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Year 3 > MedEd CNS > Flashcards

MedEd CNS Flashcards

1
Q

What cranial nerve palsy results in an eye that is down and out?

A

III

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2
Q

How many nerves cross over at the optic chiasm?

A

50%

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3
Q

Where will the lesion be to cause monocular blindness?

A

At the optic nerve right beind the eye where there is a loss in vision

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4
Q

Where will the lesion be to cause bitemporal hemianopia?

A

Optic chiasm

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5
Q

Where will the lesion be to cause right homonymous hemianopia?

A

Left optic tract

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6
Q

Where will the lesion be to cause right superior homonymous quadrantanopia?

A

The lower fibres in the left temporal lobe

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7
Q

Where will the lesion be to cause right inferior homonymous quadrantanopia?

A

Left upper fibres in the anterior parietal lobe

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8
Q

Why is there macular sparing in occipital lobe lesions?

A

Lesions in the occipital lobe because the occipital lobes doesnt have the same blood supply

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9
Q

What acronym is used to remember cranial nerve supply to the eye muscles?

A

LR6 SO4

lateral rectus=CN 6
Superior oblique= CN 4

All other muscles= CN 3

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10
Q

What is the traid for 3rd nerve plasy?

A

Ptosis
Mydriasis
Down and out gaze

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11
Q

What is myadriasis?

A

Dilation of the pupil

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12
Q

How will 4th nerve palsy present?

A

Prevents eye moving in and down

Eye is up and out

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13
Q

How will 6th nerve palsy present?

A

Eye can’t move outwards

Eye is abducted

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14
Q

What is the most common cause of bitemporal hemianopia?

A

Pituitary adenoma (compressing the optic chiasm)

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15
Q

What is trigeminal neuralgia?

A

Severe episodic facial pain the in distribution of one or more branches of CN 5

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16
Q

What are the 3 branches of CN5 on the face?

A

Forehead
Cheek
Mouth

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17
Q

What are causes of trigeminal neuralgia?

A

Compression of CN5 nerve root
Most commonly caused by a vascular loop
Otherwise caused by a tumor, chronic meningeal inflammation or MS

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18
Q

What are RF for trigeminal neuralgia?

A

Increasing age

Female

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19
Q

How will trigeminal neuralgia present?

A

Sudden intense stabbing pain that lasts for seconds and is recurrent

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20
Q

How is trigeminal neurgalia triggered?

A 
Talking
Cold wind
Eating
Washing
Shaving
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21
Q

What investigations are done for trigeminal neuralgia?

A

None, diagnosis is clinical

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22
Q

What is Bell’s palsy?

A

Acute unitlateral lower motor neurone nerve palsy

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23
Q

What is Ramsay Hunt syndrome?

A

A complication of varicella zoster infection where there is a lower motor neuron nerve palsy

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24
Q

What causes bells palsy?

A

idiopathic

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25
Q

What are RF for bells plasy

A

15-45 years of age
May be increased in pregnancy
Common in DM

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26
Q

How does bells palsy present?

A

Inability to raise the brows
Drooping eyelid and cant close eye
Drooping mouth, can’t smile or pucker lips
No muscle tone in cheek
Dry eye (keratoconjunctivitis sicca)
Hypersensivity to sound on the ipsilateral side (hyperacusis)

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27
Q

How do you differentiate bells palsy and stroke?

A

Bells palsy does not spare the forehead

Stroke does

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28
Q

What is bells phemomena?

A

Eye ball rolls up when the patient tries to close it

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29
Q

How is bells palsy investigated?

A

CT scan to rule out stroke
Bloods- WCC to rule out infection
Clinical diagnosis after ruling out other things

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30
Q

Hw does ramsay hunt syndrome present?

A

Unilateral facial paralysis and painful blisters in insilateral ear canal, anterior 2/3 of tongue and hard palate

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31
Q

What is horner’s syndrome?

A

Triad of miosis, partial ptosis and anhydrosis

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32
Q

What is neurofibromatosis

A

Autosomonal dominant genetic disorder affecting cells of neural crest origin that leads to development of multiple neurocutaneous tumors

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33
Q

What are RF for horners syndrome

A
34
Q

What is miosis?

A

Constriction of pupil

35
Q

What causes horners syndrome?

A

Anything that disrupts the face’s sympathetic nerve supply eg
Brainstem tumor or stroke
Pancoast tumor
Carotid artery dissection

36
Q

Disruption of what causes horner’s syndrome?

A

Sympathetic nerve supply to the face

37
Q

What is anhydrosis?

A

Sweating

38
Q

What inevstgations are done for horner’s syndrome? Why is each done

A

CXR- rule out pancoast tumor
CT head- rule out stroke
MRI angiography- rule out carotid dissection

39
Q

How is horners syndrome managed?

A

Treat the cause

40
Q

How is neurofibromatosis inherited?

A

Autosomal dominant

41
Q

What genes are mutated in each type of neurofibromatosis and

A

NF1- chromosome 17 (mutation in neurofinromin)= type 1

NF2- chromsome 22 (mutation in merlin)= type 2

42
Q

Which type of neurofibromatosis is more common?

A

Type 1

43
Q

What are RF for neurofibromatosis?

A

Fhx

Severe crush trauma

44
Q

What is affected in neurofibromatosis 1 vs 2?

A

Type 1= whole body

Type 2= ears

45
Q

What happens in neurofibromatosis type 1?

A

Skin lesions
Pain related to skin lesions

May also have:
Learning difficulties
Headaches
Disturbed visions
Severe constipation
46
Q

What happens in neurofibromatosis type 2?

A

Hearing loss
Tinnitus
Balance problems
Vertigo

Can have:
Headache
facial pain
facial numbness

MAY BE BILATERAL!!

47
Q

What skin leasions are seen in neurofibromatosis type 1? How many are needed for diagnosis

A

Cafe au lait macules- need to have over 5 in the body (pre puberty >5mm and post puberty >15mm)
Neurofibromas- cutaneous, subcut and diffuse plexiform
Armpit freckling

48
Q

What investigations are done for neurofibromatosis?

A 
Type 1= full body examination
Opthalmological assessment
Type 2= hearing test
CT/MRI if you are looking for tumors
Can also go genetic testing but not common
49
Q

How many cafe au lait macules are needed to diagnose neurofibromatosis? What size do they need to be?

A

over 5 over the body
pre puberty= >5mm
post puberty= >15mm

50
Q

How do you remember what is affected in neurofibromatosis type 1 v 2?

A

Type 1= 1 thing is affected= you have 1 body= affects the body
Type 2= 2 things are affected= you have 2 ears= affects the ears

51
Q

What eye will be affected and on which side if a lesion is pre chiasmal?

A

One eye on the ipsilateral side

52
Q

What eye will be affected and on which side if a lesion is chiasmal?

A

Both eyes, temporal visual field

53
Q

What eye will be affected and on which side if a lesion is post chiasmal?

A

The contralateral eye, homonymous visual field

54
Q

As an optic nerve lesion gets further back, what generally happens?

A

The area affected gets smaller

55
Q

As an optic nerve lesion is further farward, what generally happens?

A

The area affected is larger

56
Q

What are some causes of a prechiasmal lesion?

A 
Optic neuritis
Amaurosis fugax
Optic atrophy
Retrobulbar optic neuropathy
Trauma
57
Q

What are some causes of a chiasmal lesion?

A

Pituitary adenoma

Suprasellar aneurysm

58
Q

What are some causes of a post chiasmal lesion?

A

Stroke
Tumor
Trauma

59
Q

Where in the optic tract is a stroke most likely to cause a lesion?

A

Post chiasmal

60
Q

What are a lot of cases of Bell’s palsy preceded by?

A

Respiratory tract infection

61
Q

What is ramsey hunt syndrome?

A

Reactivation of chickenpox

62
Q

What organism causes ramsey hunt syndrome?

A

Varicella zoster

63
Q

How is Bell’s palsy managed?

A

High dose corticosteroids- 60 mg within 72 hrs (prednisolone or hydrocortisone)
Eye protection- eye cover and artificial tears

64
Q

What investigations are done for Bell’s palsy?

A

Borellia serology
Electroneurography if symptoms are severe
Needle electro myography if electroneurography

65
Q

What pathway is disrupted in horner’s syndrome?

A

Sympathetic

66
Q

What is anhydrosis?

A

Lack of sweating

67
Q

Why do you get one sided sweating in horner’s syndrome?

A

Anhydrosis occurs on the side of the face where sympathetic supply is lost so the other side appears sweaty

68
Q

How many seizures have to occur for a diagnosis of epilepsy?

A

2 unprovoked seizures

69
Q

What type of seizures most commonly get aura?

A

Focal temporal seizures

70
Q

What happens post ictally in epilepsy?

A

Confusion
Myalgia
Somnolence

71
Q

How will limb jerking differ in focal vs generalised seizures?

A 
Focal= only some limbs may jerk
Generalised= all 4 limbs will usually jerk
72
Q

What is the cause of epileptic seizures?

A

They have no cause- are idiopathic

73
Q

What hormone is raised in a true seizure?

A

Prolactin

74
Q

What are the first and second line drugs for focal and generalised seizures?

A 
Focal
first line= carbimazepine 
second line= lamotrigine 
Generalised
first= sodium valproate
second= carbimazepine
75
Q

What is drug escalation is status epilepticus?

A

first line= iv lorazepam or buccal diazepam
second line= IV phenytoin
third line= IV phenobarbitol
fourth line= rapid sequence induction

76
Q

What are causes of cord compression?

A

Slipped IV disc
maliganancy
Infection
Trauma

77
Q

What are symptoms of cord compression?

A

Back pain
Bilateral UMN weakness
Parasthesia
Sphincter disturbance

78
Q

What are symptoms of spinal shock syndrome?

A

Flaccid paralysis

Absent reflexes

79
Q

What are the 2 main causes of cord compression?

A

Slipped disc

Tumor

80
Q

In cauda equina vs cord compression which will have upper and lower motor neurone lesion signs?

A

Cauda equina= LMN signs

Cord compression= UMN signs

81
Q

How is cord compression managed?

A

Emergency management of high dose steroids, surgical decompression

82
Q

In cauda equina vs cord compression which will have more sphincter disturbance?

A

Cauda equina

Year 3 (104 decks)

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