neuro Flashcards
ipsilateral hemiplegia
same said loss of proprioception and vibration
contralateral loss of pain and temp
brown sequard
causes of brown sequard
cord trauma neoplams disc herniation demyelination epidual haemtoma
how does ipsilateral UMN weakness present in an exam of limbs?
tone
power
reflex
increased tone
hyperreflexia
leg lift
what are causes of bulbar palsy?
categorise them
absent jaw jerk
absent gag reflex
fasciculating tongue
infection: GBS,
inflammation: MG, MND
malignancy : neoplasm of brainstem
ischaemic: brainstem stroke
cerebeller syndrome signs?
DANISH
dysdiadochokinesia ataxia nystagmus intention tremor slurred speech hypotonia
what causes cerebeller syndrome?
vitamin C
vascular: stroke; posteriro circulation
infection: lyme disease
inflammation: Multiple sclerosis
trauma
metabolic: alcohol
iotrogenic: carbamazepine
neoplastic: tumour , acoustic neuroma
hereditary: friedrichs
cerebeller syndrome causes simple
infection: Lyme
Inflammation: MS
Malignancy: acoustic neuroma, 2O mets from breast cancer, lung
cag trinucleotide affected - repeats choero dementia dystonia saccadic eye movements
striatal colume loss and increased size of frontal horns of lateral ventricles
what is this?
Mx?
huntingtons
chorea - tetrabenzine
SSRI-
psychosis : olanzapine
diplopia causes
categorises
infection: sixth nerve palsy
inflammation: Graves, MG
malignancy: neoplasm of cranial nerves
which drug commonly causes dystonia?
metocllopramide
mx of encephalitis
what does it present with?
IV acyclovir and broad spectrum abx IV ceftriaxone 2g BD IV
seizures alongside characteristic infection signs ; neck stiffness, fever
altered mental state
management of epilepsy
lamotrigine - not teratogenic
levetiracetam
valproate- teratogenic
carbamazepine and gabapentin: focal , may worsen myoclonic seizures
ethosuximide good for absence
gabapentin
what is it used for?
SE?
focal seizures
anxiety, confusion, constipation
lamotrigine SE
what is it used for?
focal seizures blurred vision: diplopia arthralgia ataxia dizziness headache rash tremor
valproate
SE
anaemia confusion convulsions deafness extrapyramidal disorders
phenytoin
se
acne anorexia constipation dizziness gingival hypertrophy
levetiracetam
headaches
feeling sleepy
blocked nose
itchy throat
what is the most common source of bleeding in a head trauma pt
pt had lucid period followed by deterioting consciousness and a headache
what would you see on a CT?
how do you differentiate between subdural
what constitues an emergency?
management?
this is an extradural bleed
middle meningeal artery
bi convex shape - blood is fresh so appears white as it is least dense
blood is clotted and old so appears darker, also banana shaped
midline shift on ct
burr hole
how can you medically manage subdural bleeds?
transexamic acid
foot drop
causes?
what level lesion?
L5 root lesion: radiculopathy - disc herniation
GBS
treatment
what infection most commonbly associated?
what are you worried about?
monitor ventilation- abg, serial spirometry
VTE- LMWH
medically: IV immunoglobulin, plasmapheresis
campylobacter, mycoplasma and EBV: so GI upset in a question could indicate
respiratory arrest- forced vital capacity
criteria for CT headl
More than 30 minutes retrograde amnesia.
Focal neurological deficit or seizure.
GCS <13 at any time (or <15 2 hours after injury).
More than 1 episodes of vomiting.
Loss of consciousness and any amnesia in patients who:
Are >65 years
Suffered a dangerous mechanism of injury (great height, road traffic accident)
Have evidence of coagulopathy (including anticoagulation with warfarin).
clinical evidence of skull fracture
horners syndrome
causes?
pancoast tumour
stroke
carotid artery dissection - NECK pain
stroke management
4.5 hours of presenting
alteplase - inr normal , acceptable bp
mechanical thrombectomy
aspirin 300mg 2 weeks
carotid ultrasound, CT/MR angiography
inferior homonymous quadrantanopia means?
where is lesion?
loss of vision in the same lower quadrant of visual field in both eyes
parietal lobe
homonymous hemianopia with macula sparing
occipital lobe
causes stroke
brain abscess
trauma
anosmia is a lesion where?
frontal lobe
superior homonymous quadrantanopia?
lesion is in temporal lobe
in a quarter of the same visual field- so above L/R
what is a hemianopsia?
if it is homonymous
loss of half the visual fiedl
1 nasal, 1 temporal
MS- affects which nerve?
optic nerve -
optic neuritis : unilateral eye pain and visual problems
RAPD- marcus gunn
anopia where is lesion?
total visual loss due to optic nerve
ipsilateral nasal hemianopia
lesion is
lateral of optic chiasm
homonymous hemianopia is loss of what?
where is lesion
lesion to optic tract
complete loss of L/R visual field
right optic tract lesion causes complete loss of left visual fiedl
pie in the sky
meyer loop
dorsal optic radiation
parietal lobe lesion
contralateral lower quadranopia
central necrosis and rim that enhances with contrast
mx
glioblastoma- vasogenic oedema
dexamethasone
what are symptoms of meningioma
arachnoid cap cells
will show contrast enhancement) and MRI, and treatment will involve either observation, radiotherapy or sur
acoustic neuroma
associated with what?
facial nerve palsy
tinnitus
hearing loss
neurofibromatosi t2
Von hippel lindau
cerebller hemangiomas
retinal : vitreous haemorrhages
renal cysts
phaeo
what optic sign does wernickes present with/
nystagmus
restleg leg syndrome
mx
dopamine agonist
pramipexole
benzo
gabapentin
widening pulse pressure
bradycardia
irregular breathing
is what?
diagnosis?
mx?
cushing triad for raised ICP
head elevation 30
IV mannitol : osmotic diuretic
controlled hyperventilation
what are two things pathogenomic of epileptic seizures?
tongue biting
raised serum prolactin
(bromocriptine, cabergoline)
what problem do these drugs present in Parkinson patients
ergot derived
dopamine receptor agonist
impulse control
levopopa
side effects?
dopamine precursor
given with decarboxylase inhibitor
palpitation anorexia dry mouth postural hypotension psychosis
dyskinesia at peak dose
acute dystonia if stopped abruptly
MAO-B (Monoamine Oxidase-B) inhibitors
e.g. selegiline
inhibits the breakdown of dopamine secreted by the dopaminergic neurone
Antimuscarinics
block cholinergic receptors
now used more to treat drug-induced parkinsonism rather than idiopathic Parkinson’s disease
help tremor and rigidity
e.g. procyclidine, benzotropine, trihexyphenidyl (benzhexol)
refeeding syndrome
abnormality?
Hypophosphataemia
Hypokalaemia
Hypomagnesaemia
Abnormal fluid balance
NMS
Ix
findings?
Creatine kinase
leukocytosis
pyrexia
muscle rigidity
htn, tachycardia, tachypnoea
delirium
NF1
cafe au lait
iris lisch nodules
phaeo
whihc drugs worsen MG
penicillamine quinidine, procainamide beta-blockers lithium phenytoin antibiotics: gentamicin, macrolides, quinolones, tetracyclines
what is MG associated with?
crisis mx?
perncious anaemia
thymoma
RA
SLE
plasmapheresis
IV IG
erectile dynfunction
parkinsonism
dysdiakinesia
ataxia
?
multiple system atrophy
MRI findings of MS?
periventricular plaques
Dawson fingers: often seen on FLAIR images - hyperintense lesions penpendicular to the corpus callosum
CSF MS
oligoclonal bands
intrathecal IgG
mx of MND
prevents stimulation of glutamate receptors
what subtype?
ALS
riluzole
complications of meningitis
sensorineural hearing loss
seizures
CSF viral meningitis
white cells?
glucose?
normal protein.
very raised
really high >50%
lamotrigine is started and patient has a skin flair up
what could this be?
stevens johnson syndrome
what malignancy is lambert eaton associated with?
small cell lung cancer
ovarian
Mx of Lambert eaton syndrome
prednisalone and aza
IV Immunoglobulin and plasma exchange
idiopathic ICp htn?
drug causes?
COMAAR
surgical intervention?
ciclosporin oral combined pill mineralcorticoids/ steroids amiodarone abx: tetracyclines, sulhponimides
vit a
lithium
optic nerve sheath decompression and feenstration
HSV affects which lobe?
they present with aphasia?
Mx
temporal lobes
petechian haemorhages
aciclovir
what does the 4th nerve do?
what does a 4th nerve palsy look like
depresses eye moves it inwards- adduction
affected eye is deviated upwards and roatated outwards
LMN facial nerve plasy
Bell's palsy Ramsay-Hunt syndrome (due to herpes zoster) acoustic neuroma parotid tumours HIV multiple sclerosis* diabetes mellitus
