Neuro Flashcards
1
Q
Anterior cerebral artery stroke sx
A
Contralateral hemiparesis and sensory loss
Lower >upper
2
Q
Middle cerebral artery stroke
A
- Contralateral hemiparesis and sensory loss
- Upper > lower
- Contralateral homonymous hemianopia
- Aphasia
3
Q
Posterior cerebral artery
A
- Contralateral homonymous hemianopia with macular sparing
- Visual agnosia
4
Q
Weber’s syndrome
A
- Ipsilaterall CN 3 palsy
- Contralateral wekaness of upper and lower extremity
5
Q
PICA
A
- Lateral medullary syndrome, wallenberg
- Ipsilateral facial pain and temp loss
- Contralateral limb/torso pain and temp loss
- Ataxia
- Nystagmus
6
Q
Anterior inferior cerebellar artery stroke
A
- simmilar to wallenbergs but ipsilateral facial paralysis and deafness
7
Q
retinal/opthalmic artery stroke
A
- amaurosis fugax
8
Q
Basilar artery stroke
A
locked in
9
Q
definition epilepsy
A
- 2 unprovoked seizures >24hrs apart
10
Q
partial/focal seizure
A
- focal onset that can be referrable to single lobe
- simple = no affect on consciousness or memory
- complex = memory affected, post ictal confusion
11
Q
primary generalised seiuzure
A
- tonic
- clonic
- tonic clonic
- myoclonic
- atonic
- absence
12
Q
temporal lobe seizure
A
- aura
- anxiety
- automatisms = lip smacking
13
Q
frontal lobe seizure
A
- motor features
- jacksonian march
- post ictal todds palsy
14
Q
focal seizure mx
A
- lamotrigine
- levi
15
Q
generalised tonic clonic mx
A
- SV
- lamotrigine or levetiracetam if childbearing
16
Q
myoclonic mx
A
- sv
- levet
17
Q
tonic and atonic mx
A
- SV
- lamot
18
Q
DVLA criteria in eoilepsy?
A
- remove licence until specific criteria met
19
Q
benzo options for status
A
- buccal midazolam 10mg
- rectal diazepam 10mg
- IV lorazepam 4mg
20
Q
S+S ischaemic stroke
A
- FAST
- limb weakness opposite side infarct
- contralateral hemiplegia/hemiparesis
- vision loss/deficit
- hh
- aphasia
21
Q
Ix ischaemic stroke
A
- NCCT
- MRI
- Brachial BP
- Bloods, XR, ECG
- If CT shows hyper density = haemorrhagic
22
Q
ischaemic stroke acute mx
A
- thrombolysis within 4.5 hours onset with IV alteplase
23
Q
ischaemic stroke long term mx
A
- antihtn
- antiplatelet = aspirin, clopi 75mg OD
- aspirin = 300mg for 2w then reduced
- Statin 20-80mg
24
Q
thrombolysis CI
A
- recent surgery 3m
- recent arterial puncture
- hx active malignancy
- brain aneurysm
- anticoagulation
- liver disease or pancreatitis
25
haemorrhagic stroke mx
- stop anticoagulant immediately
- IV mannitol
26
carotid TIA S+S
- amourosis fugax
- aphasia
- hemiparesis
- hemisensory loss
- HH
27
vertebrobasilar TIA S+S
- diplopia, vertigo, vomiting
- choking
- ataxia
- hemisensory loss
- HH
- tetraparesis
28
TIA Ix
- diffusion weighted MRI
- carrotid doppler +/- angiography
- CT or DWMRI
- bloods
29
Mx TIA
- aspirin 300mg then 75 after 2w
- statin
- AF = anticoagulate
- carotic endarterectomy if >70% stenosis
30
S+S SAH
- thunderclap headache
- neck stiffness
- photophobia
- vomiting
- neurological sx
31
Ix SAH
- CT head = hyper-attenuation in subarachnoid space
- LP if CT normal = raised red cells and xanthochromia
32
Mx SAH
- surgery = endovascular coiling, clipping
- nimodipine
- cerebral perfusion
- dex
33
SAH aetiology
- berry aneurysms
- pckd
- injury
34
extradural haemorrhage characteristic
- head injury followed by brief unconsciousnes then fine
- young males
35
extradural patho
- fractured temporal or parietal bone = laceration MMA
36
S+S extradural
- deteriorating consciousness after head injury
- increasingly severe ehadache, vomiting, fits
- ipsilateral pupil dilates, bilateral limb weak
37
Ix and Mx extradural
- CT = lemon
- blot evacuatio nad ligation
- anticoag/platelet cessation
- iv mannitol
38
subdural haemorrhage rf
- elderly = falls, atrophy
- shaking baby
39
S+S extradural
- fluctuating cosnciousness
- headache
- confusion
- unsteady
40
subdural ix
- ct = banana
- mri
- clot +/- midline shift
41
mx subdural
- burr twist
- ac/ap cessation
- iv mannitol
- iv prothrombin and vit k
42
most common presentations of MS
- optic neuritis
- transverse myelitis
- cerebellar related symptoms
- brainstem syndromes
43
ms definition
- chronic progressive autoimmune condition involving demyelination of CNS
44
feautres optic neuritis
- central scotoma
- pain on movmenet
- impaired colour vision
- RAPD = affected eye constricts more when shining light in contralateral eye
45
lhermitte's sign
- electric shock sensation down spin when flexing neck
46
ms ix
- mri = brain and spine with contrast
- lp = oligoclonal bands igG
47
MS Mx
- RR mild = dimethyl fumarate
- RR = monoclonal abs = alemtuzumab
- methylpred for acute
- baclofen and gabapentin for spasticity
48
ms relapse tx
- 500mg oral steroids 5 days
- 1g IV daily for 3-5 days
49
signs of lowe motor neuron disease
- muscle wasting
- reduced tone
- fasciculations
- reduced reflexes
50
signs of upper motor neuron disease
- increased tone or spasticity
- brisk reflexes
- upgoing plantar reflex
51
what drug can slow als progression
riluzole
52
ALS S+S
- UMN signs and LMN wasting
- asymmetric
- bab +ve
- progressive focal muscle weakness and wasting
- fasciculations
53
PBL S+S
- lower cn nuclei
- elderly women
- dysarthria, dysphagia, nasal reurg
- fasiculations
- emotional incontinence
- 1st affected = talking, chewing, swallowing
54
are PD symptoms symmetric or asymmetric
- typically asymmetrical
55
parkinsons triad
- resting tremor = pill rolling, better on movement
- rigidity = cogwheel
- bradykinesia = buttons, shuffle walk, blank face
56
PD patho
- reduction of dopamine in basal ganglia
- mitochondrial dysfunction and oxidative stress on SN
- degeneration of dopaminergic neurones of SN
- decreased DA synthesis = decreased thalamus activity = decreased movement
57
PD Ix
- DaTSCAN
- MRI
58
PD Mx
1. levodopa with peripheral decarboxylase inhibitor = carbidopa
2. COMT inhibitors = slows breakdown of levodopa in brain
3. dopamine agonists
4. MAOB inhibitors = increase circulating dopamine
59
main se levodopa
dyskinesia
60
parkinsons plus syndromes
- multiple system atrophy = autonomic and cerebellar dysfunction
- lewy body dementia
- progressive supranuclear palsy
- corticobasal degeneration
61
essential tremor features
- fine tremor
- symmetrical
- worse on movement
- worse when tired
- improve by alcohol
62
mx essential tremor
- propranolol
- primidone
63
5 branches of facial nerve
- temporal
- zygomatic
- buccal
- marginal mandibular
- cervical
64
forehead in UMN lesion?
spared
65
LMN facial nerve palsy
- forehead affected
- drooping eyelid
- loss of nasolabial fold
66
Bells palsy S+S
- unilateral LMN facial nerve palsy
- reduction in movement on affected side
- ear pain on affected side
- dry mouth
- incomplete eye closure
- can get loss of taste on anterior 2/3
67
Mx bells
- within 72 hours 50mg pred 10 days of 60mg 5 days and reduce regime
- eye drops
68
ramsay hunt
- caused by vzv
- unilateral LMN palsy with painful vesicular rash in ear canal
- tx = aciclovir and prednisolone
69
concerning features suggesting intracranial HTN
- constant headache
- nocturnal
- worse on waking, coughing, straining
- vomiting
- papilloedema
70
cancers that most often spread to the brain
- lung
- breast
- RCC
- Melanoma
71
what is acoustic neuroma
- benign tumour of schwann cells that surround auditory nerve
- occur at cerebellopontine angle
72
AN - unilateral or bilateral
- unilateral
- associated with neurofibromatosis 2
73
S+S AN
- unilateral sensorineural hearing loss
- unilateral tinnitus
- dizzy
- full ear
- facial nerve palsy
74
AN Mx
- conservative
- surgery
- radiotherapy
75
genetics of huntingtons
- autosomal dominant
- trinucelotide repeat disorder = CAG
- Anticipation = successive generations have more repeats
76
S+S HD
- chorea
- dystonia
- rigidity
- eye movement disorders
- cognitive, psychiatric or mood problems
77
antibodies found in MG
- acetylcholine receptor antibodies
- bind to postsynaptic acetylcholine receptors = failure to trigger muscle action potential
78
S+S MG
- proximal muscles of limbs = top down
- har to climb stairs
- diplopia
- ptosis
- swallowing
- fatigue chewing
- snarl
79
Ix MG
- AChR antibodies
- CR or MRI thymus to look for thymoma
- edrophonium test
80
myasthenic crisis
- resp muscle weakness
- monitor FVC
- plasmanephrines or IVIG
81
MG Mx
- pyridostigmine = cholinesterase inhib
- immunosuppression
- thymectomy
- rituximab
82
drugs that exacerbate MG
- ciprofloxacin
- azithromycin
- propranolol
- atenolol
- verapimil
- lithium
- statin
83
where is CSF contained
- subarachnoid space = within the meninges
84
msot common cause meningitis
- neisseria meningitidis
85
kernigs test
- flex gip and knee to 90
- straighten knee keeping hip flexed
- pain = meningitis
86
brudzinski test
- flex chin to chest
- positive = patient flexes hip and knees
87
bacterial LP results
- cloudy
- high protein
- low glucose
- high neutrophils
- bacterial culture
88
viral LP results
- clear
- mildly raised protein
- normal glucose
- high lymphocytes
- negative culture
89
ix meningitis
- lp
- cultures
- meningococcal pcr
90
mx bacterial meningitis
- benzylpeniccilin if before hospital
- cefotaxime or ceftriaxone
- dexamethasone
- 60+ = cefotaxime and amoxicillin
91
meningitis post exposure prohpylaxis?
- ciprofloxacin if contact within 7 days
92
4 first line treatments for neuropathic pain
- amitriptyline
- duloxetine
- gabapentin
- pregabalin
93
presenting features of lambert eaton
- proximal muscle weakness
- autonomic dysfunction
- reduced/absent tendon reflexes
94
mx lambert eaton
- amifampridine
95
features charcot marie tooth
- high foot arches
- champagne bottle legs = distal uscle wasting
- lower leg weakness = foot drop
- reduced tendon reflexes and tone
- peripheral neuropathy
96
inhertance of charcot
autosomal dominant
97
infections related to GBS
- campylobacter
- CMV
- EBV
98
S+S GBS
- feet up
- symetrical ascending weakness
- reduced reflexes
99
Ix GBS
- nerve conduction = reduced signal
- LP = raised protein, normal wcc and gluc
100
mx gbs
- IvIg
101
neurofibromatosis type 1 gene
- csome 17
- cafe au lait
- bony dysplasoa
- yellow spots on iris
- neurofibromas
102
NF type 2 gene
- csome 22
- associated with acoustic neuromas
103
3 branches of facial nerve
- opthalmic V1
- maxillary V2
- mandibular V3
104
S+S and Mx trigeminal neuralgoa
- sudden pain
- shooting, burning pain
- triggered by touch, eating, cold
- carbamezapine
105
mx migraine
- nsaids
- triptans
- antiemetic
106
contraindications for triptans
- HTN
- Coronary artery disease-
- previous stroke, TIA or MI
107
migraine prophylaxis
- propranolol
- amitryptiline
- topiramate
108
mx cluster headaches
- triptans
- high flow 100% oxygen
- prophylaxis = verapamil
109
encephalitis S+S
- fever, headache, N+V
- seizures
- altered mental state
- rash
110
encephalitis ix
- bloods
- csf
- ct/mri
- cultures
111
mx enceph
- aciclovir
- benzylpen
112
S+S carpal tunnel
Aching in hand and arm esp. night
Paraesthesia in thumb, index and middle finger
Relived by dangling
Sensory loss and weakness abductor pollis brevis
113
mx carpal tunnel
- splint
- steroid injections
- decompression
114
drugs that exacerbate MG
- ciprofloxacin
- azithromycin
- propranolol
- atenolol
- verapimil
115
cauda equina S+S
- saddle parasthesia
- sudden onset
- motor problems
- lower back pain
- bilateral LMN reflexes
- absent ankle reflex
- decreased sphincter tone
- perianal sensory disturbance
- incintinence
- sexual dysfunction
116
CE Ix
- spine MRI
117
femoral stretch tests
L4
118
knee flexion tests
L5/S1
119
straight leg tests
L5 S1
120
plantar flexion tests
S1/2
121
CE mx
- epidural steroid
- surgical decompression
122
HZV
- shingles
- reactivation of chicken pox = infects dermatomes
123
rash in shingles
localised ermatome erythematous maculopapular rash --> clear vesicles --> crust
124
when to treat shingles
give aciclovir if within 72hrs of rash onset
125
alzheimers pathology
- atrophy of cerebral cortex
- amyloid plaques and neurofibrillary tangles
- accumulation of B amaloid peptide
126
S+S alzheimers
- loss recent memory
Difficulty word finding
Aphasia, apraxia, agnosia
Frontal executive function
Anosognosia = lack insight, stubbornness, denial
127
mx alzheimers
- acetylcholinesterase inhibitors = donepezil, rivastigmine
- memantine in later stage
128
vascular dementia
Multi infarct dementia
Reduced blood supply to brain
Onset can be within 3 months CVA
Stepwise progression
129
vascular S+S
Stepwise in severity of symptoms
Gaint and attention problems
Incontinence
Personality change
Focal neuro signs
MRI = widespread small vessel disease
130
lewy body dementia
LBD = when cognitive predate motor sx by >1 year
131
LBD S+S
Stepwise in severity of symptoms
Gaint and attention problems
Incontinence
Personality change
Focal neuro signs
MRI = widespread small vessel disease
132
front temporal dementia
Common in younger
Progressive degeneration
Personality change and behaviour disturbance
Progressive impairment of language
133
vascular mx
AChE inhibitors
memantine
134
parkinsons plus sx
Progressive supranuclear palsy = PD and vertical gaze
Multiple system atrophy = PD and PHypo, incontinence and impotence
Cortico basal degeneration = PD and spontaneous activity limb
LBD
135
brown sequard findings
Ipsilateral hemiplegia
Ipsilateral loss of vibration and proprioception
Contralateral loss of pain and temperature
136
wernickes aphasia
superior temporal gyrus = temporal lobe lesion
Speech fluent but word salad, neologisms, no sense
Impaired comprehension
137
broca aphasia
Expressive
Inferior frontal gyrus = frontal lobe lesion
no fluent speech, laboured and halting but comprehension in tact and content words may be preserved
138
GCS motor
6 = obey commands
5 = localises to pain
4 = withdraws
3 = flex to pain
2 = extends to pain
1 = none
Count best action
139
GCS verbal
5 = orientated time place person
4 = confused
3 = innapropriate words
2 = sounds
1 = none
140
GCS eye
4 = eye open spont
3 = open to speech
2 = open to pain
1 = none
141
common peroneal nerve palsy
The sciatic nerve divides into the tibial and common peroneal nerves. Injury often occurs at the neck of the fibula
Common = foot drop.
142
subacute combined degeneration of the cord
due to vitamin B12 deficiency
dorsal columns + lateral corticospinal tracts are affected
joint position and vibration sense lost first then distal paraesthesia
upper motor neuron signs typically develop in the legs, classically extensor plantars, brisk knee reflexes, absent ankle jerks
if untreated stiffness and weakness persist
143
red flag TGN
<40
Sensory changes
Deafness or ear problems
Skin or oral lesions
Pain in Opthalmic division
Optic neuritis
FHx MS
144
cushings triad in ICP
- bradycardia
- wide pulse pressure
- irregular breathing
145
ICP on eyes
down and out = 3rd nerve palsy
146
4th CN palsy
vertical diplopia = defective downward gaze
Eye turns upwards when facing medially
147
5th CN palsy
- TGN
- loss corneal reflex
- loss face sensation
- deviation of jaw to weak side
148
6th CN palsy
horizontal diplopia
cant abduct eye
149
9th nerve palsy
glossopharyngeal = loss gag reflex
150
10th nerve palsy
- uvula away from site
- loss gag
vagus
151
12th nerve palsy
- tongue to side of lesion
hypoglossal
152
S+S menieres
- inner ear disorder
- vertigo
- fluctuating hearing loss
- tinnitus
- full ear
unilateral
153
how to diagnose menieres
- 2 or more spont episodes of vertigo = 20m - 12h
- low to medium sensorineural hearing loss in 1 ear
154
menieres prophylaxis
betahistine
155
menieres management
- prochlorperazine
- antihistamines
156
triad in horners
- ptosis
- miosis
- anhidrosis
157
S+S GCA
- headache
- temporal artery tenderness
- jaw claudication
- vision loss
- scalp tenerness
mx = steroid
158
3rd nerve palsy and pain?
posterior communicating artery aneurysm
159
lacunar strokes
- either isolated hemiparesis, hemisensory loss or hemiparesis with limb ataxia
- associated with HTN
160
stroke secondary prevention
- clopidogrel and aspirin
- dipyridamole with aspirin if clopi CI
161
field defect if lesion on optic nerve
- ipsilateral monocular blindness
162
field defect if central optic chiasm lesion
- bitemporal hemianopia
163
field defect if lesion optic tract
contralateral HH
164
progressive supranuclear palsy
parkinsonism and vertical gaze palsy
165
cortico basal degeneration
parkinsonism and spontaneous activity of an affected limb
166
Foot drop caused by...
- Common peroneal nerve trauma
- L5 root lesion = radiculopathy
167
frontal lobe
- problem solving and judgement
- inhibition
- personality and emotional traits
- language production
168
temporal lobe
- understanding language
- information retrieval
- memory, hearing, learning
169
parietal lobe
- sense of touch, taste, smell
- visual perception
- reading, writing, maths
170
what are the 2 ascending tracts
- dorsal columns
- spinalthalamic tracts
- carry info to the brain
171
what are the descending tracts
- corticospinal = motor function from frontal lobe to muscles
= carry info away from brain
172
dorsal columns = sensations and deccusate
- fine touch, proprioception, vibration
- decussate medulla
- posterior and ipsi
173
spinothalamic tracts sensation and dec
- pain and temperature
- dec as soon as enter spinal tract
174
brown sequard
- ipsilateral spastic paralysis and loss of vibration and proprioception
- contralateral loss pain and temp
