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Neuro Flashcards

1
Q

Management of cluster headaches

A

Acute: 100% O2, sc triptan

prophylaxis: verapamil

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2
Q

Thrombolysis with alteplase for acute ischemic stroke

A

Administered within 4.5 hours of onset of stroke symptoms

Haemorrhage has been definitively excluded

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3
Q

Lambert-Eaton syndrome or myasthenia gravis?

A

Weakness in Lambert Eaton improves after exercise, unlike myasthenia gravis; which worsens after exercise

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4
Q

Acute relapse of MS tx

A

High-dose steroids (e.g. oral or IV methylprednisolone) for 5 days

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5
Q

Classification system for strokes

A

The Oxford Stroke Classification (also known as the Bamford Classification)

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6
Q

Oxford Stroke Classification

A

The following criteria should be assessed:

  1. unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
  2. homonymous hemianopia
  3. higher cognitive dysfunction e.g. dysphasia
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7
Q

Migraine acute attack tx vs prophylaxis

A
  • acute: triptan + NSAID or triptan + paracetamol
  • prophylaxis: topiramate or propranolol
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8
Q

What scoring system measures disability or dependence in activities of daily living in stroke patients

A

The Barthel index

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9
Q

Anterior cerebral artery

A

Contralateral hemiparesis and sensory loss

lower extremity > upper

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10
Q

Middle cerebral artery

A

Contralateral hemiparesis and sensory loss, upper extremity > lower

Contralateral homonymous hemianopia
Aphasia

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11
Q

Posterior cerebral artery

A

Contralateral homonymous hemianopia with macular sparing

Visual agnosia

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12
Q

Weber’s syndrome (branches of the posterior cerebral artery that supply the midbrain)

A

Ipsilateral CN III palsy

Contralateral weakness of upper and lower extremity

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13
Q

Posterior inferior cerebellar artery (lateral medullary syndrome, Wallenberg syndrome)

A

Ipsilateral: facial pain and temperature loss

Contralateral: limb/torso pain and temperature loss

Ataxia, nystagmus

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14
Q

Anterior inferior cerebellar artery (lateral pontine syndrome)

A

Symptoms are similar to Wallenberg’s (see above), but: Ipsilateral: facial paralysis and deafness

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15
Q

Retinal/ophthalmic artery

A

Amaurosis fugax

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16
Q

Basilar artery

A

‘Locked-in’ syndrome

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17
Q

Lacunar strokes

A
  • present with either isolated hemiparesis, hemisensory loss or hemiparesis with limb ataxia
  • strong association with hypertension
  • common sites include the basal ganglia, thalamus and internal capsule
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18
Q

Most common cancers which metastise to the brain

A

lung, breast, kidney, melanoma and colorectal

19
Q

Glasgow Coma Scale

A
20
Q

How to to differentiate between a true seizure and a pseudoseizure

A

Raised serum prolactin = true epileptic seizure

21
Q

Normal pressure hydrocephalus triad

A
  • urinary incontinence
  • dementia and bradyphrenia
  • gait abnormality (may be similar to Parkinson’s disease)
22
Q

MRC power score

A

0 No contraction
1 Flicker or trace of contraction
2 Active movement, with gravity eliminated
3 Active movement against gravity
4 Active movement against gravity and resistance
5 Normal power

23
Q

‘What?’ as the patient doesn’t understand a command

Wernicke’s aphasia

A

speech fluent, comprehension abnormal, repetition impaired

(lesion in superior temporal gyrus)

24
Q

Broca sounds like ‘broken’ as the patient’s word-flow is broken

Broca’s aphasia

A

Broca’s is an expressive aphasia

Comprehension normal but speech is non-fluent, repetition is impaired

(lesion in left inferior frontal gyrus)

25
Q

Brown-Sequard syndrome

A
26
Q

Cushing reflex

A

Widening pulse pressure, bradycardia and irregular breathing

late sign indicating impending brain herniation

27
Q

Investigation for Vestibular schwannomas

A
  • MRI of the cerebellopontine angle
  • Audiometry
28
Q

Optic neuritis features

A
  • Central scotoma (enlarged blind spot)
  • Pain on eye movement
  • Impaired colour vision
  • RAPD
29
Q

First-line for spasticity in multiple sclerosis

A

Baclofen and gabapentin

30
Q

Medication for oscillopsia in MS

A

gabapentin

31
Q
A

Dopamine receptor agonists

32
Q

common adverse effects of levodopa

A
  • dry mouth
  • anorexia
  • palpitations
  • postural hypotension
  • psychosis
33
Q

Levodopa - end-of-dose wearing off

A

symptoms often worsen towards the end of dosage interval. This results in a decline of motor activity

34
Q

Levodopa ‘on-off’ phenomenon’

A

large variations in motor performance, with normal function during the ‘on’ period, and weakness and restricted mobility during the ‘off’ period

35
Q

Levodopa - dyskinesias at peak dose

A

dystonia, chorea and athetosis (involuntary writhing movements)

36
Q

Levodopa in patient admitted to hospital or vomiting

A

Do NOT stop if admitted to hospital

If cannot take orally: give dopamine agonist patch as rescue medication to prevent acute dystonia

37
Q

Assessment tools for dementia in the non-specialist setting

A
  • 10-point cognitive screener (10-CS)
  • 6-Item cognitive impairment test (6CIT)
38
Q

Stevens-Johnson syndrome

A

Maculopapular, erythematous, diffuse rash with mucosal involvement and skin sloughing and blistering when rubbing the skin (Nikolsy’s sign)

39
Q

Which area of the brain affects Alzheimer’s

A

Widespread cerebral atrophy mainly involving the cortex and hippocampus

40
Q

Investigating a suspected SAH

A

Non-contrast CT head

  • Positive CT → confirmed SAH
  • If CT head is done >6hrs after onset and normal → do LP
  • If done within 6 hours of onset and normal → consider alt dx (do NOT do LP)
41
Q

Within what time frame should a LP be done in suspected SAH and why

A

At least 12 hours AFTER onset of symptoms

To allow development of xanthochromia

42
Q

Role of Xanthochromia in SAH diagnosis

A

Xanthochromia helps to distinguish true SAH from a ‘traumatic tap’ (blood introduced by LP procedure)

43
Q

Investigating cause of pathology once SAH confirmed

A
  • CT intracranial angiogram (to identify a vascular lesion e.g. aneurysm or AVM)
  • +/- digital subtraction angiogram (catheter angiogram)

Finals (10 decks)

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