neuro Flashcards
which parkinsons medication is most likely to cause inhibition disorders?
ropinirole (dopamine receptor agonist)
what are the features of bells palsy?
acute unilateral idiopathic facial nerve paralysis
- lmn palsy - forehead affected (umn spares forehead)
- post-auricular pain, altered taste, dry eyes, hyperacusis
what is the management of bells palsy?
oral pred
artificial tears, eye taping
?refer to ent, ?plastics if no paralysis improvement
what is degenerative cervical myelopathy?
disc degen, ligament hypertrophy, cord signal change
what are the features of DCM?
neck pain, loss of motor function in upper limb, loss of sensory function, loss of autonomic fn (urinary or faecal incontinence and/or impotence)
hoffman’s sign - flick hand - +ve = fingers twitch
secondary prevention in TIA?
clopidogrel 75mg daily
management TIA?
300mg aspirin acutely
which cranial nerves are affected in vestibular schwannomas? (acoustic neuroma)
cn V, VII and VIII
how does drug induced parkinsonism present?
bilateral sx
remain at presenting level
how does idiopathic parkinsons present?
difficulty with fine movts
inc tone
resting tremor
often asymmetrical sx
if a patient presents to primary care with seizue episodes, what is the management?
refer to neuro - antiepileptics must be started by specialists
what type of visual field defects do parietal lesions cause?
contralateral inferior quadranopia
what type of visual field defects do temporal lobe lesions cause?
contralateral superior quadranopia
what type of visual field defect would a patient with sx of diabetes insipidus have?
craniopharyngioma - lower bitemporal hemianopia
how do you differentiate a focal impaired awareness seizure from an absence seizure?
FIA - ?longer, motor phenomena, automatisms, aura
absence - often child, up to 30s, recollection of event, no automatisms
what are the sx of acoustic neuroma?
vertigo, unilateral sensorineural hearing loss and tinnitus cnviii
absent corneal reflex cnv
facial palsy cnvii
mgt ischaemic stroke for first 14 days?
300mg aspirin OD
after 14d - clopidogrel 75mg long term + statin if cholesterol over 3.5
what is the mgt for myoclonic seizures?
m - sodium valproate
f - levetiracetam
what is the mgt for absence seizures?
ethosuximide
2L m- valproate, f- lamotrigine or levetiracetam
(carbamazepine may exacerbate)
what is the mgt for tonic/atonic seizures?
m - sodium valproate
f - lamotrigine
what is the mgt for focal seizures?
focaL - Lamotrigine/Levetiracetam
1L - lamotrigine or levetiracetam
2L - carbamazepine, oxcarbazepine, zonisamide
what is the mgt for generalized tonic-clonic seizures?
m - SV
f - lamotrigine or levetiracetam
what is the management for peritumoural vasogenic oedema?
IV dexamethasone
how does a lacunar stroke present?
pure motor hemiparesis
pure sensory stroke
sensorimotor stroke
ataxic hemiparesis
dysarthria/clumsy hand syndrome
how does a TACS present?
3Hs
Hemiplegia/sensory loss
Homonymous hemianopia
Higher dysfunction
what type of diet is most likely to be effective in reducing seizure frequency in epilepsy?
ketogenic diet
how do focal aware seizures present?
sudden but short-lived change in senses (which may be taste, smell, tactile, or visual) during which the patient remains fully conscious
typically remain conscious, accompanied with sweating, twitching or gaze deviation
how does myasthenia gravis present?
muscle fatigability
- extraocular muscle weakness - diplopia
- proximal muscle weakness
- ptosis
- dysphagia
what is MG associated with?
- thymomas
- autoimmune disorders
- thymic hyperplasia
what is the investigation of choice for MG?
antibody screen - pts have abs against acetylcholine receptors
how does trigeminal neuralgia present?
unilateral brief electric shock-like pains, abrupt in onset and termination, limited to one or more divisions of the trigeminal nerve
pain evoked by light touch, including washing, shaving, smoking, talking, and brushing the teeth, and frequently occurs spontaneously
what is the management for trigeminal neuralgia?
carbamazepine
how does an AICA stroke present?
sudden onset vertigo and vomiting
ipsilAterAl fAciAl pArAlysis
how does a PICA present?
sudden onset vertigo and vomiting
dysphagia
ipsilateral facial pain and temp loss
contralateral LIMB pain and temp loss
ataxia
what is broca’s aphasia?
brocas - broken - word flow broken (expressive)
what is wernicke’s aphasia?
wernicke’s - what? - doesn’t understand a command (receptive)
how do you manage a patient with a suspected TIA if they are on warfarin/DOAC/have a bleeding disorder?
admit and arrange CT head to rule out haemorrhage before giving aspirin
how does normal pressure hydrocephalus present?
triad
1. urinary incontinence
2. gait disturbance
3. dementia
(magnetic gait specific finding NPH)
what is seen on imaging in NPH?
ventriculomegaly without sulcal enlargement
how is status epilepticus managed?
ABC - airway adjunct, oxygen, check blood glucose
1L IV benzos - prehospital PR diazepam or buccal midazolam
upper vs lower bitemporal hemianopia pathology?
Upper - pitUitary lesion
lOwer - craniOpharyngiOma
what dose of rectal diazepam do you give in status?
10mg
what is the most common neurological consequence of meningitis?
sensorineural hearing loss
(then seizures, focal neuro deficits, sepsis, abscess, brain herniation, hydrocephalus)
what are the features of neuroleptic malignant syndrome?
FEVER
Fever
Encephalopathy
Vitals dysregulation - in HR + RR
Enzyme - CK increase
Rigidity
what are the mechanisms of action of the 3 main antiemetics?
1, 2, 3
1. cyclizine h1 receptor
2. metaclopramide d2 receptor
3. ondansetron 5ht3
how does a pca stroke present?
contralateral homonymous hemianopia with macular sparing
visual agnosia
what syndrome is caused by a posterior inferior cerebellar artery infarct (PICA)?
lateral medullary syndrome
how to remember tibial vs peroneal nerve lesion presentation
TIPPED
Tibial nerve - Inversion - Plantarflexion
Peroneal nerve - Eversion - Dorsiflexion
how does spontaneous intracranial hypOtension present?
worse when upright
low csf - usually from a leak, associated with marfan’s
what needs to be considered when starting a phenytoin infusion?
cardiac monitoring - pro-arrhythmogenic effects
what is the treatment pathway for neuropathic pain?
1L: amitriptyline, duloxetine, gabapentin, or pregabalin
2L: tramadol as ‘rescue therapy’ for exacerbations
topical capsaicin for localised neuropathic pain
what drug is used for long term prophylaxis of cluster headaches?
verapamil
which blood vessels are affected in subdural haemorrhage?
bridging veins between cortex and venous sinuses
which blood vessels are affected in subarachnoid haemorrhages?
vessels of circle of willis, eg basilar and anterior circulating arteries
what is the mechanism of action of pyridostigmine?
long acting acetylcholinesterase inhibitor
used in MG
how to remember status mgt?
oh my lord phone the anaesthetist
O - O2
M - buccal midazolam or rectal diazepam
L - IV lorazepam
P - IV phenytoin
A - rapid induction of anaesthesia
what eye defect is most commonly associated with raised ICP?
3rd nerve palsy due to herniation (down and out, ptosis, sometimes pupil dilation)
where would the lesion be if there was a left homonymous hemianopia?
right optic tract (not nerve) - R optic radiation or occipital cortex
what condition is chiari malformations associated with?
syringomyelia - dilatation of csf space within spinal cord - loss of pain sensation, temp and non-discriminative touch. cape like distribution
how does an mca stroke present?
contralateral hemiparesis
sensory loss
upper extremity affected more
contralateral homonymous hemianopia
aphasia
which antiemetic causes extrapyramidal side effects?
metaclopramide
how does guillain barre present?
- progressive, symmetrical weakness of all limbs
- classically ascending
- hypOreflexia
- maybe mild sensory sx or none
- often hx of gastroenteritis
how is GBS investigated?
LP - raised protein, normal WCC
nerve conduction studies - dec motor nerve conduction velocity
what is brown sequard syndrome?
lateral hemisection of the spinal cord
how does brown sequard syndrome present?
ipsilateral weakness and proprioception/vibration loss
contralateral pain/temp loss
what is the management for acute stroke within 4.5h?
thrombolysis and thrombectomy
where is broca’s area?
inferior frontal gyrus (frontal lobe)
where is wernicke’s area?
superior temporal gyrus (temporal lobe)
what are the symptoms of normal pressure hydrocephalus?
wet - incontinence
wacky - dementia
wobbly - gait apraxia
which drugs can exacerbate myasthenia gravis?
penicillamine
quinidine, procainamide
beta blockers
lithium
phenytoin
abx: gentamicin, macrolides, quinolones, tetracyclines
what does a cnvi palsy present with?
contralateral defective eye abduction and horizontal diplopia
rhyme to remember nerve roots and their actions?
s1/2 button my shoe
l3/4 kick the door
c5/6 pick up sticks
c7/8 close the gate
what medications are used for spasticity in MS?
baclofen and gabapentin
what is the treatment for a focal seizure in a man?
lamotrigine or levetiracetam
in a patient with leg weakness and no arm weakness or aphasia, which vessel is likely to be affected?
ACA
what imaging is used for MS?
MRI brain and spine with contrast - shows demyelinating lesions
what sign is seen on MR venography in sagittal sinus thrombosis?
empty delta sign
how does sagittal sinus thrombosis present?
headache
diplopia
bilateral papilloedema
what is first line for post herpetic neuralgia?
don’t - duloxetine
get - gabapentin
pain - pregabalin
again - amitriptyline
how does trochlear nerve palsy present?
defective downward gaze, vertical diplopia
how does subacute combined degeneration of the cord present?
dorsal columns and lat corticospinal tracts
loss of proprioception and vibration sense
spasticity and brisk knee reflexes
babinski positive
first line tx for parkinsons disease?
levodopa - if motor sx affecting QoL
if not, dopamine agonist, levodopa, mao-B inhibitor
what are the side effects of phenytoin?
P - p450 interactions
H - hirsutism
E - enlarged gums
N - nystagmus
Y - yellow skin
T - teratogen
O - osteomalacia
I - interaction with B12 metabolism
N - neuropathies
what are the features of a low pressure headache?
post lumbar puncture
young women with low BMI
within 24-48h after LP
worse upright
improves in recumbent position
how are anti-epileptic drugs stopped?
can be considered if seizure free for over 2 years, stop AEDs over 2-3months
what medication is used for cluster headache prophylaxis?
verapamil
how does pontine haemorrhage present?
reduced GCS, paralysis and bilateral pin point pupils
what is cushings triad (raised ICP)?
widening pulse pressure
bradycardia
irregular breathing
which medications are associated with idiopathic intracranial hypertension?
- tetracycline abx (like doxycycline)
- isotretinoin
- contraceptives
- steroids
- levothyroxine
- lithium
- cimetidine
how does CJD present?
rapid onset dementia and myoclonus
what is lhermitte’s sign?
tingling in hands when flexing neck/electric shock sensations down spine
indicates disease near dorsal column nuclei of cervical cord
what type of stroke does contralateral homonymous hemianopia with macular sparing and visual agnosia indicate?
posterior cerebral
which antiepileptic drug is most associated with wt gain?
sodium valproate
what drugs increase the risk of IIH?
COMAAR
ciclosporin
oral contraceptives
mineralocorticoids
amiodarone
antibiotics (tetracyclines, sulphonamides)
retinoic acid
which nerve is at risk in a fracture of the humeral shaft?
radial nerve
what is weber’s syndrome?
midbrain stroke
characterised by ipsilateral CNIII palsy and contralateral hemiparesis
what type of visual field defect does Primary open angle glaUcoma cause?
Unilateral Peripheral visual field loss
what nerve does saturday night palsy affect?
radial nerve
what is tuberous sclerosis?
AD condition
neurocutaneous features
what are the features of tuberous sclerosis?
ash leaf spots
shagreen patches
adenoma sebaceum
fibromata beneath nails
cafe au lait (moreso neurofibromatosis)
devt delay
epilepsy
intellectual impairment
what are the features of neurofibromatosis?
axillary/groin freckles
pheochromocytomas
NF2 - acoustic neuromas
iris hamartomas
ocular hamartomas
AD
how does multi-system atrophy present?
- parkinsonism
- autonomic disturbance
> erectile dysfunction
> postural hypotension
> atonic bladder - cerebellar signs
how do jacksonian march seizures present?
clonic movt travelling proximally
which lobe is associated with jacksonian march?
frontal lobe
what are the most important initial investigations in status epilepticus?
ABDCE - hypoxia
BM - hypoglycaemia
how does extradural haemorrhage appear on CT?
BICONVEX mass
how does subdural haemorrhage appear on CT?
crescent
how is acute relapse of MS managed?
methylprednisolone
how does venous sinus thrombosis present?
headache
nausea and vomiting
reduced consciousness
what is the effect of rocuronium in MG?
rocuronium rocks !
(hyperefficacious)
what is the effect of suxaemethonium in MG?
Suxaemethonium sucks !!
hypoefficacious
what is the effect of suxamethonium in MG?
Suxamethonium sucks !!
hypoefficacious
what is found in CSF of pts with MS?
oligoclonal bands
how does lambert-eaton syndrome present?
- repeated muscle contractions lead to inc muscle strength
- limb-girdle weakness
- hyporeflexia
- autonomic sx
what drug is used in the management of IIH?
acetazolamide - carbonic anhydrase inhibitor
what is the pattern of typical migraine aura?
spreading scintillating scotoma
(jagged crescent)
what is the mechanism of action of memantine?
NMDA receptor agonist
which tumours most commonly metastasise to the brain?
- lung
- breast
- kidney
- melanoma
- colorectal
how is acute myasthenic crisis managed?
plasmapheresis and ivig
what is the preferred method of nutrition for patients with MND?
PEG tube
what medications are used to treat neuroleptic malignant syndrome?
dantrolene in some cases
bromocriptine (dopamine agonist)
above which level of spinal cord injury does autonomic dysreflexia occur?
above T6
what is uhthoff’s phenomenon?
neurological sx exacerbated by increases in body temp
(associated with MS)
what is uhthoff’s phenomenon?
neurological sx exacerbated by increases in body temp
(associated with MS)
what medication is used for restless leg syndrome?
dopamine agonists - ropinirole
what medication is used for restless leg syndrome?
dopamine agonists - ropinirole
