Misc neuro Flashcards by Ella Varnish

Most common complication of meningitis?

Sensorineural hearing loss

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Triad in normal pressure hydrocephalus

dementia, ataxia and urinary incontinence.

REMEMBER THIS IN DEMENTIA/DEPRESSION Q’s

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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

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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.

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

Sodium Valproate

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What increases the risk of MND?

smoking, exposure to heavy metals and certain pesticides

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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)

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What would your differentials be for a unilateral Parkinson appearance?

Multiple system atrophy (+ autonomic/cerebellar symps)

- Drug-induced parkinsonism

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MoA Sodium Valproate

Increases GABA activity

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MoA Carbamezpaine

Binds to sodium channels, increasing their refractory period

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MoA Lamotrigine

Sodium channel blocker

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MoA Phenytoin

Binds to sodium channels, increasing their refractory period

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MoA Ethosuximide

Partial antagonism of T-type calcium channels of thalamic neurons

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Adverse effects of Sodium Valproate

Weight gain
P450 enzyme INHIBITOR
Ataxia and tremor
Teratogenic (neural tube)

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Adverse effects of Carbamazepine

P450 enzyme INDUCER
Dizziness + ataxia + drowsiness
Leukopenia and agranulocytosis
SIADH
Diplopia
Aplastic anaemia

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Adverse effects of Lamotrigine

Steven-Johnsons syndrome (papules/bullae) - supportive Tx
DRESS syndrome
Leukopenia

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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