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Neurology Year 3 > Extra notes > Flashcards

Extra notes Flashcards

1
Q

What changes does chronic alcahol consumption cause in the CNS?

A

Enhances GABA mediated inhibition in the CNS (similar to benzodiazepines) and inhibits NMDA-type glutamate receptors

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2
Q

What changes does alcahol withdrawal cause in the CNS?

A

Decreased inhibitory GABA and increased NMDA glutamate transmission

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3
Q

Symptoms of alcohol withdrawal syndrome

A

> 

tremor, sweating, tachycardia, anxiety at 6-12 hours
seizures at 36 hours
delirium tremens is at 48-72 hours
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4
Q

What are the initial (early) symptoms of alcohol withdrawal syndrome?

A

Tremor, sweating, tachycardia, anxiety at 6-12 hours

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5
Q

When do seizures occur in alcohol withdrawal syndrome

A

36 hours

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6
Q

When does delirium start in alcohol withdrawal syndrome

A

48-72 hours

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7
Q

When does the initial early symptoms of alcohol withdrawal syndrome start?

A

6-12 hours

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8
Q

Management of alcohol withdrawal syndrome

A
  1. first-line: long-acting benzodiazepines e.g diazepam
    > Lorazepam may be preferable in patients with hepatic failure.
  2. carbamazepine also effective in treatment of alcohol withdrawal
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9
Q

What benzodiazepines are used in the management of alcohol withdrawal syndrome?

A

Long acting benzodiazepines e.g. diazepam

Lorazepam may be preferable in patients with hepatic failure.

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10
Q

Brown Sequard syndrome

A

Rare neurological condition characterized by a lesion in the spinal cord which results in weakness or paralysis (hemiparaplegia) on one side of the body and a loss of sensation (hemianesthesia) on the opposite side.

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11
Q

Features of right-sided Brown Sequard syndrome

A

Right sided (ipsilateral) proprioception/vibration loss & weakness but would cause contralateral (left-sided) loss of pain and temperature.

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12
Q

Features of left-sided Brown Sequard syndrome

A

Left sided (ipsilateral) proprioception/vibration loss & weakness but would cause contralateral (right-sided) loss of pain and temperature.

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13
Q

Tuberous sclerosis

A

A rare autosomal dominant condition that causes mainly non-cancerous (benign) tumours to develop in different parts of the body.

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14
Q

Tuberous sclerosis mode of inheritance

A

autosomal dominant

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15
Q

What are the cutaneous features of Tuberous sclerosis

A
  • Depigmented ‘ash-leaf’ spots
  • Shagreen patches
  • Adenoma sebaceum
  • subungual fibromata
  • Café-au-lait spots
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16
Q

What are shagreen patches

A

Roughened patches of skin over lumbar spine

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17
Q

Subungual fibromata

A

Painless, slow-growing tumor seen in the nail apparatus. They can be spherical or oval in shape and firm or elastic in consistency.

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18
Q

What are the neurological features of Tuberous sclerosis

A
  • developmental delay
  • epilepsy (infantile spasms or partial)
  • intellectual impairment
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19
Q

Retinal hamartomas

A

Dense white areas on retina (phakomata)

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20
Q

Lymphangioleiomyomatosis

A

Multiple lung cysts

A lung disease caused by the abnormal growth of smooth muscle cells, especially in the lungs and lymphatic system. This abnormal growth leads to the formation of holes or cysts in the lung.

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21
Q

Left homonymous hemianopia

A

Left visual field defect, i.e. Lesion of right optic tract

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22
Q

Right homonymous hemianopia

A

Right visual field defect, i.e. Lesion of Left optic tract

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23
Q

Homonymous superior quadrantanopia

A

Lesion of the Inferior optic radiations in the temporal lobe

Is a loss of vision in the same upper quadrant of visual field in both eyes

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24
Q

Homonymous superior quadrantanopia

A

Lesion of the inferior optic radiations in the temporal lobe (Meyer’s loop)

Is a loss of vision in the same lower quadrant of visual field in both eyes

Correct card

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25
Q

Homonymous quadrantanopia

A

PITS (Parietal-Inferior, Temporal-Superior)

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26
Q

Congruous defect of visual field: causes

A

Simply means complete or symmetrical visual field loss

Causes - optic radiation lesion or occipital cortex

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27
Q

Incongruous defects of visual field: causes

A

Usually optic tract lesions

Is incomplete or asymmetric visual field loss

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28
Q

Bitemporal hemianopia

A

Lesion of the optic chiasm

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29
Q

What causes an inferior chiasmal compression and thus bitemporal hemianopia?

A

Commonly a pituitary tumour

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30
Q

What causes a superior chiasmal compression and thus bitemporal hemianopia?

A

Commonly a craniopharyngioma

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31
Q

5-HT3 antagonists examples

A

Ondansetron

Granisetron

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32
Q

5-HT3 antagonists mechanism of action

A

Antiemetics used mainly in management of chemotherapy-related nausea. Act in the chemoreceptor trigger zone area of the medulla oblongata.

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33
Q

5-HT3 antagonists adverse effects

A

Constipation is common

Prolonged QT interval

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34
Q

Absence seizure features

A

> Absences last a few seconds
quick recovery
Provoked by hyperventilation or stress
Usually unaware of seizure
May occur many times a day
EEG: bilateral, symmetrical 3Hz spike and wave pattern

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35
Q

Global aphasia

A

Large lesion affecting the inferior frontal gyrus, superior temporal gyrus and the arcuate fasiculus resulting in severe expressive and receptive aphasia

May still be able to communicate using gestures

36
Q

Conduction aphasia

A

Classically due to a stroke affecting the arcuate fasiculus - the connection between Wernicke’s and Broca’s area

Speech is fluent but repetition is poor. Aware of the errors they are making – Comprehension is normal

37
Q

Wernicke’s (receptive) aphasia

A

Due to a lesion of the superior temporal gyrus. It is typically supplied by the inferior division of the left MCA

This area ‘forms’ the speech before ‘sending it’ to Broca’s area. Lesions result in sentences that make no sense, word substitution and neologisms but speech remains fluent - ‘word salad’

Comprehension is impaired

38
Q

Broca’s aphasia

A

Due to a lesion of the inferior frontal gyrus. It is typically supplied by the superior division of the left MCA

Speech is non-fluent, laboured, and halting. Repetition is impaired

Comprehension is normal

39
Q

Arnold-Chiari malformation

A

Describes the downward displacement, or herniation, of the cerebellar tonsils through the foramen magnum.

Malformations may be congenital or acquired through trauma.

40
Q

Features of Arnold-Chiari malformation

A

> non-communicating hydrocephalus may develop as a result of obstruction of CSF outflow
headache
syrinomyelia

41
Q

Ataxia causes

A

Cerebellar hemisphere lesions cause peripheral (‘finger-nose ataxia’)

Cerebellar vermis lesions cause gait ataxia

42
Q

Ataxia telangiectasia

A

Autosomal recessive disorder caused by a defect in the ATM gene which encodes for DNA repair enzymes. It typically presents in early childhood with abnormal movements.

43
Q

Features of Ataxia telangiectasia

A

> cerebellar ataxia
telangiectasia (spider angiomas)
IgA deficiency - recurrent chest infections
10% risk of developing malignancy, lymphoma or leukaemia, but also non-lymphoid tumours

44
Q

Erb-Duchenne paralysis

A

damage to C5,6 roots
winged scapula
may be caused by a breech presentation

45
Q

Klumpke’s paralysis

A

damage to T1
loss of intrinsic hand muscles
due to traction

46
Q

Causes of brain abscess

A

> extension of sepsis from middle ear/ sinuses
trauma or surgery to the scalp
penetrating head injuries
embolic events from endocarditis

47
Q

Investigations of brain abscess

A

CT scanning

48
Q

Management of brain abscess

A

Craniotomy is performed and the abscess cavity debrided

IV antibiotics: IV 3rd-generation cephalosporin + metronidazole

Intracranial pressure management: e.g. dexamethasone

49
Q

Carbamazepine mechanism of action

A

Binds to sodium channels increases their refractory period

50
Q

Cataplexy

A

Sudden and transient loss of muscular tone caused by strong emotion (e.g. laughter, being frightened).
Features range from buckling knees to collapse.

51
Q

Cavernous sinuses

A

Are paired and are situated on the body of the sphenoid bone. It runs from the superior orbital fissure to the petrous temporal bone.

52
Q

The cerebral perfusion pressure (CPP)

A

Is defined as being the net pressure gradient causing blood flow to the brain. The CPP is tightly autoregulated to maximise cerebral perfusion.

53
Q

Charcot-Marie-Tooth Disease

A

Charcot-Marie-Tooth Disease is the most common hereditary peripheral neuropathy.

Results in a predominantly motor loss. There is no cure, and management is focused on physical and occupational therapy.

54
Q

Most common hereditary peripheral neuropathy

A

Charcot-Marie-Tooth Disease

55
Q

Charcot-Marie-Tooth Disease features

A 
History of frequently sprained ankles
Foot drop
High-arched feet (pes cavus)
Hammer toes
Distal muscle weakness
Distal muscle atrophy
Hyporeflexia
Stork leg deformity
56
Q

Common peroneal nerve lesion

A

The sciatic nerve divides into the tibial and common peroneal nerves. Injury often occurs at the neck of the fibula

Most characteristic feature is foot drop.

57
Q

Complex regional pain syndrome

A

Umbrella term for a number of conditions such as reflex sympathetic dystrophy and causalgia. It describes a number of neurological and related symptoms which typically occur following surgery or a minor injury. CRPS is 3 times more common in women.

58
Q

Types of Complex regional pain syndrome

A

Type I (most common): there is no demonstrable lesion to a major nerve

Type II: there is a lesion to a major nerve (causalgia)

Reflex sympathetic ?

59
Q

Features of Complex regional pain syndrome

A 
progressive, disproportionate symptoms to the original injury/surgery
allodynia
temperature and skin colour changes
oedema and sweating
motor dysfunction
60
Q

Drugs causing a peripheral neuropathy

A 
amiodarone
isoniazid
vincristine
nitrofurantoin
metronidazole
61
Q

EMG characteristics for neuropathy

A

Increased action potential duration

Increased action potential amplitude

62
Q

EMG characteristics for myopathy

A

Decreased action potential duration

Decreased action potential amplitude

63
Q

Essential tremor

A

A neurological disorder that causes your hands, head, trunk, voice or legs to shake rhythmically. It is often confused with Parkinson’s disease. Essential tremor is the most common trembling disorder.

64
Q

Features of Essential tremor

A

postural tremor: worse if arms outstretched
improved by alcohol and rest
most common cause of titubation (head tremor)

65
Q

Essential tremor management

A

propranolol is first-line

primidone is sometimes used

66
Q

Sagittal sinus thrombosis

A

may present with seizures and hemiplegia

parasagittal biparietal or bifrontal haemorrhagic infarctions are sometimes seen

67
Q

Lateral sinus thrombosis

A

6th and 7th cranial nerve palsies

68
Q

Lateral medullary syndrome

A

Also known as Wallenberg’s syndrome, occurs following occlusion of the posterior inferior cerebellar artery. Affects glossopharyngeal and vagus nerves

69
Q

Features of Lateral medullary syndrome

A

ataxia & nystagmus

Brainstem features:

ipsilateral: dysphagia, facial numbness, cranial nerve palsy e.g. Horner’s
contralateral: limb sensory loss

70
Q

Refeeding syndrome

A 
Describes the metabolic abnormalities which occur on feeding a person following a period of starvation. The metabolic consequences include:
Hypophosphataemia
Hypokalaemia
Hypomagnesaemia
Abnormal fluid balance
71
Q

Pituitary apoplexy

A

Sudden enlargement of a pituitary tumour (usually non-functioning macroadenoma) secondary to haemorrhage or infarction.

72
Q

Features of Pituitary apoplexy

A

sudden onset headache similar to that seen in subarachnoid haemorrhage
vomiting
neck stiffness
visual field defects: classically bitemporal superior quadrantic defect
extraocular nerve palsies
features of pituitary insufficiency
e.g. hypotension/hyponatraemia secondary to hypoadrenalism

73
Q

Pituitary apoplexy management

A

urgent steroid replacement due to loss of ACTH
careful fluid balance
surgery

74
Q

Pituitary apoplexy investigations

A

MRI

75
Q

Post-lumbar puncture headache

A

usually develops within 24-48 hours following LP but may occur up to one week later
may last several days
worsens with upright position
improves with recumbent position

76
Q

Factors favouring pseudoseizures

A 
pelvic thrusting
family member with epilepsy
much more common in females
crying after seizure
don't occur when alone
gradual onset
77
Q

Factors favouring true epileptic seizures over pseudoseizures

A

tongue biting

raised serum prolactin*

78
Q

Reye’s syndrome

A

A severe, progressive encephalopathy affecting children that is accompanied by fatty infiltration of the liver, kidneys and pancreas. Aetiology is not fully understood although there is a known association with aspirin use and a viral cause has been postulated

79
Q

Spontaneous intracranial hypotension

A

A very rare cause of headaches that results from a CSF leak. The leak is typically from the thoracic nerve root sleeves.

80
Q

Features of Spontaneous intracranial hypotension

A

Strong postural relationship with the headache generally much worse when upright. Patients may, therefore, be bed-bound

81
Q

Spontaneous intracranial hypotension investigations

A

MRI with gadolinium: typically shows pachymeningeal enhancement

82
Q

Syringomyelia

A

Describes a collection of fluid filled cysts within the spinal cord.

83
Q

Syringobulbia

A

Syringobulbia in which there is a fluid-filled cavity within the medulla of the brainstem. This is often an extension of the syringomyelia but in rare cases can be an isolated finding.

84
Q

Causes of Syringomyelia

A

A Chiari malformation: strong association
trauma
tumours
idiopathic

85
Q

Investigations of Syringomyelia

A

full spine MRI with contrast to exclude a tumour or tethered cord
a brain MRI is also needed to exclude a Chiari malformation

86
Q

Features of Syringomyelia

A

a ‘cape-like’ (neck, shoulders and arms)
loss of sensation to temperature but the preservation of light touch, proprioception and vibration

classic examples are of patients who accidentally burn their hands without realising

this is due to the crossing spinothalamic tracts in the anterior commissure of the spinal cord being the first tracts to be affected
spastic weakness (predominantly of the lower limbs)
neuropathic pain
upgoing plantars

87
Q

Wernicke’s encephalopathy

A

A neuropsychiatric disorder caused by thiamine deficiency which is most commonly seen in alcoholics.

Neurology Year 3 (22 decks)

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