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Phase 3A Medicine > Misc neuro > Flashcards

Misc neuro Flashcards

1
Q

Most common complication of meningitis?

A

Sensorineural hearing loss

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2
Q

Triad in normal pressure hydrocephalus

A

dementia, ataxia and urinary incontinence.

REMEMBER THIS IN DEMENTIA/DEPRESSION Q’s

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3
Q

What investigation should be done in a young stroke patient?

A

‘Young’ stroke blood tests include thrombophilia and autoimmune screening - performed in those under 55 with no obvious cause of a stroke

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4
Q

Psychogenic non-epileptic seizures

A

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.

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5
Q

Which one of the following antiepileptic drugs is most associated with weight gain?

A

Sodium Valproate

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6
Q

What increases the risk of MND?

A

smoking, exposure to heavy metals and certain pesticides

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7
Q

What would you suspect if you saw a patient with Parkinsonism PLUS autonomic features? Or cerebellar features?

A
  • Multiple system atrophy (MSA-P or MSA-C)
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8
Q

What would your differentials be for a unilateral Parkinson appearance?

A
  • Multiple system atrophy (+ autonomic/cerebellar symps)

- Drug-induced parkinsonism

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9
Q

MoA Sodium Valproate

A

Increases GABA activity

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10
Q

MoA Carbamezpaine

A

Binds to sodium channels, increasing their refractory period

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11
Q

MoA Lamotrigine

A

Sodium channel blocker

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12
Q

MoA Phenytoin

A

Binds to sodium channels, increasing their refractory period

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13
Q

MoA Ethosuximide

A

Partial antagonism of T-type calcium channels of thalamic neurons

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14
Q

Adverse effects of Sodium Valproate

A
  • Weight gain
  • P450 enzyme INHIBITOR
  • Ataxia and tremor
  • Teratogenic (neural tube)
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15
Q

Adverse effects of Carbamazepine

A
  • P450 enzyme INDUCER
  • Dizziness + ataxia + drowsiness
  • Leukopenia and agranulocytosis
  • SIADH
  • Diplopia
  • Aplastic anaemia
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16
Q

Adverse effects of Lamotrigine

A
  • Steven-Johnsons syndrome (papules/bullae) - supportive Tx
  • DRESS syndrome
  • Leukopenia
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17
Q

Adverse effects of Phenytoin

A
  • P450 enzyme INDUCER
  • Dizziness + ataxia + drowsiness
  • Peripheral neuropathy
  • Megaloblastic anaemia (folate deficiency)
  • Hirtusism, coarse face
  • Enhanced Vit D metab –> osteomalacia
  • Lymphadenopathy
18
Q

Adverse effects of Ethosuximide

A

Night terrors

Rashes

19
Q

Glioblastoma multiforme Ix + Results

A

Imaging:
- Solid tumours with central necrosis and rim that enhances with contrast
- Vasogenic oedema
Histo:
- Pleomorphic tumour cells border necrotic area

20
Q

Tx of glioblastoma multiforme

A
  • Surgical w/ post-op chemo +/ radio

- Oedema –> dexamethasone

21
Q

Meningioma features

A
  • 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
22
Q

Meningioma Ix + Results

A

Histo:
- Spindle cells in concentric whorls
- Calcified psammoma bodies
CT/MRI

23
Q

Meningioma Tx

A
  • Observation, radio or surgical resection
24
Q

Pilocytic astrocytoma

A
  • Most common in kids
  • Histology: ROSENTHAL fibres (corkscrew bundles)
  • Usually presents with seizure
25
Q

Medulloblastoma

A
  • Aggressive paeds tumour
  • Arises within the infratentorial compartment
  • Spreads through CSF
  • Histo: small, blue cells, rosette pattern with mitotic figures
  • Tx = surgical resection + chemo
26
Q

Ependymoma

A
  • Commonly seen in 4th ventricle
  • May causes hydrocephalus
  • Histology = perivascular pseudo rosettes
27
Q

Hemangioblastoma

A
  • Vascular tumour of cerebellum
  • Associated with von Hippel-Lindau syndrome
  • Histo: foam cells + high vascularity
28
Q

Oligodendroglioma

A
  • Benign, slow-growing, common in front lobe
  • Histo: fried egg appearance, calcifications
  • 1p19q deletion
29
Q

Pituitary adenoma

A
  • 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
30
Q

Craniopharyngioma

A
  • 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
31
Q

Which four areas of the CNS might MS lesions be found

A

periventricular, juxtacortical, infratentorial, spinal cord

32
Q

Vestibular schwannoma presentation

A

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

33
Q

Ix and Tx of Vestibular schwannoma

A
  • 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.
34
Q

Describe a pontine haemorrhage

A
  • life-threatening condition.
  • complication secondary to chronic hypertension
  • Patients often present with reduced Glasgow coma score, quadriplegia, miosis, and absent horizontal eye movements
35
Q

Symptoms of autonomic dysrefelxia

A

severe hypertension and flushing and sweating above the level of injury
- seen in spinal cord injuries at or above T6 level

36
Q

Define syringomyelia

A

Collection of CSF within spinal cord

37
Q

Causes of syringomyelia

A
  • Chiari malformation = strong association
  • Trauma
  • Tumours
  • Idipathic
38
Q

Presentation of syringomyelia

A
  • ‘cap-like’ loss of sensation/temp
  • preservation of light touch, proprioception + vibration
  • classic example = accidentally burn hand without realising
39
Q

Which tracts are affected in syringomyelia

A

compression of the spinothalamic tract fibres decussating in the anterior white commissure of the spine

40
Q

How do you diagnose carotid artery stenosis?

A

Carotid artery stenosis is diagnosed (and degree of stenosis assessed) via duplex ultrasound

41
Q

Broca’s

A

Speech = non-fluent, laboured, halting

INFERIOR FRONTAL gyrus

42
Q

Wernicke’s

A

Speech = word substitution, neologisms, fluent speech

SUPERIOR TEMPORAL gyrus

Phase 3A Medicine (17 decks)

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