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Neuro Flashcards

1
Q

What is the presentation of intracranial bleeds?

A

Sudden onset headache

Seizures
weakness
Vomiting
Reduced consciousness

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2
Q

What are subdural haemorrhages?

A

Occur between dura mater and arachnoid mater

CT: crescent shape and not limited by suture lines

More common in elderly or alcoholic patients

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3
Q

What are extradural haemorrhages?

A

Rupture of middle meningeal artery

CT: bi-convex shape and limited by suture lines

E.g. young patient with trauma and ongoing headache, period of improvement then decline

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4
Q

What is a subarachnoid haemorrhage?

A

Bleeding into the subarachnoid space where CSF is due to ruptured cerebral aneurysm

Thunderclap headache

Associated with cocaine and sickle cell anaemia

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5
Q

What is the management of an intracranial bleed?

A

Immediate CT head to establish diagnosis

Check FBC and clotting

Admit to specialist stroke unit

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6
Q

What are the tracts affected and presentation of Brown-Sequard syndrome (spinal cord hemisection)

A

Tracts:

  1. Lateral corticospinal tract
  2. dorsal columns
  3. Lateral spinothalamic tract

Features:

  1. ipsilateral spastic paresis below lesion
  2. ipsilateral loss of proprioception and vibration sensation
  3. Contralateral loss of pain and temp sensation
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7
Q

What are the tracts affected and presentation of subacute degeneration of the spinal cord (Vit B12 and E deficiency) and Friedrich’s ataxia?

A

Tracts:

  1. Lateral corticospinal tracts
  2. Dorsal columns
  3. Spinocerebellar tracts

Features:

  1. Bilateral spastic paresis
  2. Bilateral loss of proprioception and vibration sensation
  3. Bilateral limb ataxia

Friedrich’s ataxia also has intention tremor

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8
Q

What are the tracts affected and presentation of anterior spinal artery occlusion

A
  1. Lateral corticospinal tracts
  2. Lateral spinothalamic tracts

Features:

  1. Bilateral spastic paresis
  2. Bilateral loss of pain and temp sensation
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9
Q

What are the tracts affected and presentation of syringomyelia

A

Tracts:

  1. Ventral horns
  2. Lateral spinothalamic tract

Features:

  1. Flacid paresis (intrinsic hand muscles)
  2. Loss of pain and temp sensation
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10
Q

Define TIA

A

transient neurological dysfunction secondary to ischaemia without infarction.

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11
Q

What is the presentation of a stroke?

A 
Asymmetrical:
Sudden weakness of limbs
Sudden facial weakness
Sudden onset dysphasia
Sudden onset visual or sensory loss
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12
Q

What is the management of stroke?

A

Admit patient to specialist stroke centre
Exclude hypoglycaemia
Immediate CT brain
Aspirin 300mg and continue for 2 weeks

Thrombolysis with alteplase

Thrombectomy (before 24hr)

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13
Q

What is the management of TIA?

A

Aspirin 300mg daily
Start secondary prevention measures
Seen within 24hr by stroke specialist

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14
Q

What is the gold standard imaging in stroke?

A

Diffusion-weighted MRI

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15
Q

What is the secondary prevention of stroke?

A

Clopidogrel 75mg/day
Atorvastatin 80mg but not started immediately
Carotid endarterectomy or stenting
Treat modifiable risk factors

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16
Q

What is vasovagal episodes?

A

Caused by a problem with the autonomic nervous system. When the vagus nerve receives a strong stimulation, it can stimulate the parasympathetic nervous system. This leads to hypoperfusion of the brain tissue causing patient to faint,

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17
Q

What are the causes of vasovagal syncope?

A

Primary:
Dehydration
Missed meals
Extended standing in a warm environment

Secondary:
Hypoglycaemia
Dehydration
Anaemia
Infection
Anaphylaxis
Arrhythmias
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18
Q

What is the difference between syncope and seizures?

A

Syncope:
Return of consciousness shortly after falling
No prolonged post-ictal period

Seizures:
Return of consciousness lasts more than 5 minutes
Prolonged post-ictal period

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19
Q

Describe the presentation of bell’s palsy?

A

Unilateral lower motor neurone facial nerve palsy:

  • forehead affected
  • drooping of eyelid
  • loss of nasolabial fold
  • loss of lacrimation
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20
Q

What is the prognosis of Bell’s palsy?

A

Majority of patients fully recover over several weeks but may take upto 12 months

1/3 are left with residual weakness

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21
Q

What is the management of Bell’s palsy?

A

If patient presents within 72 hours, consider prednisolone as either:
50mg for 10 days
60mg for 5 days followed by 5-day reducing regime of 10mg a day

Lubricating eye drops and tape

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22
Q

What is Ramsay-Hunt syndrome? Give the cause, presentation and treatment

A

Caused by varicella zoster virus.

Presents with unilateral lower motor neurone facial nerve palsy.

Painful vesicular rash in the ear canal, pinna and around the ear. Rash can extend to anterior 2/3 of tongue and hard palate

Treatment should be within 72 hours:
Prednisolone, aciclovir and lubricating eye drops.

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23
Q

What is cerebral palsy?

A

Permanent neurological problems resulting from damage to the brain at the time of birth. Not progressive.

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24
Q

What are the causes of cerebral palsy?

A

Antenatal:
Maternal infections
Trauma during pregnancy

Perinatal:
Birth asphyxia
Pre-term birth

Postnatal:
Meningitis
Severe neonatal jaundice
Head injury

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25
What are the types of cerebral palsy?
Spastic (Pyramidal) Dyskinetic (Extrapiramidal) Ataxic Mixed
26
What is the signs and symptoms of cerebral palsy?
``` Failure to meet milestones Increased or decreased tone Hand preference below 18mths Problems with coordination, speech and walking Feeding or swallowing problems Learning difficulties Upper motor neurone llesion signs ```
27
What is the difference between upper motor neurone and lower motor neurone lesion presentations?
``` UPN: Muscle bulk preserved Hypretonia Slightly reduced power Brisk reflexes ``` ``` LMN: Reduced muscle bulk with fasciculation Hypotonia Dramatically reduced power Reduced reflexes ```
28
What is the management of cerebral palsy?
Cannot be cured Physiotherapy and other MDT Muscle relaxants Anti-epileptic Glycopyrronium bromide
29
What are the symptoms of cluster headaches?
``` Red, swollen and watering eye Pupil constriction Eyelid drooping Nasal discharge Facial sweating ```
30
What are the treatment options for cluster headaches?
ACUTE: Triptans (e.g. sumatriptan 6mg IM) High flow oxygen for 15-20mins PROPHYLAXIS: Verapamil Lithium Prednisolone (2-3wks)
31
What is multiple sclerosis?
Chronic and progressive condition that involves demyelination of the myelinated neurones in the CNS. Caused by an inflammatory process involving the activation of immune cells against the myelin.
32
What is the pathophysiology behind multiple sclerosis?
Schwann cells in PNS Oligodendrocytes in CNS MS typically only affects CNS (Oligodendrocytes)
33
What are the causes of Multiple sclerosis?
``` Multiple genes EBV Low vitamin D Smoking Obesity ```
34
What are the signs and symptoms of multiple sclerosis?
``` Optic neuritis Eye movement abnormalities Focal weakness Focal sensory symptoms Ataxia ```
35
What is relapsing-remitting MS?
Most common pattern at initial diagnosis. Active: new symptoms are developing Not active: no new symptoms Worsening: overall worsening of disability over time Not worsening: no worsening over time
36
What is secondary progressive MS?
Where there was relapsing-remitting disease at first but now there is progressive worsening of symptoms with incomplete remissions
37
What is primary progressive MS>
Where there is a worsening of disease and neurological symptoms from the point of diagnosis without initial relapses and remissions
38
What is the diagnosis of MS?
Made by neurologist based on clinical picture and symptoms suggesting lesions that change location over time. Symptoms have to be progressive over 1 year period
39
What are the investigations in MS?
MRI scan with contrast LP shows oligoclonal bands in CSF CT for tinitus and other hearing problems
40
What is the presentation of optic neuritis?
Unilateral reduced vision developing over hours to days Central scotoma Pain on eye movements Impaired colour vision Relative afferent pupillary defect
41
What is the treatment for MS?
MDT Methylprednisolone for relapses 500mg orally daily for 5 days Symptomatic treatments
42
What is motor neurone disease?
``` Umbrella term for progressive, ultimately fatal condition where motor neurones stop functioning but sensory neurones are spared. E.g: ALS Progressive bulbar palsy Progressive muscular atrophy Primary lateral sclerosis ```
43
What is the presentation of motor neurone disease?
``` Late middle aged patient Insidious progressive weakness of muscles Weakness first noticed in upper limbs Increased fatigue when exercising Clumsiness Dysarthria ```
44
What is the diagnosis of motor neurone disease?
Clinical presentation and excluding other conditions
45
What is the management of motor neurone disease?
Riluzole can slow progression in ALS Edaravone (only in US) Non invasive ventilation
46
What is parkinson's disease?
Progressive reduction of dopamine in the basal ganglia leading to disorders of movements. Asymmetrical symptoms with one side affected more than the other. Triad: Resting tremor Rigidity Bradyinesia
47
What is the diagnosis of Parkinson's disease?
Clinically based on symptoms and examinations by a speciailst
48
What is the management of Parkinson's disease?
No cure Levodopa and bensarazide or Levodopa and carbidopa Dopamine agonists e.g. bromocryptine, pergolide and cabergoline Monamine oxidase B-inhibitor. E.g. selegiline and rasagiline
49
What are the side effects of dopamine?
Dyskinesias. E.g.: | Dystonia, chorea, athetosis
50
What are the treatments for neuropathic pain?
1. Amitriptyline 2. Duloxetine 3. Gabapentin 4. Pregabalin
51
What is the treatment for trigeminal neuralgia?
Carbamazepine If that doesn't work then refer to specialist
52
Which cancers metastasise to the brain?
Lung Breast Renal cell carcinoma Melanoma
53
What are the Gliomas and the different types?
Tumours of the glial cells Astrocytoma (most common) Oligodendroglioma Ependymoma
54
What are meningiomas?
Tumours growing from the cells of the meninges. Usually benign however can lead to raised ICP
55
What are pituitary tumours?
Tend to be benign but can grow large enough to press on optic chiasm causing bitemporal hemianopia. ``` Can also cause hypopituitarism leading to: acromegaly hyperprolactinaemia cushing's disease thyrotoxicosis ```
56
What is an acoustic neuroma?
Also known as vestibular schwannoma Tumours of the schwann cells surrounding the auditory nerve that innervates the inner ear. They occur around cerebellopontine anglle Classic symptoms are: hearing loss, tinnitus and balance problems
57
What are the features of a benign essential tremor?
``` Fine tremor Symmetrical More prominent on voluntary movement Worse when tired, stressed or after caffeine Improved by alcohol Absent during sleep ```
58
What medications can improve essential tremor?
Propranolol | Primidone
59
What is Huntington's chorea?
Autosomal dominant genetic condition that causes progressive deterioration in the nervous system. Trinucleotide repeat disorder that involved mutation in HTT gene on chromosome 4
60
What is genetic anticipation?
Feature of trinucleotide repeat disorders where successive generations have more repeats in the gene resulting in: Earlier age of onset Increased severity of disease
61
What is the presentation of Huntington's Chorea?
Insidious progressive worsening of symptoms. Typically begins with cognitive, psychiatric or mood problems. Followed by: Chorea eye movement disorders Speech difficulties Swallowing difficulties
62
What is the diagnosis of huntington's chorea?
Genetic testing
63
What is the management of huntington's?
Symptomatic treatment
64
What is myaesthenia graves and what is it linked with having?
Autoimmune condition that causes muscle weakness that gets progressively worse with activity and improves with rest Women under 40 and med over 60 Linked with having a thymoma
65
What is the pathophysiology of myaesthesia graves?
Acetylcholine receptor antibodies created by the immune system Antibodies again MuSK Antibodies against LRP4
66
What is the presentation of myaesthenia graves/
``` Diplopia Ptosis Weakness in facial movements Difficulty with swallowing Fatigue in jaw when chewing Slurred speech Progressive weakness with repetitive movements ```
67
What is the diagnosis of myaesthenia graves?
Testing for relevant antibodies: ACh-R antibodies MuSK antibodies LRP4 antibodies CT or MRI of the thymus to look for thymoma Edrophonium test
68
What is the management of myaesthenia graves?
Reversible acetylcholinesterase inhibitors (pyridostigmine or neostrigmine) Immunosuppression Thymectomy Monoclonal antibodies (Rituximab, Eculizumab)
69
What is cauda equina syndrome?
Rare but serious condition in which lumbosacral nerve roots that extend below the spinal cord are compressed
70
What are the possible presenting features of cauda equina syndrome?
``` Low back pain Bilateral sciatica Reduced sensation/pins and needles in perianal region Decreased anal tone Urinary dysfunction ```
71
What is the investigation and management of cauda equina syndrome?
Urgent MRI Surgical decompression
72
What are the associations to tension headaches?
``` Stress Depression Alcohol Skipping meals Dehydration ```
73
What is the presentation of trigeminal neuralgia?
Intense facial pain that comes on spontaneously and last between seconds to hours. Feels like electric shocks Attacks worsen over time
74
What is the most common cause of encephalitis?
HSV 1 in children | HSV 2 in neonates
75
What is the presentation of encephalitis?
``` Altered consciousness Altered cognition unusual behaviour Acute onset of focal neurological symptoms Acute onset of focal seizures Fever ```
76
What is the diagnosis of encephalitis?
``` LP (or CT if contraindicated) MRI EEG Swabs HIV ```
77
What is the management of encephalitis?
IV aciclovir treats HSV and VZV | IV ganciclovir treats CMV
78
What are the most common bones to be affected by osteosarcoma?
Femur Tibia Humerus
79
What is the presentation of an osteosarcoma?
``` Persistent bone pain Worse at night time Bone swelling Palpable mass Restricted joint movements ```
80
What is the diagnosis of an osteosarcoma?
X-ray within 48hrs shows sun-burst appearance Blood tests: high ALP
81
What is the management of a sarcoma?
Surgical resection of lesion with limb amputation and adjuvant chemo
82
Where does Ewing's sarcoma typically affect?
Pelvis Femur Shoulder girdle Ribs
83
What is hydrocephalus?
CSF build up within the brain and spinal cord either due to overproduction or a problem with draining and absorbing (arachnoid granulations)
84
What are the causes of hydrocephalus?
Most common: aqueductal stenosis. The cerebral aqueduct that connects the 3rd and 4th ventricle is stenosed so blocks normal flow of CSF ``` Other causes: Arachnoid cysts Arnold-chiari malformations Chromosomal abnormalities Congenital malformaitons ```
85
What is the presentation of hydrocephalus?
``` Babies: Bulging anterior fontanelle Poor feeding and vomiting Poor tone Sleepiness ```
86
What is the treatment for hydrocephalus/
Placing a ventriculoperitoneal shunt that drains CSF from ventricles into peritoneal cavity is used.
87
What is idiopathic intracranial hypertension?
Condition classically seen in young overweight females
88
What are the risk factors for idiopathic intracranial hypertension?
Obesity Female sex Pregnancy Drugs (COCP, steroids, tetracyclines, Vit A and lithium)
89
What is the presentation of idiopathic intracranial hypertension?
``` Headache Blurred vision Papilloedema Enlarged blind spot 6th nerve palsy ```
90
What is the management of idiopathic intracranial hypertension?
``` Weight loss Diuretics (acetazolamide) Topiramate LP Surgery ```
91
What is the presentation of a migraine?
``` Pounding or throbbing in nature Usually unilateral Photophobia Phonophobia With/without aura N+V ```
92
What is a hemiplegic migraine?
Mimic stroke: Sudden or gradual onset hemiplegia, ataxia and changes in consciousness plus normal migraine symptoms
93
What is the acute management of migraines?
Paracetamol Triptans NSAIDs Antiemetics
94
What is the prophylaxis for migraines?
Propranolol Topiramate Amitriptyline
95
What is charcot-marie-tooth disease?
Inherited disease that affects peripheral motor and sensory nerves. (usually autosomal dominant)
96
What is the presentation of charcot-marie-tooth?
``` High foot arches Distal muscle wasting Weakness in lower legs - loss of ankle dorsiflexion Weakness in hands Reduced tendon reflexes Reduced muscle tone Peripheral sensory loss ```
97
What are the causes of peripheral neuropathy?
``` Alcohol B12 deficiency Cancer and Chronic kidney disease Diabetes and Drugs (isoniazide, amiodarone and cisplatin) Every vasculitis ``` ABCDE
98
What is the management of charcot-marie-tooth?
Supportive
99
What is gullain-barre syndrome?
Acute paralytic polyneuropathy that affects the peripheral nervous system. Triggered by an infection i.e. campylobactor jejuni, CMV and EBV
100
What is the presentation of gullain-barre syndrome?
Symmetrical ascending weakness (starting at feet) Reduced reflexes Peripheral loss of sensation or neuropathic pain May progress to cranial nerves and cause facial nerve weakness
101
What is the diagnosis of guillain-barre syndrome?
Brighton criteria Nerve conduction studies LP for high CSF
102
What is the management of Guillian-Barre syndrome?
IV immunoglobulins Plasma exchange Supportive care VTE prophylaxis
103
What is neurofibromatosis?
Genetic condition that causes nerve tumours (neuromas) to develop throughout nervous system. Type 1 is more common that type 2
104
What causes neurofibromatosis type 1?
NF1 gene is found on chromosome 17. Codes for a tumour suppressor protein. Autosomal dominant
105
What is the diagnostic criteria for neurofibromatosis type 1?
At least 2 of the 7 to indicate diagnosis. CRABBING: Cafe-au-lait spots Relative with NF1 Axillary or inguinal freckles Bony dysplasia such as Bowing of a long bone Iris hamartomas (yellow brown spots on iris) Neurofibromas Glioma of optic nerve
106
What are the investigations and management of neurofibromatosis type 1?
None needed for diagnosis but can do genetic testing, Xrays and other imaging to confirm or if unsure No treatment for underlying disease - supportive
107
What is the cause of neurofibromatosis type 2?
NF2 gene found on chromosome 22 and codes for protein called merlin which is a tumour suppressor protein important for schwann cells. Autosomal dominant
108
What is the presentation of neurofibromatosis type 2?
Acoustic neuromas - (hearing loss, tinnitus, balance problems)
109
What is the management of neurofibromatosis type 2?
Surgery to resect tumours
110
What is Wenicke's encephalopathy?
Neuropsychiatric disorder caused by thiamine deficiency most commonly seen in alcoholics.
111
What is the presentation of Wernicke's encephalopathy>
Opthalmoplegia/nystagmus Ataxia Confusion
112
What is the investigation and treatment of Wernicke's encephalopathy?
Investigations: Decreased red cell transketolase MRI Treatment is with urgent replacement of thiamine (B1)
113
What are some features of fronto-temporal dementia?
``` Lack of attention to personal hygiene Repetitive behaviour Hoarding/criminal behaviours New eating habits Lack of empathy Change in social behaviours ```
114
What is the treatment for subdural haemorrhages?
Burr hole drainage
115
What medication in alzheimers disease to help with sleep?
Trazadone
116
Which nerves control eye muscles?
Optic nerve does all except SO4 and LR6 Superior oblique - Trochlear Lateral rectus - Abducens
117
What is Creutzfelt-Jakob disease?
Rapidly progressive neurological condition caused by prion proteins.
118
What are the features of Creutzfelt-Jakob disease?
Dementia (rapid onset) | Myoclonus
119
What are the investigations in Creutzfelt-Jakob disease?
CSF normal EEG: biphasic, high amplitude sharp waves MRI: hyperintense signals in basal ganglia and thalamus
120
What is the presentation of coronary artery dissection?
Horner's syndrome
121
Difference between Lambert eaton and Myasthenia gravis?
MG: fatigue with effort LE: Easier with effort
122
What is first line for micro and amcroprolactinomas?
Cabergoline
123
What is the triad of presentation for cerebellar stroke?
Headache Nausea/Vomiting Ataxia
124
Which pathway blockage causes galactorrhoea?
Tuberoinfundibular pathway
125
When can you drive after a TIA or stroke?
4 weeks for cars | 1 year for Lorry's
126
Which test is abnormal during delirium regardless of the cause?
EEG shows diffuse slowing
127
Difference between vestibular migraine and vestibular neuronitis?
Migraine is recurrent whereas neuronitis is a single episode
128
Which type of dementia is most attributed to hallucinations?
Lewy body's
129
Which heart condition does subarachnoid haemorrhage lead to?
Torsades de pointes

Finals (20 decks)

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