NEURO Flashcards
acoustic neuroma features?
DVT plus absent corneal reflex
vertigo, hearing loss, tinnitus and an absent corneal reflex.
woman has a TIA: unilateral weakness or sensory loss,
tx?
how does this differ in crescendo TIA- 2 TIAs in 7 days?
give aspirin 300 mg immediately, unless
1. the patient has a bleeding disorder or is taking an anticoagulant (needs immediate admission for imaging to exclude a haemorrhage)
2. the patient is already taking low-dose aspirin regularly: continue the current dose of aspirin until reviewed by a specialist
3. Aspirin is contraindicated: discuss management urgently with the specialist team
Specilaist revie
clopidogrel is recommended first-line (as for patients who’ve had a stroke)
aspirin + dipyridamole should be given to patients who cannot tolerate clopidogrel
how does this differ in crescendo TIA- 2 TIAs in 7 days?
CT head and aspirin
when to think idiopathic intracranial hypertension?
Obese, young female with headaches / blurred vision
typical symptoms seen in Parkinson’s disease?
Resting tremor + bradykinesia + rigidity
cluster head ache description?
tx?
Episodic, intense, unilateral eye pain, lacrimation, restless
Tx is oxygen, then subcutaneous triptan
Prophylaxis: verapamil
side effect of excess vitamin B6 (pyridoxine) ingestion?
peripheral neuropathy
horizontal diplopia
nerve damage?
cranial nerve 6 abducens
GCS points?
Motor (6 points) Verbal (5 points) Eye opening (4 points). Can remember as ‘654…MoVE’
root?
had shingles and now has post-herpetic neuralgia.
tx?
amitriptyline, duloxetine, gabapentin or pregabalin first-line.
sensory loss to the little finger and wasting of the hypothenar eminence.
nerve damage?
ulnar nerve
contraindication to triptan use in migraine?
cardiovasular diease
sudden and transient loss of muscular tone caused by strong emotion (e.g. laughter, being frightened).
cataplexy
Common peroneal nerve lesion
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
side note: L5 damage only causes foot drop but no effect on eversion
in a young person… features should prompt investigation for a secondary cause of headaches?
headache triggered by coughing
migraine
tx?
prophylaxis?
acute: triptan + NSAID or triptan + paracetamol
prophylaxis: topiramate or propranolol
side note: Propranolol is preferable to topiramate in women of childbearing age (i.e. the majority of women with migraine)
long term mx of stroke?
Aspirin 300 mg daily for 2 weeks then clopidogrel 75 mg daily long-term
Huntington’s disease is due to a defect in the huntingtin gene on chromosome…?..
4
Guillain-Barre syndrome
presentation?
ascending paralysis
c.jejuni
Phenytoin s/e
montioring?
megaloblastic anaemia (secondary to altered folate metabolism)
peripheral neuropathy
Phenytoin levels do not need to be monitored routinely but trough levels, immediately before dose should be checked if:
adjustment of phenytoin dose
suspected toxicity
detection of non-adherence to the prescribed medication
Fasciculations’ - think …..?
MND
where is the lesion- macular sparing?
Occipital cortex
A 54-year-old man complains of sweating, headaches and ‘tunnel vision’.
lesion eye?
optic chiasm
early blindness, now tunnel vision
where is the lesion?
retina
common presentation of retinitis pigmentosa.
tuberous sclerosis
adenoma sebaceum
Which of the following complications is classically associated with parotid gland surgery?
Parotid pathology can cause a lower motor neurone facial palsy
Which one of the following features of migraine is more common in children?
Gastrointestinal disturbance
Generalised tonic-clonic seizures
tx in females vs males?
focal seizure tx
absense seizure tx
myocloninc seizure tx?
tonic or atonic seizure tx?
most appropriate for secondary prevention of stroke- already taken high dose aspirin for 14 days?
Clopidogrel is the preferred antiplatelet for secondary prevention following stroke
what dermatome supplies thumb, index finger, middle finger, palm, ring finger
CT head showing temporal lobe changes
think herpes simplex encephalitis
Primary open angle glaucoma in right eye
damage visual field tract?
Unilateral peripheral visual field loss
20-year-old man presents with recent episodes of severe, stabbing pain in the right eye.
has clear nasal discharge during the episodes.
dx? trigger?
tx?
prophylaxis?
Alcohol is a common trigger for cluster headaches
ischemic stroke identified in 3 hrs
mx?
A combination of thrombolysis AND thrombectomy is recommend for patients with an acute ischaemic stroke who present within 4.5 hours
side note: BP MUST BE CONTOLLED- CAN GIVE B BLOCKER
man right sided numbness, poorly controlled htn, diabetes. ct shows no haemorrhage.
dx?
lacunar infarct
A patient having a lacunar stroke would present with either a purely motor, a purely sensory or a mixed motor and sensory deficit
typical aura in migraine?
Typical aura include a spreading scintillating scotoma (‘jagged crescent’)
A maximum of …?…. doses of IV benzodiazepines can be administered during convulsive status epilepticus
two!!
Peripheral neuropathy is a known adverse effect of WHICH ANTI EPILEPTIC DRUG?
PHENYTOIN
Parkinson’s disease - most common psychiatric problem is
depression
Useful for managing tremor in drug-induced parkinsonism
Procyclidine
PARKINSONS Has been associated with pulmonary fibrosis
Cabergoline
PARKINSONS: which medication Often has a reduced effectiveness with time
Levodopa
Neuropathic pain responds poorly to opioids.
if standard treatment failed which opioid is it most EFFECTIVE?
TRAMADOL
DVLA informing and TIA?
Can start driving if symptom free after 1 month - no need to inform the DVLA
test is used to determine whether your fingers or thumbs flex involuntarily in response to certain triggers.
name of this sign?
hoffmans sign
neurodegenerative disorder involving death of neurones in the substantia nigra
parkinsons
Which vitamin, present in Pabrinex, can prevent progression of symptoms to Wernicke’s encephalopathy?
B1 aka thiamine
Common sites of lacunar strokes are…
basal ganglia, thalamus and internal capsule
…..artery?…. is affected in ‘locked-in’ syndrome.
BASILAR ARTERY
confused 6 weeks post at RTA. what injury in brain?
subdural haematoma
can present several weeks after the initial head injury
Patients cannot drive for ….?… following a first unprovoked or isolated seizure if brain imaging and EEG normal
6 months
amaurosis fugax.
What part of the brain anatomy is affected with this type of stroke?
retinal/ophthalmic artery
Unilateral tinnitus associated with deafness is likely to be a feature of
The classical history of vestibular schwannoma includes a combination of vertigo, hearing loss, tinnitus and an absent corneal reflex
CT head of an elderly patient
unilateral crescentic lesion in the right frontoparietal area.
dx? artery?
Subdural haemorrhage results from bleeding of damaged bridging veins between the cortex and venous sinuses
Bilateral acoustic neuromas are associated with —-what genetic condition—–??
neurofibromatosis type 2
type of seizure?
surroundings like a dream
Lip smacking is an example of an automatism - an automatic, repetitive act
focal impaired awareness
presentation of myasthenia gravis? tx?
associated with?
dysphagia, diplopia, ptosis
long-acting acetylcholinesterase inhibitors
pyridostigmine is first-line
THYMOMA
most common symptom of posterior circulation stroke
dizziness
think posterior–posture… dizzy
bleeding gums— what antiepileptic med?
phenytoin
bleeding gums— what antiepileptic med?
phenytoin
first-line for spasticity in multiple sclerosis
Baclofen and gabapentin
bells palsy craniel nerve?
7 LMN
…?….. help in the diagnosis of Guillain-Barre syndrome
Nerve conduction studies
appropriate anti-emetic in parkisnsons
domeridone
side note: Cyclizine is an antihistamine which, like prochlorperazine, may exacerbate Parkinson’s disease.
episodes of suddenly smelling burnt rubber-despite there being none in her presence. lasting 2 mins
seizure type?
A woman suddenly has the sensation of smelling roses whilst at work. She is conscious throughout - focal aware seizure
essential tremor tx?
Essential tremor is an AD condition that is made worse when arms are outstretched, made better by alcohol and propranolol
ALS
long term mx for food if they can swallow?
Percutaneous gastrostomy tube (PEG)
A POCI (posterior circulation infarct) involves … what artery…?
vertebrobasilar arteries
multiple sclerosis complains of tingling in her hands which comes on when she flexes her neck.
sign?
Lhermitte’s sign
Hyperacusis - along with one sided lower facial parylsis, young person,
what condition?
Hyperacusis is when everyday sounds seem much louder to you than they should.
bells palsy
antiepileptic drugs is most associated with weight gain?
SODIUM VALPORATE
how to manage pain relief in neuropathic pain?
Drugs for neuropathic pain are typically used as monotherapy, i.e. if not working then drugs should be switched, not added
Parkinson’s disease medications: higher risk of hallucinations?
Ropinirole
parkinsons 1st line tx?
if the motor symptoms are affecting the patient’s quality of life: levodopa
if the motor symptoms are not affecting the patient’s quality of life: dopamine agonist (non-ergot derived), levodopa or monoamine oxidase B (MAO‑B) inhibitor
dose of rectal diazapem in adult?
a loss of dexterity in both hands.
struggling to type at work and use her mobile phone.
Her symptoms have been deteriorating gradually over the preceding months.
dx?
Degenerative cervical myelopathy leads to loss of fine motor function in both upper limbs.
stroke definitive mx is thrombolysis and thrombectomy for acute ischaemic attack.
what is the the time frame for each?
thrombectomy 6hrs
thrmobolysis 4.5 hours
speech non-fluent,
WHAT PART BRAIN DAMAGED?
FRONTAL LOBE
brocas dysphasia
