Neuro Flashcards by Lucy Searle

In ischaemic stroke and new AF, when is anticoagulation started?

After 14 days

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What are the indications for thrombolysis in ischaemic stroke?

4.5 hours of onset of symptoms

Haemorrhagic definitively excluded

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What are the contraindications for thrombolysis in ischaemic stroke?

Seizure
Intracranial neoplasm
Uncontrolled hypertension
Pregnancy
Stroke in prev 3 months

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What are the indications for mechanical thrombectomy?

Within 6 hours of ischaemic PCA stroke (with IV thrombolysis within 4.5 hours)

Between 6-24h of symptoms (including wake up strokes) of PCA strokes, AND imaging showing limited infarct core volume

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What is the secondary prevention in ischaemic stroke?

300mg aspirin 14 days then 75mg clopidogrel long term

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What is secondary prevention in TIA?

75mg aspirin for 14 days followed by 75mg clopidogrel long term

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What is the arcuate fasciculus?

Bundle of axons that connects Broca’s area and Wernicke’s area

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Where is the lesion that causes bitemporal hemianopia?

Optic chiasm

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What type of bitemporal hemianopia is caused by pituitary tumour/craniopharyngioma?

Pituitary - inferior chiasmal compression - upper>lower

Craniopharyngioma - super chiasmal compression - lower>upper

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What is the possible cause of transient global amnesia?

Transient ischaemia of the thalamus

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What are 6 causes of cerebellar syndrome?

Friedreich's ataxia/ataxia telangiectasia
Cerebellar haemangioma
Stroke
Alcohol
MS
Hypothyroidism

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What is the mechanism of action of phenytoin?

Binds to sodium channels which increases their refractory period

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What are the acute side effects of phenytoin?

Dizziness, diplopia, slurred speech, ataxia, seizures

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What are the chronic side effects of phenytoin?

Gingival hyperplasia
Hirsuitism
Megaloblastic anaemia
Peripheral neuropathy
Osteomalacia
TEN
Lupus
Hepatitis

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What is seen on EEG in absence seizures?

Bilateral symmetrical 3Hz spike and wave pattern

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Which anti-epileptics worsen absence seizures?

Carbamazepine
Phenytoin
Gabapentin

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What is the triad of normal pressure hydrocephalus?

Urinary incontinence
Dementia
Bradyphrenia

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What is the cause of normal pressure hydrocephalus?

Reduced CSF absorption at the arachnoid villi

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What is the pathophysiology of SDH?

If acute - high impact injuries associated with diffuse axonal injuries
Chronic - rupture of cortical bridging veins and bleeding into the outermost meningeal layer

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What are the features of SDH?

Chronic: fluctuating consciousness
Acute: comatose from outset

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What is seen on CT in SDH?

Crescent shape collection of blood

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What is the cause of extradural haematoma

Temporal region blow - skull fracture causes a rupture of middle meningeal artery

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What are the features of extradural haematoma?

Lucid interval

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What is seen on CT on extradural haematoma?

lemon shaped collection of blood

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What is the condition where there is sudden enlargement of a pituitary tumour secondary to haemorrhage of infarction?

Pituitary apoplexy

What are the features of pituitary apoplexy?

Mimics SAH Extra-ocular nerve palsies Hypotension/hyponatraemia secondary to hypoadrenalism

What is the main cause of upbeat nystagmus?

Cerebellar vermis lesions

What are 2 causes of downbeat nystagmus?

Arnold-Chiari malformation | Foramen magnum

Which antibiotics are used in cerebral abscess?

IV 3rd gen cephalosporin and metronidazole

What are the risk factors for IIH?

``` Obesity Female Pregnancy COCP Steroids Tetracyclines Vitamin A ```

What is Arnold-Chiari malformation?

Downward displacement/herniation of the cerebellar tonsils through the foramen magnum

What are the features of Arnold-Chiari malformation?

Non-communication hydrocephalus Headache Syringomelia

What causes the symptoms of syringomelia?

Dilation of a CSF spacee within the spinal cord, causing compression of the spinothalamic tracts decussating in the anterior white commissure

What are the features of syringomelia?

Dissociative loss of sensation of pain, temperature, non-discriminative touch Cape like distribution of sensory loss

What are the features of Gerstmann's syndrome?

Alexia Acaculi Finger Agnosia Right-left disorientation

Where is Broca's area?

Inferior frontal gyrus

What is seen in parietal lesions?

Apraxia Asterognosis Inferior homonymous quadrantanopia Sensory inattention

What is seen in occipital lesions?

HH with macula sparing Cortical blindness Visual agnosia

What is seen in temporal lobe lesions?

Wernicke's aphasia Superior homonymous quadrantanopia Auditory agnosia Prosopagnosia

What is seen in frontal lobe lesions?

``` Broca's (expressive aphasia) Disinhibition Perserveration Anosmia Inability to generate a list ```

What is the pathophysiology of Lambert Eaton myasthenic syndrome?

Antibody against pre-synaptic voltage gated calcium channels Associated with SCLC, breast, ovarian Ca

What are the features of Lambert-Eaton myasthenic syndrome?

``` Repeated muscle contractions lead to increased muscle strength Proximal muscles Hyporeflexia Dry mouth Impotence ```

Which antibody is associated with cerebellar syndrome and ovarian/breast cancer?

Anti-Yo

Which antibody is associated with painful sensory neuropathy, cerebellar syndrome, SCLC/neuroblastoma?

Anti-Hu

Breast Ca/SCLC and ocular opsoclonus-myoclonus is associated with which antibody?

|Anti-Ri

What is Steele-Richardson-Olszewski syndrome?

Progressive supranuclear palsy

What are the features of progressive supranuclear palsy?

``` Postural instability and falls Stiff broad based gait Impairment of vertical gaze Parkinsonism with prominent bradykinesia Cognitive impairment within months ```

What are the features of multiple system atrophy?

Parkinsonism Autonomic disturbance - ED, postural hypotension, atonic bladder Cerebellar signs

What is the pathophysiology of neuroleptic malignant syndrome?

Dopamine blockade by anti-psychotics triggers massive glutamate release and subsequent neurotoxicity and muscle damage

What is the treatment of neuroleptic malignant syndrome?

Dantrolene Decreases excitation-contraction coupling in skeletal muscle by binding to the ryanodine receptor, decreasing calcium release from sarcoplasmic reticulum

What is the treatment of severe serotonin syndrome?

Cyproheptadine | Chlorpromazine

What are the features of Meniere's disease?

Hearing loss Vertigo Tinnitus Sensation of fullness/pressure

Which drugs are ototoxic?

Aspirin/NSAIDs Aminoglycosides Loop diuretics Quinine

Which tracts does anterior spinal artery syndrome affect?

Lateral corticospinal and spinothalamic

What are the features of anterior spinal artery syndrome?

Bilateral spastic paresis | Bilateral loss of temperature and pain sensation

Which arteries supply Broca's and Wernicke's area?

Broca's - superior division of left MCA | Wernicke's - inferior division of left MCA

What is the syndrome of anterior cerebral artery stroke?

Contralateral hemiparesis and sensory loss L limbs>U limb

What is the syndrome of middle cerebral artery stroke?

Contralateral hemiparesis and sensory loss, U limb>L limb Unilateral facial droop Aphasia Contralateral HH

Stroke of the arcuate fasciculus results in what?

Conduction aphasia

What are the features of PCA stroke?

Contralateral HH with macular sparing | Visual agnosia

What is Weber's syndrome a stroke of?

Medial portion of midbrain supplied by PCA branch

What is Benedikt syndrome a stroke of?

Tegmentum of midbrain and cerebellum supplied by PCA branch

What are the features of Weber's syndrome?

Contralateral hemiparesis and 3rd nerve palsy

Stroke of posterior inferior cerebellar artery results in which syndrome?

Lateral medullary syndrome (Wallenberg syndrome)

What are the features of lateral medullary syndrome?

Ipsilateral dysphagia, facial numbness, CN palsy | Contralateral sensory loss

What are the symptoms of lateral pontine syndrome (AICA stroke)?

Ipsilateral facial paralysis and deafness | Cerebellar signs

Quadraplegia can result from a stroke of which artery?

Basilar artery

What is Millard-Gubler syndrome?

Stroke of pons Ipsilateral 6th and 7th nerve palsies Contralateral hemiparesis

What are the features of lacunar strokes?

Isolated hemiparesis, hemisensory loss, or hemiparesis with limb ataxia