Misc neuro Flashcards
Most common complication of meningitis?
Sensorineural hearing loss
Triad in normal pressure hydrocephalus
dementia, ataxia and urinary incontinence.
REMEMBER THIS IN DEMENTIA/DEPRESSION Q’s
What investigation should be done in a young stroke patient?
‘Young’ stroke blood tests include thrombophilia and autoimmune screening - performed in those under 55 with no obvious cause of a stroke
Psychogenic non-epileptic seizures
Psychogenic non-epileptic seizure (previously called a pseudoseizure) should be considered in a patient who remains conscious during whole-body convulsions, exhibits no post-ictal state and can remember what happened. In this case, the psychiatric comorbidities make psychogenic non-epileptic seizure more likely.
Which one of the following antiepileptic drugs is most associated with weight gain?
Sodium Valproate
What increases the risk of MND?
smoking, exposure to heavy metals and certain pesticides
What would you suspect if you saw a patient with Parkinsonism PLUS autonomic features? Or cerebellar features?
- Multiple system atrophy (MSA-P or MSA-C)
What would your differentials be for a unilateral Parkinson appearance?
- Multiple system atrophy (+ autonomic/cerebellar symps)
- Drug-induced parkinsonism
MoA Sodium Valproate
Increases GABA activity
MoA Carbamezpaine
Binds to sodium channels, increasing their refractory period
MoA Lamotrigine
Sodium channel blocker
MoA Phenytoin
Binds to sodium channels, increasing their refractory period
MoA Ethosuximide
Partial antagonism of T-type calcium channels of thalamic neurons
Adverse effects of Sodium Valproate
- Weight gain
- P450 enzyme INHIBITOR
- Ataxia and tremor
- Teratogenic (neural tube)
Adverse effects of Carbamazepine
- P450 enzyme INDUCER
- Dizziness + ataxia + drowsiness
- Leukopenia and agranulocytosis
- SIADH
- Diplopia
- Aplastic anaemia
Adverse effects of Lamotrigine
- Steven-Johnsons syndrome (papules/bullae) - supportive Tx
- DRESS syndrome
- Leukopenia
Adverse effects of Phenytoin
- P450 enzyme INDUCER
- Dizziness + ataxia + drowsiness
- Peripheral neuropathy
- Megaloblastic anaemia (folate deficiency)
- Hirtusism, coarse face
- Enhanced Vit D metab –> osteomalacia
- Lymphadenopathy
Adverse effects of Ethosuximide
Night terrors
Rashes
Glioblastoma multiforme Ix + Results
Imaging:
- Solid tumours with central necrosis and rim that enhances with contrast
- Vasogenic oedema
Histo:
- Pleomorphic tumour cells border necrotic area
Tx of glioblastoma multiforme
- Surgical w/ post-op chemo +/ radio
- Oedema –> dexamethasone
Meningioma features
- Second most common primary tumour in adults
- Usually benignm extrinsic tumour of CNS
- Typically in falx cerebri, superior sagittal sinus or convexity of skull base
Meningioma Ix + Results
Histo:
- Spindle cells in concentric whorls
- Calcified psammoma bodies
CT/MRI
Meningioma Tx
- Observation, radio or surgical resection
Pilocytic astrocytoma
- Most common in kids
- Histology: ROSENTHAL fibres (corkscrew bundles)
- Usually presents with seizure
Medulloblastoma
- Aggressive paeds tumour
- Arises within the infratentorial compartment
- Spreads through CSF
- Histo: small, blue cells, rosette pattern with mitotic figures
- Tx = surgical resection + chemo
Ependymoma
- Commonly seen in 4th ventricle
- May causes hydrocephalus
- Histology = perivascular pseudo rosettes
Hemangioblastoma
- Vascular tumour of cerebellum
- Associated with von Hippel-Lindau syndrome
- Histo: foam cells + high vascularity
Oligodendroglioma
- Benign, slow-growing, common in front lobe
- Histo: fried egg appearance, calcifications
- 1p19q deletion
Pituitary adenoma
- Benign tumour of the pituitary gland
- Secretory or non-secretory
- May present with symptoms of secretions or bitemporal heminanopia
- Ix = pituitary blood profile + MRI
- Tx = hormonal/surgical
Craniopharyngioma
- Most common paeds supratentorial tumour
- Solid cyst of sellar region
- Derived from Rathke’s ouch
- Hormonal disturbance, bitemp hemianopia or hydrocephalus
- Histo: remnant of Rathke’s pouch
- Ix: pituitary blood profiles + MRI
- Tx: surgery + post-op radio
Which four areas of the CNS might MS lesions be found
periventricular, juxtacortical, infratentorial, spinal cord
Vestibular schwannoma presentation
Vertigo, hearing loss, tinnitus and an absent corneal reflex
Features can be predicted by the affected cranial nerves:
cranial nerve VIII: vertigo, unilateral sensorineural hearing loss, unilateral tinnitus
cranial nerve V: absent corneal reflex
cranial nerve VII: facial palsy
Ix and Tx of Vestibular schwannoma
- referred urgently to ENT
- MRI (gadolinium-enhanced) of the cerebellopontine angle is the investigation of choice
- Audiometry is also important as only 5% of patients will have a normal audiogram.
- Management is with either surgery, radiotherapy or observation.
Describe a pontine haemorrhage
- life-threatening condition.
- complication secondary to chronic hypertension
- Patients often present with reduced Glasgow coma score, quadriplegia, miosis, and absent horizontal eye movements
Symptoms of autonomic dysrefelxia
severe hypertension and flushing and sweating above the level of injury
- seen in spinal cord injuries at or above T6 level
Define syringomyelia
Collection of CSF within spinal cord
Causes of syringomyelia
- Chiari malformation = strong association
- Trauma
- Tumours
- Idipathic
Presentation of syringomyelia
- ‘cap-like’ loss of sensation/temp
- preservation of light touch, proprioception + vibration
- classic example = accidentally burn hand without realising
Which tracts are affected in syringomyelia
compression of the spinothalamic tract fibres decussating in the anterior white commissure of the spine
How do you diagnose carotid artery stenosis?
Carotid artery stenosis is diagnosed (and degree of stenosis assessed) via duplex ultrasound
Broca’s
Speech = non-fluent, laboured, halting
INFERIOR FRONTAL gyrus
Wernicke’s
Speech = word substitution, neologisms, fluent speech
SUPERIOR TEMPORAL gyrus
