neuro Flashcards
treatment of a brain abscess
Brain abscess: IV 3rd-generation cephalosporin (ceftriaxone) + metronidazole
presentation of a brain abscess
Fever, headache and features of raised intracranial pressure (vomiting, blurring of vision)
suspected vestibular shwannoma- diagnosis
audiogram and MRI head scan
presentation of vestibular schwannoma/ acoustic neuroma
The classical history of vestibular schwannoma includes a combination of vertigo, hearing loss, tinnitus and an absent corneal reflex.
what condition can bilateral vestibular schwannoma/ acoustic neuroma commonly occur within?
NF2
What is autonomic dysreflexia?
clinical syndrome occurs in patients who have had a spinal cord injury at, or above T6 spinal level.
presentation of autonomic dysreflexia
extreme hypertension, flushing and sweating above the level of the cord lesion, agitation, and in untreated cases severe consequences of extreme hypertension have been reported, e.g. haemorrhagic stroke.
MS- CSF findings
oligoclonal bands
presentation of dyskinesia
dystonia, chorea, athetosis
examples and noteable side effect of dopamine agonists
bromocrimptine, cabergoline, pergolide
side effect= pulmonary fibrosis
describe a 6th cranial nerve palsy
internuclear ophthalmoplegia and conjugate lateral gaze disorder
so problems moving the eye (muscles) with a lateral gaze
presentation of optic neuritis
Optic neuritis presents with unilateral reduced vision developing over hours to days. Key features are:
Central scotoma. This is an enlarged blind spot.
Pain on eye movement
Impaired colour vision
Relative afferent pupillary defect
management of MS relapses
methylprednisolone
oculomotor palsy presentation
‘down-and-out’ eye position, hence the patient’s difficulty with eye adduction
ptosis and inability to adduct eye
presentation of syringomyelia
a ‘cape-like’ (neck, shoulders and arms)
loss of sensation to temperature but the preservation of light touch, proprioception and vibration
presentation of encephalitis
fever, headache, psych symptoms, seizures, vomit
focal symptoms (aphasia etc)
what cranial nerves does a vestibular schwannoma affect
Cranial nerves V, VII and VIII are affected in vestibular schwannomas
trochlear nerve palsy
Palsy results in defective downward gaze → vertical diplopia
trigeminal nerve palsy
Lesions may cause:
trigeminal neuralgia
loss of corneal reflex (afferent)
loss of facial sensation
paralysis of mastication muscles
deviation of jaw to weak side
abducens nerve palsy
Palsy results in defective abduction → horizontal diplopia
facial nerve palsy
Lesions may result in:
flaccid paralysis of upper + lower face
loss of corneal reflex (efferent)
loss of taste
hyperacusis
vestibulocochlear nerve palsy
Hearing loss
Vertigo, nystagmus
Acoustic neuromas are Schwann cell tumours of the cochlear nerve
glossopharyngeal nerve palsy
Lesions may result in;
hypersensitive carotid sinus reflex
loss of gag reflex (afferent)
vagus nerve palsy
Lesions may result in;
uvula deviates away from site of lesion
loss of gag reflex (efferent)
accessory nerve palsy
Lesions may result in;
weakness turning head to contralateral side
hypoglossal nerve palsy
Tongue deviates towards side of lesion
side effects of levodopa
dry mouth
anorexia
palpitations
postural hypotension
psychosis
epilepsy- localising features of focal seizures- temporal lobe
Hallucinations (auditory/gustatory/olfactory),
Epigastric rising/Emotional,
Automatisms (lip smacking/grabbing/plucking),
Deja vu/Dysphasia post-ictal)
epilepsy- localising features of focal seizures- frontal lobe
Head/leg movements, posturing, post-ictal weakness, Jacksonian march
epilepsy- localising features of focal seizures- parietal lobe
paraesthesia
epilepsy- localising features of focal seizures- occipital lobe
flutters/ flashes
MS- first line management of spasticity
baclofen and gabapentin
normal pressure hydrocephalus presentation
Urinary incontinence + gait abnormality + dementia
wet, wobbly, wacky
encephalitis- CSF findings
lymphocytosis, elevated protein
what is encephalitis commonly associated with?
measles
criteria for a total anterior circulation infarct
involves middle and anterior cerebral arteries
all 3 of
- unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
- homonymous hemianopia
- higher cognitive dysfunction e.g. dysphasia
criteria for a partial anterior circulation infarct
2 of:
1. unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
2. homonymous hemianopia
3. higher cognitive dysfunction e.g. dysphasia
criteria for a Lacunar infarct
involves perforating arteries around the internal capsule, thalamus and basal ganglia
presents with 1 of the following:
1. unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three.
2. pure sensory stroke.
3. ataxic hemiparesis
criteria for a posterior circulation infarct
involves vertebrobasilar arteries
presents with 1 of the following:
1. cerebellar or brainstem syndromes
2. loss of consciousness
3. isolated homonymous hemianopia
criteria for lateral medullary syndrome
ipsilateral: ataxia, nystagmus, dysphagia, facial numbness, cranial nerve palsy e.g. Horner’s
contralateral: limb sensory loss
criteria for Webers syndrome
ipsilateral III palsy
contralateral weakness
what medications should be avoided in myasthenia gravis?
penicillamine
quinidine, procainamide
beta-blockers
lithium
phenytoin
antibiotics: gentamicin, macrolides, quinolones, tetracyclines
myasthenia gravis- investigations
Acetylcholine receptor (ACh-R) antibodies (85% of patients)
Muscle-specific kinase (MuSK) antibodies (10% of patients)
LRP4 (low-density lipoprotein receptor-related protein 4) antibodies (less than 5%)
A CT or MRI of the thymus gland is used to look for a thymoma.
The edrophonium test can be helpful where there is doubt about the diagnosis.
treatment of myasthenia gravis
Reversible acetylcholinesterase inhibitors (usually pyridostigmine or neostigmine)
Immunosuppression (e.g. prednisolone or azathioprine) suppresses the production of antibodies
Thymectomy can improve symptoms even in patients without a thymoma
Monoclonal antibodies- Rituximab, Eculizumab
which anti-emetic is safe to use in Parkinsons and why?
domperidone- does not cross the blood-brain barrier
clinical signs of idiopathic intracranial hypertension
headache
blurred vision
papilloedema (usually present)
enlarged blind spot
sixth nerve palsy may be present (inability to abduct eye)
medication overuse headache- how should analegesia (simple and opioids) be discontinued?
simple analgesia + triptans: stop abruptly
opioid analgesia: withdraw gradually
parkinsons- describe the tremor
unilateral tremor that improves with voluntary movement
diagnosis of an acoustic neuroma
MRI of the cerebellopontine angle
characteristic features of CJD
Creutzfeldt-Jakob disease is characterised by rapid onset dementia and myoclonus
migraine prophylaxis
topiramate/ propanolol
what medication used in the management of epilepsy must you be cautious with if the patient is on warfarin?
sodium valporate
what cranial nerves does a vestibular shwannoma effect?
Cranial nerves V, VII and VIII
what is neurofibromatosis type 2 assosciated with?
Neurofibromatosis type 2 is associated with bilateral vestibular schwannomas
nerve supplying the innervation to the finger extensors (motor)
radial
nerve supplying the interossei muscles (adduction of the fingers)
ulnar
nerve supplying sensation to the lateral shoulder
axillary nerve
what drugs can cause exacerbations of myasthenia gravis?
The following drugs may exacerbate myasthenia:
penicillamine
quinidine, procainamide
beta-blockers
lithium
phenytoin
antibiotics: gentamicin, macrolides, quinolones, tetracyclines
