Neuro Flashcards

1
Q

What is a stroke and TIA?

A

Stoke = permanent, neurological deficit lasting >24 hours

TIA = transient neurological dysfunction secondary to ischaemic without infarction

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2
Q

Px of TACS?

A

3/3 of:
1. Unilateral weakness (+/- sensory loss) of the face, arms and leg
2. Homonymous hemianopia
3. Higher cerebral dysfunction (dysphasia, visuospatial disorder)

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3
Q

Px of lacunar syndrome?

A
  • Pure motor or pure sensory stroke
  • Ataxic hemiparesis
  • Dysarthia
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4
Q

Px of POCS?

A
  • Isolate homonymous hemianopia
  • Cerebellar dysfunction
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5
Q

MCA embolism affects?

A

Face & upper limb > lower limb

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6
Q

ACA embolism affects?

A

Lower limb > upper limb

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7
Q

Scoring tools to identify stroke?

A

In community -> FAST (Face, arm, speech, time)
+ Exclude hypoglycaemia

In hospital -> Rosier scoring tool

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8
Q

TIA Mx?

A
  1. Aspirin
  2. <24hr see stroke specialist
  3. Consider MRI, carotid imaging
    • secondary prevention:
      - Clopidogrel
      - Atorvastatin
      - If carotid stenosis >50%
      -> endarterectomy
      - Modify risk factor
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9
Q

Acute ischaemic stroke mx?

A
  1. Aspirin
    + PPI if dyspepsia hx
  2. Thrombolysis (alteplase)
    - Within 4.5 hours
    • Thrombectomy
      - Within 6 hours
      - Salvageable brain tissue seen
  3. Consider decompressive hemicraniectomy in previously fit cases
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10
Q

Haemorrhagic stroke mx?

A

Return clotting levels to normal
- Reverse warfarin with Prothrombin + IV vit K

Consider lowering BP if:
- Px within 6h
- Systolic Bp between 150-220

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11
Q

What does a dominant hemisphere stroke affect?

A

Often affects language

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12
Q

What does a non-dominant hemisphere stroke affect?

A

Affects spatial awareness

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13
Q

Points for eyes in GCS?

A

4 = Spontaneous
3 = Speech
2 = Pain
1 = None

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14
Q

Points for verbal response in GCS?

A

5 = Orientated
4 = Confused conversation
3 = Inappropriate words
2 = Incomprehensible words
1 = None

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15
Q

Points for motor response in GCS?

A

6 = Obeys commands
5 = Localises pain
4 = Normal flexion
3 = Abnormal flexion
2 = Extends
1 = None

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16
Q

At what score, consider securing airway?

A

8 or less

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17
Q

What is the origin of a extradural haemorrhage?

A

Middle meningeal artery

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18
Q

What is the origin of an subdural haemorrhage?

A

Bridging cerebral veins

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19
Q

What is the origin of a subarachnoid haemorrhage?

A

Circle of wilis, sacular
‘Berry’ aneurysms

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20
Q

Where does an extradural haemorrhage occur?

A

Between skull bone and dura

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21
Q

Where does a subdural haemorrhage occur?

A

Between dura and arachnoid

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22
Q

Who and Px of extradural haemorrhage?

A

Who:
Young
Head trauma
Rapid GCS decline
Temporal bone fracture

Px:
Lucid intervals
Unilateral fixed pupil ->
bilateral

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23
Q

Who and Px of subdural haemorrhage?

A

Who:
Older patients
Low impact trauma
Alcoholics

Px:
Progressive headache and confusion

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24
Q

Who and Px of subarachnoid haemorrhage?

A

Who:
Sickle cell anaemics
CTD
Cocaine use
Strenuous activity (weightlifting, sex)

Px:
Worst headache ever (occipital)
N&V
Neck stiffness Photophobia

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25
CT of extradural & subdural
Extradural - Hyperdense biconvex lens (LEMON) Subdural - Hypodense crescent shaped (BANANA)
26
Px of raised ICP?
Constant headache worse on waking / coughing / bending forward Vomiting Visual field defects Unilateral ptosis
27
Initial Ix of raised ICP
Fundoscopy -> papilloedema
28
Complications of raised ICP
Cushing's reflex Herniation
29
What is the triad of cushing's reflex?
Bradycardia, increased BP, irregular breathing
30
What herniates in a sub-falcine herniation and what is compressed?
Cingulate gyrus Contralateral hemisphere -> hydrocephalus Pericallosal arteries -> lower limb hemiparesis
31
What herniates in an uncal herniation and what is compressed?
Medial temporal lobe CN III palsy -> unreactive, fixed & dilated pupil Ipsi posterior c artery -> contralateral homo hemianopia
32
Px of brain tumours?
- Raised intra-cranial pressure - Focal neurological symptoms - Seizures
33
Px of brain tumours in children?
Tiptoeinig, ataxia, vomiting with headache
34
What could a ring-enhancing lesion be on MRI of brain? (MAGIC DR)
M – metastasis A – abscess G – glioblastoma I – infarct C – contusion D – demyelinating disease R – radiation necrosis
35
Px of migraine?
Unilateral pounding N&V Worse moving Photophobia Aura
36
Px of tension headache?
Bilateral pressing ache Non-pulsatile
37
Px of cluster headache?
Sharp, throbbing around eye 30-50y Smoker
38
Frequency and length of cluster headache?
8 / day lasting 45-90 mins
39
Frequency and length of paroxysmal hemicrania headache?
40/day, 10-30 mins
40
Frequency and length of SUNCT headache?
200/day, <2mins
41
Frequency and length of migraine headache?
>5 month Lasting 4-72 hours
42
Acute mx of migraine?
Paracetamol, NSAIDs, Triptans
43
Acute mx of cluster headache?
- High flow O2 - Subcut sumatriptan
44
Acute mx of paroxysmal hemicrania headache?
Indomethacin
45
Acute mx of SUNCT headache?
Lamotrigine Gabapentin
46
Migraine prophylaxis?
1. Mindfulness or CBT + Vit B2 (riboflavin) 2. Consider 6-12mo: - Amitriptyline - Propranolol - Topiramate 3. Acupuncture if drugs ineffective
47
Tension headache prophylaxis?
1. Relaxation techniques 2. Basic analgesia 3. Amitriptyline
48
Mx of sinus headache?
<10 days -> self-limiting (majority viral) + basic analgesia >10 days with no improvement - High-dose nasal corticosteroid (mometasone) - Consider antibiotics
49
Px of hormonal headache?
Generic, non-specfic, tension-like headache o Two days before and first three days of menstrual period o Around the menopause o Pregnancy (first few weeks)
50
Mx of hormonal headache?
Basic analgesia, COCP can improve symptoms Menstrual migraine – Frovatriptan or zolmitriptan on days of migraine or from 2 days before period
51
Px of trigeminal neuralgia?
Sharp stabbing intense pain lasting up to 2 minutes of CN V distribution - ‘Electric shock in jaw’ - 90% unilateral
52
Mx of trigeminal neuralgia?
Carbamazepine Surgery to decompress trigeminal nerve
53
Facial nerve functions?
Motor: - Muscles of facial expression - Stapedius in the inner ear - Neck muscles – posterior digastric, stylohyoid and platysma Sensory: - Taste from anterior 2/3rd tongue Parasympathetic: - Submandibular & sublingual salivary glands - Lacrimal glands (tear production)
54
How to tell if lesion of facial palsy is UMN or LMN?
UMN lesion -> forehead spared as other side of brain saves day Lower motor neuron lesion -> forehead affected
55
UMN lesion causes of facial palsy?
Strokes Tumours
56
LMN lesion causes of facial palsy?
Bell's palsy Ramsay hunt syndrome Acoustic neuroma M.S
57
Px of Bell's palsy?
Rapid onset (<72h) unilateral LMN facial nerve palsy Facial muscle weakness – reduced movement, dropping of eyebrow & mouth corner Difficulty chewing, change in taste Incomplete eye closure -> dry eye Ear and postauricular region pain
58
Mx of Bell's palsy?
Full recovery in 3-4 months - Oral prednisolone, lubricating eye drops, tape eye at bedtime
59
Mx of ramsay-hunt syndrome?
Prednisolone + aciclovir + lubricating eye drops
60
Px of ramsay-hunt syndrome?
LMN facial nerve palsy Painful tender vesicular rash in ear canal, pinna and around affected ear
61
What nerve is affected and where is the numbness in carpal tunnel syndrome?
Median nerve Numb thumb + radial 2 and a half fingers
62
What nerve is affected and where is the numbness in cubitaltunnel syndrome?
Ulnar nerve Numb pinky + half of ring finger Weakness of small muscles of hand but not the thumb - Weak hand grip
63
What is the px of radial nerve injury?
Wrist drop – weak thumb, finger and wrist extension Tenderness over distal radial head, pain worse at night
64
Mx of carpal tunnel syndrome?
A 6-week trial of: - Wrist splint - Steroid injection - Hand exercises Carpal tunnel nerve decompression
65
Mx of cubital tunnel syndrome?
Severe -> surgical decompression
66
Mx of radial nerve injury?
Severe -> Wrist splint to maintain extension
67
C6 sensation?
Sensation: Neck Lateral forearm Thumb and index finger
68
C6 motor weakness?
Elbow flexion Forearm supination Wrist extension
69
C7 sensation?
Lower neck Interscapular Posterior forearm Middle finger
70
C7 motor weakness?
Elbow extension Forearm pronation Wrist flexion Finger extension
71
C8 sensation?
Inter- & infra-scapular Medial forearm 4rth & 5th finger
72
C8 motor weakness?
Thumb extension Finger flexion
73
L4 sensation?
Anterior thigh Medial lower leg / foot
74
L4 motor weakness?
Knee extension Ankle dorsiflexion
75
L5 sensation?
Posterolateral thigh Lateral leg Medial foot
76
L5 motor weakness?
Dorsiflexion foot/toes Knee flexion & hip extension
77
S1 sensation?
Posterior thigh and leg Lateral side of foot
78
S1 motor weakness?
Plantar flexion foot/toes Knee flexion & hip extension
79
Causes of radiculopathy?
Degenerative changes – spondylosis (bony spurs impinging nerves), herniation Lesions – tumours, osteomyelitis Spinal stenosis
80
Cervical level and reflex?
C6 - Biceps, brachioradialis C7 - Triceps L4 - Patellar reflex L5, S1 - Achilles reflex
81
Frontal lobe seizure px?
Unusual movements Screaming, swearing or laughing Urinary incontinence Twitching / jerking of muscles
82
Occipital lobe seizure px?
Unusual visions (seeing things) Uncontrollable eye movements Repeated blinking
83
Parietal lobe seizures px?
Unusual sensations (numbness, tingling, burning, crawling) Difficulty understanding language, reading, writing or doing maths Seeing things as the wrong size
84
Temporal lobe seizures px?
Unusual feelings (deja vu, frightened) Unpleasant taste, smell or sound Lip smacking, repeated swallowing or chewing
85
Ix for epilepsy?
EEG MRI
86
Mx of tonic-clonic seizures?
1. Sodium valproate 2. Lamotrigine or carbamazepine
87
Mx of focal seizures?
1. Carbamazepine or lamotrigine 2. Sodium valproate or levetiracetam
88
Mx of infantile spasms?
Prednisolone Vigabatrin
89
S/e of sodium valproate?
Teratogenic Liver damage Hair loss Tremor
90
Carbamazepine s/e?
Agranulocytosis Aplastic anaemia
91
Phenytoin s/e?
Folate and VitD deficiency Megaloblastic anaemia Osteomalacia
92
Lamotrigine s/e?
Stevens-Johnson syndrome or DRESS syndrome Leukopenia
93
Definition of status epilepticus?
Seizures lasting more than 5 minutes or more than 3 seizures in one hour
94
Does M.S affect peripheral or central nervous system?
Affects CNS (oligodendrocytes)
95
Common Px of M.S?
Optic neuritis Eye movement abnormality Focal weakness Focal sensory symptom Ataxia
96
Sixth nerve palsy description?
Internuclear ophthalmoplegia Conjugate lateral gaze disorder
97
Types of M.S?
Relapsing-remitting (most common) - disease followed by recovery Secondary progressive - initial relapsing-remitting which progressively worsens Primary progressive - no relapses or remissions over 1 year
98
M.S Ix?
MRI Lumbar puncture -> oligoclonal bands in CSF
99
Px of optic neuritis/
Unilateral reduced vision over hours - days Central scotoma Pain on eye movement Impaired colour vision RAPD
100
Mx of M.S relapse?
Methylprednisolone: 1. 500mg OD for 5 days 2. 1g IV for 3-5 days
101
Px of MND?
Progressive muscle weakness No sensory loss Fatigue when exercising Clumsiness, dropping things
102
Mx of MND?
Riluzole - extends life by three months
103
Parkinson's px?
Resting tremor - "pill rolling" Rigidity - "cogwheel rigidity" Bradykinesia: - Hand writing gets smaller - "shuffling gait" - Reduced facial movements Other px: - Anosmia - Depression, insomnia - Postural instability - Cognitive impairment
104
Parkinson's tremor vs Benign essential tremor?
Parkinson's tremor: - Worse at rest - Improves with movement - No change with alcohol Essential tremor: - Improves at rest - Worse with movement - Improves with alcohol
105
Mx of Parkinson's?
Motor symptoms affecting quality of life -> levodopa Motor symptoms not affecting quality of life: - Dopamine agonist - Monoamine oxidase inhibitor - Levodopa Dopamine agonists: - Bromocryptine - Pergolide - Cabergoline MO-B inhibitor: - Selegiline - Rasagiline
106
Levodopa s/e?
Dyskinesias: Dystonia - abnormal postures or exaggerated movements Chorea - jerking, random abnormal involuntary movement Athetosis - involuntary twisting or writhing movements
107
Neuroleptic malignant syndrome px?
Occurs within hours to days of starting an anti-psychotic Pyrexia Muscle rigidity Autonomic lability Agitated delirium Raised creatine kinase
108
Neuroleptic malignant syndrome mx?
Stop antipsychotic IV fluids to prevent renal failure Consider - dantrolene, bromocriptine
109
Mx of benign essential tremor?
Propranolol Primidone
110
First line Mx of neuropathic pain?
Amitriptyline Duloxetine Gabapentin Pregabalin
111
First line Mx of trigeminal neuralgia?
Carbamazepine
112
Is forehead sparing in UMN lesion or LMN lesion?
Upper motor neuron lesion has forehead sparing UMN has bilateral supply to forehead LMN has unilateral supply to forehead So if forehead affected, must be LMN
113
Px of bell's palsy?
LMN facial nerve palsy - Forehead affected - Drooping of eyelid - Loss of nasolabial fold
114
Mx of bell's palsy?
If within 72h -> prednisolone + eye drops
115
Mx of Ramsay-hunt syndrome?
Acyclovir + prednisolone + eye drops
116
Px of Ramsay-Hunt syndrome?
LMN facial nerve palsy: - Forehead affected - Drooping of eyelid - Loss of nasolabial fold Painful and tender vesicular rash in ear canal
117
Signs of raised ICP?
Constant head Worse on waking Worse on coughing, straining or bending forward Vomiting Other: - Visual field defects - Focal seizures - Papilledema
118
What cancers commonly metastasise to the brain? (5)
Lung Breast Bowel Renal cell carcinoma Melanoma
119
What is the inheritance of Huntington's disease?
Autosomal dominant
120
Features of Huntington's disease?
Chorea - sudden, uncontrollable jerky movements Personality changes Dystonia Saccadic eye movements
121
Px of myasthenia gravis?
Proximal muscles and small muscles of head and neck affected more - Diplopia - Ptosis - Weak facial movements - Difficulty swallowing - Jaw fatigue when chewing - Slurred speech
122
Ix of myasthenia gravis?
Antibody testing: - Acetylcholine receptor (ACh-R) antibodies - Muscle-specific kinase (MuSK) antibodies - LRP4 antibodies CT or MRI of thymus to look for thymoma Endrophonium test
123
Mx of myasthenia gravis?
Acetylcholinesterase inhibitors - Pyridostigmine Immunosuppression - Prednisolone or Azathioprine Monoclonal antibodies - Rituximab, Eculizumab
124
Mx of lambert-eaton syndrome?
Ix & Mx small cell lung cancer Amifampridine
125
Causes of peripheral neuropathy mnemonic?
ABCDE A - Alcohol B – B12 deficiency C – Cancer and Chronic Kidney Disease D – Diabetes and Drugs (e.g. isoniazid, amiodarone and cisplatin) E – Every vasculitis
126
Px of Charcot-Marie-Tooth?
High foot arches (pes cavus) Distal muscle wasting -> "inverted champagne bottle legs" Weakness in lower legs & hands Peripheral sensory loss
127
Mx of Gullian Barre?
IV immunoglobulins Plasma exchange VTE prophylaxis Supportive care
128
What is neurofibromatosis type 2 most associated with?
Acoustic neuromas - Hearing loss - Tinnitus - Balance problems
129
Px of tuberous sclerosis?
Epilepsy + skin signs: - Ash leaf spots - Shagreen patches - Angiofibromas - Cafe-au-lait spots - Poliosis - isolated patch of white hair on head
130
Px of neurofibromatosis type 1 mnemonic?
CRABBING