Neuro Flashcards
Name the ascending spinal tracts?
What’s their overall function?
DCML Spinothalamic (anterior and lateral) Spinocerebellar (ant and post) Spino-olivary Cuneocerebellar (only higher up) Rostral spinocerebellar (only higher up)
SENSORY
Name the descending spinal tracts?
What’s their overall function?
Corticospinal (anterior and lateral) Reticulospinal Rubrospinal Tectospinal Vestibulospinal
MOTOR
Function of lateral STT?
Pain & temp
Function of anterior STT?
Crude touch pressure
Function of DCML ?
Fine touch, vibration & proprioception
Fasiculus cuneatus = upper limb (above T6)
Fasciculus gracilis = Lower limb (below T6)
IPSILATERAL - crosses at medulla
Function of spin-cerebellar and spine-olivary tracts
Unconscios proprioception - lower limbs
Is STT ipsilateral or contralateral?
Contralateral - fibres cross at vertebral level
Name the pyramidal tracts?
What are their function?
Are they ipsilateral or contralateral?
Anterior and lateral CST
Voluntary movement
Anterior = ipsilateral - fibres do not cross until the level they innervate
Lateral = contralateral - Desiccateed e.g instruction from right side of brain travels on left side of spinal cord
Function of rubrospinal tract?
Fine motor control
Function of medial and lateral reticulospinal tracts?
Medial = Contraction and increased tone Lateral = Inhibits contraction & decreases tone
Cerebellar signs?
DANISH
Disdiadochkinesis/dismetria (past pointing) Ataxia Nystagmus Intention tremor Speech - slurerred, inappropriate, slow Hypotonia
Side effects of Na Valproate?
TERATOGENIC
liver damage
hair loss
tremor
1st line treatment of focal seizures?
Side effects?
Carbamazepine
Agranulocytosis
Aplastic anaemia
Induces the P450 system so there are many drug interactions
Side effects of phenytoin?
Folate and vitamin D deficiency Megaloblastic anaemia (folate deficiency) Osteomalacia (vitamin D deficiency)
Important potential side effect of lamotrigine?
Steven Johnson syndrome
Definition of status epilepticus
Seizure duration >5 mins
OR
>3 seizures in an hour
Management of status epilepticus
ABCDE
- give O2
- Get IV access - give IV lorazepam 4mg and repeat after 10 mins if seizure ongoing
- IV phenobarbital or phenytoin if seizures continue
Buccal midazolam or rectal diazepam may also be used
When must you inform the DVLA that you have seizures?
Immediately after 1st seizure - stop driving
can recommence after 6 months if no further seizures
When are you at most risk of seizing after moderate - heavy alcohol consumption?
6-48 hours after stopping drinking
What’s a good website for patients or parents of patients with epilepsy?
epilepsy.org.uk
When might you be able to stop taking your epilepsy medications?
Seizure free for 2 years
What investigations may you perform for epilepsy?
MUST DO AN ECG Neurological examination EEG MRI - look for any causes FBC, U&E, LFTs - assess general health
Dose of folic acid for pregnancy in women with epilepsy?
5000 micrograms vs 400 in normal population
anti-epileptics safe in pregnancy?
Lamotrigine and levetiracetam
Long term use of anti-epileptics increase the risk of…
Osteoporosis
What contraceptives should be avoided in enzyme inducing anti-epileptics such as carbamazepine and phenytoin?
COCP and POP - reduced effectiveness
Emergency contraceptive in epilepsy?
Copper IUD
Contraceptive advise when taking lamotrigine?
Non enzyme inducing but oestrogen can reduce the effectiveness of lamotrigine – Progesterone only contraceptive
Myelin cells in CNS?
Oligodendrocytes
Which type of hypersensitivity is MS?
Type IV (cell mediated)
Electrical shock sensation on flexion of neck?
Lermits sign
- problem in sensory pathway of cervical spinal cord - DCML
how long do symptoms have to be progressing for to be diagnosed as primary progressive MS?
1 year
Features of optic neuritis?
Central scotoma
RAPD
Painful eye movements
Impaired colour vision
What will an LP show in MS?
Oligoclonal bands
Treatment of acute relapse of MS
Methylprednisolone 500mg daily for 5 days
or 1g IV if severe/oral doesn’t work
Which spinal tract is most affected by syringomyelia?
STT
- arises from centre of cord so affects fibres when they deccusate
- cape like numbness
Trigeminal autonomic cephalgia management acute vs prophylaxis?
Acute = oxygen therapy Prophylaxis = verapamil
forehead affected =
LMN
plucking at clothes/smacking lips suggests what kind of seizure?
Focal , affecting temporal lobe
Management of paroxysmal hemicranial?
absolute response to indomethacin
spasticity in MS?
Baclofen & gabapentin
Functions of the frontal lobe?
Voluntary movement
Expressive language
higher functioning
Occipital lobe function?
Vision & memory
Temporal lobe function?
understanding and processing language
Parietal lobe function?
Sensory perception - taste, smell, hearing, sight
cognition
writing
speech
Swollen neurons/Picks bodies?
Frontotemporal dementia
CSF shows raised tau but normal amyloid?
Frontotemporal
Intracellular fibrillary tangles
Alzheimers
What must you include when stating that someone has agoraphobia?
Whether it is with or without panic disorder
What are the core symptoms of depression? (3)
Low mood
Anhedonia
Fatigue
Name the atypical antipsychotics
Olanzapine Clozapine Quetiapine Risperidone Aripiprazole
Name the atypical antipsychotics
Olanzapine Clozapine Quetiapine Risperidone Aripiprazole
Name the typical antipsychotics
High potency
- Haloperidol
- Prochlorperazine
Low potency
- Chlorpromazine
IQ < ? is a learning disability?
<70
Average = 100
Mild
Moderate
Severe
Profound LD ranges
mild = 50-69
moderate = 35-49
severe = 20 - 34
profound <20
Indications for ECT?
Severe resistant depression
Intractable (prolonged) mania
4th line in resistant schizophrenia
Catatonia
Absolute contraindications to ECT
MI <3 months
Recent CVA
Intracranial mass
Pheochromocytoma
Section 47 form
Lack of capacity in x for x duration
What is section 136
Someone found in a public place who appears to have a mental disorder can be taken by the police to a Place of Safety.
Can only be used for up to 24 hours, whilst a Mental Health Act assessment is arranged
What is section 17a
Supervised Community Treatment (Community Treatment Order)
- can be used to recall a patient to hospital for treatment if they do not comply with conditions of the order in the community, such as complying with medication
symptoms of neuroleptic malignant syndrome
Fever
rigidity
autonomic dysfunction
Treatment of acute dystonia?
Procyclidine
Management of MS flare?
Mild - symptomatic therapy
Moderate - methyl prednisolone 500mg for 5 days
Severe - admit for IV steroids
Which antiemetics need to be avoided in Parkinson’s?
Metoclopramide and prochlorperazine
Low dose domperidone may be used instead
Antidepressants in parkinson’s?
SSRI are effective but can worsen motor and REM sleep disorders
TCAs can also be used but beware cognitive impairment & risk of falls
Symmetrical pill rolling tremor?
Drug induced Parkinsonism
What is split hand syndrome associated with?
Amyotrophic lateral sclerosis (AML)
Most common and 2nd most common MND?
1 = Amyotrophic lateral sclerosis 2 = Progressive bulbar palsy
Treatment for muscle cramps?
Baclofen
Quinine
Treatment of muscle spasms?
Baclofen
Tizanidine/dantrolene
is emotional lability an UMN or LMN sign?
UMN
Which dementia is common in MND?
Frontotemporal
Differentials of UMN problem?
Spastic CP
Acquired brain injury
Tumour
Imaging in demyelination?
MRI contrast
Post exposure prophylaxis for meningitis?
One dose of ciprofloxacin
Seizure where clonic movements move proximally
Frontal lobe
Na Valproate is associated with weight gain.
True or false?
True
visual defect with craniopharyngioma?
inferior quadrantanopia
