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Year 3 - MedEd Lectures > Neuro 1 > Flashcards

Neuro 1 Flashcards

1
Q

Which conditions may damage any Cranial Nerve?

A

Diabetes

Multiple Sclerosis

Tumours

Sarcoidosis

Vasculitis

SLE

Syphilis

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2
Q

What could cause changes in a younger person’s sense of smell?

A

Frontal Lobe Tumour

Trauma, the Olfactory Nerve may be sheared as it sits in the Cribiform Plate

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3
Q

How does the presentation of a loss of visual acuity point to the possible cause?

A

Bilateral - Age-Related Macular Degeneration

Sudden - Infarct

Over a few hours - MS Inflammatory Attack (Painful)

If old - Ischaemia/Diabetes

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4
Q

What would be your Ddx in a patient presenting with a decrease in Optic Acuity?

A

Refractive Error

Ocular Media

Age related macular degeneration

Diabetic Retinopathy

Optic Neuropathy (MS/Ischaemia)

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5
Q

What is Conjunctivitis and how does it present?

A

Pink Eye

Chemosis (Eyelid Oedema)

Crust and Discharge

Foreign Body Sensation

Photophobia

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6
Q

How do you distinguish between the causes of Conjunctivitis?

A

Bacterial

  • Thick Yellow/Pus Discharge
  • Reduced Vision
  • Urethritis/Vaginal Discharge ?STD

Viral

  • Watery Clear Discharge
  • Normal Vision
  • Fever/Lymphadenopathy

Allergic

  • Young Adults
  • IGE Mediated
  • Itching, Sneezing, Red, Watery Oedematous eye
  • Typical Allergic cause and presentation
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7
Q

What are cataracts and how do they present?

A

Clouding of the lens and eye.

Visual impariment and glare.

‘Halos’ around lights.

painless

Reduced red reflex OE

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8
Q

What is glaucoma and how does it present?

A

Visual loss due to Optic Nerve damage.

Usually due to Raised Intraocular Pressure

Must be ruled out in a case of Acutely Red, Swollen Eye

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9
Q

How does Glaucoma-related visual loss progress?

A

Begins peripherally, then progresses more centrally.

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10
Q

What are the two main types of Glaucoma?

A

Open Angle

  • Wide angle between the drainage canal and the iris - Good Drainage
  • Trabecular Meshwork Dysfunction
  • Bilateral, progressive, mild

Closed Angle

  • Poor Drainage
  • Trabecular Meshwork is fine, but the angle through which humour drains is smaller
  • Unilateral, sudden, painful
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11
Q

What is Uveitis?

A

Inflammation of the Uvea (Made up of the Iris, Ciliary Body and Choroid)

Anterior involves the Iris and Ciliary Body

Posterior involves the Vitreous Body, Choroid and Retina

SBA - Can be associated with autoimmune disease

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12
Q

How would you differ between Anterior and Posterior Uveitis?

A

Anterior

  • Autoimmune
  • Painful, Pink Eye
  • Increased Tear Production & Photophobia

Posterior

  • Infective
  • Painless
  • Floaters and Scotomata
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13
Q

What are the main causes of Anterior Uveitis?

A

Seronegative Spondyloarthropathies

Rheumatoid Arthritis

Sarcoidosis

SLE

IBD

Behcet’s

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14
Q

What are the main causes of Posterior Uveitis?

A

CMV

EBC

HSC

VZV

Syphilis

TB

Lyme Disease

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15
Q

How could you classify the types of Visual Field Defects?

A

Prechiasmal

  • One eye only
  • Ipsilateral

Chiasmal

-Bitemporal Hemianopia

Post-Chiasmal

  • Homonymous
  • Contralateral
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16
Q

What are the main causes of Prechiasmal visual field defects?

A

Ischaemia (TIA)

Inflammation (MS, Giant Cell Arteritis)

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17
Q

What is Amaurosis Fugax?

A

Visual Field Defect seen in patients experincing a Prechiasmal TIA.

Described a being like ‘A veil coming down over one eye for a few minutes’

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18
Q

What are the main causes of Chiasmal Visual Field Defects?

A

Pituitary Tumour

Craniophyrangioma

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19
Q

How do Bitemporal Hemianopias develop when due to structures compressing the Optic Chiasm?

A

If originating superior to the Optic Chiasm, the visual field defect will begin as a Bitemporal Inferior Quadrantanopia

If originating inferior to the Optic Chiasm, the visual field defect will begin as a Bitemporal Superior Quadrantanopia

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20
Q

What are the main causes of Post-Chiasmal Visual Field Defects?

A

Tumours

Multiple Sclerosis

Strokes

21
Q

In which lobes are the lesions when patients present with Hemitemporal Quadrantanopias?

A

Superior - Temporal

Inferior - Parietal

22
Q

What is Neglect Syndrome?

A

Lesions in the Parietal Lobe lead to patients ignoring one side of their world.

Not Blindness, they can see things, but can’t register them.

Will eat food on one side of their plate

Shave one side of their face

Wash the right side of their body

23
Q

What does the loss of the consensual pupillary light reflex indicate?

A

CN III Lesion

24
Q

What does the loss of the direct pupillary light reflex indicate?

A

CN II Lesion

25
Q

What is the triad associated with Horner’s Syndrome?

A

Ptosis

Miosis

Anhydrosis

26
Q

What can cause Horner’s Syndrome?

A

Benign Causes, such as Migraine and Goitre

Neurological Causes, such as MS and Syringeomyelia

Life-Threatening Lesions, such as Tumours on the sympathetic pathway or Pancoast’s Tumour (Lung Apex)

Carotid Dissection

27
Q

Which classic sign would you see upon Cranial Nerve examination of a patient with an Oculomotor Nerve Palsy?

A

Down and Out Pupil

Occurs due to unopposed action of the 4th and 6th Nerves.

Ptosis would also be seen

28
Q

What is the difference between a Medical and Surgical 3rd Nerve Palsy?

A

Medical palsies occur due to medical causes often affecting the blood supply to the nerve. Down and out pupil occurs first.

Surgical palsies occur due to compressive lesions from outside. The parasympathetic chain is affected first, hence you see ptosis before a down and out pupil.

29
Q

What are the causes of a Medical 3rd Nerve Palsy?

A

Diabetes

Vasculitis affecting ‘Vasa Nervosum’ - would see pupillary sparing

30
Q

What are the causes of a Surgical 3rd Nerve Palsy?

A

Raised ICP

Aneurysm Rupture

31
Q

What would you see in a patient with a Trochlear Palsy?

A

The eye looks Up and In

32
Q

What causes Bell’s Palsy?

A

Idiopathic

Commonly due to viruses (Herpes Simplex Virus 1/Varicella Zoster)

Compression of Facial Nerve within the Facial Canal

Diabetes is a Risk Factor

33
Q

How would you investigate a suspected case of Bell’s Palsy?

A

OE - Inability to:

  • Wrinkle Brow
  • Close Eye
  • Puff Cheeks
  • Smile

Viral Serology

34
Q

How would you manage a patient with Bell’s Palsy?

A

Eyepatch - patient can’t close eyes so at risk of corneal abrasions

Prednisolone

35
Q

What is Ramsay Hunt Syndrome?

A

LMN Facial Palsy due to Varicella Zoster

Shingles in the CNs

36
Q

How does Ramsay Hunt Syndrome present?

A

Bell’s Palsy with more pronounced features

Pain

Vesicle formation in the Ipsilateral Ear, Hard Palate or Anterior 2/3 of the Tongue.

Typical over 60

37
Q

What is the significance of forehead involvement in Bell’s Palsy?

A

Forehead Sparing is seen in UMN lesions, since CN 7 has double innervation from each hemisphere. Suspect a stroke.

If forehead shows signs, then it is due to a LMN condition (ie. inflammation due to a viral infection)

38
Q

How is Weber’s Test used to localise Neurological deficits?

A

Sensioneural Hearing Loss in one ear will cause the vibration from Weber’s Test to be louder in the unaffected ear.

Conductive Hearing Loss causes the vibration to be louder in the affected ear.

39
Q

What do the results of Rinne’s Test indicate?

A

Rinne’s Positive = Air Conduction > Bone Conduction - This is normal

Rinne’s Negative = Bone Conduction > Air Conduction - This is indicative of Conductive Hearing Loss

40
Q

What can cause Conductive Hearing Loss?

A

External Auditory Canal

Otitis Externa, Foreign Body, Wax

Drum

Perforation (Trauma/Infection)

Middle Ear

Acute/ Serous Otitis Media

Oval Window

Otosclerosis

41
Q

What can cause Sensorineural Hearing Loss?

A

Inflammation (Meningitis/Viral)

Tumour (Acoustic Neuroma)

Ototoxic Drugs (Aminoglycosides. eg. gentamycin, Aspirin, Loop Diuretics)

Trauma

Meniere’s Disease

42
Q

What is Neurofibromatosis?

A

Hereditary condition causing tumours to form on Neuronal tissue.

Type 1 > Type 2

Increased risk of CNS cancer.

43
Q

Describe Neurofibromatosis Type 1.

A

Autosomal Dominant

Peripheral and Spinal Neurofibromas - Affects whole body

Cafe au lait spots

Freckling

Optic Nerve Glioma

Learning Difficulties

Headaches

44
Q

Describe Neurofibromatosis Type 2

A

Mainly affects the ears

Hearing Loss

Tinnitus

Balance Issues

Headache

Facial Pain/Numbness

45
Q

What does a ‘Bovine Cough’ indicate?

A

Damage to CN IX and X

46
Q

What is Bulbar Palsy?

A

A Lesion in the Medulla Oblongata causing LMN signs affecting CN X, XI and XII.

Presents with:
Absent gag reflex

Wasted, fasciculating tongue

Nasal Speech

Sign of MND

47
Q

What is Pseudobulbar Palsy?

A

Lesion affecting the UMNs supplying the Bulbar LMNs. See UMN signs.

Spastic Tongue

Increased Jaw Jerk

Monotonous, slurred, high pitched speech

Labile Emotions

48
Q
A

Year 3 - MedEd Lectures (29 decks)

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