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163 Cards in this Set
- Front
- Back
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In a neurological context, wasting may suggest what?
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a motor neuron disease or any other pahtylogy affecting the LMNs
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What things may also exert remote effects through so called paraneoplastic syndromes?
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tumors
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Wasting may be related to the release of what?
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cytokine release
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Fasciculations occur in LMN lesions and represent what?
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spontaneous discharge from motor units
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What are the main categories of involuntary movements?
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-tremor
-chorea -athetosis -hemiballismus -dystonia -myoclonus -tics |
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What is a tremor?
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rhythmical trembling of a part of the body
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A tremor can be divided into what main categories?
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-postural tremors
-intention tremors -resting tremors |
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Resting tremors are important in what disease?
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Parkinson's
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Parkinson's tremor can also affect what?
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the wrist, causing repreated pronation and supination or flexion and extension
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What is a repetative nod also called?
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titubation
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When can resting tremors diminish?
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with movement of the limbs
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Postural tremors are also called what?
Why? |
physiological tremors because they are exaggerations of the normal physiological trmoer that everybody has
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What are some causes of postural tremors?
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-fear or anxiety
-fatigue -caffeine -drugs -lithium -theophylline -w/drawal of alcohol -thyrotoxicosis |
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What is the hallmark of an intention tremor?
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it is absent when the limb is at rest but becomes evident with movement
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What is one way that intention tremors are different than other tremors?
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Its amplitude does not remain constant and may increase with time or movement
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A true intention tremor signifies what?
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a cerebellar disorder
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What other cerebellar signs besides an intention tremor might a person have?
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-incoordination, past-pointing
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What is chorea?
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irregular, jerky movements that can affect most muscle groups in a random sequence
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What might be the first thing you notice in chorea?
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fidgety or restlessness or their behavior is eccentric
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What is a trombone tremor?
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moving tongue seen in chorea
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What things can cause chorea?
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-Huntington's
-Sydenham's -thyrotoxicosis -polycythaemia -pergnancy -SLE |
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What is Athetosis?
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slow snake like writhing movement that tends to affect the peripheries like the hands, feet, and face
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When chorea and athetosis coexist together, what is it callled?
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choreoathetosis
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What is hemiballismus?
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abnormal movement that is so violent that it causes the flailing of one or both limbs on one side of the body
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What is the cause of hemiballismus?
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lesion of the contralateral sub-thalamic nucleus
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What is dystonia?
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when the part of the body assumes an abnormal posture due to a sustained contraction of a particular muscle group
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What is an example of a focal dystonia?
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-writer's cramp
-spasmodic toticollis |
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What is is called when the neck muscles lead to forward flexion?
-backward flexion? |
-antecollis
-retrocollis |
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Generalized dystonias tend to be seen more commonly in who?
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children as a result of birth trauma, metabolic, or neurodegenerative disorders
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Sufferers of generalized dystonias exhibit what?
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a torticollis, the back may twist or arch backwards, and the arms typically rotate inwards and extend , with the wrists flexed. They may also walk on tiptoes
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What is myoclonus?
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a brief, shock-like jerks that may be restircted to a muscle group or more genraliezed
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What type of myoclonus is usually a component of juvenile epilepsy?
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generalized myoclonus
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How is myoclonus distinct from chorea?
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myoclonus is usually rhythmicial and do not flit from one muscle group to another
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When can myoclonus be seen in a normal person?
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when they fall asleep
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What is a tic?
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an irregular jerky movement that is repeated continually
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Can tics be suppressed?
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yes, sometimes
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Hypertonia is due to what?
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UMN lesion known as a clasp-knive regidity or spasticity
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In parkinson's disease, what are the two types of hypertonia that can be seen?
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cog wheel and lead pipe
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Hypotonia is due to what?
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LMN lesion
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What is agnosia?
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inability of the cerebral cortex to recognize or interpret stimuli
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What area of the brain is responsible for interpretation of stimuli?
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parietal cortex of the non-dominant hemisphere
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What are the two clinial forms of agnosia?
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visual and tactile
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What is tactile agnosia?
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inability to recognize objects by touch
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What is apraxia?
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inablity to perform previously learned activities despite having intact more function
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Apraxia is a feature of what?
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damage to the non-dominant parietal cortex
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The anterior circulation of the brain is derived from what?
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carotid arteries that give rise to the anterior and middle cerebral arteries
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The posterior circulation of the brain is derived from what?
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two vertebral arteries that ascend in the enck and join to form the basilar artery
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What is TACS?
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total anterior circulation syndrome, and is the result of infarction of the entire area supplied by the carotid circulation on one side
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What is the triac of TACS?
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-contralateral motor or sensory loss
-hemianopia -disorder of language (left side) or agnosia (right side) |
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What is PACS?
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term used when only two of the triad for TACS is present
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What is lacunar syndrome?
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a smal infarct caused by disease of a small vessel within the substance of the brain
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What is the typical presentation of a lacunar stroke?
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isolater motor or sensory loss or ataxia of a limb
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A lacunar infarct of the internal capsule may cause what?
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A dense hemiparesis via involvement of the pyramidal tracts
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What is POCS?
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posterior circulation syndrome and refers to strokes occuring in th eterritory suppplied by the bertebrobasilar system
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What are some typical symptoms of POCS?
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vertigo, vomiting, and nystagmus, diplopia, and dysphagia
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What are some complications from stroke?
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-bedsores
-contractures -aspiration pneumonia -depression |
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What is the cause of Parkinson's disease?
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degeneration of the dopamine containing cells in the substantia nigra of the basal ganglia
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What are some findings in the arms for PD?
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-resting tremor
-rigidity -bradykinesia |
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What are some other features of PD?
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-expressionless face
-monotonous low volume voice -stooped posture -shuffling gait -lack of arm swing -small spidery writing -drooling -greasy skin |
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If a pt presents with UMN lesions you should suspect what?
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Parkinsonism and NOT PD
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What are the three Parkinson's plus syndromes?
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Steele Rickardson Olsewski
-Shy Drager -Olivo ponto cerebellar |
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What is Steele Richardson Olsewski syndrome?
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Parkinsonism plus failure of vertical gaze and pseudobulbar palsy due to degeneration of th eupper brainstem
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What is Shy Drager Syndrome?
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Parkinsonism plus autonomic failure and is also known as multi system atrophy
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What is Olivo ponto cerebellar syndrome?
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Parkinsonism plus cerebellar and pyramidal involvement
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MS is characterized by two or more episodes of what?
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-neurological dysfunction which are separated both in time and site
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MS is attributed to what?
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multiple plaques scattered throughout the CNS
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What are some findings of MS seen in the arms?
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hyper-reflexia
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Tell me is seen in the eyes in MS?
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-nystagmus
-ataxic nystagmus -spastic paraparesis |
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Motor neuron disease is characterized by what?
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progressive degeneration of motor fibers
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What are the three clinical patterns of motor neuron disease?
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1-Progressive muscular atrophy
2-Amyotrophic Lateral Sclerosis 3-Progressive bulbar palsy |
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Progressive muscular atrophy is characterized by what?
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anterior horn cell degeneration leading to LMN signs
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What is ALS?
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lateral corticospinal tract involvement
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What is progressive bulbar palsy?
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Disease that affects CN IX-XII.
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What are some findings in the arms of pts with motor neuron disease?
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mixture of UMN and LMN signs with striking absence of sensory signs, for example, generalized wasting, fasciculations, with brisk reflexes
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What are some other features of Motor neuron disease?
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-dysarthria
-dysphagia -wasted fasciculating tongue -spastic paraparesis |
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What are some causes of CTS?
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-Pregnancy
-Idiopathic -Gout -Myxoedema -Acromegaly -Rhenumatoid Arthritis -Amyloidosis |
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What is GBS?
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an acute inflammatory polyneuropathy
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What is usually the cause of GBS?
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a predecing acute viral illness that is followed by 1-3 weeks of ascending paralysis, areflexia with mild sensory involvement
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How is GBS dx?
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usually clinical features, and is supported by nerve conduciton studies
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What is the tx for GBS?
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IVIG or plasmapharesis
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What are some causes of primary HAs?
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-migraine
-tension HA -cluster HA |
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Sudden onset of a HA is what?
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of great concern
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If a HA comes on suddenly and then spreads laterally anc comes on in seconds and is severe, it could be what?
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SAH
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What are some causes of recurrent HAs?
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-tension HA
-migraines -sinusitis |
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A cerebral tumor worsens with what?
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-straining
-coughing -sneezing |
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A sharp, shooting pain HA suggest what?
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nerve root irritation or neuralgia
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A burning pain type HA suggest what?
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neuralgia
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A HA that is present on waking or wakes a person from sleep should raise the suspicion of what?
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space occupying lesion in the brain
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A HA that gets owrse at the end of the day may be due to what?
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tension HA
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A space occupying lesion can worsen if the pt does what?
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bends foreward or if they starin in the toilet
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A sinusitis gets worse if the pt does what?
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bends foreward
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With temporal arteritis, there is pain where?
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over the temporal arteries at the temples and sometimes over the occiput when the pt combs their hair
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What are some signs of a cluster HA?
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-severe unilateral HA, sometimes burning quality, also ipsilateral, conjunctival injection, lacrimation, nasal congestion and rhinorrhea, miosis, and ptosis
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Meningitis is characterized by what?
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-severe HA
-nausea -photophobia -neck stiffness |
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What are some signs asssociated with viral meningitis?
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-sore throat
-arthralgia -muscle pain |
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What are some signs associated with bacterial meningitis?
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-focal neurological signs and fits
-petechial rash -septicaemia |
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What are some signs of encephalitis?
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-decreased level of consciousness
-focal or generalized fits -focal neurological signs -neck sitffness |
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Whata re some signs of a SAH?
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-severe ha of sudden onset, nausea, photophobia, neck stiffness
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What are some signs of space occupying lesions?
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-dull HA worse in the morning and with straining
-nausea -vomiting -seizures -personality changes |
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What are some signs of temporal arteritis/
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-HA localized to temples or occiput
-malaise -pain on chewing -Raynaud's phnomenon of the tongue -visual loss -associated iwth polymyalgia rheumatica |
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What are some exapmoles of limitiation of EEGs?
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-an epileptic may have a normal EEG between attacks
-large intracerebral lesions may not register any electrical abnormality -small lesions can cause widespread electrical changes |
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What are some physiological causes of dizziness/
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-warm environment
-over exertion -anxiety -hyperventilation |
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What is conductive deafness?
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inability of the outer and middle ear to conduct sound to the inner ear
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What can cause conductive deafness?
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a disease anywhere from the external auditory meatus to the stapes
-otitis externa -otitis media -Paget's disease -perforated ear drum |
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What is sensorineural deafness due to?
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Damage to the cochlear or to the cholear nerve, which together with the vestibular nerve conducts sensory input to the brain as the vestibulocochlear nerve
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What are some causes of sensorineural deafness/
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-presbycusis (due to ageing)
-noise-induced deafness -ototoxicity due to drugs (frusemide or gent) |
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If your pts has healthy hearing, during the Weber test, what should happen?
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equal hearing in both ears
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If during the Weber test a pt hears louder in one ear, what does this mean?
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ther is a conduction deafness in theear perceiving the louder sound or thiere is a sensorineural deafness in the other ear
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The Rinne test relies on what?
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the principle that in the healthy person, air conduction is better than bone conduction
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If during the Rinne test the pt doesn't hear the tuning fork this implies what?
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a conduction defect in that ear
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What is a negative Rinne test?
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if the pt doesn't hear the tuning fork
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If the pts has a sensorineural deficit in the tested ear you will elicit what?
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a positive Rinne test
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A generalized seizure is when the electrical discharge does what?
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spreads to both cerebral hemispheres simultaneously
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With an atonic seizure, the person does what?
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loses control of all voluntary muscles and falls to the floor
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With tonic seizures the person exhibitis what?
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jerking of the limbs and trunk as the muscles contract and relax alternately
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Myoclonic siezures are seizures that are described as what?
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rhythmical, shock-like jerking movments that are less coarse and violent than clonic seizures
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What is an absence seizure?
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non convulsive episode usually seen in childhood and is synonymous with petit mal seizure
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What is a Jacksonian march?
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a focal seizure (partial) wich has progressive motor effects
it starts with the twitching of a hand before spreadign up the arm to the trunck and lower leg |
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What happens in the tonic phase of a tonic clonic seizure?
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-all muscles of the body contract and the body does rigid
-pt may cry out -pt falls to floor -pt may bite tongue and have incontinence -pt gets no oxygen flow into lungs |
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What happens during the clonic phase?
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-rhythmic jerking movements of the limbs and trunck
-frothing at the mouth may occur |
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What is it called when a series of seizures may follow each other concurrently?
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status epilepticus
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Why is status epilepticus dangerous?
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pt may die of cardiorespiratory failure
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Simple partial seizures produce clear cut symptoms depending on what?
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area of the brain affected
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Complex partial seizures involve impairment of consciousness, which may be partial, so the patient may what?
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have some awareness of events happening aroudn them
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What is automatism?
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When even with a total loss of conscious control, the pt may still be able to exhibit complex behavior patterns without memory
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Glaucoma is a disorder of what?
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the optic nerve
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Glaucoma is most likley associated with what?
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raised IOP
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Glaucoma procues optic cupping and in chronic cases what?
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optic atrophy
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A level of what is used as the cut off for glaucoma?
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21 mm Hg
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Intraocular pressure is a function of flow of what?
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aqueous fluid within the eye
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Why is primary open-angle glaucoma an insidious condition?
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because the rise in IOP is gradual and the patient can compensate for any loss of vision in the early stages
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Open angle glaucoma is sually seen when in life?
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not before 40 and usualy in 60s
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Open angle glaucoma is more commonly seen in who and in what eye?
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Afro-Caribbean people in the myopic (short sighted) eye
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Tell me what the eye looks like in open angle glaucoma.
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-eye is white
-vision deteriorates gradually -subtle arcuate scotoma -cupped optic disk |
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What is the tx for open angle glaucoma?
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-eye drops with combo of BB, pilocarpine, and carbonic anhydrase inhibitors
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Close angle glaucoma symptoms can develop how soon?
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rapidly over afew hours
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Close angle glaucoma in more common in people with what?
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a shallow anterior chamber
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What eye is more common to have close angle glaucoma?
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hypermetropic (long-sited) eye
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What race and sex does close angle glaucoma effect more?
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caucasians and women
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In close angle glaucome, there is a rapid rise in IOP which can reach what levels?
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50-100 mm Hg
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The fast rise in IOP can cause what?
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corneal clouding, that can produce rainbow-colored haloes around light sources
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In close angle glaucome there is a rapid loss of visual acutiy and the yey is red because of what?
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injection of the ciliary blood vessels aroudn the cornea
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What are some other S/S of closed angle glaucoma?
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-pain
-HA -nausea -vomiting -photophbia -semi dilated, oval, fixed pupils |
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What is the tx for close angle glaucoma?
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-pain relief
-antiemetics -eye drops such as pilocarpine -peripheral iridectomy |
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WHat are the most common viruses that cause meningitis?
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-echovirus
-cocksackie |
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Pts with clinically pts may have a prodrome of what?
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influenza type illness
-lassitude -muscle and joint pain -fever -develop severe HA and neck stiffness |
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What are the MMCs of bacterial meningitis?
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-n. meningitidis
-s. pneumonia -h. flu |
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What do pts with bacterial meningitis present with?
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-HA
-neck stiffness -photophobia -vomiting -drowsiness -fits -cranial nerve palsies -hemiplegias -hydrocephalus |
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What is a sign of septicemia what is associated with meningitis?
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pupuric rash that does not blanch
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The inner ear has how many SCCs?
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three
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Within each ear is fluid and the direction of flow can be deterected by what?
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cupula
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Young adults tend to get BPPV from what?
-elderly |
-head injury
-degenerative changes in labyrinths |
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What is done to confirm the dx of BPPV?
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Dix-Hallpike monoeuvre
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Meniere's syndrome is characterized by what?
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-vertigo
-hearing impairment -tennitus |
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What is the end result of Meneire's?
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accumulation of excessive endolymphatic fluid in the endolymphatic sac
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What sex does Meniere's affect more?
Age? |
-women
-35-55 |
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What may precede a Meniere's attack?
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hearing loss
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Tell me about the hearing loss in Meniere's disease.
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sensorineural in origin and affects the lower frequencies preferentially
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There may be a sensation of what in the affected ear before the onset of vertigo?
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pressure
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What is the tx for Meniere's syndrome?
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-symptomatic with antiemetic with or without B-Histidine
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What is PD?
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chronic neurological disorder due to depletion of dopamine in the basal ganglia
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What are 4 trigger features of PD?
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-apathetic face
-usually elderly person -flexed posture -pill-rolling tremor |
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What are some other features of PD/
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-slow movements
-rigidity -greasy skin -excessive drooling -tiny spidery writing -shuffling gait -prone to falling -postural hypotension |
