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General Finals & SBA Review > Laz Neurology > Flashcards

Laz Neurology Flashcards

1
Q

Signs of anterior cerebral artery damage

A

Affects motor cortex
Lower limb weakness (hemiparesis or a hemiplegia)
Contralateral side

Can get contralateral sensory defects, loss of leg and perineum sensation
Also affects frontal lobe -> disinhibition syndrome
Olfactory lobe -> Amosmia

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2
Q

Signs of middle cerebral artery blockage

A 
Contralateral weakness
Hemisensory loss
Facial weakness (forehead sparing, can you raise your eyebrows?)
Hemineglect
Quadrantopia
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3
Q

Which lobes does the anterior cerebral artery supply?

A

Motor
Sensory
Frontal
Olfactory

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4
Q

Which lobes does the middle cerebral artery supply?

A

Motor

Sensory

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5
Q

Which lobe is supplied by the posterior cerebral artery?

A

Occipital lobe

Cerebellum

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6
Q

Signs of posterior cerebral artery infarct

A

Vertigo
Ipsilateral ataxia
Hoarseness
Contralateral pain/temperature sensation loss

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7
Q

Ix for stroke

A

ECG because arrhythmia
Echo because thrombi, endocarditis
FBC because thrombocytopenia or polycythaemia
U&E because renal impairment, looking for kidney disease because can cause HTN
Lipid levels, cause of stroke

Should do a vasculitic screen (think of the stroke ward)

Gold standard = CT head to try and detect haemorrhage
Carotid artery Doppler to see if any carotid artery disease

MRI brain = a lot more sensitive

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8
Q

Mx of ischaemic stroke

A

Timing is crucial
CT head, once haemorrhage is ruled out, can do thrombolysis

If 4.5hr< and excluded haemorrhage, give aspirin 300mg and clopidogrel 75mg

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9
Q

Additional management alongside aspirin, clopidogrel and heparin in stroke

A

SALT review

Long term prophylaxis post discharge

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10
Q

What’s the cut off for considering hemicraniectomy?

A

<48hr

Has to be a mass effect to justify

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11
Q

When can you consider hemicraniectomy?

A

Mass effect

<48hr from onset

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12
Q

Management of haemorrhaged stroke

A 
IV mannitol (lowers ICP) 
Encourage hyperventilation to lower ICP

Surgical = coiling/clipping (for aneurysms)
Evacuation (for haematoma)

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13
Q

Long term management of stroke

A 
Lifestyle and conservative measures 
Rehab = MENDOS 
- MDT
- Eating = SALT review
- Neurorehab 
- DVT prohpylaxis 
- OT management 
- Sores (avoid pressure sores)

The aim is to reduce disability and handicap

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14
Q

Features of extradural haemorrhage

A

Trauma
Damages MCA
Big lenticular lesion (looks like a lens)
ACUTE

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15
Q

Features of subdural haemorrhage

A

Crescent-shaped haemorrhage (along the edge)
Usually in elderly, because its rupture of BRIDGING veins
Slow, insidious onset
Often in patients on blood thinners

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16
Q

Subarachnoid haemorrhage

A

Thunderclap, SUDDEN
Very old people or 20-30yo
Rupture of an aneurysm, usually berry aneurysm in the circle of Willis
On CT see the SCF filled with blood

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17
Q

Management of subdural haemorrhage

A

Supportive!
Monitor GCS
Re-scan if deteriorates

If really large with significant impairment, can consider surgical options

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18
Q

Features of meningitis

A

Photophobia
Headache (because the lining of brain is inflamed which causes increased ICP)
Neck stiffness
Altered mental state (confusion, irritable, drowsy)
Seizures (more common in encephalitis)
Fever

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19
Q

The most common cause of meningitis in adults

A

Viral

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20
Q

Most common bacterial meningitis cause

A

Neisseria meningitis

Streptococcus

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21
Q

What is Kernig’s sign?

A

Meningitis sign

Straightening the leg irritates the meninges

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22
Q

Signs of bactierial meningitis

A

Normal meningitis stuff
Sepsis
Fever
Non-blanching rash

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23
Q

Mx of meningitis

A

Start antibiotics immediately in a side room
Bloods (inflammatory signs)
Raised CRP usually indicates bacterial meningitis
Check for raised ICP (contraindicates a LP) = CT head

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24
Q

Signs of raised ICP

A

Focal neurology
Seizures
Papilloedema
LOC

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25
Q

Why don’t you do an LP on raised ICP?

A

Risk of coning

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26
Q

Contraindications to LP acryonym

A 
Try LP Unless Contra INdicated 
Thrombocytopaenia
Lateness 
Pressure 
Unstable 
Coagulation disorder
Infection 
Neurological signs
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27
Q

Where do you aim for the LP?

A

L4/L5

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28
Q

LP viral meningitis

A 
NORMAL glucose 
High WBC 
High protein
Clear
Lymphocytes
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29
Q

LP bacterial menigitis

A

LOW glucose (being used up)
Much higher protein levels
Turbid
Neutrophils

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30
Q

LP for TB features

A

Low glucose
High protein levels
Lymphocytes
Fibrin web appearance

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31
Q

LP for fungal infection

A

Low glucose
High protein
Eosinophils!

32
Q

Best way to remember LP results

A

Glucose levels
Cells present

Bacterial = neutrophils, low glucose 
Viral = lymphocytes, normal glucose
TB = lymphocytes with low glucose 
Fungal = eosinophils with low glucose
33
Q

Key management of meningitis

A

Antibiotics + anti-virals
IV cefotaxime
IV acyclovir

34
Q

What can you give for meningitis if allergic to penicillin?

A

Chloramphenicol

35
Q

Complete meningitis management

A 
IV cefotaxime 
IV acyclovir
Fluids 
Dexamethasone 
Electrolyte replacement 
Anticonvulsants if seizure = lorazepam
36
Q

What is encephalitits

A

Inflammation of the brain parenchyma (the brain itself)

37
Q

Most common causes of encephalitis

A

HSV/VZV

Bacterial = Neisseria meningitides

38
Q

Ix for encephalitis

A

Bloods
LP
Blood cultures
CT head for raised ICP

39
Q

What is Parkinson’s DISEASE

A

A neurodegenerative disease of dopaminergic neurones in substantia nigra

40
Q

Parkinsonism is …

A

Symptoms of Parkinson’s without the Parkinsons

E.g. with antipsychotic medications

41
Q

Parkinsonian plus syndrome is …

A

Group of neurodegenerative diseases with parkinsonian features

42
Q

Motor features of Parkinson’s

A

Tremor
Rigidity (cog wheel)
Akinesia and BRADYKINESIA
Postural instability

TRAP

43
Q

At what point of loss do Parkinson’s patients begin to manifest motor symptoms?

A

70% dopaminergic loss

44
Q

Prodromal Parkinson disease

A

Depression, anxiety, fatigue, REM sleep behaviour disorder, memory issues

45
Q

Late-stage Parkinson’s features

A 
Falls
Dysphagia
Dementia
Psychotic Sx
Urinary Sx
46
Q

Why do Parkinson’s pts have small handwriting?

A

Struggle to coordinate big movements

47
Q

Ix of Parkinson’s

A 
Try levodopa and see if it improves Sx (trial)
Serum caeruloplasmin (rule out Wilsons)
MRI brain to exclude vascular disease/hydrocephalus
48
Q

Mx of Parkinson’s disease

A

Parkinson’s disease is because dopaminergic neurones are dying
L-DOPA + carbidopa (which stops peripheral dopamine breakdown, which would cause really bad nausea)

49
Q

L-DOPA + Carbidopa name of drug

A

Sinemet

50
Q

How do MAO B inhibitors work?

A

Dopamine can be broken down by MAO B

So blocking its breakdown keeps dopamine in the brain

51
Q

Why does L-DOPA wear off?

A

The neurones are still dying

Just improving their production for now

52
Q

Drug for early-onset Parkinsons’

A

Amantadine
Dopamine agonist
Saves L-DOPA (sinemet) for later on

53
Q

What is multiple system atrophy and what are its features?

A

a-synuchleinopathy
Causes autonomic dysfunction -> postural hypotension and urinary retention (remember Hillingdon case)
Cerebral ataxia
Parkinsonian features

It is a Parkinson + syndrome

54
Q

What is corticobulbar degeneration?

A

Alien limb movement
Unilateral Parkinson’s
It’s a Parkinson+ syndrome

55
Q

Can’t move eyes vertically
Parkinsons symptoms
Lots of falls

A

Progressive supranuclear palsy

56
Q

Lewy body dementia features

A

Visual hallucinations
Early dementia
Parkinsonian symptoms

57
Q

Features of Alzheimer’s

A

Chronic neurodegenerative disease with insidious onset + progressive slow decline, resulting in memory loss and behavioural changes

Amnesia
Aphasia 
Agnosia (can't recognise objects)
Apraxia (using a hair brush upside down, difficulty planning movement)
Poor abstract thinking
58
Q

Cause of Alzheimer’s

A

Cholindergic loss

59
Q

Ix for Alzheimer’s

A

MMSE assesment
Rule out Wilsons
Thyroid disease and B12 can manifest as dementia, so test for these
CT head/MRI to exclude vascular disease

Mainly a clinical Dx

60
Q

What might the CT show in Alzheimer’s

A

Cerebral atrophy
Big spaces
Largened ventricles

61
Q

Mx of Alzheimer’s

A

Donepezil (help to preserve memory and functional abilities)
Memantine (second line)
+/- antipsychotics = risperidone (reduce behavioural symptoms

Appropriate care and support

62
Q

Features of vascular dementia

A

Stepwise decline

Symptoms depend on site

63
Q

Features of frontotemporal dementia

A 
Disinhibition
Personality change
Inattention
Apathy
Language impairment
64
Q

What is a seizure

A

Excessive, abnormal, synchronised discharge of neurons -> clinical manifestations

65
Q

Definition of epilepsy

A

The tendency to have recurrent, unprovoked seizures
2 seizures, more than 24hr apart
Unprovoked seizure MUST be Ix appropriately because 60% will have another seizure within 10 years

66
Q

What is a tonic-clonic seizure?

A

Grand mal
Start with LOC, then tonic (stiff)
Then clonic (repetitive limb movements)

67
Q

Ix for seizure

A 
Septic screen 
Electrolyte screen 
ECG
EEG
CT head (pick up SOL)
BM

Increased WCC could indicate brain infection
Encephalitis can cause them
Drug-induced seizures are very common (you’ve seen one)

68
Q

Which key initial investigation can indicate they’ve had a seizure?

A

Lactate

69
Q

Status epilepticus Mx

A 
A-E
High flow O2
Check BM
IV access? -> lorazepam 4mg bolus
If not -> buccal midazolam
Can give 2 doses
If that doesn't work, give IV diazepam
70
Q

Stabilised the status episode, now what do you do?

A 
Monitor 
ABG
Cultures
Think about glucose, alcohol, sepsis!
WHAT HAS CAUSED IT?
71
Q

Who should you alert with status?

A

ITU/anaesthetics
May be considering vasopressors if it doesn’t resolve = ITU stuff
Need to keep airway sufficient!

72
Q

Epilepsy long term management

A

Inform DVLA
Got to be seizure free for 12mo
Ketogenic diet (because they get into the brain?!)
Psychological support

Try to keep on very few medications
Carbamazepine

73
Q

Management of cluster headache

A

Avoid alcohol and smoking

Acute Mx = oxygen, sumatriptan nasal spray
Prevent = verapamil

74
Q

Management of migraine

A

Avoid CHOCOLATE
Med = sumatriptan
Anti-emetics in the acute setting

Propanalol to prevent

75
Q

Treatment for temporal arteritis

A

Prednisolone 1mg/kg/day for 4 weeks
PPI cover
Aspirin to reduce risk of vision loss

General Finals & SBA Review (8 decks)

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