Meeran Book Neuro Flashcards
What is Brown-Sequard syndrome?
A hemisection in the spinal cord leading to contralateral loss of pain and temperature and ipsilateral loss of fine touch, vibration, proprioception and movement
What is the management of MS?
A course of oral prednisolone
What is the main risk factor for stroke?
Hypertension
Do jerky movements during a collapse indicate seizure?
No, any cause of collapse can cause some limb jerking
What are the signs on opthalmoscopy of retinal artery occlusion?
Cherry red fovea and oedema
What are the absolute contraindications for thrombolysis?
- Bleeding disorder
- Recent haemorrhage
- Trauma
- Surgery
- Acute cerebrovascular event
What is most affected in diabetic neuropathy?
Vibration and proprioception
What is the Parkinsonian gait?
Narrow based shuffling gait
How often should headache patients take analgesia?
No more than two days per week, to avoid medication overuse headaches
What is the management of migraines?
- Conservative
- Sumatriptan (IV in an acute setting)
- Beta blockers, prophylactically
What is a complex partial seizure?
A seizure confined to one area of the brain however the patient is unable to recall the events
Automatisms commonly characterise a partial seizure
What is the difference between a complex partial seizure and a simple partial seizure?
Both will originate from a focal area in the brain, however patients with simple seizures will be able to recall the events
What are absence seizures?
They commonly occur in children and typically last seconds with the patients being unable to recall the events
What are the first line medications for complex partial seizures?
Carbamazepine, lamotrigine and sodium valproate
Where would the lesion be if a patient had left sided facial weakness and right sided hemiparesis?
The brainstem
What are the afferent and efferent limbs of the pupillary reflex?
Afferent: optic nerve
Efferent: oculomotor nerve
What is a relative afferent pupillary defect?
An impairment in the afferent part of the pupillary reflex
Eg. if the lesion is on the left side
- Right pupil constricts when light is shone into pupil
- Left consensual reflex is in tact
- Both pupils dilate as light is removed
- Left pupil does not constrict when light is shone
- Right consensual reflex is not initiated
What is the most indicitive sign of myaesthenia gravis?
Fatiguability
What are the key diagnostic tests for Lambert Eaton Myaesthenic Syndrome?
- Anti-VGCC
- EMG
Why is a neck CT/ ultrasound obtained in patients with Myaesthenia Gravis?
Because it’s associated with thymoma formation
What is forehead sparing?
The eyes and above are not paralysed, indicating upper motor neuron pathology
What is the management of Bell’s palsy?
- Presenting <72 hours, oral prednisolone
- Presenting >72 hours, conservative management
Where is the lesion in intranuclear opthalmoplegia?
In the medial longitudinal fasciculus between cranial nerves 3 and 6 in the brainstem
What is a positive Hoffman’s reflex?
Securing the middle finger, flicking the nail and observing the thumb contract indicating pathology in the upper region of the spinal cord
What is the glabellar tap?
Positive in patients with Parkinson’s, tapping on the bridge of the nose causing the patient to blink after the tapping has ceased
What is Tinsel’s sign?
Tapping on a trapped nerve, causing electric shock distributions along the neuronal pathway
How can Alzheimer’s and Frontotemporal dementia be distinguished?
Alzheimers will predominantly present with aphasia and memory impairment
What is a hemiplegic gait?
Gait where the leg is swung round due to a lesion in the CNS, causing weakness and spasticity in the leg
What would cause a spastic gait?
Upper motor neuron injury
What is a scissoring gait?
Commonly seen in cerebral palsy and MS
Bilateral spasticity of the legs
What are stomping gaits?
Hard steps due to decreased fine touch, vibration and proprioception sensation, commonly in patients with diabetic nephropathy
Increased vibrations will eventually reach in tact nerves
What is Meniere’s?
Episodes of vertigo lasting 2-3 hours accompanied by tinnitus, hearing impairments and sensation of increased ear pressure
What is the difference between Mernier’s and Vestibular Neuronitis?
Vestibular neuronitis presents almost identically, however is not accompanied by hearing loss
How does subarachnoid haemorrhage present on CT?
Bleeding between the fissures and sulci
Where is Broca’s area located?
Left frontal/ parietal lobe
Where is Wernicke’s area located?
Left parietal/ temporal lobes
