05/06/2021 Flashcards
acoustic neuroma diagnosis
MRI of cerebellopontine angle
axillary freckles
neurofibromatosis type 1
NF1
cafe au lait axillary/groin freckles Peripheral neurofibromas Iris hamatomas Scoliosis Pheochromocytoma
NF2
Bilateral vestibular schwannomas
Multiple intracranial schwannomas, meningiomas and ependymomas
painful third nerve palsy
posterior communicating artery aneurysm
what causes webers
midbrain strokes- ipsilateral 3rd nerve palsy with contralateral hemiplegia
what are adenoma sebaceum
feature of tuberous sclerosis
tuberous sclerosis inheritance
autosomal dominant
cutaneous features of tuberous sclerosis
ash-leaf spots shagreen patches adenoma sebaceum fibromata beneath names café au lait may be seen
neurological features of tuberous sclerosis
developmental delay
epilepsy
intelluctual impairment
where is affected in broca’s aphasia
expressive aphasia- left-sided stoke affecting the MCA due to a lesion of the inferior frontal gyrus
where is affected in wernicke’s aphasia
Due to a lesion of the superior temporal gyrus. It is typically supplied by the inferior division of the left MCA
MOA of 5-HT 2 antagonists
chemoreceptor trigger zone in medulla oblongata
unilateral spastic paresis and loss of proprioception/vibration sensation wth loss of pain and temperature sensation on the opposite side
brown-sequard
cluster headache prophylaxis
verapamil
acute rescue therapy cluster headache
sumatriptan with high flow oxygen
pain and temperature sensation in brown-sequard
loss of contralateral
weakness in brown-sequard
ipsilateral weakness below lesion
proprioception in brown-sequard
ipsilateral loss
loss of corneal reflex
acoustic neuroma
assessing stroke in acute setting
ROSIER
- LOC/syncope (1)
- seizure activity (1)
- new onset of;
+ asymmetrical facial weakness (1)
+ asymmetric arm weakness (1)
+ asymmetric leg weakness (1)
+ speech disturbance (1)
+ visual field defect (1)
Anterior cerebral artery stroke
contralateral hemiparesis and sensory loss, lower extremity > upper
Middle cerebral artery stroke
contralateral hemiparesis and sensory loss, lower extremity > upper
contralateral homonymous hemianopia
aphasia
posterior cerebral artery stroke
Contralateral homonymous hemianopia with macular sparing
Visual agnosia
weber’s syndrome (branches of the posterior cerebral artery that supply the midbrain) stroke
ipsilateral CNIII palsy
Contralateral weakness of upper and lower extremity
posterior inferior cerebellar artery (lateral medullary syndrome, Wallenberg syndrome) stroke
Ipsilateral: facial pain and temperature loss
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus
Anterior inferior cerebellar artery (lateral pontine syndrome) stroke
Wallenbergs
Ipsilateral: facial paralysis and deafness
retinal/ophthalmic artery stroke
amaurosis fugax
basilar artery stroke
locked-in syndrome
how do lacunar strokes present
isolated hemiparesis, hemisensory loss or hemiparesis with limb ataxia
Strong association with hypertension
Basal ganglia, thalamus and internal capsule
diminished response to repetitive stimulation on EEG
myasthenia gravis
management of nausea in parkinsons
give domperidone (guy trembling with bottle of demo perignon)
motor eyes pnuemonic
LR6 SO4 ao3
diagnosis of carotid artery stenosis
duplex ultrasound
Management of neuropathic pain
1) amitriptyline, gabapentin or pregabalin
management of status epilepticus
ABC
1st- benzodiazepines
2nd- phenytoin or phenobarbital infusion
3rd (refractory status)- general anaesthesia
tremor + high pitched voice
essential tremor
features of bell’s
> lower motor neuron facial nerve palsy - forehead affected
– in contrast, an upper motor neuron lesion ‘spares’ the upper face
> patients may also notice post-auricular pain (may precede paralysis), altered taste, dry eyes, hyperacusis
who is predisposed to bell\s palsy
pregnant women
management of bell’s palsy
all patients should get oral prednisolone within 24hrs
parkinsonism + atonic bladder + postural hypotension
multi-system atrophy
features of neuroleptic malignant syndrome
rigidity
hyperthermia
autonomic instability
altered mental status
what is an arnold-chiari malformation
downward displacement, or herniation of the cerebellar tonsils through the foramen magnum
features of arnold chiari malformation
non-communicating hydrocephalus
headache
syringomyelia
what is syringomyelia
dilatation of a CSF space in the spinal cord
pathophysiology of syringomyelia
compression of spinothalamic tracts decussating in the anterior white commisure
symptoms of syringomyelia
dissociative loss of sensation of pain, temperature and non-discriminative touch
cape-like distribution of sensory loss
longevity of cluster headaches
15 minutes to 2 hours
dose of rectal diazepam in seizures
child <1yr 5mg
child 2-11 yrs 5-10mg
adult 10-20 mg
elderly 10 (max 15)mg
thrombectomy target in acute ischaemic stroke
6 hours
when can thrombectomy target be increased in acute ischaemic stroke
> potential to salvage brain tissue, shown by imaging such as CT perfusion or diffusion-weighted MRI sequences showing limited infarct core volume
how to differentiate between common peroneal nerve lesion and L5 radiculopathy
if isolated peroneal lesion there will be weakness of foot dorsiflexion and eversion, reflexes will be normal
if L5 there will be weakness of hip abduction
features of wernickes encephalopathy and korsakoffs syndrome
Wernickes; C- onfusion O- pthalmoplegia A- taxia T- hiamine deficiency
Korsakoff's; R- etrograde amnesia A- neterograde amnesia C- onfabulation K- orsakoff psychosis
saturday night palsy
compression of the radial nerve against the humeral shaft, possibly due to sleeping in a hard chair
laughter -> fall/collapse
cataplexy
motor innervation of ulnar nerve
medial two lumbricals adductor pollicis interossei hypothenar muscles flexor carpi ulnaris
thoracic outlet syndrome causes
neurogenic or vascular
clinical presentation of neurogenic thoracic outlet syndrome
> painless muscle wasting of hand muscles, with patients complaining of hand weakness e.g. grasping
> sensory symptoms such as numbness and tingling may be present
> if autonomic nerves are involved, the patient may experience cold hands, blanching or swelling
clinical presentation of vascular thoracic outlet syndrome
> subclavian vein compression leads to painful diffuse arm swelling with distended veins
> subclavian artery compression leads to painful arm claudication and in severe cases, ulceration and gangrene
fasciculations
think MND
baseline investigation for MS
MRI brain with contrast
scale that measures disability or dependence in activities of daily living in stroke patients
barthel
vertical diplopia
trochlear nerve palsy- worse when reading or going down stairs
nerve root landmarks C2 C3 C4 C5 C6 C7 C8
T4
T5
T6
T10
L1
L4
L5
S1
S2
S3
C2= Posterior half of skull C3= high turtleneck shirt C4= low collar shirt C5= ventral axial line of upper limb C6= thumb + index (make a 6) C7= middle finger + palm of hand C8= ring + little finger
T4= nipples (T4 at the teat pore) T5= infra-mammary fold T6= xiphoid T10= umbilicus
L1= inguinal ligament L for ligament, 1 for 1nguinal L4= knee caps (down on alL 4's) L5= big toe, dorsum of foot, except lateral aspect (L5= largest of all 5 toes)
S1= lateral foot, small toe S1 the smallest 1 S2= genitalia S3= genitalia
commonest neurological manifestation of sarcoidosis
facial nerve palsy due to parotid gland enlargement
conduction dysphasia
speech fluent, repetition poor. comprehension intact
controlled hyperventilation
reduces CO2, causes vascoconstriction of cerebral arteries and reduced ICP
management of generalised tonic-clonic seizures
1) sodium valproate
2) lamotrigine, carbamazepine
management of absence seizures
1) sodium valproate or ethosuximide
management of myoclonic seizures
1) sodium valproate
2) clonazepam, lamotrigine
management of focal seizures
1) carbamazepine or lamotrigine
2) levetiracetam, oxcarbazepine or sodium valproate
drugs associated with SJS
phenytoin salicylates sertraline imidazole nevirapine carbamazepine
large artery acute ischaemic stroke management
mechanical clot review
klumpke’s paralysis
brachial trunks C8-T1
weakness of the hand intrinsic muscles. Involvement of T1 may cause a Horner’s syndrome.
erbs palsy
brachial trunks C5-6
pronated and medially rotated.
Lambert-Eaton syndrome or myasthenia gravis?
Weakness in Lambert Eaton improves after exercise, unlike myasthenia gravis; which worsens after exercise
features of intracranial venous thrombosis
headache
N&V
test of venous sinus thrombosis
MR venogram
what suggests idiopathic parkinsons?
asymmetrical symptoms
features favouring pseudoseizures
pelvic thrusting family member with epilepsy more common in females crying after seizure dont occur when alone gradual onset
treatment of idiopathic intracranial hypertension
acetazolamide- CAI that reduces the production of CSF
facial palsy that spares the upper face
UMN lesion
surgical third nerve palsy
ptosis, enlarged pupil, inability to adduct/supradduct
cause of normal pressure hydrocephalus
2ry to reduced CSF absorption at the arachnoid villi
- head injury, SAH or meningitis
tried in normal pressure hydrocephalus
urinary incontinence
dementia
gait abnormality
Bitemporal hemianopia- lower quadrant defect
inferior chiasmal compression, commonly a pituitary tumour
Bitemporal hemianopia- upper quadrant defect
superior chiasmal compression, commonly a craniopharyngioma
which medicatons are likey to cause inhibition disorders
dopamine receptor agonists- ropinirole
weakness of foot dorsiflexion and elevation
common peroneal nerve lesion
screening tests for cause of stroke
- anti-nuclear antibodies(ANA)
- anti-phospholipid (APL) antibodies
- anticardiolipin (ACL) antibodies
- lupus anticoagulant (LA)
- coagulation factors
- ESR
- Homocysteine
- syphillis serology
appearance of chronic subdural haematoma on scan
hypodense (dark) crescenteric collection around the convexity of the brain
what is autonomic dysreflexia
> unbalanced physiological response
characterised by;
extreme hypertension, flushing and sweating above the level of the cord lesion, agitation, and in untreated cases severe consequences of extreme hypertension have been reported, e.g. haemorrhagic stroke.
what causes autonomic dysreflexia
spinal cord injury at, or above T6 spinal level.
management of autonomic dysreflexia
removal/control of the stimulus and treatment of any life-threatening hypertension and/or bradycardia
smiths fracture injury
median nerve- thenar muscle failure
cutaenous sensation to the axilla
intercostobrachial
what is todd’s paresis?
post-ictal weakness in focal seizures
exacerbating factors in myasthenia gravis
penicillamine quinidine, procainamide beta-blockers lithium phenytoin antibiotics: gentamicin, macrolides, quinolones, tetracycline
syncopal episode vs seizure
syncopal episodes have a short post-ictal period
management of MND
riluzole- prolongs life by about 3 months
resp care= BIPAP
the sensation of fine touch, proprioception and vibration are all conveyed in the ____ ______
dorsal column
what is lhermitte’s sign?
indicates disease near the dorsal column nuclei of the spinal cord - tingling in hands when flexes neck
management of acute relapse of MS
high dose steroids
most common inherited sensorimotor neuropathy
charcot-marie-tooth
treatment of myasthenia gravis
Pyridostigmine is a long-acting acetylcholinesterase inhibitor that reduces the breakdown of acetylcholine in the neuromuscular junction, temporarily improving symptoms of myasthenia gravis
lesions at T1 will cause
finger abduction weakness
syringomyelia = ______ sensory loss
spinothalamic
investigation in suspected acoustic neuroma
audiogram and gadolinium-enhanced MRI head scan
use of anaesthesia in MG
MG: rocuronium ‘rocks’
Suxamethonium sucks
when to suspect encaphalitis
altered mental status
which nerves are affected in vestibular shwanommas?
cranial nerves V, VII, VIII
managing tremor in drug induced parkinsons
procyclidine
side effect of cabergoline
pulmonary fibrosis
long term use of levodopa
reduced effectiveness with time
symptoms of paroxysmal hemicrania
attacks of severe, unilateral headache, usually in the orbital, supraorbital or temporal region
last less that 30 mins
management of paroxysmal hemicrania
indomethacin
management of neuroleptic malignant syndrome
stop antipsychotic
IV fluids to prevent renal failure
dantrolene
bromocriptine, dopamine agonist
what is internuclear ophthalmoplegia
lesion of medial longitudinal fasciculus- a tract that allows conjugate eye movement
presentation of internuclear ophthalmoplegia
impairment of adduction of ipsilateral aye, contralateral eye adducts however with nystagmus
jacksonian movement
clonic movements travelling proximally - frontal lobe epilepsy
most common psychiatric problem in parkinsons
depression
headache, fever and focal neurology
brain abscess
what does loss of proprioception and vibration sense point towards?
dorsal columns- subacute combined degeneration of the spinal cord
pontine haemorrhage
Patients often present with reduces Glasgow coma score, quadriplegia, miosis, and absent horizontal eye movements.
barthel index
measures disability or dependence in ADL in stroke patients
isolated high protein in CSF
indicative of GBS
