Muscle e.g. diabetic myopathy NMJ e.g. myasthenia gravis
Peripheral nerve e.g. GBS Spinal cord e.g. cord compression
Cerebrum e.g. Stroke
Slide 5
Timeline Immediate Intermediate Long-term
Slide 6
UMN vs. LMN ???
Slide 7
UMN vs. LMN UMNLMN HyperreflexiaHyporeflexia
HypertoniaHypotonia ClonusMuscle wasting No muscle
wasting/fasciculationFasciculation Plantars upgoing (lower
limbs)Plantars downgoing (lower limbs)
Slide 8
Pyramidal vs. Extrapyramidal PyramidalExtrapyramidal
WeaknessTremor SpasticityChorea Pronator driftHemiballismus Loss of
skilled movementAthestosis HyperreflexiaDystonia Change in
tone/tendon reflexes Plantars upgoing Loss of abdominal/cremasteric
reflex
Facial nerve palsies Bulbar vs. pseudobulbar Pseudobulbar = UMN
of CN IX-XII Spastic tongue Sparing of forehead Bulbar = LMN of CN
IX-XII Tongue wasting/fasciculation Affects all facial muscles
Slide 11
Slide 12
The tracts Dorsal column Corticospinal Spinothalamic ? ? ?
Slide 13
Lateral Spinothalamic Pain and temperature Decussates at the
level of the spinal cord
Slide 14
Anterior Spinothalamic Crude touch and pressure Decussates at
the level of the spinal cord
Slide 15
Dorsal columns Discrimination, proprioception, vibration.
Crosses at the medulla. Subacute combined degeneration of the cord,
Tabes dorsalis, Spinal trauma.
Slide 16
Corticospinal Tracts Descending motor tracts. Cross at the
medulla.
Stroke Syndromes TACS all 3PACS 2 of 3LACSPOCS Hemiplegia/hemi
sensory loss See leftNo visual field defect Bilateral motor or
sensory Visual field disturbance Pure motorConjugate eye movement
disturbance Disturbance in higher function e.g. dyphasia/dysphag ia
Pure sensoryCerebellar dysfunction Sensory-motorHemiplegia or
cortical blindness Ataxia
Slide 31
Visual Defects Ipsilateral blindess Bilateral hemianopia Left
homonymous hemianopia Left superior quadrantanopia Left homonymous
hemianopia with macular sparing
Slide 32
Cases
Slide 33
Case 1 57 year old man complaining of weakness and altered
sensation in upper limbs and lower limbs Loss of sensation from
shoulders and down, urinary incontinence On Examination: CN intact
Upper limbs weakness, hypotonia, reduced reflexes Lower limbs
spasticity, hyper-reflexia and Babinski +ve, reduced sensation from
shoulders down
Slide 34
Case 2 85 year old man with long standing (20yr) history of
balance problems worse in the dark. Gait is high stepping On
Examination: CN intact Motor intact Loss of proprioception with +ve
Rombergs test
Slide 35
Case 3 23, female presents to her GP with a 2 week history of
bilateral leg weakness having started with pins and needles and
numbness in her hands and feet. She has had a few days of urinary
incontinence which has resolved. 2 years ago she had an episode of
blurred vision and pain in the right eye which lasted a month and
fully resolved
Slide 36
Case 4 56 male 6 month history of progressive weakness of his
right hand. Also had problems with swallowing and has choked whilst
eating on several occasions o/e he has wasting of his upper and
lower limbs and some fasciculation's were noted his right plantar
was up going and his reflexes were generally brisk
Slide 37
Things weve not had time to cover Peripheral neuropathies Motor
neurone Parkinsons Huntingtons GBS Myasthenia gravis
Slide 38
Peripheral Neuropathies A alcohol B B12 deficiency C CKD D
drugs/diabetes E every vasculitis
