Neuro Flashcards
Sensory loss over anterior thigh
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test
L3
Sensory loss over anterior knee
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test
L4
Sensory loss over dorsum of foot
Weakness in foot and big toe dorsiflexion
Reflexes intact
Positive sciatic nerve stretch test
L5
Sensory loss over posterolateral aspect of leg and lateral foot
Weakness of plantarflexion
Reduced ankle reflex
Positive sciatic nerve stretch test
S1
Controlled hypo/hyper-ventilation in raised ICP?
Hyper - lower pCO2 causes cerebral vasoconstriction
When to refer to ENT for bell’s palsy?
If no improvement after 3 weeks - refer urgently
4 Parkinson’s plus syndromes?
MSA
Lewy Body
Progressive supranuclear palsy - impairment of vertical gaze
Corticobasal degeneration - alien limb
For each of these where is the lesion and describe the aphasia:
- Wernicke’s?
- Broca’s?
- Conduction?
- Global?
Wernicke’s (Receptive):
- Comprehension impaired, speech fluent but makes no sense - ‘word salad’
Global:
- Severe receptive and expressive aphasia - can communicate using gestures
Broca’s (Expressive):
- Inferior frontal gyrus (MCA)
- Comprehension normal, speech is non-fluent and halting
Conduction:
- speech fluent, comprehension normal, but repetition is poor - aware of errors they are making
MS management:
- acute relapse?
- for fatigue?
- for spasticity?
- bladder dysfunction?
- oscillopsia (visual field oscillation)?
Relapse: IV methylpred 5 days - shortens relapse but no effect on recovery
Fatigue:
- Rule out anaemia, thyroid, depression
- Amantadine
- Mindfulness, CBT
Spasticity:
- Baclofen
- Gabapentin
- Diazepam, Dantrolene or Tinzadine
Bladder - urgency, frequency, overflow, incontinence etc:
1. bladder USS to assess residual volume
2. If normal residual volume, anticholinergics may help frequency
3. If significant residual volume - intermittent self-catheterisation
(be aware anticholinergics may worsen symptoms)
Oscillopsia:
- Gabapentin
Hoarseness and uvula deviating to left?
Right vagus lesion
uvulAWAY from lesion
Cerebral venous thrombus Ix
MRI venogram
1st line management of absence seizures?
Sodium valproate or ethosuxomide
ACA stroke?
MCA stroke?
PCA stroke?
Basilar stroke?
ACA:
- contralateral hemiparesis/sensory
- lower extremity worse
MCA:
- contralateral hemiparesis/sensory
- upper worse then lower
- contralateral homonymous hemianopia
- Aphasia
PCA:
- contralateral homonymous hemianopia with macular sparing
- visual agnosia
Basilar:
- locked in syndrome
1st line and 2nd line options for generalised tonic clonic seizures?
1st - valproate
2nd line - lamotrigine, carbamazepine
1st line and 2nd line options for focal seizures?
1st line - carbamazepine or lamotrigine
2nd line - levetiracetam, oxcarbazepine, valproate
MND linked with which dementia?
Frontotemporal
Antibodies in MG?
anti-AChR
anti-MuSK
Treatment of LEMS?
3,4-diaminopyradine
SE valproate?
Reversible hair loss Weight gain Tremor Thrombocytopaenia Oedema Liver stuff
SE lamotrigine
Rash
SJS
SE levetiracetam?
Mood swings
SE carbamazepine?
Impaired balance
Blurred/double vision
What anti-epileptics are P450 inducers and inhibitors?
Inducer: carbamazepine and phenytoin
Inhibitor: valproate
CI triptans?
IHD
Commonest brain tumour in kids?
Infratentorial brain tumour in kids?
Pilocytic astrocytoma
Medulloblastoma
Tabes dorsalis?
Neurosyphilis
Loss of DCML only
Anterior cord syndrome?
Bilateral spastic paresis and loss of pain/temperature
DCML normal
Central cord syndrome?
Due to whiplash etc
Corticospinal - upper limbs more than lower
Spinothalamic lost as fibres decussate
Pituitary apoplexy
- what is it?
- presentation?
- Ix?
- management?
Sudden enlargement of a pituitary tumour secondary to haemorrhage/infarction
‘thunderclap’ pain behind eye
Vomiting, neck stiffness
bitemporal hemianopia
MRI
Urgent steroid replacement
Surgery
Loss of finger abduction and thumb adduction?
T1
Head injury:
- criteria for immediate CT? (6)
- criteria for CT within 8 hours? (4)
Immediate:
- GCS <13 initially
- GCS <15 2 hours post-injury
- suspected skull fracture
- post-traumatic seizure
- focal neurological deficit
- > 1 episode of vomiting
8 hours:
- age 65+
- Hx of bleeding/clotting disorders
- dangerous mechanism of injury
- > 30 mins retrograde amnesia before event
Diplopia and difficulty opening mouth after facial injury?
Zygoma fracture
Foot drop, loss of hip abduction, all reflexes intact?
L5
Initial steps in haemorrhage stroke/haemorrhagic transformation?
Stop/reverse any anti platelet/anticoagulant drugs
Maintain BP to a target 140mmHg systolic
