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My Phase 3a > Neuro > Flashcards

Neuro Flashcards

1
Q

What type of ascending tract allow for the sensations pain, temperature and crude touch?

A

Spinothalamic

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2
Q

What are the two spinothalamic tracts and is their function?

A

Lateral spinothalamic- sensory pain and temperature

Anterior spinothalamic- sensory crude touch (non localised)

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3
Q

Define a ‘stroke’

A

An acute neurological deficit lasting longer than 24 hours and caused by cerebrovascular aetiology

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4
Q

What are the types of stroke and what percentage of strokes do they account for?

A

Ischaemic stroke- ~87% strokes

Haemorragic- 13% (3% being sub arrach)

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5
Q

Name some risk factors for ischaemic strokes

A

Older age, Hx of TIA, Hx of stroke, Family hx, hypertension, smoking, DMT2, AF

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6
Q

Define a TIA

A

Transient Ischeamic Attack- transient neurological dysfunction of the brain or spinal cord secondary to ischemia without infarction

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7
Q

What areas of the brain does the ACA supply? And how could a stroke present if the ACA was blocked?

A

Frontal lobe

Contralateral weakness- more so in legs than arms
Abulia/hypobulia- absence of lack of willpower/decision making
Executive dysfunction/ disinhibition
Akinetic mutinism- can’t speak or move, only of caudate head involved
Urinary incontinence

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8
Q

Which areas of the brain can be affected by a MCA stroke?

A

Areas of the frontal, temporal and parietal lobe aswell as the basal ganlia (via the lenticulostriate arteries).
*2/3rds of ischaemic strokes occur in the MCA

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9
Q

Name some signs of a MCA stroke?

A

Contralateral hemiparesis involving face, arms and legs
Contralateral sensory loss
Constralateral Homonomous hemianopsia
Dysarthria- can’t speak

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10
Q

What areas of the brain can be affected by a PCA stroke?

And what are the presentations of a stroke in these areas?

A

Occipital lobe- contralateral homonymous hemianopia, cortical blindness in bilateral regions

Temporal lobe (medially)- memory loss, changes in behaviour

Thalamus- contralateral sensory loss, aphasis (if dominant side affected), executive dysfunction, memory loss, reduced consciousness

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11
Q

What diagnositic recognition tool is often used in A&E to rapidly help recognising a stroke?

A

ROSIER- Recognition of Stroke in the Emergency Room

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12
Q

Initial management of a suspected stroke?

A

Refer to stroke team
Exclude hypoglycaemia
Immediate CT to exclude haemorragic stroke
Aspirin 300mg stat and continue for 2 weeks

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13
Q

Confirmed inscahemic stroke, give what thrombylytic tx if within 4.5 hours?

A

Alteplase-
a tissue plasminogen activator
Need to be monitored for signs of bleeding

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14
Q

What is the gold standard imaging technique for a stroke?

A

Diffusion weighted MRI

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15
Q

What is used for secondary prevention of a stroke

A

Clopidogrel 75mg daily
Atorvastatin 80mg- not immediately
Carotid endartectomy or stenting if necessary
Treatment of modifiable risk factors

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16
Q

GCS- what are the the three sections and the number of points they hold?

A

Eyes- 4
Verbal response- 5
Motor- 6

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17
Q

What is the breakdown of the GCS eye score?

A

4- spontaneous
3- open to voice
2- open to pain
1- no response

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18
Q

What is the breakdown of the GCS verbal score?

A 
5- responsive/orientated
4- confused
3- inappropriate words
2-incomprehensible sounds
1- no response
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19
Q

What is the breakdown of the GCS motor function score?

A 
6- obeys command
5- localises pain
4- normal flexion to pain
3- abnormal flexion to pain
2- extends to pain 
1- no response
20
Q

Rupturing of bringing veins usually causes which type of cranial bleed?
What does this usually look like on a CT?

A

Subdural haemorrage

Cresent shape

21
Q

Extradual haemorrages are usually caused by rupture to what vessel? What does this bleed usually look like on a CT?
What is a common cause/presentation?

A

Middle meningeal in temporo-parietal region

Bi-convex shape due to being limited by cranial sutures

Younger patient with head recent head trauma, had improvement in neurological state before rapid decline

22
Q

How do subarachnoid usually present?

What are common causal associations?

A

Thunderclap headache
Stiff neck
Nausea and vomiting

Cocaine and sickle cell anaemia

23
Q

Acute managment of intercranial bleed?

A

Immediate CT
Check FBC and clotting
Admit to stroke unit and/or neurosurgeons
Consider intubation/ITU
Correct any clotting abnormality
Treat severe hypertension but avoid hypotension

24
Q

Patient with suspected sub arachnoid hemorrage, CT negative, next investigation? And findings?

A

Lumbar puncture-

  • Red cell count raised- however, if decreasing over samples, could be needle trauma
  • Xanthocromia- yellow CSF due to bilirubin, present due to blood breakdown
25
Q

Treatment of a subarachnoid haemorrage

A

Neurosurgical referal
?surgical intervention if aneurysm- coiling or clipping
Nimodipine (CCB)- to prevent vasospasm
Lumbar puncture or shunt to treat hydrocephalus
Antiepilectics to treat seizures

26
Q

Contraindications of alteplase?

A 
Hx or evidence of a bleed e.g. subarac
BP > 185/110
Low platelet count 
Prolonged QT interval >15
Known arteriovenous malformation
Seizures with prolonged neuro deficit
Active internal bleeding
27
Q

How will someone with UMN weakness signs present?

A

Increased tone
Reduced power
Brisk reflexes
Babinski response- plantar goes up

28
Q

How will someone with LMN weakness signs present?

A 
Muscle wasting
Fasciculations
Reduced power
Reduced tone
Reduced reflexes
29
Q

What is Multiple Sclerosis?

A

A chronic progressive neurological condition involving demyelination of neurones in the CNS. It is an inflammatory process caused by immune cells attacking oligiodentrocytes causing this loss

30
Q

MS symtoms are descibed as being disseminated in time and space, what does this mean?

A

Lesions change location throughout the CNS over time meaning the corresponding symptoms change

31
Q

How does MS most often present?

A

Symptoms progress over 24 hours

  • Optic neuritis- most common px, loss of vision in one eye
  • Abducens/6th nerve lesions–> Internuclear opthalmoplegia, a conjugate lateral gaze disorder (can’t move both eyes together)
  • Focal weakness- e.g. bells palsy, horners syndrome, limb paralysis, incontinence
  • Focal sensory problems- trigeminal neuralgia, numbness, parasthesia (pins&needles), Lhermitte’s sign (electric shock down spine when bending neck)
  • Ataxia- sensory or cerebellar
32
Q

What are the four disease patterns of MS?

A

Clinically isolated syndrome- first or one episode, can’t diagnose from this
Relapsing remitting- most common, sub classes: active/not active, worsening/not worsening
Primary progressive- continuily worsening from first symptoms
Secondary progressive- continually worsening after initial relapsing remitting pattern

33
Q

What investigations can support a MS diagnosis?

A

MRI- can show lesions

Lumbar puncture- shows oligoclonal bands in CSF

34
Q

Management of MS?

A

Disease modifying drugs
Treating relapses- methylprednisolone 500mg daily (1g IV if this fails)
Treating symptoms- pain killers, SSRIs, physio

35
Q

Presentation of MND?

A

Progessive weakness affecting limbs, trunk, face and speech (dysarthria)
LMN- muscle wasting, reduced reflexes, fasiculations, reduced tone
UMN signs- brink reflexes, increased tone or spasticity, upgoing plantar reflexes

36
Q

Management of MND?

A

Riluzole- prolongs life by few months in ALS

Management of symptoms and end of life care

37
Q

Triad of Parkinsons?

A

Resting tremor
Rigidity
Bradykinesia- slow movement

38
Q

Which area of the brain is affected in Parkinsons?

A

Substantia niagra of basal ganglia- produces dopamine

39
Q

Differences between Parkinsons and Benign essential tremor

A

P- asymetrical BET- symetrical
P- 4-6 hz (pill rolling tremor) BET- 5-8Hz
P- worse at rest BET- better with rest
BET- improves with alcohol

40
Q

Treatment for Parkinsons

A

Levodopa- synthetic dopamine
Carbidopa or benserazide- peripheral decarboylase inhibtor- prevents breakdown of levodopa.
- Co-benyldopa (levodopa and benserazide)
- Co-careldopa (levodopa and carbidopa)

COMT inhibitors
- Entacapone

Dopamine agonists (SE= pulmonary fibrosis)

 - Bromocryptine
 - Pergolide
 - Carbergoline

Monoamine oxidase- B inhibitors- prevent breakdown of neurotransmitters ie dopamine

- Selegiline
- Rasagiline
41
Q

What medications can be used to treat Benign Essential Tremor?

A

Propanolol- non-selective beta blocker

Primidone- barbiturate (CNS depressant) anti-epileptic

42
Q

Differential diagnosis of a tremor?

A 
Benign essential tremor
Parkinsons
MS
Huntingtons chorea
Hyperthyroidism
Fever
Medications e.g. antipsychotics
43
Q

Management of tonic clonic seizures

A

1st- sodium valporate

2nd- carbamezapine or lamotragine

44
Q

Management of a focal seizure

A

Opposite of tonic clonic
1st- carbamezapine or lamotragine
2nd- sodium valporate or levetiracetam

45
Q

What is the first line tx for epilepsy? What are they key side effects?

A 
Sodium valporate
Side effects:
- Teratogenic
- Liver damage and hepatitis
- Hair loss
Tremor

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