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Flashcards in Patterns of Neurological Presentation Deck (28)
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1
Q

describe focal weakness

A

in distribution of peripheral nerve or spinal root
hemi-distribution
pyramidal distribution

2
Q

describe non-focal weakness

A

generalized
predominantly proximal or distal
if truly generalized - including bulbar motor function otherwise quadri or tetraparesis

3
Q

upper motor neurone?

A

between brain and spinal cord level

4
Q

lower motor neurone?

A

between spinal cord and tissue site

5
Q

describe motor signs of UMN lesion

A

corticospinal distribution of weakness
increased deep tendon and pathological reflexes
decreased superficial reflexes
sphincter function can be impaired
increased muscle tone (flexed arms, extended legs)
can have muscle hypertrophy

6
Q

Babinski reflex?

A

type of pathological reflex
upgoing plantar
drawing a pin along sole of foot causes hyperextension of big toe and fanning of other toes

7
Q

pattern of sensory loss in UMN lesion?

A

central pattern

8
Q

motor signs of LMN lesion?

A

generalized, predominantly proximal, distal or focal distribution of weakness (no involvement of corticospinal innervated muscles)
normal reflexes (deep reflexes can be decreased)
sphincter function usually normal
normal/decreased muscle tone
muscle wasting

9
Q

pattern os sensory loss in LMN lesion?

A

can have no sensory loss

can have glove and stocking, peripheral nerve or root distribution

10
Q

general UMN pattern?

A

increased tone
brisk reflexes
pyramidal/corticospinal weakness (weak arm extensors and leg flexors)

11
Q

general LMN pattern?

A
wasting
fasciculation
decreased tone
decreased or absent reflexes 
flexor plantars
12
Q

general pattern of muscle disease?

A

wasting (usually proximal)
decreased tone
decreased or absent tendon reflexes

13
Q

general pattern of NMJ disease?

A

fatiguable weakness
normal/decreased tone
normal reflexes
no sensory symptoms

14
Q

general pattern of functional weakness?

A
no wasting
normal tone
normal reflexes
erratic power
non-anatomical loss
15
Q

what can cause UMN lesions?

A

acute stroke syndromes
SOLs
spinal cord problems

16
Q

how can location of UMN lesion be determined?

A

hemispheric = contralateral pyramidal weakness in face, arm, leg
parasagittal frontal lobe = paraparesis
spinal cord = pyramidal weakness below level of lesion

17
Q

what can cause LMN symptoms from anterior horn cells?

A

MND

spinal muscular atrophy

18
Q

how does LMN peripheral nerve involvement present?

A

symmetrical (usually length dependant) polyneuropathy with weakness and sensory symptoms
mononeuropathy as a result of nerve compression or mononeuritis multiplex which occurs in diabetes or vasculitis

19
Q

what causes NMJ disease?

A
acetylcholine receptor (or musk) antibody mediated myasthenia gravis
inhibition of acetylcholinesterase by organophosphate poisoning or interfere with presynaptic calcium channel function in lambert eaton paraneoplastic syndrome
20
Q

which tumour is associated with myasthenia gravis?

A

thymoma

21
Q

4 examples of sensory loss patterns and what causes them?

A

stocking and glove = length dependant neuropathy
sensory level = spinal cord
hemianaesthesia = contralateral cerebral lesion or with no other signs - non-organic disorder
dissociated sensory loss with lost spinothalamic but preserved dorsal column sensation = hemicord damage (e.g brown sequard)

22
Q

4 cerebellar signs?

A

broad based, unsteady gait
intention tremor/ataxia
dysdiadochokinesis
nystagmus and dysarthria

23
Q

extrapyramidal/parkinsonism symptoms?

A

bradykinesia, rigidity, resting tremor, impaired gait and posture
hypomimia
hypophonia
impaired postural reflexes
asymmetrical in PD, symmetrical in drug induced or atypical PD

24
Q

extrapyramidal/parkinsonism gait?

A

reduced arm swing, stooped posture, small steps, festination, turning en bloc

25
Q

what problems occur with temporal lobe dysfunction?

A

memory
agnosia
language disorders (Wernicke’s and broca’s)
visual fields (upper homonymous quadrantanopia)
auditory
limbic
temporal lobe epilepsy

26
Q

what problems occur with parietal lobe dysfunction?

A
visual field (lower homonymous quadrantanopia)
sensory 
gerstmann's syndrome
dyspraxia
inattention
denial
27
Q

treatment protocol for parkinsons?

A

symptomatic treatment with levodopa/dopamine agonist
OT,PT exercise etc
deep brain stimulation for some patients

28
Q

cardinal features of PD?

A
resting tremor 
rigidity
bradykinesia
postural instability
usually asymmetrical