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Finals HH > Neuro > Flashcards

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
  4. 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
Q

CT of extradural & subdural

A

Extradural - Hyperdense biconvex lens (LEMON)

Subdural - Hypodense crescent shaped (BANANA)

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26
Q

Px of raised ICP?

A

Constant headache worse on waking / coughing / bending forward

Vomiting

Visual field defects

Unilateral ptosis

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27
Q

Initial Ix of raised ICP

A

Fundoscopy -> papilloedema

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28
Q

Complications of raised ICP

A

Cushing’s reflex
Herniation

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29
Q

What is the triad of cushing’s reflex?

A

Bradycardia, increased BP, irregular breathing

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30
Q

What herniates in a sub-falcine herniation and what is compressed?

A

Cingulate gyrus

Contralateral hemisphere -> hydrocephalus

Pericallosal arteries -> lower limb hemiparesis

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31
Q

What herniates in an uncal herniation and what is compressed?

A

Medial temporal lobe

CN III palsy -> unreactive, fixed & dilated pupil

Ipsi posterior c artery -> contralateral homo hemianopia

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32
Q

Px of brain tumours?

A
  • Raised intra-cranial pressure
  • Focal neurological symptoms
  • Seizures
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33
Q

Px of brain tumours in children?

A

Tiptoeinig, ataxia, vomiting with headache

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34
Q

What could a ring-enhancing lesion be on MRI of brain?
(MAGIC DR)

A

M – metastasis
A – abscess
G – glioblastoma
I – infarct
C – contusion
D – demyelinating disease
R – radiation necrosis

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35
Q

Px of migraine?

A

Unilateral pounding
N&V
Worse moving
Photophobia
Aura

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36
Q

Px of tension headache?

A

Bilateral pressing ache
Non-pulsatile

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37
Q

Px of cluster headache?

A

Sharp, throbbing
around eye

30-50y
Smoker

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38
Q

Frequency and length of cluster headache?

A

8 / day lasting 45-90 mins

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39
Q

Frequency and length of paroxysmal hemicrania headache?

A

40/day, 10-30 mins

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40
Q

Frequency and length of SUNCT headache?

A

200/day, <2mins

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41
Q

Frequency and length of migraine headache?

A

> 5 month
Lasting 4-72 hours

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42
Q

Acute mx of migraine?

A

Paracetamol, NSAIDs, Triptans

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43
Q

Acute mx of cluster headache?

A
  • High flow O2
  • Subcut
    sumatriptan
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44
Q

Acute mx of paroxysmal hemicrania headache?

A

Indomethacin

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45
Q

Acute mx of SUNCT headache?

A

Lamotrigine
Gabapentin

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46
Q

Migraine prophylaxis?

A
  1. Mindfulness or CBT
    + Vit B2 (riboflavin)
  2. Consider 6-12mo:
    - Amitriptyline
    - Propranolol
    - Topiramate
  3. Acupuncture if drugs ineffective
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47
Q

Tension headache prophylaxis?

A
  1. Relaxation techniques
  2. Basic analgesia
  3. Amitriptyline
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48
Q

Mx of sinus headache?

A

<10 days -> self-limiting (majority viral) + basic analgesia

> 10 days with no improvement
- High-dose nasal corticosteroid (mometasone)
- Consider antibiotics

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49
Q

Px of hormonal headache?

A

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)

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50
Q

Mx of hormonal headache?

A

Basic analgesia, COCP can improve symptoms

Menstrual migraine – Frovatriptan or zolmitriptan on days of migraine or from 2 days before period

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51
Q

Px of trigeminal neuralgia?

A

Sharp stabbing intense pain lasting up to 2 minutes of CN V distribution
- ‘Electric shock in jaw’
- 90% unilateral

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52
Q

Mx of trigeminal neuralgia?

A

Carbamazepine

Surgery to decompress trigeminal nerve

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53
Q

Facial nerve functions?

A

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
Q

How to tell if lesion of facial palsy is UMN or LMN?

A

UMN lesion -> forehead spared as other side of brain saves day

Lower motor neuron lesion -> forehead affected

55
Q

UMN lesion causes of facial palsy?

A

Strokes
Tumours

56
Q

LMN lesion causes of facial palsy?

A

Bell’s palsy
Ramsay hunt syndrome
Acoustic neuroma
M.S

57
Q

Px of Bell’s palsy?

A

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
Q

Mx of Bell’s palsy?

A

Full recovery in 3-4 months
- Oral prednisolone, lubricating eye drops, tape eye at bedtime

59
Q

Mx of ramsay-hunt syndrome?

A

Prednisolone + aciclovir + lubricating eye drops

60
Q

Px of ramsay-hunt syndrome?

A

LMN facial nerve palsy

Painful tender vesicular rash in ear canal, pinna and around affected ear

61
Q

What nerve is affected and where is the numbness in carpal tunnel syndrome?

A

Median nerve

Numb thumb + radial 2 and a half fingers

62
Q

What nerve is affected and where is the numbness in cubitaltunnel syndrome?

A

Ulnar nerve

Numb pinky + half of ring finger

Weakness of small muscles of hand but not the thumb
- Weak hand grip

63
Q

What is the px of radial nerve injury?

A

Wrist drop – weak thumb, finger and wrist extension

Tenderness over distal radial head, pain worse at night

64
Q

Mx of carpal tunnel syndrome?

A

A 6-week trial of:
- Wrist splint
- Steroid injection
- Hand exercises

Carpal tunnel nerve decompression

65
Q

Mx of cubital tunnel syndrome?

A

Severe -> surgical decompression

66
Q

Mx of radial nerve injury?

A

Severe -> Wrist splint to maintain extension

67
Q

C6 sensation?

A

Sensation:
Neck
Lateral forearm
Thumb and index finger

68
Q

C6 motor weakness?

A

Elbow flexion
Forearm supination
Wrist extension

69
Q

C7 sensation?

A

Lower neck
Interscapular
Posterior forearm
Middle finger

70
Q

C7 motor weakness?

A

Elbow extension
Forearm pronation
Wrist flexion
Finger extension

71
Q

C8 sensation?

A

Inter- & infra-scapular
Medial forearm
4rth & 5th finger

72
Q

C8 motor weakness?

A

Thumb extension
Finger flexion

73
Q

L4 sensation?

A

Anterior thigh
Medial lower leg / foot

74
Q

L4 motor weakness?

A

Knee extension
Ankle dorsiflexion

75
Q

L5 sensation?

A

Posterolateral thigh
Lateral leg
Medial foot

76
Q

L5 motor weakness?

A

Dorsiflexion foot/toes
Knee flexion & hip extension

77
Q

S1 sensation?

A

Posterior thigh and leg
Lateral side of foot

78
Q

S1 motor weakness?

A

Plantar flexion foot/toes
Knee flexion & hip extension

79
Q

Causes of radiculopathy?

A

Degenerative changes – spondylosis (bony spurs impinging nerves), herniation

Lesions – tumours, osteomyelitis

Spinal stenosis

80
Q

Cervical level and reflex?

A

C6 - Biceps, brachioradialis
C7 - Triceps

L4 - Patellar reflex
L5, S1 - Achilles reflex

81
Q

Frontal lobe seizure px?

A

Unusual movements
Screaming, swearing or laughing
Urinary incontinence
Twitching / jerking of muscles

82
Q

Occipital lobe seizure px?

A

Unusual visions (seeing things)
Uncontrollable eye movements
Repeated blinking

83
Q

Parietal lobe seizures px?

A

Unusual sensations (numbness, tingling, burning, crawling)

Difficulty understanding language, reading, writing or doing maths

Seeing things as the wrong size

84
Q

Temporal lobe seizures px?

A

Unusual feelings (deja vu, frightened)
Unpleasant taste, smell or sound
Lip smacking, repeated swallowing or chewing

85
Q

Ix for epilepsy?

A

EEG
MRI

86
Q

Mx of tonic-clonic seizures?

A
  1. Sodium valproate
  2. Lamotrigine or carbamazepine
87
Q

Mx of focal seizures?

A
  1. Carbamazepine or lamotrigine
  2. Sodium valproate or levetiracetam
88
Q

Mx of infantile spasms?

A

Prednisolone
Vigabatrin

89
Q

S/e of sodium valproate?

A

Teratogenic
Liver damage
Hair loss
Tremor

90
Q

Carbamazepine s/e?

A

Agranulocytosis
Aplastic anaemia

91
Q

Phenytoin s/e?

A

Folate and VitD deficiency
Megaloblastic anaemia
Osteomalacia

92
Q

Lamotrigine s/e?

A

Stevens-Johnson syndrome or DRESS syndrome
Leukopenia

93
Q

Definition of status epilepticus?

A

Seizures lasting more than 5 minutes or more than 3 seizures in one hour

94
Q

Does M.S affect peripheral or central nervous system?

A

Affects CNS (oligodendrocytes)

95
Q

Common Px of M.S?

A

Optic neuritis
Eye movement abnormality
Focal weakness
Focal sensory symptom
Ataxia

96
Q

Sixth nerve palsy description?

A

Internuclear ophthalmoplegia
Conjugate lateral gaze disorder

97
Q

Types of M.S?

A

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
Q

M.S Ix?

A

MRI
Lumbar puncture -> oligoclonal bands in CSF

99
Q

Px of optic neuritis/

A

Unilateral reduced vision over hours - days

Central scotoma
Pain on eye movement
Impaired colour vision
RAPD

100
Q

Mx of M.S relapse?

A

Methylprednisolone:
1. 500mg OD for 5 days
2. 1g IV for 3-5 days

101
Q

Px of MND?

A

Progressive muscle weakness
No sensory loss
Fatigue when exercising
Clumsiness, dropping things

102
Q

Mx of MND?

A

Riluzole - extends life by three months

103
Q

Parkinson’s px?

A

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
Q

Parkinson’s tremor vs Benign essential tremor?

A

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
Q

Mx of Parkinson’s?

A

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
Q

Levodopa s/e?

A

Dyskinesias:

Dystonia - abnormal postures or exaggerated movements

Chorea - jerking, random abnormal involuntary movement

Athetosis - involuntary twisting or writhing movements

107
Q

Neuroleptic malignant syndrome px?

A

Occurs within hours to days of starting an anti-psychotic

Pyrexia
Muscle rigidity
Autonomic lability
Agitated delirium
Raised creatine kinase

108
Q

Neuroleptic malignant syndrome mx?

A

Stop antipsychotic
IV fluids to prevent renal failure
Consider - dantrolene, bromocriptine

109
Q

Mx of benign essential tremor?

A

Propranolol
Primidone

110
Q

First line Mx of neuropathic pain?

A

Amitriptyline
Duloxetine
Gabapentin
Pregabalin

111
Q

First line Mx of trigeminal neuralgia?

A

Carbamazepine

112
Q

Is forehead sparing in UMN lesion or LMN lesion?

A

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
Q

Px of bell’s palsy?

A

LMN facial nerve palsy
- Forehead affected
- Drooping of eyelid
- Loss of nasolabial fold

114
Q

Mx of bell’s palsy?

A

If within 72h -> prednisolone + eye drops

115
Q

Mx of Ramsay-hunt syndrome?

A

Acyclovir + prednisolone + eye drops

116
Q

Px of Ramsay-Hunt syndrome?

A

LMN facial nerve palsy:
- Forehead affected
- Drooping of eyelid
- Loss of nasolabial fold

Painful and tender vesicular rash in ear canal

117
Q

Signs of raised ICP?

A

Constant head
Worse on waking
Worse on coughing, straining or bending forward
Vomiting

Other:
- Visual field defects
- Focal seizures
- Papilledema

118
Q

What cancers commonly metastasise to the brain? (5)

A

Lung
Breast
Bowel
Renal cell carcinoma
Melanoma

119
Q

What is the inheritance of Huntington’s disease?

A

Autosomal dominant

120
Q

Features of Huntington’s disease?

A

Chorea - sudden, uncontrollable jerky movements
Personality changes
Dystonia
Saccadic eye movements

121
Q

Px of myasthenia gravis?

A

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
Q

Ix of myasthenia gravis?

A

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
Q

Mx of myasthenia gravis?

A

Acetylcholinesterase inhibitors - Pyridostigmine

Immunosuppression - Prednisolone or Azathioprine

Monoclonal antibodies - Rituximab, Eculizumab

124
Q

Mx of lambert-eaton syndrome?

A

Ix & Mx small cell lung cancer

Amifampridine

125
Q

Causes of peripheral neuropathy mnemonic?

A

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
Q

Px of Charcot-Marie-Tooth?

A

High foot arches (pes cavus)
Distal muscle wasting -> “inverted champagne bottle legs”
Weakness in lower legs & hands
Peripheral sensory loss

127
Q

Mx of Gullian Barre?

A

IV immunoglobulins
Plasma exchange
VTE prophylaxis
Supportive care

128
Q

What is neurofibromatosis type 2 most associated with?

A

Acoustic neuromas
- Hearing loss
- Tinnitus
- Balance problems

129
Q

Px of tuberous sclerosis?

A

Epilepsy + skin signs:
- Ash leaf spots
- Shagreen patches
- Angiofibromas
- Cafe-au-lait spots
- Poliosis - isolated patch of white hair on head

130
Q

Px of neurofibromatosis type 1 mnemonic?

A

CRABBING

Finals HH (21 decks)

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