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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
Treatment of a subarachnoid haemorrage
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
Contraindications of alteplase?
``` 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
How will someone with UMN weakness signs present?
Increased tone Reduced power Brisk reflexes Babinski response- plantar goes up
28
How will someone with LMN weakness signs present?
``` Muscle wasting Fasciculations Reduced power Reduced tone Reduced reflexes ```
29
What is Multiple Sclerosis?
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
MS symtoms are descibed as being disseminated in time and space, what does this mean?
Lesions change location throughout the CNS over time meaning the corresponding symptoms change
31
How does MS most often present?
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
What are the four disease patterns of MS?
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
What investigations can support a MS diagnosis?
MRI- can show lesions | Lumbar puncture- shows oligoclonal bands in CSF
34
Management of MS?
Disease modifying drugs Treating relapses- methylprednisolone 500mg daily (1g IV if this fails) Treating symptoms- pain killers, SSRIs, physio
35
Presentation of MND?
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
Management of MND?
Riluzole- prolongs life by few months in ALS | Management of symptoms and end of life care
37
Triad of Parkinsons?
Resting tremor Rigidity Bradykinesia- slow movement
38
Which area of the brain is affected in Parkinsons?
Substantia niagra of basal ganglia- produces dopamine
39
Differences between Parkinsons and Benign essential tremor
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
Treatment for Parkinsons
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
What medications can be used to treat Benign Essential Tremor?
Propanolol- non-selective beta blocker | Primidone- barbiturate (CNS depressant) anti-epileptic
42
Differential diagnosis of a tremor?
``` Benign essential tremor Parkinsons MS Huntingtons chorea Hyperthyroidism Fever Medications e.g. antipsychotics ```
43
Management of tonic clonic seizures
1st- sodium valporate | 2nd- carbamezapine or lamotragine
44
Management of a focal seizure
Opposite of tonic clonic 1st- carbamezapine or lamotragine 2nd- sodium valporate or levetiracetam
45
What is the first line tx for epilepsy? What are they key side effects?
``` Sodium valporate Side effects: - Teratogenic - Liver damage and hepatitis - Hair loss Tremor ```

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