EMQs in Clinical Medicine.pdf - Peshawar Medical College

Neurology – revision boxes 105
REVISION BOXES
Neurology
Box 1 summarizes some features of different causes of headache.
Box 1 Headache: classic presentation in an EMQ [29, 30]
Symptoms
Headache type
• Stress, tight band around head Tension headache
• Sudden onset, ‘kicked in back Subarachnoid haemorrhage
of head’; associated with vomiting
• Unilateral ‘throbbing’, aura, Migraine
vomiting, photophobia
• Tender pulseless temporal
Giant-cell arteritis
arteries; jaw claudication
• Pain worse on coughing/sneezing; Mass lesion
confusion, seizures, localizing focal
neurology; signs of intracranial
pressure, e.g. papilloedema
• Usually obese young woman; ↑ CSF Benign intracranial hypertension
(cerebrospinal fluid) pressure but
no mass lesion
• Fever, neck stiffness,
Meningitis
photophobia, rash
• Head injury, chronic course
Subdural haemorrhage
fluctuating consciousness
Discriminating an upper motor neuron lesion (UMN) from a lower motor
neuron (LMN) lesion helps to exclude options in an EMQ (Box 2).
Box 2 Distinguishing UMN and LMN lesions
UMN lesion
LMN lesion
• Involves corticospinal tract
• Lesion at level of anterior horn
• Weakness in upper limb extensors, cell or distal to it
lower limb flexors (pyramidal • Fasciculation and wasting
distribution)
• Loss reflexes
• Increased tone
• Hypotonia
• Hyperreflexia, clonus
• Pronator drift
• Loss of abdominal reflexes
• Extensor plantar response