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IF both Legs are affected - where is the MOST likely lesion
-usually spinal CNS
What are the most likely causes of a lesion affecting both legs
Central spinal cord compression/lesion e.g. disk herniation, cauda equina
Hemi- (one-half of the body affected): Where is the lesion ?
usually cranial CNS
Hemi- (one-half of the body affected): what are the causes for the lesions?
Quadri- /Generalized- (all four limbs affected): what are the causes x5
cervical spine injury,
Guillian-Barre syndrome (GBS), muscle disorders
Mono- (one limb affected) -
Single nerve root/peripheral nerve palsy, diabetes mononeuropathy,
(head and neck)
Acute onsets of neurological symptoms
Chronic onset of neurological symtpoms
Chronic Infection (e.g abscess, TB)
Diabetes (chronic disease)
Are these Symmetric or Asymmetric >?
Diabetes (Mononeuritis)- Foot & hand drop
Amyotrophic lateral sclerosis
Are these Symmetric or Asymmetric >?
What are the Ascending neuropathies
What are the descending neuropathies
LMN lesions characteristics
Muscle paresis or paralysis
hypotonia or atonia- Tone is not velocity dependent.
Areflexia or hyporeflexia -Along with deep reflexes even cutaneous reflexes are also decreased or absent
Strength -weakness is limited to segmental or focal pattern, Root innervated pattern
which often presents with spastic paralysis - paralysis accompanied by severe hypertonia.
Rest/Activity- affects which syndromes ?
Activity worsens weakness of myasthenia gravis,
improves Lambert-Eaton syndrome.
Sensory Loss (Numbness/Paraesthesias) - seen in which disorders
Neuropathies both CNS (strokes, tumors, spinal cord lesions)
and PNS (Diabetes, GBS) may have sensory loss.
dysarthria, and dysphagia from palatal weakness
Botulism -major symptoms
- ptosis, early cranial nerve involvement
eye pain, visual loss, diplopia
Myasthenia Gravis -
ptosis, blurring vision, dysarthria
SPINAL CORD COMPRESSION
bilateral weakness + sensory symptoms,
history of trauma (slipped on hunting trip) & Urinary and bowel dysfunction
bilateral weakness and paresthesia, Chronic exposure, GI, neurological symptoms: loss of concentration and memory loss
SCD (Sub-acute Combined Degeneration of the Spinal Cord)
weakness + sensory symptoms, chronic
INFLAMMATORY MYOPATHIES (Polymyositis/
bilateral weakness but no sensory symptoms
poverty of speech/Loss of speech - negative symptoms of schizophrenia
abrupt STOP in the middle of a train of thought - negative sign schizophrenia
In ability to answer a question without driting AWAY form the topic WILL eventually the question
Ideas related only BY RHYMING SOUNDS not by ideas or can alteration
MID speech the topic changes
IDEAS will slip off of the TRAIN onto another topic that MIGHT be related
When you echo part of your speech Once or continuously; more like turrets where the repeat when asked a questions
Flight of ideas
MANIA-> a rapid progression of unrelated ideas
will give the same answer to MANY/ALL questions - Or repeats a single word.
Autonomic instability (hypertension and tachycardia),
decreased power 1/5 and areflexia in the lower limbs, sensation loss in
lower limbs. ****
These symptoms describe ?
albuminocytologic dissociation= CHARACTERISTiC of
GBC- high protein with out a change in WBC ( very late stages of polio)
Nerve Conduction studies in the first 10 days for GBS
OFTEN NORMAL if first 10 days
What disease has Autonomic instability (hypertension and
*Chronic GBS (Chronic Inflammatory Demyelinating Polyneuropathy)
presents very similarly to Acute GBS, but the course of disease lasts for
more than 4 weeks.
Diagnostic criteria Required for GBS
• Progressive weakness of 2 or more limbs due to neuropathy
• Disease course <4 weeks* (for Acute GBS)
A 32-year old man presents to the emergency room with abdominal cramps, diarrhea and
weakness of the upper limbs. He recalls that he ate canned beans about 12 hours prior to
presentation. Physical examination reveals ptosis, weakness of the extraoccular muscle
weakness, hoarseness of voice, and a suppressed gag reflex. Power in the upper limb is
2/5. It is 3/5 in the lower limb.
WHAT IS THE PHYSICAL FINDING ?
What is the Diagnosis ?
Reduced tone in the upper limb.
The diagnosis is Botulism.
A 30 year old woman presents with leg weakness and paresthesia of
the arm and leg. She denies fever and weight loss. Three years ago
she had an episode of transient vision loss. On physical examination
there is hyperreflexia, bilateral extensor plantar reflexes and cerebellar
dysmetria with poor finger to nose movement. Ocular exam shows that
the right eye does not move past the midline when asked to look right
with nystagmus in the right eye.
Which of the following is the most likely diagnosis?
A. Multiple sclerosis
defined as a reduction in the power that can be exerted by one or more muscles.
Simply a lack of strength.
A positive Romberg test suggests WHAT about ataxia
suggests that the ataxia is sensory in nature d/t the loss on proprioception
If a patient is ataxic and Romberg's test is
it suggests what about ataxia
it suggests that ataxia is
cerebellar in nature, that is, depending on localized cerebellar dysfunction instead.
- HTLV-1 myelopathy- Symptoms:
think tax protein = ataxia
signs and symptoms
such as motor and sensory changes in the
spastic gait in combination with weakness of the lower limbs, clonus
expand to slight or partial paralysis, cerebral dysfunction, anxiety, insomnia,
confusion, agitation, abnormal behavior, paranoia, terror, hallucinations, progressing to delirium
Guilliane barre (Acute inflammatory demyelinating polyneuropathy) post camplyobacter indection
Findings: increase CSF protein with normal cell count
(albuminocytologic dissociation). increase protein
Subacute combined degeneration of spinal cord, aka ___?
What is it due to?
due to degeneration of the posterior and lateral columns of the spinal cord
because of a def. of b12
Central pontine myelinolysis
complication of treatment of patients with profound, life-threatening hyponatremia. results in locked in syndrome
A PERSON PRESENTS WITH : Unilateral pyramidal pattern of limb weakness with facial involvement suggesting contralateral cerebral hemisphere dysfunction, IF THEY ARE OLD what is the diagnosis
IF THEY ARE YOUNG what is the diagnosis
stroke (old) or MS (young)
Often due to:
characterized by rapid, uncoordinated jerking movements affecting primarily the
face, feet and hands, is a major sign of acute rheumatic fever
is characterized by muscle weakness of the limbs. It is the result of an autoimmune reaction, where antibodies are formed against voltage-‐gated calcium channels in the neuromuscular
Test: eye flicker test
The ischemic penumbra definition
represents part of the hypoperfused region that can potentially be
salvaged by timely intervention
Patent foramen ovale is increasingly recognized as a conduit
for paradoxical embolism
small vessel or lacunar stroke, seen in roughly 20% of ischemic strokes,
of the small penetrating end-‐arterioles which have no collateral sources of flow
Pure motor hemiparesis :
Location: Posterior limb of the
internal capsule, basal pons,
medial medulla, or corona
Symptoms: normal sensation
Pure sensory stroke
Location : Thalamus (especially the ventroposterolateral nucleus) or pontine tegmentum
Symptoms: Normal muscle strength
Dysarthria-‐clumsy hand syndrome
Basal pons or genu of
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