Neuro Flashcards
Neurocutaneous syndromes
Neurofibromatosis
Sturge Weber
Tuberous sclerosis
Von Hippel Lindau
Ataxia telegiectasia
Operating and historical definition of status epilepticus
Operating: >5Mins
Hisorical: >30mins
Difference between medical and surgical third nerve palsies
Surgical CN3 palsy usually affects pupil(Causes mydriasis)
Medical CN3 palsy may spare the pupil
Causes of peripheral neuropathy
Diabetic neuropathy
Alcoholism
Syphilis
Charcot Marie tooth
Leprosy
Triad of Miller Fisher Syndrome
A subset of GBS
Ophthalmoplegia
Ataxia
Areflexia
Webers test
Localises towards side of conductive hearing loss
OR
Localises away from side of sensorineural hearing loss
Rinne test
Positive: AC>BC (Normal or sensorineural hearing loss)
Negative: BC>AC(conductive hearing loss)
CN and muscles involved in bulbar palsy(medulla oblongata lesion)
CN 9,10,11,12 LMN lesion
Palate and tongue muscles
1st rule of 4 of Brainstem
4 CN in brainstem and above
4 CN in pons
4 CN in medulla oblongata
2nd rule of 4 of brainstem
4 midline nuclei that can divide 12
CN 3,4,6,12
3rd rule of 4 of brainstem
4 midline structures
- Motor(corticospinal)
- Medial Lemniscus(DCML)
- MLF
- Motor nuclei of midline(3,4,6,12)
4th rule of 4 of brainstem
4 side structures
- Spinothalamic
- Spinocerebellar
- Sympathetic pathway
- Sensory nucleus of CN V
Dydx MG and LEMS
LEMS has reduced reflexes,MG does not
Chronic Mx of MG
AchE-inhibitor: Pyridostigmine
Immunosuppression: Corticosteroids or azathioprine
5 key signs in neuro exam
Wasting
Reflexes
Tone babinski
Non modifiable risk factors for stroke
Age
Gender
ethnicity
Modifiable stroke risk factors
DM
HLD
HTN
Atrial fibrillation
Smoking
Atherosclerotic disease
Vasculitides
HIV
OCPs
Haem eg Thrombophilias
Signs of POCS posterior occipital circulation stroke
- CN palsy with contralateral motor loss
- Bilateral motor sensory deficit
- Conjugate eye movement
- Cerebellar dysfunction
- Isolated homonymous hemianopia
Features of TACS total anterior circulation stroke
ALL of the following
-loss of higher cortical dysfunction
-homonymous hemianopia
-motor/sensory stroke
-
Features of partial anterior circulation stroke(PACS)
2 of the TACS criteria
OR
1) higher cortical dysfunction alone
2) Limited sensory motor deficit
Features of Lacunae stroke(LACS)
Any of
1) Pure motor deficit
2) Pure Sensory deficit
3) Ataxic Hemiparesis
4) Sensorimotor
5) NO higher cortical function loss or posterior circulation issues
Nerves that pass through the cavernous sinus
CN3, CN4, CNV1 CNV2 CN6
Nerves that pass through the superior orbital fissure
CN2 CN3 CN4 CNV1 CN6
Exclusion criteria for rTPA
- Age >80
- On anticoagulation regardless of INR
- NIHSS >25
- Hx of stroke/DM
6Ms of complex opthalmoplegia
- Myasthenia Gravis
- Myopathy of EOMs
- Miller Fisher Syndrome
- Mononeuritis multiplex
- Multiple Sclerosis
- Multiple CN pathology
4 steps to multiple CN neuropathies
- Rules of 4
- Brainstem clubs
- Meninges/base of skull lesions
- Peripheral neuropathy
Gold standard for SAH diagnosis
4 vessel cerebral angiogram
-2 ICA 2 vertebral artery
CT or digital subtraction
Dx criteria of NF1
2/7 of
Cafe au lait spots or hyperpigmented nodules(6+ , >5mm for prepubertal, >15mm for postpubertal)
Neurofibromas
Crowe sign( Freckles on axillary/inguinal region)
Lisch nodules(2+)
Optic nerve Gliomas
Sphenoid dysplasia/ long bone abnormalities
First deg relative with NF1
Gene affected by NF1
NF1 gene on chromosome 17
Gene affected by NF2
NF2 gene on chromosome 22
Criteria for fitness to drive for an patients with epilepsy in Singapore
3 years seizure free and 1 year off anti epileptic drugs
