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Phase 3a > Neuro > Flashcards

Neuro Flashcards

1
Q

MND?

A

Neurodegenerative disorder that affects MN which control voluntary movement

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2
Q

Types of MND?

A

Amotrophic Lateral Sclerosis
Progressive Bulbar Palsy
Progressive Muscular Atrophy
Primary Lateral Sclerosis

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3
Q

What type of MND only affects the small muscles of the hands and feet?

A

Progressive Muscular Atrophy

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4
Q

What type of MND only affects UMN?

A

Primary Lateral Sclerosis

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5
Q

What type of MND affects only LMN of 9,10,12?

A

Progressive Bulbar Palsy

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6
Q

UMN signs?

A 
Spasticty 
Babinksi
Hoffman's reflex
Brisk Reflexes 
Stiffness of upper movements 
Poor balance
Weak upper limb extension  + Lower limb flexion
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7
Q

LMN signs?

A

Fasciculations
Weakeness
Cramps
Reduces reflexes

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8
Q

Late stage signs of MND?

A

Bladder + Bowel incontinence

Oculomotor problems

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9
Q

Signs of MND?

A

Asymmetrical distal weakness
Brisk Reflexes
No changes in sensation or pain
Limb onset - Bulbar onset - Resp onset

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10
Q

Distribution of weakness seen in MND?

A

Asymmetrical distal weakness

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11
Q

Complication of MND?

A

Resp failure or Pneumonia

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12
Q

Diagnosis of MND?

A

Nerve conduction studies - fibrillation and fasciculations high amplitude and long duration
El Escorial criteria of UMN + LMN symptoms
CT/ MRI/ Bloods/ Muscle Biopsy - rule out

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13
Q

Criteria used to rate the severity of MND symptoms?

A

El Escorial

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14
Q

Management of MND?

A 
Riluzole 
Ventilator 
PEG feed 
ACP
Palliative care
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15
Q

Sign of cluster headache?

A

Severe pain + Unilateral lacrimation and redness of the eye lasting 1 to 2 hours
Rapid onset

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16
Q

Management of cluster headache?

A

Triptans
Short course steroids
Other: Verapamil, Topiramate or Lithium Carbonate

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17
Q

Migraine?

A

Recurrent unilateral headache associated with GI + Visual disturbance

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18
Q

Precipitating factors of Migraine?

A 
Cheese 
OCP
Caffeine 
Alcohol 
Anxiety 
Travel 
Exercise 
Noise 
Sleep Disturbances
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19
Q

Ddx of Migraine?

A

SAH, TIA, Meningitis

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20
Q

Management of Mild Migraine?

A

Paracetamol, NSAIDS, High dose Aspirin

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21
Q

Management of Moderate/ Severe Migraine?

A

Triptans

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22
Q

Migraine Prophylaxis?

A

Sodium Valproate
Propanolol
Amitriptyline
Botox

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23
Q

Management of recurrent migraines?

A

Pizotifen

Flunarizine

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24
Q

Pathophysiology of Trigeminal Neuralgia?

A

Vascular compression of the trigeminal nerve leading to central demyelination of the nerve root or MS, tumours, abnormalities of the skull base or AV malformations

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25
Q

Trigeminal Neuralgia?

A

Severe episodic facial pain in the distribution of 1 or more branches of the trigeminal nerve

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26
Q

Management of trigeminal neuralgia?

A

Carbamazepine post attack

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27
Q

GCA?

A

Chronic vasculitis characterised by granulomatous inflammation in the walls of medium/ large-sized arteries

Temporal or aorta + it’s branches

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28
Q

Signs of GCA?

A 
Loss of vision 
Tender scalp 
Jaw claudication 
Systemic features 
Sore throat
Hoarseness
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29
Q

Diagnosis of GCA?

A

History
Bloods - Normochromic Normocytic anaemia, Elevated ESR + CRP
Temporal artery biopsy

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30
Q

Management of GCA?

A

Prednisone

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31
Q

Diagnosis of a spinal cord compression?

A

MRI - Cause and site of compression

X-ray - Degenerative bone disease + destruction of the vertebrae

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32
Q

Management of spinal cord compression?

A

Surgical decompression + stabilisation of the spine

Dexamethasone

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33
Q

How does dexamethasone help decompress the spine?

A

Reduces oedema around the lesion

improves outcome in cord compression caused by malignancy

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34
Q

Cauda equina syndrome

A

Severe compression of the cauda equina - nerve roots L2 and beyond

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35
Q

Clinical features of Causa Equina syndrome?

A

Bladder + Bowel Incontinence
Saddle Numbness
Back Pain
Weakness in the legs

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36
Q

Ataxia?

A

Damage to the cerebellum causing patients to have symptoms that mimic being drunk

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37
Q

Friedreich’s Ataxia?

A

AR spinocerebella degeneration that affects spinal cord, heart and pancreas

GAA repeats on chromosome 9 so less frataxin made so build-up of iron in mitochondria leads to oxidative damage

Spinal cord becomes thinner + nerve cells lose myelin

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38
Q

Signs of Friedreich’s Ataxia?

A 
Slurred speech 
Foot deformities 
Scoliosis
Ataxia 
Cardiac arrhythmia 
Diabetes 
Loss of dorsal columns - absent proprioception + vibration 
Loss of vision and hearing
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39
Q

Cause of death in people with Friedreich’s Ataxia?

A

Hypertrophic cardiomyopathy

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40
Q

Age of onset of Friedreich’s Ataxia?

A

5 to 20 years old

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41
Q

Initial symptoms of Friedreich’s Ataxia?

A

Loss of proprioception and weakness moving upwards
Difficulty walking
Fatigue

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42
Q

Diagnosis of Friedreich’s Ataxia?

A

Genetic testing - expanded GAA repeat
MRI or brain + spinal cord
Echo

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43
Q

Management of Friedreich’s Ataxia?

A

Rehab + Walking aids
ACEi - Cardiac abnormalities
Surgery - slow down progression of scoliosis

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44
Q

Syringomelia or Syringobular?

A

Fluid filled cavities within the spinal cord or brain stem. Pressure forced cerebellar tonsils through the foramen magnum

Pain and sensory loss in upper limbs

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45
Q

Benign brain tumours?

A

Meningioma

Neurofibroma

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46
Q

Signs of brain tumours?

A

Mass effects depending on surrounding structures
Raised ICP
Epilepsy

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47
Q

Signs of raised ICP?

A 
Headache
Vomiting 
Papiloedema 
Made worse by coughing or sneezing 
Mydriasis 
Dyspnoea 
Decerebate or Decorticate posturing
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48
Q

Hydrocephalus?

A

Accumulation of CSF in the cranium by obstruction of CSF flow or increased CSF production

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49
Q

Normal Pressure Hydrocephalus?

A

Dilation of the ventricles + excess CSF without increased ICP

Elderly, Dementia, Urinary Incontinence, Ataxia

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50
Q

Communicating hydrocephalus?

A

Non-obstructive
Impaired CSF reabsorption in the absence of obstruction between ventricles and subarachnid space

Haemorrhage, Meningitis, Abnormal arachnoid villi

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51
Q

Non-communicating hydrocephalus?

A

Obstructive

Obstruction of either foramen of Monroe, cerebral aqueduct, fourth ventricle, foramen of Luschka + Foramen of Magendie

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52
Q

Hydrocephalus Ex Vacuo

A

Compensatory enlargement of CSF space in response to brain parenchyma loss and not increased CSF production

Brain atrophy, Schizophrenia, Post-traumatic brain injuries

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53
Q

Causes of hydrocephalus in children?

A 
Arnold Chiari malformation 
Aqueductal stneosis 
Meningitis 
Haemorrhage 
Neural tube defects 
Brain tumour
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54
Q

Signs of hydrocephalus in babies?

A

Rapid head growth
Vomiting
Sleepiness
Seizures

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55
Q

Signs of hydrocephalus in adults?

A 
Headaches
Diplopia
Poor balance 
Urinary Incontinence 
Personality change 
3rd Nerve Palsy
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56
Q

Management of hydrocephalus?

A

External ventricular drain

Shunt between ventricles and right atria/ Peritoneum

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57
Q

Monro Kellie hypothesis?

A

Sum of the volume of the brain is constant. An increase of one compartment causes a decrease in the other

Brain tissue, CSF
+ Blood

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58
Q

Causes of raised ICP?

A 
Cerebral oedema - Acute hypoxia or trauma 
Intracranial SOL
↑CSF production or ↓CSF absorption 
Non-communicating hydrocephalus 
Idiopathic intracranial hypertension
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59
Q

Diagnosis of raised ICP?

A

ICP monitor

CT

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60
Q

Management of raised ICP?

A

Propofol - sedate
Mannitol - osmotic diuresis
Prophylactic anticonvulsant
Decompressive craniotomy or remove SOL or Drain

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61
Q

Signs of idiopathic intracranial hypertension?

A 
Papilloedema 
Retrobulbar pain 
Visual field loss 
Headache 
Pulsatile tinnitus 
Photopsia 
Diplopia 
Temporary visual disturbance
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62
Q

Diagnosis of IIH?

A

Headache + Papilloedmea in the absence of hypertension
↑Opening pressure on LP
Normal neural image + CSF composition

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63
Q

Management of IIH?

A 
Treat symptoms and save vision 
Acetazolamide 
Furosemide 
Optic sheath fenestration 
Weight loss
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64
Q

MOA acetazolamide?

A

Carbonic anhydrase inhibitor that decreases CSF production

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65
Q

Mononeuropathy?

A

Compression of a single nerve affecting the muscle it innervates

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66
Q

Causes of carpal tunnel?

A

Compression, Entrapment or Direct damage

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67
Q

Signs of carpal tunnel?

A

Pain + paraethesia at night

Wasting + weakness of the thenar muscles

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68
Q

Management of carpal tunnel?

A

Nocturnal splint
Surgical decompression
Local steroid injection

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69
Q

What does B12 deficiency cause?

A

Polyneuropathy and subacute degeneration of the spinal cord

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70
Q

B12 deficiency signs?

A

Distal loss of proprioception and vibration
Absent ankle
Exaggerated knee + Babinski reflex

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71
Q

GBS?

A

Guillain-Barre Syndrome - post-infection inflammatory demyelinating polyneuropathy

Antibody-mediated nerve damage

Rapidly ascending symmetrical weakness

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72
Q

Miller Fisher Syndrome

A

Variant of GBS that affects cranial nerves of the eyes

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73
Q

Autonomic symptoms of GBS?

A

Postural hypotension
Cardiac Arrhythmia
Ileus
Bladder Dysfunction

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74
Q

Diagnosis of GBS?

A

Nerve conduction studies - Slow motor conduction due to demyelination

Neuro exam

LP - Raised protein + WCC

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75
Q

Management of GBS?

A 
IVIg - decrease duration + severity of paralysis 
Plasmapheresis 
Monitor FVC 
PEG feed 
Heparin
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76
Q

What is a stroke?

A

Rapid onset neurological deficit lasting more than 24 hours

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77
Q

Causes of stroke?

A 
Embolism 
Thrombosis 
AF
Polycythemia 
Hypertension 
Atheroma 
Alcohol
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78
Q

Complications of stroke?

A 
Haemorrhagic transformation of ischaemic stroke 
Cerebral oedema 
Seizures 
VTE
Cardiac complications 
Infection 
Long term mobility problems 
Difficulties with ADL
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79
Q

Diagnosis of Stroke?

A

CT
MRI - any haemorrhagic transformation
Carotid doppler if suspected carotid stenosis

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80
Q

Tool used to classify the severity of stroke?

A

NIHSS - National Institute of
Health Stroke Scale - baso full neuro exam

15 item scale that measures the severity of stroke-related neurological deficits/monitors response to acute treatments

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81
Q

Management of confirmed ischaemic stroke?

A

Thrombolysis <4.5 hours (Alteplase) or Mechanical thrombectomy

or

300mg Aspirin followed by Clopidogrel if confirmed no haemorrhagic transformation

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82
Q

Secondary prevention of ischaemic stroke?

A

Dual platelet therapy for 3 months and lifestyle changes

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83
Q

Secondary prevention of ischaemic stroke in patients with AF?

A

Warfarin

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84
Q

HASBLED?

A

Risk of major bleed (intracranial bleed) in a patient with AF

Hypertension, Abnormal renal or liver function, Stroke, Labile INR, Elderly >65, Drugs or alcohol (antiplatelt or NSAIDS + more than 8 drinks weekly)

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85
Q

CHADVASC?

A

Risk of stroke in a patient with AF

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86
Q

BSC: Lacunar infarct?

A

Small vessel disease - occlusion of deep penetrating arteries

Pure sensory
Pure motor
Ataxic hemiparesis
Sensori-motor stroke

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87
Q

BSC: Posterior Circulation stroke?

A

Ipsilateral Cranial nerve palsy
Bilateral motor/ sensory deficit
Conjugate eye movements disorder e.g. gaze paresis
Cerebellar dysfunction
Isolated homonymous hemianopia or cortical blindness

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88
Q

Gaze palsy?

A

Inability of the eyes to move together on a single horizontal plane

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89
Q

Examples of cerebellar dysfunction?

A 
Ataxia
Nystagmus 
Vertigo 
Diplopia 
Dysarthria
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90
Q

BSC: TACS or PACS?

A

TACS - 3
PACS - 2

Unilateral weakness +/- sensory loss
Homonymous hemianopia
Dysphasia or Visuospatial disorder

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91
Q

TIA?

A

Focal neurological deficit lasting <24 hours due to ischaemia of blood vessel in the brain

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92
Q

Crescendo TIA?

A

2+ TIA in a week increasing the risk of stroke

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93
Q

Investigations of TIA?

A

Bloods - glucose, FBC, ESR, Creatinine, Electrolytes, Cholesterol, INR

MRI within 24 hours
ABCD2
Coronary artery CT or doppler?
ECG

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94
Q

ABCD2?

A 
Risk of stroke after TIA 
Age >60
BP >140/90
Clinical features 
Diabetes + Duration
95
Q

Management of TIA?

A

Aspirin or Clopidogrel (Wafarin if AF)
Secondary prevention - control DM + HTN
Surgery - Carotid endarterectomy
No driving for 1 month

96
Q

Rfx of Intracerebral haemorrhage?

A 
Hypertension 
Smoking  
Alcohol 
Increased age 
Aneurysm
97
Q

Management of Intracerebral haemorrhage?

A

Stop anticoagulation
Control hypertension
Mannitol + Ventilation to decrease ICP

98
Q

Subdural haematoma?

A

Accumulation of blood in the subdural space following rutpure of vein in saggital sinus

Headache, Drowsiness, Confusion

Banana CT

Surgical removal

99
Q

Most at risk of subdural haematoma?

A

Atophic brains e.g. elderly or Alcoholics

100
Q

Extradural Haemorrhage?

A

Bleeding between endosteal dura and skull following head injury

Rapid deterioration + focal neurological sings

Surgical drainage

101
Q

Subarachnoid Haemorrhage?

A

Spontaneous bleed in the subarachnoid space following rupture of an aneurysm or congenital AV malformation

102
Q

Clinical features of SAH?

A 
Asymptomatic until rupture
Sudden thunderclap headache 
3rd nerve pasly 
Nausea
LOC
Neck stiffness + Kernig sign 
Small warning headaches before
103
Q

Kernig sign?

A

When the hip is flexed there is limited/ painful knee extension

104
Q

Brudzinski sing?

A

Passive neck flexion elicits hip + knee flexion

105
Q

Management of SAH?

A

Nimodipine CCB
0.9% saline
Obliteration of aneurysm
Manage hypertension

106
Q

How does Nimodpine aid the management of SAH?

A

Decreases cerebral artery spasms

107
Q

Primary Infection - Varicella?

A

Replicates within skin or resp epithelium then picked up by immune cells and carried to lymph nodes

108
Q

Primary viraemia VSV?

A

Attacks the reticuloendothelial system that is made of phagocytic cells

109
Q

Secondary viraemia VSV?

A

2 weeks later when the virus starts attacking T cells starts

110
Q

Tzank cells?

A

giant multinucleated cells made of fused keratinocytes

111
Q

Secondary infection of VSV? Skin

A

T cells express proteins that bind to receptors on the skin

Release virus into skin and infect keratinocytes - spreading from cell to cell

Tzanck cells release INF a and INF B which inhibit viral protein synthesis and nearby cells being infected = Tiny lesions separated by normal areas of skin

112
Q

Secondary infection of VSV? Neurones

A

Virus travels retrogradely back to the dorsal root ganglion or trigeminal ganglion

Adaptive immunity kills the virus all over the body apart from the ones hiding in the ganglion

Moment of weak immune system causes reactivation then virus travels back to skin

113
Q

Complication of VSV?

A

Secondary bacterial infections (Hepatitis or pneumonia or encephalomeningitis)

114
Q

Varicella symptoms?

A

2 weeks after virus enters body
Fever, headache, weakness
Skin lesion - Macules to Papules to Fluid filled vesilces to Scabs
Painful sores on mucosal surfaces

115
Q

Herpes simplex symptoms?

A

Painful, itching or tingling localised to a specific dermatome on one side of the body
Rash lasts 4 weeks
Post-herpatic neuralgia >90 days

116
Q

Diagnosis of VSV?

A

Rash
Tzanck test
Bloods - antibodies
PCR for viral DNA

117
Q

Management of VSV?

A 
Topical antipuritic 
Pain relief 
Anti-viral - if immunocompromised 
VZ Ig
Varicella vaccine
118
Q

Anti-virals that can be given in an immunocompromised patient with VSV?

A

Acyclovir
Famciclovir
Valacylovir

119
Q

Why is aspirin CI in patients with VSV?

A

Reye syndrome risk

Liver is affected by both the virus and aspirin resulting in a toxic build-up of ammonia

120
Q

What is the function of thiamine?

A

Thiamine Pyrophosphate is a metabolically active version of thiamine

Glucose metabolism
Metabolises lipids and carbohydrates
Maintain normal amino acid + neurotransmitter levels
Propagation of neural impulses

121
Q

How does alcohol abuse result in decreased B1 function?

A

Blocks the phosphorylation of thiamine
Ethanol decreases B1 absorption in the duodenum
Liver Cirrhosis - less storage space for thiamine
Other: Malnutrition, Anorexia, GI cancer, IBD

122
Q

WE?

A

Reversible and Acute

Ophthalmoplegia (weakness/ paralysis of eye muscles)
Ataxia
Change in mental state (Confusion, apathy or difficulty concentrating)

123
Q

KE?

A

Irreversible and Chronic

Affects limbic system due to damage of mamillary bodies

Anterograde/ Retrograde Amnesia
Confabulation

124
Q

What must be given after thiamine treatment to prevent metabolic acidosis?

A

Glucose

125
Q

Examples of BPS of dementia?

A

Hallucinations, Delusion, Agitation, Depression, Anxiety, Withdrawal, Inappropriate sexual behaviour

126
Q

Parkinsons?

A

Progressive movement disorder caused by the depletion of dopamine secreting cells of the SN

127
Q

Cause of death in patients with Parkinsons?

A

Bronchopneumonia or Aspiration Pneumonia

128
Q

Drugs that can cause drug-induced Parkinsons?

A

Antiemetics (phenthiazine)
Anaesthesia
Antipsychotics

129
Q

Dopamine dysregulation syndrome?

A

Compulsive pattern of dopaminergic drug misuse due to prolonged use of dopaminergic medication

e.g. Gambling or Sexual behaviour

130
Q

Early sign of Parkinson’s?

A

Mood changes
Ansomia
Acting out dreams during their sleep
Visual/ Auditory hallucinations

131
Q

Chorea?

A

Continuous quick movements of hands and feet during voluntary movements but stop when sleeping

132
Q

Sydenham’s Chorea?

A

Chorea in childhood following rheumatic fever

Antigens of strep bacteria similar proteins found on membranes of neurones of basal ganglia

Transient rapid irregular movements of limbs, trunk + face

133
Q

Athetosis?

A

Slow, Writhing, Fixed movements of distal limbs due to degeneration of globus pallidus

134
Q

Huntington’s disease?

A

AD Chromosome 4 mutation of huntingtin protein

Chorea of limbs, face, dysphasia then dementia

135
Q

Hemiballismus?

A

Violent swinging of 1 side of the body due to infarction or haemorrhage in the contralateral subthalamic nucleus

136
Q

Myoclonus?

A

Involuntary jerk of single muscle or group of muscle when falling asleep

137
Q

Management of dystonia?

A

Anticholinergics - Botox, Procyclidine, Benzotropine

138
Q

Cerebral palsy?

A

Motor disorder arising from damage to the brainstem during fetal life = Non-progressive loss of muscle control

139
Q

Spastic cerebral palsy?

A

UMN lesion
Tight stiff movements
Hypertonia
Scissor gait or Toe walk gait

140
Q

Spastic diplegia?

A

Atonic then spastic lower limbs

Starts <1 years old then usually resolves by 5

141
Q

Types of cerebral palsy?

A

Spastic (UMN)
Ataxic (Cerebellum)
Dyskinetic (Basal ganglia)

142
Q

Sciatica?

A

Pain, Tingling, Numbness which arises from an impingement of lumbosacral nerve root as they emerge from the spinal canal and are felt in a specific dermatome

143
Q

Causes of lumbosacral impingement?

A

Herniated interverterbral disc
Spondylolisthesis
Spinal stenosis
Infection or met cancer

144
Q

Signs of sciatica?

A 
Unilateral leg pain radiating to the knee, foot or toes 
Lower back pain 
Dermatomal altered sensation 
\+ve straight leg test 
Babinski +ve
145
Q

STarT Back?

A

Risk stratification tool used to identify modifiable risk factors for back pain disability

146
Q

Common cause of myelopathy?

A 
Disc osteophytes cord compression
Congenital stenosis 
Trauma 
Disc Herniation 
Degenerative disease
147
Q

Examples of lateralising signs?

A

Gaze paresis
Inattention
Agitated at one side

148
Q

Myelopathy?

A

Injury/ Severe compression of the spinal cord
UMN signs
Loss of fine finger movements, legs don’t feel like their own, can’t feel the ground underneith, legs don’t d what I tell them

They leave the way they come in

149
Q

Presenting neuro findings?

A
  • Mr X, XX year old man, Who refereed them
  • They described: (go through pain tool)
  • Of note in background history (PMH, Dx, Allergies, Sx, Fx)
  • Clinically, general appearance, vital signs (full details), positive findings on examination. Of note, Negative finding include absence of
  • In summary, this is Mr X, XX year old man, with symptoms of XX and signs XX, suggestive of XX syndrome
150
Q

Squint?

A

Misalignment of the visual axis. Eyes are not directed at the same object at the same time

151
Q

Difference between a Manifest squint and Latent squint?

A

Manifest (Tropia) - When 1 eye us fixed on the object then the other eye is deviated

Latent (Phoria) - Squint occurs when the use of both eyes is interrupted - fusional control present

152
Q

Rfx of squint?

A

Low birth weight
Maternal smoking
Hypermetropia (long sighted)
Family history

153
Q

Penalization therapy?

A

Vision in the normal eye is deliberately blurred to force the child to use their amblyopic eye or use atropine drops

154
Q

Horner’s syndrome?

A

Oculosympathetic paresis. Ipsilateral damage of the sympathetic trunk

155
Q

Causes of Horner’s syndrome?

A

Pancoast tumour
Traumatic brain injury
Spinal cord lesions

156
Q

Signs of horner’s syndrome?

A 
Miosis 
Partial ptosis 
Anhidrosis 
Enophthalmus 
Flushing
157
Q

Diagnosis of Horner’s syndrome?

A

Apraclonidine - cocaine eyedrops/ alpha agonists used to reduce occular pressure and dilate pupils

Paredrine - Causes more norepinephrine to be released to induce pupil dilation

158
Q

Bell’s palsy?

A

Temporary inability to control facial muscles on one side of the face within 72 hours

159
Q

Cause of Bell’s Palsy?

A

Pressure on the facial nerve as it travels within the auditory canal

160
Q

Scoring system used to assess the severity of damage to the facial nerve?

A

House-Brackman Score

161
Q

Meningitis?

A

Inflammation of the leptomeninges of the brain and spinal cord

162
Q

Aetiology of meningitis?

A

Autoimmune
Intrathecal medications
Drug induced from using antibiotics
Infectious

163
Q

Bacterial causes of meningitis?

A

Neisseria Meningitdis
Strep Pneumonia
Haemophilus Influenzae
TB

164
Q

Signs of Meningitis?

A 
Headache
Neck stiffness
Photophobia 
\+ve Kernig + Brudzinski sign 
Phonophobia 
Seizure 
Systemic features
165
Q

Complications of meningitis?

A 
Meningococcal septicaemia 
Cerebral infarction 
Hearing loss 
Seizures 
Cognitive impairment 
Communicating hydrocephalus
166
Q

Prophylaxis of meningitis?

A

Rifampicin + Ciprofloxacin

167
Q

Management of meningitis?

A

Benzylpenicillin, Cefortaxime or Chloramphenicol

168
Q

Encephalitis?

A

Inflammation of the brain parenchyma which causes abnormal mental states + motor/sensory defects

169
Q

Signs of encephalitis?

A 
Flu-like symptoms 
Fever, Headache, drowsiness
Hemiparesis
Dysarthria 
Seizures + Coma
170
Q

Investigations of encephalitis?

A

CT or MRI - cerebral oedema
CSF - increased lymphocytes
Viral serology of CSF or blood

171
Q

Abscesses Summary?

A

Pussified swelling of the brain

Cerebral (Contrast-Enhanced CT) or Spinal Epidural (MRI)

Antibiotics + Surgical Decompression

172
Q

Transmissible Spongiform Encephalopathy?

A

Prions - Proteins that trigger normal brain proteins to fold abnormally

As proteins build up it causes the brain shrink and form holes

Progressive dementia + Spongiform changes to the brain

173
Q

Myasthenia gravis?

A

autoimmune disorder of the NMJ characterised by weakness + fatiguability of occular, bulbar and proximal limb weakness

174
Q

Pathophysiology of myasthenia gravis?

A

Autoantibodies against acetylcholinesterase receptors of the post-synaptic membrane of the NMJ

70% associated with thymic tumour

175
Q

What other autoimmune conditions are associated with myasthenia gravis?

A

RA
Pernicious anaemia
Autoimmune thyroid disease

176
Q

Ddx of myasthenia gravis?

A

Graves disease
Cranial nerve lesions
MND
Lambert Eaton Myasthenic Syndrome

177
Q

What is Lambert Eaton myasthenic syndrome?

A

Variation of myasthenia gravis but affects the Pre-synaptic membrane of the NMJ

178
Q

Investigations used to confirm myasthenia gravis?

A

Nerve conduction studies - Repetitive stimulation of a nerve will show decreased muscle action potential

Bloods - autoantibodies

CT/ MRI - thymic tumour
Tensilon test

179
Q

Management of myasthenia gravis?

A

Acetylcholinesterase inhibitor e.g. Pyridostigmine or Rivastigmine

Azathioprine

Thymectomy

180
Q

2 types of autoantibodies seen in patients with myasthenia gravis?

A

Anti-acetylcholine receptor antibodies

Anti-musk (muscle specific tyrosine kinase) antibodies

181
Q

Signs of myasthenia gravis?

A

Fatiguability of occular muscles
Bulbar symptoms
Eventual resp difficulties
Unable to hold arms straight

182
Q

Myasthenic Crisis? SLUDGE

A 
Salivation 
Lacrimation 
Urination 
Defecation 
GI distress
Emesis
183
Q

What is the Tensilon test?

A

Inject acetylcholinesterase inhibitor Edrophonium to increase concentration of AcH in the NMJ to temporarily improve symptoms

184
Q

Management of myasthenic crisis?

A

Plasmapheresis

IV immunoglobulins

185
Q

Muscular dystrophy?

A

X-lined recessive group of diseases that causes progressive weakness and wasting of muscles

Defect in dystrophin protein

Thigh - Pelvis - Arms

186
Q

Myotonia?

A

Delayed muscle relaxation after contraction

187
Q

Dystrophia myotonica?

A

AD progressive distal weakness with myotonia, ptosis, facial muscle weakness and wasting

188
Q

Signs of dystrophia myotonica?

A 
Facial muscle weakness 
Ptosis 
Baldness
Cataracts
Hypogonadism 
Cardiomyopathy 
Mild mental handicap 
Glucose intolerance
189
Q

Management of Dystrophia myotonica?

A

Phenytoin or Procainamide

190
Q

Multiple sclerosis?

A

Autoimmune demyelinating disease of the CNS

191
Q

Pathophysiology of MS?

A

Mylin - oligoendrocytes + BBB
T-cells with special ligands attach to the BBB and enter then attach to myelin then release cytokines which cause blood vessel dilation and allow macrophages and B cells to enter
Macrophage engulfs Oligodendrocytes and B-cells make antibodies against myelin
Inflammation = Demyelination = Exposed axon = Plaque formation (scar tissue)

Regulatory cells come late to the party to tell everyone to chill out

192
Q

Types of MS?

A

Relapsing Remittant
Secondary Progressive
Primary Progressive
Progressive Relapsing

193
Q

Aetiology of MS?

A 
Genetics - Female or HLA DR2 
EBV infection (antigens similar to myelin)
194
Q

What may a patient with suspected MS present with a history of?

A

Optic neuritis
Transverse Myelitis
Cerebellar related symptoms
Brainstem syndromes

195
Q

Signs of MS?

A

History of flare up of neurological symptoms e.g.:

  • Diplopia
  • Vision loss
  • Ascending sensory disturbance/ Weakness
  • Coordination problems
  • Lhermitte’s sign
  • Uhthoff Phenomena

20 to 50 years old

196
Q

Investigations of MS?

A 
Full bloods - rule out any other causes 
McDonald Criteria 
MRI - White plaques 
CSF - antibodies 
Nerve conduction studies 
MOG +ve
197
Q

MOG+ve?

A

Myelin Oligodendrocyte glycoprotein (adhesion molcule) found in myelin sheath of nerve cells

Antibodies can be made against it

198
Q

Acute Management of MS?

A

Acute Relapse - Methylprednisolone or Cyclophosphamide

199
Q

MS fatigue?

A

Amantadine

200
Q

MS spasticity?

A

Baclofen

201
Q

MS Oscillopsia?

A

Sensation of environment moving even when stationary

Gabapentin or Memantine

202
Q

MS disease progression management?

A

SC Beta interferon - Decrease inflammatory cytokines and increase T regulatory

Glatiramer Acetate - Take me instead T-cell

Fingolimod - Locks lymphocytes in lymph node purgatory

203
Q

Second-line MS disease progression management?

A

Natalizumab + Mitoxantrone

Risk of multifocal leukoencephalopathy + cardiac toxicity

204
Q

Seizure?

A

Prolonged deplorisation of groups of adjacent neurones + decreased inhibitory neurotransmitters

Epilepsy - tendency of recurrent seizures

205
Q

Difference between simple partial and complex partial?

A

Simple partial doesn’t affect consciousness or memory

206
Q

Types of generalised seizures?

A

Grand Mal (GTC) - tense, tongue bite, incontinence

Petite Mal (Absence)

Myoclonic Akinetic

Tonic - isolated movements

207
Q

Ddx of epilepsy?

A 
Vasovagal syncope 
Psychogenic non-epileptic seizure 
TIA
Panic attacks with hyperventilation 
Migraine
208
Q

Management of acute epilepsy?

A

Protect from injury
+ Check airway + Recovery position

Buccal Midazolam
Rectal Diazepam
IV Lorazepam

209
Q

Long term 1st line Management of Partial seizures?

A

Lamotrigene or Carbamazepine

210
Q

Long term 2nd line management of Partial seizures?

A

Levetiracetam

211
Q

Long term 1st line management of grand mal seizures?

A

Sodium Valproate

Lamotrigene

212
Q

Why may carbamazepine not be used in newly diagnosed GTC seizures?

A

May exacerbate myoclonic and absence seizures?

213
Q

Long term 1st line management of absence seizures?

A

Ethosuximide or Sodium Valproate

214
Q

Narcolepsy?

A

Inability to regulate sleep-wake cycles

215
Q

Pathophysiology of Narcolepsy?

A

Hypothalamic Neurones release Orexin/ Hypocretin A + B to regulate sleep-wake cycles
Autoimmune damage of Orexin during adolescence

216
Q

Clinical features of Narcolepsy?

A

Daytime sleepiness (despite sleeping normal night hours, symptoms improve with naps, vivid dreams, sleep cycle lasts mins before REM)

Cataplexy (Episodes of muscle weakness triggered by emotions, face or whole-body)

Hallucinations (Hypnogogic or Hypnopompic)

Sleep Paralysis

Fragmented Sleep

217
Q

Diagnosis of Narcolepsy?

A

Polysomnography (EEG, ECG, EOG, EMS)

Multiple sleep latency test

218
Q

Management of Narcolepsy?

A

Good sleep hygiene
Stimulant - Methylphenidate, Dexamphetamine
Sodium Oxybate - Helpful for cataplexy 2 to 3 hours before a meal
Antidepressant

219
Q

Neurofibromatosis?

A

AD mutation of the NF1 gene on chromosome 17 or NF2 gene on chromosome 22

Benign nerve sheath tumour of the PNS

220
Q

NF1?

A

Small cutaneous or large plexiform neurofibromas on the skin
Freckles in the axilla or inguinal region
Lisch nodules of the eye
Optic pathway ganglion
Cafe au Lait spots

Other: disfigurements, LD, hypertension, Epilepsy, Probems with bones e.g. hypermobility, fracture, curved spine, changes to shape of chest wall

221
Q

Maccune Albright Syndrome?

A

Cafe Au Lait Spots + Endocrine Dysfunction

222
Q

NF2?

A

Bilateral Acoustic Neuroma - Schwannoma
Bilateral Cataracts
Meningioma - Benign (Brain + spinal cord) or psammomatous meaning heavily calcified lesions (spine)
Ependymoma - Ependymal cells from the lining of the ventricles (4th usually) - present with large lateral and 3rd ventricles + Raised ICP

223
Q

GCS eyes?

A

Spontaneous
Speech
Pain
Nothing

224
Q

GCS Verbal?

A 
Orientated 
Confused 
Inappropriate words
Incomprehensible 
Nothing
225
Q

GCS motor?

A 
Obeys command
Moved to localised pain 
Flexion withdrawal 
Decorticate 
Decerebrate (abnormal extension)
No Response
226
Q

Radiculopathy?

A

Sharp shooting radiating limb pain in the pattern of a dermatome
e.g. Spinal Claudication - Bilateral radiating leg pain or paraesthesia that comes with walking and made better by rest or leaning forward

227
Q

Vertebral pain syndrome?

A

Wear and Tear degenerative disease
Localised aching pain with limited radiation, stiff muscles and worse with activity
No neurological signs
Visible or palpable paravertebral muscle spasms, tenderness or restricted movements

228
Q

Anterior cord syndrome?

A

Syndrome that affects the anterior 2/3 of the spinal cord resulting in motor paralysis below the level of the lesion (corticospinal tracts)
loss of pain + temp (Bilateral spinothalamic)
Back pain + autonomic dysfunction

229
Q

Causes of anterior cord syndrome?

A

Ischaemia of the anterior spinal artery (anterior and lateral horns)
Iatrogenic - Thoracic or Thoracoabdominal aortic aneurysm
Hypotension
Increased Spinal canal pressure

230
Q

Signs of anterior cord syndrome?

A

Bilateral weakness and loss of pain + temp below the level of the lesion
+/- autonomic dysfunction
+/- back pain

231
Q

Investigation of anterior cord syndrome?

A

MRI - T2 hyperintensities on sagittal view showing vertical pencil-like lesion
LP, Bloods, CSF testing

232
Q

Management of anterior cord syndrome?

A

IV fluids + Lumber drain to maintain pressure within the spinal cord (post aortic surgery)

233
Q

Ddx of anterior cord syndrome?

A 
Cauda equina syndrome 
Transverse myelitis 
Disc Herniation
MS
Brown Sequard
234
Q

Brown Sequard?

A

Contralateral Pain + Temp

Ipsilateral Weakness

Phase 3a (8 decks)

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