Nupbridg neuro 20220823

Older lady frequent falls.

 
 
Sit to stand
Stance
walk to 6m.
Part of foot landing Stride length foot clearancd
Wide based more than shoulder or more than 12cm. In ataxia cerebellar or sensory or vestibular
Arm swing
Turning en bloc more than 3 steps
Romberg to differentiate cerebellar and sensiry.
Push and pull
 
 
 
Psp falls back Parkinson's falls forward.
 
 
Freq falls
Neuro ataxia, post instability Parkinson,
Parkinson's trap
Cerebellar signs
NPH bladder bowel dementia
Multiinfarct vascular dementia. Ll
Vestibular nystagmus tinnitus vertigo
Non neuro e.g. msk
 
 
Examination
inspection includes movement disorders involuntary movements.
Tone is for movement disorders and corticospinal
Reflexes and power is for corticospinal tract UMN and LMN
Coord is for cerebellar
Sensory loss is for pattern and modality. dermatomal distribution. Peripheral nerve aphenous, spn.
Glove stocking.
Pinprick is spinothalamic and small fibre. Proprioception is for dorsal column and large fibre.
Sensory symptoms brain or peripheral nerve.
 
Wasting and fasciculatikns. Lmn and distribution. - quadriceps think of LMN l2 to lumbar plexus to
femoral nerve . Or diffuse.
Deformity foot drop, pes cavus in cmt, Charcot joint dm neuropathy
ulcers - dm. Skin is indicates autonomic function.
 
Tone for umn Vs lmn
 
Reflex kj l3 4 femoral nerve. AJ diminished l5 S1 or peripheral neuropathy. plantar response
Power. ankle dorsiflex l4 l5 common peroneal. Toe l5. ankle plantar flexion S1 tibial nerve sciatic
nerve gastroc soleus.
 
Vibration sense do IPJ of toe.
If cerebellar signs, proceed to finish e.g. head and truncal titubation, nystagmus, dyaarthia British
constitutikn, dysmtetria (multi joint.) , dysdiadochokinesia ("faster and higher").
 
Vermis is nvolvemrnt is nystagmus and truncal.
Hemispherical involves appendices.
Flocculonodular lobe. Vertigo
spinocerebellar pathway - Spinocerebellar ataxia.
 
unilateral means structural
Bilateral means metabolic e.g. toxins
 
 
 
 
50yo m no PMH except mvp. Sudden onset unsteadiness and disorientation. No weakness njmbness.
No slurring ,diplopia, dysphagia.
 
examine cranial nerves.
 
Inspect face for ptosis,
Ptosis (Horner syndrome) + ataxia = lateral medullary syndrome
ptosis is levator palpebrae superioris weakness myopathies. nmj (fatiguability), CN iii (DM or
surgical) Midbrain (long tract signs)
 
multidirdctiibak nystagmus
Decreaded sensation right side of face.
Facial nerve
 
Palate sluggish
 
Complex ophthalmoplegia if it doesn't fit into one nerve
 
Important signs
Ptosis. Check pupils = nerve.
Ophthalmoplegia
Facial nerve palsy
Bulbar palsy
 
Parkinson's examine ul. Look at the face!! Test apraxia for cbgd i.e. cannot copy (cannot perform
learned movement but no motor or sensory issue. Can also ask Hx brush teeth comb hair.)
 
 
episodic disorders rely on Hx
Headache. Just need fundus
Epilepsy long case - onset, frequency, type of seizures. How under control?
 
Hx and pe neuro signs
Motor with objective weakness, ataxia, movement disorder including involuntary movements
decreased increased or abnormal. Sensory radiculopathy neuropathy spinal cord or cns.
Cortical - dementia etc.
Cranial nerve deficits
 
 
 
Mg ocular ptosis diplopia. Bulbar symptoms. Proximal muscle. Resp diaphragm.
Fatiguability, diurnal variation.
Compare both sides for shoulder abduction.
 
Foot drop 50% cpn. ankle dorsiflexoon. Tib anterior. Deep peroneal common sciatic nerve sacral
plexus. L4l5.
Cpn also involves superficial peroneal nerve sensation and eversion
Sciatic also involves tibial nerve i.e. plantar flexors and inversion. If cannot walk on toes means
plantar weakness.
Proximal sciatic nerve involves knee extensions
Sacral plexus supplies hip abduction and extension
L4 l5 - need to check sensation
Corticospinal - spasticity.
 
Wrist drop 90% radial nerve
ECU ecrlb. Radial nerve
brachial plexus, posterior cord, posterior divisoons, c5 to c8
 
Pin only affects motor to thumb eip fingers, no sensory srn.