Neurology Suggestion for Post Graduate Exams
Prepared by Dr. Isha Ali
MBBS (Ibrahim Medical College)
FCPS Part-1 (Medicine), MD Part-1 (Cardiology, DMC)
HMO (DMCH)
**** Gait abnormalities??
- Circumduction ——- Upper motor neuron lesion
- Slapping’ due to foot drop ——–Lower motor neuron lesion L5 root or common peroneal nerve
- Narrow-based, short strides —— Parkinsonism
- Wide-based, short strides (marche à petits pas, magnetic gait) —-Frontal lobe lesion
- Wide-based, irregular strides ——–Cerebellar lesion
- High-stepping gait ———Dorsal column lesion/sensory neuropathy
***In older age groups?? Normally-
Pupils: tend to be smaller
Ankle reflexes: may be bilaterally absent
Vibration sense: may be reduced in the lower legs
*** Neurological Emergencies?
- Status epilepticus
- Stroke
- Guillain–Barré syndrome
- Myasthenia gravis (if bulbar and/or respiratory)
- Spinal cord compression
- Subarachnoid haemorrhage
- Neuroleptic malignant syndrome
**Nervous system comprises of neurons and neuroglial cells/supporting cells
–Neuron is the structural and functional unit of nervous system
–No. of neuroglial cells is more than that of neurons (commonly mistaken mcq)
–Neuron comprises of cell body and nerve fibres (axon and dendrites)
–Cardiac muscle, skeletal muscle and neurons are permanent cells
–Muscle cells and nerve cells are excitable!
–Mature neurons cannot divide but immature neurons and neuroglial cells can divide!
–In two brain areas, the hippocampus and olfactory bulb, there is strong evidence for generation of substantial numbers of new neurons
–Neuroglial cells include Astrocytes, Oligodendrocytes, Microglia, Schwann cells, Ependymal cells
–Astrocytes are responsible for making blood-brain barrier, responsible for formation of scar tissue
–Oligodendrocytes are responsible for formation of myelin sheath in the CNS and Schwann cells are responsible for the same in PNS
–Microglia (derived from monocytes—-mesodermal origin)—known as macrophages
–Ependymal cells line up the ventricles
–Grey Matter—-Cell body, proximal part of axon, blood vessels, neuroglial cells
–White matter—Rest of the axon, blood vessels, neuroglial cells
** Learn cortical lobar functions from Davidson—-(important for Fcps Part-1)
***Frontal release signs are Grasp reflex, palmomental response, pout response (this ques came
during my Fcps Part-1 exam)
**Constructional apraxia found in Parietal(non-dominant) lesion
**Complex hallucinations found in temporal lobe lesion
**Impaired musical skills found in temporal(non-dominant) lesion
**Astereognosis found in parietal lobe lesion
**Broca’s area is located in Frontal lobe, lesion causes motor aphasia
**Wernicks area is located in Temporal lobe, lesion causes sensory aphasia
**Rhythm is processed on the dominant temporal side and melody/pitch on the non-dominant
–Learn the brainstem syndromes from Davidson??
***Wallenberg or Lateral medulla syndrome (V.V.V.V.V.V.I)???
-Ipsilateral 5th, 9th, 10th, 11th palsy
-Ipsilateral Horner’s syndrome
-Ipsilateral cerebellar signs
-Contralateral spinothalamic sensory loss
-Vestibular disturbance
**First line investigation for stroke patients—–CT scan of brain (high risk of radiation)
**MRI is useful to assess posterior fossa and temporal lobes(no risk of radiation)
**EEG?
–With closed eyes, the normal background activity is 8–13 Hz (known as alpha rhythm), most
prominent occipitally and suppressed on eye opening.
–Other waves—beta (faster than 13/s), theta (4–8/s) and delta (slower than 4/s).
–Sedative poisoning—there is increase in fast frequencies (beta)
–EEG is used in reduced consciousness, in encephalitis, in certain dementias such as
Creutzfeldt–Jakob disease, sleep disorders, and in the classification and prognosis of epilepsy
–50% of patients with proven epilepsy will have a normal ‘routine’ EEG
***LP is contraindicated if there is any clinical suggestion of raised intracranial pressure
(papilloedema), depressed level of consciousness, or focal neurological signs suggesting a
cerebral lesion, when there is a risk of local haemorrhage (thrombocytopenia, DIC)—-if
adequate measures are not taken!!!!!!
**The quadriceps muscle is most commonly biopsied for muscle biopsy!
**Nerve conduction study?
–used in the disease of peripheral nervous system
–Recorded potential diminished but less or normal conduction—–Axial type
–Conduction block is more but recorded potential is normal——Demyelinating variety
**Visual evoked potentials (VEPs) are most commonly used to help differentiate CNS
demyelination from small-vessel white-matter changes
**EMG??
–Myopathy will cause muscle fibre splitting, which will result in a large number of smaller units
on EMG
–Axonal loss or destruction to the muscle will lead to increasing size of each individual unit on
EMG
‘Red flag’ symptoms in headache?
**Sudden onset??
-Subarachnoid haemorrhage
-Cerebral venous sinus thrombosis
-Pituitary apoplexy
-Meningitis
**Focal neurological symptoms??
-Intracranial mass lesion
-Vascular
-Neoplastic
-Infection
**Constitutional symptoms (Weight loss, General malaise, Pyrexia, Meningism, Rash)
-Meningoencephalitis
-Neoplastic (lymphoma or metastases)
-Inflammatory (vasculitic)
**Raised intracranial pressure (worse on wakening/lying down, associated vomiting)
Intracranial mass lesion
**New onset aged > 60 yrs
Temporal arteritis
**Primary headache syndromes??
- Migraine (with or without aura)
- Tension-type headache
- Trigeminal autonomic cephalalgia (including cluster
headache)
- Primary stabbing/coughing/exertional/sex-related headache
- Thunderclap headache
- New daily persistent headache syndrome
*** Anxiety is the most common cause of dizziness in those under 65 years
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Neurology Suggestion for Post Graduate Exams
