Neuro Flashcards
Damage to which parts of the nervous system can cause ptosis?
Midbrain
Cervical sympathetic chain (superior tarsal muscle)
Oculomotor nerve (Levator Palpebrae Superioris muscle)
How can the 3 likely causes of ptosis be differentiated?
Size of pupil
- Horner’s syndrome will cause a small pupil
- III nerve palsy (generally) a large pupil (and associated eye movement abnormalities)
- Neuromuscular disorders (with the exception of botulism) the pupil size will be normal
What would you expect visual fields to show in raised icp?
enlarged blind spots
peripheral constriction of the visual fields
Tx for relapsing remitting MS in between episodes?
Beta interferon
Dimethyl fumarate
Which drugs increase the risk of idiopathic intracranial hypertension? COMAAR
Ciclosporin OCP Mineralocorticoids Amiodarone Abx (tetracyclines, sulphonamides) Retinoic acid
Which drugs may exacerbate myasthenia and should be avoided?
penicillamine quinidine, procainamide beta-blockers lithium phenytoin antibiotics: gentamicin, macrolides, quinolones, tetracyclines
Acute migraine tx?
Triptan + NSAID
or triptan + paracetamol
Migraine prophylaxis?
topiramate or propranolol
Best tx for initial symptomatic relief in MG?
Pyridostigmine (long-acting acetylcholinesterase inhibitor)
What type of headaches are usually completely responsive to indomethacin?
Paroxysmal hemicrania
Symptoms of paroxysmal hemicrania?
Severe, unilateral headaches
Usually in the orbital, supraorbital or temporal region
Attacks come multiple times a day
Normally <30 mins
Autonomic features e.g. tearing/nasal congestion
Features of temporal lobe focal seizure? (HEAD)
Hallucinations (auditory/gustatory/olfactory)
Epigastric rising/Emotional
Automatisms (lip smacking/grabbing/plucking)
Deja vu/Dysphasia (post-ictal)
Features of frontal lobe focal seizure?
Head/leg movements, posturing, post-ictal weakness, Jacksonian march
Features of parietal lobe focal seizure?
Paraesthesia
Features of occipital lobe focal seizure?
Floaters/flashes
Classical hx for an acoustic neuroma?
Absent corneal reflex
Vertigo
Hearing Loss
Tinnitus
How to remember homonymous quadrantanopias?
PITS (Parietal-Inferior, Temporal-Superior)
superior: lesion of the inferior optic radiations in the temporal lobe (Meyer’s loop)
inferior: lesion of the superior optic radiations in the parietal lobe
Where is the lesion in incongruous defects?
optic tract lesion or optic radiation because the fibres are more spread out
Where is the lesion in congruous (complete/symmetrical) defects?
optic radiation lesion or occipital cortex
BPPV positive Hallpike manouvre sign?
Rotary nystagmus
Which sign differentiates between organic and non-organic lower leg weakness?
Hoover’s sign
Causes of a bitemporal hemianopia?
NEOPLASTIC Pituitary macroadenoma Meningioma Craniopharyngioma Chiasmatic glioma
NON-NEOPLASTIC Aneurysm or ectatic carotid artery Epidermoid cyst Sarcoid Dermoid cyst
Where is the lesion in superior quadrantonopia?
Inferior optic radiations in temporal lobe
Where is the lesion in homonymous hemianopia?
incongruous defects: lesion of optic tract
congruous defects: lesion of optic radiation or occipital cortex
macula sparing: lesion of occipital cortex
Suspected pituitary apoplexy, immediate 1st step?
IV hydrocortisone
MND nerve conduction studies?
Normal motor conduction
1st line tx for spasticity in MS?
Baclofen and gabapentin
What electrolyte abnormality is associated with SAH?
Hyponatraemia
NF1 features?
Café-au-lait spots (>= 6, 15 mm in diameter) Axillary/groin freckles Peripheral neurofibromas Iris hamatomas (Lisch nodules) in > 90% Scoliosis Pheochromocytomas
NF2 features?
Bilateral vestibular schwannomas
Multiple intracranial schwannomas
mengiomas and ependymomas
how to tell the difference between drug induced and idiopathic PD?
Asymmetrical symptoms suggests idiopathic Parkinson’s
brain abscess mx?
IV 3rd-generation cephalosporin + metronidazole
Long term prophylaxis of cluster headaches?
Verapamil
common complication of intraventricular haemorrhages
Hydrocephalus