1
Q
UMN signs
A
increased reflexes
increased tone
weakness/spastic paralysis
Positive babinski
2
Q
LMN signs
A
decreased reflexes
normal/decreased tone
fasciculations
weakness (flaccid paralysis)
3
Q
def paresis
A
weakness of voluntary movements
4
Q
def paraparesis
A
partial paralysis of both legs
5
Q
def tetra paresis/quadreplegia
A
partial or total loss of all four limbs and torso
6
Q
cerebellar ataxia features
A
- broad based gait
- nystagmus
- vertigo and nausea
- staccato dysarthria
- cannot say baby hippopotamus
7
Q
sensory ataxia features
A
can CNS or PNS
- stamping gait
- worse in the dark/ have to look down at their feet
- sensory disturbances (sensation, proprioception)
- l’hermitte’s phenomenon
- tight band sensation around torso
- bladder disturbances (if in spinal cord)
8
Q
vestibular ataxia features
A
- vertigo (made worse by head movement)
- nausea and vomitting
- hearing loss/tinnitus
9
Q
Back pain red flags
A
- malignancy (weight loss, long lasting pain, doesn’t vary with movement, constant day and night)
- collapse fracture/trauma (sudden pain, severe and localised, new or worsening kyphosis, osteoporosis)
- cauda equina (bowel/bladder/sexual involvement, radiates down legs, sudden onset, saddle anaesthesia)
- infection (weight loss, travel abroad, night sweats)
- thoracic back pain
- > 55 yo or <20 yo
10
Q
Four limb weakness differentials
A
- acute cervical cord syndrome
- myasthenia gravis
- acute myositis
- Guillaume barre syndrome
- motor neurone disease
- myotonic dystrophy
- polymyositis
11
Q
Presentation of Guilaine barre syndrome
A
- infection 1-3 weeks before onset of neuropathy
- start with symmetrical paresthésie and pain
- followed by progressive weakness
- sensory ataxia
- aréflexie
- CN involvement (bilateral facial weakness, ophthalmoplegia, dysarthria, dysphasia)
- diaphragmatic involvement (SoB worse by lying flat, oropharyngeal weakness)
12
Q
investigations for Guillain Barre syndrome
A
Lumbar puncture:
- shows cyoalbuminologic dissociation
- normal cell count
- elevated protein level
EMG
Nerve conduction studies
13
Q
measurements in lumbar puncture
A
- opening pressure
- WCC
- RCC
- protein
- glucose
14
Q
CSF interpretation: clear, colourless WCC count: 0.5 Glucose > 2/3 blood glucose Protein (g/L): 0.15-0.4
A
normal
15
Q
CSF interpretation: turbid appearance WCC count: 500-10000 polymorphs Glucose: v low Protein (g/L): high
A
bacterial meningitis
16
Q
CSF interpretation
- appearance: turbid, viscous, straw
- WCC count: <500 lymphocytes/polymorphs
- glucose: low
- protein: v high
A
tuberculous meningitis
17
Q
CSF interpretation:
- appearance: viscous, clear
- WCC count <500 lymphocytes/polymorphs
- glucose: low
- protein: v high
A
fungal meningitis
18
Q
CSF interpretation:
- appearance: clear
- WCC count <1000 lymphocytes
- glucose: normal
- protein: raised
A
viral meningitis
19
Q
differentials for hemiplegia
A
- stroke
- MS
- tumour
- subdural heamatoma
- trauma
20
Q
differentials for brain stem syndrome
A
- stroke
- MS
- tumour
- trauma
21
Q
differentials for spinal cord syndrome
A
- spondylosis
- haematoma
- tumour
- trauma
- MS
22
Q
common neuropathoies
A
- common perineal nerve palsy
- Bell’s palsy
23
Q
causes of footdrop
A
- lumbar nerve root lesion (radiculopathy)
- common perineal nerve palsy (neuropathy)
- sciatic nerve lesion
24
Q
presentation of lumbar radiculopathy
A
- foot drop
- significant back pain
- loss of ankle reflex on the same side
25
presentation of common perineal nerve pals
- painless
- often occurs after period of unaccustomed activity (especially kneeling)
- ankle reflex preserved
26
when do you use nerve conduction studies (EMG)?
PNS:
- peripheral nerves
- muscles
- neuromuscular junctions
27
acute pharmacological management of tonic clonic seizure
(if seizure lasting for more than 5 minutes)
- buccal midazolam (first line) OR
- rectal diazepam
- IV lorazepam
28
first line pharmacological treatment for generalised seizures
sodium valproate
29
first line pharmacological treatment for focal seizures
carbamazepine
30
different types of seizures
- generalised:
- tonic clonic (stiffness, convulsions)
- absence
- myoclonic (short muscle twitching)
- focal/partial
- simple (remains conscious)
- complex (impaired consciousness)
31
generalised tonic clonic seizure presentation
- prodromal: aura or no warning
- tonic phase: stiffness
- clonic phase: synchronous jerking of limbs, eyes remain open, bitten tongue, double incontinence
- postictal phase: flaccid unresponsiveness with confusion and drowsiness lasting up to a couple of hours, headaches common
32
myoclonic seizures presentation
jerks: momentary brief contractions of a muscle or muscle group
33
temporal lobe seizure aura
- deja vu
- jamais vu
- fear
- olfactory, gustatory or auditory hallucinations
- altered perception
- abdominal rising sensation
- nausea
34
frontal lobe seizure aura
conjugate gaze deviate away from epileptic focus, head turns
35
occipital lobe seizure aura
visual phenomenas (zigzag lines and coloured scotomas)
36
which metabolic disturbances are likely to increase likelihood of seizure
hyponatraemia
| hypoglycaemia
37
which symptoms make seizure more likely
- bitten tongue
- head turning to one side during TLoC
- no memory of abnormal behaviour before, during or after
- prolonged limb jerking
- confusion after the event
- prolonged deja vu or jamais vu
38
which symptoms make seizures less likely
- prodromal symptoms that have been abolished by sitting or lying down
- sweating before the episode
- prolonged standing that appears to precipitate TLoC
- pallor during the episodes
39
pre syncopal symptoms
PPP
- position (upright)
- provocation (pain, fear)
- prodrome (lightheadedness)
40
presentation of non epileptic attack disorder
violent shaking, head moving side to side, arching back, episodes of stillness before starting again, forced eye closure/preserved consciousness
41
diagnosis of seizures
refer to specialist on 2 week wait
detailed history
EEG
ECG
MRI
42
tension headache presentation
tight band like sensation
precipitate by stress
not aggravated by routine activities of daily living
43
migraine presentation
- unilateral
- multiple triggers, lasts for hours
- pounding/throbbing
- aversion to bright lights and loud noises, nausea, can be preceded by aura
- aggravated by routine activities
44
cluster headache presentation
20 minute-2h, unilateral, retroorbital pain
redness, lacrimation, lid swelling
clusters last 4-12 weeks
always affects same side (by attacks)
45
increased intracranial pressure presentation
headache triggered by changes in position or exerrcision
changes in vision on leaning forward
+ papilloedema, reduced levels of consciousness, vomitting, cushion's triad
46
red flag headache
- sudden onset high severity headache
- headache with fever
- new onset neurological deficit or cognitive dysfunction
- change in personality
- impaired level of consciousness
- recent head trauma (<3/12)
- headache triggered by cough, sneeze, exercise, or change in posture
- headache associated with halos around lights or that gets worse in the dark
- headache associated with jaw claudication and scalp tenderness
47
pathophysiology of MS
- infection by virus or bacteria that crosses BBB
- destruction of myelin sheaths in CNS (immune attack against oligodendrocytes):
loss of nerve fibres, local oedema, glial scaring or sclerosis
48
epidemiology and risk factors for MS
- age of onset: 20-40 yo
- female:male ration: 3:1
- affects mainly caucasians
- risk factors: smoking, vit D deficiency, EBV
49
symptoms of MS
- cerebrum: cognitive impairement, sensory/motor deficit, depression
- optic neuritis: pain on mint, loss of vision, red colour desaturation, RAPD, Uhthoff's phenomenon
- cerebellum: tremor, clumsiness, poor balance
- brainstem: vertigo, impaired speech and swallowing
- spinal cord: weakness, stiffness and spasms, Lhermitte's phenomenon, bowel/bladder/sexual dysfunction, pin (burning/stabbing)
- worse in heat, infection
50
types of MS
- relapsing remitting
- secondary progressive
- primary progressive
- progressive relapsing
51
diagnosis of MS
- history (2 attacks at 2 different time: disseminated in space and time)
- MRI
- CSF (oligoclonal IgG)
- evoked potentials
52
treatment of MS
- relapse: high dose corticosteroids (oral or IV)
| - disease modifying therapy: betaferon
53
Causes of seizures
- genetics
- structural change (brain injury, infection, stroke, tumour)
- over/under eating
- alcohol
- drugs
54
MS cardinal symptoms
Optic neuritis
Weakness
Cerebellar dysfunction
55
Hat are the DANISH symptoms of cerebellar dysfunction
```
dysdiadochokinesis
ataxia
nystagmus
intention tremor
scanning dysarthria
heel-shin test positivity
```
56
Uhthoff phenomenon
worsening of symptoms when body gets overheated from saunas, shower, hot weather
57
Lhermitte sign
brief sudden sensation resembling electric shocks going down your neck and spine (and can radiate down arms and legs)
triggers by bending forwards
Year 4
flashcards
Decks in class (13)
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