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Yr 4 - ACC > Corrections - Neuro > Flashcards

Corrections - Neuro Flashcards

1
Q

In what scenarios is dexamethasone contraindicated in the management of meningitis?

A
  • septic shock
  • meningococcal septicaemia
  • immunocompromised
  • meningitis following surgery
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2
Q

What is the normal range of CSF protein?

A

0.15-0.40 g/L

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3
Q

What is the normal value of CSF glucose?

A

CSF glucose is normally >70% of the plasma glucose levels.

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4
Q

Which vaccines are offered for meningitis?

When are they offered?

A

Meningitis B vaccine –> all babies at 8 and 16 weeks, with a booster after their 1st birthday.

Hib/Meningitis C vaccine –> all babies around 12/13 months.

Meningitis ACWY vaccine at age 13-18 - especially for new university students.

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5
Q

Which vaccine is recommended for ‘fresher’ university students?

A

Meningitis ACWY vaccine

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6
Q

A 69-year-old woman presents with a 3 week history of a headache which is worse on the right side. She is generally unwell and feels ‘weak’, noting particular difficulty in getting up from a chair.

What is condition?

A

Temporal arteritis.

The weakness is due to the presence of polymyalgia rheumatica, a condition which is on the same spectrum as temporal artertitis.

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7
Q

What are the features of Cushing’s reflex?

A

Bradycardia, hypotension (widened pulse pressure), & irregular respirations.

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8
Q

Contraindications of lumbar puncture?

A

1) raised ICP (this may be demonstrated by the Cushing’s reflex)

2) meningococcal sepsis

3) severe respiratory/cardiac compromise

4) significant bleeding risk

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9
Q

What is alternative way to confirm diagnosis of meningitis in cases of raised ICP?

A

Whole blood PCR and blood cultures (if LP is contraindicated)

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10
Q

What Abx is given as prophylaxis for meningitis?

A

Ciprofloxacin (or rifampicin)

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11
Q

What is venous sinus thrombosis?

A

A thrombotic obstruction of the cerebral veins and/or dural sinuses. The thrombus will reduce the venous drainage, increasing the intracranial pressure.

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12
Q

What imaging is used to diagnose venous sinus thrombosis?

A

MR venogram

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13
Q

Presentation of venous sinus thrombosis?

A

Raised ICP e.g. headache, N&V, reduced consciousness

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14
Q

What vaccines should not be given in immunocompromised patients?

A

Live attenuated vaccines:

  • yellow fever
  • varicella zoster
  • MMR
  • TB
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15
Q

With a medication overuse headache, can triptans be stopped suddenly or should they be gradually decreased?

A

Can be stopped abruptly

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16
Q

Features of encephalitis?

A
  • fever, headache, psychiatric symptoms, seizures, vomiting
  • focal features e.g. aphasia
  • peripheral lesions (e.g. cold sores) have no relation to the presence of HSV encephalitis
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17
Q

What is responsible for 95% of cases of encephalitis in adults?

A

HSV-1

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18
Q

What brain lobes does encephalitis typically affect?

A

Temporal and inferior frontal

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19
Q

Management of all cases of suspected encephalitis?

A

IV aciclovir

Note - HSV meningitis can progress to encephalitis. In this case, add IV aciclovir to treatment.

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20
Q

What medication is used for long-term prophylaxis of cluster headaches?

A

Verapamil

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21
Q

What medication is used in acute management of cluster headaches?

A

1) Sumatriptan
2) 100% O2

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22
Q

What is Abx management for bacterial meningitis in patients:

1) 3 months - 50 years
2) >50 years

A

1) cefotaxime or ceftriaxone

2) cefotaxime (or ceftriaxone) + amoxicillin (or ampicillin)

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23
Q

What is Herpes zoster ophthalmicus (HZO)?

A

Describes the reactivation of the VZV in the area supplied by the ophthalmic division of the trigeminal nerve.

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24
Q

Features of herpes zoster ophthalmicus (HZO)?

A

1) vesicular rash around the eye, which may or may not involve the actual eye itself

2) Hutchinson’s sign: rash on the tip or side of the nose –> indicates nasociliary involvement and is a strong risk factor for ocular involvement

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25
What is the most common causes of viral meningitis in adults?
Enteroviruses e.g. coxsackievirus
26
What are the 3 most common organisms causing bacterial meningitis in neonates-3months old?
1) GBS 2) E. coli 3) Listeria monocytogenes
27
To detect a SAH, when should the LP be done?
at least 12 hours after the start of the headache
28
1st line management of brain abscess?
IV 3rd generation cephalosporin (e.g. ceftriaxone) + metronidazole Can add dex if oedema
29
Meningiomas are extra-axial lesions, what does this mean?
They do not arise from the brain parenchyma.
30
What are the features of focal seizures with impaired awareness?
- emotional disturbance e.g. patient may be become tearful - automatism (the performance of actions without conscious thought or intention) - post-ictal state in which patient may become very tired
31
What is the 1st line for myoclonic seizures in males?
Sodium valproate
32
What is the 1st line for absence seizures?
Ethosuximide
33
Causes of serotonin syndrome?
Excess serotonin caused by: 1) SSRIs 2) SNRIs 3) Recreational drugs e.g. MDMA
34
Symptoms of serotonin syndrome?
- tremor - confusion - muscle rigidity - agitation - muscle twitching - hyperreflexia - autonomic hyperactivity e.g. tachycardia and hypertension
35
What is the most common feature of carbon monoxide poisoning?
Headache (often described as dull, throbbing and frontal).
36
Cause of headache in carbon monoxide poisoning?
Due to the formation of carboxyhaemoglobin in the blood which reduces oxygen delivery to the brain.
37
What cerebral vessel is likely to be affected in patients presenting with contralateral homonymous hemianopia with macular sparing and visual agnosia?
Possterior cerebral artery (PCA)
38
What are some factors that favour a pseudoseizure?
- pelvic thrusting - family member with epilepsy - much more common in females - crying after seizure - don't occur when alone - gradual onset
39
How is serum prolactin affected in a true seizure?
Raised
40
What is lateral medullary syndrome? What vessel is affected? What are the features?
What --> A neurological disorder causing a range of symptoms due to ischemia in the lateral part of the medulla oblongata in the brainstem Vessel --> Posterior inferior cerebellar artery Features; - ataxia, nystagmus - ipsilateral: facial pain and temperature loss - contralateral: limb/torso pain and temperature loss
41
How does lateral medullary syndrome cause ipsilateral facial pain and temperature loss?
Due to damage to the trigeminal nucleus, and the fact that the fibres of the trigeminal nerve do not decussate
42
How does lateral medullary syndrome cause contralateral limb/torso pain and temperature loss?
due to damage to the lateral spinothalamic tract
43
How does lateral medullary syndrome cause ataxia?
due to damage to the inferior cerebellar peduncle
44
How does lateral medullary syndrome cause nystagmus?
due to damage to the vestibular nucleus
45
What electrolyte abnormalities are caused by refeeding syndrome?
Hypokalaemia, hypomagnesaemia, hypophosphataemia
46
What is the hallmark feature of refeeding syndrome?
Hypophosphataemia --> may result in significant muscle weakness, including myocardial muscle (→ cardiac failure) and the diaphragm (→ respiratory failure).
47
Associated affects of a stroke affecting the anterior cerebral artery vs middle cerebral artery?
ACA: - Contralateral hemiparesis and sensory loss - Lower extremity > upper MCA: - Contralateral hemiparesis and sensory loss - Upper extremity > lower - Contralateral homonymous hemianopia - Aphasia
48
is contralateral homonymous hemianopia seen in a stroke affecting the ACA or MCA?
MCA
49
How does the optic disc appear in temporal arteritis?
The optic disc appears pale and oedematous due to anterior ischaemic optic neuropathy secondary to inflammation of the posterior ciliary arteries.
50
How does optic neuritis affect the eyes?
- pain on movement - reduced visual acuity - relative afferent pupillary defect due to reduced response to light of the afferent pathway in the affected eye -poor discrimination of colours, 'red desaturation' - central scotoma
51
What investigation is diagnostic in optic neuritis?
MRI of the brain and orbits with gadolinium contrast
52
Management of TIA?
300mg aspirin and refer for assesment.
53
Is a CT needed prior to aspirin 300mg in a TIA?
If patient not on anticoagulants --> not needed as haemorrhage rarely causes TIA If patient is on anticoagulants/has coagulopathy --> immediate CT head would be indicated
54
When is assessment needed following TIA?
24 hours --> if they present within 7 days of suspected TIA 7 days --> if they present after 7 days
55
What investigation is required for all patients with intracranial bleesd who become unresponsive?
Urgent CT head --> to check for hydrocephalus.
56
What does Horner's syndrome classically present with?
Ipsilateral ptosis, miosis and anhydrosis
57
What helps determine the site of the lesion in regard to Horner's syndrome?
Anhydrosis. If anhydrosis affects: 1) head, arm, trunk --> central lesions e.g. stroke, springomyelia 2) just face --> pre-ganglionic lesion e.g. Pancoast's, cervical rib 3) absent --> post-ganglionic lesion e.g. carotid artery dissection
58
What is the most characteristic feature of a common peroneal nerve lesion?
Foot drop
59
Features of common peroneal nerve lesion?
- foot drop (weakness of foot dorsiflexion) - weakness of foot eversion - weakness of extensor hallucis longus - sensory loss over the dorsum of the foot and the lower lateral part of the leg - wasting of the anterior tibial and peroneal muscles
60
Management of acute relapse of MS?
High dose steroids (IV or oral).
61
What is Uhthoff's phenomenon?
A transient worsening of neurological function lasting <24 hours that can occur in MS due to increases in core body temperature e.g. hot weather, exercise, hot bath, fever.
62
1st line management of focal seizures?
lamotrigine or levetiracetam
63
1st line management of tonic clonic seizures?
Males --> sodium valproate Females --> lamotrigine or levetiracetam
64
1st steps in epilepsy management following a FIRST seizure?
Refer to epilepsy clinic before starting medications.
65
Following a first seizure, anti-epileptic drug treatment should only be started before specialist review in exceptional circumstances. What are these circumstances?
1) Seizure activity observed on EEG 2) Presence of a neurological deficit 3) Presence of a structural brain abnormality 4) Patient, parent or carer considers the risk of a further seizure to be unacceptable
66
When is a carotid endarterectomy considered in patients?
Considered in a patient who has had a TIA with carotid artery stenosis exceeding 70% on the side contralateral to the symptoms
67
How is carotid stenosis diagnosed (and degree of stenosis assessed)?
Duplex US
68
Management of intracerebral haemorrhage following thrombolysis?
Stop aspirin 300mg and control BP (target for 140mmHg)
69
What investigation should all TIA patients have?
Urgent carotid doppler (unless they are not a candidate for carotid endarterectomy)
70
What is Ramsay Hunt syndrome?
Caused by the reactivation of the varicella zoster virus in the geniculate ganglion of the seventh cranial nerve.
71
features of Ramsay Hunt?
- auricular pain is often the first feature - facial nerve palsy - vesicular rash around the ear - other features include vertigo and tinnitus
72
Management of Ramsay Hunt?
Oral aciclovir & corticosteroids
73
What is progressive supranuclear palsy?
A 'Parkinson Plus' syndrome. Features: - postural instability and falls - stiff, broad-based gait - impairment of vertical gaze (down gaze worse than up gaze - patients may complain of difficultly reading or descending stairs) - parkinsonism: bradykinesia is prominent - cognitive impairment: primarily frontal lobe dysfunction
74
What are the 1st line medications for management of spasticity in MS?
1) Baclofen (GABA agonist) 2) Gabapentin
75
Following a head injury, NICE has guidance regarding whether a head CT is indicated immediately (i.e. within 1 hour) or within 8 hours. What are the criteria for a CT head within 1 hour?
- GCS < 13 on initial assessment - GCS < 15 at 2 hours post-injury - suspected open or depressed skull fracture - any sign of basal skull fracture - post-traumatic seizure - focal neurological deficit - more than 1 episode of vomiting
76
What are the criteria for a CT head within 8 hours following a head injury?
- age ≥65 - any history of bleeding or clotting disorders including anticogulants - dangerous mechanism of injury e.g. fall from a height of greater than 1 metre or 5 stairs - more than 30 minutes' retrograde amnesia of events immediately before the head injury
77
If a patient is on warfarin who have sustained a head injury with no other indications for a CT head scan, when should a CT head scan be performed?
Within 8 hours of injury
78
Which cranial nerve is susceptible to damage early in the course of raised ICP?
Abducens CN VI (due to its long intacranial course)
79
Palsy of which cranial nerve results in defective abduction and therefore horizontal diplopia?
VI (Abducens)
80
Which cranial nerve is affected in a relative afferent pupillary defect (RAPD)?
Optic nerve
81

Yr 4 - ACC (73 decks)

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