Neuo Passmed Flashcards
Contralateral hemiparesis + sensory loss, lower extremity >upper
Anterior cerebral artery
Contralateral hemiparesis + sensory loss, upper extremity > lower.
Contralateral homonymous hemianopia
Aphasia
Middle cerebral artery
Contralateral homonymous hemianopia with macular sparing
Visual agnosia
Posterior cerebral artery
Ipsilateral CN III palsy
Contralateral weakness of upper and lower extremity
Weber’s syndrome:
Branches of posterior cerebral artery that supply the midbrain.
Ipsilateral: facial pain/numbness + temperature loss
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus
Posterior inferior cerebellar artery (lateral medullary syndrome, Wallenberg syndrome)
Symptoms are similar to Wallenberg’s (see above), but:
Ipsilateral: facial paralysis and deafness
Anterior inferior cerebellar artery (lateral pontine syndrome)
Locked-in syndrome
Basilar Artery
Either isolated hemiparesis, hemisensory loss
Strong assoc. w/ hypertension
lacunar stroke
What increases the risk of intracerebral haemorrhage after treatment for stroke?
Aspirin, Clopidogrel + IV Alteplase all increase the risk of further bleeding and clinical deterioration.
What is cushing’s triad?
Hypertension, Bradycardia, Tachypnoeic
Total Anterior Circulation
- unilateral hemiparesis and/or hemisensory loss of the
face, arm & leg - homonymous hemianopia
- higher cognitive dysfunction e.g. dysphasia
Partial Anterior Circulation infarct
involves smaller arteries of anterior circulation e.g. upper or lower division of middle cerebral artery
2 of the above criteria are present
Lacunar Infarct
involves perforating arteries around the internal capsule, thalamus and basal ganglia presents with 1 of the following:
1. unilateral weakness (and/or sensory deficit) of face and
arm, arm and leg or all three.
2. pure sensory stroke.
3. ataxic hemiparesis
Posterior Circulation
Involves vertebrobasilar arteries
- cerebellar or brainstem syndromes
- loss of consciousness
- isolated homonymous hemianopia
Vitamin B12 Deficiency?
subacute combined degeneration of spinal cord.
Dorsal column affected first.
Rapid correction of hyponatremia can cause what?
Osmotic demyelination syndrome
Osmotic demyelination syndrome presents with…
Speech disturbances, swallowing dysfunction, limb paralysis, movement disorders, and behavioural and psychiatric disturbances
When will thrombectomy be suitable between 6 - 24hrs?
If there is the potential to salvage brain tissue shown via CT perfusion / diffused-weighted MRI
Is Migraine contraindicated COCP?
If patient have migraine w/ aura then the COCP is absolutely contraindicated due an INCREASED risk of stroke
Parkinson’s + dementia + visual hallucinations, think?
Lewy body Dementia
Chronic Lithium use?
Fine tremor in chronic treatment, coarse tremor in acute toxicity
Focal seizure on the Temporal lobe (HEAD)
Hallucinations (auditory/gustatory/olfactory), Epigastric rising / Emotional, Automatisms (lip smacking/grabbing/plucking), Deja vu/Dysphasia post-ictal)
Focal Seizure on the Frontal Lobe
Head/leg movements, posturing, post-ictal weakness, Jacksonian march
Focal seizure on the parietal Lobe
Paraesthesia (Sensory affected)
Focal Seizure on the occipital Lobe
Floaters / Flashes (Visual affected)
Amyotrophic lateral sclerosis (50% of patients)
LMN signs in legs and UMN signs in arms
Primary lateral sclerosis
UMN only
Progressive muscular atrophy
LMN signs only
affects distal muscles before proximal
carries best prognosis
Progressive bulbar palsy
palsy of the tongue, muscles of chewing/swallowing and facial muscles due to loss of function of brainstem motor nuclei
carries worst prognosis
Management of acute migraine?
Triptan + NSAID or triptan + paracetamol
Prophylaxis for migraine?
Topiramate or propranolol if experiencing 2 or more attacks per month
Brown-squared syndrome?
Caused by lateral hemisection of the spinal cord.
ipsilateral weakness below lesion
ipsilateral loss of proprioception and vibration sensation
contralateral loss of pain and temperature sensation
Which bacteria are most likely to cause GBS?
Campylobacter Jejuni
Typical symptoms of Guillain-Barre syndrome
progressive, symmetrical weakness of the limbs, often in an ascending fashion
Foramen ovale contents
Otic ganglion V3 (Mandibular nerve:3rd branch of trigeminal) Accessory meningeal artery Lesser petrosal nerve Emissary veins
Foramen Spinosum
Middle meningeal artery
Meningeal branch of the Mandibular nerve
Foramen rotundum
Maxillary nerve
Jugular Foramen
Anterior: inferior petrosal sinus
Intermediate: glossopharyngeal, vagus, and accessory nerves.
Posterior: sigmoid sinus (becoming the internal jugular vein) and some meningeal branches from the occipital and ascending pharyngeal arteries.
Stylomastoid foramen
Stylomastoid artery
Facial Nerve
Superior Orbital Fissure
Oculomotor nerve (III) Recurrent meningeal artery Trochlear nerve (IV) Lacrimal, frontal and nasociliary branches of ophthalmic nerve (V1) Abducent nerve (VI) Superior ophthalmic vein
Subacute Combined Degeneration of the spinal cord
Posterior section of the spinal cord
- Bilateral spastic paresis
- Bilateral loss of proprioception and vibration sensation
- Bilateral limb ataxia
Friedrich’s ataxia
Same as subacute combined degeneration of the spinal cord
In addition to cerebellar ataxia → other features e.g. intention tremor
Anterior spinal Artery occlusion
- Bilateral spastic paresis
2. Bilateral loss of pain and temperature sensation
What is paroxysmal hemicrania?
Occurs in women + occurs multiple times a day.
Involves attacks of severe, unilateral headache, usually in the orbital, supraorbital or temporal region.
Associated with autonomic features,
What is Internucluar ophthalmoplegia?
Occurs due to a lesion of the Medial Longitudinal Fasciculus (MLF), a tract that allows conjugate eye movement
Contralateral eye abducts w/ nystagmus.
What is the 1st line for spasticity in multiple sclerosis?
Baclofen and gabapentin
What is Thoracic Outlet Syndrome?
Disorder involving compression of brachial plexus, subclavian artery or vein at the site of the thoracic outlet.
Lesion in the Amygdala may cause?
Docility, dietary changes and hyperphagia, hyperorality, hypersexuality and visual agnosia.
Features of Glioblastoma Multiforme?
Most common primary tumour in adults –> poor prognosis.
Solid tumours with central necrosis.
Treatment surgical +/- chemo or radiotherapy. Steroids used to treat oedema.
Features of Meningioma’s?
Second most common primary brain tumour.
Benign and arise from the arachnoid cap cells of the meninges
Located next to the dura + cause symptoms by compression rather than invasion.
Features of Pilocytic astrocytoma’s?
Most common primary brain tumour in children.
Histology: Rosenthal fibres (corkscrew eosinophilic bundle).
Features of Medulloblastoma?
Aggressive paediatric brain tumour that arises within the infratentorial compartment.
Histology: Rosette pattern of cells with many mitotic figures.
Mechanism of Action of Baclofen?
GABA receptor agonists that acts in the CNS.
What are oligodendrocytes?
responsible for myelin production in the CNS.
What are Schwann cells?
responsible for myelin production in the PNS
RAPD pathway of mechanism?
Occurs when there is a defect in the afferent pathway. Presents with absent constriction of both pupils when a light is shown in the affected eyes. e.g. RAPD in the left eye.
Broca’s area
Non-fluent of speech and grammar is impaired, but comprehension is intact.
Wernicke’s aphasia
Difficulty understanding language and speech which lacks meaning (neologisms) Comprehension is impaired
Conduction aphasia
Speech is fluent but repetition is poor. Aware of the errors they are making. Comprehension is intact.
What is syringomyelia?
A fluid filled cyst forms in spinal cord and expands over time.
Causes slowly progressive neurological symptoms.
Is NF1/2 related to bilateral vestibular schwannoma?
NF2 is related to vestibular schwannomas.
What is the most common complication following meningitis?
Sensorineural hearing loss (most common) Seizures, focal neurological deficit Infective = sepsis Intracerebral abscess Pressure Brain herniation Hydrocephalus
What does a Positive Hoffmans Sign mean?
sign of upper motor neuron dysfunction and points to a disease of the central nervous system.
Acoustic neuroma is best visualised?
MRI of cerebellopontine angle
How would a pt with Uncal herniation present?
Raised ICP can cause a 3rd nerve pals.
May loss consciousness
Diplopia
Acute treatment for cluster headache?
Subcutaneous sumatriptan and 100% oxygen.
What is Multiple System Atrophy?
Postural hypotension, autonomic disturbance may be seen in Parkinson’s disease the ataxic gait point towards a diagnosis of multiple system atrophy.
Urinary incontinence + Gait Abnormality + Dementia
Normal Pressure Hydrocephalus
What mimics TIA ?
Hypoglycaemia = can lead to focal neurological symptoms.
Management for bells palsy?
Oral prednisolone within 72 hrs and give eye lubricants.
