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MRCP > Neuro > Flashcards

Neuro Flashcards

1
Q

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

A

After 14 days

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2
Q

What are the indications for thrombolysis in ischaemic stroke?

A

4.5 hours of onset of symptoms

Haemorrhagic definitively excluded

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3
Q

What are the contraindications for thrombolysis in ischaemic stroke?

A 
Seizure
Intracranial neoplasm
Uncontrolled hypertension
Pregnancy
Stroke in prev 3 months
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4
Q

What are the indications for mechanical thrombectomy?

A

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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5
Q

What is the secondary prevention in ischaemic stroke?

A

300mg aspirin 14 days then 75mg clopidogrel long term

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6
Q

What is secondary prevention in TIA?

A

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

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7
Q

What is the arcuate fasciculus?

A

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

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8
Q

Where is the lesion that causes bitemporal hemianopia?

A

Optic chiasm

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9
Q

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

A

Pituitary - inferior chiasmal compression - upper>lower

Craniopharyngioma - super chiasmal compression - lower>upper

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10
Q

What is the possible cause of transient global amnesia?

A

Transient ischaemia of the thalamus

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11
Q

What are 6 causes of cerebellar syndrome?

A 
Friedreich's ataxia/ataxia telangiectasia
Cerebellar haemangioma
Stroke
Alcohol
MS
Hypothyroidism
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12
Q

What is the mechanism of action of phenytoin?

A

Binds to sodium channels which increases their refractory period

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13
Q

What are the acute side effects of phenytoin?

A

Dizziness, diplopia, slurred speech, ataxia, seizures

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14
Q

What are the chronic side effects of phenytoin?

A 
Gingival hyperplasia
Hirsuitism
Megaloblastic anaemia
Peripheral neuropathy
Osteomalacia
TEN
Lupus
Hepatitis
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15
Q

What is seen on EEG in absence seizures?

A

Bilateral symmetrical 3Hz spike and wave pattern

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16
Q

Which anti-epileptics worsen absence seizures?

A

Carbamazepine
Phenytoin
Gabapentin

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17
Q

What is the triad of normal pressure hydrocephalus?

A

Urinary incontinence
Dementia
Bradyphrenia

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18
Q

What is the cause of normal pressure hydrocephalus?

A

Reduced CSF absorption at the arachnoid villi

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19
Q

What is the pathophysiology of SDH?

A

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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20
Q

What are the features of SDH?

A

Chronic: fluctuating consciousness
Acute: comatose from outset

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21
Q

What is seen on CT in SDH?

A

Crescent shape collection of blood

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22
Q

What is the cause of extradural haematoma

A

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

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23
Q

What are the features of extradural haematoma?

A

Lucid interval

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24
Q

What is seen on CT on extradural haematoma?

A

lemon shaped collection of blood

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25
Q

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

A

Pituitary apoplexy

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26
Q

What are the features of pituitary apoplexy?

A

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

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27
Q

What is the main cause of upbeat nystagmus?

A

Cerebellar vermis lesions

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28
Q

What are 2 causes of downbeat nystagmus?

A

Arnold-Chiari malformation

Foramen magnum

29
Q

Which antibiotics are used in cerebral abscess?

A

IV 3rd gen cephalosporin and metronidazole

30
Q

What are the risk factors for IIH?

A 
Obesity
Female
Pregnancy
COCP
Steroids
Tetracyclines
Vitamin A
31
Q

What is Arnold-Chiari malformation?

A

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

32
Q

What are the features of Arnold-Chiari malformation?

A

Non-communication hydrocephalus
Headache
Syringomelia

33
Q

What causes the symptoms of syringomelia?

A

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

34
Q

What are the features of syringomelia?

A

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

35
Q

What are the features of Gerstmann’s syndrome?

A

Alexia
Acaculi
Finger Agnosia
Right-left disorientation

36
Q

Where is Broca’s area?

A

Inferior frontal gyrus

37
Q

What is seen in parietal lesions?

A

Apraxia
Asterognosis
Inferior homonymous quadrantanopia
Sensory inattention

38
Q

What is seen in occipital lesions?

A

HH with macula sparing
Cortical blindness
Visual agnosia

39
Q

What is seen in temporal lobe lesions?

A

Wernicke’s aphasia
Superior homonymous quadrantanopia
Auditory agnosia
Prosopagnosia

40
Q

What is seen in frontal lobe lesions?

A 
Broca's (expressive aphasia)
Disinhibition
Perserveration
Anosmia
Inability to generate a list
41
Q

What is the pathophysiology of Lambert Eaton myasthenic syndrome?

A

Antibody against pre-synaptic voltage gated calcium channels

Associated with SCLC, breast, ovarian Ca

42
Q

What are the features of Lambert-Eaton myasthenic syndrome?

A 
Repeated muscle contractions lead to increased muscle strength
Proximal muscles
Hyporeflexia
Dry mouth
Impotence
43
Q

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

A

Anti-Yo

44
Q

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

A

Anti-Hu

45
Q

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

A

|Anti-Ri

46
Q

What is Steele-Richardson-Olszewski syndrome?

A

Progressive supranuclear palsy

47
Q

What are the features of progressive supranuclear palsy?

A 
Postural instability and falls
Stiff broad based gait
Impairment of vertical gaze
Parkinsonism with prominent bradykinesia
Cognitive impairment within months
48
Q

What are the features of multiple system atrophy?

A

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

49
Q

What is the pathophysiology of neuroleptic malignant syndrome?

A

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

50
Q

What is the treatment of neuroleptic malignant syndrome?

A

Dantrolene

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

51
Q

What is the treatment of severe serotonin syndrome?

A

Cyproheptadine

Chlorpromazine

52
Q

What are the features of Meniere’s disease?

A

Hearing loss
Vertigo
Tinnitus
Sensation of fullness/pressure

53
Q

Which drugs are ototoxic?

A

Aspirin/NSAIDs
Aminoglycosides
Loop diuretics
Quinine

54
Q

Which tracts does anterior spinal artery syndrome affect?

A

Lateral corticospinal and spinothalamic

55
Q

What are the features of anterior spinal artery syndrome?

A

Bilateral spastic paresis

Bilateral loss of temperature and pain sensation

56
Q

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

A

Broca’s - superior division of left MCA

Wernicke’s - inferior division of left MCA

57
Q

What is the syndrome of anterior cerebral artery stroke?

A

Contralateral hemiparesis and sensory loss

L limbs>U limb

58
Q

What is the syndrome of middle cerebral artery stroke?

A

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

59
Q

Stroke of the arcuate fasciculus results in what?

A

Conduction aphasia

60
Q

What are the features of PCA stroke?

A

Contralateral HH with macular sparing

Visual agnosia

61
Q

What is Weber’s syndrome a stroke of?

A

Medial portion of midbrain supplied by PCA branch

62
Q

What is Benedikt syndrome a stroke of?

A

Tegmentum of midbrain and cerebellum supplied by PCA branch

63
Q

What are the features of Weber’s syndrome?

A

Contralateral hemiparesis and 3rd nerve palsy

64
Q

Stroke of posterior inferior cerebellar artery results in which syndrome?

A

Lateral medullary syndrome (Wallenberg syndrome)

65
Q

What are the features of lateral medullary syndrome?

A

Ipsilateral dysphagia, facial numbness, CN palsy

Contralateral sensory loss

66
Q

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

A

Ipsilateral facial paralysis and deafness

Cerebellar signs

67
Q

Quadraplegia can result from a stroke of which artery?

A

Basilar artery

68
Q

What is Millard-Gubler syndrome?

A

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

69
Q

What are the features of lacunar strokes?

A

Isolated hemiparesis, hemisensory loss, or hemiparesis with limb ataxia

MRCP (17 decks)

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