NEURO

When is there forehead sparing and when is there not in a CN7 lesion
Stroke - forehead sparing as UMN. Bells palsy forehead affected as LMN
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Antibodies in Myasthenia Gravis
Anti-ACh-R and Anti-MUSK
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Combination of Sjrogens and coeliac leads to what
proximal ataxia
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Treatment of Wernickes encephalopathy
Parbinex
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Acute onset chorea is suggestive what
SLE
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Name 3 causes of weakness with UMN signs
Stroke, MS, brain tumour
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Name 2 causes of weakness associated wit LMN signs
Neuropathy and myopathy
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Peripheral NS weakness can occur where
anterior horn cell, nerve roots, nerve, NMJ
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CNS weakness can occur where
motor cortex, medulla, spinal cord (also pyramidal tracts)
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Location of the cause of proximal and distal weakness
Proximal-muscle Distal-nerve
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Symmetrical muscle weakness is suggestive of what
Genetic of metabolic cause
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Asymmetrical muscle weakness is suggestive what
Vasulitic or inflammatory cause
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Fatiguability of muscle is suggestive of a problem where
NMJ (myasthenia gravis)
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Relapse and remissions is suggestive of what kind of problem
Inflammation (MS)
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What cells produce myelin
Schwann cells
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Foot drop nerve palsy
Common peroneal nerve
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Myasthenia gravis is caused by what
Thymus dysfunction
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Weakness distribution in MG
fatiguable weakness- proximal weakness, neck and face (head drop and ptosis), extra ocular (complex diplopia), bulbar (speech and swallow)
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Investigation of MG
Tensilon test - tensilon test stops the breakdown of ACh so acutely improves weakness
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Treatment of MG
pyridostigmine (also immunosuppressants - steroids, azithoprine)
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How does GBS present
Ascending polyneuropathy - numbness and weakness (glove and stocking)
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When does GBS present
Post infectious - campylobacter (autoimmune response - happens quickly)
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CSF results of GBS
Increase in protein
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Treatment of GBS
IVIg
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What is mononeuritis multiplex?
individual nerves picked off randomly
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What predisposes is mononeurtitis multiplex?
Inflammatory conditions such as vasculitis --> autoimmune attacks vasovasorum (capillaries)
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Carpal tunnel is related to what nerve
median nerve
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What is involved in a vasculitic screen?
FBC/ESR/U+Es/CRP and ANA/ENA/ANCA/dsDNA
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Criteria of a Total Anterior Circulation Stroke (TACS)
All 3: Unilateral weakness, homonymous hemianopia, dysfunction of higher cortical function (dysphagia, visuospatial disorder)
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Criteria of Partial Anterior Circulation Stroke (PACS)
2 of: Unilateral weakness, homonymous hemianopia, dysfunction of higher cortical function (dysphagia, visuospatial disorder)
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Criteria of Posterior Circulation Syndrome (POCS)
1 of: cranial nerve palsy and contralateral motor/sensory deficit, bilateral motor/sensory deficit, conjugate eye movement disorder, cerebellar dysfunction, isolated homonymous hemianopia
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Criteria of Lacunar Stroke (LACS)
1 of: pure sensory stroke, pure motor stroke, sensori-motor stroke, ataxic hemiparesis
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What is the ABCD2 score
A-age > 60 (1), B-BP >140/90 (1), C -clinical features: unilateral weakness (1) speech disturbance (1), D - duration > 60 (2) 10-60 (1), D - diabetes (1)
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What is classes as a risky ABCD2 score
over or equal to 4
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Treatment of stroke
Aspirin and clopidogrel/dipyramidamole
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What is Todds paresis
Post ictal weakness
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Thrombolysis guidelines
Altepase given if <4,5 hrs and haemorrhage excluded
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A fixed dilated pupil is suggestive of what?
A third nerve palsy - CN3 runs over the petrous part of the temporal bone so is compressed in raised ICP
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Biceps and triceps reflex are related to what cervical roots
Biceps = C6 (6 letters) Triceps = C7 (7 letters)
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Dorsiflexion and plantarflexion nerve roots
Dorsiflexion = L5 Plantarflexion = S1
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Descending motor system is made up of what fibres
C fibres - slow conducting carry pain and temperature A fibres - fast conducting carry light touch and proprioception
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What does an extradural haemorrhage look like on CT
Rugby ball (high pressure trauma like you would get in a rugby match)
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What does a subdural haemorrhage look like on CT
Crescent shaped (low pressure trauma - high risk bleeding patients
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What is horners syndrome?
Lung cancer pushes on the syympathetic chain causing a droopy eyelid and a loss of sweating
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What is brown sequard syndrome?
ipsilateral weakness and loss of proprioception, contralateral loss of pain and temp below the lesion
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What is central cord syndrome
disproportionately greater motor impairment in upper compared to lower extremities, and variable degree of sensory loss below the level of injury in combination with bladder dysfunction and urinary retention.
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What do nerve palsies in CN 3, 4, 5 and 6 suggest
Cavernous sinus syndrome
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Progressive muscular weakness without pain and numbness
MND
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MND is a disorder where
Anterior horn cell
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What is the assessment tool called for MCI and dementia
Addenbrooks cognitive examination
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Papp-Lantos bodies are hallmark of what?
Multiple system atrophy
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What is progressive supranuclear palsy?
gradual deterioration in basal ganglia, brainstem, cerebral cortex, spinal cord and dentate nucleus of cerebellum
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Symptoms of progressive supranuclear palsy
loss of balance, changes in personality, bradykinesia, visual symptoms
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Acquired causes of peripheral neuropathy
DM, vascular neuropathy, alcohol abuse, B12 deficiency
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What is the hereditary cause of peripheral neuropathy
Charcot-Marie-Tooth disease
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CSF findings for MS
oligoclonal bands
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Treatment of MS
Oral prednisolone
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Petechial rash is typically caused by what organism
Neisseria meningitidis
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Brain mets come from where?
Lung, breast, malignant melanoma, colon and kidney cancer
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what cranial nerve abnormality is most affected in neurosarcoidosis
Facial nerve
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What is lambert-eaton syndrome?
defective ACh release at the presynaptic nerve resulting in proximal muscle weakness (thought to be paraneoplastic in small cell lung cancer)
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How is Duchenne inherited?
X-linked
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What is elevated in Duchenne?
Creatinine kinases
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Treatment of BPPV?
Epley manoeuvre
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What is Menieres disease?
Disorder of the inner ear caused by change in fluid volume in the labyrinth
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Antibodies in Myasthenia Gravis

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Anti-ACh-R and Anti-MUSK

Card 3

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Combination of Sjrogens and coeliac leads to what

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Card 4

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Treatment of Wernickes encephalopathy

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Card 5

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Acute onset chorea is suggestive what

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