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CNS > Clinical Medicine > Flashcards

Clinical Medicine Flashcards

1
Q

Complete cord transection causes

A

Trauma

Transverse myelitis (usually post-infectious or demyelinative)

Tumour

Radiation injury

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2
Q

Syringomyelia pattern

A

CAPE

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3
Q

Causes of mononeuropathy multiplex

A

Vasculitis of vasa nervorum

Sarcoidosis

Diabetes mellitus

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4
Q

MS vs NMO Sphincteric Symptoms

A

MS: urinary urgency and incontinence
NMO: urinary retention

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5
Q

INO sides affected

A

Typically bilateral

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6
Q

What structure is usually affected in incoordination caused by MS?

A

Middle cerebellar peduncle

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7
Q

Structures other than the typical central ones affected in MS

A

Centrum semiovale

Middle cerebellar peduncle

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8
Q

MS Spine MRI lesions

A

Spine MRI lesions involve the dorsal or lateral spinal cord rather than a dense transverse cross section

Are typically restricted to one or two segments

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9
Q

Spinal muscular atrophy

A

Autosomal recessive

Treatment: Antisense oligonucleotide (ASO)

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10
Q

Normal ICP

A

In adults is 8 to 18 mmHg (15-22 cmH2O)

In children the pressure is about 10-20 cm H2O and it’s even lower in babies.

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11
Q

Cushing’s Triad

A

Bradycardia, change in breathing, increased BP

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12
Q

Structures affected by hernias

A

Transtentorial - uncus herniates and affects pca and 3rd cranial nerve (if squeezes more also cerebral peduncle), in 5% contralateral peduncle and CN 3 could be affected

Subfalcine - cingulate gyrus herniates and ACA affected so paramedian cortex infarction

Central - both temporal lobes herniate and compress midbrain

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13
Q

Causes of posterior vermis syndrome

A

medulloblastomas or ependymomas

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14
Q

Intenion tremor most severe association in posterior lobe syndrome

A

Most severe tremors are associated with damage to the dentatothalamic tract

Not sure if these are for most severe or general causes:

MS
Midbrain infarctions

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15
Q

Anterior lobe syndrome cause

A

alcoholism

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16
Q

Titubation associated with?

A

Paraneoplastic syndrome

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17
Q

Spinocerebellar ataxia 2

A 
Genetic condition
Truncal ataxia
Limb ataxia
Wide pace
Eye movement problem
Intention tremor
Titubation
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18
Q

How many cardinal features are required to diagnose Parkinson’s?

A

2 out of 4

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19
Q

Parkinsonism vs Parkinson disease

A

Parkinsonism
– Group of hypokinetic movement disorders that have in common
rigidity & bradykinesia

20
Q

Atypical parkinsonian syndromes

A

Corticobasal degeneration (CBD)
Progressive Supranuclear Palsy (PSP)
Multiple System Atrophy (MSA)

21
Q

Tourette syndrome

A

≥2 motor + ≥1 vocal + >1year

22
Q

Medial Temporal Epilepsy does not affect which sense?

23
Q

Epileptic Syndrome EEGs

A

WEST SYNDROME: hypsarrhythmia
DRAVET SYNDROME: generalized spike and polyspikes wave
LENNOX GASTAUT SYNDROME: generalized and focal spike and slow waves
JUVENILE MYOCLONIC EPILEPSY: rapid generalized spike and slow waves discharges
CHILDHOOD EPILEPSY WITH CENTROTEMPORAL SPIKES: centrotemporal spikes

24
Q

REM sleep behaviour disorders are usually associated with what condition?

A

Parkinson’s disease

25
Q

Narcolepsy Molecular Mechanism

A

HLA-DQB1*0602 on chromosome 6 is a marker, autoimmune attack against hypocretin neurons (orexin neurons) so less hypocretin 1 (orexin) in CSF, some dominant inheritance

26
Q

What is the most useful factor for classifying dementias?

A

Pathoaetiology

27
Q

What ages are considered presenile and senile?

A

Presenile: below 65
Senile: 65 and above

28
Q

Progressive Supranuclear Palsy

A

Axial rigidity + parkinsonism

Fall backward

Vertical gaze is affected downward

29
Q

Genes Of Late Vs Early Onset Alzheimer’s Disease

A

Early: APP, PSEN1, PSEN2
Late: APOE4, TREM2

30
Q

Normal pressure hydrocephalus

A 
Dementia
Magnetic gait
Urinary incontinence
Parkinsonism
When you do imagining you find disproportionate to age enlargement of brain ventricles
Treated with ventriculoperitoneal shunt
31
Q

How is delirium diagnosed?

A

Acute onset and fluctuating course, inattention, and either disorganised thinking or altered level of consciousness.

32
Q

If initial investigations are negative for HSE?

A

Repeat all after 4 days

33
Q

Atypical acute bacterial meningitis presentation

A

Neck stiffness may be absent in unconscious patients.

In elderly, presentation may be atypical with no fever no headache and no neck stiffness just nonspecific confusion

34
Q

Acute bacterial meningitis CT MRI

A

CT:
CT brain in bacterial meningitis can demonstrate sulcal effacement
but may be normal.

MRI:
T1 - Postcontrast T1-weighted MRI
often reveals enhancement of the leptomeninges within the
cerebral sulci.

T2 - MRI typically shows T2 hyperintensity in the cerebral sulci.

DWI - Diffusion restriction in the sulci may also be seen on DWI,, but not
specific for infectious meningitis.

35
Q

Chronic meningitis is defined as?

A

Meningitis lasting longer than 1 month without improvement

36
Q

Cerebrovascular complications of TBM

A

Cerebrovascular complications of tuberculous meningitis that occur typically as multiple or bilateral lesions in the territories of the middle
cerebral artery perforating vessels are termed as tuberculous vasculopathy

37
Q

TBM Prognosis

A

Mortality is greatest in patients younger than age 5 years, older
than age 50 years, or in those in whom illness has been present for
more than 2 months.

38
Q

Brain abscess and subdural empyema

A

both are given ceftriaxone and metronidazole (for anaerobes)
Subdural empyema is usually by extension from sinusitis or otitis media whereas brain abscesses are usually caused by streptococci and are drained if larger than 2.5 cm or are causing symptoms and limiting LOC (lateral occipital complex)

39
Q

Glucose in meningitis

A

Glucose is decreased in bacterial (including mycobacterial) and
fungal infections and generally normal in viral infections, but it may
be decreased in mumps, herpes simplex virus 2 and CMV infection.

40
Q

Headache durations and treatments

A

SUNCT: 1sec-10min + v. difficult to treat
Paroxysmal hemicrania: 2-30min + indomethacin
Cluster: 15-180 min + oxygen
Trigeminal neuralgia: carbamezepine good
Preventive migraine treatment: monoclonal Abs vs CGRP

41
Q

Where is titubation seen

A

Paraneoplastic syndrome and SCA2

42
Q

Edema and region affected

A

Vasogenic - white matter
Cytotoxic - white and grey
Interstitial - periventricular

43
Q

ICP Corticosteroids

A

Tumour or abscess

44
Q

When to stop hyperventilating for ICP

A

less than 25 mmhg co2

45
Q

Which type of cardiac arrest is the most common in causing brain hypoxia?

46
Q

Secondary prevention of stroke

A

TIA = aspirin vs clopidogrel
AFib = aspirin vs warfarin
recap from week 3 note

CNS (8 decks)

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