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Phase 3a > Neuro > Flashcards

Neuro Flashcards

1
Q

Stroke definition

A

Syndrome rapid onset cerebral deficint lasting >24 hours or leading to death

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2
Q

RF ischaemic stroke

A
  • HTN
  • Smoking and alcohol
  • Cholesterol
  • Obesity
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3
Q

S+S ischaemic stroke

A
  • FAST
  • Limb weakness on opposite side infarct
  • Contralateral hemiplegia/hemiparesis
  • Vision loss/deficit
  • HH
  • Aphasia
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4
Q

Ix ischaemic stroke

A
  • NCCT
  • MRI
  • Brachial BP
  • Bloods, XR, ECG
  • If CT shows hyper density = haemorrhagic
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5
Q

Ischaemic stroke acute Mx

A
  • Thrombolysis within 4.5 hours onset
  • IV alteplase
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6
Q

Ischaemic stroke long term Mx

A
  • Antihypertensives
  • Antiplatelet = long term aspirin, clopidogrel
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7
Q

Thrombolysis contraindications

A
  • Recent surgery 3 months
  • Recent arterial puncture
  • Hx active malignancy
  • Brain aneurysm
  • Anticoagulation
  • Liver disease or pancreatitis
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8
Q

Haemorrhagic stroke Mx

A
  • Stop anticoagulants immediately =
  • IV mannitol
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9
Q

TIA definition

A
  • Brief episode neuro dysfunction due to temporary focal cerebral or retinal ischaemia
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10
Q

Carotid TIA S+S

A
  • Amourosis fugax
  • Aphasia
  • Hemiparesis
  • Hemisensory loss
  • HH
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11
Q

Vertebrobasilar TIA S+S

A
  • Diplopia, vertigo, vomiting
  • Choking
  • Ataxia
  • Hemisensory loss
  • HH
  • Tetraparesis
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12
Q

TIA Ix

A
  • FBC, ESR, U+E
  • Carrotid doppler +/- angiography
  • CT or diffuse weighted MRI
  • Echo
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13
Q

TIA Mx

A
  • Immediate = Aspirin 300mg then 75 after 2 weeks (or clopi)
  • Statin
  • If AF = anticoagulation
  • Carotid endarterectomy if >70% carotid stenosis
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14
Q

Epilepsy definition

A
  • Recurrent tendency to spontaneous, intermittent, abnormal electrical activity in brain
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15
Q

Clinical definition epilepsy

A
  • At least 2 unprovoked seizures >24h apart
  • 1 unprovoked seizure and probability of further
  • Diagnosis of an epilepsy syndrome
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16
Q

Partial/focal seizure

A
  • Focal onset that can be referrable to single lobe
  • Simple = no affect on consciousness or memory, no post ictal
  • Complex = memory/awareness affected, post ictal confision
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17
Q

Primary generalised seizure

A
  • Tonic
  • Tonic clonic
  • Clonic
  • Myoclonic
  • Atonic
  • Absence
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18
Q

Temporal lobe seizure

A
  • Aura
  • Anxiety
  • Automatisms = lip smacking
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19
Q

Frontal lobe seizure

A
  • Motor features
    0 Jacksonian march
  • Post ictal todds palsy
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20
Q

Focal seizure mx

A
  • Lamotrigine
  • Levi
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21
Q

Mx tonic seizure

A

SV or lamot

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22
Q

Mx myoclonic seizure

A

SV or levi

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23
Q

Mx TC seizure

A

SV or lamot

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24
Q

Mx absence seizure

A

SV or ethos

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25
Q

Mx atonic seizure

A

SV or lamot

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26
Q

Status epilepticus

A
  • TC seizure lasting 5+ minutes
  • Buccal midazolam 1st line community
  • Rectal diazepam or IV lorazepam
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27
Q

Extradural haemorrhage characteristic

A

Head injury followed by brief duration unconsciousness, followed by improvement
- Young males

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28
Q

Extradrual haemorrhage patho

A
  • Often due ti fractured temporal or parietal bone causing laceration of MMA
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29
Q

S+S extradural

A
  • Deteriorating consciousness after head injury
  • Increasingly severe headache, vomiting and fits
  • Ipsilateral pupil dilates, bilateral limb weakness
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30
Q

Ix and mx extradural

A
  • CT = lemon
  • Clot evacuation and ligation
  • anticoag/antiplatelet cessation
  • IV mannitol
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31
Q

Subdural haemmorhage RF

A
  • Elderly = falls, atrophy
  • Shaking baby
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32
Q

S+S subdural

A
  • Fluctating consciousness
  • Sleepiness
  • Headache
  • Personality change and confusion
  • Unsteadiness
  • Increased ICP
  • Seizures
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33
Q

Subdural Ix

A
  • CT/MRI = clot +/- midline shift
  • Banana on CT
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34
Q

Mx subdural

A
  • Irrigation/evacuation = Burr twist
  • AC/AP cessation
  • IV mannitol
  • IV prothrombin and Vit K
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35
Q

SAH aetiology

A
  • Berry aneurysms (PCKD< ED)
  • Injury
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36
Q

SAH S+S

A
  • Thunderclap
  • Vomiting
  • Seizures
  • Coma/drowsiness
  • Photophobia/vision changes
  • Neck stiffness
  • Kernig and Brudzinski
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37
Q

SAH Ix

A
  • CT = star shaped
  • LP if doubt CT = yellow within 12 hrs and detectable for 2 weeks
  • CT angiography
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38
Q

SAH Mx

A
  • Cerebral perfusion
  • Nimodipine = ca agonist
  • Dexamethasone
  • Endovascular coiling
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39
Q

Migraine no aura

A

At least 2 of
- Unilateral pain
- Throbbing
- Moderate > severe
- Motion sensitive
and 1 of
- N/V
- Photophobia/phonophobia

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40
Q

Migraine with aura

A
  • 1 or more typically fully reversible aura sx
    at least 3 of
  • 1 aura sx spreasd gradually over 5 mins
  • 2 or more aura sx in succession
  • 5-60 minute aura duration
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41
Q

Aura Mx

A
  • NSAID or analgesics for acute
  • Triptans (avoid if IHD, HTN uncontrolled)
  • Propranolol for prevention
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42
Q

S+S tension headache

A
  • Bilateral non pulsing headache
  • Scalp muscle tenderness
  • Tight band sensations
  • Pressure behind eyes
  • Bursting sensations
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43
Q

Cluster headache S+S

A
  • Retro orbital pain
  • Tearing/lacrimation
  • Swollen eyelid
  • Facial flushing
  • Rhinorrhoea
  • Miosis and ptosis
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44
Q

RF cluster

A
  • Male
    FHx
  • Smoking
  • Alcohol
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45
Q

Mx cluster

A
  • Smoking cessation
  • Analgesics unhelpful
  • Subcut sumatriptan
  • High flow oxygen (acute)
  • Prevention = CCB = verapamil
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46
Q

RF drug overuse headache

A
  • Analgesic medication (codeine, opiates)
  • Triptans
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47
Q

ALS S+S (MND)

A
  • UMN signs and LMN wasting
  • Asymmetric onset
  • Bab +ve
  • progressive focal muscle weakness and wasting
  • Fasciculations
  • Increased plantar
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48
Q

PBL S+S (MND)

A
  • Lower CN nuclei
  • Elderly women
  • Dysarthria, dysphagia, nasal regurgitation
  • Fasciculation
  • Emotional incontinence
  • 1st affected = talking, chewing, swallowing
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49
Q

PMA S+S

A
  • Pure LMN presentation = weakness, wasting, fasc
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50
Q

El Escorial criteria ALS

A

Definite = lwoer and upper in 3 regions
Probable = lowe and upper in 2
- Possible = in 1 region
- Suspected = U or LMN signs onlu in 1 or mroe

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51
Q

Mx MND

A
  • Antiglutamatergic = riluzole
  • NG tube
  • Analgesic ladder
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52
Q

Triad in Parkinsons

A
  • Tremor = at rest, may be unilateral
  • Rigidity = pain, cogwheel,
  • Bradykineia/hypokinesia = buttons, writing, walking, blank face
  • Postural instability
  • typically asymmetrical tremor
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53
Q

Patho parkinsons

A
  • Decreased dopamine levels
  • Mitochondrial dysfunction and oxidative stress on substantia nigra
  • Progressive degeneration of dopaminergic neurones of substantia nigra
  • Decreased DA synthesis in the striatum
  • Decreased thalamus activity
  • Decreased movement
54
Q

Parkinsons Ix

A
  • DaTSCAN
  • MRI
55
Q

Parkinsons Mx

A
  1. Levodopa (synthetic dopamine) with PDI like carbidopa and benserazide
  2. COMT inhibitors = entacapone to slow breakdown of levodopa
  3. dopamine agonists
  4. MAOB inhibitors = break down NT = rasagiline, selegiline
56
Q

Levodopa complications

A
  • Invol movements or dyskinesia
  • Response fluctuations
  • Psychiatric
57
Q

MS S+S

A
  • Optic neuritis = painful reduction vision
  • Transverse myelitis
  • Spasticity
  • Lhermitte = electric shock
  • Fatigue
  • Bladder involvement
  • UMN signs
  • Worse with heat
58
Q

MS Ix

A
  • Disseminated in time and sspace
  • MRI = gold
  • CSF = oligoclonal bands IgG
59
Q

MS Mx

A
  • RR mild = dimethyl fumarate
  • RR = monoclonal abs = alemtuzumab
  • Methylprednisolone for acute relapses
  • Baclofen and gabapentin for spasticity
60
Q

Pathogens bacterial meningitis in age groups

A
  • Neonates = GBS
  • Children <2 = SP
  • Up to 50 = NM and SP
  • > 50 = SP
61
Q

S+S meningitis

A
  • Headache
  • Fever
  • Neck stiffness
  • N+V, photophobia, irritability
  • Confusion, delirium, sleepy
  • Maculopapular rash
62
Q

Meningitis Ix

A
  • Bloods
  • Cultures
  • CT
  • LP after CT
    Bacterial LP
  • Cloudy and purulent
  • Increased granulocytes
  • High lactate and protein
  • Decreased glucose
    Viral LP
  • Clear fluid
  • Cell count variable with increased lymph
  • Normal or low lactate
  • Normal protein and glucose
  • No organisms
63
Q

Meningitis Mx

A
  • Primary care if NB rash = IM benzylpen 1.2mg
  • Broad spec Abx, steroids (IV dex), LP
  • 1st line abx empirical therapy before LP or after CT = cefs
  • amox >60
64
Q

Encephalitis S+S

A
  • Fever, headache, N+V
  • Seizures
  • Altered mental state
  • Rash
65
Q

Enceph Ix

A
  • Bloods
  • CSF
  • CT/MRI
  • Cultures
66
Q

Enceph Mx

A
  • Aciclovir
  • IV benzylpen
67
Q

S+S carpal tunnel

A
  • Aching in hand and arm esp. night
  • Paraesthesia in thumb, index and middle finger
  • Relived by dangling
  • Sensory loss and weakness abductor pollis brevis
68
Q

Causes carpal tunnel

A
  • Swelling/compression
  • Prolonged flexion
  • Acromegaly
  • Myeloma
  • RA
  • Pregnancy
69
Q

Mx carpal tunnel

A
  • Splinting
  • Local steriod injection
  • Decompression surgery
70
Q

Myasthenia gravis definition

A
  • Autoimmune disease medaited by antibodies to Ach receptors
71
Q

MG pathophysiology

A
  • Autoantibodies to ach receptors form
  • AChR lost on postsynaptic membrane of NMJ
  • Failure to trigger muscle action potential
72
Q

MG S+S

A
  • Increasing muscle fatigue = top down
  • Proximal and asymetrical
  • Ptosis
  • Diplopia
  • Snarl
  • Voice deterioration
  • Tendon reflexes
73
Q

Myasthenic crisis

A
  • Resp muscle weakness
  • Monitor forced vital capacity
  • Plasmanephrines or IVIG
74
Q

MG Ix

A
  • Tensilon test
  • Anti AChR
  • Decremental muscle response to repetitive nerve stimulation
  • CT thymus
  • Ice improves ptosis by >2mm
  • Nerve conduction
75
Q

MG Mx

A
  • Anticholinesterase = pyridostigmine
  • Relapses with prednisolone
  • Thymectomy
76
Q

Drugs that execerbate MG

A
  • Ciprofloxacin
  • Azithromycin
  • Propranolol
  • Atenolol
  • Verapamil
  • Lithium
  • Statins
77
Q

Cauda equina S+S

A
  • Saddle paraesthesia
  • Sudden onset
  • Motor problems
  • Lower back pain
  • Bilateral LMN weakness
  • Absent ankle reflex
  • Decreased sphincter tone
  • Perianal, perineal or sensory disturbance
  • Incontinence
  • Sexual dysfunction
  • Bilateral motor and reflex deficits
78
Q

CE Ix

A
  • Spine MRI
  • Femoral stretch test = L4
  • Knee flexion test = L5/S1
  • Straight leg raining test = L5/S1
  • Plantar flexion test = S1/S2
79
Q

CE Mx

A
  • Epidural steroid
  • Surical decompression
  • Immobilise spine
  • Anti inflams
80
Q

HZV

A
  • Shingles
  • Reactivation of chickenpox = infects dermatomes
81
Q

S+S HZV

A
  • Localised dermatome pain and paraesthesia
  • Localised dermatome erythematous maculopapular rash –> clear vesicles –> crust
  • headache, fever, malaise
82
Q

HZV Ix

A
  • PCR
  • CSF analysis
  • Clinical
83
Q

HZV Mx

A
  • Vaccine
  • Aciclovir <72 hours of rash onset
  • Analgesia
  • Topical abx
  • TCA
84
Q

Alzheimers pathology

A
  • Atrophy of cerebral cortex
  • formation of amyloid plaques and neurofibrillary tangles (contain tau proteins)
  • Accumulation of B amyloid peptide
85
Q

S+S Alzheimer’s

A
  • Loss of recent memory
  • Difficulty word finding
  • Aphasia, apraxia, agnosia
  • Frontal executive function
  • Anosognosia = lack insight, stubbornness, denial
86
Q

Alzheimers management

A
  • Acetylcholinesterase inhibitors = donepezil, rivastigmine
  • Memantine in late stage (antiglutaminergic)
87
Q

Vascular dementia

A
  • Multi infarct dementia
  • Reduced blood supply to brain
  • Onset can be within 3 months CVA
  • Stepwise progression
88
Q

Vascular dementia S+S

A
  • Stepwise in severity of symptoms
  • Gaint and attention problems
  • Incontinence
  • Personality change
  • Focal neuro signs
  • MRI = widespread small vessel disease
89
Q

Lewy body dementia

A
  • Parkinsonism
  • LBD when cognitive Sx predate motor by >1 yr
  • PDD when motor prior to or within 1yr cognitive issues
90
Q

LBD S+S

A
  • Fluctuating cognition
  • Recurrent visual hallucinations
  • REM
  • 1 or more PD Sx
  • Can treat with rivastigmine or donepezil
91
Q

Fronto temporal dementia

A
  • Common in younger
  • Progressive degeneration
  • Personality change and behaviour disturbance
  • Progressive impairment of language
92
Q

Vascular dementia Mx

A
  • AChE inhibitors
  • Memantine
93
Q

Parkinsonian plus syndromes

A
  • Progressive supranuclear palsy = PD and vertical gaze
  • Multiple system atrophy = PD and PHypo, incontinence and impotence
  • Cortico basal degeneration = PD and spontaneous activity limb
  • LBD
94
Q

Brown sequard findigns

A
  • Ipsilateral hemiplegia
  • Ipsilateral loss of vibration and proprioception
  • Contralateral loss of pain and temperature
95
Q

Wernicke’s aphasia

A
  • superior temporal gyrus
  • Speech fluent but word salad, neologisms, no sense
  • Impaired comprehension
96
Q

Broca’s aphasia

A
  • Expressive
  • Inferior frontal gyrus
  • no fluent speech, laboured and halting but comprehension in tact and content words may be preserved
97
Q

anterior cerebral artery

A
  • contralateral hemiparesis and sensory loss
  • lowe extremity > upper
98
Q

MCA

A
  • contralateral hemiparesis and sensory loss
  • upper > lower
  • Contralateral HH
  • Aphasia
99
Q

PCA

A
  • Contralateral HH with macular sparing
  • Visual agnosia
100
Q

Weber’s syndrome

A
  • Ipsilateral CN3 palsy
  • Contralateral wekaness lower and upper extremity
101
Q

PICA

A
  • Ipsilateral facial pain and temp loss
  • contralateral limb/torso pain and temperature loss
  • ataxia, nystagmus
102
Q

Basilar

A

locked in syndrome

103
Q

Lacunar strokes

A
  • isolated hemiparesis, hemisensory loss or hemiparesis with limb ataxia
  • HTN assocaited
  • basal ganglia, thalamus and internal capsule
104
Q

GCS motor response

A

6 = obey commands
5 = localises to pain
4 = flexes to pain
3 = Mr carrol says no
2 = extends to pain
1 = none

105
Q

GCS verbal response

A

5 = orientated time place person
4 = confused
3 = innapropriate words
2 = sounds
1 = none

106
Q

GCS eye response

A

4 = eye open spont
3 = open to speech
2 = open to pain
1 = none

107
Q

Bell’s Palsy

A
  • Acute unilateral facial nerve weakness or paralysis of rapid onset
  • Herpes simplex, varicella zoster and autoimmunity
  • unilateral LMN palsy (non forehead sparing)
  • Droop eyebrow, corner of mouth and loss of nasolabial fold
108
Q

Bell’s palsy symptoms

A
  • Rapid onset
  • Facial muscle weakness
  • Drooping off eyebrow and corner of the mouth and loss of nasolabial fold
  • Difficulty chewing, dry mouth and changes in taste
  • Incomplete eye closure, dry eye or excessive tearing
  • Numbness of tingling of cheek +/- mouth
109
Q

Bell’s palsy management

A
  • Keep eye lubricated with drops and ointment and tape
  • Prednisolone
110
Q

Ramsay hunt

A
  • VZV
  • Unilateral lower motor neurone facial nerve palsy
  • Vesicular rash in ear canal
  • within 72hrs prednisolone and aciclovir
111
Q

Meniere’s

A
  • Hearing loss
  • Vertigo
  • Tinnitus
  • Excessive buildup of endolymph in inner ear
  • Acute = prochlorperazine and antihistamine
  • Prophylaxis = betahistine
112
Q

total anterior circulation stroke

A
  • Middle and anterior cerebral arteries
  • Unilateral weakness (+/- sensory) of face, arm and leg
  • Homonymous hemianopia
  • Higher cerebral dysfunction = dysphasia, visuospatial
113
Q

Partial anterior circulation stroke

A

2 of the following
- Unilateral weakness of face, arm, leg
- Homonymous hemianopia
- Higher cerebral dysfunction (and this alone can be PACS)

114
Q

Posterior circulation syndrome

A
  • Cerebellum and brainstem
    1 of following
  • cranial nerve palsy and a contralateral motor/sensory deficit
  • bilateral motor/sensory deficit
  • conjugate eye movement disorder
  • cerebellar dysfunction
  • Isolated homonymous hemianopia
115
Q

Lacunar stroke

A
  • No loss of higher cererbal function
    1 of
  • Pure sensory stroke
  • Pure motor stroke
  • Sensori-motor stroke
  • Ataxic hemiparesis
116
Q

Common peroneal nerve palsy

A

The sciatic nerve divides into the tibial and common peroneal nerves. Injury often occurs at the neck of the fibula

Common = foot drop.

Other features include:
weakness of foot dorsiflexion
weakness of foot eversion
weakness of extensor hallucis longus
sensory loss over the dorsum of the foot and the lower lateral part of the leg
wasting of the anterior tibial and peroneal muscles

117
Q

subacute combined degeneration of the cord

A

due to vitamin B12 deficiency
dorsal columns + lateral corticospinal tracts are affected
joint position and vibration sense lost first then distal paraesthesia
upper motor neuron signs typically develop in the legs, classically extensor plantars, brisk knee reflexes, absent ankle jerks
if untreated stiffness and weakness persist

118
Q

Red flag for trigeminal neuralgia

A
  • <40
  • Sensory changes
  • Deafness or ear problems
  • Skin or oral lesions
  • Pain in Opthalmic division
  • Optic neuritis
  • ## FHx MS
119
Q

Cushings triad in ICP

A
  • Bradycardia
  • Wide pulse pressure
  • Irregular breathing
120
Q

Effect of IIH on the eyes

A

down and out = 3rd nerve palsy

121
Q

Pontine haemorrhage

A
  • Secondary to chronic HTN
  • Quadraplegia
  • Miosis
  • Absent horizontal eye movements
122
Q

Bell’s palsy vs Ramsey Hunt

A

BP
- Lack of rash
- Normal otosopy
RH
- Vesicular rash around ear
- Abnormal otoscopy

123
Q

4th CN palsy

A
  • Defective downward gaze = vertical diplopia
124
Q

5th CN palsy

A
  • Trigeminal neuralgia
  • Loss corneal reflex
  • Loss of face sensation
  • Deviation of jaw to weak side
125
Q

6th nerve palsy

A
  • Horizontal diplopia
126
Q

9th nerve palsy

A
  • loss of gag reflex
127
Q

10th nerve palsy

A
  • uvula away from lesion site
  • loss gag reflex
128
Q

12th nerve palsy

A
  • tongue deviates to side of lesion
129
Q

trigeminal neuralgia

A
  • 5th CN
  • paroxysmal attacks of pain = eating
  • carbamezapine
130
Q

Mx IIH

A
  • weight loss
  • Diuretics = acetazolamide
  • topiramate
  • repeat LPs
  • Surgery

Phase 3a (23 decks)

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