory neuropathy with hands and foot numbness
Association with friedreich’s ataxia
- Optic atrophy
- High arched palate
- HOCM
- DM
- Scoliosis/ kyphosis
Most common cause of death in Freidrech’s ataxia?
HOCM and arrhythmia
Which parts of the nervous system are commonly affected in Freidrech’s ataxia?
- Posterior column
- Corticospinal tract
- Spinocerebellar tract
Clinical signs of Freidrech’s ataxia
- Pes Cavus
- Bilateral cerebellar ataxia
- Leg wasting with absent reflexes and bilateral up-going plantars
- Posterior column signs ( deep sensations)
D.D of depressed knee & ankles jerks with upgoing plantar response?
- Combination of conditions
- MS with peripheral neuropathy
- stroke with peripheral neuropathy
- cervical myelopathy with peripheral neuropathy
- cervical and lumbar spondylosis - Conus medullaris lesion
- Subacute combined degeneration
- Syphilis - taboparesis
- Friedreich’s ataxia
- MND
Causes of sensorimotor poly neuropathy
Investigations for sensorimotor poly neuropathy
GBS investigations
