neuro Flashcards
types if brain herniation
uncal (transtentorial)
subfalcine
tonsillar
central
what typ eof brain herniation causes a blown pupil
uncal - presses on CN III
what type of brain herniation causes contralateral leg weakness and how
subfalcine herniation
catches the anterior cerebral arteries
if someone has extreme HTN and bradycardia whta type of brain herniation is suspected
tonsillar
what is done in a cerebellar examination
D- dysdiadokinesia
A- ataxia
N- nystagmus
I - intention tremours
S- slurred or staccato speech
H - hypotonia /heel shin test
most common primary adult brain tumour
glioblastoma
most common childhood brain tumour
GRADE 1 ASTROCYTOMA
how would a grade 1 pilocytic astrocytoma present in children
evidence of raised ICP - falling behind in school
walking on tiptoes
brain biopsy showing rosenthal fibres- corkscrew eosinophilic bundle
grade 1 astrocytoma (pilocytic)
treatment of grade 1 astrocytoma
surgery is curative
grade III astrocytoma called
anaplastic astrocytoma
GRade III astrocytoma prognosis
2 year median survivial
solid tumours with central necrosis and a rim that enhances with contrast
gliobastoma multiforme
treatment of gliobalastoma and med surviala
what i sused to treat oedema
1 year
tx - surgical with postoperative chemotherapy and/or radiotherapy. Dexamethasone is used to treat the oedema.
hypermethylation of what gene has been linked to improved glioblastoma prognosis
MGMT
what type of surgery is performed on gliobastomas
fluorescence-guided surgery using 5-ALA
what colou rdoes tumour show up after usign 5-ALA
pink
how often is radio given in glioblastoma post -op
5 dyas a week for 6 weeks
side effects of radiotherapy
drops IQ by 10
skin
hair
tired
what chemo agent is used first line in glioblastoma
what it is then switched to
temozolamide - if not respondin after 6 months switch to PCV
where are oligodendromas found
frontal lobe
calcifications with ‘fried egg appearance brain biopsy
oligodendroma
cancers that most commonly spread to the brain
lung
breast
skin. (melanoma)
bowel idney
where do meningiomas originate from
arachmoid cap cells
psmammoma bodies on brain biopsy
meningioma
what cancer is seen in kids post chemo
meningiomas
bilateral acoustic neuromas/vestibular schwannoma assoc with what condition
neurofibromatosis II
what three blood tests shoul dbe done for any children with a midline tumour
B-HCG
AFP
LDH
will determine if germinoma
Small, blue cells. Rosette pattern of cells with many mitotic figures
medulloblastoma
duchennes inheritance pattern
x-linked recessive
pathophysiology of Huntingtons
- what protein is toxic
progressive degen of basla ganglia due to abnormally long GLUTAMINE protein that are toxic
in huntingtons what repeats code for gllutamine and how many are seen in a normla unaffected individual
CAG - norm 20 repeats
what number of repeats is diagnostic of huntingtons
36 CAG repeats
prognosis of huntingtons
15-20 years
pathophysiology of duchennes - what type of mutation
dystophin deficiency - most commonly deletion
diagnosis of duchennes
increased CK
genetics
what type of cardiomyopathy is assoc with duchennes
dilated
pathophysiology of spinal muscular atrophy
SMN1 deficiency - single nucleotide splices out exon & of SMN1 which is essential for prevention of motor neuron loss
inheritance pattern of spinal muscular atrophy
auto recessive
symptoms o fspinal muscular atrophy
proximal muscle weakness and wasting
repisratory muscles
what is lost in Spinal muscular atrophy
loss of anterior horn cells
what genetic mutations and corresponding chromosomes are implicated in alzheimers
Amyloid precurosr protein (APP) - chromo 21
presenilin 1 - chromo 14
presenilin 2 - chromo 1
what apopprotein is linked to susceptiability to alzheimer and what does it encode for
apoprotein E allele E4 - encodes a cholesterol transport protein
macroscopic pathological changes in alzheimer
wide spread cerebral atrophy - partic cortex and hippocampus
microscopic changes in alzheimers
type A Beta- amyloid plaques and intraneuronal neurofibrillary tangles cause by abnormal aggregation of the tau protein
hyperphosphorylation of the tau protein has been linked to AD
what neurotrasnmitter is there a deficit of in alzheimers
acetylcholine
non-parma management of alzheimers
-‘a range of activities to promote wellbeing that are tailored to the person’s preference’
- group cognitive stimulation therapy for patients with mild and moderate dementia
pharma management of alzheimers
mild - mod
cholinesterase inhibitors - e.g donepezil, rivastigmine and galantamine
second line alzheimers treatment
memeantine - NMDA inhib
when is donepezil contra indicated n alzheimers
if bradycardic
where is morphine metabolised
liver by glucorondiation
what is morphine excreted by
kidney
what is codeine metabolised by
liver
what pain medication is safe in severe renal impairement
alfentinil, buprenoprihne and fentanyl
1st line management of trigemnal neuralgia
carbamazapine
what is the cushings reflex
extreme HTN and bradycardia often pre-terminal event
what occurs in a diffuse axonal injury
result of mechanical shearing following deceleration, causing disruption and tearing of axons
scar formation of astrocytes is called
gliosis
what MAP can autoregulation in brain no longer compensate for
50mmHg
what is a watershed area in the brain
area between two arterial territories
first line investigation for suspect stroke
non contrast CT
scoring system for sctroke
ROSIER score
what medication should be given as soon as haemorhaggic stroke ruled out
300mg aspirin
what is the criteria for alteplase use in storke
haemorrhagic excluded
less than 4.5 hrs from onset
contra indications to thrombylysis in stroke
LP in last 7 days
pregnancy
GI haemorrhage in preceeding 3 weeks
intracranial neoplasm
prev haemorhhagic stroke
oesophageal varices
when should thrombectomy be offered
if within 6-24 hrs of stroke involving the PROXIMAL ANTERIOR CIRCULATION
when should thrombectomy be offered
if within 6-24 hrs of stroke involving the PROXIMAL ANTERIOR CIRCULATION
OFFER THROMBYLSIS TOO IF <4.5 HRS
second prevention medications after ischaemic stroke
clopidogrel
aspirin + MR dypiridamole if clop not tolerated
what level of carotid stenosis would warrent an carotid endartectomy following TIA
> 70%
defitnition of a TIA
a transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischaemia, without acute infarction. REF
most common site of thrombotic cerebral infarct
MCA
most common site of orgin in emboli in stroke
ICA or aortic arch
what aneurysms can cause haemorhagic stroke
charcot - bouchard aneurysm
where do most berry aneurysms occur
ICA
most common cause of subarachnoid haemorrhage
head trauma
first line investigation for subarachnoid haemorrhag
non contrast CT
when should an LP be done in suspect subarachnoid
if a CT that was done more than 6 hrs after presentation is normal do an LP
what time perios after onset of sympotoms should LP be done in subarachnoid haemorrhage and wy
min 12 hours to allow xanthochromia (RBC breakdown) to occur
what LP findings suggest sub arachnoid haemorrhage
increased or normal opening pressure and xanthchromia
what are UMN symptoms
increased tone (spascitiyt)
hyperrelfexia
weakness
what are LMN symptoms
decreased tone
muscle wasting
fasiulations
diminished refelxes
symptoms of progressive supranuclear palsy
parkinsonism
falls
vertical gaze palsy - patients complain of difficulty reading of descending stairs
IX after seizure
EEG and MRI
features of parkinsons
bradykinesia, tremor and rigidity
are parkinsons symptoms symmetrical
no they are classically asymmetrical
autonomic dysfucntion seen in parkinsons
postural hypotension
dx of parkinsons
clinically
-if young can do a DAT i.e. under 40
what is seen under microscope in parkinsons
lewy bodies
first line treatment of parkinsons if motor symptoms predominate
Levodopa
what type of drug is levodopa combined with to prevent peripheral metabolisation of levadopa to dopamine outside Brain
decarboxylase inhibitor e.g. cabidopa or benserazide
if a patient with parkinsons is admitted to hospital and cannot take their levadopa what should be done
dopamine agonist patch as rescue medication to prevent acute dystonia
what should be obtained prior to starting a dopamine agonist and why
echo, ESR, creatinine and chest x-ray
dopamine receptor agonists (bromocriptine, cabergoline) have been associated with pulmonary, retroperitoneal and cardiac fibrosis
drug class options in parkinsons
dopamine agonisst
MOA- B inhib
LEVADOPA
COMT - inhibitors
examples of dopamine agonsitis used in parkinsons
ropinerole, pramipexole, apomorphine
examples of MAO-B inhibitors
selegeline, rasagaline
what scan is used to differentiate parkinsonism from dystonia
DAT scan
what eye symptoms do kids with hydrocephalus present with
sunsetting eyes - can see alot of whites at the top
types of hydrocephalus
communicating
non-communicating (obstructive)
causes of obstructive hydrocephalus
tumours,
SAH
developmental abnormalities (e.g. aqueduct stenosis).
causes of non obstructive hydrocephalus
choroid plexus tumour (very rare))
failure of reabsorption at the arachnoid granulations (e.g. meningitis or post-haemorrhagic).
triad of symptoms in normal pressure hydrocephalus
and treatment
dementia
gait disturbance
incontinenece
weird, wet, wobbly
VP shunt
what is hydrocephalus ex vacuo
increase in CSF secondary to brain loss e.g. alzheimers
meningitis organisms in neonates
group B strep - from mum
e.coli
listeria
causes of viral meningitis
coxsachie
mumps
HSV
HIV
measels
treatment of viral meningitis
suppoertive
aciclovir if suspect seocndary to HSV
what is Waterhouse-Friderichsen syndrome
adrenal insufficiency secondary to adrenal haemorrhage
can patients with meningococcal septicaemia have an LP
no is contraindicated
what should be done for investigations for meningococcal septicaemia
cultures and PCR
management of children under 3 months with meningitis
IV amoxicillin adn Iv cefotaxime
management of children >3months with meningitis
Iv cefotaxime or ceftriazone
what shoudl be given in meningits if >50
cefotaxime (or ceftriaxone) + amoxicillin (or ampicillin)
when shoudl dexamethasone be avoided in meningitis
septic shock, meningococcal septicaemia, or if immunocompromised, or in meningitis following surgery’ or children < 3 months
what should be given in suspect meningococcal disease in community
IM benpen
what is a coup and contra coup injury
coup - injury at point of impact
contra-coup - injury at opposite side of brain
what is injured in subdural heamoatoma
bridging veins
most common subtype of MND
ALS - amyotrophic lateral sclerosis
median survival of MND
3 years after onset
most common presentation of ALS
asymmetrical limb weakness
symptoms of MND
are the eyes involved
asymmetrical limb weakness
mixed UMN and LMN symps
wastiing of the hands and tibialis
fasiculations
NO SENSORY SYMPTOMS or extra ocular muscle symptoms
finidings on nerve conduction studies in MND
Normal motor conduction - excludes neuropathy
treatment of MND
Riluzole - extends life by 3 months
what is used to treat respiratory weakness in MND
BiPaP at night
what dementia is MND associated with
Frontotemporal dementia
what tests are done in MND and how is diagnosis achieved
nerve conduction studies - normal
electrophysioloigy - dewer impluses increased amplituted
MRI - exclude cord compresssion
is a Dx of exclusion
how to you distinguish rigidity from spascitity
rigidity felt throughout movement
no increase with speed
what is ballism
extreme form of chorea that involves swinging movements
what is syndenhams chorea
self limiting chorea seen in children following GABHS infection
causes of chorea
huntingtons, wilsons, syndenhams, drugs, basal ganglia lesion, anti phospholipid syndrome
what is a hypnic jerk and what clinical sign s it an example fo
jump as you fall asleep
myoclonus
causes of predom sensory peripheral neuropathy
diabetes
Leprosy
Vit B12 deficiency
alcoholism
uraemia
causes of predom motor periph neuropathy
guillane barre
charcot marie tooth
what infection often triggers Guillain barre
campylobacteur
characteristic feature of guillain barre
progressive, symmetrical weakness of all the limbs.
most common inital feature of guillain barre
back and leg pain
what direction does weakness tend to progress in guillain barre
ascending - legs first
what investigaitions are done in guillain barre
why is one done ?
LP and nerve conduction studies
LP - to rule out infectious mimics e.g. HIV CMV
what nerve conduction study results would be expected in guillain barre
decreased motor nerve conduction velocity (due to demyelination)
prolonged distal motor latency
increased F wave latency
what type of disease is GBS
autoimmune
most common hereditary peripheral neuropathy
charcot marie tooth
physical manifestation i charcot marie tooth
high arched foot
champagne bottle calf
pathophysiology of MS
autoimmune antibodies agains myelin of CNS
most common form of MS
relapsing remitting
what vitamin deficiency is linked to MS
vitamin D
what is the most significant symptoms in those presenting wiht MS
lethargy
visual symptoms in MS
optic neuritis
optic atrophy
Uhthoffs phenomenon
internuclear opthalmoplegia
what is Uhthoffs phenomenon and when is it seen
seen in MS
worsening of vision following rise in body temperature
what is Lhermitte’s syndrome
paraesthesiae in limbs on neck flexion
seen in MS
what drug can be used to treat fatigue in MS
amantadine
what is seen in CSF in MS
IgG oligoclonal bands
what is used to treat acute relapses of MS and duration
IV or oral mthylpred for 5 days
treatment of spascity in MS
baclofen
example of DMARD in MS
natalizumab, tecfidera
what GCS warrants a CT in under 1 hour
<13
how many episodes of vomiting warrant a Ct in under 1 hour
> 1
when should immediate head CT be done
LOC or amnesia with any of
- traumtic injury mechanism
- > 65
- coagulopathy
what focal head injury presents with a lucid interval
extradural heamatoma
if MND presents without bulbar symptoms (dysphagia, brisk jaw refelx, tongue wasting) what test should be doen and why
MRI to exclude spinal cord compression
